Health-care Reform Bill now in House

[kmcrawfo]

Thus far with the new vast Democrat Majority in DC huge issues are having a tendency to be passed in the cloak of night with little public debate or criticism. An example of this is the Cap-and-Trade Bill which passed recently in the House. The vast majority of people in this country have no idea what cap-and-trade is. If they did the bill (which passed by 1 vote) likely would have had much more opposition.

We as a country can not let health-care reform be forced through the senate and house without ample discussion, debate, and reform. A rushed, bad plan will be bad for everyone from doctors to patients to businessmen to individual tax-payers.

Please take the time to do some research on this bill and let your congressmen know how you think.

When I say research, I mean actually read the darn bill or least an unbiased summary of it. Don't take some spin you get from NBC, the paper, the radio, etc and assume it to be true.

This is a huge, huge deal....

Make your voice heard and make sure it is an educated / factual voice. If people let emotions outweight intellect here we will be going down a bad road indeed.

[kmcrawfo]

http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf

Have I read it.... You bet. This slightly impacts what I do.

[kmcrawfo]

I personally think the bill in its current format is quite bad.

A few flaws I see for discussion:
1. Currently people/couples making over roughly $187,000 are footing 100% on this healthcare plan. All people need to have some skin in the game. Even if the poorest of the poor only put $5 per year in the pot and the "rich" put $50,000 in the pot. Systems where everything is free for a select group always fail.

2. This is a double-hit on business owners. Not only will they take the tax hit on gross income, but there is now an additional tax/expense of required healthcare coverage. Talk about sticking it to the backbone of this country's economy.

3. So we increase the pool of insured patient dramatically, but put no new physicians in the pool. Also, there will be an inevitable drop in reimbursements once the honeymoon period of 3 years is up and the insurance czar takes over, which will give even less incentive for people to enter the field. End result = more patients, less doctors. This = worse access and worse care. This is not supposition. It will happen. It will be additionally worsened when the best doctors and subspecialists like myself who already have exceedingly high demand drop the government run plan due to slow payments, low payments, etc. This results in even less doctors and worse access. This may or may not happen, but is highly likely since it already has occurreed in the Medicaid, Tricare, and Medicare patient population. The government solution will be to increase physician extenders (Nurse practitioners, Physician Assistants, etc). Great, even less quality of care. Then more will be placed on family practice docs, etc... Once again who do you want treating your heart failure, melanoma, multiple sclerosis, etc. An primary doc or a cardiologist, dermatologist, and neurologist.

I think that is plenty to chew on without getting into other gripes I have....

Please keep this civil and constructive.

[BandAid]

Dude, it's 1018 pages long. I get the feeling I won't make it through reading the bill before it is voted on.

[Xman95]

Obama's not going to be happy until the government is running everything. I don't care if what his supporters say, that man is a socialist. He's not a Democrat. He's not even a Democrat with slight socialist influences. He's a socialist. But he sure can give a nice speech, can't he?

[golfitup]

Is there a country that has a good socialized health care system that may be worth copying for our borders?

[Mark 3 Pointer]

I'll give someone a dollar if they can explain to me in 5th grade english how the linked flow chart would work for the following scenarios.


Flow chart link - http://docs.house.gov/gopleader/House-Democrats-Health-Plan.pdf

Scenarios:

1) I need to see my doctor for my yearly checkup.
2) I cut my hand and need emergency surgery.
3) I have liver disease and am in need of a liver transplant.
4) I need to see a specialist for a undiagnosed neurological problem.

[picknroll]

http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf

Have I read it.... You bet. This slightly impacts what I do.


KMCRAWFO: I see reference to "year one" but what are you hearing as to when this nonsense would go into effect?

[Strange Brew]

"Patriot Act"????

"Affordable Health Choices Act"????

"Employee Free Choice Act"?????

Two legs bad, Four Legs Good.

All animals are equal, some are more equal than others.

Those who have read understand the Doublespeak in play.

[bobbiemcgee]

I think we should just fly the sick poor to Thailand...10 times cheaper.

[Fred Garvin]

"Patriot Act"????

"Affordable Health Choices Act"????

"Employee Free Choice Act"?????

Two legs bad, Four Legs Good.

All animals are equal, some are more equal than others.

Those who have read understand the Doublespeak in play.

More trite Orwell from the board idiot.

[Fred Garvin]

All animals are equal, some are more equal than others.



Notice he quotes the character named Squealer. How apropos.

[Snipe]

Interesting article from the NYTimes by Peter Singer. Singer is an outlier. He is liberal in many respects. He is a philosopher. He has advocated for zoophilia (sex with animals) as long as you are nice to your dog, and he is an advocate for post natal abortion. That means killing babies after they are born defective. I can make an argument for that, but that is not touched on in this article.


Why We Must Ration Health Care (http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?pagewanted=1&partner=rss&emc=rss)


You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

My dad went through hundreds of thousands of dollars on the federal dole (P&G covered the copay) when he went through kemo. If the government offered someone $100,000 to just die, who knows what people would choose? They could actually save money.

I wanted my dad to live. He wanted to live too. Spare no expense is easy when the government foots the bill. The only chance we have at government cutting costs is to start rationing health care.

The cost savings will never come from taxing people that pay taxes to cover the uninsured. That is a sure fire loser. The cost savings will only come from rationing people and denying the treatment when a government employee determines it is cost ineffictive.


Remember the joke about the man who asks a woman if she would have sex with him for a million dollars? She reflects for a few moments and then answers that she would. “So,” he says, “would you have sex with me for $50?” Indignantly, she exclaims, “What kind of a woman do you think I am?” He replies: “We’ve already established that. Now we’re just haggling about the price.” The man’s response implies that if a woman will sell herself at any price, she is a prostitute. The way we regard rationing in health care seems to rest on a similar assumption, that it’s immoral to apply monetary considerations to saving lives — but is that stance tenable?

That is a great way to put it. At some point tough decisions need to be made. I also think this proves that all women are whores. I have known that for quite some time, but I liked the way he said it.

To be continued...............

[Snipe]

The case for explicit health care rationing in the United States starts with the difficulty of thinking of any other way in which we can continue to provide adequate health care to people on Medicaid and Medicare, let alone extend coverage to those who do not now have it. Health-insurance premiums have more than doubled in a decade, rising four times faster than wages. In May, Medicare’s trustees warned that the program’s biggest fund is heading for insolvency in just eight years. Health care now absorbs about one dollar in every six the nation spends, a figure that far exceeds the share spent by any other nation. According to the Congressional Budget Office, it is on track to double by 2035.

President Obama has said plainly that America’s health care system is broken. It is, he has said, by far the most significant driver of America’s long-term debt and deficits. It is hard to see how the nation as a whole can remain competitive if in 25 years we are spending nearly a third of what we earn on health care, while other industrialized nations are spending far less but achieving health outcomes as good as, or better than, ours.

Medicare and Medicade are breaking the bank. They are going insolvent unless we start denying care to people that need care. We need to start not treating more people and we need to start it right now.

It is a paradox. National healthcare will cover everyone. But in order to afford to cover everyone we need to not treat people that are sick due to cost/benefit ratios. So in some respects health care for all can boil down to no heath care for you. Sometimes you need to take one for the team. I am looking at you Q.


Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse. If we ration we won’t be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend. When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money. The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?

It has to be done, and it will be done one way or the other. Since that is the reality, then the only question is what the best way to do it is. I think he is spot on that point. We can't avoid this. Medicare and Medicade will quickly be insolvent. You have to ration care. You have to set a budget and keep to it. There is no other way.


Governments implicitly place a dollar value on a human life when they decide how much is to be spent on health care programs and how much on other public goods that are not directed toward saving lives. The task of health care bureaucrats is then to get the best value for the resources they have been allocated. It is the familiar comparative exercise of getting the most bang for your buck. Sometimes that can be relatively easy to decide. If two drugs offer the same benefits and have similar risks of side effects, but one is much more expensive than the other, only the cheaper one should be provided by the public health care program. That the benefits and the risks of side effects are similar is a scientific matter for experts to decide after calling for submissions and examining them. That is the bread-and-butter work of units like NICE. But the benefits may vary in ways that defy straightforward comparison. We need a common unit for measuring the goods achieved by health care. Since we are talking about comparing different goods, the choice of unit is not merely a scientific or economic question but an ethical one.

As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years. That suggests that saving one teenager is equivalent to saving 14 85-year-olds. These are, of course, generic teenagers and generic 85-year-olds. It’s easy to say, “What if the teenager is a violent criminal and the 85-year-old is still working productively?” But just as emergency rooms should leave criminal justice to the courts and treat assailants and victims alike, so decisions about the allocation of health care resources should be kept separate from judgments about the moral character or social value of individuals.

If the Government decides your health care decisions you have fundamentally changed the relationship between citizen and the State. And once you go there, I doubt we will ever go back. Every election will then be fought on liberal terms. How much State involvement and government services provided will be the disscussion. It will be a bedrock foundation.

I don't agree with the bolded part of the quote. I think the man is silly to even write that. We are not all equal, and nobody really believes that bullshit anyway. I bet that if pressed our philospher author would disagree too.


But just as emergency rooms should leave criminal justice to the courts and treat assailants and victims alike, so decisions about the allocation of health care resources should be kept separate from judgments about the moral character or social value of individuals.

Everything is political. Everything. If Government controlls health care than people in the government will get better health care. Obama is President of the United States. He is more important that you and me. He goes to the head of the list. If he needs a life saving surgery, he goes in front of me.

I am thinking of the whore argument again. Sleep with me for a million? Even Blobfan might take me up on that. Sleep with me for $50? Not too many takers. Once you make the needed exception for the President you allow a certain ranking of values. What if that teenager is a violent criminal? If we get to pick and choose, I don't pick him. I pick Q's cancer treatment instead. We will have to make choices, and Q has paid his taxes.

Some countries already do this. If you are a smoker you can't get a transplant or expensive cancer surgury. Or maybe if you are overweight you won't get some treatments. They do this because you are partly responsible for your own condition. I can see the reasoning plain as day. It is logical.

Where I depart from the author is that I think a man on death row doesn't deserve the same treatment as the President. And we all know that would be true. Those are extremes though, but extremes are often relevant in bringing about great arguments. Bill Gates is not the President, but he is far more important to humanity than me. He employs so many people and has created much wealth. Conversely, I am much more value than a gang banger drug dealer who just had some shots of lead pumped into him on the street corner. The best thing about gang violence is that the violent drug gangs tend to kill each other. It is only when the innocent are involved that we tend to take notice. Just as Obama and Bill Gates go to the head of line before me, I get to go to the head of the line before that crap. I have some value. I am not Bill Gates, but I haven't raped or killed anyone and I pay my taxes.

I can't wait until some government official makes these tough decisions for us.

I think Obama is bold in even talking about it. It will break the bank. Something needs to be done. I applaud Obama for taking on such a though argument. It is a surefire loser anyway you go, and that is why we don't ration care properly now. We need to cut people off. We can't afford it.


Rationing public health care limits free choice if private health insurance is prohibited. But many countries combine free national health insurance with optional private insurance. Australia, where I’ve spent most of my life and raised a family, is one. The U.S. could do something similar.

I think we need a private system so that people can pay to get decent healthcare. We also need a rationed public system where we cut costs and deny treatment for people who don't deserve care.

That sounds like a winner for everyone!

[DC Muskie]

I appreciate how Kevin wants you to read the bill, in an unbiased manner and come to the same conclusion he does that the bill is awful and we are headed down the wrong path.

Thanks for the guide!

[Snipe]

I appreciate how Kevin wants you to read the bill, in an unbiased manner and come to the same conclusion he does that the bill is awful and we are headed down the wrong path.

Thanks for the guide!

To his credit he does want you to read the bill yourself, and he provides a link. You do get to come to your own conclusions.

I haven't read the bill. I am against any massive expansion of government. Government isn't good at what it does already. I can only imagine how efffective it will be once it controls the banks, the auto makers, the energy sector and the health care industry. It is beyond madness and this government power has no basis in our constitution.

[kmcrawfo]

I appreciate how Kevin wants you to read the bill, in an unbiased manner and come to the same conclusion he does that the bill is awful and we are headed down the wrong path.

Thanks for the guide!

I posted three seperate comments. The first message states there is a bill, you should research it, and let your congressmen know what you think. The second is a link to the bill. The third is a few thoughts I have on the current bill.

I don't recall anywhere stating I want you to come to the same conclusion as myself. I stand by my opinion that this bill is a mistake and will be bad for all involved. If you'd like to read to bill or do some research and come up with your own thoughts, go for it.

You seem quick to criticise and insult, but offer little in return.

You are welcome to disagree... I didn't ask for a bunch of yes-men and at-a-boy comments. I asked for civil, constructive discussion and debate.

[Snipe]

I think he has a point.

[murray87]

To his credit he does want you to read the bill yourself, and he provides a link. You do get to come to your own conclusions.

I haven't read the bill. I am against any massive expansion of government. Government isn't good at what it does already. I can only imagine how efffective it will be once it controls the banks, the auto makers, the energy sector and the health care industry. It is beyond madness and this government power has no basis in our constitution.

Amen and amen!!!

There is also a serious need to disabuse people of the notion that healthcare is a "right."

[DC Muskie]

I posted three seperate comments. The first message states there is a bill, you should research it, and let your congressmen know what you think. The second is a link to the bill. The third is a few thoughts I have on the current bill.

I don't recall anywhere stating I want you to come to the same conclusion as myself. I stand by my opinion that this bill is a mistake and will be bad for all involved. If you'd like to read to bill or do some research and come up with your own thoughts, go for it.

You seem quick to criticise and insult, but offer little in return.

You are welcome to disagree... I didn't ask for a bunch of yes-men and at-a-boy comments. I asked for civil, constructive discussion and debate.

I appreciate the fact you have helped me understand how democracy works. If you take that as an insult, please accept my apology. You seem to think that the Democrats are rushing to push through an agenda that if shown the light the day, would be stopped. If that isn't directing someone to follow your thought process, then I don't know what is.

Again, if that is an insult to you, then I apologize. If I am quick to criticize, then maybe I should wait a day before responding. Again, accept my apologies.

You assume that this bill is rushed, and rushing things is bad. The fact is, you don't like the bill. Having a discussion here is not going to change whether the bill will be passed or not. You want to have your say, then go for it.

Rather then hear my thoughts on the bill, I'm interested in hearing your ways to fix this challenge. Since you are a doctor, who owns his own business, what system do you think works best, not only for you, but for the people who look to you for services.

Since this bill is rushed, and therefore bad, how would you propose to change it. If I am quick to criticize, then move beyond criticizing the method of which this bill was introduced, and what is in it, and come up with a better solution.

[DC Muskie]

There is also a serious need to disabuse people of the notion that healthcare is a "right."

Yikes.

Double Yikes.

[blobfan]

Amen and amen!!!

There is also a serious need to disabuse people of the notion that healthcare is a "right."

People think they have a right to drive. Hell, some people think they have a right to drink and drive as long as they don't actually run someone over. People think they have a right to a lot of things they shouldn't: the right to the job they think they deserve and the home they think they deserve and the car they think they deserve, the right to be unchallenged in one's religious or other life choices. Everything people want these days is expressed as a right. People seem to think their religious rights are violated when someone tells them "Merry Christmas" for goodness sake!

I've given up hope that barn door will ever be closed again.

[Snipe]

Amen and amen!!!

There is also a serious need to disabuse people of the notion that healthcare is a "right."

I would agree with that. If healthcare is a right, why not housing and food?

If you take personal property away from some people to provide something to someone else, that doesn't sound like a right. That sounds like slavery.

[DC Muskie]

I would agree with that. If healthcare is a right, why not housing and food?

What's to stop people from marrying goats? Or trees?

Wait..wrong slippery slope I think.


If you take personal property away from some people to provide something to someone else, that doesn't sound like a right. That sounds like slavery.

Slavery is forced labor of people used as property. I'm not sure how annexation is slavery.

I'm also not sure how making sure everyone has health insurance is like taking someone's personal property.

[Xman95]

Slavery is forced labor of people used as property. I'm not sure how annexation is slavery.

You are 100% correct, DC. Snipe, what you mentioned is not really slavery. It's socialism.

[GuyFawkes38]

DC, I agree with you on the right to health care.

But here's the big question: Does everyone have the right to the same quality of care?

of course, I would answer no.

[DC Muskie]

You are 100% correct, DC. Snipe, what you mentioned is not really slavery. It's socialism.

What does socialism have to do with annexation?

[DC Muskie]

But here's the big question: Does everyone have the right to same quality of care?

of coruse, I would answer no.

No. It's impossible task anyway. What's not impossible, what IS possible, is providing healthcare to everyone.

[GuyFawkes38]

No. It's impossible task anyway. What's not impossible, what IS possible, is providing healthcare to everyone.

True.

But I do think that lots of people on the left see a strong public option as a means (a trojan horse) to attain single option health care (like canada).

They argue that American's, even the wealthy ones, spend way too much on health care and a single option would limit costs and equalize care.

Edit: here's the evidence: http://www.youtube.com/watch?v=zZ-6ebku3_E

[GuyFawkes38]

Relating to my post above, I'm still trying to find out the strength of the "public option" in the new house bill.

That's key. If a strong "public option" is passed, the federal government has every incentive to squeze out insurance companies and doctors.

I think everyone has a right to health care. But it makes more sense to create a safety net approach. Don't try to change the system (we already have a sort of safety net, but it's deeply flawed and bankrupts people and forces many into emergency rooms for care).

[BandAid]

I didn't get to read all of Snipe's manifesto concerning Peter Singer, but that dude is sick. The day I let that man start thinking for me is the same day I'd be put six feet under.

[GuyFawkes38]

I think we need a private system so that people can pay to get decent healthcare. We also need a rationed public system where we cut costs and deny treatment for people who don't deserve care.

That sounds like a winner for everyone!

just read snipes posts, and agree with the above, except the part on denying treatment for people who don't "deserve" it (this isn't Haiti or the USSR).

I think it's important to allow rich people to spend as much money as they want on health care (a strong public choice program would try to take such a choice away). Although such spending might seem irrational, it also often leads to innovation.

But if your falling back on the safety net which government provides, limits should be placed financially on your care.

Even DC admits, we should NOT seek equal quality of care.

[BandAid]

I think we need a private system so that people can pay to get decent healthcare. We also need a rationed public system where we cut costs and deny treatment for people who don't deserve care.

That sounds like a winner for everyone!

How do you decide who to deny care to? The too sick? The handicapped? The poor?

You are walking way to close to eugenics and euthanasia. We're talking Nazi and Marxist things here (both extremes on either side of the political spectrum).

We're suggesting that once some one no longer has utility to simply cast them aside, as if they were a broken part in the economic machine. People aren't tools, they're people.

Do we cast aside cloistered nuns who pray all day because we don't see tangible, material returns from their life?

I'm not going to tell you about the finances of this bill, nor could I streamline the healthcare system. But I can and will advocate respect for all human life, regardless if they deserve it or not.

[GuyFawkes38]

How do you decide who to deny care to? The too sick? The handicapped? The poor?

You are walking way to close to eugenics and euthanasia. We're talking Nazi and Marxist things here.

We're suggesting that once some one no longer has utility to simply cast them aside, as if they were a broken part in the economic machine. People aren't tools, they're people. Do we cast aside cloistered nuns who pray all day because we don't see tangible, material returns from their life?

http://www.gao.gov/cghome/centrist20050121/img2.jpg

choices will have to be made.

Again, this sounds crude, but should the government fund hopeless back surgeries for an 80 year old instead of funding eduction for 8 year olds.

you can't avoid choices.

[BandAid]

If the patron if literally dying from their back ailment, then I would advocate performing the surgery even with the slightest chance of success.

I'm not going to tell you about the finances of this bill, nor could I streamline the healthcare system. But I can and will advocate respect for all human life, regardless if they deserve it or not.

[GuyFawkes38]

If the patron if literally dying from their back ailment, then I would advocate performing the surgery even with the slightest chance of success.

So your saying if his or her life really sucked, but he or she wasn't dying, don't give the surgery.

That's a choice (a tough one, but the right one)

[GuyFawkes38]

I specifically disagreed with Snipes use of the world "deserve".

But bandaid, I think we have to agree here that while everyone should receive health care, not everyone should or will receive the same quality of care. Financially, we can't do that.

[BandAid]

I digress. I think our discussion on this page alone has illustrated the difficulties of a nation-wide health care plan. Simply put, the problem is we have the government making these choices on who does and does not receive such and such treatment at such and such time.

For my conclusion (and hopeful retirement from this thread), I primarily oppose the deprivatization of health care for the aforementioned reason (although there are others). Additionally, I encourage everyone to respect all forms of human life at all times, and I would advise no one to take advice from Peter Singer.

[kmcrawfo]

True.

But I do think that lots of people on the left see a strong public option as a means (a trojan horse) to attain single option health care (like canada).

They argue that American's, even the wealthy ones, spend way too much on health care and a single option would limit costs and equalize care.

Edit: here's the evidence: http://www.youtube.com/watch?v=zZ-6ebku3_E

This bill is not a strong public option, it is the first step in the goal of elimnation of private insurance.

If you read the bill it is clearly built to destory and eliminate private insurance and make the government the only option for healthcare.

The media will not go over these subtle, insidious aspects of the plan.

Here are a few kickers in the bill. Once this is passed and goes into effect these things take place:

1. Everyone is required to have health insurance, even if you don't want it. If you choose not to partake in the government plan, you must pay a tax/surcharge in order to opt out.

2. All employers will no longer be able to offer private insurance plans to new employees, or if an employee want to change coverage he/she must switch to the government plan. You must offer the government plan if you have a payroll of over $100,000. Otherwise you can not offer health insurance. Should you choose to not offer insurance you must pay a tax/surcharge from your business payroll of 8%. (This is the kicker.... All employers will be required to use government healthcare plans. Who do you think provides the most insurance in this country.)

Despite what Obama and other supporters of this bill tell you, it is clearly meant to make it much more expensive (maybe impossible) for private insurance to exist. Sure, you can keep your current plan if you can afford it and the private insurance company can afford to stay open.


Should an employer elect to provide the government option, it appears the employer must cover 70% of the cost.

The top tax rate in the country will go up to 59% after this bill is passed (New York City)

I have already spoken to numerous business owners about the impact this will have on their companies. Let's use the medical field as an example, since I can use real world numbers.

A full time dermatology practice in terams of staff/productivity may have approximately 25 employees. The first dermatologist/business owner hires the following:

1 dermatologist, 4 physician extenders, 3 billing, office manager, 10 medical assistants, 1 histotech, 3 reception/front desk, 1 aestetician, 1 massage therapist.

Payroll = $1,440,000
New Payroll Tax on company = $115,200
New Other Taxes in healthcare plan = roughly $60,000-70,000

New Taxes on my business: $150,00- 200,000

Result = Company fires 3 employees, providers take small pay cut, schedule more patients and spend less time with them. Freeze on expansion / growth.

The end result is small business owners, who provider 70% of the jobs in this country, will lay-off/not hire new employees, or be forced out of business.

[kmcrawfo]

Actually, the real solution might be for people to switch from hiring employees to hiring contractors whenever possible.

The contractor would then have to fend for themselves since they would not be an employee and not count against taxes/payroll/etc...

[kmcrawfo]

just read snipes posts, and agree with the above, except the part on denying treatment for people who don't "deserve" it (this isn't Haiti or the USSR).

I think it's important to allow rich people to spend as much money as they want on health care (a strong public choice program would try to take such a choice away). Although such spending might seem irrational, it also often leads to innovation.

But if your falling back on the safety net which government provides, limits should be placed financially on your care.

Even DC admits, we should NOT seek equal quality of care.

The system Snipe suggests is exactly what we are heading towards if this bill is passed. The wealthy will get good private care, while the lower-middle class will get a sub-par public option where care eventually will be rationed.

If that is what people want, then go for it.

Good luck finding a doctor/appointment, getting that MRI, or seeing a specialist if you are in the public option (See the experiments with similar plans in Massachutes and Tennessee).

[GuyFawkes38]

The system Snipe suggests is exactly what we are heading towards if this bill is passed. The wealthy will get good private care, while to lower-middle class will get a sub-par public option where care eventually will be rationed.

If that is what people want, then go for.

Good luck finding a doctor/appointment, getting that MRI, or seeing a specialist if you are in the public option (See the experiments with similar plans in Massachutes and Tennessee).

I'm not sure exactly what Snipe was advocating, but I would certainly not argue that most middle class people would need to fall back on a safety net.

I think I used those exact words, "safety net". If you lose your job and you get cancer, it seems like as a society we should provide some other option than bankruptcy.

Should the people in the safety net receive the same quality of care as a middle class man with employee provided insurance? I don't think so. It's, after all, a safety net.

[kmcrawfo]

I'm not sure exactly what Snipe was advocating, but I would certainly not argue that most middle class people would need to fall back on a safety net.

I think I used those exact words, "safety net". If you lose your job and you get cancer, it seems like as a society we should provide some other option than bankruptcy.

Should the people in the safety net receive the same quality of care as a middle class man with employee provided insurance? I don't think so. It's, after all, a safety net.

I don't have a problem with such a system. The problem, that is not what people think they are getting. It seems most people think they are going to get the same quality of care as today, expect for it will be free/subsidized by the government (ehhh, I mean tax-payers).

There is no way that a public option can do anything but lower the overall care based on cost & number of people covered vs. number of healthcare provider/facilites/etc...

Besides, we already have a safety net (medicaid, county hospitals, and religous run hospitals). Is this system really going to be an upgrade for the population that utilizes those systems.

I don't think it will be.

[GuyFawkes38]

I don't have a problem with such a system. The problem, that is not what people think they are getting. It seems most people think they are going to get the same quality of care as today, expect for it will be free/subsidized by the government (ehhh, I mean tax-payers).

There is no way that a public option can do anything but lower the overall care based on cost & number of people covered vs. number of healthcare provider/facilites/etc...

Besides, we already have a safety net (medicaid, county hospitals, and religous run hospitals). Is this system really going to be an upgrade for the population that utilizes those systems.

I don't think it will be.

good point.

I'm sure many would receive better care under medicaid than the system I'm advocating.

But the most important reason for having a "safety net" is financial protection. And I think most American's agree. They want some sort of protection for if they go unemployed and their kid gets strep and they have to pay hundreds of dollars for medicine on that. Or if, god forbid, they get diabetes and have to pay thousands.

they have assets and don't qualify for medicaid.

[blobfan]

Relating to my post above, I'm still trying to find out the strength of the "public option" in the new house bill.

That's key. If a strong "public option" is passed, the federal government has every incentive to squeze out insurance companies and doctors.

I think everyone has a right to health care. But it makes more sense to create a safety net approach. Don't try to change the system (we already have a sort of safety net, but it's deeply flawed and bankrupts people and forces many into emergency rooms for care).

On what basis does everyone have a right to health care? I missed the health care clause in our constitution during civics class.

All these discussions keep keep focusing on catastrophic care and long term health problems yet the politicians keep saying too many people lack access to basic services. Why don't we focus on providing basic well-care and reduced cost for all rather than covering all health care for all? I keep reading articles about people leaving general practice and doctors being drowned in debt. Why not open government clinics and trade a certain number of years in general practice for a medical education?

[kmcrawfo]

good point.

I'm sure many would receive better care under medicaid than the system I'm advocating.

But the most important reason for having a "safety net" is financial protection. And I think most American's agree. They want some sort of protection for if they go unemployed and their kid gets strep and they have to pay hundreds of dollars for medicine on that. Or if, god forbid, they get diabetes and have to pay thousands.

they have assets and don't qualify for medicaid.

The simplest way to provide a safety net is for all people to carry catrostrophic care insurance. Then, set up health savings account which are tax-exempt. I wouldn't have as much of a problem with the government susidizing this to some degree because it would reduce costs.

Catastrophic care insurance is dirt cheap.

If someone has a health savings account, which is their own money. Each time they go to the doctor, they spend money out of the account. Once the account hits zero, they have a certain amount of money they have to spend, then catastrophic care insurance kicks in.

It is more complex then I have outlined, but I like giving the power of choice to people. If people feel they are spending their own money/resources, they are likely to be more responsible and frugal.

[picknroll]

Here's how I see it:

1) In the late 40s, healthcare benefits/insurance took the place of increases in wages, which at the time were frozen.

2) The medical rate of inflation mirrored the normal CPI for years until the advent of Medicare in 1965. Since that time, the medical rate of inflation has consistently outpaced CPI with one factor being increasing Medicare reimbursements, overcharging and fraud.

3) In 1999, the insurance companies "invented" HMOs. They basically told us not to worry, we would have little or no out of pocket costs and our employers at the time typically paid 100% of our premium. Voila...we had an "entitlment" mentality created by insurers.

4) In 1996, HMOs ran their course and became unsustaianle. Couple that with HIPAA, the first pasrt which was the guaranteed issue of small group health plans for companies with 2-50 employees. The 20% of the insured population with chronic claims, or imagined illnesses (fostered by the aforementioned HMO entitlement program) began costing others who were physically and mentally disciplined and practiced good health.

5) In 1999, the FDA allowed pharmeceutical companies to begin advertising direct to the consumer, i.e. "call your doctor, see your doctor" much to the disdain of said doctors. Since that time, prescription drug usage has become rampant and addiction to prescription drugs is now higher addiction than illegal ones. we have become a "synthetic society"

6) over the past 10 or more years, we have become an extremely litigious society, which has created higher malpractice premiums and led to the practice of often unnecessary defensive medicine.

7) the insurers now have created HSAs, a 180 degree change from HMOs, leaving us all dazed and confused. (Although HSAs are gaining in popularity and quite interestingly, we are discovering we really don't need all that medical attention we have demanded since we were told 'not to worry".

May the voices and minds of reason prevail over the healthcare reform debacle. We should insist everyone is held personally accountable to join in the nation of the insured, we should help those who are truly in need, and not tax us any further (directly or indirectly) for causes without foundation.

[GuyFawkes38]

kmcrawfo, that's really interesting. I could see the government mandating that the unemployed purchase catastrophic health care insurance like states mandate car insurance. The government could also encourage people to make large donations to their health care saving account (maybe match some % of it).

of course, I'm not sure if such a policy would be popular. But it leaves the government out. I think we both agree that's a really good thing.

[xu2006]

In interesting news, the CBO announced that the current plans will most likely not lower costs in the future. Source (http://online.wsj.com/article/SB124775966602252285.html)

The Massachusetts model, on which the House and Senate plans are based, is experiencing costs on average 33% higher than the rest of the nation, and is considering a move back to capitation. Capitation, for those of you keeping score at home, was what the managed care companies (insurers) attempted back in the 90s and failed. Paying a set per-member per-month fee to providers has its benefits, but also has the potential to decrease physician productivity and lead to skimping on care.

On the flip-side is the model we currently have. Payment is based on the volume of procedures/visits they perform, which can lead to over utilization. Utilization and cost drive total cost, so increasing utilization (which will happen in the future no matter what as the baby boomer generation continues to age - Guy, you understand this) increases cost.

I don't have a solution - or I'd be getting paid a lot more and sitting in Washington. I'm just worried that the changes being proposed aren't going to do what we hope. I suggest everyone read as much as you can about the reform being proposed, because this could be the most significant public policy shift in any of our lifetimes. The implications are mind boggling.

Just to get things exciting (Guy) - when Medicare legislation was passed in 1965, the average lifespan in the U.S. was between 66 and 70 years. Interesting how benefits didn't kick in until one reached age 65 and conceivably only had a few years of life left. Now we're nearing an average lifespan of 78 or so. Those extra few years are very costly.

[DC Muskie]

On what basis does everyone have a right to health care? I missed the health care clause in our constitution during civics class.

Does, "promote the general welfare..." mean anything to you?

[kmcrawfo]

In interesting news, the CBO announced that the current plans will most likely not lower costs in the future. Source (http://online.wsj.com/article/SB124775966602252285.html)

The Massachusetts model, on which the House and Senate plans are based, is experiencing costs on average 33% higher than the rest of the nation, and is considering a move back to capitation. Capitation, for those of you keeping score at home, was what the managed care companies (insurers) attempted back in the 90s and failed. Paying a set per-member per-month fee to providers has its benefits, but also has the potential to decrease physician productivity and lead to skimping on care.

On the flip-side is the model we currently have. Payment is based on the volume of procedures/visits they perform, which can lead to over utilization. Utilization and cost drive total cost, so increasing utilization (which will happen in the future no matter what as the baby boomer generation continues to age - Guy, you understand this) increases cost.

I don't have a solution - or I'd be getting paid a lot more and sitting in Washington. I'm just worried that the changes being proposed aren't going to do what we hope. I suggest everyone read as much as you can about the reform being proposed, because this could be the most significant public policy shift in any of our lifetimes. The implications are mind boggling.

Just to get things exciting (Guy) - when Medicare legislation was passed in 1965, the average lifespan in the U.S. was between 66 and 70 years. Interesting how benefits didn't kick in until one reached age 65 and conceivably only had a few years of life left. Now we're nearing an average lifespan of 78 or so. Those extra few years are very costly.

People should read up on the Massachutes and Tennessee models which were implemented. Both have been tremendously expensive failures. Yet, congress and this administration are now trying to model this bill after such endeavors. Yikes?!?

I personally think the Health Savings Accounts combined with Catastrophic care Insurance is the way to go. Moving away from current insurance coverage plans and managed care will reduce the overall cost of healthcare. Moving towards a fee-for-service system will reduce costs over the long term and since patient's are in charge of their own HSA, they will be more frugal with their health care.

For people that get in trouble (i.e. Cancer, severe accident, etc...) the catastrophic are insurance kicks in and helps covers all expenses above X amount.

There are bills floating around in congress right now in committee that have plans somewhat like this, but they are not likely to become options.

[kmcrawfo]

Addittionally, the government getting involved and requiring coverage of certain conditions has made insurance much, much more expensive.

For instance, the government has required that all plans in many areas have to provide OB coverage. What if you don't want OB coverage. Too bad, the government requires your carrier to provide it. Therefore, your premium goes from $175/month to $300/month.

This occurs all over the place from required coverage for diabetic foot care, certain vaccines, screening tests, etc... These required coverages jack up the cost of care. People should be able to choose what coverage they want and don't want. Leave the gov't requirements out of it and the cost will go down.

Everyone getting OB, vaccnines, foot care, sounds great... Until your premiums go up 200% as result. I mean, do people really think because the gov't mandates coverage that insurance companies are going to give it for free?

[blobfan]

Does, "promote the general welfare..." mean anything to you?

Promoting welfare is very different from providing welfare and isn't that from the part describing the purpose of the US government, not the rights the framers believe we as humans have?

I just reviewed the constituion and the bill of rights and see nothing to indicate we have a right to health care. Nor does it say that our government is supposed to provide for our rights; it is only meant to defend them.

[blobfan]

...I mean, do people really think because the gov't mandates coverage that insurance companies are going to give it for free?

It seems they do. A recent poll shows 56% of people are for an health care reform but 61% think employers should pay for, 52% say controlling costs is a higher priority than expanding health care, 90% oppose limits on the care provided and 53% don't want the benefits taxed.

The majority seems to be expecting health care to be fixed for free. If it's not coming from the government, then it's the health care industry, including insurers, and employers that are on the hook.

[DC Muskie]

Promoting welfare is very different from providing welfare and isn't that from the part describing the purpose of the US government, not the rights the framers believe we as humans have?

Here we go again talking about what white guys in the 1780's thought our rights were and therefore that is it. Next thing you know I'll have to read how this is a Christian country, with Christain values.

The Preamble of the Constitution pretty much sums up the thought of what the government is suppossed to be...the people. Without the scope, the Bill of Rights is pretty much meaningless.


I just reviewed the constituion and the bill of rights and see nothing to indicate we have a right to health care. Nor does it say that our government is supposed to provide for our rights; it is only meant to defend them.

It also says nothing about having roads, schools, or public restrooms either. The Constitution doesn't actually give us the right to live. Nor does it give us the right to die. Why is health care something that needs to be specifically spelled out as a right in the Constitution?

People seem to revert back to the Constitution when it comes to health care, bailouts, and generally anything they see as an expansion of government.

While forgetting...

We're not suppossed to have a standing army. But we do. We haven't declared war properly in this country since World War II. But we have gone and continue to go to war. We have citizens in this country that have no representation in the federal government, but are taxed. But people are afraid that government is going to screw up health care, because rich white guys in the 1780's didn't put it on a list, like they neglected to put, "We will not own black people."

[American X]

You seem quick to criticise and insult, but offer little in return.


You have succinctly summarized your interlocutor.


In other news, I hope ObamaCare covers Depends, because I just crapped myself:

The Reckless Congress (http://online.wsj.com/article/SB124779717982855785.html)

[kmcrawfo]

You have succinctly summarized your interlocutor.


In other news, I hope ObamaCare covers Depends, because I just crapped myself:

The Reckless Congress (http://online.wsj.com/article/SB124779717982855785.html)

This certainly does a good job a summarizing many flaws in the plan, but it is just the tip of how awful this bill is.

I can not see how this passes in its current state. There certainly are enough blue-dog democrats to kill this due to their fiscally conservative nature.

[GuyFawkes38]

Just to get things exciting (Guy) - when Medicare legislation was passed in 1965, the average lifespan in the U.S. was between 66 and 70 years. Interesting how benefits didn't kick in until one reached age 65 and conceivably only had a few years of life left. Now we're nearing an average lifespan of 78 or so. Those extra few years are very costly.

Let me first say that I love older people.

But having an aging demographic trend sucks.....well, I guess it's good for those above 50, who don't care about health care expenses, and sucks for us under who don't have the political numbers or power to reform medicare.

[bobbiemcgee]

Let me first say that I love older people.

But having an aging demographic trend sucks.....well, I guess it's good for those above 50, who don't care about health care expenses, and sucks for us under who don't have the political numbers or power to reform medicare.

Yeah, I could careless about my $1100.00 monthly health care bill as a self-employed 62 yr. old. I just got word they will not be renewing it although I've had no claims for 5 yrs. However, since I have a medical savings plan with 28k in it, I'm going to stop paying it this month and hope for the best. If you call any of the major companies for a quote, you won't hardly get your age out of your mouth before they hangup. If they punch in 62 for the age, the computer won't GIVE A QUOTE. You could be the most qualified candidate in the world for a job and you'll NEVER get it @ 62 as the employer will not want to pay the extra premium for an older person in his work force. If you think this is a good deal for people above 50, you need to use some of your obviously cheap plan to have your head examined.

[GuyFawkes38]

Yeah, I could careless about my $1100.00 monthly health care bill as a self-employed 62 yr. old. I just got word they will not be renewing it although I've had no claims for 5 yrs. However, since I have a medical savings plan with 28k in it, I'm going to stop paying it this month and hope for the best. If you call any of the major companies for a quote, you won't hardly get your age out of your mouth before they hangup. If they punch in 62 for the age, the computer won't GIVE A QUOTE. You could be the most qualified candidate in the world for a job and you'll NEVER get it @ 62 as the employer will not want to pay the extra premium for an older person in his work force. If you think this is a good deal for people above 50, you need to use some of your obviously cheap plan to have your head examined.

point taken.

I used the 50+ age because such people are part of a demographic block which will push the US into unprecedented amounts of debt with Medicare. And they will be part of a powerful voting block who likely won't reduce their own benefits even though it's the responsible thing to do.

[bobbiemcgee]

Sorry about the Vent. Healthcare is ridicuously expensive and soon will exceed most people's mortgage payment. The older people can say "hey, stop having all those babies",(see Octomom) and it will go on and on.

[GuyFawkes38]

Sorry about the Vent. Healthcare is ridicuously expensive and soon will exceed most people's mortgage payment. The older people can say "hey, stop having all those babies",(see Octomom) and it will go on and on.

Speaking to your point about being self-employed, as a conservative/libertarian, it's hard for me to admit this. But part of me envies the European health care system because the euro model completely separates employment and health care. I know the tax rates suck. But being able to start a business and not worry about insane health care prices for you and your employees is pretty awesome.

[picknroll]

People should read up on the Massachutes and Tennessee models which were implemented. Both have been tremendously expensive failures. Yet, congress and this administration are now trying to model this bill after such endeavors. Yikes?!?

I personally think the Health Savings Accounts combined with Catastrophic care Insurance is the way to go. Moving away from current insurance coverage plans and managed care will reduce the overall cost of healthcare. Moving towards a fee-for-service system will reduce costs over the long term and since patient's are in charge of their own HSA, they will be more frugal with their health care.

For people that get in trouble (i.e. Cancer, severe accident, etc...) the catastrophic are insurance kicks in and helps covers all expenses above X amount.

There are bills floating around in congress right now in committee that have plans somewhat like this, but they are not likely to become options.

I agree with this post. Sen. Paul Ryan (R-Wisc) is a champion of consumer-driven healthcare. I am self-employed, and my wife and I each have a $3000 deductible HSA-compatible plan. The calendar-year risk is $3000 because there is no post-deductible coinsurance. We fund our HSA as we wish and when we wish. It works for us.

But let me say in simplistic terms this healthcare reform crap is all about the money. We Americans spend a ton of money on premiums and out of pocket costs. Uncle Sam's eyes light up from the idea of getting their hands on that money and using it to keep Medicare and Medicaid solvent, which are about to go broke. Again, spreading the wealth - taking money from a younger and healthier pool, rationing care and moving those dollars to the poor and elderly among us. Socialism pure and simple. Follow the money, follow the money.

[Snipe]

Speaking to your point about being self-employed, as a conservative/libertarian, it's hard for me to admit this. But part of me envies the European health care system because the euro model completely separates employment and health care. I know the tax rates suck. But being able to start a business and not worry about insane health care prices for you and your employees is pretty awesome.

Health care should not be related to employment. Everyone should get their own health care unrelated to where they work. It is only that way because facist FDR froze wages and they only way they could increase them was to offer perks and benefits.

If everyone paid their own way healthcare wouldn't cost so much. The problem with health care is that there is little market mechanism and competative forces have little chance to work. Most people that are parents don't know the cost to have their baby. They know the monthy premium that they pay, and they know the co-pay, but they don't know the cost. Many doctors don't know the cost of what they do. It depends upon what insurance plan and what contract you have. So many people in a system are unaware of the costs. It is no surprise that costs run amok.

[bobbiemcgee]

Here is a case in point: I take the drug Norvasc for HB pressure. It is the most widely prescribed HB prescription IN THE WORLD! However, review the price per pill on this chart. You will see the highest price is right here in the good ol USA, sometimes 4x what other's charge. Regardless of where you order it, it comes in the same box from the same plant. I take the generic from Valuepharmeceuticals.com. Yeah, I get my drugs from FI -JI. NO Prescription needed. Generic: $7.50 for 30. Norvasc in US: 2 bucks a pill.

http://www.pharmacychecker.com/Pricing.asp?DrugName=Norvasc&DrugId=19093&DrugStrengthId=31112#

[picknroll]

Health care should not be related to employment. Everyone should get their own health care unrelated to where they work. It is only that way because facist FDR froze wages and they only way they could increase them was to offer perks and benefits.

If everyone paid their own way healthcare wouldn't cost so much. The problem with health care is that there is little market mechanism and competative forces have little chance to work. Most people that are parents don't know the cost to have their baby. They know the monthy premium that they pay, and they know the co-pay, but they don't know the cost. Many doctors don't know the cost of what they do. It depends upon what insurance plan and what contract you have. So many people in a system are unaware of the costs. It is no surprise that costs run amok.

Snipe, this oblivious devil-may-care attitude toward cost by began with the advent of employer-based HMOs in 1989. The insurance companies told us not to worry, just seek healthcare without regard to cost and at the time, employers footed virtually all of the premium. Doctors were paid on a capitation basis whether they saw patients or not. This became the perfect storm for the working public to falsely see healthcare as an "entitlement" until 1996 when, to the shock of many, the HMO concept became unsustainable. The general public now yearns for the return of the "entitlement" HMO days, and they think that's what they'll get with the public option being waved in their faces.

[blobfan]

People seem to revert back to the Constitution when it comes to health care, bailouts, and generally anything they see as an expansion of government.

While forgetting...

We're not suppossed to have a standing army. But we do. We haven't declared war properly in this country since World War II. But we have gone and continue to go to war. We have citizens in this country that have no representation in the federal government, but are taxed. But people are afraid that government is going to screw up health care, because rich white guys in the 1780's didn't put it on a list, like they neglected to put, "We will not own black people."
I didn't say that the government should only do something that is spelled out specifically. That was not the intent of those old white guys from the 1700s that you seem to look down upon. And just because something isn't a right doesn't mean the government shouldn't be involved. I believe our government should focus on protecting our basic rights but needs to be pragmatic in addressing practical, every day issues, such as building the interstates to support travel across multiple states.

But by putting something, like health care, in terms of rights, we are going to make stupid decisions that don't consider future implications. Just like was done with social security, which many people seem to see as their right. If we approach health care as a right we ignore the need to talk about the practical side. We need to have a serious discussion about how much to provide and how to fund it before any bill is passed. As of right now all discussions seem to be based on the premise that we'll provide unlimited health care and everyone except individuals will be taxed to pay for it. That's just not realistic.

We have a right to not have our health impacted adversely by outside forces. We do not have a right to health care. We can't have a right to health care without impinging on the freedom of health care providers.

[kmcrawfo]

I didn't say that the government should only do something that is spelled out specifically. That was not the intent of those old white guys from the 1700s that you seem to look down upon. And just because something isn't a right doesn't mean the government shouldn't be involved. I believe our government should focus on protecting our basic rights but needs to be pragmatic in addressing practical, every day issues, such as building the interstates to support travel across multiple states.

But by putting something, like health care, in terms of rights, we are going to make stupid decisions that don't consider future implications. Just like was done with social security, which many people seem to see as their right. If we approach health care as a right we ignore the need to talk about the practical side. We need to have a serious discussion about how much to provide and how to fund it before any bill is passed. As of right now all discussions seem to be based on the premise that we'll provide unlimited health care and everyone except individuals will be taxed to pay for it. That's just not realistic.

We have a right to not have our health impacted adversely by outside forces. We do not have a right to health care. We can't have a right to health care without impinging on the freedom of health care providers.

I generally agree with these statements....

In my mind the government should only provide/be invovled in very few things, such as:

1. Essential Infrastructure (highways, etc..)
2. A military to protect its people
3. Laws and the entities needed for enforcement of these laws
4. Minimal Taxation (a low, flat rate) to only cover the above responsibilities

Nearly Everything else is better served by the private sector including:

education, healthcare, retirement, welfare, etc...

Private education > public education
Despite a much high $$$ spent per student in public schools, private schools vastly outperform them.

Private healthcare > gov't healthcare:
Quality of care and access to care with private plans dwarfs gov't plans. Good luck finding an internest who will accept you as a new patient if your insurance is TriCare or Medicaid and even Medicare in many markets.

Private retirement plans > Social Security:
Forget about the stock market, just put your social security withholdings into a CD it will give your more for retirement.

Private Charity > Gov't Welfare:
Private groups (i.e. churches, etc...) get much better results per $ spent.

In every instance the government spends more money and delivers worse results than the private sector. Why? Maybe because it is not their money and there is no accountability. The government has perfected the science of inefficiency and waste. Many, if not most, people in government are concerned about how to maintain / elevate their positions & power; not, doing what is best for the Country.

Why is it when the government fails time after time that people are so eager to give them more responsiblity and power. The United States has been the most successful and powerful country in history due the ingenuity and hardwork or its people, not its government.

[Snipe]

I would agree with that. If healthcare is a right, why not housing and food?


What's to stop people from marrying goats? Or trees?



I don't have a problem with people marrying goats or trees or anything else. The government shouldn't be in the marriage business. Marry whoever you want. Why should the rest of us care if we don't know you? The government should not sanction any private union, and you shouldn't have to pay the government to officially sanction your union. That isn't freedom or liberty.

I do have a problem with working and having the government take my property in order to provide someone with healthcare, and they don't have to work themselves. I don't think that is right. My Freedom of Speech doesn't cost anyone a dime. Health care as a right is a right to tax people and make them do something for you.

Maybe slavery is a bad term for it, but it does appeal to me. I am born and I choose to work. Part of my burden would be to provide healthcare for people that don't work or produce. The government will forcibly take my property and the fruit of my labor and give it to their benefit. I see some slavery in that. We are not on the plantation, and I don't have to change my name to Toby, but I have to work to provide for them. I reject that.

[Strange Brew]

Does, "promote the general welfare..." mean anything to you?

As blob said, there is a huge difference between the words "promote" and "provide".

Also, you stated that there is no place in the Constitution that allows for a standing army.
Does "provide for the general defense" mean anything to you? Ironically, that line is found in the same portion (Article I, section 8) of the Constitution as the general welfare line.

[Snipe]

You are 100% correct, DC. Snipe, what you mentioned is not really slavery. It's socialism.

Maybe socialism is slavery. I can't opt out of the tax system.

Everyone of our laws is in the end enforced by men with guns. We don't see it because it rarely gets to that point. But that is a fact.

Try not paying your property taxes. If doesn't matter if you claim they are unjust or if you don't even have a well thought argument. Try not paying them. At some point the government will say you no longer own the property. If you continue to live there at some point men with guns will show up and escort you away.

Every tax law that we have is backed with men with guns. If that wasn't the case, I wouldn't pay my taxes. The goverment uses force to take property away from you. There isn't any other way in any government in all of history.

So if the government decides to use its force to take my property away from me to give it to the health care of someone else, I claim that it is a form of slavery that I can't escape. Is it socialism? Sure. But it is still slavery too. I become an indentured servant who is working for the government to provide sevices to someone else, because they were born with the "right" for me to provide for their care. I call that slavery. I don't care what you call it. A rose by any other name....

[Snipe]

Slavery is forced labor of people used as property. I'm not sure how annexation is slavery.



That is one definition of slavery. I am not sure how annexation is not slavery. The government will use police powers to annex my personal property. To me personal property is sacred. It is part of my being. If the government took away my house they would be taking away a part of me. It they make me work to provide for others why am I not a slave?



I'm also not sure how making sure everyone has health insurance is like taking someone's personal property.

Let me clarify this for you. Healthcare isn't free. To provide healthcare to people that don't wish to work and pay for it you have to take property from others and give it to them. Maybe there is another way. Maybe the magic health care fairy sprinkles a little healthcare dust and everyone feels just great. In my world it costs to go to the doctor, because the doctor needs to be paid.

I am a landlord by trade. You know that. Why isn't housing a right? Isn't that a more basic need than healthcare? Why should my tenants have to pay me for this basic human right? What about food? Food is higher on the list than healthcare or even housing. Why shouldn't we provide food and housing and healthcare to everyone? The answer to that question is that we pretty much already do. Emergency rooms don't reject people. Healthcare is free to those people. People live in public housing and food stamps are so abundant that the American poor face an obesity epidemic. And that affects the healthcare system too.

Do you ever consider the law of unintended consequences?

[Snipe]

DC, I agree with you on the right to health care.

But here's the big question: Does everyone have the right to the same quality of care?

of course, I would answer no.


No. It's impossible task anyway. What's not impossible, what IS possible, is providing healthcare to everyone.


We already have heathcare for everyone. Go to an emergency room. See if they turn you away.

Both of you agree that everyone doesn't have a right to the same quality of care. That is rationing by definition. So Obama wants to give 40 million uninsured people healthcare insurance. That will not cut costs. The only way costs are cut is when we deny healthcare. We already have national health care. The only way we save money is if we start cutting people off. That needs to happen. We need to start refusing to treat people.

And that is what national health care is all about.

[Snipe]

True.

But I do think that lots of people on the left see a strong public option as a means (a trojan horse) to attain single option health care (like canada).

They argue that American's, even the wealthy ones, spend way too much on health care and a single option would limit costs and equalize care.

Edit: here's the evidence: http://www.youtube.com/watch?v=zZ-6ebku3_E

Great video. I recommend people watch that. Obama wants government healthcare and a single payer system. He has said it in his own words. It is his goal.

[Snipe]

I didn't get to read all of Snipe's manifesto concerning Peter Singer, but that dude is sick. The day I let that man start thinking for me is the same day I'd be put six feet under.

Singer makes some points. I will give him that. He is also not ordinary. Bigtime leftist. I wouldn't let him watch my children, but he is interesting. Some of his points are inescapable.

[Snipe]

just read snipes posts, and agree with the above, except the part on denying treatment for people who don't "deserve" it (this isn't Haiti or the USSR).



You appear to be a fool on this issue.

Let me explain.

You get that government care needs to be rationed. Then you say that we shouldn't deny treatment on people that don't "deserve it".

How do you define rationing? I think it is about giving care to people that deserve it vs. giving care to people who don't. Isn't that what rationing is all about?

Any rationing would be done by the government. That means it would be a political issue and an issue in every election. It may be that your 75 year old mother isn't worth the cost. Or it may be that the 19 year old gang banger with a wrap sheet isn't worth the cost. Those would be political issues. I would not decide them. If it was my choice, and your mother was a faithful taxpayer, I would side with her contributions to the system. The same way they cut benefits for people who smoke, I would cut benefits for people who engage in high risk criminal activity. It already happens in some forms in socialized medical countries. They make judgements, and those are value judgements. Those are poltical judgements.

You can't get around it. If we all have to pay, we all have the right to draw the line. Maybe we save all the gangbanging thugs and let your dad die seven years earlier than technology would warrrant. When the government provides healthcare, it fundamentally changes the relationship between citizen and state. We all become patrons to the nanny state. The Government will provide for all of our health. We will all become dependents.

DC thinks this is a good thing. To me it is a nightmare. But putting that aside, we will have to deal with who lives and who dies. You can't get around it. We already have this problem by the way. That is why Medicare is going bankrupt. We pay for everything and nobody cuts them off. Obama is a brave man for taking on this fight. We need to start denying people coverage.

[Snipe]

The system Snipe suggests is exactly what we are heading towards if this bill is passed. The wealthy will get good private care, while the lower-middle class will get a sub-par public option where care eventually will be rationed.

If that is what people want, then go for it.

Good luck finding a doctor/appointment, getting that MRI, or seeing a specialist if you are in the public option (See the experiments with similar plans in Massachutes and Tennessee).

I would agree with that. We will have full health care for the rich and government rationed health care for the poor.

The rich will always live better than we do. That is a benefit of being filthy rich. I envy them. No matter how you change the system the rich will always do better. I can't think of any era in human history where the rich didn't live better. Par for the course.

So excluding the rich, look at the middleclass and poor. The poor already don't pay for their healthcare. The middleclass pay a lot. I can see the middleclass paying more and getting less with this legistlation. That would be a sure fire loser. I am sure plenty of middleclass people want everyone covered, but they also have wives and kids and they want to make sure they get covered.

I don't think the middle class would enjoy to have less health coverage. They already pay a great amount for healthcare. The rich would see no decline in coverage. That is because they are rich in the first place. So the brunt of the battle will fall upon the middleclass. And givin our government, I predict that nobody will fall in love with government healthcare. The people paying higher prices will have to get less healthcare for the system to even work. It won't work.

[Snipe]

Yeah, I could careless about my $1100.00 monthly health care bill as a self-employed 62 yr. old. I just got word they will not be renewing it although I've had no claims for 5 yrs. However, since I have a medical savings plan with 28k in it, I'm going to stop paying it this month and hope for the best. If you call any of the major companies for a quote, you won't hardly get your age out of your mouth before they hangup. If they punch in 62 for the age, the computer won't GIVE A QUOTE. You could be the most qualified candidate in the world for a job and you'll NEVER get it @ 62 as the employer will not want to pay the extra premium for an older person in his work force. If you think this is a good deal for people above 50, you need to use some of your obviously cheap plan to have your head examined.


Healthcare should not be linked to employment. They act like employers don't judge you, but as you noted, they do.

My baseball coach in little league was a vietnam vet. He had been injured and had open heart surgery. He was pretty well fucked up, and nobody would hire him because of the health care costs. I was probably 9 when he explained it me. The gravity came much later.

He took a bullet for your freedom. It fucked him up. His survival was a miracle, and he had three surgeries and had the scars on his front and back to prove them. Nobody wanted to hire him, because the cost of his health care. We should have a system where everyone can look for work.

Your employment does not make a difference to you house painter, or the guy that does your drywall. It doesn't effect your car insurance or your credit rating. Your dentist doesn't care, or your accountant, lawyer et all.... Why should employment be so linked to health care. It is a bad system and people should be free.

[GuyFawkes38]

You appear to be a fool on this issue.

Let me explain.

You get that government care needs to be rationed. Then you say that we shouldn't deny treatment on people that don't "deserve it".

How do you define rationing? I think it is about giving care to people that deserve it vs. giving care to people who don't. Isn't that what rationing is all about?

Any rationing would be done by the government. That means it would be a political issue and an issue in every election. It may be that your 75 year old mother isn't worth the cost. Or it may be that the 19 year old gang banger with a wrap sheet isn't worth the cost. Those would be political issues. I would not decide them. If it was my choice, and your mother was a faithful taxpayer, I would side with her contributions to the system. The same way they cut benefits for people who smoke, I would cut benefits for people who engage in high risk criminal activity. It already happens in some forms in socialized medical countries. They make judgements, and those are value judgements. Those are poltical judgements.

You can't get around it. If we all have to pay, we all have the right to draw the line. Maybe we save all the gangbanging thugs and let your dad die seven years earlier than technology would warrrant. When the government provides healthcare, it fundamentally changes the relationship between citizen and state. We all become patrons to the nanny state. The Government will provide for all of our health. We will all become dependents.

DC thinks this is a good thing. To me it is a nightmare. But putting that aside, we will have to deal with who lives and who dies. You can't get around it. We already have this problem by the way. That is why Medicare is going bankrupt. We pay for everything and nobody cuts them off. Obama is a brave man for taking on this fight. We need to start denying people coverage.

I'm all for the government providing a safety net and using it to ration out and often deny care.

But do you really think it would be politically feasible for the government to do this on a non-medical basis. Would policy makers really want to deny care to those who don't "deserve" it.

The government often doesn't have the greatest record at putting people in jail. Even you've admitted that there's no reason why we should have hundreds of thousands of drug users and dealers in jail. Would they deserve health care, snipe? they are in prison not contributing to society.

A lot of this type of stuff will sort out in a more fair manner with market forces. Chances are my mother and father, who've worked hard their entire lives, would be able to afford better health care than an 18 year old gang banger (in a society where medicare is cut and rationed out, which I want, more would supplement care. Which is fine). Your choice above is a false one.

[DC Muskie]

That is one definition of slavery. I am not sure how annexation is not slavery. The government will use police powers to annex my personal property. To me personal property is sacred. It is part of my being. If the government took away my house they would be taking away a part of me. It they make me work to provide for others why am I not a slave?


I love you Snipe. I'm not sure how you can define owning a person, to the government taking property, to you being treated as a slave. But I always admire the try.



Let me clarify this for you. Healthcare isn't free. To provide healthcare to people that don't wish to work and pay for it you have to take property from others and give it to them. Maybe there is another way. Maybe the magic health care fairy sprinkles a little healthcare dust and everyone feels just great. In my world it costs to go to the doctor, because the doctor needs to be paid.

I am a landlord by trade. You know that. Why isn't housing a right? Isn't that a more basic need than healthcare? Why should my tenants have to pay me for this basic human right? What about food? Food is higher on the list than healthcare or even housing. Why shouldn't we provide food and housing and healthcare to everyone? The answer to that question is that we pretty much already do. Emergency rooms don't reject people. Healthcare is free to those people. People live in public housing and food stamps are so abundant that the American poor face an obesity epidemic. And that affects the healthcare system too.

Do you ever consider the law of unintended consequences?

I'm just going to wrap this section up with a question...

50 million people are out of work, or can't work, and therefore can't get health insurance?

I mean the answer for health care for everyone is emergency care? Seriously? That's the response?

Guys, this is about acess to healthcare. Not access to emergency care, or access to food, or anything else you want to list. I presume most of our us our Catholic, and the Catholic Health Association and Catholic Charities USA say access to healthcare is a human right.

[Snipe]

I'm all for the government providing a safety net and using it to ration out and often deny care.

But do you really think it would be politically feasible for the government to do this on a non-medical basis. Would policy makers really want to deny care to those who don't "deserve" it.

The government often doesn't have the greatest record at putting people in jail. Even you've admitted that there's no reason why we should have hundreds of thousands of drug users and dealers in jail. Would they deserve health care, snipe? they are in prison not contributing to society.

A lot of this type of stuff will sort out in a more fair manner with market forces. Chances are my mother and father, who've worked hard their entire lives, would be able to afford better health care than an 18 year old gang banger (in a society where medicare is cut and rationed out, which I want, more would supplement care. Which is fine). Your choice above is a false one.

I am not sure my choice above is a false one. In some countries they have targeted smokers or the obese because these people's own actions increase the cost of health care for everyone. You can make a similar argument for rock climbers. If you engage in rock climbing you increase your chances for a substantial injury. It is your own choice, just like smoking or overeating. Why would that not apply to a man who joins a criminal gang and buys a gun? If you are involved in illegal gunplay, you are most likely increasing all of our health care costs through your own actions. The people that you shoot. The people that shoot you. We would all pay for that.

If we do get government care and rationing we will have to be forced to deal with these types of questions. Who deserves care? Some people will be refused care. Should people's own actions have in maintaining a healthy body come into play? Should smokers be made to quite smoking to get care? Should the obese be made to lose weight to get a hip replacement? What do you do with a rock climber with brokern legs and a bike rider without a helmet with a cracked head? And in the same vein, what about the guy who buys a gun and illegally uses it?

In places with national health care, they already have these sorts of debates. It started with the smokers, because they are all evil and smoking is bad.

People talk about bang for your buck. How much bang for your buck are you going to get from saving that gangbanger. Given rates of recidivism he will likely end up using the gun again and putting more bodies into the health care system. That doesn't seem like a wise investment.

To save money we have to start denying people health care. It will be the government that makes the decision. The only thing left is determining who to deny the care too.

We probably won't end up denying care to rock climbers, bike riders or gang bangers. We will start with old people. To save money we have to start limiting their health care.

Obama Will Repeal Medicare (http://www.creators.com/conservative/dick-morris/obama-will-repeal-medicare.html)


Obama's health care proposal is, in effect, the repeal of the Medicare program as we know it. The elderly will go from being the group with the most access to free medical care to the one with the least access.

Indeed, the principal impact of the Obama health care program will be to reduce sharply the medical services the elderly can use. No longer will their every medical need be met, their every medication prescribed, their every need to improve their quality of life answered.

I can't see how that doesn't happen. They want to add 40 to 50 million to the ranks of the insured. That isn't going to cut costs, which is why they are proposing tax increases to pay for it.

Where do the promised savings coming from? Rationing care, and denying it to old people. That is where they will start. Then I think they will go after the smokers. Too bad though that smokers already pay for children's health insurance though the tax on cigarettes.

[Snipe]

Guys, this is about acess to healthcare. Not access to emergency care, or access to food, or anything else you want to list. I presume most of our us our Catholic, and the Catholic Health Association and Catholic Charities USA say access to healthcare is a human right.



They also say (http://www.catholichealthcare.us/OurVision/principles/reformprinciples.htm)that Healthcare in the United States should


"Deliver the same level and quality of care to everyone without limits or variations based on age; race; ethnicity; financial means; or health, immigration or employment status.

Earlier in this thread you didn't agree with equality of care.

Under this type of system any sick immigrant could come to the United States and demand the same quality of care as the President and Bill Gates.

I also think that the Catholic Health Association and Catholic Charities USA have a different stance than the current administration on terminating the lives and the health care of young infants in the womb. Those people won't be receiving health care from Obama. They will continue to be murdered.

I don't know why a discussion of human rights would not involve or allow the discussion of other "human rights".

Catholics have found food, housing and healthcare to be human rights. You would think that religious liberty and a right to life are at the top of the list.

Here is a statement (http://www.vatican.va/holy_father/benedict_xvi/speeches/2006/march/documents/hf_ben-xvi_spe_20060330_eu-parliamentarians_en.html)from the current Pope that also appears on the mission statement page of the Catholic Family and Human Rights institute (http://www.c-fam.org/about_us/id.43/default.asp).


"As far as the Catholic Church is concerned, the principal focus of her interventions in the public arena is the protection and promotion of the dignity of the person, and she is thereby consciously drawing particular attention to principles which are not negotiable. Among these the following emerge clearly today:

- protection of life in all its stages, from the first moment of conception until natural death;

- recognition and promotion of the natural structure of the family - as a union between a man and a woman based on marriage - and its defense from attempts to make it juridically equivalent to radically different forms of union which in reality harm it and contribute to its destabilization, obscuring its particular character and its irreplaceable social role;

- the protection of the right of parents to educate their children.

These principles are not truths of faith, even though they receive further light and confirmation from faith; they are inscribed in human nature itself and therefore they are common to all humanity. The Church's action in promoting them is therefore not confessional in character, but is addressed to all people, prescinding from any religious affiliation they may have. On the contrary, such action is all the more necessary the more these principles are denied or misunderstood, because this constitutes an offence against the truth of the human person, a grave wound inflicted onto justice itself."

Pope Benedict XVI, 2006


I don't know where the "Human Right" to healthcare falls on the list. It certainly doesn't trump the right to life. I would think the church looks at housing and hunger as bigger isuues as well, as healthcare without a home or food to eat would mean very little.

All of those are admirable goals. How do we provide from all of them in real life? What are the unintended consequences? What do you do about free riders on the system? If we give everyone a human right to food, housing and healthcare any imigrant can show up on shore and demand some service. I think that would be a disaster. If we design a plan that breaks the system we must take into a consideration that a broken system will harm far more people than the situation right now.

[DC Muskie]

So basically since the CHA can't get the government or the courts to override Roe V Wade, they should keep all other positions to themselves? Or that any of their positions really can be done in real life.

Interesting.

[Snipe]

I would prefer that the Catholics stay out of the courts and lobbying Congress, but everyone does it so I shouldn't blame them.

You like to cite Catholics and play that card when it suits your purpose. You don't seem to be critical of the Administration you love on right to life issues, and you don't seem to place much importance in the Pope's views on the family and marriage being between a man and a woman. You are selective in a curious way.

I don't think we can give equal care to everyone of every age without any discrimination. I don't think we are going to give the same care to everyone. I don't think we are going to put it into law that illegal immigrants get the equal care to everyone either. What has been proposed is not what Catholics are talking about, and it won't be the result either. We are going to have to deny care and discriminate to balance the budget. That will happen.

We can talk about human rights to housing, health, living without hunger, even the human right to work. I doubt they can be realitically incorporated in meaningful ways in which everyone considers equal and fair. And none of this speaks to property rights. You are going to have to violate someone else's rights and take away their property to give others housing, healthcare, food and whatever else you conjure up as a basic human right.

Just because it isn't perfect doesn't mean we can do anything. We are doing something and providing care right now. It isn't enough for some people. Will this plan make the system better or worse? Depending on who you are, the answer to that question changes.

In my estimation:

Rich People: The same level of care at increased cost.
Middle Class People: Less care at increased cost.
Poor People: More care at no cost.

Most people will not see a benefit from this. And the CBO says that this plan does nothing but ADD costs. It does not cut costs as some have claimed. That is why they are proposing raising taxes to fund it.

We spend a lot of money on healthcare to the poor. Is the level we spend enough? Is it too much? Should we spend more? Where does that money come from? With the same number of doctors, how can 50 million people get free healthcare without a long line forming for the people in the middle class who already pay for the services?

[DC Muskie]

You like to cite Catholics and play that card when it suits your purpose. You don't seem to be critical of the Administration you love on right to life issues, and you don't seem to place much importance in the Pope's views on the family and marriage being between a man and a woman. You are selective in a curious way.

I'm selective because I don't throw the entire kitchen sink when discussing one issue. You always bring up slippery slope scenarios. You always want to point out this or that when trying to discuss one issue. I'm not sure how being critical on the Pope's stance on marriage helps solve challenges to access for health care in the United States.

I guess I should remember everything when bringing up a topic that basically boils down to money with you.

So I stand corrected. If this plan is going to cost me more money, the hell with it! And I don't think gays should be married! And everyone in the world should drive on the right side of the road! What else am I forgetting....vouchers for everyone! Wait...no vouchers! I can't remember where we stand on that.

I think you are incredbly lucky, smart person Snipe. You are a small business owner, in touch with what goes on in society and especailly in your community. You've worked to get an education, have a family, provide food, get a house. My hope is others will see your example and go out and take advantage of things you have had.

Because that's basically what it comes down to...there are the go geters and go takers. and then their are just takers.

Everything is fine. Except everything costs too much. But that is better than having things cost more.

[Snipe]

DC, it isn't just the increased cost that concerns me personally, but a decrease in the level of care for me and my family. I think I will end up paying more and my family would get less care. That is a terrible option for me to support.

I don't know where you stand for health care for illegals, but the churches position is that are entitled (indeed it is their human right) to get the best care that we can give them (because we all deserve equal care).

Now you can say that I bring Illegal immigrants or abortion into the argument, but those are part of the churches position on health care. The church believes those infants have a right to life and health care. The church believes immigration status should not be a factor in health care. You brought up the churches position. I am trying to point out that the churches position may not work well as a practical matter. I also added that the church has plenty of positions, and not all of them are feasible in a realistic way.

Another thing about these "human rights" is that the lead to an entitlement society. People demand housing, food and healthcare because it is their right. The entitlement attitude and the freerider problem are the bane of our inner city sections of poverty today. Dad used to put food on the table and the roof over your head. It didn't matter if dad was a garbage man or a janitor, he was respected in being a provider. When the government took over for dad it destroyed the family. Uncle Sam puts that roof over your head and that food on the table. Guess we didn't need dad at all and he is gone.

Government health care just enlarges the nanny state and the entitlement society. We are all just children of the State, and it is up to the State to take care of us. I see how far we have gotten with the nanny state so far. This won't end well.

[DC Muskie]

You have such a doomsday scenario here. Illegal immigrants would come all the way over to use our entitled healcare system! And the Snpes would be forced to pay more, while standing long lines!

It seems to me you need to reform immigration, rather then throw out a health care system simply because another problem would complicate it.

I think sick people would overrun this program. And those sick people would think they are entitled to care. And they better be able to pay for it, because I'm not going to pay in more and stand outside while they get treatment.

Is health care problem just a made up thing in this country?

[kmcrawfo]

Interestingly enough, most americans want nothing to do with this bill:

Zogby on Friday released a poll showing these numbers:

Americans disapprove of the healthcare bill currently in the house by a 50-42% margin

84% of Americans with insurance are completely satisfied with their current healtcare coverage

46% of Americans without insurance are completely satisfied with their current healthcare coverage

margin of error of plus/minus 1.6 percentage points.

So, the vast majority of this country is completely satisfied with their healthcare (Even half of those without insurance). Furthermore, a majority of Americans oppose this bill. Yet, it is still possibly going to be rushed through congress where the majority of congressmen won't even read the bill (I mean, it is really long, who can blame them...)

[kmcrawfo]

How many services/entities in this country have a 84% satisfaction rate? Particularly one as complex as healthcare....

I don't know the exact numbers, but approximately I think 93-94% of the country is insured somehow.

So, approximately 83% of the country is completely satisfied with their healthcare. No kind of satisfied.... Completely.

Perhaps the question be asked do you think that complete satisfaction rate will go up? or down? with nationalized healthcare.

I bet a large sum of money that up is not the right answer.

[kmcrawfo]

I am not saying we shouldn't shoot for 100% satisfaction. But, we should all be inteligent enough to know that is not realistic/possible. Unfortunately, neither is 100% coverage.

Even the current house's bill does not cover 17 million americans.

So, roughly half of the people without coverage still won't have coverage if this is passed, and at what cost to the rest of the country...

[XU 87]

You have such a doomsday scenario here. Illegal immigrants would come all the way over to use our entitled healcare system! And the Snpes would be forced to pay more, while standing long lines!


Is health care problem just a made up thing in this country?

1) It happens all the time. I read some stat a few weeks ago, which I can't find right now, which discussed the large number of women who come to the U.S. for the sole purpose of having their baby in an American hospital.

2) In some respects it is. See KMCrawford's post above which talks about how most people are satisfied with their health insurance. Now that's not to say we don't have significant problems with high costs, but overall our health care system works fairly well. Most people, even the uninsured, can obtain sophisticated health care in a timely fashion. People in Canada can't say that.

I still can't find the stat I was looking for. But overall, it is estimated, depending on your source, that 160,000 to 500,000 babies are born per year in the U.S. to parents who are illegal immigrants.

[DC Muskie]

87-

That's why I am sold on this. I hope this doesn't pass. Cost too much, too many illegals will come in and make things worse. Plus, I am very satisfied with my healthcare.

No changes, and no to this bill!

[Kahns Krazy]

No changes, and no to this bill!

Right. Everyone opposed to this bill is opposed to any changes in the current healthcare system. That's a real original way to make people with a different opinion look silly.

Healthcare deserves attention. It does not require sweeping 'reform' be rushed through.

With the way the stimulus package has "fixed" the economy so far, I'm not sure I want the current group of legislators fixing anything else for a while.

You know what I want in healthcare? A price menu. Just like McDonalds. I want to understand what I'm paying and what my insurance is paying.

I had some unexplained chest pains that put me in the hospital for an overnight stay. I was bounced from room to room and given test after test, and some medication. At no point did anyone ever say "This next test will be $1,500, of which you will be responsible for $400."

Healthcare is the only business that exists where it's acceptable to not tell you until after the fact how much a service is. If you want to reform anything about healthcare, start there.

[GuyFawkes38]

Kahns, I'm sure kmcrawfo would disagree with me, but the AMA (and doctors outside of the organization) are the main force pushing against transparency.

The AMA also restricts the labor market in health care. It shouldn't take the education and experience level of a doctor with a 200 thousand dollar salary to prescribe a patient medicine for strep throat. It seems like a trained nurse could do that. In most European countries, people just go strait to the pharmacy for such medication. In the US, this responsibility falls on doctors who are overqualified to deal with such routine crap.

[Lloyd Braun]

It will be additionally worsened when the best doctors and subspecialists like myself who already have exceedingly high demand drop the government run plan due to slow payments, low payments, etc. This results in even less doctors and worse access. This may or may not happen, but is highly likely since it already has occurreed in the Medicaid, Tricare, and Medicare patient population. The government solution will be to increase physician extenders (Nurse practitioners, Physician Assistants, etc). Great, even less quality of care. Then more will be placed on family practice docs, etc... Once again who do you want treating your heart failure, melanoma, multiple sclerosis, etc. An primary doc or a cardiologist, dermatologist, and neurologist.

Two blurbs: 1) Increasing midlevel providers improves quality of care. They are not replacing physicians, that's why they are called extenders. This increases time the physician can spend on the most difficult cases. I suspect you do not utilize midlevel providers efficiently if you still hold the opinion that they decrease quality of care. 2) Primary care providers refer way too much. I know you may disagree since you are a specialist and you benefit from referrals, but there are a lot of specialists managing too much basic medicine. The medical community is trained in a super-specialized system, so as soon as a problem becomes difficult the patient is referred. A point can be reached where there are just too many cooks in the kitchen and a patient gets lost in the pile of paperwork or feels like meat through the grinder.

That said, I too am against the reform bill as it is.

[Snipe]

You know what I want in healthcare? A price menu. Just like McDonalds. I want to understand what I'm paying and what my insurance is paying.

I had some unexplained chest pains that put me in the hospital for an overnight stay. I was bounced from room to room and given test after test, and some medication. At no point did anyone ever say "This next test will be $1,500, of which you will be responsible for $400."

Healthcare is the only business that exists where it's acceptable to not tell you until after the fact how much a service is. If you want to reform anything about healthcare, start there.

Amen Kahns. Try even asking about price and most people in the hospital don't have the faintest idea.

Go to a hospital website and try to get an idea of how much it takes to have a baby or fix a broken arm. You can't find it. They don't publish prices, estimates or price ranges. That is different for fields in which insurance and government do not cover the cost, such as laser eye surgury.

Medical Competition Works for Patients (http://www.realclearpolitics.com/articles/2007/10/medical_competition_works_for.html)


Health-care costs overall have been rising faster than inflation, but not all medical costs are skyrocketing. In a few pockets of medicine, costs are down while quality is up.

Dr. Brian Bonanni has an unusual medical practice. His office is open Saturdays. He e-mails his patients and gives them his cell-phone number.

"I need to be available 24 hours a day," he says. "I want to be there when a patient has questions, and I want to be reachable."

I'll bet your doctor doesn't say that. Bonanni knows he has to please his patients, not some insurance company or the government, because he's paid by his patients. He's a laser eye surgeon. Insurance rarely covers what he does: reshaping eyes so people can see without glasses.

His patients shop around before coming to him. They ask a question that people relying on insurance don't ask: "How much will that cost?"

"I can't get away with not telling the patient how much exactly it's going to cost," Bonanni says. "No one would put up with it. And the difference of a hundred dollars sometimes makes their decision for them."

He has to compete for his patients' business. One result of that is lower prices. And while the procedure got cheaper, it also got better. Today's lasers are faster and more precise.

Prices have fallen and quality has risen in other medical fields where most people pay for care themselves, like cosmetic surgery. Consumer power works -- even in medicine.

Costs go down and customer service go up. Hospitals can have horrible customer service. When I was at the Cleveland Clinic with my dad you couldn't find anyone to answer a question. Doctors often make rounds at 5:00am in the morning to avoid questions. They don't have to answer you. You don't pay the bill.


A doctor in Tennessee I talked to publishes his low prices, such as $40 for an office visit.

Most doctors would say you can't make money this way. But Dr. Robert Berry told me you can. "Last year, I made about the average of what a primary-care physician makes in this country," he said.

Berry doesn't accept insurance. That saves him money because he doesn't have to hire a staff to process insurance claims, and he never has to fight with companies to get paid.

His mostly uninsured patients save money, too

$40 a visit. It is unheard of. I wonder what a visit costs when the government pays for it?

Not only should hospitals publish prices, they should also offer cash discounts. You should get a generous discount for letting them avoid the paperwork and processing costs, let alone the wait time for reimbursment. Instead hospitals charge more to the uninsured. People with insurance are the ones who get huge discounts off of the sticker price. That part of the system is messed up.

Clinics at Walmart and some pharma chains have been popping up. They offer a menu, and prices are posted. They don't post them on the web, prices are determined locally:


Clinics at Walmart (http://www.walmart.com/clinics)
Independent health clinics are now offering healthcare services to our customers in select Walmart stores nationwide. These clinics provide one-stop convenience for many basic healthcare needs at affordable prices.

Clinic Services
All clinics offer essential preventative and routine health services for a standard set of common health aliments and screening needs that can be performed without urgent or emergency care, including:

•Acne •Bladder infections •Blood sugar testing •Camp and school physicals •Cholesterol screening •Common vaccinations •Ear aches •Flu •Insect bites and stings •Minor wounds •Sinus infections •Upper respiratory infections •Wart removal

Clinics have been popping up around the nation to give consumers access to maintenance healthcare for $50 -$70 bucks. Walmart had some trouble with an original contractor but has remained committed to the process. Other pharma chains have had better success. When the prices are posted though and competition is around the prices tend to go down.

What the clinics do is take the low level stuff out for good value.

[Strange Brew]

Amen Kahns. Try even asking about price and most people in the hospital don't have the faintest idea.

Go to a hospital website and try to get an idea of how much it takes to have a baby or fix a broken arm. You can't find it. They don't publish prices, estimates or price ranges. That is different for fields in which insurance and government do not cover the cost, such as laser eye surgury.

Medical Competition Works for Patients (http://www.realclearpolitics.com/articles/2007/10/medical_competition_works_for.html)



Costs go down and customer service go up. Hospitals can have horrible customer service. When I was at the Cleveland Clinic with my dad you couldn't find anyone to answer a question. Doctors often make rounds at 5:00am in the morning to avoid questions. They don't have to answer you. You don't pay the bill.



$40 a visit. It is unheard of. I wonder what a visit costs when the government pays for it?

Not only should hospitals publish prices, they should also offer cash discounts. You should get a generous discount for letting them avoid the paperwork and processing costs, let alone the wait time for reimbursment. Instead hospitals charge more to the uninsured. People with insurance are the ones who get huge discounts off of the sticker price. That part of the system is messed up.

Clinics at Walmart and some pharma chains have been popping up. They offer a menu, and prices are posted. They don't post them on the web, prices are determined locally:



Clinics have been popping up around the nation to give consumers access to maintenance healthcare for $50 -$70 bucks. Walmart had some trouble with an original contractor but has remained committed to the process. Other pharma chains have had better success. When the prices are posted though and competition is around the prices tend to go down.

What the clinics do is take the low level stuff out for good value.

Snipe, Kahns, It sounds like you would like people to be able to determine demand (micro, thus the aggregrate of a multitude of these decisions effects macro) based off of knowledge of the market price. You know we can't have people making informed choices based on their own, individual cost/benefit analysis. :rolleyes:

[GuyFawkes38]

Ezra Klein, a left leaning health care expert for the Washington Post, writes on his blog (http://voices.washingtonpost.com/ezra-klein/2009/07/good_news_out_of_massachusetts.html):



Good News Out of Massachusetts

In 2006, Massachusetts passed a big health-care reform bill. The structure of it was actually pretty similar to what we're seeing nationally. A[nd, like what we're seeing nationally, it didn't have much in the way of cost controls. But nor did it promise to. The short-term priority, officials said, was getting coverage to everyone. The long-term priority was cost control. And the two would work together.

After all, without cost controls, subsidizing health-care coverage would become unaffordable, and Massachusetts would have to abandon the reforms it had worked so hard to pass. Without cost control, there could be no universal health-care system. That would focus the mind, they predicted. That would help them make the hard decisions.

This theory made some sense, but it was never clear if it would actually amount to anything. But now Massachusetts is trying to move away from fee-for-service medicine, and towards a payment system that doesn't push doctors to maximize their income by maximizing their treatments.

That's a huge reform. Much bigger than anything we're considering nationally. It's a direct attempt to change the behavior of politically powerful providers to preserve the coverage that the reforms gave to individuals. It will be difficult. The doctors' lobby is already giving angry quotes to the press. But the vote on the commission was unanimous. And the members of the commission felt it was necessary. After all, the only choices before them were going forward on reform and going backward. The status quo was no longer an option. That wasn't been true before reform. But it's true now.

If I was a doctor, I would start freaking out. The AMA should put all of their resources against the upcoming bill.

[kmcrawfo]

I'm not sure where that came from. It appears Mass it running from universal coverage as quick as it can. It just cut loose illegals....

http://liveshots.blogs.foxnews.com/2009/07/17/massachusetts-universal-health-care-cuts/

When was that vote taken?

[kmcrawfo]

Okay... I read the Massachutes article about the commission. This is nothing new. It sounds like they are making a move towards a Capitation system.

This means a doc is paid based on how patients are in his/her enrollement. Basically a $$ per head, so to speak.

It has been tried, mainly in California, and is a complete disaster.

There is no incentive to see patients, because doctor X gets the same money whether he see 20 patients/day or 75 patients/day. There is no fee for service.

So, do you really think a doc is going to bust his tail to see another 10 patients at the end of the day?

In this case its not the docs who should run for cover, it is the patients because you will have a much, much more difficult time getting to see a doc who has no incentive to see you.

Docs try to hoard patient #'s to get the capitation $$$, but then see them as little as possible because there is no incentive to do so.

Geez, you'd think people would quit implenting systems which have already been tired and proven to be worse than the status-quo:

1. Universal care fails in Massachutes, so let try it for the whole country
2. Hey, capitaion was horrible in California, why not give it shot in Massachutes

etc, etc, etc...

[Snipe]

GuyFawkes, I would tend to agree with you and so does Uncle Milty.


Is there a racket in the house? (http://www.pittsburghlive.com:8000/x/pittsburghtrib/opinion/columnists/steigerwald/s_458393.html)

Licensure, Friedman said, is the key to the medical profession's economic power. It also enabled the AMA to accomplish some very union-like things -- set qualifications unnecessarily high, prevent technological innovation, thwart new methods of delivering health care and keep nurses, immigrant doctors and midwives from performing duties that did not require "Cadillac" medical training.

As Friedman explained 44 years ago, and as Forbes magazine likes to reiterate now and then, the AMA essentially runs the doctor sector. It controls and approves medical schools, sits on state licensing boards and does whatever it can to use government to squelch competition and make sure there are never too many doctors.

Unfortunately for consumers of health care, the AMA has been doing its job too well. According to a June 4 Los Angeles Times story, until a year or two ago the AMA -- despite population growth, higher demand for medical services and one-third of 750,000 doctors being 55 or older -- had thought there was a doctors glut and kept the number of medical school grads flat for 25 years. Now there's talk of boosting enrollment 30 percent.

Friedman's position was radical -- then and now. He argued for an end to state licensure for M.D.s and dismissed as hypocrisy the doctor sector's claim that the economic self-protection racket it has built was for the good of patients and not their own wallets.


Medical Licensure by Milton Friedman (http://www.fff.org/freedom/0194e.asp)


The medical profession is one in which practice of the profession has for a long time been restricted to people with licenses. Offhand, the question, "Ought we to let incompetent physicians practice?" seems to admit of only a negative answer. But I want to urge that second thought may give pause.

In the first place, licensure is the key to the control that the medical profession can exercise over the number of physicians. To understand why this is so requires some discussion of the structure of the medical profession. The American Medical Association is perhaps the strongest trade union in the United States. The essence of the power of a trade union is its power to restrict the number who may engage in a particular occupation. This restriction may be exercised indirectly by being able to enforce a wage rate higher than would otherwise prevail. If such a wage rate can be enforced, it will reduce the number of people who can get jobs and thus indirectly the number of people pursuing the occupation. This technique of restriction has disadvantages. There is always a dissatisfied fringe of people who are trying to get into the occupation. A trade union is much better off it can limit directly the number of people who enter the occupation-who ever try to get jobs in it. The disgruntled and dissatisfied are excluded at the outset, and the union does not have to worry about them.

The American Medical Association is in this position. It is a trade union that can limit the number of people who can enter. How can it do this? The essential control is at the stage of admission to medical school. The Council on Medical Education and Hospitals of the American Medical Association approves medical schools. In order for a medical school to get and stay on its list of approved schools it has to meet the standards of the Council. The power of the Council has been demonstrated at various times when there has been pressure to reduce numbers. For example, in the 1930's during the depression, the Council on Medical Education and Hospitals wrote a letter to the various medical schools saying the medical schools were admitting more students than could be given the proper kind of training. In the next year or two, every school reduced the number it was admitting, giving very strong presumptive evidence that the recommendation had some effect. . . .

Let us see if Uncle Milty was right.

This article was from 2005:


Medical miscalculation creates doctor shortage (http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm)

The shortage will worsen as 79 million baby boomers reach retirement age and demand more medical care unless the nation starts producing more doctors, according to several new studies.

The country needs to train 3,000 to 10,000 more physicians a year — up from the current 25,000 — to meet the growing medical needs of an aging, wealthy nation, the studies say. Because it takes 10 years to train a doctor, the nation will have a shortage of 85,000 to 200,000 doctors in 2020 unless action is taken soon.

The predictions of a doctor shortage represent an abrupt about-face for the medical profession. For the past quarter-century, the American Medical Association and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians. In 1994, the Journal of the American Medical Association predicted a surplus of 165,000 doctors by 2000. [THAT IS THEIR LABOR UNION TALKING!]

"It didn't happen," says Harvard University medical professor David Blumenthal, author of a New England Journal of Medicinearticle on the doctor supply. "Physicians aren't driving taxis. In fact, we're all gainfully employed, earning good incomes, and new physicians are getting two, three or four job offers."

The nation now has about 800,000 active physicians, up from 500,000 20 years ago. They've been kept busy by a growing population and new procedures ranging from heart stents to liposuction.

But unless more medical students begin training soon, the supply of physicians will begin to shrink in about 10 years when doctors from the baby boom generation retire in large numbers.

And now that Obamacare is upon us, we don't have the Doctors to do it.

From the Washington Examiner:


Obamacare won't survive coming doctor shortage (http://www.washingtonexaminer.com/opinion/Obamacare-won_t-survive-coming-doctor-shortage-7886872-49202437.html)

President Obama's ambitious plan for radically increasing the government's role in the nation's health care system misses one critical detail: There aren't enough primary care physicians in America now and their numbers are declining. That means government won't be able to deliver the expanded health care Obama is promising to millions of uninsured people.

From the New York Times:


Shortage of Doctors an Obstacle to Obama Goals (http://www.nytimes.com/2009/04/27/health/policy/27care.html)

WASHINGTON — Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

...

Even people with insurance have problems finding doctors.

From the Washington Post:


Primary-Care Doctor Shortage May Undermine Reform Efforts
No Quick Fix as Demand Already Exceeds Supply (http://www.washingtonpost.com/wp-dyn/content/article/2009/06/19/AR2009061903583.html)

As the debate on overhauling the nation's health-care system exploded into partisan squabbling this week, virtually everyone still agreed on one point: There are not enough primary-care doctors to meet current needs, and providing health insurance to 46 million more people would threaten to overwhelm the system.

...

The overall shortage of doctors may grow to 124,400 by 2025, according to a study by the Association of American Medical Colleges. And, the report warns, "if the nation moves rapidly towards universal health coverage" -- which would be likely to increase demand for primary care and reduce immediate access to specialists -- the shortages "may be even more severe."

...

"You're talking about an eight-to-12-year period to fix the problem," said Robert L. Phillips Jr., director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, part of the American Academy of Family Physicians.

Evidence that demand already exceeds the supply of primary-care doctors ripples through the system as patients increasingly have trouble finding a new doctor, then wait weeks or months for an appointment, spend more time in the waiting room than in the examining room, encounter physicians who refuse to take any form of insurance, and discover emergency rooms packed with sick people who cannot find a doctor anywhere else.

...

Washington has also been training a microscope on the groundbreaking effort in Massachusetts to provide everyone in the state with health insurance: Adding 340,000 people to the rolls of the insured there since 2006 has underscored a shortage of doctors. It takes 63 days on average to get an appointment with a family doctor in Boston, more than twice the wait in Washington, and seven times as long as in Philadelphia and Atlanta, according to a Merritt Hawkins survey.

"If Massachusetts is any guide, with increased access you'd see pent-up demand for health care, and you'd see a lot of frustration with the waiting time to access health care," Phillips said. "It'll swamp the emergency rooms, and those people will be seeking health care in the most expensive settings."

[Snipe]

DC Muskie portrays me as cold hearted and cost centered. I am cost centered in a sense, but that isn't the only bit. I countered to him that a major concern for me is quality of care for my family.

Look at numbers on the doctor shortages. If you are middle class and the government suddenly insures 50 million more people two things will happen:

1) You will pay more for sure, because health care doesn't pay for itself. But more importantly,

2) You won't be able to get the same level of care you got before. I would like to see a constructive argument against that instead of tit for tat. How can the middle class retain the same quality of care with a shortage of doctors? It can't happen if you add 50 million people into the system that already has a shortage. The only solution is rationing while waiting in line, and those were lines I paid not to wait in before. Now I will be paying more to wait in line.

More cost and less coverage. I am not making this up to drive home some political point. I can't see it any other way. Who in the hell wants more cost and less coverage? If I was single and an idealist, maybe I would take one for the team. I got a wife and two little boys, and I would sacrifice cost before coverage. I want my boys healthy. I could take more cost before I gave my children less coverage. Any plan that gives my children less coverage is a loser, and this plan is a bonafied loser.

[DC Muskie]

Right. Everyone opposed to this bill is opposed to any changes in the current healthcare system. That's a real original way to make people with a different opinion look silly.

I never said that. But look at the poll, majority of people don't want changes. I am now one of them. If I look silly, it's only because I have joined the masses.


Healthcare deserves attention. It does not require sweeping 'reform' be rushed through.


Someone has to explain how long it exactly takes to change something, that doesn't need changing according to the poll. Is something rushed because it happens in a week, should it take a year, five years? Four months?

It's not like they put this bill out there and then the next day voted for it. I'm not sure why people think this is being rushed. If people have problems with this bill, they will have time to debate and vote it down.

[DC Muskie]

Snipe-

I'm not painting you as cold and cost centered. I understand your position completely. It's very simple, just like you have laid out.

You care about the quality of care for your family. You think adding 50 million who have no care, let alone some sort of quality, should not flood the system because that will cost you quality.

I hope one day we will have a society made up completely of small business owners. Everyone should work hard to own their own company and get the quality of health care that Snipe has for his family.

Until then, I agree with him. The quality of my health care should not suffer, simply because other people don't have it. It seems pretty simple to me.

[DC Muskie]

With the way the stimulus package has "fixed" the economy so far, I'm not sure I want the current group of legislators fixing anything else for a while.

Or ever. I mean these guys and gals can not get anything right. If there was a system in place where we can replace these nitwits and put people in their place to make sure things that need "fixing" get fixed. That would be great.

I'm not sure the stimulus package has "fixed" anything. I'm not sure how you can "fix" such a big problem in a manner of months, especially when people complain that things seem to be rushed through Congress. We have a bunch of people here in Washington, who rush to pass something, only not to see results.

I know my organization is helping a small portion of the stimulus. I have applied to the state of Maryland to assist paying me to do outreach to people to sign up for the SNAP program. More people who use SNAP will use my program, and drive my numbers up. In the last year, people using SNAP to pay for their food has increased from 2% of my revenue to 4%.

[Kahns Krazy]

Not only has the stimulus not fixed anything, it has created a very large invoice that needs to be paid on down the line.

I'm sure the healthcare system can be improved. I'm not willing to let the current group try to fix it. I saw Obama on the Today show this morning saying that "Nobody" is satisfied with the current system. Either he is lying, or the poll referenced previously is lying. I'm concerned that the President has an agenda that does not concern itself with reality.

[XUglow]

I just want it to be fair. I don't know of anyone that wants to deny healthcare to people that need it. On the other hand, there are a lot of people that don't have healthcare because they just don't want to spend the money. Those people are getting healthcare and paying as they go. It is a calcualted risk.

What I don't want to see is the responsible people in the US paying for health insurance for the irresponsible crew that has just been putting it off for one reason or the other.

The Dane keeps me posted on free health care issues in Denmark. In a nutshell, it is a good system, but it has issues. The system was initially iinundated with people that went to the doctor with silly stuff because it was free, so they started requiring a fee due when you were treated. The fee kept people with legit problems from seeing the doctor, so they dropped the fee, but the malingerers returned, so they returned to the fee system and returned it to you if you were legitimately sick. They also had issues with people from poor countries flooding to Denmark to get free health care, so they had to change the eligibility rules to limit your access to free care for the first few years that you moved to the country.

[kmcrawfo]

Young German doctors leaving the country
AP ^ | 06/23/06 | KIRSTEN GRIESHABER

Posted on Saturday, June 24, 2006 7:18:20 AM by TigerLikesRooster

Young German doctors leaving the country

By KIRSTEN GRIESHABER, Associated Press Writer

Fri Jun 23, 11:57 AM ET

Anesthesiologist Christian Favoccia had no trouble deciding to ditch his job at the university hospital in Duesseldorf for a new one at a clinic in Amsterdam.

By leaving home, the 36-year-old specialist will make almost three times as much money, work shorter hours and have better chances at promotion.

"At this point I honestly can't tell you if I will ever come back to Germany," Favoccia said. "I am skeptical that they'll be able to offer me the same kind of incentives any time soon."

Germany's well-trained but frustrated young doctors are leaving the country for higher pay in ever greater numbers, leaving some hospitals struggling to fill positions.

More than 12,500 German doctors are working abroad already, and 2,300 left the country in 2005 alone, according to the doctors' association, the Marburger Bund. The Netherlands, Britain, United States, Australia, Switzerland and the Scandinavian countries are among the top destinations.

"There are more than 5,000 jobs available at hospitals due to the number of people who have left," Michael Helmkamp, a spokesman for the Marburger Bund, said Tuesday. "Clinics all over Germany are facing shortages and many hospitals cannot provide their former standard of health care anymore."

Favoccia, who got his medical degree from the University of Bochum before moving on to the University Hospital Duesseldorf 5 1/2 years ago, is already taking Dutch classes together with a colleague who is also planning to move to Amsterdam. He said he did not mind starting a new life in the Netherlands even though he would miss his friends at home.

"My father came to Germany as an immigrant from Italy in the 1960s and built up a new life here, I guess I can do the same in Holland," said Favoccia, who is single.

A spokeswoman for the federal Health Ministry said Thursday that only some regions of Germany are struggling with a shortage of doctors while cities like Berlin are in fact facing a surplus.

"These general assumptions by the Marburger Bund are not always true," said spokeswoman Ina Klaus. "And besides that the government is contributing millions of euros for clinics to improve the working conditions of doctors."

At the University Hospital in Duesseldorf, dozens of doctors have left for better jobs abroad, said Favoccia. The situation is particularly dramatic at the anesthesia department where 17 out of 80 doctors have quit their jobs within the last year.

Low salaries are one of the main reasons. Favoccia is making $2,900 a month after taxes in Duesseldorf, but at the University Hospital in Amsterdam he will earn $8,150 after deductions — and work fewer hours.

Young clinic doctors never made a lot of money in Germany but knew that later in their career their tough beginnings at the hospital would pay off, said Favoccia. That was before changes to the government health insurance program aimed at limiting health costs — and restricting what doctors can charge.

There are very few private clinics in Germany, so most young doctors start their careers at university hospitals, state-run or municipal clinics.

"Today, it is not worth it anymore to struggle for years because after all the changes in the German health system you will never become rich, not even as a senior doctor or if you own a private practice," he said.

But it is not just about the money. Many express frustration with working conditions and career prospects.

"The hospital is not providing me with good training and the autocratic behavior of the chief physicians in Germany is completely outrageous and outdated," said Nelson Amaral, 28, another anesthesiologist in Duesseldorf. He starts a new job at the Derriford Hospital in Plymouth, England, in August.

Amaral said that his reasons for leaving were not only about better educational opportunities in England and the higher salary — he is making $2,500 net now and will earn about $3,700 in Plymouth — but also because he is fed up with what he described as the strong hierarchies among clinic staff.

"If you're not one of the bosses' favorites, they can keep you down forever and make sure that's you're not being promoted at all — it's just so arbitrary," he said.

Discontent among doctors has been building up for some time. For the last three months, some 12,000 clinic doctors staged strikes against their work conditions, forcing state-run and university clinics to provide only emergency care. An agreement was reached last week, providing clinic doctors with a pay raise of up to 20 percent based on their seniority and position, three additional days for continuing education training and a reversal of cuts to their year-end bonus.

The health crisis is far from over though — as state-run and university clinics were getting back to regular work hours, doctors at more than 700 city-run hospitals across Germany were threatening to also strike for higher salaries Wednesday.

One doctor who has left says it may be a long time before she returns.

"I thought I'd only stay for a year but now I am so happy with my job that I am not even thinking of moving back anytime soon — at least not as long as the situation in Germany is so disastrous," said Nina Lennhof, 30, a psychiatrist who quit her job in Berlin three years ago for a position at St. Thomas' Hospital in London.

"And they really like German doctors here — we're used to working hard and not expecting much in return."



Another country where the socialized / universal health care has failed is Germany. It actually has worsened since this article was written. In general, doctors are highly educated, motivated individuals. Don't believe docs won't leave for greener pasteurs (Bermuda, Australia, the growing private sector in Canada, and other countries) if the government takes things far enough....

[xu2006]

Interesting - prepare to say goodbye to private insurance options.

http://www.ibdeditorials.com/IBDArticles.aspx?id=332548165656854

[XUglow]

Interesting - prepare to say goodbye to private insurance options.

http://www.ibdeditorials.com/IBDArticles.aspx?id=332548165656854

Wow. This is perplexing legislation at best. I would love to hear this provision explained so that I can understand the reasoning behind it.

[DC Muskie]

After what Kevin posted I'm not sure how anyone could defend having any socialized medicine.

We need to defeat this bill or doctors will leave.

[kmcrawfo]

Wow. This is perplexing legislation at best. I would love to hear this provision explained so that I can understand the reasoning behind it.

This is what I was talking about a few days ago on page 4 of this thread. I've actually read this bill and have been pointing out some of these things that the media has either neglected or are just starting to report. It is a bad, bad bill with so many things in it that will negatively impact a huge percentage of the population. There is a reason the president and majority leaders are trying to push this through quickly. With scrutinization and analysis this bills warts will show to the public soon enough.

Anyways, I'll cut and paste what I wrote earlier about the grandfather clause on page 16 of the bill here:
__________________________________________________ __
This bill is not a strong public option, it is the first step in the goal of elimnation of private insurance.

If you read the bill it is clearly built to destory and eliminate private insurance and make the government the only option for healthcare.

The media will not go over these subtle, insidious aspects of the plan.

Here are a few kickers in the bill. Once this is passed and goes into effect these things take place:

1. Everyone is required to have health insurance, even if you don't want it. If you choose not to partake in the government plan, you must pay at least a 2.5% tax/surcharge in order to opt out.

2. All employers will no longer be able to offer private insurance plans to new employees, or if an employee want to change coverage he/she must switch to the government plan. You must offer the government plan if you have a payroll of over $100,000. Otherwise you can not offer health insurance. Should you choose to not offer insurance you must pay a tax/surcharge from your business payroll of 8%. (This is the kicker.... All employers will be required to use government healthcare plans. Who do you think provides the most insurance in this country.)

Despite what Obama and other supporters of this bill tell you, it is clearly meant to make it much more expensive (maybe impossible) for private insurance to exist. Sure, you can keep your current plan if you can afford it and the private insurance company can afford to stay open.

Should an employer elect to provide the government option, it appears the employer must cover 70% of the cost.

So, an employer must offer the government plan.... Private insurance will no longer be an option.

__________________

[murray87]

Some interesting info from The Heritage Foundation that touches on the Investors Business Daily info:

With the public’s trust in his handling of health care tanking (50%-44% of Americans disapprove), the White House has launched a new phase of its strategy designed to pass Obamacare: all Obama, all the time. As part of that effort, Obama hosted a conference call with leftist bloggers urging them to pressure Congress to pass his health plan as soon as possible.

During the call, a blogger from Maine said he kept running into an Investors Business Daily article that claimed Section 102 of the House health legislation would outlaw private insurance. He asked: “Is this true? Will people be able to keep their insurance and will insurers be able to write new policies even though H.R. 3200 is passed?” President Obama replied: “You know, I have to say that I am not familiar with the provision you are talking about.” (quote begins at 17:10)

This is a truly disturbing admission by the President, especially considering that later in the call, Obama promises yet again: “If you have health insurance, and you like it, and you have a doctor that you like, then you can keep it. Period.” How can Obama keep making this promise if he is not familiar with the health legislation that is being written in Congress? Details matter.

We are familiar with the passage IBD sites, and as we wrote last week, the House bill does not outright outlaw private individual health insurance, but it does effectively regulate it out of existence. The House bill does allow private insurance to be sold, but only “Exchange-participating health benefits plans.” In order to qualify as an "Exchange-participating health benefits plan," all health insurance plans must conform to a slew of new regulations, including community rating and guaranteed issue. These will all send the cost of private individual health insurance skyrocketing. Furthermore, all these new regulations would not apply just to individual insurance plans, but to all insurance plans. So the House bill will also drive up the cost of your existing employer coverage as well. Until, of course, it becomes so expensive that your company makes the perfectly economical decision to dump you into the government plan.

President Obama may not care to study how many people will lose their current health insurance if his plan becomes law, but like most Americans, we do. That is why we partnered with the Lewin Group to study how many Americans would be forced into the government “option” under the House health plan. Here is what we found:

Approximately 103 million people would be covered under the new public plan and, as a consequence, about 83.4 million people would lose their private insurance. This would represent a 48.4 percent reduction in the number of people with private coverage.
About 88.1 million workers would see their current private, employer-sponsored health plan go away and would be shifted to the public plan.
Yearly premiums for the typical American with private coverage could go up by as much as $460 per privately-insured person, as a result of increased cost-shifting stemming from a public plan modeled on Medicare.

It is truly frightening that the President of the United States is pressuring Congress in an all-out media blitz to pass legislation that he flatly admits he has not read and is not familiar with. President Obama owes it to the American people to stop making promises about what his health plan will or will not do until he has read it, and can properly defend it in public, to his own supporters.

[kmcrawfo]

After what Kevin posted I'm not sure how anyone could defend having any socialized medicine.

We need to defeat this bill or doctors will leave.

The point is universal healthcare has never worked... Anywhere.

Every country that has implemented leads to substandard care, unsustainable cost, and once the eventual dramatic cutback on reimbursments becomes too excessive an eventual exodus of the physicians themselves may even occur.

This has happened in Candada, Germany, the UK, and other countries. It also has happened in Massachutes, California, and Tennessee.


Why are some people so eager to implement a system that will inevitably fail, be more expensive, and be worse than what we have now?

[DC Muskie]

Why are some people so eager to implement a system that will inevitably fail, be more expensive, and be worse than what we have now?

I have no idea.

[blobfan]

Why are some people so eager to implement a system that will inevitably fail, be more expensive, and be worse than what we have now?

Because the media runs sad stories about people going bankrupt because of the cost of cancer treatment or because some kid didn't get approval from his parents insurer for the 500K of medicine he needs each year to control his rare form of hemophilia. So rather than focus on reforming the current medical system, a few outlyers are going to make us ditch the whole thing in favor of a new system, proven not to work but which sounds all ooey-gooey-love-thy-neighbor-and-make-sure-we-are-all-given-everything-we-think-we-need.

[Kahns Krazy]

Why are some people so eager to implement a system that will inevitably fail, be more expensive, and be worse than what we have now?

Did you ever work in an office where a new hire comes in convinced that everything you do is done wrong without understanding why you do it in the first place?


http://upload.wikimedia.org/wikipedia/commons/9/9d/Barack_Obama.jpg

The delivery, pricing, safety, regulation and legislation of healthcare is ungodly complex, but it all got that way for a good reason at one point in time.

Obama wants to make a name for himself by "fixing" it. I am quite certain that he has no idea whats wrong with it, and incredibly certain that he doesn't understand why it got that way.

[nickgyp]

Kahn:

Yes, I did several years ago. And it was a municipal government department. Ran off the good and experienced people and killed morale so thoroughly that I have instructed my kids never to work for the government. Sad because the our citizenry needs good people rather than inept people in government but maybe that is all part of the grand scheme of liberals just to make it so people don't give a crap.

[DC Muskie]

I'm so glad I'm on the right side now.

Jeez, who do these liberals think they are? I'm absolutely laughing at the idea they can tie their shoes correctly, let alone fix a problem that should be as easy as ordering a number two value meal.

I would never work for the government. I would just get and lazy and spend my time on a college messageboard in July no less, posting about how much small business owners don't know squat.

[Snipe]

I do give credit to Obama. He has gone where no man has gone before. He has a point to it all as well. I think it is brave, and perhaps the most courageous thing he has done. He knows we have to kill old people, and he is bold enough to spell it out.

New York Times Link (http://www.nytimes.com/2009/05/03/magazine/03Obama-t.html?_r=3&pagewanted=5&hp)


THE PRESIDENT: Now, I actually think that the tougher issue around medical care — it’s a related one — is what you do around things like end-of-life care —

Yes, where it’s $20,000 for an extra week of life.

THE PRESIDENT: Exactly. And I just recently went through this. I mean, I’ve told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.

So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.

And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart.

I don’t know how much that hip replacement cost. [Why didn't you? You are the Pres. If you don't know, we don't know.]

I would have paid out of pocket for that hip replacement just because she’s my grandmother. [You didn't, and you didn't even ask what that hip replacement cost. You had no idea as you have admitted. You were not about to pay, you never even researched the cost]

Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

And it’s going to be hard for people who don’t have the option of paying for it.

THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

So how do you — how do we deal with it?

THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

-----------------
Like I said I give credit to Obama for being honest. He really is out front on this issue.

This is one point that I agree with him. For the sake of the budget and our future we need to deny medical care to our senior citizens. No way around it.


I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

If that is true, we could give a lot of health care to the poor and uninsured who don't pay their way by denying people care that paid their taxes. I think we should do this. In the end it is about what is right. Those people have a human right to health care, even though they haven't paid anything. The older taxpayers may have paid taxes, but they are expendable.

What I am not sure on is why we need drastic health care reform right now. Couldn't we accomplish everything we need at this point just by denying older people care and letting the die? Isn't that the crux of it anyway? Why not reformat the system to just not give older people care? All of our cost savings are based on not giving them care. Adding 50 million people into the system doesn't introduce cost savings. We only win when they lose.

Maybe we could make fertilizer out of them or something so we could see some cost benefits. We can't afford all of these oldies hanging round.

In all seriousness Obama is right. I don't think it is 80% of the cost, but a large portion of your health care costs come in the last six months of your life. We have to reduce those costs.

The economic concept of opportunity cost tells us that a dollar spent here cannot be spent somewhere else. I am a big fan or opportunity cost, and that is why I hated the stimulus package to nowhere. We could have done a lot more. You can argue that the massive dollars spent in the last months of life could be better spent.

I think they could be better spent. Obama does too. I agree with him on that. He is bold for taking on such a losing argument.

[chico]

I

Maybe we could make fertilizer out of them or something so we could see some cost benefits. We can't afford all of these oldies hanging round.



Soylent Green!


This is the thread that refuses to go away.

[Kahns Krazy]

This is a silly statement

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

No shit. Did you know that people that over 80% of people that don't take any medications spend nothing on prescriptions?! Amazing.

Women account for over 80% of birth related expenses!



This statement is not true:


For the sake of the budget and our future we need to deny medical care to our senior citizens

Managing chronic illness and end-of-life issues through medication therapy is the cheapest way to provide healthcare. Bush was actually on the right track on that one.

For the sake of our budget, we need to provide a level of health care to our senior citizens that focuses on quality of life and affordable medication management.

[bobbiemcgee]

Originally Posted by Snipe
I

Maybe we could make fertilizer out of them or something so we could see some cost benefits. We can't afford all of these oldies hanging round.


Thx. Maybe I can come back as Miracle Gro for your Marijuana plants.

[Snipe]

Managing chronic illness and end-of-life issues through medication therapy is the cheapest way to provide healthcare. Bush was actually on the right track on that one.

For the sake of our budget, we need to provide a level of health care to our senior citizens that focuses on quality of life and affordable medication management.

What was Bush right on? The Medicare Perscription Plan? Is that Part D? Is that projected to save us money in the long run?

I don't know the industry like you do. I am ignorant of many of the particulars. This is what I do know, which are budget projections from the General Accounting Office:

http://www.gao.gov/special.pubs/longterm/aug2007challenge.jpg

How do we go about changing that graph and keeping costs under control?

[Kahns Krazy]

Frankly, I have zero concern about what the GAO says will happen in 2080. I would love to see what the GAO would have predicted for us today in 1940. Even without "reform", increases in medical costs will reach a point at which they are no longer sustainable, and will self correct. If you were to continue out that line that the GAO has there, those three categories will exceed 100% of the GDP somewhere around 2250. Can't happen any more than real estate values can continue to outpace inflation. It just doesn't work

In fairness, I didn't say Bush was right, I said he was on the right track. Part D is projected to lower overall healthcare costs by increasing the availability of disease management medication, and theoretically decreasing the cost of the medication. I don't think the second part of that is working so well.

The cost of a lifetime of generic Zocor is about 10% of the cost treating one cardiac event in the emergency room.

[GuyFawkes38]

Frankly, I have zero concern about what the GAO says will happen in 2080. I would love to see what the GAO would have predicted for us today in 1940. Even without "reform", increases in medical costs will reach a point at which they are no longer sustainable, and will self correct. If you were to continue out that line that the GAO has there, those three categories will exceed 100% of the GDP somewhere around 2250. Can't happen any more than real estate values can continue to outpace inflation. It just doesn't work


Obama, of all people, is genuinely concerned about the growth of medicare.

Your argument is basically, "screw Freidman, there is such thing as a free lunch".

how exactly will prices "self correct". The only hope for "self correction" is a rate of growth in the economy much higher than the past would indicate.


I'm not sure if Kahns is a baby boomer, but his post above reflects everything wrong with the generation.

[Kahns Krazy]

You couldn't have misunderstood my post any more.

I don't believe that the GAO has any clue what will happen in 2080, so I do not concern myself with their projections. They can not possibly predict changes in technology or changes in legislature.

Medical costs will self correct because at some point, people will lose interest in paying the higher cost. Quantity demanded will be lower than quantity supplied at that price point, even if there there is confusion in the equation because of insurance, subsidy, etc. See also: Real Estate, Oil.

I'm not suggesting we sit around and wait for that to happen, I'm merely saying that projections like the chart above are largely pointless.

I'm not sure what this means:


Obama, of all people, is genuinely concerned about the growth of medicare.


Is he concerned that it's not growing fast enough?

[GuyFawkes38]

maybe I was too shrill with my post.

I do think Medicare offers little incentive for it's users to cut back care due to cost increases (unless we moved towards means testing).

I hope your right. I hope technological advances in health care push expenses down. But most health care costs stem from labor. For costs to decrease, there has to be changes in the health care labor market. Doctors have to take pay cuts or allow nurses to conduct more care.

[Snipe]

KK,

The longer the period upon which you make projections the less likely your projections are going to be realistic and accurate. I will agree with you on 2080. But what about 2030? Or 2020? I think that projections for the next ten years are probably pretty close to reality given the current system. And I think they project Medicare to be insolvent by 2017.

Now Medicare could go insolvent by 2016 or it may last until 2020, but I think the general gist of the projection is correct. It will be insolvent. Costs are rising and we have a problem with costs. The insolvency of Medicare means that the costs will exceed what we anticipated and planned for them to be. This means we will have to divert dollars currently spent on other services and use those dollars for medicare. Maybe we cut education, social services, infrastucture or defense. Maybe we cut them all and raise taxes to boot. I don't see that problem going away. Tough choices are ahead. The base point that Obama has made is that this is a problem that we have to address. I think he is correct at the base.

You seem to have faith in the price mechanism and the role it will play in keeping costs down. Medicare is a heath service consumed by by the individual, the cost of which is then spread over hundreds of millions of people. My Dad's cancer surgery and kemo cost hundreds of thousands of dollars. Somebody else was footing that bill. We didn't worry about it. It never entered into the conversation.

If we all had to pay, we would make different decisions. If I work my whole life and save $200,000, and at age 72 I need a $200,000 operation, maybe I say no. Maybe I say I want to buy a house or fund the college education for my grandchildren. If you offered people $100,000 to forgoe a $200,000 surgery, some people would snap it right up.

http://img101.imageshack.us/img101/5083/screenhunter7kw4.jpg

Take it away Uncle Milty (http://www.clubforgrowth.org/2006/11/milton_friedman_rip.php):


"There are four ways in which you can spend money. You can spend your own money on yourself. When you do that, why then you really watch out what you’re doing, and you try to get the most for your money. Then you can spend your own money on somebody else. For example, I buy a birthday present for someone. Well, then I’m not so careful about the content of the present, but I’m very careful about the cost. Then, I can spend somebody else’s money on myself. And if I spend somebody else’s money on myself, then I’m sure going to have a good lunch! Finally, I can spend somebody else’s money on somebody else. And if I spend somebody else’s money on somebody else, I’m not concerned about how much it is, and I’m not concerned about what I get. And that’s government. And that’s close to 40% of our national income."

In the situation of my father and his medical care, we were spending other people's money on his health care. When you spend other people's money on yourself, the concern is value. It was the government's money, so we spared no expense.

Short Bonus Video:

Milton Friedman - Other People's Money (http://www.youtube.com/watch?v=k2Kg2SvsI8Q)

[Kahns Krazy]

Chemo. It's chemo.

Also, it didn't truly "cost" hundreds of thousands of dollars to treat your dad. There may have been some bullshit invoice created somewhere that had that number, but that has very little to do with what the actual cost of treatment is.

We're back to my desire to see a menu with prices on it. Start there, and the rest of it will get a lot clearer.

[Snipe]

I don't doubt that the invoices they send out don't reflect the actual cost, but they have to print them out for some reason. I do agree we need a price menu. It is just about impossible to find out what things really cost.

He did spend a good amount of time in the hospital. He had surgery. He went through Chemo. When he came home he had medical equipment to feed him through a tube that bypassed his mouth and throat and went straight into his belly. He had nurses that would check in while at home. He saw tons of specialists. They were constantly running blood tests. He had physical therapy. It wasn't just Chemo I was talking about, I was talking about a whole experience. I think my sister saw a big bill for everything, but I never saw anything. I would imagine it would cost a good deal.

I don't know how much all of that really costs. I am right there with you on a price menu. Even searching the web you really can't find out what people charge for stuff. That does lead to a dangerous environment in terms of cost control.

[XU 87]

I hope your right. I hope technological advances in health care push expenses down.

If anything, technology pushes costs up. For example, my mom was diagnosed with a herniated disc in 1959. She got an x-ray and was told to lay in bed for a week or two. I bet her medical expnses were less than $100.

Today, you get a ct-scan, mri, muscle relaxants and other meds, physical therapy, and potentially surgery. There's just a lot more ways to treat a bad back, and virtually every other disease, than a generation ago.

Bad heart in 1970? Not much you can do other than lose weight and don't walk up stairs. (That was the actual medical advise given to a relative in the 1960's).

Bad heart in 2009? Open heart surgery, a surgery which one surgeon basically described as being "routine' for him.

[picknroll]

The point is universal healthcare has never worked... Anywhere.

Every country that has implemented leads to substandard care, unsustainable cost, and once the eventual dramatic cutback on reimbursments becomes too excessive an eventual exodus of the physicians themselves may even occur.

This has happened in Candada, Germany, the UK, and other countries. It also has happened in Massachutes, California, and Tennessee.

Why are some people so eager to implement a system that will inevitably fail, be more expensive, and be worse than what we have now?

Because that part of the American public is generally apathetic, ill-informed, irresponsible, and still looking for an entitlement i.e., something they mistakenly think is going to be free.

[kmcrawfo]

Chemo. It's chemo.

Also, it didn't truly "cost" hundreds of thousands of dollars to treat your dad. There may have been some bullshit invoice created somewhere that had that number, but that has very little to do with what the actual cost of treatment is.

We're back to my desire to see a menu with prices on it. Start there, and the rest of it will get a lot clearer.

This is a common misconception people have when they receive EOBs from insurance/medical offices. The EOB show the doctor's fee scedule, which is usually 3-4x the actual charge/reimbursement. This is due to the insurance system and regs that medicare and the feds have in place. You have one fee schedule and can't lower it for cash/non-insured people without special documentation or you commit insurance fraud. This results in higher costs to non-insured.

I won't bore people with the details, but it is the reason why you get an EOB that shows the doctor got paid $3000 for a surgery, but the charge/cost was $10,000. In reality, the surgery only was $3000, but patients get so confused and accuse the doctor of "trying to rip off the insurance, etc..." People just don't know how the system works.

I don't know if that helps explain things or makes it more confusing...

Bottom line if you remove these regs doctors could accept Tricare/Medicare/etc.. and charge cash/uninsured patients a lower rate and not get in trouble. As of now the government somewhat restricts this.

[Snipe]

Did you ever work in an office where a new hire comes in convinced that everything you do is done wrong without understanding why you do it in the first place?


http://upload.wikimedia.org/wikipedia/commons/9/9d/Barack_Obama.jpg

The delivery, pricing, safety, regulation and legislation of healthcare is ungodly complex, but it all got that way for a good reason at one point in time.

Obama wants to make a name for himself by "fixing" it. I am quite certain that he has no idea whats wrong with it, and incredibly certain that he doesn't understand why it got that way.

This post made me laugh.

An article from John Stossel made me revist this post.


Arrogance (http://www.realclearpolitics.com/printpage/?url=http://www.realclearpolitics.com/articles/2009/07/22/arrogance_97561.html)
By John Stossel

It's crazy for a group of mere mortals to try to design 15 percent of the U.S. economy. It's even crazier to do it by August.

Yet that is what some members of Congress presume to do. They intend, as the New York Times puts it, "to reinvent the nation's health care system".

Let that sink in. A handful of people who probably never even ran a small business actually think they can reinvent the health care system.

Politicians and bureaucrats clearly have no idea how complicated markets are. Every day people make countless tradeoffs, in all areas of life, based on subjective value judgments and personal information as they delicately balance their interests, needs and wants. Who is in a better position than they to tailor those choices to best serve their purposes? Yet the politicians believe they can plan the medical market the way you plan a birthday party.

Leave aside how much power the state would have to exercise over us to run the medical system. Suffice it say that if government attempts to control our total medical spending, sooner or later, it will have to control us.

...

Now focus on the spectacle of that handful of men and women daring to think they can design the medical marketplace. They would empower an even smaller group to determine -- for millions of diverse Americans -- which medical treatments are worthy and at what price.

How do these arrogant, presumptuous politicians believe they can know enough to plan for the rest of us? Who do they think they are? Under cover of helping uninsured people get medical care, they live out their megalomaniacal social-engineering fantasies -- putting our physical and economic health at risk in the process.

...

Like the politicians, most people are oblivious to F.A. Hayek's insight that the critical information needed to run an economy -- or even 15 percent of one -- doesn't exist in any one place where it is accessible to central planners. Instead, it is scattered piecemeal among millions of people. All those people put together are far wiser and better informed than Congress could ever be. Only markets -- private property, free exchange and the price system -- can put this knowledge at the disposal of entrepreneurs and consumers, ensuring the system will serve the people and not just the political class.

This is no less true for medical care than for food, clothing and shelter. It is profit-seeking entrepreneurship that gave us birth control pills, robot limbs, Lasik surgery and so many other good things that make our lives longer and more pain free.

To the extent the politicians ignore this, they are the enemy of our well-being. The belief that they can take care of us is rank superstition.

Who will save us from these despots? What Adam Smith said about the economic planner applies here, too: The politician who tries to design the medical marketplace would "assume an authority which could safely be trusted, not only to no single person, but to no council or senate whatever, and which would nowhere be so dangerous as in the hands of a man who had folly and presumption enough to fancy himself fit to exercise it."

[Snipe]

Frankly, I have zero concern about what the GAO says will happen in 2080. I would love to see what the GAO would have predicted for us today in 1940.


"In 1965, hospitalization coverage under Medicare was projected to cost $9 billion by 1990. The actual price tag was $66 billion (http://www.realclearpolitics.com/printpage/?url=http://www.realclearpolitics.com/articles/2009/07/22/arrogance_97561.html)."

At least they were close.

[Kahns Krazy]

If anything, technology pushes costs up. For example, my mom was diagnosed with a herniated disc in 1959. She got an x-ray and was told to lay in bed for a week or two. I bet her medical expnses were less than $100.

Today, you get a ct-scan, mri, muscle relaxants and other meds, physical therapy, and potentially surgery. There's just a lot more ways to treat a bad back, and virtually every other disease, than a generation ago.

Bad heart in 1970? Not much you can do other than lose weight and don't walk up stairs. (That was the actual medical advise given to a relative in the 1960's).

Bad heart in 2009? Open heart surgery, a surgery which one surgeon basically described as being "routine' for him.


I get your point, but that's apples and oranges, and also gets back to my point about a price menu.

I would love for a doctor to say "Well, we have two options. I can take a simple x-ray, see if i find anything, and most likely tell you to rest for 2 weeks and come back. That option is $100. Or, we can do an MRI. This will give us a much clearer picture and be able to identify some things that an x-ray will not. That option is $2,000. Which one do you choose, patient?"

[GuyFawkes38]

I get your point, but that's apples and oranges, and also gets back to my point about a price menu.

I would love for a doctor to say "Well, we have two options. I can take a simple x-ray, see if i find anything, and most likely tell you to rest for 2 weeks and come back. That option is $100. Or, we can do an MRI. This will give us a much clearer picture and be able to identify some things that an x-ray will not. That option is $2,000. Which one do you choose, patient?"

I'm not sure how much a price menu would help. In both cases, you'll be spending a ton of cash on the specialist doctor who makes 20 times more than the specialist doctor in Germany or any other country on earth.

[Kahns Krazy]

Did anyone watch the press conference last night? I actually busted out laughing when Obama was talking about the case of the guy who got the cops called on him breaking into his own house.

I think Obama almost got a case of the giggles when he started to say "if I were forcing my way into my house.... wait, I guess I live here now. That wouldn't happen. I'd get shot."

[DC Muskie]

Did anyone watch the press conference last night? I actually busted out laughing when Obama was talking about the case of the guy who got the cops called on him breaking into his own house.

I think Obama almost got a case of the giggles when he started to say "if I were forcing my way into my house.... wait, I guess I live here now. That wouldn't happen. I'd get shot."

I caught the end where he discussing that event. I was shocked that in one sentence he said not knowing all the facts, then turned around and said the police acted stupidly.

I can do that, but I'm stupid. I don't expect the president to act that stupidly.

Is stupidly even a word?

[GoMuskies]

That case is obviously getting a lot of run up here. I think stupid is the key word in the whole affair. The person who called the cops because this guy was "breaking in" to his own house probably acted stupidly. The prof probably acted stupidly when he got belligerent that the cops had the audacity to respond to a 911 call. And the cops probably acted stupidly by arresting the guy instead of just saying, "Yeah, whatever, we'll remember this the next time when someone actually IS breaking into your house."

Stupid, stupid and stupid. Definitely not worthy of making a prime time Presidential news conference on healthcare reform.

[bobbiemcgee]

A guy standing in his own living room with two photo id's, one which is his Driver's License with the correct address on it, shouldn't be taken downtown and booked.....Sorry, it is stupid.

[Kahns Krazy]

I caught the end where he discussing that event. I was shocked that in one sentence he said not knowing all the facts, then turned around and said the police acted stupidly.

I can do that, but I'm stupid. I don't expect the president to act that stupidly.

Is stupidly even a word?

I'm not a big Obama supporter, but I kind of agree with him on that one. I don't think you need to know all the facts to know that it's a bonehead move to arrest someone in their own house stemming from a B&E call.

[GoMuskies]

A guy standing in his own living room with two photo id's, one which is his Driver's License with the correct address on it, shouldn't be taken downtown and booked.....Sorry, it is stupid.

Yeah, but everyone knows that mouthing off to a cop is a good way to get a mouth full of teeth, no matter what race you are. So this is progress.

[bobbiemcgee]

Yeah, but everyone knows that mouthing off to a cop is a good way to get a mouth full of teeth, no matter what race you are. So this is progress.

After giving the cop 100% proof of my identity, I would only expect the cop to use his teeth to bite his tongue, do a 180, and get the f^ck out of my house.

[DC Muskie]

Well, I think everyone knows where I stand with Obama. Anyone who is going to bring your money to me is alright.

The president confessed that Gates is a friend. Then prefaced everything with not knowing all the facts. He could have stayed in that general area of saying "the entire thing sort of snowballed into something that it shouldn't." And left it there.

Instead he called the cops stupid. Not exactly the move I would have made if I were the president.

Who knows if Gates assaulted the cops? Does anyone? I know there's a dispute on whether Gates quickly produced his license.

But I agree with Go. The entire thing is stupid and shouldn't have been the closing statement to a health care press conference.

[XUglow]

Sounds like a bit of a shell game coming. Tie the healthcare bill to injustices around the country, so when people say, "I am not in favor of the healthcare bill in its current form", the supporters can answer, "So you are OK with arresting innocent black people?"

[Snipe]

I caught the end where he discussing that event. I was shocked that in one sentence he said not knowing all the facts, then turned around and said the police acted stupidly.



I agree. I don't see why Obama jumped in on this. He could have deflected the question. And being critical of police when you aren't sure of the facts is not a good political move.

I can't see how the thing had anything to do with racial profiling. They had a 911 call and the police had to respond. He was arrested after they knew full well of his identity. That isn't racial profiling.

Racial Profiling to me is pulling Gates over and assuming he is a drug dealer for driving a nice car, then finding out he is a Harvard Prof.

I think Gates acted like an ass, and pushed it until they cuffed him The police probably shouldn't have cuffed him, but that doesn't change my guess that Gates is an ass. They had other witnesses besides police. And what is a tenured Harvard prof doing talking about a police officers mother? "I will see your mama outside". WTF?

If anyone was racial profiling it was Gates, who thought the Police must be there to mess with him just because he is a black man.

I guess the cops should have walked away. That doesn't excuse Gates for being a jerk.

Reading Gate's account is comical. He just stepped on his porch and and was suddenly arrested out of the blue. Oh Golly Gee! What happened? When you put the two accounts side by side I would buy the police officer's story.

[XUglow]

Reading Gate's account is comical. He just stepped on his porch and and was suddenly arrested out of the blue. Oh Golly Gee! What happened? When you put the two accounts side by side I would buy the police officer's story.

So this means that you are against the healthcare bill.

[Kahns Krazy]

Hmm. I didn't mean to hijack the health care thread. I was merely commentating that Obama made a funny in the press conference, and I enjoyed it.

[GuyFawkes38]

I feel sort of bad for Gates. No one is in their right mind after a transcontinental flight. He lost his temper and called the police racist. In subsequent interviews, it's hard to back away from such an outrage.

I took a class on race at Xavier. There's a whole industry of African American intellectual hacks who write about tupac, rap, and living the gangster lifestyle.

By far the most respected and astute African American intellectual is Gates. He's been able to become both a popular voice and still keep his dignity.

[bobbiemcgee]

Both are/were a waste of taxpayer money.

[XU 87]

I get your point, but that's apples and oranges, and also gets back to my point about a price menu.

I would love for a doctor to say "Well, we have two options. I can take a simple x-ray, see if i find anything, and most likely tell you to rest for 2 weeks and come back. That option is $100. Or, we can do an MRI. This will give us a much clearer picture and be able to identify some things that an x-ray will not. That option is $2,000. Which one do you choose, patient?"

I agree with your point and that's the main problem we have. Right now, because of having insurance, people don't have to pay the $2000 for the MRI. So most people just say, "Other than a small co-pay, I don't have to pay for this. So give me the MRI right now".

Besides the fact that we have so many ways to treat us now, costs keep going up because people have no incentives to price shop or to look for cheaper alternatives. Safeway has an insurance program that the WSJ wrote about. Basically, Safeway gives incentives to its employees to keep their medical expenses down. And guess what? Safeway's insurance premiums haven't risen in the few years.

[XU 87]

I feel sort of bad for Gates.

I don't. He's an adult who acted like an a$$hole to a policeman who was there to protect his house. If anything, Gates should apologize to the cop for being such an immature jerk and for making such imflammatory comments to the cop.

It's amazing to me that the cop is the one who has to defend his actions.

[XU 87]

A guy standing in his own living room with two photo id's, one which is his Driver's License with the correct address on it, shouldn't be taken downtown and booked.....Sorry, it is stupid.

That's not why he was arrested and your post disregards what occurred. He was arrested after going outside and he kept screaming at the cop. If you or I did that, we'd also be arrested for disorderly conduct.

And our charges wouldn't be dismissed the following day.

[bobbiemcgee]

That's not why he was arrested and your post disregards what occurred. He was arrested after going outside and he kept screaming at the cop. If you or I did that, we'd also be arrested for disorderly conduct.

And our charges wouldn't be dismissed the following day.

Yelling at a cop on your own property when he's about to waste 5 hours of your and the taxpayer's time cuz he just doesn't like what you have to say.....sorry , not enough to arrest somebody. Dumb Cop. He should have just left, what was so hard about that. That's what they tell the domestic cases to do.

[XUglow]

Yelling at a cop on your own property when he's about to waste 5 hours of your and the taxpayer's time cuz he just doesn't like what you have to say.....sorry , not enough to arrest somebody. Dumb Cop. He should have just left, what was so hard about that. That's what they tell the domestic cases to do.

Do you watch Cops?

Suspect - "This is my house/car/driveway officer."
Cop: "Can I see some ID?"
Chaos ensues.

A cop is investigating a break-in. The guy tells the cop he lives there and that they are breaking in because the door in jammed. What is the cop supposed to think? Jammed doors... oh yeah, those happen all of the time. How about showing me some ID?

If the cops are at my house investigating something... and they have been... I am going to behave myself and do what they ask when they ask it. What excuse would I have for coming across as a prick? (OK, they were looking for Miss Muskie after she bopped a guy with a wine bottle. She wasn't there. They were skeptical. I let them search for her.)

I am not taking sides, but the cops are pros. If you are cool, they will be cool. End of story.

[bobbiemcgee]

Most cops are professional, but not all the time, like the the one here who stuck his gun in the Mickey D's drive thru window cuz his order wasn't ready....had a great record.

[XUglow]

Most cops are professional, but not all the time, like the the one here who stuck his gun in the Mickey D's drive thru window cuz his order wasn't ready....had a great record.

...and this is relevant how? I am guessing that some professors have done some stupid things as well.

[bobbiemcgee]

...and this is relevant how? I am guessing that some professors have done some stupid things as well.

Exactly, Gates did a stupid thing by berating the cop. The cop did a stupid thing by arresting him, when all he had to do was walk after he determined there was no crime. Mouthing off to a cop is not punishable by jail time, especially if he's dead wrong.

[danaandvictory]

Exactly, Gates did a stupid thing by berating the cop. The cop did a stupid thing by arresting him, when all he had to do was walk after he determined there was no crime. Mouthing off to a cop is not punishable by jail time, especially if he's dead wrong.

Didn't Gates present ID that showed he was the resident of the house?

[UCGRAD4X]

I think it is interesting that one argument for the Health Care Bill Democrats keep pushing is that Republicans have not offered alternatives. Obama in his recent infomercial characterized the Republicans as only saying NO and offering no solutions.

Then why does an article by By DAVID ESPO and ERICA WERNER of the Associated Press state:

"At the White House, Obama met with senators in an attempt to speed completion of a bipartisan deal that has been under discussion for weeks."

Who are these bipatisans and if it has been in the works for weeks, how can Obama and the Dems make such statements?

[bobbiemcgee]

I'm driving my new car bought from a govt owned automaker down a federally paid for interstate. I got the car by trading in my clunker for 4500 (CARS program) and wrote a check on my bailed out bank checking acct. My family, educated @ bailed out public schools and Universities are with me, as we listen to Obama on fed regulated airwaves and drink municipally regulated tap water. We have combined our stimulus checks for a nice vacation at a NATIONAL PARK. We are appalled at the thought of PUBLIC Health Insurance!!! That would be SOCIALISM!!!!


Oh, btw, thanks for govt sponsored mortgage modification program lowering my payment so I could afford the new car!!!

[Billy]

Exactly, Gates did a stupid thing by berating the cop. The cop did a stupid thing by arresting him, when all he had to do was walk after he determined there was no crime. Mouthing off to a cop is not punishable by jail time, especially if he's dead wrong.

Yes. This.

The whole thing has been just a big giant vat of stupidity. Both sides.

[XUglow]

I got the car by trading in my clunker for 4500 (CARS program)

I have a friend that acted responsibly and purchased a high-mileage 2002 Chevy Cavalier 7 years ago. It may be worth $1500 or less because it has 160,000 miles on it. It doesn't get 18 MPG now, but the EPA rating, which is what CARS uses, is about 26. Her car doesn't qualify for the $4500 trade-in. She doesn't understand why the government is rewarding less responsible people that went out and purchased a low-mileage car.

Hmmm... I gues that is like the banks and car companies and whatever. Responsible banks got nothing. Irresponsible banks got bailed out.

[bobbiemcgee]

"She doesn't understand why the government is rewarding less responsible people...."

seems to be the overwhelming trend nowadays.....

[American X]

Finally, a White House initiative in which I want to partake.

If they are compiling an enemies list, I want to be on it.

[GuyFawkes38]

Here's a great article on health care: http://www.theatlantic.com/doc/200909/health-care

Via my favorite blog (Marginalrevolution.com), here are two distburing paragraphs:


How am I supposed to be able to afford health care in this system? Well, what if I gave you $1.77 million? Recall, that’s how much an insured 22-year-old at my company could expect to pay—and to have paid on his and his family’s behalf—over his lifetime, assuming health-care costs are tamed. Sure, most of that money doesn’t pass through your hands now. It’s hidden in company payments for premiums, or in Medicare taxes and premiums. But think about it: If you had access to those funds over your lifetime, wouldn’t you be able to afford your own care? And wouldn’t you consume health care differently if you and your family didn’t have to spend that money only on care?

and


From 2000 to 2005, per capita health-care spending in Canada grew by 33 percent, in France by 37 percent, in the U.K. by 47 percent—all comparable to the 40 percent growth experienced by the U.S. in that period. Cost control by way of bureaucratic price controls has its limits.

[j77]

Finally, a White House initiative in which I want to partake.

If they are compiling an enemies list, I want to be on it.
where can i join the sara palin fan club? you guys carried 16 states ,mostly in the south...grow up... and turn off the gospel hour music!

[xudash]

I won't get into where I stand on this, but I would ask anyone here a simple question:

Do you agree that anything this complex, resulting in 1,000 page documents and apparently multiple versions at that, should be evaluated carefully and over a sufficient amount of time? Do you agree that there have been clear and absolute attempts to rush this through?

[Snipe]

Here's a great article on health care: http://www.theatlantic.com/doc/200909/health-care

Via my favorite blog (Marginalrevolution.com), here are two distburing paragraphs:



and

I am a big fan of Marginal Revolution.

The link is here.

A very good article on health care economics (http://www.marginalrevolution.com/marginalrevolution/2009/08/a-very-good-article-on-health-care-economics.html)

[GuyFawkes38]

I am a big fan of Marginal Revolution.

The link is here.

A very good article on health care economics (http://www.marginalrevolution.com/marginalrevolution/2009/08/a-very-good-article-on-health-care-economics.html)

Thanks, I was to lazy to provide a link.

And I vaguely remember you saying that you read Greg Mankiw's blog too. For some reason, economist write incredible blogs. I guess they have to stick to facts and logic.

[American X]

where can i join the sara palin fan club? you guys carried 16 states ,mostly in the south...grow up... and turn off the gospel hour music!

Same place you lern grammer and spelll.

If you join only attack political threads, me ban you for good.

[Juice]

Same place you lern grammer and spelll.

If you join only attack political threads, me ban you for good.

He has only posted in this thread and the one on Voinovich. I don't get why he comes to a basketball message board to discuss politics. Why wouldn't he just find a political message board?

[American X]

Stated with no sense of irony:

"We come before you to follow in the footsteps of those who gave our country Social Security and then Medicare," House Speaker Nancy Pelosi said.

House Leaders Unveil Health Bill (http://online.wsj.com/article/SB125682351602615905.html)

Well, I am appropriately frightened to death for Halloween.

[Kahns Krazy]

No Republicans are expected to vote for the bill.

Oh good. I love this "reaching across the aisle" politics.

[boozehound]

A lot of democrats probably won't vote for the bill either...

Even with the "Super Majority" does anyone actually think that the Dems will get this done? I have extremely skeptical to say the least. I guess that's why I don't get too 'up in arms' about the healthcare arguments. I don't think that they will actually accomplish anything with the universal healthcare bill.

[kmcrawfo]

A lot of democrats probably won't vote for the bill either...

Even with the "Super Majority" does anyone actually think that the Dems will get this done? I have extremely skeptical to say the least. I guess that's why I don't get too 'up in arms' about the healthcare arguments. I don't think that they will actually accomplish anything with the universal healthcare bill.

The legislation is so entirely abysmal that they can't even get their own party to vote for it. No republicans are needed on this. The Dems are afraid to push this through without any republican support because they know that the results of this will be entirely on their shoulder, which they don't want. A couple token republicans would solve that dilemma, but I don't see that happening.

The two revised versions currently in the house and senate are equally bad.

[X-band '01]

Oh good. I love this "reaching across the aisle" politics.

That's meant to apply to the "Blue Dog" Democrats and the run-up-the-debt Democrats.

[xudash]

I recall reading an article that noted that about 7 million citizens are truly in need of assistance: the truly poor, pre-existing conditions, etc. 7 million who need AND WANT assistance.

Focus on tort reform, helping those people and adjusting the way private insurers operate (i.e. regulatory stuff, etc.) and I would think we could pull something off that would work, be affordable and be described in less than 1,990 pages. In fact - and I didn't get it from Rush Limbaugh - Texas inacted tort reform and look at what is going on in that state in terms of affordable coverage.

1,990 pages people! If you think that group of idiots led by something as stupid as Pelosi nutted this thing, you are in for a rude awakening.

[XUglow]

Natalie Noel, oft-featured Glow girl and breast-cancer survivor, testified Wednesday in Congress in favor of the public option.

During the hearing, we watched a 3-minute clip of a film, “Reinventing Paradise,” where the producer, Natalie Noel, was also present and gave testimony. Natalie is a cancer patient whose insurance coverage was recently terminated and her 3-minute clip captures stories of Gulf Coast residents who have suffered health-care hardships post-Katrina. Representative Jackson-Lee responded to Noel’s film and testimony by stating, “although all of us want to believe we live in a democracy…we know some are left out; the sick, the frail, the mentally ill…those who can’t tell their stories.”

Nat and her dad had similar cancers at the same time. She covered the difference between her care with insurance vs. her dad's care who didn't have insurance. She is in remission. Her dad's situation was terminal. When she finished testifying, she found out that her dad had passed away while she was at the witness table.

Side note - I did not find out until I was reading the article about her testimony before Congress that her insurance had been canceled by BC/BS. I don't know that private insurance will ever cover her again. I don't know how that works.

http://www.aaanativearts.com/images/articles/noel-beach.jpg Nat with Adam Beach.

[kmcrawfo]

Natalie Noel, oft-featured Glow girl and breast-cancer survivor, testified Wednesday in Congress in favor of the public option.

Side note - I did not find out until I was reading the article about her testimony before Congress that her insurance had been canceled by BC/BS. I don't know that private insurance will ever cover her again. I don't know how that works.

http://www.aaanativearts.com/images/articles/noel-beach.jpg Nat with Adam Beach.

This is certainly a sad story. Without knowing the details of her father's cancer, it can not be said what the outcome would have been with different/more extensive treatments. Keetp in mind that in government run healthcare, single payer systems such as the UK and Canada the government employees often decide with a formula based on age and estimated future productivity to society whether people receive treatment for cancer at all.

Regarding her future insurability there are numerous ways she can get coverage. I don't know what she does for a living, but university, government, and large insitutional plans do/can not raise premiums or exclude based on prior medical history. A reform policy that would allow several small business to aggregate into one large healthcare policy would allow small businesses to offer similar policies to their employees. Right now, in most states, this does not exist.

Furthermore, at least at my office, no cancer patient is ever turned away due to inability to pay/lack of insurance. Everyone pays something (I believe people don't appreciate it as much if it is free/handout). However, it may be as little $10 for a several thousand dollar surgery. If a patient needs chemotherapy and can not afford it, in general, I can find assistance through the manufacturer or other resource.

In general, there are hospitals/doctors across the country with similar mindsets/programs. My policy is that patients need to give me a copy of their most recent tax return and the number of dependents. I have a chart/grid that calculates where they fall in terms of "poverty". I am surprised when some patients refuse to provide this information and expect to simply take care of them for free because they say they can't afford it. I don't know what to make of that, but I have my opinions which I won't share in this.

It would be helpful if she could get a tax-exempt Health Savings Account, and then get a catastrophic healthcare plan with a high deductable. BC/BS are the most strict and difficult insurance company to work with. I can't stand them. Regarding HSAs, some states even allow you to role over the HSA amounts each year into IRAs or savings accounts if the funds aren't used.

As unfortunate as this situation is, there are plenty of ways to fix this problem she describes without handing our healthcare over to the government where it will be handled as wonderfully as social security, medicare, and medicaid. That will only make things worse, for sure.

[bobbiemcgee]

[QUOTE=xudash;146834]I recall reading an article that noted that about 7 million citizens are truly in need of assistance: the truly poor, pre-existing conditions, etc. 7 million who need AND WANT assistance.

Dash - you are truly out of touch with reality if you think only 7 million out of 309 million need or want health insurance. We have 3.5 million homeless people at any given time thru the year, but I'm sure they're still paying their premiums.

[kmcrawfo]

[QUOTE=xudash;146834]I recall reading an article that noted that about 7 million citizens are truly in need of assistance: the truly poor, pre-existing conditions, etc. 7 million who need AND WANT assistance.

Dash - you are truly out of touch with reality if you think only 7 million out of 309 million need or want health insurance. We have 3.5 million homeless people at any given time thru the year, but I'm sure they're still paying their premiums.

His numbers are quite accurate. More recent studies show the numbers to fall between 7-9 million.

The number we hear nationally is about 47-48 million.

This breaks down like this:

17 million, or 34%, are eligible for public/government programs but aren't enrolled.
15 million, 31%, are make enough money to afford coverage, either through their job related plan or an individual plan, but don't want to spend the money.
7 million, or 16%, are 'short term' uninsured, which means either in between jobs or in the waiting period for their group health plan.
That leaves 9 million, or 19%, that are truly uninsured or insurable. That's where we need something to help people out.

California, is often used as a microcosm of the country when it comes to healthcare. 6.7 million are uninsured there:

3 million, or 44%, are eligible for public programs but not enrolled.
2 million/29%, have the money to pay for coverage but don't want to pay for it.
.7 million are in that short term category again.
This leaves 1 million, or 14%, of Californians that are referred to as the 'hard core uninsurables.'

This information is easy to find if you do a search.

[XUglow]

kmc, I was trying to relate the story factually without making political commentary or taking sides on the issue. She has an agenda. I don't. I already provide health insurance for all of my employees. I have zero issues with my current coverage.

Nat is largely self-employed in the entertainment industry, and as such, she has been self-insured. For the short term, she is going to go to work for Rep. Sheila Jackson-Lee in Washington. It will be her second stint in Washington. (She worked for Charlie Wilson before.)

I don't know much about her dad's cancer. I think he had lymphoma and had a large mass in his right armpit. It was removed along with several lymph nodes. I have no idea what other treatment he received.

[kmcrawfo]

kmc, I was trying to relate the story factually without making political commentary or taking sides on the issue. She has an agenda. I don't. I already provide health insurance for all of my employees. I have zero issues with my current coverage.

Nat is largely self-employed in the entertainment industry, and as such, she has been self-insured. For the short term, she is going to go to work for Rep. Sheila Jackson-Lee in Washington. It will be her second stint in Washington. (She worked for Charlie Wilson before.)

I don't know much about her dad's cancer. I think he had lymphoma and had a large mass in his right armpit. It was removed along with several lymph nodes. I have no idea what other treatment he received.

Sorry, if my reply came on harshly or as criticism. It wasn't meant to be so. I was just pointing out thoughts/ideas that came to mind after reading your post. I wasn't trying to imply anything negative to you in any way. With the new gig she has lined up, sounds like Nat is going to be just fine. Which is good.

[Snipe]

Dash - you are truly out of touch with reality if you think only 7 million out of 309 million need or want health insurance. We have 3.5 million homeless people at any given time thru the year, but I'm sure they're still paying their premiums.

3.5 million people at any give time? That is 1% of the population. For Greater Cincinnati the population is around a million. That would mean we have around 10,000 homeless people at any given time. That is more than the entire population of Over The Rhine.

I have seen some studies that calculate the number of homeless by including the number of homeless people that actually live in homes. Those are my favorite homeless, the homeless living in homes. Those people would actually be homeless, if it wasn't for that damned home.

[Snipe]

From the USA Today: (http://www.usatoday.com/news/nation/2007-01-10-homeless_x.htm)

Study: 744,000 homeless in United States


There were 744,000 homeless people in the United States in 2005, according to the first national estimate in a decade.

A little more than half were living in shelters, and nearly a quarter were chronically homeless, according to the report Wednesday by the National Alliance to End Homelessness, an advocacy group.

Look at who is counting? I wonder if they have an incentive to inflate the numbers?

Here is the local angle from a Cincinnati:

Tarbell Goes Off! (http://www.enquirer.com/editions/2002/03/06/loc_korte_city_hall.html)


Tuesday, Mr. Tarbell once again questioned how long Ms. Beck has lived in Cincinnati (more than three years) and where she lives (Hyde Park).

He took exception to “newcomers who seem to come to Cincinnati with preconceived notions of the problems of our community, and how they're going to solve them.”

And then he blasted the Homeless Coalition's September study that found there were 25,000 homeless people in Cincinnati, noting that the entire population of Over-the-Rhine is 7,000.

“You're telling me that every single one of them — plus three of their friends — are homeless,” he said. “That is so inappropriate that the only definition that is deserving is "fraudulent.'”

An unflappable Ms. Beck held her own, saying her tenure in Cincinnati had nothing to do with her credibility. And she defended the 25,000 figure, which includes people “doubling up” with friends and family.

“Whether you agree with me or not is up to you,” she said. “The federal government doesn't agree with me, either.”

"Doubling up"! Those are my favorite homeless. The homeless with homes!


Also this:

Following the stricter HUD definition (not including people who are doubled up), we estimate that there are 1,300 people homeless each night in Cincinnati -- 1100 in shelters and an additional 200 on the street"


So for Cincinnati, some can estimate 25,000, some can estimate 10,000. The actual number is around 1,300. And I can't tell you how many of those 1,300 are already covered by medicade, medicare or other government medical plans, but I would bet the number is higher than zero.

[bobbiemcgee]

1.Number of Homeless Persons in U.S. Annually: 3.5 million.
2.Number of Homeless Persons in U.S. Nightly: 842,000.
3.About 15 million of us experience homelessness at least once in our lifetime.
4.39% of the homeless are under the age 18: 1.35 million children per year and 200,000 on any given night.
5.23% of all homeless people were members of families with children
6.400,000 veterans are homeless per year, 200,000 on any given night.
7.The role of mental illness and substance use is less than you may assume: Approximately 16% of the single adult homeless population suffers from some form of severe and persistent mental illness; 30% currently addicted to alcohol or drugs. The cliché is that the closing of mental hospitals turned out many crazy people onto the streets. That is in fact a smaller and often over-emphasized part of the problem.
8.The bigger part of the problem is stagnant income and less affordable housing. The main cure for homelessness is affordable homes. 9 million low-income renter households nationwide pay more than half of their income for housing. In no community in the U.S. today can someone who gets a fulltime job at the minimum wage reasonably expect to find a modest rental unit he or she can afford.



http://pnhp.org/blog/2009/07/02/only-in-america-medical-bankruptcy-homelessness/

[bobbiemcgee]

[QUOTE=kmcrawfo;146858][QUOTE=bobbiemcgee;146852]

His numbers are quite accurate. More recent studies show the numbers to fall between 7-9 million.

The number we hear nationally is about 47-48 million.

This breaks down like this:

17 million, or 34%, are eligible for public/government programs but aren't enrolled.
15 million, 31%, are make enough money to afford coverage, either through their job related plan or an individual plan, but don't want to spend the money.
7 million, or 16%, are 'short term' uninsured, which means either in between jobs or in the waiting period for their group health plan.
That leaves 9 million, or 19%, that are truly uninsured or insurable. That's where we need something to help people out.

California, is often used as a microcosm of the country when it comes to healthcare. 6.7 million are uninsured there:

3 million, or 44%, are eligible for public programs but not enrolled.
2 million/29%, have the money to pay for coverage but don't want to pay for it.
.7 million are in that short term category again.
This leaves 1 million, or 14%, of Californians that are referred to as the 'hard core uninsurables.'

Easy to find if you quote Orrin Hatch, as you have done. And what happens if the 32 million decide to go to the Hospital? You'll pay anyway, because the Insurance cos. will just lump another 12% on your premium as they have done double digit increases for the last 9 yrs. in a row. Soon your ins. bill will be more than your house payment, unless you plan to stay 20 yrs. old for the rest of your life.

[bobbiemcgee]

So your solution would be to get the 17 million people on the public dole? Maybe we can run a National sign-up program with some stimulus money. And the 7 million waiting for group health plans - they don't need or want the Insurance? Hmmmm, wonder why they bother trying to get some.

[Snipe]

I recall reading an article that noted that about 7 million citizens are truly in need of assistance: the truly poor, pre-existing conditions, etc. 7 million who need AND WANT assistance.



Dash - you are truly out of touch with reality if you think only 7 million out of 309 million need or want health insurance. We have 3.5 million homeless people at any given time thru the year, but I'm sure they're still paying their premiums.

You did say that we had 3.5 million homeless at any give time. And you doubted that any of the 3.5 million had health insurance. I don't think I distort here, that is the case you laid out.

Your posts makes me harken back in time to a homeless advocate in the olden days.

From Thomas Sowell: Lying Statistics (http://www.papillonsartpalace.com/lying.htm)


During the "homelessness" crusades of the 1980s, for example, homeless advocate Mitch Snyder made up a statistic about how many millions of homeless people there were in this country and threw it out to the media, which snapped it up and broadcast it far and wide. This fictitious number was repeated so often, and was so widely accepted, that people who actually went out and counted the homeless found that it was they who were discredited when their totals differed radically from Mitch Snyder's arbitrary number.

Only belatedly did some major media figure -- Ted Koppel on "Nightline" -- actually confront Mitch Snyder and ask the source of his statistic. Snyder then admitted that it was something he made up, in order to satisfy media inquiries. Moreover, homeless advocates defended what Snyder had done and called it "lying for justice."


Or this:


For example, in the early 1980s, CBS reporter Ted Koppel tried to find out why the number of homeless people in America was often said to be 2 to 3 million. He asked a well-known advocate for the homeless, Mitch Snyder, about the source of this statistic. Basically, explained Snyder, the estimate was a guess. “Everybody said, ‘We want a number. . . We got on the phone, we made a lot of calls, we talked to a lot of people, and we said, ‘Okay, here are some numbers’” (as cited in Best, 2001, p. 34). Snyder himself did not consider the estimate valid (Best, p. 34).

I bet we have a lot of homeless too. It could be millions. I swear!


Today activists are still providing much of the statistical data on homelessness. A search of the federal government’s statistical gateway, FedStats (www.fedstats.gov), finds links to various programs for the homeless, but returns no convenient government estimates of the number of homeless in the United States. Resources on the University of Michigan’s Statistical Resources on the Web page (2002) include a report on programs for the homeless by the U.S. Department of Housing & Urban Development and a status report on homelessness in selected cities from the U.S. Conference of Mayors. The only fact sheets available are provided by an advocacy group, the National Coalition for the Homeless (NCH). The estimate of the number of homeless in NCH Fact Sheet #2 (2002) is much more sophisticated than Snyder’s earlier guess. After reviewing the difficulties of counting the “hidden” homeless and the merits of various studies, the NCH concludes that the Urban Institute’s estimate that about 3.5 million people experience homelessness in a year is the most reliable.

Gotta love those paid advocates for a cause. We like to call them activists. They get paid to activate. That is what they do.





Following the stricter HUD definition (not including people who are doubled up), we estimate that there are 1,300 people homeless each night in Cincinnati -- 1100 in shelters and an additional 200 on the street"

So for Cincinnati, some can estimate 25,000, some can estimate 10,000. The actual number is around 1,300. And I can't tell you how many of those 1,300 are already covered by medicade, medicare or other government medical plans, but I would bet the number is higher than zero.


1.Number of Homeless Persons in U.S. Annually: 3.5 million.
3.About 15 million of us experience homelessness at least once in our lifetime.
2.Number of Homeless Persons in U.S. Nightly: 842,000.
4.39% of the homeless are under the age 18: 1.35 million children per year and 200,000 on any given night.
5.23% of all homeless people were members of families with children
6. 400,000 veterans are homeless per year, 200,000 on any given night.




Lets look at your numbers...

You first claimed that 3.5 million people were homeless at any given time. When questioned on that, you retreated and cited statistics that claim that this is a yearly figure.

You now claim that 3.5 million are homeless every year but the nightly number is 842,000.

I don't agree with any of your numbers but for the sake of argument, let us both accept that they are true.

It looks like most people solve the problem of homelessness on their own. If 3.5 million are homeless every year, yet on any given night we only have 842,000, we have an incredible amount of people that have found homes and solved the problem. We should celebrate this fact. Americans find a way!

Extrapolate this over the course of a decade to see what I mean. Over the course of a decade, if you had a rate of 3.5 million homeless a year, you would have 35 million homeless people. But we don't actually have that. When measured in a point in time, we only have 842,000. That means that the other 34 million plus have found homes.

To chart it out it would look like this:

Statistics For The Decade:

Homelessness Solved: 34,158,000 (98%)
Homeless in Transistion: 842,000 (2%)

Now that doesn't measure repeat offenders, and my statistic distorts reality in that aspect. You claim that 15 million Americans are homeless over the course of a lifetime, so many Americans become homeless again and again.

Even Still The Statistics Look Promising:

Homelessness Solved: 95%
Homeless in Transistion: 5%

So the point in time numbers can simply be summed up by people that are in transition. We probably shouldn't even call them homeless, just moving to a new home. That is the reality in most of the cases. Some families actually move out of housing in cities like LA, Chicago and New York because when they enter a shelter it puts them first on the list for government housing. Nothing like free housing brother.

That is another demonstration of my favorite law, the Law of Unintended Consequences. In those cases, government policy actually creates homelessness as an incentive, and it also inflates the statistics of homeless families. This does happen. We pay people to be homeless. Who would have thought?

Your Mocking of XUDash!

You mocked XUDash and said that "Homeless People" don't have insurance. That is why we are here in the first place. This thread is about health insurance.

You cite statistics that 39% of the homeless are under the age of 18. Well guess what, though programs like Medicade (http://en.wikipedia.org/wiki/Medicaid) and S-Chip (http://en.wikipedia.org/wiki/State_Children's_Health_Insurance_Program), all of these homeless people already have government provided medical insurance.

By your own accounts, we already cover 39% of the homeless right there! Praise to Allah!

But don't stop there, lets look at the veterans you cited. Your source claimed that 200,000 of the 842,000 homeless every night are veterans. Guess what, that is 24% of your homeless that can apply and receive VA benefits from the United States Government.

So just my quick and dirty so far goes like this:

Minors: 39%
Veterans: 24%

39+24= 63%

I have already covered 63% of your homeless insurance problem! Give me time and I may cover some more!

So you started out saying that 3.5 million people are homeless and without insurance. Then we backtracked to a number of 842,000 that are homeless, and 63% of these have insurance according to you. That leaves 311,000 people and we don't know if they are covered by Medicade or other government programs. I suggest that many might be.

Now if I were to question your statistics, I would look at the number of purported veterans. You claim 39% of homeless are under 18. Those people are not veterans. Of the remaining 61% of adults, you seem to claim a disproportianate amount of veterans. I don't agree with any of your numbers, but the number of Veterans is obviously out of whack and fishy. Veterans and the homeless have long been used for political purposes as a way to attract more funding. I would implore you not to associate yourself with such studies. Please do not push for your own agenda on the backs of the brave people that proudly serve this nation.

[bobbiemcgee]

First of all, I have not "mocked" anybody, just chose to disagree with the numbers you made up. I am a veteran and have volunteered @ the VA hospital so I obviously resent that stupid comment and have no idea how this thread got to be a doubt to my patriotism.
That was totally uncalled for. The US Census that costs about 5 billion for also got it wrong bcuz the 46 million people lied:

http://www.census.gov/Press-Release/www/releases/archives/income_wealth/014227.html

My primary concern is with the ridiculous cost of health ins. and the double digit yearly rise over the last 9 yrs. People with 1.5-2.5 annual raise can't afford 12% annual raises in premiums. Your basic solution: Get all the millions of people who now qualify for free ins to get it and further bankrupt the system. I guess you don't find it ironic that you are proposing exactly what the Health Bill is. When they go to the Hospital, some "health genie" will pick up the tab and it won't cost you anything. Dream on. An indigent person can now go to the hospital and apply for Medicaid and get it 3 mos. retroactive!!! Won't cost you a dime.

I would like to know why a drug I pay 7.50 a month for in Fiji costs 109.10 at the corner drug store. Same drug, same box. I would like to know why heart surgery overseas cost 10k instead of 120k. I would like to know why a pill you take everyday of your life that costs 10-15 cents, costs 20 dollars in an intravenous bag (must be the extra water). The American Public is being totally and completely ripped off but they just keep paying the ridiculous cost and keep blaming "the other guy". The ins. cos. and hospitals just keep adding their 10-12% to the total output and laugh at the consumer cuz they don't care what it costs. Someday, you'll be paying 20k a yr for ins. and have a complete attitude change. If you get too fat, they'll drop you. If your wife can still have babies, nonononono. If she has a fat baby, too bad.

I apologize if I have offended you in some way with my opinions on a basketball messageboard. Get over it. People disagree, life in a free society.

[Snipe]

Bobbie I had a few drinks and went to rambling. I don't like the way some homeless studies seem to inflate the number of veterans. It is a pet peeve of mine. My intent is not to question your patriotism but the motives and intent of the people behind the studies. The statistics get manipulated and numbers get thrown around or made up of whole cloth.

You did argue that we had 3.5 million homeless and implied that they didn't have coverage. That clearly isn't the case on either point. I don't think our system is working well. It is not the system I would have, but many of those people have medicaid coverage. And if you don't like medicaid, then you don't like our current government health care. I don't like it either.

As for Insurance companies ripping us off, they really don't make impressive margins. The returns to the owners (shareholders) aren't all that impressive.

[bobbiemcgee]

'nuff said. I would just say the "small margins" are a percentage of billions and billions of dollars and they have no incentive to cut costs unless they think they are going to lose some money that quarter, but if they do, guess what, raise rates.

[kmcrawfo]

I would like to know why a drug I pay 7.50 a month for in Fiji costs 109.10 at the corner drug store. Same drug, same box. I would like to know why heart surgery overseas cost 10k instead of 120k. I would like to know why a pill you take everyday of your life that costs 10-15 cents, costs 20 dollars in an intravenous bag (must be the extra water). The American Public is being totally and completely ripped off but they just keep paying the ridiculous cost and keep blaming "the other guy". The ins. cos. and hospitals just keep adding their 10-12% to the total output and laugh at the consumer cuz they don't care what it costs. Someday, you'll be paying 20k a yr for ins. and have a complete attitude change. If you get too fat, they'll drop you. If your wife can still have babies, nonononono. If she has a fat baby, too bad.
.

Most generic drugs can be obtained at Walmart / Kroger/ Target / etc.. for a few bucks now. The private sector figured that out and if you do some research and go to your doctor with a list of those drugs and ask can one of these be substituted for what I am currently taking generally the answer would be yes. If not, then you may be on something truly new/novel and the question needs to be asked do I really need this new drug? What the positives vs. negatives including health benefits vs. side effects vs. cost and so on. Most problems such as diabetes, high blood pressure, etc. can be handled using the low cost programs.

Also, remember that pharma companies invest billions of dollars into research and devlopment of new drugs. They should charge as much as the market will allows to recoup those costs and make a profit. If they don't make a profit, there is no incentive to continue making new drugs. Agree or disagree with the ethical nature of this premise, it is reality. Yes, the United States subsidizes the pharma costs for much of thoe world, but if we didn't, drug inovation would be stymied.

Concerning the costs of care, your numbers are way, way, way overexagerated. If you go into a hospital without insurance, you can absolutely get heart surgery for around $10,000 - 20,000. The $100,000 numbers come from an artificial inflation due to insurance contracts. It is considered insurance fraud to charge different payers different amounts, so all providers have 1 fee schedule. This fee schedule must capture the highest payer, so if a hospital / doctor has one payer to reimburses $100,000, you must charge all payers $100,000. Therefore, the patient without insurance will get a $100,000 bill. However, if you talk to the doctor/hospital they can/will do an adjustment down the medicare/tricare reimbursement which will be roughly $10,000.

For example, I have a payer that gives me $426 for a specific procedure. Medicare pays $43 for this procedure. I must send Medicare a bill for $426. If I sent the a bill for $43 and I was audited, I could be charged with fraudulent claims stating I am overchargind/discounting depending on which way they look at. However, I can adjust claims for financial hardship, lack of insurance, etc. But, the paperwork is significant.

This is really too complex of a topic for a message board. However, in general, people to not understand how things really work. The government and insurance companies through regulations and insurance laws make it very difficult for doctors/hospitals to charge a low rate. If those regs were removed and we had a cash pay-for-service system the rates would plummit and overhead/complexity would become much lower. Unfortunately, I don't enver see that happening.

[American X]

Not surprising the WSJ would be critical, but crowns Pelosi's bill as maybe "the worst piece of post-New Deal legislation ever introduced."

Worst Bill Ever (http://online.wsj.com/article/SB10001424052748703399204574505423751140690.html)

"Critics will say we are exaggerating, but we believe it is no stretch to say that Mrs. Pelosi's handiwork ranks with the Smoot-Hawley tariff and FDR's National Industrial Recovery Act as among the worst bills Congress has ever seriously contemplated."

[kmcrawfo]

Not surprising the WSJ would be critical, but crowns Pelosi's bill as maybe "the worst piece of post-New Deal legislation ever introduced."

Worst Bill Ever (http://online.wsj.com/article/SB10001424052748703399204574505423751140690.html)

"Critics will say we are exaggerating, but we believe it is no stretch to say that Mrs. Pelosi's handiwork ranks with the Smoot-Hawley tariff and FDR's National Industrial Recovery Act as among the worst bills Congress has ever seriously contemplated."

The WSJ has it right. This bill would be crippling to our entire country on so many fronts.

[bobbiemcgee]

Thx for your reply. It is indeed a screwed-up system. The one fact that you can be charged with fraud for charging less is just ridiculous. Should be the other way around. I 'm sure the average American has no idea you can negotiate the costs down 60-70-80-90%. I know I didn't. I agree the Pharma Cos. have to do expensive research, but why do we Americans have to pay most of the tab in higher drug prices? Most of the drugs aren't even made here. How come the VA (they negogiate as a Country) pays the least amount of anybody, while Ins. Cos. and ( I guess ) Medicare pays the sticker price? If given the choice, would anybody overpay 5-7 times?

If you're out of gas in the middle of the desert, and someone happens by with a gallon to get you to the next exit, and they want $50 for the gallon, you'll pay it. Same thing with Emergency health care, if you're having a heart attack, you can't jump on the cell phone and shop around. They can charge anything they want (and will), just HELP me.

If someone dents your car and you file a claim with the 3 dealer estimates, you're ins. co will tell you to take it to the low bidder. However, YOU don't HAVE TO. You can tell them to send you a check for the low bid and find a body shop on your own for less and pocket the difference. But there are no "better deals" in our current health care system. Like you said, charge less and go to jail. That's "sick" (pun intended) You never see a sale for "gall bladder surgery", but why not? I'm sure all Drs. go to a Car Lot and say "I'll just pay the sticker price please."

When I lived in Fla., my Primary Dr. went "cash only". He eliminated his ins. people and the cost of a visit went from $79 to 45. You could still file with your ins. co. for re-imbursement. It was great for me cuz I had a MSA. Your charge for a $426 procedure that you get 43 for makes me wonder why a patient just couldn't write you a MSA check for 43 and be done with it?

Guess I just don't get it. If I ran an Insurance Co. today, I would buy a nice Jet and shuttle everyone to Thailand. No fraud charges there. I'd do very well with much lower premiums.
I'd throw in a nice vacation after their surgery.

[kmcrawfo]

When I lived in Fla., my Primary Dr. went "cash only". He eliminated his ins. people and the cost of a visit went from $79 to 45. You could still file with your ins. co. for re-imbursement. It was great for me cuz I had a MSA. Your charge for a $426 procedure that you get 43 for makes me wonder why a patient just couldn't write you a MSA check for 43 and be done with it?

.

You hit the nail on the head right here. This is exactly what I am talking about. Having medicine becoming a cash product where people file their own claims would cause rates of care to plummit. Your doc's fees dropped almost 50%. Make it like car insurance. You choose your deductible, what's covered/not coverred, limits of coverage, etc... You also choose to file/not file. The government mandates that so many things must be covered. What if you don't want OB or In-Patient Psych coverage. Too bad, the government mandates it be included in all policies in some states. This makes you pay to things you don't need/want. Hence, your premiums go up.

The problem is that a cash system in medicine has become so foreign in our society. People don't want to file on their own, don't understand how to, etc... Medical insurance is the only insurance you buy with intent to use. That is not what insurance is supposed to be. That is why premiums are so darn expensive. You are going to use it. The insurance company has to hedge a bet on how much and make a profit.

We should go to a cash system with low premium, uber-high deductible and tax exempt health savings accounts. All money not used at the end of the year out of your HSA, rolls over into a tax-exempt IRA or savings account. You see, there is incentive not to abuse the system because if you don't, you get the money tax free. You also will negotiate lower fees with your docs and shop around because it is your money. To cover your tail in case of emergency you can get a supplemental catastrophic policy which would cover "emergent" ER care. (i.e stroke, gun-shot, etc..) These policies are cheap as dirt because you not likely to use it. Once over 65 (or 70 someday) when stroke, heart attack, etc... are more likely you drop that policy and fall onto the medicare.

I believe the solution to our healthcare dilemma is to simplify things, just as your doc in Florida did. The more complex we make it, the more confusing and expensive it gets.

[vee4xu]

Like anything else these days just tell what your taking from me and how much more I owe to give it to everyone else.

[GuyFawkes38]

Is there a Supreme Court ruling tomorrow or something?

I'm going to try my hardest to not get into political conversations at work tomarrow.

[Snipe]

I think Obama should have submitted McCain's plan for Health Care to get bi-partisan support. It is not like McCain thought of the plan, and it was bandied about for awhile. The theory (if not the McCain plan itself) was endorsed by Jason Furman, an economic policy director for Obama.

Here is a tidbit from economist Grek Mankiw's blog back in the day:


Saturday, September 06, 2008
Post-Partisan Health Policy

The PEP blog draws our attention to this trenchant analysis of health policy:


The most promising way to move forward in all three dimensions – coverage, cost, and long-run fiscal situation – is to replace the employer exclusion with a tax credit, a step that has been proposed many times before (e.g., Butler 1991 and Pauly and Hoff 2002). Firms would still be allowed to deduct the cost of their contributions to employee premiums, just as they can deduct wages and other expenses today for the purpose of calculating taxable income. But workers would now have to include employer contributions to health insurance in their earnings for the purpose of calculating taxes (precisely which taxes is discussed below). In exchange for, workers who purchased qualifying insurance would get a refundable tax credit. Qualifying insurance would be along the lines proposed by the President in his standard deduction for health insurance, including limits on out-of-pocket payments, coverage of a general range of medical care, and guaranteed renewability by the provider (Treasury 2008).

The PEP blog then points out,


This is a pretty fair description of the McCain health care plan. The funny thing is, this is not be found in McCain campaign literature or on his senate website, but rather in a paper written by Jason Furman, Obama's Economic Policy Director.

All true. This description is from the McCain campaign website:


John McCain Will Reform The Tax Code To Offer More Choices Beyond Employer-Based Health Insurance Coverage. While still having the option of employer-based coverage, every family will receive a direct refundable tax credit - effectively cash - of $2,500 for individuals and $5,000 for families to offset the cost of insurance. Families will be able to choose the insurance provider that suits them best and the money would be sent directly to the insurance provider. Those obtaining innovative insurance that costs less than the credit can deposit the remainder in expanded Health Savings Accounts.

Obviously, there is a lot of common ground between Furman and McCain on this specific policy reform. My guess is that most health economists would endorse the Furman-McCain plan.

I remember reading this post years ago, and I wanted to get back to it today.

Imagine Barrack Obama if he would have proposed John McCains plan.

Instead of colluding with special interests and letting Nancy Pelosi and Harry Reid hijack his legacy with a bill that still isn't even implemented, imagine if he just took the simple route of adopting his opponents plan because it still would serve his interests.

Could he have been stopped? McCain was the defacto leader of the Republican Party in 2008. It was the Republican plan. It would be the height of graciousness and reaching across the aisle.

One of the drawbacks of market based reform in health-care is that many people get health care through their employer. You don't get to choose. The McCain plan spoke to that. And of course, the Obama administration would have modified the plan, and done it in ways that they liked.

Obama could have gotten health care done early, with bi-partisan support, and it would be a landmark paradigm shift in the way we look at health care. I think looking back that might have been his biggest goof. It was there for the taking.

To truly reform healthcare, we need to detach it from the employer. McCain basically proposed this, and Obama could have gotten it for free. And it was a simple plan, at least compared to Obamacare, and it could have been enacted immediately. I think it would have already been a success, and Obama wouldn't have the Obamacare albatross hanging on his neck.

It will be interesting to see what the Supreme Court says in the next few minutes, but I wanted to voice my opinion on Obama's lost opportunity.

[Olsingledigit]

Obama got what he wanted with the help of Justice Roberts. Very disappointing for all Americans today. The government's power is essentially now unlimited as long as they just call it a tax. God help us all.

[DC Muskie]

Thank God corporations are people.

[stophorseabuse]

Obama has done a LOT of what he was elected to do.

Agree or not, he will be able to sell to his base, which overwhelmingly elected him last time, the promises he has fulfilled.

I don't know if it will be enough to overcome the Economy, but Obama has had a few very good days.

[XU 87]

Obama got what he wanted with the help of Justice Roberts. Very disappointing for all Americans today. The government's power is essentially now unlimited as long as they just call it a tax. God help us all.

I agree. What can government not do? What power does it not have now?

Obamacare only applies to employees who work more than 29 hours per week. We're now going to see a lot more part time employees.

In addition, it only applies to businesses with 50 or more employees. There's another disincentive for a business to grow. And I'd hate be the low people on the totem pole at a business that has 52 employees.

I just wish liberals would some day realize that businesses are in business to make a profit, and when the government increases their expenses, they have to find a way to cut costs. And if government makes it too expensive to grow and get bigger, then the business won't grow. But for some reason, liberals don't understand these concepts.

[Snipe]

Beware the law of unintended consequences.

We all have to pay for that piper.

[DC Muskie]

I agree. What can government not do? What power does it not have now?

Obamacare only applies to employees who work more than 29 hours per week. We're now going to see a lot more part time employees.

In addition, it only applies to businesses with 50 or more employees. There's another disincentive for a business to grow. And I'd hate be the low people on the totem pole at a business that has 52 employees.

I just wish liberals would some day realize that businesses are in business to make a profit, and when the government increases their expenses, they have to find a way to cut costs. And if government makes it too expensive to grow and get bigger, then the business won't grow. But for some reason, liberals don't understand these concepts.

Are you reading this Chief Justice Roberts???!!

Damn liberal.

Does anyone here actually think companies that have 52 employees that are successful in making a profit will actually NOT grow and expand?

Personally I am shocked the mandate stood. But I am really enjoying reading people's reaction to this decision. And knowing that Bush's biggest appointment to the bench was the deciding factor.

Someone better check with Scalia and make sure his head didn't explode.

[XU 87]

Are you reading this Chief Justice Roberts???!!

Damn liberal.

Does anyone here actually think companies that have 52 employees that are successful in making a profit will actually NOT grow and expand?



You are confusing whether something is constitutional as opposed to whether something is bad policy.

As for your last paragraph, if government makes it too expensive to grow, companies won't grow. Or if it becomes too risky to grow, due to the increased costs involved, then the company stays the same size. That's the way real businesses and real people who are in the real world make decisions. So the answer to your question is "Yes." Those that live in fantasy land will answer otherwise.

Just wait and see how many 29 hour per week employees we will be seeing.

[xu95]

Obama has done a LOT of what he was elected to do.

Agree or not, he will be able to sell to his base, which overwhelmingly elected him last time, the promises he has fulfilled.

I don't know if it will be enough to overcome the Economy, but Obama has had a few very good days.

He had his base locked up. What you need to be concerned about is the independents. I think they will really like Romney.

[Snipe]

Are you reading this Chief Justice Roberts???!!

Damn liberal.

Does anyone here actually think companies that have 52 employees that are successful in making a profit will actually NOT grow and expand?

Personally I am shocked the mandate stood. But I am really enjoying reading people's reaction to this decision. And knowing that Bush's biggest appointment to the bench was the deciding factor.

Someone better check with Scalia and make sure his head didn't explode.

I would form a new company. I would not go over the 49 limit. Yes, I do think that the limit maters.

Why would it not? That means if I have a security detail and I am about to go over 50, I just create a new company for the security service. But yes, I do feel that many companies will not expand because the don't won't to go over the 50 employee limit. It is just good sense, and I am not making this up.

It will happen.

[GoMuskies]

I'm fairly confident that starting a new company controlled by the same person or group of people or groups of companies will not allow you to sidestep the law. There will be attribution rules and the like to prevent that.

[GuyFawkes38]

I love broccoli. So overall, I'm ok with this decision.

Anyways, elections have consequences. Obama spent a lot of hard earned policital capital on health care reform. We'll get what we deserve, whatever it is.

[Snipe]

I'm fairly confident that starting a new company controlled by the same person or group of people or groups of companies will not allow you to sidestep the law. There will be attribution rules and the like to prevent that.


You know more than I do with the law, and my company is small. If I was up to 35 employees, I would probably start hiring a guy like you to make sure we didn't have any difficulty when we branched to a couple of LLCs. That is why I pay you guys. That is why I have an LLC.

One guy can have many LLCs, and I currently do. I am not rich either, I just hoped to be. Some of my LLC filings are ridiculous wastes of resources.

Everyone one of them could have 49 employees. You work for a substantial corporation, and you probably would view it differently if you worked for a man with several companies of 30 employees each. I wish I was that guy. I bet the number of people that own multiple companies of less that 50 people is more than 1. And I bet they pay attention to that 50 employee number. I know that they do. They do. It is a factor. Going over 50 is a big deal, and we shouldn't act like it isn't.

[Mrs. Garrett]

Q. You know I was wondering if this Obamacare was a good idea. I really don't know. Where can I go to find out?

A. A basketball message board

[DC Muskie]

You are confusing whether something is constitutional as opposed to whether something is bad policy.

As for your last paragraph, if government makes it too expensive to grow, companies won't grow. Or if it becomes too risky to grow, due to the increased costs involved, then the company stays the same size. That's the way real businesses and real people who are in the real world make decisions. So the answer to your question is "Yes." Those that live in fantasy land will answer otherwise.

Just wait and see how many 29 hour per week employees we will be seeing.

It was such bad policy to people they actually thought it was unconstitutional. Don't dismiss Roberts approval as something completely different.

In the real world companies provide health care to their workers. In the real world those workers pay a portion of the costs. In the real world, the expenses that businesses face don't just come from the government. In fact in the real world plenty of companies get subsidies in order to operate at a profit.

So the answer to my question is "of course not." No one who is running a business at a profit and sees the opportunity to grow and expand is going to look at this new health care law and say, "too risky, I'll stay put." They can't go that over a long period of time. They simply can't.

I too would love to see how many part time workers we will have going forward. I would bet it would be shockingly non existent.


I would form a new company. I would not go over the 49 limit. Yes, I do think that the limit maters.

Why would it not? That means if I have a security detail and I am about to go over 50, I just create a new company for the security service. But yes, I do feel that many companies will not expand because the don't won't to go over the 50 employee limit. It is just good sense, and I am not making this up.

It will happen.

This is hilarious. In America, you are telling me that people will not build their companies because they now have to provide health insurance, something they most likely would have to do anyway to keep a competitive edge?

So you are telling me all new companies will be under 50 people?

[DC Muskie]

He had his base locked up. What you need to be concerned about is the independents. I think they will really like Romney.

Depends on where those independents live.

Obama is polling puts him at 292 electoral votes. As of today he has a 63% chance of winning Iowa a 61% chance of winning Ohio and a 58% chance of winning Virginia.

Unless the independents in those states start moving towards Romney, Obama will be reelected.

[bjf123]

Q. You know I was wondering if this Obamacare was a good idea. I really don't know. Where can I go to find out?

A. A basketball message board

You can find the answers to the Ultimate Question of Life, the Universe, and Everything on this message board. You didn't know that?

[XU 87]

This is hilarious. In America, you are telling me that people will not build their companies because they now have to provide health insurance, something they most likely would have to do anyway to keep a competitive edge?

So you are telling me all new companies will be under 50 people?

http://www.businessweek.com/articles/2012-05-03/why-france-has-so-many-49-employee-companies

[Snipe]

This is hilarious. In America, you are telling me that people will not build their companies because they now have to provide health insurance, something they most likely would have to do anyway to keep a competitive edge?

So you are telling me all new companies will be under 50 people?

The 50 employee limit, if you have never heard of it before, is not about health care. Many federal laws don't apply to small companies, and they cap it at 50.

So it isn't about health care and never really has been. If you have a small company you don't have to comply with most federal legislation if you are under the 50 cap. That is what I was talking about.

To tell you the truth, I am just assuming that Obamacare respects the 50 cap as well. I don't know, and I haven't read the law. Also, I am not close to 50 employees, because if I was, I would know the law.

If I ever employed 60 people, I would do it under multiple organizations to escape federal regulation. Obviously, if I had 1,000 or 10,000 employees that would not be the case, but I would go well over the 50 cap by any means necessary and still avoid federal regulation. I am not the only person to come up with this idea. It happens. When you joke about 52 employees, you don't realize how real that is. It happens. Only a fool would not realize that. Any single proprietor with 49 employees has a huge transaction cost just by hiring the very next (and 50th) employee. Many of those people surprisingly seek to avoid those costs and regulations. Shocking!

[paulxu]

Romney was for the mandate...before he was against it.

That should satisfy a lot of independent voters. They can just pick one or the other.

[GuyFawkes38]

So Roberts argues that the ACA imposes a tax in a similar way as a government imposes taxes on cigarette purchases.

Which seems odd because how can anyone be taxed for being passive and doing nothing. When you buy cigarettes, you are actively endangering your health and putting financial liability on others. So a government imposes a tax on this active behavior.

But here's the key line from Roberts, "the Constitution does not guarantee that individuals may avoid taxation through inactivity."

So lets say a couple decides not to have kids (so they are "inactive"), could they be taxed under the constitution. It appears so.

[Snipe]

I also want to add something DC. I have worked for a company with less than 50 employees. They provided great benefits. I was controller of a trucking company that had 225 people, but 25 were paid on staff and 200 were independent owner/operators that managed their own trucks. Had we been over 50 legally realized employees for Federal purposes, it would have changed the way that we did business. It wasn't that my employer would have had to provide health care, because he already did. It was all the other rules and regulations.

Obamacare is just going to add to the existing tranche of rules and regulations that small businesses don't want to encounter. They want no part of it. Big business is big business for sure, but small business likes flying under the radar. Hiring that 50th employee is a bigger deal than you give credit for. It is real.

Not making that up.

[DC Muskie]

http://www.businessweek.com/articles/2012-05-03/why-france-has-so-many-49-employee-companies

How this an example of what you are talking about?

Also if you actually notice in the article, one example was one entrepreneur setting up multiple companies to skirt the law, which is completely different from the one we are setting up here.

Never mind that at all really....

The point is the guy is still making money expanding and growing his company. In France. Which is not the United States. Last time I checked.

[DC Muskie]

I also want to add something DC. I have worked for a company with less than 50 employees. They provided great benefits. I was controller of a trucking company that had 225 people, but 25 were paid on staff and 200 were independent owner/operators that managed their own trucks. Had we been over 50 legally realized employees for Federal purposes, it would have changed the way that we did business. It wasn't that my employer would have had to provide health care, because he already did. It was all the other rules and regulations.

Obamacare is just going to add to the existing tranche of rules and regulations that small businesses don't want to encounter. They want no part of it. Big business is big business for sure, but small business likes flying under the radar. Hiring that 50th employee is a bigger deal than you give credit for. It is real.

Not making that up.

I'm not sure what your point is here. You worked for a compnay that had great benefits, worked for a company that had 225 employees that had a different, legal set up.

Did that prevent any growth? Did either company start making a profit?

[Snipe]

Are you reading this Chief Justice Roberts???!!

Damn liberal.

Does anyone here actually think companies that have 52 employees that are successful in making a profit will actually NOT grow and expand?

Personally I am shocked the mandate stood. But I am really enjoying reading people's reaction to this decision. And knowing that Bush's biggest appointment to the bench was the deciding factor.

Someone better check with Scalia and make sure his head didn't explode.


I'm not sure what your point is here. You worked for a compnay that had great benefits, worked for a company that had 225 employees that had a different, legal set up.

Did that prevent any growth? Did either company start making a profit?

If you were not sure what my point was, I just returned to quoting your original post where you mocked the thought of "52 employees". Going from 49 employees to 50 employees on the federally recognized payroll is expensive in both time and money. I would venture that Obamacare would only exacerbate that.

That has nothing to do with healthcare though, because that was true 10 years ago as well. Obamacare would only add to the burden of going from 49 to 50.

That was my point, and perhaps it is inconsequential. I am getting to the point where I don't think we can pay for it no matter what sort of system we design. I have little faith in our future viability, or perhaps it is just a mid-life identity crisis.

I am interested if you read my post about Obama accepting the McCain plan. I think that could have saved him a great deal of grief, and gotten us off of the employer mandated system without him being blamed. When employer healthcare collapses now, Obama will be to blame. Give me your thoughts.

[DC Muskie]

When employer healthcare collapses now, Obama will be to blame. Give me your thoughts.

I don't disagree. I'm not a huge fan of mandates but can see their usefulness.

What cracks me about this is, the Obama plan is basically the same one offered in 1993 as a counter measure to the Clinton plan, which was a disaster.

[XU 87]

How this an example of what you are talking about?



Have you ever heard the saying, "You can lead a horse to water but you can't make him drink it?"

[DC Muskie]

Have you ever heard the saying, "You can lead a horse to water but you can't make him drink it?"

Does that something to do with France?

[GuyFawkes38]

Some commentators have claimed that this is a sneaky big win for conservatives and that John Roberts has outsmarted the liberals.

Here's an article with that view:
http://thecaucus.blogs.nytimes.com/2012/06/28/an-important-new-limit-on-the-commerce-clause/

[murray87]

Mick Cronin is hoping this ruling will led to a related ruling that mandates people actually attend UC basketball games again. If not, they will be taxed as if they had attended with a separate penalty tacked on assuming they would have purchased food and beverages at the game.

[Masterofreality]

John Roberts should be a politician.

Great Washington Post analysis:

"After Chief Justice Charles Evan Hughes deftly beat back Franklin Delano Roosevelt’s court-packing proposal, FDR said, with grudging admiration, that Hughes was the best politician in the country. “That was hardly the way Hughes would have chosen to be remembered,” writes James Simon in “FDR and Chief Justice Hughes,” “though there was much truth in the president’s remark.”
I doubt Roberts wants to be known for his political skills, either. But in today’s decision, he showed that, like Hughes before him, he’s got those skills in spades.
The decision today is being reported as 5-4, with Roberts voting with the liberals. Akhil Reid Amar, a constitutional scholar at Yale Law, sees it differently. “The decision was 4-1-4,” he said.

Here’s what Amar means: The 5-4 language suggests that Roberts agreed with the liberals. But for the most part, he didn’t. If you read the opinions, he sided with the conservative bloc on every major legal question before the court. He voted with the conservatives to say the Commerce Clause did not justify the individual mandate. He voted with the conservatives to say the Necessary and Proper Clause did not justify the mandate. He voted with the conservatives to limit the federal government’s power to force states to carry out the planned expansion of Medicaid.*”He was on-board with the basic challenge,” said Orin Kerr, a law professor at George Washington University and a former clerk to Justice Kennedy. “He was on the conservative side of the controversial issues.”
His break with the conservatives, and his only point of agreement with the liberals, was in finding that the mandate was a “tax”*— a finding that, while extremely important for the future of the Affordable Care Act, is not a hugely consequential legal question.
“We won,” said Georgetown law professor Randy Barnett, who was perhaps the most influential legal opponent of the Affordable Care Act. “All the arguments that the law professors said were frivolous were affirmed by a majority of the court today. A majority of the court endorsed our constitutional argument about the Commerce Clause and the Necessary and Proper Clause.*Yet we end up with the opposite outcome. It’s just weird.”
One interpretation is that Roberts was playing umpire today: He was simply calling balls and strikes, as he promised to do in his Senate confirmation hearings. But as Barnett’s comments suggest, the legal reasoning in his decision went far beyond the role of umpire. He made it a point to affirm the once-radical arguments that animated the conservative challenge to the legislation. But then he upheld it on a technicality.
It’s as if an umpire tweaked the rules to favor his team in the future, but obscured the changes by calling a particular contest for the other side.*”John Roberts is playing at a different game than the rest of us,” wrote Red State’s Erick Erickson. “We’re on poker. He’s on chess.”
By voting with the liberals to uphold the Affordable Care Act, Roberts has put himself above partisan reproach. No one can accuse Roberts of ruling as a movement conservative. He’s made himself bulletproof against insinuations that he’s animated by party allegiances.
But by voting with the conservatives on every major legal question before the court, he nevertheless furthered the major conservative projects before the court*— namely, imposing limits on federal power. And by securing his own reputation for impartiality, he made his own advocacy in those areas much more effective. If, in the future, Roberts leads the court in cases that more radically constrain the federal government’s power to regulate interstate commerce, today’s decision will help insulate him from criticism. And he did it while rendering a decision that Democrats are applauding.
“For those of us who oppose the Affordable Care Act as a policy matter, this is a bad day,” Barnett said. “For those of us in this fight to preserve the limits of constitutional government, this is not a bad day.”
And for President Obama, who has labored without success to find a bipartisan foothold in his advocacy for the Affordable Care Act, Roberts’s coup in writing an opinion that has found support on both sides must inspire some grudging respect."

[XU 87]

I've read a few articles similar to the Post article claiming that the Conservatives really won because of the Commerce clause stuff, etc. I think that's all a bunch of intellectual nonsense.

And if Roberts ruled this way because he wanted to show that the court wasn't partisan, he should immediately resign. Judges should rule on what the law says. They shouldn't rule based on how they will be perceived by the public.

The bottom line is that he increased the power of the federal government today. And future federal governments will simply try to expand on that power. Who cares if they expand on that power via the Commerce clause or the ability to tax?

Are future liberal Supreme Court judges going to be more restrained by Roberts' opinion saying that the Commerce Clause and other things are limited? No way. What he says in that opinion will be disregarded in the future by liberal judges. But what he has allowed to happen and what he has permitted the government to do will not be disregarded. And we live with that essentially forever.

[LA Muskie]

The bottom line is that he increased the power of the federal government today. And future federal governments will simply try to expand on that power. Who cares if they expand on that power via the Commerce clause or the ability to tax?

Are future liberal Supreme Court judges going to be more restrained by Roberts' opinion saying that the Commerce Clause and other things are limited? No way. What he says in that opinion will be disregarded in the future by liberal judges. But what he has allowed to happen and what he has permitted the government to do will not be disregarded. And we live with that essentially forever.

Nope. Not at all. "He" didn't expand federal power today. That's been done over a period of several decades by "conservative" and "liberal" courts alike. At most they refused to limit federal power, but I don't even think they did that. The commerce clause ruling is a paradigm shift in constitutional jurisprudence.

And while seemingly arcane the tax/spend dichotomy is huge. There isn't a politician in the country who wants to run on a "raise taxes" agenda. The check on the tax power lays in the electorate.

All of that said, while I think the law is a hot mess, as a small business owner and a husband and father of 2 (the 2nd arriving last week), it is infinitely better than the current system. I suspect the vast majority of those who oppose the law never had to buy health insurance for themselves or -- more critically -- those they care deeply for.

PS: I still don't understand how it's a "tax" for federal power purposes, but not a "tax" for anti-injunction act purposes...seems like a very awkward logical stretch to get to that conclusion.

[Masterofreality]

PS: I still don't understand how it's a "tax" for federal power purposes, but not a "tax" for anti-injunction act purposes...seems like a very awkward logical stretch to get to that conclusion.

Charles Krauthammer agrees with you:

"How to reconcile the two imperatives — one philosophical and the other institutional? Assign yourself the task of writing the majority opinion. Find the ultimate finesse that manages to uphold the law, but only on the most narrow of grounds — interpreting the individual mandate as merely a tax, something generally within the power of Congress.

Result? The law stands, thus obviating any charge that a partisan court overturned duly passed legislation. And yet at the same time the Commerce Clause is reined in. By denying that it could justify the imposition of an individual mandate, Roberts draws the line against the inexorable decades-old expansion of congressional power under the Commerce Clause fig leaf.

Law upheld, Supreme Court's reputation for neutrality maintained. Commerce Clause contained, constitutional principle of enumerated powers reaffirmed.

That's not how I would have ruled. I think the "mandate is merely a tax" argument is a dodge, and a flimsy one at that. (The "tax" is obviously punitive, regulatory and intended to compel.) Perhaps that's not how Roberts would have ruled had he been just an associate justice, and not the chief. But that's how he did rule.

Obamacare is now essentially upheld. There's only one way it can be overturned. The same way it was passed — elect a new president and a new Congress. That's undoubtedly what Roberts is saying: Your job, not mine. I won't make it easy for you.

Charles Krauthammer's email address is letters@charleskrauthammer.com."

[UCGRAD4X]

(the 2nd arriving last week)

Congratulations, LA, on expanding the Musketeer fan base.

Sorry I missed this little detail elsewhere.

Are other details available?

[GuyFawkes38]

All of that said, while I think the law is a hot mess, as a small business owner and a husband and father of 2 (the 2nd arriving last week), it is infinitely better than the current system. I suspect the vast majority of those who oppose the law never had to buy health insurance for themselves or -- more critically -- those they care deeply for.


Being in your position, you might know this better than myself. If I understand this right, the ACA will encourage small business owners like yourself to ask you employees to go on the private exchange insurance market because the ACA imposes a penalty on businesses that is much less than the cost of actually enrolling an employee into a comparable plan that they can receive on the exchange market.

[blueblob06]

Agreed, congrats LA!

[jhelmes37]

Apparently when you read the health care thread, you realize it's also the baby announcement thread!

Congrats to you, LA!

And Ava Madison (my 2nd daughter) was born last Thursday. The Musketeer legion at our house is growing by leaps and bounds.

[bjf123]

Apparently when you read the health care thread, you realize it's also the baby announcement thread!

Congrats to you, LA!

And Ava Madison (my 2nd daughter) was born last Thursday. The Musketeer legion at our house is growing by leaps and bounds.

Congrats to both of you!

[Masterofreality]

Attention Internet Security Administration:

Thread Hijacking in process!!!!!!!!

[LA Muskie]

Being in your position, you might know this better than myself. If I understand this right, the ACA will encourage small business owners like yourself to ask you employees to go on the private exchange insurance market because the ACA imposes a penalty on businesses that is much less than the cost of actually enrolling an employee into a comparable plan that they can receive on the exchange market.
We are very small (defined under current law as under 25 employees) and therefore the law actually benefits my business -- we are not required to provide coverage, but if we do we may be eligible for tax credit for subsidizing employee coverage.

That said, and I believe this is true of many (if not most) small businesses, I've never been concerned about an employer mandate. Much to the contrary, from Day 1 I have always wanted to provide healthcare benefits to my employees. The hangup has always been the cost, which has been prohibitive in a small group plan.

The minute I can cost-effectively procure healthcare for my employees, I will do it. I will do it because I believe that the employees want it, and happy employees are generally better employees. Additionally, there is a chance it will make my employees healthier, which would help my bottom line.

As for the employer-secured vs. private exchange dichotomy, separate "Small Business Health Option Programs" -- known as SHOP Exchanges -- are being created. They are sort of a hybrid. The employer contracts with the exchange, but gets exchange pricing. In fact, small businesses can maximize their tax credits (up to 50% credit) for going this route.

As for larger businesses that won't be eligible for SHOP Exchanges, I don't see the insurance companies leaving the business, so I am confident they will find a way of competing with the exchanges to make it cost-effective for large companies to maintain their company-provided coverage.

[LA Muskie]

Congratulations, LA, on expanding the Musketeer fan base.

Sorry I missed this little detail elsewhere.

Are other details available?
Sorry. Whirlwind last week so that was the first time I mentioned it on the boards. He came a bit early, and he's tiny, but he and mom are doing well. His name is Christian Michael, and he weighed in at 5 1/2 lbs and 18 inches. But he's eating non-stop, so I'm pretty sure he'll catch up soon.

Thanks to all for your congratulations and well-wishes! Another Muskie is in the house!!!

[LA Muskie]

Apparently when you read the health care thread, you realize it's also the baby announcement thread!

Congrats to you, LA!

And Ava Madison (my 2nd daughter) was born last Thursday. The Musketeer legion at our house is growing by leaps and bounds.

Congrats to you as well. Absolutely love that name!

[GuyFawkes38]

We are very small (defined under current law as under 25 employees) and therefore the law actually benefits my business -- we are not required to provide coverage, but if we do we may be eligible for tax credit for subsidizing employee coverage.

That said, and I believe this is true of many (if not most) small businesses, I've never been concerned about an employer mandate. Much to the contrary, from Day 1 I have always wanted to provide healthcare benefits to my employees. The hangup has always been the cost, which has been prohibitive in a small group plan.

The minute I can cost-effectively procure healthcare for my employees, I will do it. I will do it because I believe that the employees want it, and happy employees are generally better employees. Additionally, there is a chance it will make my employees healthier, which would help my bottom line.

As for the employer-secured vs. private exchange dichotomy, separate "Small Business Health Option Programs" -- known as SHOP Exchanges -- are being created. They are sort of a hybrid. The employer contracts with the exchange, but gets exchange pricing. In fact, small businesses can maximize their tax credits (up to 50% credit) for going this route.

As for larger businesses that won't be eligible for SHOP Exchanges, I don't see the insurance companies leaving the business, so I am confident they will find a way of competing with the exchanges to make it cost-effective for large companies to maintain their company-provided coverage.

This is part of the reason why I'm sympathetic to ACA. You shouldn't have to have 15,000 employees to effectively bargain with insurance companies. The current market place is okay for Procter and Gamble, GE, and government employees, but awful for small businesses and individuals without insurance.

On a related note, this is a good history of broccoli:
http://www.slate.com/blogs/browbeat/2012/06/29/the_supreme_court_health_care_and_broccoli_why_is_ broccoli_the_poster_child_of_despised_vegetables_. html
I love broccoli.

[Snipe]

I don't disagree. I'm not a huge fan of mandates but can see their usefulness.

What cracks me about this is, the Obama plan is basically the same one offered in 1993 as a counter measure to the Clinton plan, which was a disaster.

It really isn't a mandate anymore, per the Supreme Court, it is just a tax. That takes away any moral responsibility to adhere to it, you either pay for expensive health insurance, or you pay the inexpensive tax. The expensive health care premiums go to the insurance industry to help them cover costs. The tax you would pay does't go to them, it goes to the Federal Government. And if you ever need expensive health insurance, you can sign up at any time with no pre-existing conditions. It will destroy what was left of the private market for health care and drive up costs. Only suckers will continue to pay the premiums under that scenario.

Who is going to pay for expensive insurance when you can pay the cheaper tax? If your insurance is paid by someone else, you will still want insurance for sure, but if you are paying insurance? And how does it break down demographically? People that come here from corrupt Latin American countries are more prone to game the system. That is why they have so much corruption down there, my theory is that the people have something to do with their notoriously corrupt practices. I could be wrong, perhaps they will be saints in America, but 75% of first generation Mexicans immigrant households are on welfare.

I don't see insurance companies being able to function unless they come under the umbrella of the state with this plan.

Why not just give everyone a voucher and tell them to go by the best health insurance they can find?

[Snipe]

All of that said, while I think the law is a hot mess, as a small business owner and a husband and father of 2 (the 2nd arriving last week), it is infinitely better than the current system. I suspect the vast majority of those who oppose the law never had to buy health insurance for themselves or -- more critically -- those they care deeply for.



It hasn't even been implemented yet, can you spare me the "infinitely better" impartial review? Maybe it is going to be, and then maybe again it is not. I believe that a lot of life is about trade offs, not just good and bad. What will the trade offs be with this new legislation? I don't know, but I can see it being a big fail. That is actually my prediction. That is not to say that some people won't benefit, because somebody always does.

I can't see how it will work on a fiscal/economic level for a country already in massive debt. The numbers seem to be massaged and don't add up.

[LA Muskie]

It hasn't even been implemented yet, can you spare me the "infinitely better" impartial review? Maybe it is going to be, and then maybe again it is not. I believe that a lot of life is about trade offs, not just good and bad. What will the trade offs be with this new legislation? I don't know, but I can see it being a big fail. That is actually my prediction. That is not to say that some people won't benefit, because somebody always does.

I can't see how it will work on a fiscal/economic level for a country already in massive debt. The numbers seem to be massaged and don't add up.
A "big fail" will be no worse than we already have. Viewed in that light, it's all upside.

[Snipe]

We are very small (defined under current law as under 25 employees) and therefore the law actually benefits my business -- we are not required to provide coverage, but if we do we may be eligible for tax credit for subsidizing employee coverage.

That said, and I believe this is true of many (if not most) small businesses, I've never been concerned about an employer mandate. Much to the contrary, from Day 1 I have always wanted to provide healthcare benefits to my employees. The hangup has always been the cost, which has been prohibitive in a small group plan.

The minute I can cost-effectively procure healthcare for my employees, I will do it. I will do it because I believe that the employees want it, and happy employees are generally better employees. Additionally, there is a chance it will make my employees healthier, which would help my bottom line.

As for the employer-secured vs. private exchange dichotomy, separate "Small Business Health Option Programs" -- known as SHOP Exchanges -- are being created. They are sort of a hybrid. The employer contracts with the exchange, but gets exchange pricing. In fact, small businesses can maximize their tax credits (up to 50% credit) for going this route.

As for larger businesses that won't be eligible for SHOP Exchanges, I don't see the insurance companies leaving the business, so I am confident they will find a way of competing with the exchanges to make it cost-effective for large companies to maintain their company-provided coverage.

I think it is admirable that you want to give your employees coverage. But you don't, because it is too expensive. That is a fact many business owners face. You will need a tax credit to give them coverage, but credits aren't free and that money will have to come from somewhere. Somebody else, the American taxpayer, will help you provide your employees coverage.

I am not against the American taxpayer chipping in, but do they need to do it for businesses, or should they just give everyone a tax credit? Your employees are already on their own for insurance, why not give the credit to them instead of you? You can't afford to give it to them. Why should the government pay you to buy their insurance? If you have 20 employees, you would be deciding on a plan for 20 people. If the government gave a credit to all of them, they could decide on the best plan for them.

This isn't about health care, it is about health insurance. It is an important distinction that gets lost. Your employees already have health care, what you want to give them is health insurance. Why not just have Uncle Same give them all some money and let them choose if we are going this route. We can only do this while we still have carriers of health insurance. Once the government exchanges at set up, private companies will be competing against the taxing authority, and I don't like their long term odds. I think they will either perish or become agents of the state, or maybe like a utility company.

I think true cost reduction comes from consumer choice. Most people can't fire their heathcare plan, because they get it from someone else. And many people at hospitals are not customer friendly because you aren't paying the bill. Somebody else is paying, and you get treated that way sometimes, at least in my experience. Healthcare has already been moving to a customer service model closer to the BMV/DMV. I don't like the future if it continues like that. I think that the whole system is at stake.