Health Care Reform - almost a done deal? DONE

[Angry Citizen]

That is bipartisan legislation. Such has not happened here, and that is the responsibility solely of the Democratic party.

The Republican party has made its platform into the "Party of No". If a Republican were attached to any major piece of Obama legislation, he would bear the stigma associated with it. The level of partisanship in this country is such that a bipartisan effort on the bill was impossible.

As was shown in the bipartisan meeting (which I watched start to finish), the Republicans repeatedly made references toward "starting over". It's a stall tactic designed to ensure that Democrats have an extraordinarily large political defeat, wasting political capital and making them look like ineffectual fools.

I'm a libertarian (no, not like Beck), so I really don't like either party very much, but an interesting trend emerges when we consider socialized medicine. Countries with socialized medicine tend to be healthier, and the expenses paid per capita are drastically lower. The Obama bill is nowhere close to socialized medicine (even the vaunted public option is removed), but it is a trend towards something that has a noticeable track record of working. I may be a libertarian, but I'm not so married to my ideology that I cannot make an exception. Perhaps you should too.

 

[Zefram]

It appears to me your changing the subject in these references. The issue at hand is interstate insurance, i.e. giving payers the ability to shop out of state to get away from provincial monopolies. These references, at quick glance, talk about the concentrated power of insurance companies in states where the payers are prevented from going elsewhere.

It must have been a very quick glance, as both links are about providers, not insurance companies. Regardless of where your insurance company is headquartered, you're going to deal with providers in your area. And your insurer is going to have to negotiate reimbursement rates with those providers if they're going to pay for your care. Unless your plan is also for people to travel out of state whenever they need medical care? Even so, increasing payer fragmentation doesn't inherently bring down costs when providers have the clout to keep raising them.

Of the dozen or so Republican drafted bills, I've seen none with a mandate to buy insurance at the federal level.

Really? Wyden-Bennett has a federal mandate (Republican co-sponsors: Robert Bennett, Lamar Alexander, Mike Crapo, Lindsey Graham, Judd Gregg). The http://thomas.loc.gov/cgi-bin/bdquery/z?d103:s.01770: (in 1993) had both an individual and an employer mandate (as I already indicated above, the Republican sponsors still in the Senate are: Kit Bond, Bob Bennett, Orrin Hatch, Dick Lugar, and Chuck Grassley). Ryan's bill (and H.R. 3400 in a slightly different fashion) has auto-enrollment in place of a mandate.

For the STATES! And people won't be forced on to them. C'mon.

The exchanges in H.R. 3590 are state-administered. States that can achieve superior results in another way can get a waiver to do so.

They might support the info exchange, but one can not reasonably claim via the stimulus bill, since no Republicans voted for the stimulus bill in the House and only 1-2 Senators.

Shocking. The HITECH Act is one of the true keys to value-based delivery system reform in this country and we have almost no Republicans to thank for it.

 

[Zefram]

(Take a look at the plans in Louisiana and Florida
Let's see, 30,000,000 X $850.00 = $25,500,000,000 per month = $306,000,000,000 per year. Hmmm an extra $306 billion per year in Government expenditures.?

I can't believe CBO hasn't snatched you right up.

 

[calculusrocks]

I'm a libertarian (no, not like Beck), so I really don't like either party very much, but an interesting trend emerges when we consider socialized medicine. Countries with socialized medicine tend to be healthier, and the expenses paid per capita are drastically lower. The Obama bill is nowhere close to socialized medicine (even the vaunted public option is removed), but it is a trend towards something that has a noticeable track record of working. I may be a libertarian, but I'm not so married to my ideology that I cannot make an exception. Perhaps you should too.

No you are not a libertarian. You are a closet liberal, who supports big liberal gov't.

 

[mheslep]

As was shown in the bipartisan meeting (which I watched start to finish), the Republicans repeatedly made references toward "starting over". It's a stall tactic designed to ensure that Democrats have an extraordinarily large political defeat, wasting political capital and making them look like ineffectual fools.

That's the Dem's fault. If they had started on with, e.g., a Ryan+Some Dem bill we'd have a good health care bill now. They chose to go it alone.

I'm a libertarian (no, not like Beck), so I really don't like either party very much, but an interesting trend emerges when we consider socialized medicine. Countries with socialized medicine tend to be healthier, and the expenses paid per capita are drastically lower. The Obama bill is nowhere close to socialized medicine (even the vaunted public option is removed), but it is a trend towards something that has a noticeable track record of working. I may be a libertarian, but I'm not so married to my ideology that I cannot make an exception. Perhaps you should too.

So what's the logic here? What makes you think the pending legislation promising vast increases in federal involvement in the heath system will improve anything, especially when the government controls so much of it already? US health is indeed far too expensive, but why don't you take a real look at medical outcomes in other countries before casually talking about how good they are. I have, in great detail, with real personal health consequences on the line.

 

[WhoWee]

I can't believe CBO hasn't snatched you right up.

Just having fun.

 

[Angry Citizen]

No you are not a libertarian. You are a closet liberal, who supports big liberal gov't.

Argh! Here I lie, skewered by your rebuttal, the likes of which has not been seen since Voltaire himself!

I support one policy, and I'm suddenly a 'closet liberal'. Classy. Now, if I were as classy as you, I'd rebut that you are a closet conservative, who supports big conservative government. Oh, what's that? Conservatives don't support big government? Well, it sure wasn't my party that supported the Department of Homeland Security, the War On Drugs and the PATRIOT Act.

 

[Angry Citizen]

So what's the logic here? What makes you think the pending legislation promising vast increases in federal involvement in the heath system will improve anything, especially when the government controls so much of it already? US health is indeed far too expensive, but why don't you take a real look at medical outcomes in other countries before casually talking about how good they are. I have, in great detail, with real personal health consequences on the line.

Because a trend towards federal control historically tends to increase health standards and decrease costs. You recall, of course, that the legislation which started the major rise in health costs occurred under Ronald Reagan, yes? I am referring, of course, to the bill stipulating that a person cannot be refused emergency treatment. We the taxpayer already pay for this 'liberal' bill. If you were serious about ending government health care, you would've been against the Reagan bill from the outset.

 

[calculusrocks]

Argh! Here I lie, skewered by your rebuttal, the likes of which has not been seen since Voltaire himself!

I support one policy, and I'm suddenly a 'closet liberal'. Classy. Now, if I were as classy as you, I'd rebut that you are a closet conservative, who supports big conservative government. Oh, what's that? Conservatives don't support big government? Well, it sure wasn't my party that supported the Department of Homeland Security, the War On Drugs, the institution of the Federal Reserve and the PATRIOT Act.

Look, there are some libertarian who support a small government with functions for police, fire, military. They are the pragmatists. But, there are no libertarians who support health care as one of those functions. None. Libertarians are opposed to statism in all forms. You have no libertarian rationale for your support of universal health care. Instead, you drop the same talking points as the liberals. If it walks like a duck, talks like a duck, then guess what. It is a duck.

"The republicans are the party of no..."
"I'm not blinded by ideology..."

 

[mheslep]

Really? Wyden-Bennett has a federal mandate (Republican co-sponsors: Robert Bennett, Lamar Alexander, Mike Crapo, Lindsey Graham, Judd Gregg). The http://thomas.loc.gov/cgi-bin/bdquery/z?d103:s.01770: (in 1993) had both an individual and an employer mandate (as I already indicated above, the Republican sponsors still in the Senate are: Kit Bond, Bob Bennett, Orrin Hatch, Dick Lugar, and Chuck Grassley).

I missed the W-B mandate, thanks for pointing that out.

Ryan's bill (and H.R. 3400 in a slightly different fashion) has auto-enrollment in place of a mandate.

In place of? What's with the specious word play? The former is nothing like the latter.

The exchanges in H.R. 3590 are state-administered. States that can achieve superior results in another way can get a waiver to do so.

State administered Federal rules that people are going to be forced on by the millions. Saying the 3590 Federal exchanges are a Republican idea is akin to painting strips on a horse and calling it a zebra.

Shocking. The HITECH Act is one of the true keys to value-based delivery system reform in this country and we have almost no Republicans to thank for it.

I'll take that as a snarky self-correction of your earlier claim this was also a Republican supported idea.

 

[mheslep]

Because a trend towards federal control historically tends to increase health standards and decrease costs.

You mistake cause and effect. One might as well say the increase in the Stork population tends to increase health standards.

You recall, of course, that the legislation which started the major rise in health costs occurred under Ronald Reagan, yes?

I would say that EMTALA occurred under Tip O'neil, and I know the major rise in US health costs began with WWII wage controls, creating employer provided tax exempt insurance.

 

[Angry Citizen]

Look, there are some libertarian who support a small government with functions for police, fire, military. They are the pragmatists. But, there are no libertarians who support health care as one of those functions. None. Libertarians are opposed to statism in all forms. You have no libertarian rationale for your support of universal health care. Instead, you drop the same talking points as the liberals. If it walks like a duck, talks like a duck, then guess what. It is a duck.

"The republicans are the party of no..."
"I'm not blinded by ideology..."

What a terrible justification for your labelling crusade. In your mind, there are no libertarians who support universal health care, because anyone who supports universal health care is not a libertarian. Like I said, there is no libertarian rationale for my support of universal health care. My beliefs coincide with libertarian philosophy in a great many cases. They do not coincide with libertarian philosophy in all cases. I think for myself based on the situation in question. Like I said, I am not blinded by my ideology. I give due credence to historical trends in all forms. If this were a debate on socialism itself, I would be attacking the leftist view based on the same historical trends, which overwhelmingly show that socialism is a very poor economic model for long term sustainability.

When you're so blinded by your party label that you become immune to the lessons of history, of logic and of compromise, you doom yourself to hateful rhetoric, relentless opposition, and staggeringly illogical standpoints -- such as your crass and brutish blanket label of anyone on the other side of the fence on one bloody issue.

Hilariously, you point to the one justification behind it: pragmatism. What the hell is so different about socialized law enforcement, socialized fire and emergency medical services, and socialized military? Maybe they should be privatized too -- just to fall in lock-step with our ideology.

 

[Angry Citizen]

You mistake cause and effect. One might as well say the increase in the Stork population tends to increase health standards.

Are you saying that health care and health are unrelated? Maybe cancer has nothing to do with the mortality rate of individuals 65 years and older.

 

[mheslep]

Well, it sure wasn't my party that supported the Department of Homeland Security, the War On Drugs and the PATRIOT Act.

Yes the libertarian position would be to oppose those creations, but both parties have supported them to varying degrees and continue to do so.

 

[mheslep]

Are you saying that health care and health are unrelated? Maybe cancer has nothing to do with the mortality rate of individuals 65 years and older.

Lets not throw strawmen around. Your statement was

Because a trend towards federal control historically tends to increase health standards and decrease costs

It is fallacy to conclude from that statement that federal control increases health standards.

 

[Angry Citizen]

It is fallacy to conclude from that statement that federal control increases health standards.

That is hardly fallacious. Countries with higher levels of centralized, governmental control of health care tend to have longer average lifespans and lower rates of infant mortality. I am eager to see how this correlation does not imply causation.

 

[WhoWee]

Thank you Angry Citizen - for once again - taking the focus off of the specifics of the debate.

If health care "reform" were a scientific problem, would ANY OF YOU look at it this way?

 

[calculusrocks]

...

 

[calculusrocks]

What a terrible justification for your labelling crusade.

You're the one that labels yourself as a libertarian in the first place. Nonsense.

In your mind, there are no libertarians who support universal health care, because anyone who supports universal health care is not a libertarian.

Yup. It advocates the use of force and coercion.

Like I said, there is no libertarian rationale for my support of universal health care. My beliefs coincide with libertarian philosophy in a great many cases. They do not coincide with libertarian philosophy in all cases. I think for myself based on the situation in question. Like I said, I am not blinded by my ideology.

Libertarianism is rooted in ideology. Here's a YouTube for those curious. https://www.youtube.com/watch?v=muHg86Mys7I

I give due credence to historical trends in all forms. If this were a debate on socialism itself, I would be attacking the leftist view based on the same historical trends, which overwhelmingly show that socialism is a very poor economic model for long term sustainability.

So in this paragraph you attack the socialists on economy, but yet you support the annexation of 1/6 of the US Economy. Really! I know a duck when I see a duck.

 

[mheslep]

What the hell is so different about socialized law enforcement, socialized fire and emergency medical services, and socialized military?

These are all things that are to be avoided as much as possible as they have great carrying costs, are inefficient, and lead to abuses. However, most of them have no alternative and they are necessary. Or, per Washington,

Government is not reason, it is not eloquence, it is force; like fire, a troublesome servant and a fearful master.

Societal life requires we use the fearful master, but it should be as little as possible.

 

[calculusrocks]

It's time to refocus - AGAIN.
http://www.washingtonpost.com/wp-dyn/content/article/2009/10/14/AR2009101403953.html

"In a health-care debate defined by big numbers and confusing details, the prospect of losing benefits such as a free gym membership through the Silver Sneakers program is tangible, and it has spooked some seniors, who are the nation's most reliable voters and have been most skeptical about reform.

Medicare Advantage was established in the 1970s (under a different name) when private insurers convinced Congress that they could deliver care at lower costs than Medicare. The program blossomed in the late 1990s when Congress bolstered it with millions in additional federal subsidies to for-profit HMOs. It has proven popular among younger, active seniors who had managed-care plans as workers, and about a quarter of Medicare's 45 million beneficiaries are enrolled.

Many private plans require no additional monthly premiums, yet the government pays an average of $849.90 in monthly subsidies to insurance companies for a person on Medicare Advantage, according to the Kaiser Family Foundation. That is about 14 percent more than the government spends on people with standard Medicare, according to the nonpartisan Medicare Payment Advisory Commission.

"The promise of Medicare Advantage and Medicare HMOs was to save the government money, to save consumers money, all the while providing additional benefits and coordinating care," said Joseph Baker, president of the Medicare Rights Center. "That promise has been unfulfilled overall because the plans are overpaid by the federal government at this point." "

You can blame this mess on insurance companies until your head explodes. However, the TRUTH is that the Center for Medicare and Medicaid (CMS) runs this program. This is the Government run insurance program. Please note the cost PER PERSON to the Government is $849.90 per month. Then the individual pays co-pays, deductibles, some pay premiums - then we have the Part D prescription costs ($4,550 out of pocket cost to escape the Standard Coverage Gap).

The Government is the problem - not the solution.

I thought this was an excellent post.

 

[Zefram]

I missed the W-B mandate, thanks for pointing that out. In place of? What's with the specious word play? The former is nothing like the latter.

Yes, in place of. Auto-enrollment is in Ryan's bill for the same reason the mandate is in other bills: to achieve near-universal coverage and avoid adverse selection issues. They are two mechanisms with the same goal--getting as many people into the system as possible.

State administered Federal rules that people are going to be forced on by the millions. Saying the 3590 Federal exchanges are a Republican idea is akin to painting strips on a horse and calling it a zebra.

Ryan's exchanges:

• Certified by the Feds in accordance with federal rules ("In General- The Secretary of Health and Human Services (referred to in this title as the `Secretary') shall establish a process for the review of applications submitted by States for the establishment and implementation of State-based health care Exchanges (referred to in this title as a `State Exchange') and for the certification of such Exchanges. The Secretary shall certify a State Exchange if the Secretary determines that such Exchange meets the requirements of this title.)
• Participating plans required to have benefit parity with members of Congress
• Autoenrollment to facilitate universal coverage
• Guaranteed access ("The State Exchange shall ensure that, with respect to health insurance coverage offered through the Exchange, all eligible individuals are able to enroll in the coverage of their choice provided that such individuals agree to make applicable premium and cost sharing payments.")
• HIPAA limitations on pre-existing condition exclusions are applied to nongroup plans--i.e. in the Exchange--for the first time
• Risk adjustment mechanisms to provide a "limitation on exorbitant premiums" (i.e. a weak form of modified community rating)

Yes, philosophically very different from the state-based exchanges in the Democratic reform proposals. Except for the federal directives, I suppose.

I'll take that as a snarky self-correction of your earlier claim this was also a Republican supported idea.

Oh, HIE has strong bipartisan support (even the red states are gobbling up HIE Cooperative grants to build functioning HIEs in their states). But with these Republicans, that rarely translates into votes.

 

[Angry Citizen]

So in this paragraph you attack the socialists on economy, but yet you support the annexation of 1/6 of the US Economy. Really! I know a duck when I see a duck.

Of course. Socialist policies are not socialism. Socialism and social democracies are two very different things. 1/6 of the US economy has already been annexed. If legislation to pay for it and ensure it is universal are such terrifying concepts, then so be it. I'd rather have good health care than ascribe to an inflexible ideology. If you're against universal health care just because it's the evil guvmnt, then you're against it for all the wrong reasons. If there were an historical trend towards lower health standards and greater costs inherent in socialized medicine, naturally I would be against it. Unfortunately, the trend is against you here. You are, essentially, supporting the same thing the socialists support: a system that is proven to be ineffective and inefficient.

 

[mheslep]

That is hardly fallacious.

Yes it is unless one shows the connection between the two, as you are now attempting to do here:

Countries with higher levels of centralized, governmental control of health care tend to have longer average lifespans and lower rates of infant mortality. I am eager to see how this correlation does not imply causation.

That's a Wikipedia level look at the topic. For instance, lifespans are obviously impacted by many things other than health care. If you want to know about quality health care, take a detailed look as I suggested above, at survival rates for cancer, heart disease, i.e. what happens to you if you actually get sick and see a doctor. You'll find most often the best place to be is in the US. If you want to know about lifespan causes start with McDonalds and car wrecks.

 

[Angry Citizen]

If you want to know about quality health care, take a detailed look as I suggested above, at survival rates for cancer, heart disease, i.e. what happens to you if you actually get sick and see a doctor. You'll find most often the best place to be is in the US.

These statistics ignore the fact that the United States is known to have more specialists in these kinds of fields. If the United States' health care was so good, its average life span would be at or near the top spot, right? It's not.

Sure, other things could be affecting the statistic. But what? Average life span is a pretty huge indicator of public health, because it is a broad view of health that ignores focused studies on certain diseases. If the summary of American health care is, "We can treat your really bad diseases pretty darn well, but you're still not likely to outlive a Japanese or Norwegian", then American health care needs to change regardless.

 

[mheslep]

Yes, in place of. Auto-enrollment is in Ryan's bill for the same reason the mandate is in other bills: to achieve near-universal coverage and avoid adverse selection issues. They are two mechanisms with the same goal--getting as many people into the system as possible.

So? It is nonsensical to cite Ryan's auto-enrolment as an example of a Republican idea in the current Democratic bill. One might as well say the Republicans and Democrats both want 'good' things and that therefore all their particular methods for getting there are pretty much the same.

 

[calculusrocks]

Apparently this Canadian socialist was not so rooted in http://www.google.com/hostednews/canadianpress/article/ALeqM5h0QC7bditrEb3wYz_6_b-gsGGDxA" as to get his heart surgery in the Canadian socialist system. If the US switches from mixed economy (gov't built HMOs in the 1970s) to total socialization the health care, where are Canadian politicians going to go for their health care?

 

[mheslep]

These statistics ignore the fact that the United States is known to have more specialists in these kinds of fields. If the United States' health care was so good, its average life span would be at or near the top spot, right? It's not.

Sure, other things could be affecting the statistic. But what?

Diet. Crime. Average driving distance. Gene pool. If one controls life span for these causes of death, the US is close to or at the the top. For infant mortality, the US difference is about 0.6 deaths out of a 1000 from the top, if you believe the infant death rates are measured the same way everywhere.

If the summary of American health care is, "We can treat your really bad diseases pretty darn well, but you're still not likely to outlive a Japanese or Norwegian", then American health care needs to change regardless.

The US health care system does need to change, but I advocate that along the way we not screw up the fact that we do indeed treat 'diseases pretty darn well'

 

[mheslep]

Oh, HIE has strong bipartisan support (even the red states are gobbling up HIE Cooperative grants to build functioning HIEs in their states). But with these Republicans, that rarely translates into votes.

I find this line so tiresome. Some $850 billion (the stimulus bill) of our money is taken by force and spent. But since we may have vociferously opposed its authorization, it is somehow not appropriate to get in line and take our own money back. Or if we do, that demonstrates we really supported the idea all along and were just acting out of politics. Please.

 

[hamster143]

Diet. Crime. Average driving distance. Gene pool. If one controls life span for these causes of death, the US is close to or at the the top. For infant mortality, the US is about 0.6 deaths out of a 1000 from the top, if you believe the death rates are measured the same.

Yes, there was that famous article that claimed that crime and accidents accounted for most of the difference in life expectancies between the US and OECD ... unfortunately, it turned out to be fake. As you can easily calculate by yourself, crime effectively reduces the US life expectancy by something like 0.4 years compared to virtually crime-less countries like Japan. If you also account for traffic accidents, you can probably explain away some more. The US is 1 year behind UK/Germany, 2 years behind New Zealand & Italy, 4 years behind Iceland and Japan.

I find it doubtful that the US has the worst dietary habits of all major countries. New Zealand has worse gene pool than the US (as recently as 100 years ago, it was basically populated by cannibal natives and convicts). Iceland has a horrible climate, but people manage to live quite long over there.

Smoking is an important contributor to premature death, but it turns out that Americans smoke substantially less than, say, Japanese or Greeks.

The US infant mortality is twice that of Iceland or Japan, 25% higher than in New Zealand or Italy.

 

[calculusrocks]

hamster, do you have any sources at all? If so, what is your point?

 

[hamster143]

hamster, do you have any sources at all? If so, what is your point?

My source is Wikipedia. My point is that the claim that "If one controls life span for these causes of death, the US is close to or at the the top" is inaccurate. In fact, the US does have one of the lowest life expectancies and highest infant mortalities in the developed world. So, we do NOT treat 'diseases pretty darn well', and the worry that we might somehow "break" our treasured healthcare system by trying to set up universal healthcare may be overblown.

 

[calculusrocks]

My source is Wikipedia. My point is that the claim that "If one controls life span for these causes of death, the US is close to or at the the top" is inaccurate. In fact, the US does have one of the lowest life expectancies and highest infant mortalities in the developed world. So, we do NOT treat 'diseases pretty darn well', and the worry that we might somehow "break" our treasured healthcare system by trying to set up universal healthcare may be overblown.

Great, then you can provide a link to it.

Well, when democrat politicians start going to Iceland, or wherever to get their critical treatments, then I'll see your point.

 

[hamster143]

Great, then you can provide a link to it.

Well, when democrat politicians start going to Iceland, or wherever to get their critical treatments, then I'll see your point.

Link to which part?

Would it be adequate if I provided links that showed that Sarah Palin's family went to Canada to get medical treatment?

Look, I have no doubt that the system we have here in the country is ideal for the wealthiest 1% (including most democrat and republican politicians). If your money is, for all intents and purposes, unlimited, you can get very good healthcare and you don't need to go to Canada or anywhere else.

Unfortunately, I'm not in the top 1% and probably neither are you, or most Americans on this forum.

 

[WhoWee]

Link to which part?

Would it be adequate if I provided links that showed that Sarah Palin's family went to Canada to get medical treatment?

Please do - and don't forget to explain the circumstances.