deliberate: "Let me leave this sponge in this fat guy for fun" negligence: "Where did that sponge go, oh well I'll let the nurse find it" incompetence:"If I don't finish this soon, I'll miss my golf game" "What sponge?"
You don't need "coverage" for that. Just pay.
[...]
No. Just pay the penalty, which is 1/10th the cost or so, depending. Or don't even pay the penalty. That's even cheaper.
Oh, there's no question that it costs a bunch more, not less.
Obamacare makes everyone buy more insurance, plus subsidize a bunch of other people's free ride. It also breaks a number of cost-control incentives, and substitutes incentives to increase cost.
Since insurance companies now have to pay out 85% (or more) of premiums in medical expenses, the easiest way to increase the dollars they're allowed to keep is to jack up their expenses. 15% of $150 million is more than 15% of $120 million.
Since insurance companies have to accept you, but expensive patients will bankrupt them, they'll be competing to provide the worst possible service to the sick patients who need them most. Otherwise, if they're good, sick people will flock to them, and flip their boat.
Health care costs were previously increasing about 7% a year, and CBO now estimates that'll be 8% a year under Obamafare, IIRC. Oh, and rates have already jumped $2,200 a family per year, versus the $2,500 Obama promised in savings.
Sen. Corker said he hasn't met a thinking person who thinks it works.
Throwing the dice into a toilet doesn't seem like a good way to design circuits or policy. Why not just read the thing and decide?
I think the people who praise it are relying on the sound-bite promises, and not on what's actually in there.
In the end it doesn't matter if it's upheld or not, it'll collapse of its own weight. For one thing, you can't force the ~190 million people who don't want this to do something they don't want to do. They won't comply. For another, the cost. And another, the affect on quality of care.
-- Cheers, James Arthur
That doesn't fix anything: Irresponsible people and those (legitimately :-) ) without means won't have enough money to do so, and hence the rest of us are still going to end up paying for their care. It seems better to just take it out of payrolls or taxes instead...
I'd up that penalty, and I'd make not paying (assuming you have the means) equivalent to tax fraud; that should motivate a lot of people to play nice.
I think most people being made to buy "more" insurance are those who have "none" at present. :-)
I agree it subsidizes others, but we already do this. Will the total subsidies be more? Maybe. Probably, even. It'll certainly shift around the distribution of just who is and isn't subsidized -- ostensibly in a way that is more fair. (Whether or not it is in practice gets back to that old nut of... how many people receiving, e.g., welfare are just lazy bums vs. honest people truly just down on their luck?)
Since many employer-provided group policies currently accept everyone, I don't really see how that's much different than what we have now.
To some extent because it's so darn huge and comprehensive that I don't think anyone can really predict how it'll turn out. Sure, I can find individual pieces and say, "oh, that's a good idea" or "geez, what crap!" but as for the sum total... I don't think I'd be at all accurate in my assessment.
There's nothing wrong with congress going back and tinkering with the thing. Indeed, it'd be absolutely amazing if *both* the Democrats and Republicans *didn't* start doing so!
In many cases I expect you're correct about that.
Oh, I dunno... if there were no enforcement of tax codes, I would wager at least 190 million people wouldn't file at all or would at least heavily fudge their tax returns. You also have to keep in mind that of the people who aren't fully sold on Obamacare, it's probably more like
19 million who *vehemently* oppose it.Should be interesting times...
---Joel
If you can. If you look as if you can't, US hospitals have been known to refuse to treat decidedly ill patients.
ew
Strange that this kind of system works fine in Europe and delivers a comparable quality of health care at about two-thirds of the price per head.
Dream on.
oThe UK system costs about half what the US system does. If you are willing to shop around and spend your own money in the UK you can jump quite a few of queues, and get US quality health care - at a price.
oTwaddle. The US system is expensive because it's inefficient and rewards the wrong behaviour. There's no moral hazard - health care (cosmetic surgery excepted) is not something that people consume as a luxury. They only put themselves into the hands of the medical profession if they can't avoid it.
e ,Not in James Arthur's rigorously pre-programmed mind. It's not a question that he's equipped to consider - the answer is pre-programmed and comes out without and kind of rational consideration.
Of course, if you take the approach to it's logical conclusion, you end up with the French and German systems, which cost about two-third per head of the US system and manage to cover everybody. James Arthur needs to think it out again, but his preconceptions are going to prevent him from thinking about it in any useful way.
And they are going to have to be regulated into reducing their - already extravagant - expenses.
A problem that the French and German health insurance providers seem to cope with without competing to offer the worst possible service.
heir boat.
Which doesn't seem to happen in France, Germany or Australia, but James Arthur has a direct line to his own private cloud-cuckoo-land where every right-wing-nitwit fantasy comes true.
US health care costs are unreasonably high, and have been unreasonably high for at least the past thirty years. If the inhabitants of Gods' Only Country had had enough sense to look at other peoples approach to the problem, they might have found a better solution or two.
He's a Republican. Where's he going to meet a thinking person? As opposed to a far-right-thinking person ...
Canadian commentators see US health insurance as spending much too much on internal administration costs.
l eBecause it's 900-odd ages long and packed with bribes to keep the health insurance industry on-side?
Surprise, surprise.
Since it brings the US health care system a little closer to the European model, you may be in for a surprise.
They pay income tax ...
Faint hope.
They've put up with your current - ridiculously expensive - system for at least thirty years now. The extra cost of the bribes Obama had to pay to keep the insurers on-side might just be the straw that breaks the camel's back, but this seems unlikely. US taxpayer have put up with even more extravagant expenditures on defence for just as long - you spend as much on defence as the next ten countries down the pecking order put together, which is three times as much as is traditionally considered necessary. You extravagance with health involves spending only half as much again as the people whose systems you ought to be emulating, and one would this expect the US taxpayer to get excited about defence long before they got excited about health care.
For whom? People who are now insured are suddenly going to get worse care because your over-provisioned system is going break down?
Are - say - an extra thirty million patients who have now got health insurance going to overload your system?
The UK's National Health Service is actually designed to deliver no more health care than is actually useful. The US system - like the French and German systems - supports quite a bit of excess capacity.
-- Bill Sloman, Nijmegen
And let's not forget, a chunk of the 30-40% loot the lawyers get turn into "campaign contributions". 'nuff said ...
-- Regards, Joerg http://www.analogconsultants.com/
Well, that's the way it was when I was a kid--you just paid. My dad's patients weren't wealthy, and they weren't a burden on anyone.
You're buying into a bunch of false premises. Are youngsters unable to get or afford care, and thus in need of a mandate to live off their parents' policies? Isn't that one of the supposed boons of Obamafare? If so, why do we need them in the mandate to fund the thing?
You've never paid a dime for my care, but I'll make it my mission in life under Obamafare.
That's not in the law.
That's not in the law.
Wrong. You, Joel Koltner, will have to buy prenatal care, other services, and pay for a bigger policy with no cap and a smaller deductible.
You really just need to study the thing. Guessing isn't helpful here.
It's going to make you, Joel, pay a higher premium for the reasons above, plus to cover higher medical costs heaped on the doctors and medical supply makers, AND to subsidize both people with no insurance, and people who have insurance, but make less money than you.
It's made more acute by the limitation on loss ratios--the insurance companies won't last long otherwise.
There's enforcement in the Obamacare mandate? They specifically say there's no criminal penalty, and the IRS is not allowed to use its usual collection methods.
Here's the mandate again:
So, you don't even have to pay their unconstitutional penalty. Don't pay anything--there's not much they can do. Or pay the penalty, get insurance only when needed, and you've got no issue at all--you're totally golden.
I'd wager it's more like 100 million people's families who violently oppose and resent it.
"Almost half of Americans oppose Obamacare, and only 36 percent support it, according to a new New York Times/CBS News poll shows."
The people who passed this in the dead of night, without discussion and without letting anyone read it, are gone, tossed out in anger. It passed without a single Republican vote, and with a number of unelected Democrats voting in the Senate.
It's illegitimate to change a society this way without their consent. If you want division and war, this is a great start.
Besides that, it doesn't cut cost, our main problem.
For a number of reasons I pointed out, it already costs more, and will increase the rate of cost growth in the future. Even Obama has said Medicare's breaking the bank, growing out of control. Guess what-- that's a gov't program! Nice job controlling costs, Congress.
--James
=20
Incredibly unlikely that the Republicans could do squat in 2018, there would already be way too much entrenched bureaucracy to touch it. A lot like tobacco subsidies.
?-)
You "just paid". People with less money had a problem.
But they weren't poor either, otherwise they couldn't have afforded to be his patients.
Some of them clearly can't afford care. You don't want people with untreated infectious disease wandering around infecting other people - treating them for free (or rather at other people's expense) may be inequitable, but it's cheaper than dealing with the consequences of letting them infect other people. Think about Typhoid Mary ... though Chlamydia Kate may be more topical.
tHe may never have paid a dime for your direct care, but the medical science that made your care possible was funded collectively, and we've all paid for that. We should have invested more in working out how to get people to think straight - you could use some help there.
Yet.
g.
Yet.
fIf he didn't have that already ...
tBut there are going to be fewer people wandering around with untreated infectious diseases, and fewer people who've delayed coming in for treatment until their condition had gotten bad enough that they required expensive extended treatment for a condition that would have been cheap to treat early.
One of the reasons that US health insurance is absurdly expensive is that the industry spends a lot of money making sure that people aren't getting treatment for stuff for which they aren't insured. Making the policies more comprehensive saves money on that kind of checking.
You've got a long way to go before your health insurance companies can cut their overhead expenses down to Canadian, French and German levels, but those countries get health care that's roughly as good as the best your system has to offer for about 30% less per head.
e IThe French and German health insurance industries don't exhibit this problem. James Arthur is imagining things, as usual.
n dThere are plenty of others.
the
Not true. Eliminating some sanction isn't eliminating all sanctions.
But you may not like what they can do. Ganisheeing works well on anybody who has a stable income or visible assets.
Right-wing fantasies.
of
Republicans and conservatives hate it, as you'd expect - they've been using it as a stick to beat Obama for years now. The health insurance companies have spend a lot of the insurance premiums paid to them - ostensibly to buy health care - to fund propaganda opposing the legislation. Calling that kind of opposition "violent resentment" is a stretch. It's basically party-political name-calling.
But it's legitimate to slide tax loop-holes into irrelevant legislation - James Arthur's political morality is remarkably flexible, and can be reduced to "republicans good, democrats bad" without losing any significant information.
Whereas sustaining the previous inadequate and inequitable system would have made everybody happy?
Getting more people covered was the primary aim. Keeping the health insurance industry on-side while doing that was expensive. Moving the system closer to universal health care (which is cheaper and can be just as good - and there are plenty of overseas examples of that) is almost certainly the best route to making it cheaper.
But everybody else's government controlled health care systems are cheaper than yours. Congress hasn't done a good job so far, but that's because they've not intervened enough.
Health care isn't an arena where the free market delivers an optimal solution, and relying on reciting free market mantra's isn't going to make things better, as even James Arthur would have realised by now, if he could have got himself de-programmed.
-- Bill Sloman, Nijmegen
ly
That's making stuff up. I paid living on my own, earning minimum wage.
Wrong, and dumb. My dad started as a pediatrician, seeing mostly young couples without much other than new babies.
People in our community. We couldn't go shopping or to the grocery store but that two or three would come up and greet us. He knew every one of them, their kids, and all their histories.
Ah, so plagues and infectious disease are rampant in America? Baloney.
You keep assuming Americans can't see doctors and get health care. That's false. Anyone--ANYONE--can get care, free if they need it. We have a gov't program for that. Anybody who needs it can sign up for it.
Being a federal program, it's badly run, horribly inefficient, delivers a lowered standard of care, and it's highly expensive--a third to half or some such of most state budgets.
Obamacare seeks to drive another 30 or 50 million people onto that or similar programs. Tens of millions who have and are perfectly happy with their medical care will be forced onto Medicaid.
That's worse, not better.
You keep making up things you imagine, about things you have no knowledge of, then arguing about things that aren't real.
-- Cheers, James Arthur
tely
But with no responsibilities.
But enough to pay him. Incidentally, what's dumb about not knowing that your father was a pediatrician who practiced in a largely lower- middle-class area. Was I supposed to be able to look that up on Google?
Hell, we couldn't go shopping or to the grocery store without people coming up and greeting us. It was a small town, and that's what people do in small towns.
e rHIV, and Chlamydia are. Drug resistant tuberculosis was a threat - at one stage - but you woke up to it early enough to more or less get it under control. SARS got a toe-hold in Canada. Plagues aren't usually rampant, but they are always possible. If you wait long enough, one is bound to turn up.
No. I assume that quite a few of them are reluctant to do so because it's going to cost them money that they really don't want to spend.
Up to a point.When Hurricane Katrina put a lot of people into hospitals in New Orleans, the care most of them got was inadequate. Naomi Klein's "The Shock Doctrine"
includes an anecdote about about a car accident she and her husband were involved in New Orleans at the time. She and her husband were looked after - very well - in a totally empty private hospital that could (in theory) have care for a few of the indigent poor who were cluttering up the public hospitals.
or
Your life expectancy figures tell a different story
And every right wing politician makes it their business to make sure that it stays ineffective.
In your unbiased opinion.
Look in your mirror sometime. I know quite a bit.A lot of what I know isn't what you think you know, but that doesn't make me either wrong or ill-informed. I don't make things up - much as you would like to think so.
-- Bill Sloman, Nijmegen
IMNSHO, anyone having cosmetic surgery for anything other than repairing injury, damage, or congenital defect, does so entirely at their own risk, and deserves everything they get.
--
"For a successful technology, reality must take precedence
over public relations, for nature cannot be fooled."
(Richard Feynman)
tely
When the minimum wage was $2.50 an hour, my doctor charged $31 for an office visit. Luckily I was making many multiples of the minimum wage. Did you pay two days wages so that you could visit your doctor?
Did your dad drive an S-class Mercedes?
e rWhen your dad was starting out, TB was still rampant. When you were born, silver nitrate was dripped into your eyes because the PTB figured your mom likely had syphilis.
eEmergency room care is not the cheapest care -- who knew?
Treatment from a randomly selected doctor or even hospital, where the doc has to be brought up to speed on each and every visit is not efficient -- who could have guessed that one?
Your job does not require the use of logic? Or does your family support you?
If healthcare costs had more or less kept pace with inflation, that might still work. Unfortunately, that hasn't been the case at all, so we now have a lot more people (per capita) who legitimately can't afford health care. Also note that given the exact same symptoms that you might have had as a kid, today you're likely to get a lot more diagnostic procedures and treatments simply because so many are available. While this costs money, it of course also means that we can relieve a lot more suffering than we used to.
I realize that no matter which way you cut it, there are finite resources in the world and it's not like you can tax people at anything approaching 100% for very long either. Therefore people with more money of their own will continue to have access to better healthcare... which is fine... but I do think we have a moral obligation to provide some basic level of healthcare to everyone, and requiring everyone to pay into a plan that does just that fundamentally strikes me as a reasonable approach even though, yes, some people will end up benefiting from the system more than others.
Because many parents don't have insurance in the first place. But I would have to say that the Obamacare regulations requiring insurers to cover kids and getting rid of restrictions on pre-existing conditions was a step in the right direction... but it still strikes me as less efficient than if everyone is covered.
Sure, and you've never paid a dime of mine... but both of us have absolutely paid for some guy out there who was in an auto accident, and even though he had the means to purchase insurance, he chose not to... yet of course the hospital still put him back together anyway since despite the unfairness to you and me there was a moral obligation to do so.
[...] [...] [...] > You really just need to study the thing. Guessing isn't helpful here.Yeah, you're correct there.
Apparently I need to give Obama a call and tell him to consult me before he proposes his next few bills... :-)
But you'd agree with me that Obamacare -- assuming it isn't struck down
-- will have plenty of tinkering (by both parties) in the next 6 years, right?
As I recall Obama's been claiming medical costs should drop somewhat. What makes you think they'll rise (for a given procedure)?
I won't be surprised if that changes pretty quickly. It looks to me like the kind of thing you stick in there to get the few extra votes you need to get the thing passed...
Perhaps a little public shaming? Seems to work for those who don't like sex offenders in their neighborhoods...
I agree some people will do this, but come on... the vast majority of people are honest. While it makes sense to lock a money box that, e.g., everyone knows about that sits unattended on a shelf in a secluded back room, in reality how many people would steal from the thing even if they were confident they could get away with it? Maybe 1-2%?
I'm OK with a 98% solution in this case.
They don't even tell you the actual questions asked, which is poor -- I suspect I could "spin" the questions in the poll such that I'd get It's illegitimate to change a society this way without their consent.
Maybe. Or perhaps it'll go into effect, people will see that overall it does a lot more good than harm, and the country will actually end up more cohesive and productive.
I agree it was a pretty dangerous approach that was used -- kinda like fishing with dynamite -- but people who feel desperate do desperate things. The usual justification is, "the ends justify the means," and whether or not *that* is true is a much more philosophical conversation than I'd be able to usefully engage in.
Geez, I keep thinking here how, in some portrayals, there are parallels with "The Hunger Games" trilogy -- the purported "good guys," in the end, kill off a bunch of kids and their own troops but make it appear that the "bad guys" did it so as to obtain their support and overthrow the "bad guys" once and for all. Life goes on, purportedly for the better, but people with the knowledge of what really happen end up completely dead inside.
---Joel
o.
I missed this one. The whole purpose of insurance is to get other people to pay for your care. The money I have spent on insurance over the years has paid to rebuild other peoples burnt houses, and to repair other people's smashed up cars. Similarly, the cost of health insurance was money I earned but was not paid directly, used to "repair" other workers' (and their families) injuries and illnesses.
sible
bamacare,
e you
ould
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at
That doesn't strike me as trivial, and wouldn't be trivial to anybody poor enough to want to avoid paying for health insurance.
You rarely seem to feel obligated to argue honestly or informatively.
Ability to do what?
Seems reasonable - it's a misdemeanor rather than a felony.
-- Bill Sloman, Nijmegen
The minimum wage is now, what, $7.50. I was just charged $140 to see a physician's assistant. After not listening to me, she wrote a script for two pain killers, one that worked (Motrin - that I could have gotten at Wallyworld in smaller pills) and one that did absolutely nothing (hydrocodon + acetaminophen).
No envy here!
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Of course my job requires logic--ECL, CMOS, TTL, you name it. How about yours?
-- Cheers, James Arthur
s
It's my view--having watched as it happened--that government created that problem.
Or, alternatively, just waste a lot more resources than necessary, with all natural checks on that tendency toward waste having been systematically eliminated by gov't policy, O/C being the final leap.
yThat's so vague it's hard to parse. What is "health care?" If you mean "doctor," why not say "doctor?"
If medicines are too expensive, why do we make people pay a doctor, and a pharmacist, and an insurance company to get them? And report every step to the federal government, multiple times?
Does "health care" mean "free condoms?" Obama thinks so. Does it mean "free sterilization?" Obama calls that "womens' health."
There are many more basic needs in life--like food, for example--why do we need special provision for health care? Why not provide the opportunity for everyone who can to work and afford whatever they want? Isn't that better?
[...]
o.
Did we buy him a new car too? Was that our duty? Why wasn't it his duty to buy insurance if he wanted it?
And how did we get from there to "free" contraception and a bunch of other nonsense?
But the basic argument--that we have to force people into the plan we want, otherwise they'll shift cost onto our scheme--is false. Current cost-shifting accounts for roughly $80 of a family's annual insurance. Obama said $1k, but it's b.s.
*Obamacare* creates massive cost-shifting. If you want to force people into your system, they're going to force you to pay their costs. [...]
No, I don't think it'll be politically possible to tinker with it. It's fatally flawed, *should be* struck down (it's not constitutional), and likely will be. If not, more than half the country wants it repealed, and that's what should happen. And if not repealed, it'll quickly fall of its own weight.
Cluster-kludging a steaming pile can't ever fix its fatally flawed design.
I think maybe I know too much about O/C to understand how you could ask that. What makes you think costs should fall? Empirically, they've already risen due to O/C, and will continue to do so.
Policy-wise, I've already laid out how O/C adds expense, and creates mass perverse incentives to increase costs.
I don't think Republicans could or should allow band-aids on this hopeless mess. It simply can't be patched into usefulness.
e ,I don't consider it dishonest at all, more like a civic duty and a form of civil disobedience.
I consider the whole thing--Obamacare--an enormously dishonest, deceitful attempt by irresponsible people to make other, responsible people subsidize their lives--medical expenses, plus some additional life expenses (such as Sandra Fluke's birth control).
If they wanted an insurance firm with certain qualities and values, then start one! Let everyone join, bar no one, charge whatever you want. Make something! Create something good and worthy! But don't steal what other people have made and like, and destroy it.
Obamacare is a selfish lie, designed by people who purport to be charitable, but want to do it with other people's money. That's why there's a mandate, and that's why it's needed.
41% strongly support repeal:You simply have no concept of the depth of the rancor, bitterness, and ill-will this has created, no concept. I personally will not comply.
The Catholic bishops have said they won't comply either, that they will shut down the largest private charitable health care system in the country first.
It may be popular in Oregon. In that case, you should have passed something like it in Oregon, tried it, and proved it was good, not inflicted it on the nation, using a temporary Congress that's now gone, thrown out on their a$$e$ for this very intolerable act.
Obamacare is the real Hunger Games.
--James
so.
A stunning admission, but yes, that's Obamacare.
It pits every citizen against every other, competing for one another's scarce resources. Dog-eat-dog.
--James Arthur
So shouldn't government then be the one to help fix it? :-)
But your point is fair; there's surely some degree of correctness there, it's just very difficult to ascertain how much.
Doctors, nurses, physical therapists, x-ray techs -- the whole gauntlet. "Health care" to me is the "product" you receive from hospitals, urgent care clinics, etc.
I would never make the blanket statement that "medicine is too expensive." Some medicine is too expensive for many people; few medicines are too expensive for everybody. (E.g., I think aspirin is under a penny each?)
Those are definitely gray areas. If I had been in charge of the Obamacare bill, I don't think I would have included them, since they are rather politically charged and condoms are cheap or even free from various private resources such as Planned Parenthood.
The decision to include birth control as part of any medical plan isn't strictly about morality, though -- having a kid is darned expensive for any health care plan, so from a cost containment point of view you only want people having kids when they actually *intended* to! :-)
Because health care needs are much less predictable: I know that to survive I need ~2,500 calories (or whatever) each and every day, on average, so it's rather straightforward to budget for food*. On the other hand, I don't know when I'm going to come down with pneumonia or be in an auto accident and suddenly be facing thousands of dollars in medical bills. This is the whole point of insurance, right?
In general yes, but not in the case where we have a moral obligation to ensure everyone has particular goods (e.g., food) or services (e.g., health care) to people: In those cases there needs to be an established "baseline" that everyone receives, and you can then work to add to the baseline. (E.g., Obamacare is going to cover fixing a broken leg, you're going to have to spend your own money if you want a facelift.)
I feel no moral obligations to buy people cars. :-) ...Although I do support programs that provide bus passes for the working poor.
IMO it absolutely was his duty to buy insurance, regardless of whether or not he wanted it.
I would presume the truth is somewhere in the middle -- Obama's going to exaggerate, the Republican party is going to be overly conservative in their estimates.
I know. And I realize that Obama and friends have purposely downplayed just how bloody expensive this is truly going to be, particularly initially. Obama isn't going to go down in the history books as some kind of master diplomat who brokered a deal where there was give-and-take on both sides but in the end everyone was reasonably satisfied with the outcome; he's going to go down as a bit a "bomb thrower" who took some extreme measures to forcibly obtain what he felt was right, despite a goodly percentage of the country believing his ideas to be quite radical. The interesting part will be (as I mentioned in the last post) whether or not history decides his ends justified the means...
And hey, there's a good chance he'll win in November, and if you think the man has been radical up until now... just wait for his 2nd act!
If he does manage to spark off a true civil war you'll have my vote for, "no, the ends did not justify the means."
Less paperwork, a larger group of people to spread fixed costs around, and certain economies of scale as more people are treated.
OK, that's fair. Are you willing to become a martyr and go to jail (rather than pay up) to demonstrate your commitment to what you consider right, though?
That's definitely a key difference in our viewpoints: I agree there are some irresponsible people out there, but I don't believe anyone involved in creating Obamacare consciously felt they were trying to get responsible people to subsidize those few irresponsible folks.
Well, perhaps if McCain have been elected that would have been an option?
Indeed, apparently not...
I can't imagine how they'd morally justify the later there. Heck, such as action would cause them to lose a huge degree of popular support, both from secular and religious people IMO.
Oregon votes Democratic in the counties surrounding Portland, Eugene, Corvallis, and (mostly) Salem. Other than that it's actually quite supportive of Republicans... but of course the population of the greater Portland area ends up making us a blue state.
There actually is something like that here: The Oregon Health Plan
---Joel
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