You hate Obama's health care penalty for the uninsured?

[Nebula815]

The way I see, it, because the gap between the obscenely rich and the poor is increasing, it is ethical to balance this gap through taxation. I also fear however that as populations grow and grow and as the wealthy see the general public as increasingly burdensome, we might see some very serious changes happen regarding our rights. We may see very dark days ahead.

Why do you see an inequality of outcome as a bad thing? That is part of a free society. Our "poor" are among the richest poor in the world, especially considering obesity is a huge problem amongst our poor. Their standard of living only continues to go up. Economic advancement will lead to a lot of wealthy people.

 

[Ivan Seeking]

We all know, of course, that when you are young and healthy, you pay into the healthcare system and don't use the services, but when you are old and sickly, you get more money out than you pay in. So let's stop pretending everyone is on a level playing field and give people individual health savings plans that let them build-up coverage over a lifetime rather than just getting it when they get old. That will convince the young that they aren't flushing their money down the toilet by buying health insurance they have almost no chance of using.

Catastrophic illness or injury can easily result in medical expenses that far exceed one's ability to pay. That is the point of having insurance and not just a savings plan. Likewise, I have auto insurance, and professional liability insurance for that matter, in the event that I get sued for millions in expenses or damages. I cannot possibily save enough money to cover all possibilities. This is why we have insurance in the first place. You are arguing against the basic logic that lies behind all insurance plans. By spreading the cost of individual catastrophic expenses over many policy holders, the risk to any single holder is reduced to manageable levels. But, in order to this to be possible for medical insurance, everyone must participate.

 

[Nebula815]

Catastrophic illness or injury can easily result in medical expenses that far exceed one's ability to pay. That is the point of having insurance and not just a savings plan. Likewise, I have auto insurance, and professional liability insurance for that matter, in the event that I get sued for millions in expenses or damages. I cannot possibily save enough money to cover all possibilities. This is why we have insurance in the first place. You are arguing against the basic logic that lies behind all insurance plans.

In a proper free-market health insurance system, you could purchase affordable health insurance, or if you go without it, fine, but you pay out of pocket if anything catostrophic happens (which would probably mean bankruptcy).

 

[Ivan Seeking]

Have you read the law?

Can you answer the question or not?

 

[Ivan Seeking]

In a proper free-market health insurance system, you could purchase affordable health insurance, or if you go without it, fine, but you pay out of pocket if anything catostrophic happens (which would probably mean bankruptcy).

But for many people, we don't have affordable health insurance. I don't understand your point.

 

[Ivan Seeking]

I never agreed to this contract. I only pay taxes because I'd go to jail if I didn't.

Okay, fine. So what is your answer to my question? Are you willing to sign a waiver or accept the terms that allow medical workers to refuse treatment based on credit ratings or credit card limits?

 

[Ivan Seeking]

And there will be exceptions given to those in poverty. So those of the 32million who are in poverty will stay uninsured because they still don't want to pay for coverage and they won't pay a fine.

What evidence exists to show that given the option for affordable coverage, most of these 32 million would refuse it? I have known [or known of] many families who want insurance but simply can't afford it under the current system. No one wants to face financial ruin due to bad luck, when it could be avoided.

 

[Ivan Seeking]

As do most Americans, I pay a fee for private medical insurance that in turn pays for any 'extended medical treatment' for my family. Thus, also as most Americans under 65, I demand not a thing from the federal government by way of medical benefits, at least for now. As for emergency 911 services, they are provided by my local county, paid for out of my existing state and local taxes, and depending on the situation reimbursed by insurance. I'd prefer the federal government stay the heck out either domain, thank you very much.

As soon as you get into an ambulance, you are outside of the tax-based emergency services. What seems strange to me is that you apparently have no problem with the tax-based emergency services.

Since you already have insurance and this doesn't affect you, what is the problem? Or is it a matter of saying that you're covered so screw everyone else?

 

[jreelawg]

Why do you see an inequality of outcome as a bad thing? That is part of a free society. Our "poor" are among the richest poor in the world, especially considering obesity is a huge problem amongst our poor. Their standard of living only continues to go up. Economic advancement will lead to a lot of wealthy people.

I don't think the model is sustainable, something has to give eventually, and we are getting closer to that point.

 

[turbo]

Mandated health-insurance coverage is an idea that has been around for decades - among Republicans, primarily. Now that it is written into law, Republicans hate the idea.

http://news.yahoo.com/s/ap/20100327/ap_on_bi_ge/us_health_overhaul_requiring_insurance;_ylt=AgJjGhf_NFkaLm.Yb2umQzCs0NUE;_ylu=X3oDMTM3NWp1YjFnBGFzc2V0A2FwLzIwMTAwMzI3L3VzX2hlYWx0aF9vdmVyaGF1bF9yZXF1aXJpbmdfaW5zdXJhbmNlBGNwb3MDMwRwb3MDOARzZWMDeW5fdG9wX3N0b3J5BHNsawNuZXdoZWFsdGhpbnM-

 

[TurtleMeister]

Our "poor" are among the richest poor in the world, especially considering obesity is a huge problem amongst our poor. Their standard of living only continues to go up.

That is true. If it were not then we would not have an illegal immigration problem.

What evidence exists to show that given the option for affordable coverage, most of these 32 million would refuse it?

On average, the poor are poor for a reason. They make bad choices. I know that's not evidence, just an observation. And if you think it's not true then you probably have not lived around the poor very much.

I have known [or known of] many families who want insurance but simply can't afford it under the current system.

It remains to be seen that the new system will lower costs. If it doesn't then we will simply have a tax on the poor.

No one wants to face financial ruin due to bad luck, when it could be avoided.

Many of the poor are already in financial ruin.

 

[Ivan Seeking]

There will be a new low-cost pool from which the disadvantaged can purchase insurance. This will not reduce the current cost of standard private insurance, but it does seek to contain those costs, which are rising quickly.

Cadillac plans will be taxed. So those plans become more expensive by design.

 

[Ivan Seeking]

Also, I should have mentioned in the op that there are exemptions to the penalty, for the poor.

It was not clear if the sliding scale is based on the time of that the law is in effect, or the time that a person has gone without insurance.

I have not read all 2400 pages plus the reconcilation act, yet.

 

[Nebula815]

Mandated health-insurance coverage is an idea that has been around for decades - among Republicans, primarily. Now that it is written into law, Republicans hate the idea.

http://news.yahoo.com/s/ap/20100327/ap_on_bi_ge/us_health_overhaul_requiring_insurance;_ylt=AgJjGhf_NFkaLm.Yb2umQzCs0NUE;_ylu=X3oDMTM3NWp1YjFnBGFzc2V0A2FwLzIwMTAwMzI3L3VzX2hlYWx0aF9vdmVyaGF1bF9yZXF1aXJpbmdfaW5zdXJhbmNlBGNwb3MDMwRwb3MDOARzZWMDeW5fdG9wX3N0b3J5BHNsawNuZXdoZWFsdGhpbnM-

Establishment Republicans, perhaps. Conservatives have always hated the idea.

 

[Nebula815]

But for many people, we don't have affordable health insurance. I don't understand your point.

My point was if we had a proper free-market health insurance system, we wouldn't have the problem of health insurance rising so much in cost. However, I do not see government intervention as the solution to bring the cost down, I think we have to identify the various components of the system that increase costs and work to reform them.

Also, when you say one gets into an ambulance, how are they out of the taxpayer-funded services? The ambulances are from the fire services, which are taxpayer-funded.

 

[Zefram]

Establishment Republicans, perhaps. Conservatives have always hated the idea.

I'm curious, do you consider any of the following to be conservatives: Robert Bennett, Kit Bond, Bob Dole, Chuck Grassley, Dick Lugar, Ted Stevens, John Warner, Orrin Hatch, Mike Crapo, Lindsey Graham, Lamar Alexander, Judd Gregg?

 

[Nebula815]

Bob Dole and Lindsay Graham most certainly not, I am not up-to-speed on the views of all the others. I recognize the names though.

 

[russ_watters]

Yes (http://cboblog.cbo.gov/?p=389 ). They estimate it would lower spending by one half of one percent (0.2% from reduced medical liability premiums and 0.3% from reductions in "defensive medicine").

Note, that report is for a "typical package of reforms" and so doesn't necessarily represent what could actually be accomplished with proper leglislation.

According to the study linked below, everything about malpractice costs $29 billion a year and defensive medicine is another $100 to $178 billion a year. So the CBO's estimate of a "typical package" reducing that by $10 billion is only a 5-8% of the problem. I have a very hard time believing a good package of legislation couldn't drop that by, say, half: $65-$105 billion a year.

http://www.aaos.org/news/aaosnow/nov08/managing7.asp

Also, what I doubt either of these studies or predictions about Obamacare take into account is the secondary economic effects: supply and demand. By forcing people to buy insurance and forcing insurers to cover everything under the sun, prices will be driven up via supply and demand. Conversely, by reducing unnecessary services, supply and demand will drive the unit cost of services down. These effects will not be insignificant.

 

[Zefram]

The "typical package" CBO analyzed for Hatch contained:

• A cap of $250,000 on awards for noneconomic damages;
• A cap on awards for punitive damages of $500,000 or two times the award for
  economic damages, whichever is greater;
• Modification of the "collateral source" rule to allow evidence of income from
  such sources as health and life insurance, workers’ compensation, and automobile
  insurance to be introduced at trials or to require that such income be subtracted
  from awards decided by juries;
• A statute of limitations—one year for adults and three years for children—from
  the date of discovery of an injury; and
• Replacement of joint-and-several liability with a fair-share rule, under which a
  defendant in a lawsuit would be liable only for the percentage of the final award
  that was equal to his or her share of responsibility for the injury.

Certainly there are alternative proposals like special medical courts, etc but this is a fairly standard and aggressive prescription.

The Kessler-McClellan study's estimates of the costs of defensive medicine are on the high end and the CBO http://www.cbo.gov/doc.cfm?index=4968&type=0 on the generalizability of their result in 2004:

More recently, some researchers observed reductions in health care spending correlated with changes in tort law, but their studies were based on a narrow part of the population and considered spending for only a few ailments. One study analyzed the impact of tort limits on Medicare hospital spending for patients who had been hospitalized for acute myocardial infarction or ischemic heart disease; it observed a significant decline in spending in states that had enacted certain tort restrictions. [...]

When CBO applied the methods used in the study of Medicare patients hospitalized for two types of heart disease to a broader set of ailments, it found no evidence that restrictions on tort liability reduce medical spending. Moreover, using a different set of data, CBO found no statistically significant difference in per capita health care spending between states with and without limits on malpractice torts.

So there's good reason to be skeptical of the utility of a statement like "If the Kessler and McClellan estimates were applied to total U.S. healthcare spending in 2005, the defensive medicine costs would total between $100 billion and $178 billion per year."

 

[Argentum Vulpes]

Limiting number of doctors is a terrible idea. The more doctors, the more competition, the lesser the cost. We need to flood the market with doctors.. Take away health care from hands of MBAs by making it not-for-profit. Dont give me that 'this is america' b.s. Because whatever 'this' is, is crap.

Wow if my point was the broad side of a barn, I'd be feeling like Dick Cheney's duck hunting partner right now. Did you even bother looking at the link I provided? My point was that the federal government needs to jump up the AMAs rear end about this artificial limiting of the supply of doctors here in the USA.

 

[russ_watters]

The "typical package" CBO analyzed for Hatch contained:

Certainly there are alternative proposals like special medical courts...

That helps limit the lawsuits a little, but doesn't directly address the problem of defensive medicine. What I think would help more is specific guidelines protecting doctors against the need for defensive medicine, such as not being able to sue for a misdiangosis of an unusal malady. If there is a 99% chance that based on your symptoms you have a certain problem, it doesn't make sense to immediately test for the malady that is the other 1% and a doctor should not be held responsible for making that call. Heck, even take the decision out of the doctor's hands: for the most common maladies, you can put together a matrix of diagnoses and so just by following procedures, a doctor is protected against being sued for not making that 1 - in - 100 diagnosis.

 

[TheStatutoryApe]

Wow if my point was the broad side of a barn, I'd be feeling like Dick Cheney's duck hunting partner right now. Did you even bother looking at the link I provided? My point was that the federal government needs to jump up the AMAs rear end about this artificial limiting of the supply of doctors here in the USA.

I've been looking and can not find a nonpartisan or official AMA source on this policy of limiting the number of physicians. There are apparently a limited number of medical schools which is maintained by the AMA but this does not necessarily seem unreasonable as it ought to help maintain a proper standard in the field. Your link also cites high rejection rates for applicants to medical school but does not seem to include any idea of whether or not those rejected were at all qualified.

 

[Shackleford]

So, in order to eliminate or greatly reduce taxpayer subsidy for uncompensated health care services ($40 billion/year), we're going to subsidize millions of people who cannot afford their health care insurance.

Hm.

Also, premiums for health care insurance will invariably rise thus making it less affordable for people and requiring a greater government subsidy for the poor so they can get health care insurance.

This corporate fascism is simply the first step toward a single-payer system. The next step is price controls and such. This unconstitutional bill will do nothing to increase access to health care insurance. There are a myriad things to do that would through the market-driven system reduce cost to both the health care providers and the health care insurers. The DemonCats of course didn't do any of this.

Remember, health care service and health care insurance (a privately-offered product) are privileges, not rights. There's a big difference between social safety nets that we want (e.g. emergency service, fire, etc.) and socialism/fascism. We are very fortunate to have built a nation and an economic system that give us near-instantaneous life-giving aid. This was done through capitalism and the free market. Health care service is very valuable. The training involved requires years of commitment and a lot of money. You are paid by the problem you solve. People in health care solve problems we all have.

 

[calculusrocks]

Okay, fine. So what is your answer to my question? Are you willing to sign a waiver or accept the terms that allow medical workers to refuse treatment based on credit ratings or credit card limits?

I don't condone the government's efforts in the health insurance at all, except for laws and enforcement that prevent fraud. I don't expect government to steal treatment for me any more than I expect to steal treatment from the doctor himself. The government is completely in bed with the corporations (and the lawyers) as far as I'm concerned. Did the health insurance industry take losses in the stock market after the bill signed? No. It carried the DOW because now the health insurance industry knows that they can force people to buy their product, thanks to government. We already have limited choice because I'm not allowed to buy insurance across state lines.

More entitlements, more taxes, more spending, more laws. No matter what the problem is, the solutions presented by the politician is more entitlements, more taxes, more spending more laws. It doesn't matter if it spawns more and more problems. The solution presented is more entitlements, more taxes, more spending, more laws. If it worked, wouldn't we see the positive results of this approach by now? To what success?

All I see is my choice, my freedom, being offloaded into Washington because they think they somehow know (because their own narcissism prevents them from seeing their own track record) what is best for me. I won't willingly sign anything that gives the impression that I condone any of this.

As far as this contract with the government goes, yeah that's a bunch of nonsense since they are able to erase the contract and make changes as they go along meanwhile they hold my signature in ink.

 

[mheslep]

As soon as you get into an ambulance, you are outside of the tax-based emergency services. What seems strange to me is that you apparently have no problem with the tax-based emergency services.

Hard to do privately without a monopoly.

Since you already have insurance and this doesn't affect you, what is the problem?

You seemed to be addressing everyone above when you stated:

There is an implicit contract between you and the government in which you demand that emergency and extended medical treatment be made available if you are sick or seriously injured.

but I see you were referring only to the uninsured. Even so, I challenge several assertions made in that first post: that there is any 'implicit contract' between the individual and the federal government for any 'extended' medical service. The mandate at hand is federal law. After some limited emergency care enforced by EMTALA, medical providers do have the right to deny service. Often one is not 'all alone'. There are numerous charitable organizations that help pick up the tab for the unfortunate.

Or is it a matter of saying that you're covered so screw everyone else?

Well in response I won't get into my charitable habits here. However, given that the US spends $500B/year in taxpayer based Medicare and Medicaid services, which I pay into handsomely via taxes, I find that a silly proposition.

 

[mheslep]

Mandated health-insurance coverage is an idea that has been around for decades - among Republicans, primarily. Now that it is written into law, Republicans hate the idea.

http://news.yahoo.com/s/ap/20100327/ap_on_bi_ge/us_health_overhaul_requiring_insurance;_ylt=AgJjGhf_NFkaLm.Yb2umQzCs0NUE;_ylu=X3oDMTM3NWp1YjFnBGFzc2V0A2FwLzIwMTAwMzI3L3VzX2hlYWx0aF9vdmVyaGF1bF9yZXF1aXJpbmdfaW5zdXJhbmNlBGNwb3MDMwRwb3MDOARzZWMDeW5fdG9wX3N0b3J5BHNsawNuZXdoZWFsdGhpbnM-

For individual mandates, that's in the STATES, where the US constitution has nothing to say on the matter. There was one Republican co-sponsored bill - Wyden-Bennett - that called for federal mandates. I don't see a reversal of Republican opinion anywhere.

 

[TheStatutoryApe]

I would like to see nationalized health care. This though just seems like some ridiculous bastard hybrid. It would appear as though the idea is for people to get a taste of better access to health care but not appreciate the aftertaste the system leaves leading to more and more reforms that will eventually lead to nationalized healthcare. A foot-in-the-door bill.

 

[russ_watters]

I agree that it is a "foot-in-the-door bill", but I'm glad the "public option"/fully nationalized healthcare piece was defeated by the Republicans (I consider the republicans more winners here than democrats). I simply can't believe that the government can do something like health care more efficiently than the priate market. Further, I went to college, work hard, and make good money. In a free society, people are supposed to be allowed to enjoy the benefits of their success. It is therefore against the principles of a free society to take those benefits away.

Caveat: Right now, the super-rich in those countries with nationalized healthcare still do somewhat have the right to use their success to improve their medical care: they can just fly to the US for treatment! (And many do!)

 

[mheslep]

I would like to see nationalized health care.

Since the current bill is a form of nationalized health care, I assume you mean you want either single payer by the government (Canada), or you want the government to actually run the medical system, docs, hospitals and all (UK). Why?

 

[mheslep]

[...]When CBO applied the methods used in the study of Medicare patients hospitalized for two types of heart disease to a broader set of ailments, it found no evidence that restrictions on tort liability reduce medical spending. Moreover, using a different set of data, CBO found no statistically significant difference in per capita health care spending between states with and without limits on malpractice torts

[...]So there's good reason to be skeptical of the utility of a statement like "If the Kessler and McClellan estimates were applied to total U.S. healthcare spending in 2005, the defensive medicine costs would total between $100 billion and $178 billion per year."

Last I looked at the Texas malpractice reforms, one finds the results reflected in the malpractice premiums charged to physicians, and it was overwhelmingly clear they had dropped dramatically post reform. If we believe that is true, as well as the CBO report above, then possibly that means that hospitals and doctors have not been passing on the cost reductions, i.e., prices are 'sticky' as they say in economics.

 

[edward]

For individual mandates, that's in the STATES, where the US constitution has nothing to say on the matter. There was one Republican co-sponsored bill - Wyden-Bennett - that called for federal mandates. I don't see a reversal of Republican opinion anywhere.

Republicans were for mandatory health insurance care before they were against it.

But Hatch's opposition is ironic, or some would say, politically motivated. The last time Congress debated a health overhaul, when Bill Clinton was president, Hatch and several other senators who now oppose the so-called individual mandate actually supported a bill that would have required it.

http://www.wbur.org/npr/123670612

http://blondesense.blogspot.com/2010/03/wow-mandatory-health-care-insurance-is.html

 

[mheslep]

Republicans were for mandatory health insurance care before they were against it.

Some supported it, maybe they still do. So? Nixon supported wage and price controls. Does that mean 'Republicans' support wage and price controls? The thesis proposed in this thread is that 'Republicans' have reversed themselves on individual health mandates at the federal level. Yeah? Who? Hatch?

 

[BoomBoom]

My problem with the mandate is that you are required to purchase a product from a private company that will make a profit from it. It would be OK I think if there were a public option or some other non-profit provider, but I am not a fan of making insurance companies richer than they already are as mandated by government.

I suspect the insurance companies will make bank on this and after reaping the benefits for awhile and posting record profits, we may have to revisit the public option idea in the future.

 

[turbo]

I suspect the insurance companies will make bank on this and after reaping the benefits for awhile and posting record profits, we may have to revisit the public option idea in the future.

Probably sooner than later, too. The insurance companies will take all they can get until the more restrictive (read "fair") regulations regarding coverage for adults begins in 2014, and then who knows what they can pull off? Barring a wholesale takeover by the GOP in 2012, we will be fighting the public option fight all over again.

If the GOP takes the WH in 2012, the public option is dead. Possibly for a very long time.

 

[mheslep]

BTW, the individual federal insurance mandate is not high on my list of objections to this new Obamacare law, per se. I'm mainly concerned that it sets a precedent for federal the government mandating anything, like mandating that I buy a Government Motors automobile. If I could find a good legal argument, I'd have much less objection, though I still not favor it.