ObamaCare - The New Perspective

[Aramike]

Originally Posted by Betonov

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

I 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]

Originally Posted by JU_88

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:

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]

Originally Posted by tater

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]

Originally Posted by mookiemookie

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]

Originally Posted by CaptainHaplo

"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...

Originally Posted by CaptainHaplo

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]

Originally Posted by GoldenRivet

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]

Originally Posted by gimpy117

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.