ObamaCare - The New Perspective

[Aramike]

Now that the Democrats have been handily rebuked, we are left with the question of the healthcare bill passed last year. Republicans are singing "repeal" while Democrats are expressing little regret.

What say you? Repeal ObamaCare?

And if so, do you support ANY healthcare overhaul? What ideas do YOU have?

[TLAM Strike]

I voted no because I would only support a repeal in place of a single payer system.

I don't think they have given any time to see if this new system even works.

[Castout]

Send Obama here and we'll send you ours call it leaders exchange.


Only permanent. . .I'm not being subjective, emotional or fanatical about the person or even his personality as I don't believe in a man cult but what he's trying to accomplish and do. The other American leaders I'd love to have are Martin Luther King Jr and JFK but some Americans shot them to death for scaring them to death with their ideals . . .

[Betonov]

The law includes numerous health-related provisions to take effect over a four-year period, including prohibiting denial of coverage/claims based on pre-existing conditions (http://en.wikipedia.org/wiki/Pre-existing_conditions),If this is now not implemented and wont be if it is repelled, so this actaully means, that if I, having an asthma and a hightened cancer and diabetes risk due to fammily history, wouldnt get an insurance and probibly had to take a masive loan just to cover my medical bill if I brake my leg. I'm sorry my dear americans, but that is medieval

[Skybird]

Bernanke wants to print another 900 billion, media report. Isn't that the real story to discuss?

In the end, the question of whether or not private persons have health insurrance in America, is of no direct importance for Europeans. What is of intrest for us is all American decision-making that effects the international economic and financial market, the deficit, the substantial structural problems, the attempt of the Fed to artifically devalue the dollar (ironiocally what they accuse the Chinese of), the debt burden. All these characteristics of present America - costs all other nations and economies much much money.

As long as the Fed is allowed to go on rampage whenever it wants, any disucssion about the costs of the health reform being too huge, is almost pointless, and more a controvery about pure ideologics.

Forbes magazine, btw, today has released it'S list of most powerful people in the world. 1st place is no longer the US president, but the Chinese premier Hu. With US finances constantly detoriating and leading the country into increasing dependency from foreign nations, that is unlikely to change again soon.

[mookiemookie]

Now that the Democrats have been handily rebuked, we are left with the question of the healthcare bill passed last year.
No we're not left with that question at all. The Dem's still control the Senate and have veto power in the White House. It's not being repealed.

The CBO estimates that nationwide Romneycare will cut the deficit by $1.3 billion over 20 years. (http://voices.washingtonpost.com/ezra-klein/2010/03/cbo_health-care_reform_bill_cu.html) How would the newly-minted deficit hawks pay for a repeal?

I'm with TLAM - I would only be in favor of repeal in exchange for a single payer system. Make no mistake, this bill was a bloated piece of garbage written by insurance companies, but there are pieces of it that do good.

[CaptainHaplo]

A repeal won't happen. Its red meat political posturing, but logistically there is no way to have it occur.

However, its important to remember that each portion of Congress has within its purvue certain responsibilities. The House of Representatives controls the purse strings. What you will see is the HoR refuse to fund the various agencies and points of the bill, keeping it from being implimented.

For example - the "clearance house" where private insurance and government insurance will both be "sold", will not be funded. The funds to allow for "governmental health insurance" will not have any fiscal allocation. So if its not funded, no one can get it - thus it doesn't exist.

Repeal? Not happening for at least 2 years. Dead in the water? Bet on it.

[SteamWake]

A repeal most likely wont happen but I say put it to a vote and make them veto it.. make the left 'own' the legislation.

[AVGWarhawk]

A total repeal will probably not happen however the pork and other goodies within the bill need to be removed. In short, the bill was crammed up our arses with little say. I would hope the bill is looked over again and change are made.

[CaptainHaplo]

Oh the house will vote initially to repeal it - and the senate might actually PASS the repeal - but Obama will veto that. There will not be enough votes to override it. Once that is symbolically done, then you will see the House use the purse strings to kill it. They will also try to trim it, but nothing will get past Obama on that score. So it will have to be starved to be made to die.

[Bubblehead1980]

The bill needs to to absolutely be repealed for many reasons.The main reason is the law is unconstitutional due to the individual mandate.Several lawsuits are in the courts and will make it to SCOTUS where most likely obamacare will thrown out due to the mandate.Most Justices on SCOTUS care about the constitution still.

Other reasons are the costs....taxes on medical equipment etc that will drive costs up, not down, the money it will cost to expan medicare etc

Once Obamacare is out, can keep the few good things such as not being able to deny for prexisting conditions, can't be dropped, can stay on parents insurance until 26 etc.

This law is one of the biggest threats to this country's future and must be eliminated at all costs.

[GoldenRivet]

No we're not left with that question at all. The Dem's still control the Senate and have veto power in the White House. It's not being repealed.

Yet.

While i agree we need some kind of reform... this bill was clearly not a bipartisan venture and is another welfare grab taking money from those who work, and giving it to those who dont. thats all it is.

we need reform... not THIS reform.

in fact i would almost 100% support the bill if i were not FORCED under duress to buy healthcare.

I shouldn't have to pay for your health care any more than you should have to pay for mine.

[AVGWarhawk]

No we're not left with that question at all. The Dem's still control the Senate and have veto power in the White House. It's not being repealed.


We have to understand that states are challenging this bill. I think by overwhelming majority of the voters and pressure on the new powers that be...this bill will die or be drastically changed.

[GoldenRivet]

We have to understand that states are challenging this bill. I think by overwhelming majority of the voters and pressure on the new powers that be...this bill will die or be drastically changed.

even i say it shouldnt "die".

there are about a half dozen things worth keeping.

on the whole though. Get rid of the mandate, give me freedom of choice - and im all in.

yet the Dems wont even budge on that.

[mookiemookie]

I shouldn't have to pay for your health care any more than you should have to pay for mine.

That's what insurance is. Cancel every insurance policy you have if you don't like it.

[GoldenRivet]

That's what insurance is. Cancel every insurance policy you have if you don't like it.

but as yet i have the OPTION.

My wife and i would pay into private insurance so that WE can have specific coverages and options... not so that the welfare crack whore mother of 7 illegitimate children can pick and chose coverages and options.

what part of "give me the option to choose whether or not i have insurance" are you not getting?

[mookiemookie]

but as yet i have the OPTION.

My wife and i would pay into private insurance so that WE can have specific coverages and options... not so that the welfare crack whore mother of 7 illegitimate children can pick and chose coverages and options.

what part of "give me the option to choose whether or not i have insurance" are you not getting?

hee hee

:D

[GoldenRivet]

Im basically tired of "certain members of society" getting their free ride.

[tater]

That's what insurance is. Cancel every insurance policy you have if you don't like it.

Insurance is voluntary.

This law is idiotic, and is overwhelmingly negative. It also doesn't address any of the real problems. Forcing docs to see patients that they actually lose money seeing would be like forcing auto workers to build cars and pay them less than their lunches and gas money costs. Should auto-workers subsidize car prices by being paid less than their direct costs to get to and be at work?

This disincentivizes becoming a doc in the first place (negative incomes are unattractive), when a real problem is a lack of providers. Don't worry, we can mint more by lowering standards. Maybe the DO schools can crank out more poorly qualified "docs" to meet the need—don't see any too far after graduation, they are not required to re-certify like real docs.

Oh, wait, docs won't make negative incomes, they can't. In return, insurance must pay even more, which means massive premium hikes assuming your employer doesn't elect for the de facto public option in the plan of dumping people on medicaid. Have fun in the waiting room next to the guy in the orange jumpsuit and manacles.

All that without the entirely unknown stuff since most of the actual details (required to know anything about how the bill really works, or costs) are left to unelected people to decide for us. Anyone claiming to know the real net results of this bill is flat out lying, since again, very little is actually written down (amazing given the size of the bill), and is to be added by people who no not represent the people at some indeterminate time in the future.

A good law would not be nearly as long, and would have everything written down so we'd know what to expect. Any bill—or process—to work on healthcare that is not 100% transparent, with clear language, and plenty of time for the public to actually understand the bill should have been summarily rejected.

Note that Obama said as much during the campaign (he must have been lying). he said the entire process should be televised on CSPAN. He said that any healthcare solution needed to be bipartisan, it was just too important to be partisan. He said there should be no "closed door" sessions. The actual bill was passed in a completely partisan way, was incredibly opaque with votes bought in closed door sessions, and no one in congress, much less lay people could possibly have understood the bill before it was voted on.

[Platapus]

This poll is not valid as it does not give us all the choices. Why would anyone think this question can be answered with only those two options. :nope:

[Ducimus]

Why would anyone think this question can be answered with only those two options. :nope:

Because some people here can only see in two dimensions, with nothing in between?

[Tchocky]

Because some people here can only see in two dimensions, with nothing in between?

WRONG

[Buddahaid]

Even if you work and live within your means, how can you afford not to have health insurance? I have insurance, but if I didn't, I would be very hard put to pay the $60,000.00 it cost to have my wifes broken ankle repaired. $7,300.00 for the ER visit and $56,000.00 for the surgery. :o

[Platapus]

Because some people here can only see in two dimensions, with nothing in between?

Yeah, I am afraid you are right.

In a kooky way, it must be comforting for many, to be able to only see the realities of life through black and white lenses.

Every time I try to see the world in black and white, all I see is varying shades of gray.

[tater]

Even if you work and live within your means, how can you afford not to have health insurance? I have insurance, but if I didn't, I would be very hard put to pay the $60,000.00 it cost to have my wifes broken ankle repaired. $7,300.00 for the ER visit and $56,000.00 for the surgery. :o

That the actual amount paid, or a billed amount? What gets billed, and what the contract is for actual payment can be very different.

My wife at first comped a surgery, and they got reamed for several thousand bucks anyway, then had to charge for the surgery, because the insurance would not pay with no surgeon fee. Her fee was a couple hundred bucks, the total cost was closer to 15 grand.

One huge problem is the disconnect between paying and getting service. The patient and the doc—neither have a clue how much it costs. There is no feedback at all.

[Platapus]

A few years ago, The Frau had to get some surgery that was not covered by insurance. Once the doctor understood that we were paying cash, the "cost" of the operation dropped significantly.. as in less than half. :yep:

[tater]

A few years ago, The Frau had to get some surgery that was not covered by insurance. Once the doctor understood that we were paying cash, the "cost" of the operation dropped significantly.. as in less than half. :yep:

It's like that because if the posted rate was lower, then some health plan might demand a discount on THAT rate. Usually the amount collected from insurance is a fraction of the billed amount.

Imagine if the plumber could send you a bill, and you could send them 50% and they'd say "thank you, come again!" instead of sending you to collections.

BTW, you can always make arrangements to pay, then pay SOMETHING every month. Even $5 and my wife's office would never send you to collections. He biggest few stiffs on payment have all had one thing in common...

all were lawyers. %$#@%$# deadbeats. The lawyer jokes can start any time.

[Aramike]

No we're not left with that question at all. The Dem's still control the Senate and have veto power in the White House. It's not being repealed.That's a pretty bold statement. Just two years we were overwhelmed with predictions of doom for the GOP, and now look where we are.

Honestly, I suspect that a very real, determined, and intensive effort to repeal Obamacare will begin as soon as the new Congress is sworn in. Furthermore, I believe that you are overestimating the meaning behind the fact that the Dems maintained control of Congress during this election - far more Democrat Senators are up for reelection in 2012 than this time around, many of which come from moderate to conservative districts which went Democrat in '06 due to dissatisfaction with Bush and the GOP that was heavily entrenched at the time. I will not be in the least bit suprised if they begin to move away from their vote on healthcare in the interest of self-preservation.

If that happens, I don't see a presidential veto - if the Democrats and Republicans both come out against Obamacare, Obama would be sealing his fate by going against both his party and the opposition (enemy).

Bottom line is that it would be insane to think that the GOP won't be intense in going after this issue, as it is a proven winner for them.

[Aramike]

This poll is not valid as it does not give us all the choices. Why would anyone think this question can be answered with only those two options. :nope:I think you need to re-read the question then. I'm not sure what choice other than "yes" or "no" there is to "would you support the repeal of Obama's healthcare legislation?".

Also, if you read my original post, I ask for details regarding the gray areas I think you're referring to.

[Aramike]

Oh, and an aside: part of my motivation for this thread was to do a poll that shows how GT isn't predominantly conservative or liberal in its thinking, as I tire of reading time and time again from people on both sides how their ideas are not gaining any traction because the whole board is against them. :arrgh!:

[Aramike]

If this is now not implemented and wont be if it is repelled, so this actaully means, that if I, having an asthma and a hightened cancer and diabetes risk due to fammily history, wouldnt get an insurance and probibly had to take a masive loan just to cover my medical bill if I brake my leg. I'm sorry my dear americans, but that is medievalI missed this...

...actually, I agree with you here. There should be a subsidy for coverage of pre-existing conditions - but ONLY under certain circumstances.

For instance, if you've been unemployed and can prove that you weren't carrying health insurance because you couldn't afford it, than there should be a means to help you out.

On the other hand, if you decided that you weren't going to pay for health insurance because you just didn't want to and then something came up, sorry to say, that's your own damn fault. If you make decisions that have terribly negative consequences, it is not Joe Taxpayer's responsibility to clean your mess up for you.

True story: I was out having a few drinks recently with the wife and I overheard young people talking about health insurance. One was bitching about how preexisting conditions should be covered because insurance is too damned expensive.

His bar tab was $50. He could get independant coverage for that amount.

Why is it that in this county we've gotten to the point where some irresponsible behavior is not only expected, but expected to be consequence free?

[GoldenRivet]

if...

1. The right to elect NO health insurance was part of the plan.

2. The right to refuse payment into the health care plan if you are on another plan already. (or the right to pay into it if you desire)

3. keep the pre-existing coverage material in the bill

4. REQUIRE all government employees, the President, Members of the House and Senate to use the government subsidized health insurance plan in public hospitals within a 30 mile radius of their homes.

I'd support it.

These dems won't budge on any of that though and i dont understand why.

[JU_88]

Didnt vote as im not from the U.S
But I will say that here in the UK we have had an 'Obama care' style system for decades and it works ok. (The NHS)
British people do moan about it (as they moan about everything) - but they moan even more when they injure themselve while abroad in the U.S, their first complaint being that your costs are shocking.

So for obviouse reasons I dont see the problem with a collective system where everyone helps everyone out by putting a small amount of money in the pot each month.
Its no more 'socialist' than current tax systems which you already have in place.
If you are so opposed to a national healthcare system, then you might as well demand the government sends you an itemized bill for your tax dollars - to ensure they've only spent it on things that benefitted yourself.

No offense, But its a bit of a self-centered attitude im seeing 'why should I help anyone but myself'.
I honestly find it quite surprising for a nation which is generally quite proud and patriotic, Id have thought that more of you would be more willing to consider your fellow Americans, some of whom might be less fortunate than yourself.

I apprieciate that it may seem unfair to pay up if you dont need any personal treatment right now - but one day you probably will and if you are not insured, can you really garrantee you will definatley be able to afford it when that day comes?

I know its easy to focus on the negatives, like those who might exploit the system, (but remember that it comes with so many possitives too)
I think the main problem for you is that its an additional monthly wage deduction - which is hard to swallow at first.

But give it a chance guys, its really not so bad.

Edit - I have to say I like GR's excellent above four suggestions^. That would have been a far more sensible approach for the Dems - rather than simply ramming it down everyones throat.

[Sailor Steve]

So for obviouse reasons I dont see the problem with a collective system where everyone helps everyone out by putting a small amount of money in the pot each month.
It's arguable whether we should have a problem with it, and so we do debate it. My biggest objection isn't the idea of putting a little in the pot. My biggest objection is someone else taking it from me forcefully and putting it in the pot for me.

Its no more 'socialist' than current tax systems which you already have in place.
Which I also object too.

If you are so opposed to a national healthcare system, then you might as well demand the government sends you an itemized bill for your tax dollars - to ensure they've only spent it on things that benefitted yourself.

No offense, But its a bit of a self-centered attitude im seeing 'why should I help anyone but myself'.
And your point is? Again, I agree that everyone should be kind, generous and giving. But I don't like the idea of anyone taking from someone and "giving" in their name.

In answer to your other arguments, I'll repeat what I've said in other contexts: If you really believe that is the best way to go, why don't you have a tax rate of 100%, and just give us what you think we need.

[tater]

Forcing the same rates for people that are at grossly higher risk breaks the entire model of insurance. People that skydive should pay higher life insurance premiums than people who, I dunno, "quilt" as a hobby, for example. It's only fair.

GRs ideas cannot work. If you can opt out of insurance, but the insurers are forced to accept you with a preexisting condition, there is no reason to get fully insured until you are already sick. Get cancer, THEN get insurance. The PE conditions stuff is exactly what is needed, a stick to push HEALTHY people to get insured. The penalty for failure to do this NEEDS to be high, or no one will buy insurance until needed.

Imagine if you could buy car insurance retroactively. You'd get the minimum required, then upgrade to comprehensive on the cell phone AFTER a crash. That is what dumping preexisting conditions means. It is exactly the same.

The fundamental problem with the US insurance model is having coverage be provided by the employer. Insurance should be bought by the INSURED. This incentivates shopping. You don't see health plans advertising the way Geico does, for example, but you would. This would also end COBRA nonsense. Insurance should not be connected to an employer, but YOU. The government can incentivize insurance through 100% write-offs for premiums, not off AGI, but off taxes paid. Also allow insurance to cross state lines. State by state screws up everything.

On the provider end, medicare and medicaid need to be completely reworked. The latter pays well below cost to specialists (GPs might break even, even including their time). Any government charity care should be a write-off for the provider. If my wife gets paid $17 for something that private insurance pays $117 for (and her direct cost is $60), she should be able to write-off $100 as a charitable contribution instead of what happens now—we pay her employees $43 out of pocket so that the medicaid patient can be seen, wife gets ZERO for her time (really gets -$43). The write off should be 100% of that difference off AGI. The "retail" amount can be set as a reasonable multiple of medicare assuming medicare is unfixed.

Also needed is tort reform (dems will never vote against lawyers though). Lawsuits themselves are not a huge total cost, but they have created a culture of defensive medicine that costs as much as 20% of total healthcare costs nationally. Insurance profit, BTW, is 1-2% of total healthcare costs. Insurance=evil, defensive medicine caused by scum-sucking lawyers? Apparently=meh (even though fixing this saves 10X the money that it would for insurance to make ZERO profit).

Medicare sets costs right now, which is why the bill is so very awful. When an unelected goon drops medicare payments to docs, it does NOT just affect medicare. Other contracts are pegged to that coding. Short term, medicare drops, docs stop seeing medicare. Then the privates drop their payouts in lockstep, then docs are screwed since they count on the higher private pays to subsidize the charity care called medicare and medicaid (former is not as bad as the latter, but you're lucky to even break even on it).

The entire bill needs to be scraped, and done over properly. There is nothing in those thousands of pages worth keeping in the context of the bill. Some bits might be worth keeping rewritten into a smaller bill that doesn't stink.

[gimpy117]

Personally, I think it's High time we get universal health care, not this bill that mandates you get health care coverage via a company. I think the mandate part should be taken out. We ran the numbers, and as a poor collage student I can't afford it, and even with the government subsidies my mother cannot as well. So i suppose we get fined every year. Other parts are good, and should be kept.

I was highly disappointed when the Republicans forced the bill to be watered down to a bill that makes people buy health coverage. Universal Health care is something that i feel this country would benefit highly from. As somebody that has been in a situation where they are not insured I can assure you it would help a lot of us. Take my mother for instance. She is not some straw man "crack whore", Shes a fine upstanding woman who works harder than any person i know to keep a roof over her and our heads and food on the table. There is no way she can pay for health insurance. About 2 years ago she cracked a Molar because of stress. Sadly, She couldn't afford to get a false tooth because they are expensive. So she just has no molar. Shes 54 now, still working, But I'm sure she hasn't had a check up in years...because it costs money. I myself am 19 and trying to put myself through school. I have reoccurring tonsilitious stemming from a really bad staff infection when i was 17. I haven't been able to see a doctor about it because I simply cannot afford it. And Believe me, having your tonsils be on fire for a solid week is not fun. I suppose we're some of the lucky ones though...none of us 3 have have cancer or something liek that. I would hate to have to hold a BAKE SALE so i could buy my next round of chemo rather than die.

People like me and my mother could have a much higher standard of life if we passed a universal health care bill. We would be paying taxes on it just the same as you. and you would also have health insurance as well. Guaranteed.

[tater]

Nonsense. I'd be paying for it for you, as would everyone else who has insurance now. Anyone who would benefit from universal care is pretty much guaranteed not to to be pulling their weight in taxes. Anyone eligible for any "subsidy" already pays no meaningful taxes.

The reality in the US is that the large majority of people are happy with the healthcare they have. Universal care would reduce quality of care.

The US system, warts and all is arguably the best on earth.

The only good metric of quality of care is not "lifespan" or other nonsense that is confounded by lifestyle issues. Look at treatable but otherwise fatal illness incidence, and mortality rates.

Do this for breast cancer. Mortality/incidence is better in the US (we have a much higher incidence, but slightly lower death rate). The only factor here is delivered care. The US stats include the uninsured, medicare, medicaid, etc. We still "win." The US is the best place to get treated for cancer where living and dying is solely a function of medical care quality. The stats are similar for cancer after cancer. Heart disease is harder since lifestyle is so very critical for that.

<EDIT>Here is a prostate cancer example, BTW (from a UK urology journal). The top is incidence per population at large, bottom is mortality per population at large:
http://ldc.upenn.edu/myl/llog/ProstateCancerRates.png
Put death rate per 100,000 over incidence per 100,000:
USA: ~17% mortality.
UK: ~47% mortality.
Sweden: ~44%

Is it cheap? Nope. It's a diminishing returns thing. You can get close for a LOT less money. With universal care, that's what you'll get. Actuarially the society might benefit, but it also means that mom might have to "take one for the team" when she gets breast cancer. It's great to do the most cost effective thing unless it's YOU who has to pay the price.

In the US, over 90% of lifetime healthcare costs are incurred in the last months of life.

I'll type that again:
In the US, over 90% of lifetime healthcare costs are incurred in the last months of life.

Understand that. Insurance profits at most 2% of total cost. 90% of cost is needless care (needless if buying a few quality months is considered needless—which I would not think if it was time to be with my kids, for example, before dying, I'd be all for buying even 2 months at huge cost to spend time with them).

Reducing defensive care would take a "generation" or two of docs to come into effect (the "culture" is already inculcated), but could save 10-20%. The only other way to reduce costs is to ration end of life care. "death panels" might be hyperbole, but guess what, any public system or public rules that are supposed to reduce our national cost either ration care for possibly terminal disease, or they are so much BS. So if such a system claims to cut costs in any meaningful way, it MUST ration that 90% cost.

But back to my observation about US death rates to cancers. Part of the reason out rate is better is that we do waste this 90%. The deal is that some people respond really well, but oncologists don't know until they try. It;s a case where empirical care might do squat for a lot of people, but do really well for SOME. My mom was on tamoxifin, and responded super well. It was very expensive, but it bought her a few years. Others she knew took it, and it did squat. So we can reduce those costs, but some people then have to die.

[CaptainHaplo]

"As somebody that has been in a situation where they are not insured I can assure you it would help a lot of us."
"People like me and my mother could have a much higher standard of life if we passed a universal health care bill."

"A democracy cannot exist as a permanent form of government. It can only exist until the voters discover that they can vote themselves largesse from the public treasury. From that moment on, the majority always votes for the candidates promising the most benefits from the public treasury with the result that a democracy always collapses over loose fiscal policy, always followed by a dictatorship." - Author Unknown (often attributed to Alexander Tyler)

Understand that I am not slamming you personally gimpy. However your statements prove the above quote to be true. Its a human reaction. The reality that we have a republic, and that it (the people) see the collapse coming and are trying to avoid it.

"We would be paying taxes on it just the same as you. and you would also have health insurance as well. Guaranteed."

Yes - your right. However, do you really think the taxes paid will actually cover all the costs of health care for all Americans? Because insurance is that you pay a little - and someone else - in this case - the government - would pay the rest. So you think the taxes from all the citizens would be sufficient to pay for all the health care that all the citizens need? If not - then you run a deficit - meaning that the government has to take (steal) money from other places and programs, or go into debt. If you look at the history of the government and its administation of social programs, like medicare - you can see that it will mismanage the program and will run a deficit. This is why "universal healthcare" is a bad idea - because it cannot be paid for.

I feel bad for you - but there are already a slew of social programs that offer people in similiar situations help. Look into it. But ask your mom about what happens when you don't pay the bills you have - sooner or later it all comes crashing down. Are there some good things in this bill? Sure, but the good is vastly outweighed by the bad. It needs to be redone. 2800+ pages - and how many "good things" can you name?

[mookiemookie]

Imagine if you could buy car insurance retroactively. You'd get the minimum required, then upgrade to comprehensive on the cell phone AFTER a crash. That is what dumping preexisting conditions means. It is exactly the same.

No it's not. Human beings are not cars. Telling someone "we won't repair the door scrape on your Kia" is not the same as telling someone "We won't cover your chemo treatments."

Fixing a car isn't a situation that will drive you bankrupt. It's not a life or death matter. Health care is both. You can repair a car without insurance. Then you can go out and buy insurance on that car with no problems. The same cannot be said about health insurance.

Cars without door dings are not as valuable to us as a nation as a healthy population is.

[AVGWarhawk]

You can repair a car without insurance.


You can get healthcare without insurance.

[CaptainHaplo]

Cars without door dings are not as valuable to us as a nation as a healthy population is.

The current immigration stance would indicate otherwise... not to mention we as a country and as a planet are overpopulated.

Not encouraging anything - just pointing out the reality.

[tater]

No it's not. Human beings are not cars. Telling someone "we won't repair the door scrape on your Kia" is not the same as telling someone "We won't cover your chemo treatments."

Fixing a car isn't a situation that will drive you bankrupt. It's not a life or death matter. Health care is both. You can repair a car without insurance. Then you can go out and buy insurance on that car with no problems. The same cannot be said about health insurance.

Cars without door dings are not as valuable to us as a nation as a healthy population is.

It's exactly the same.

No preexisting conditions means no buying insurance til AFTER the "crash" to use the car analogy. They are exactly the same. This is why even the dems wanted the "mandate." The mandate goes with no preexisting conditions because with the no PE limitations, you MUST force buying care, else no one will. They go hand in hand. That was clearly the context of my statement.

Once actually sick with something like cancer, it's not at all like a car. You can fix a car, but you cannot fix a person 100%. People who have had cancer are at vastly higher risk to utilize more care moving forward. So much so that charging higher premiums might not be cost-effective. If they can be expected to cost X hundred grand, their premiums would need to be huge compared to most people where the insurance company has an expectation value that allows for their small profit.

You don't know the healthcare business. Really. Right now, Medicare rejects almost as many claims as the entire private insurance industry combined. Look through some files for ABN paperwork, lol.

BTW, there is a difference between rules that forbid CANCELING insurance due to a new condition, and denying insurance for preexisting conditions. If insured, I'm fine with the insurer being on the hook for your care. What I don't want is for people to be allowed to buy insurance only AFTER they get diagnosed.

[gimpy117]

"A democracy cannot exist as a permanent form of government. It can only exist until the voters discover that they can vote themselves largesse from the public treasury. From that moment on, the majority always votes for the candidates promising the most benefits from the public treasury with the result that a democracy always collapses over loose fiscal policy, always followed by a dictatorship." - Author Unknown (often attributed to Alexander Tyler)

Im going to turn it around on you when I bring up the Slew of rich and powerful who are using the system in the very same way for their benefit. I wonder why the tax rate is near historic lows for the top bracket...


Yes - your right. However, do you really think the taxes paid will actually cover all the costs of health care for all Americans? Because insurance is that you pay a little - and someone else - in this case - the government - would pay the rest.

If countries did it 50 years ago why can we not do it in 2010? Control costs, and make it affordable. Heck, Just giving everybody health insurance from a government program would help eliminate all the people who burden the system because they cant pay.

[Bubblehead1980]

even i say it shouldnt "die".

there are about a half dozen things worth keeping.

on the whole though. Get rid of the mandate, give me freedom of choice - and im all in.

yet the Dems wont even budge on that.


The Dems don't believe in freedom of choice or power of the individual, so not going to happen.

[tater]

Im going to turn it around on you when I bring up the Slew of rich and powerful who are using the system in the very same way for their benefit. I wonder why the tax rate is near historic lows for the top bracket...

You are really quite clueless on taxes. Not unexpected since you clearly don't actually pay any meaningful amount.

One, the % of federal taxes collected that come from the "rich" are at a high.'

Two, there are Marginal" rates, and "effective" rates. Do you understand the difference? Do you know there IS a difference? (I think not).

Marginal rates are the rates on the 5 "tax brackets." The taxes actually collected stay remarkably constant, even when marginal rates wildly fluctuate (like dropping the top marginal rate from 70% to 40%, say). Why is this? It's because no one actually pays the marginal rate on all of their income. People who don't itemize might not understand this I guess. or people without filled out tax forms that are say, 30-50 pages long.

Effective rates are the amount actually paid as a % of income. Since oyu pay the marginal rate (nominally) on each bracket interval, someone who makes $1 into the top rate, only pays the top rate on that $1. The effective rate averages this.

John Kerry's effective rate the year he ran for Pres was 15%, for example. His top marginal rate was 39%.

If the typical "rich" earner pays an effective rate of, say, 28%, then the top marginal rate could be dropped a lot, and with the right changes in allowed deductions, he'd pay the same taxes (or more).

Bottom line is you have pretty much no idea what you are talking about. Again, understandable for someone at the U who probably fills out an EZ form.

[Bubblehead1980]

The system is fine as it is for most part and Dems have made an issue where there really is not one, I have insurance and am happy.I feel for those who do not BUT we should not uproot our system, violate the constitution, drive costs up for policy holders in order to meet the Left's "social justice" agenda.

I believe a good plan would be for a reasonable fee every 3 or even 6 months, citizens who meet certain requirements(case by case basis, based on fianances, situation etc) could qualify for medicaid.Talking mid income people who can not afford health insurance currently nor do they qualify for medicaid currently, they could pay the fee and have some coverage until they can afford private insurance.Now this would be sort of a liability only type insurance, such as car insurance where if you get sick, you can see a doctor or when things such as cancer happens.Wouldn't include a lot of the perks regular insurance is but it would help many things and provide some coverage.

Tort reform(ironic coming from a law student I know but lawsuits are a big cause of high costs)

Incentives to companies to lower costs that will be revoked if costs do not come down.

lower taxes on medical equipment not raise them as obamacare does.

Leave in the FEW good parts of obamacare...


Can not deny for pre existing conditions

Can not be dropped if you get ill

Can stay on parents insurance until 26

[gimpy117]

You are really quite clueless on taxes. Not unexpected since you clearly don't actually pay any meaningful amount.

One, the % of federal taxes collected that come from the "rich" are at a high.'


sure, % collected from the rich are at an all time high, but its not because "were soaking the rich" its because the rich are making crazy amounts of money. Tax rates are at 35%. They used to be much much higher...like 70-80%..but now it's 35% and they have the lion share of taxes. Why is that? Because wages for the average american have stagnated, but the top earners have seen much growth.

[AVGWarhawk]

but the top earners have seen much growth.


Can we see the numbers?

There is an old saying..."The more you make the more they take."

[tater]

sure, % collected from the rich are at an all time high, but its not because "were soaking the rich" its because the rich are making crazy amounts of money. Tax rates are at 35%. They used to be much much higher...like 70-80%..but now it's 35% and they have the lion share of taxes. Why is that? Because wages for the average american have stagnated, but the top earners have seen much growth.

Sigh.

The top marginal rate was that high—BUT NOBODY PAID IT.

Get that through your head. No one paid that tax rate. The tax system is so full of loopholes (fewer NOW), that the rate was 70%, but the "rich" still paid the same EFFECTIVE rate they do now.

The PERCENTAGE the rich pay is at a high. Not the amount. It has squat to do with "stagnation" since the lower 60% already pay basically nothing (the middle 20% matter slightly, but pull way less than their share, and the bottom 40% pay nothing). The rich pay more for a number of reasons. Fewer loopholes (and AMT), and yes, more taxpayers in the "rich" bracket as well. The lower classes are paying an all time low in income taxes. Literally less than zero for many.

Seriously, post about taxes when you grow up and pay some. Your posts on these subjects come off as if they were written by a teenager incensed about not having mommy and daddy giving them a cool enough car.

[tater]

BTW, I mentioned something anyone who has dealt with the office side of a medical practice knows, but I glossed over it. The 2 government programs, medicaid and medicare are without question the WORST about rejecting claims.

The docs in my wife's office have 5-6 employees each. 1 is a medical assistant, and the rest do paperwork except some techs and a PA. Call it 4 paper pushers per doc. The private insurance is pretty seamless. Presbyterian pays electronically, right away. Very little work. I bet 3/4 of the billing people hours are spent on medicaid and medicare—and the docs only take medicaid on a limited basis!

So going to "single payer" where the payer is the government sounds like it should save loads of cost, but it won't, since the only really inefficient "insurance" to deal with is... THE GOVERNMENT.

They don't just reject for medical reasons (though both already ration care in that way). They are far more likely to reject for nonsense reasons than real insurance (those do that as well, just not nearly as much). A given form must have a certain box ticked, even though the tick in no way changes the diagnosis, or anything. ANY person reading it would know the box should have been ticked but wasn't by mistake. Do they process? Hell no, they reject it. Do they tell you WHY? HELL NO! Your employees have to do the whole thing over, never having a clue what was wrong. If that was done on the private forms, the office might get a call from the insurance people and they fix it over the phone.

This is what you are in favor of, like it or not.

[mookiemookie]

The PERCENTAGE the rich pay is at a high. Not the amount. It has squat to do with "stagnation" since the lower 60% already pay basically nothing (the middle 20% matter slightly, but pull way less than their share, and the bottom 40% pay nothing). The rich pay more for a number of reasons. Fewer loopholes (and AMT), and yes, more taxpayers in the "rich" bracket as well. The lower classes are paying an all time low in income taxes. Literally less than zero for many.


No. The proportion maybe at a high (and yes, that has everything to do with rising incomes), but the effective tax rate is not:

http://www.epi.org/page/-/img/040710-snapshot-final.jpg

http://www.americanprogress.org/issues/2010/08/img/linden_table4.jpg

Taxes are a tricky thing. The top marginal rate only matters to the people whos earn enough to have to pay it. Raise it too much, and they shelter more money as they have more opportunity to do so. Lower it, and it doesn't really matter as they don't pay it anyways because they've sheltered the money. The ones that really matter are the lower tax brackets. Everyone (even the rich) pays those. Lower those and you're bringing in less money from everyone. Raise those and you're putting the thumbscrews to everyone, and especially the people without the tax shelter opportunities the rich enjoy.

I say eliminate the loopholes. And sorry for derailing the thread.

[tater]

Amount paid. Not effective rate. The % of taxes collected.

As I said, the rates are entirely meaningless. % amount collected, ideally as a function of GDP.

Nice lie on the charts, BTW, the CBO and IRS don't track the top 400 families. They show quintile stats. Some stats are also available for top 10%, 1%, etc. That is "reduced" data by some partisans. Or by all means, link to the images in a CBO doc from their page.

I mentioned effective rates to the reflexive goon because he seems to tie marginal rates to what anyone actually pays without any thought. Proportion is clearly all that matters.

<EDIT> I will correct myself, looks like the IRS recently added the top 400, probably because they were told to do so by the admin to know who we are supposed to demonize. They never had in the past. Maybe they could add a grpah for deadbeats at the bottom.

[tater]

The average effective income tax rate for a median income US family is ~4.6%.

Ours wobbles between 28 and 30.

[mookiemookie]

Nice lie on the charts, BTW, the CBO and IRS don't track the top 400 families.

Wrong again: http://www.irs.gov/pub/irs-soi/00in400h.pdf

http://www.irs.gov/taxstats/article/0,,id=203102,00.html

If you're going to state something with such certainty, a 10 second Google search may save you some face.

[tater]

Found this, showing partisanship based on marginal rates is pretty silly.

http://www.exampler.com/blog/wp-content/uploads/2010/06/twitpic-photos-full-114575122.png

[reignofdeath]

First Im not claiming to be an expert on the economic system but I am going to touch on a few things.

First thing that I dont like is what was said a few pages back. I do not like the idea of paying for other peoples health insurance when they dont take care of themselves (Ie people who smoke all the time and have a higher risk of cancer etc.) and or to quote the almost exact words, the crack-whore mother of 7 children who does nothing but collects a welfare check. To me that just pisses me off, (Mainly because my father who works his ass off at GM knows quite a few people who 'claim' disability because of back problems or etc and definately are not disabled (Ive seen quite a few of them acting in a very non disabled manner)

Its also kind of the same thing, Id rather pay for myself, thats it. Yes I understand that seems selfish, but I hate the idea of paying for someone who has gotten themselves in that situation and its not of just ill fate or bad luck. And the fact that it forces anybody to be accepted no matter what pre-existing condition is senseless. It allows too many people to beat the system, again that was shown a few pages back, I believe by tater, Im not sure though.

Secondly, (not connected to the healthcare bill, somewhat) I think welfare and disability need completely reworked and or scrapped. Same thing as above, I know many people that my dad knows (as friends or fellow co workers) who claim disabillity and welfare when they CAN work. Its not that they cant, its that they just dont want to, and whats the incentive when the government is going to give you a check anyways? My old physics teacher got on a discussion of this with us (he ran for elected office in my hometown and won, just citing he knows a thing or two about politics) and pulled up facts and told us about when he went to either Maine or Connecticut that there is no incentive to become a teacher there, since unemployment pays higher than the salary of a teacher.

I understand why welfare and disability and unemployment checks are there. The only problem is, in my view, WAAAY too many people milk the system and that creates a burden on everyone else.Endrant

[tater]

I edited, the IRS only added this recently, they had never tracked the meaningless top 400 before.

But what does this have to do with healthcare other than I get to pay for it for gimpy, regardless?

[mookiemookie]

<EDIT> I will correct myself, looks like the IRS recently added the top 400, probably because they were told to do so by the admin to know who we are supposed to demonize. They never had in the past. Maybe they could add a grpah for deadbeats at the bottom.

That'd be the Bush administration then. Here's an article from 2008 on the IRS's top 400 study. http://online.wsj.com/article/SB120468366051012473.html

Looks like it mentions that the first study was done in 2003.

[mookiemookie]

But what does this have to do with healthcare other than I get to pay for it for gimpy, regardless?

:D Like I said, sorry for derailing the thread.

[tater]

That'd be the Bush administration then. Here's an article from 2008 on the IRS's top 400 study. http://online.wsj.com/article/SB120468366051012473.html

Looks like it mentions that the first study was done in 2003.

I've been watching the CBO page since well before that. Had not seen the top 400 on IRS, but then again I never looked for such a meaningless set of stats, I always look for the total taxpayer info, broken by quintiles (as they are taxed).

[tater]

Last year on that chart is 2007. (SOI doc)

They claim the total collected is $1,115,601,803 in thousands of dollars. So add 3 zeros.

1,115,601,803,000. That's 1.1 TRILLION in taxes.

If that is true, that's the bulk of all income taxes collected. Seems odd, I assumed it would be high, but not that high a % of all taxes.

[CaptainHaplo]

"The increase in health spending, from $2.34 trillion in 2008 to $2.47 trillion in 2009, was the largest one-year jump since 1960. CMS predicts total U.S. health spending in 2019 will be $4.5 trillion"

Source: http://swampland.blogs.time.com/2010/02/04/the-unsustainable-u-s-health-care-system/

"In 2008, U.S. health care spending was about $7,681 per resident and accounted for 16.2% of the nation’s Gross Domestic Product (GDP); this is among the highest of all industrialized countries."
Source:http://www.kaiseredu.org/Issue-Modules/US-Health-Care-Costs/Background-Brief.aspx

So Gimpy, 1.1 Trillion in income in 2007 - lets say it jumped to 1.3 Trillion in 2008 (though that would be a huge exaggeration), but the total cost is 2.34 Trillion - are you saying that the difference is going to be made up by the payment of insurance premiums to the government? Take 2008 - $7,681 dollars PER RESIDENT was spent. Yet there is no way that insurance premiums are going to cost that much per person - so where does the rest of the money come from???? This is why it won't work - it simply cannot be paid for!

Heck man, simple math - even if you took EVERY dime paid in taxes, cutting EVERY program - from defense to social security to welfare, defunding the government entirely - meaning no federal justice system, no federal prisons, no military, no NOTHING - and added it to whatever was collected on insurance premiums using this "government health care" - you STILL would have a shortfall!!!!!

This is why single payer doesn't work. You want affordable health care - get the AMA to stop limiting the number of doctors that are graduated every year at 100,000. Stop the insanity of defensive medicine. End the stupidity modern medicine is forced to deal with, from extreme costs on malpractice insurance, to the idiocy of paperwork they must do to get paid.

[tater]

The AMA has exactly zero control of the number of docs graduated. It doesn't even include all docs, it's mostly primary care, and mostly lefty primary care docs into the bargain (AMA is very political).

As it is, with the current number of docs minted, some are great, most are pretty good, and some suck. Lowering standards will result in more in the latter pile.

Also, just as a reality check, upping the number of med school grads starting next year means the first new docs you will see will be the least trained types in 7 years from that start date (4 years med school, a short, 3 year residency). Surgeons... wait 2 more years, min, for fellowships and some residencies add 2 more.

[CaptainHaplo]

Oh I agree they have no CONTROL - but as one of the largest lobbying groups in Washington (3rd largest in 2002) - they have lobbied to limit the number of doctors being graduated. The argument that more graduates equates to more crappy doctors - I would disagree. How many excellent doctors, scientists, etc are not able to go to school for financial reasons? The cost is prohibitive, and MANY students with the grades and the desire cannot afford to go, because of the cost.

However, this has nothing to do with the question being raised.... and that is how will something be paid for when the cost exceeds the income from premiums AND every dime that the government collects in taxes....

It can't be paid for.... thus it is doomed to fail.

[tater]

Never met any who decided not to go for cost reasons. They all have loads of loans, instead. AMA lobbying doesn't alter med school admissions, they are not set by congress. It's a decision made by the med schools.

There is another problem. Overall, we need more docs. But we don't need more in, say NYC, or in nice CT suburbs. So med schools start admitting more people. Great. Now what? This isn't the CCCP, they get to CHOOSE what specialty they want to do. What if the most popular specialties are not what is needed most? Guess you just admit more til you get the minimum of the ones you want, and have a glut of others?

OK, now one way or another we have XX% more docs in the pipeline.

They are needed in the middle of nowhere, not in places where most people want to live. How do you force people to move to, I dunno, the middle of Iowa, or godawful SE New Mexico (everyone would be happy to live in Santa Fe, but who wants Roswell or Clovis?).

That's the problem. It;s a free country, and the docs are needed where docs don't want to live. As a result, docs get headhunter mail begging them to practice in some crap town, frequently for a lot of money. Only money can attract people. They likely end up with a guy out of residency who comes and gets the huge salary for a few years, then punches out and moves someplace else.

There are scholarships here in NM that already trade med school for a few years in the sticks. Most would rather shell out a hundred grand for tuition and not have to live in Roswell, though.

This is part of the reason difference professional societies set different limits on how many residents they train. Say they need 20% more overall, and train 20% more. Instead of moving to the sticks, the new 20% move where they like. Now, places that are already well served have a glut, and each sees a decrease in business. there is a window for the ideal number of docs so that they all work full time, and make a decent living. Too many, and they have a smaller share of limited patients. Meanwhile, away from popular areas, people have NO docs in a specialty and are under served. It's not simple.