[United States] Health Care Reform

[Serious Paul]

Well President Obama, and the Democratic party seem to be trying to tackle Health Care Reform-a massive project; filled with all sorts of pit falls even with out the political in fighting and bickering. The debate has sparked a number of discussions, some of which I will try to post spin off threads about here on SST.

Several things about the way this "discussion" has played out in public has come to seriously bother me. Other parts have piqued my interest, and made me think.

One of the things that has come to bother me, is that it seems like both of the big sides to this debate (Obviously the issue is far too multifaceted to just have 2 sides; but unfortunately for me the Republican's and Democrats get the lion's share of media coverage, etc...) have stepped up their rhetoric to the point where the issue has become confusing for "the layman"; the general public. Be it staged protests (Obviously not all protestations are staged; and even some of the staged ones are presenting legitimate and perfectly valid concerns.) or accusing anyone who disagrees with the President a racist (This seems to be increasing in frequency, and bothers the hell out of me. I voted for him because I felt he was capable of doing the job, that he's black is incidental to me. I think many more people agree wit this point of view, and don't care as much about race as the good people at the Chicago Tribune seem to want us t5o believe.) to various media outlets trying to incite rage-well frankly all of it's a little disappointing in a way.

Now I like that public discourse is occurring, and that people are getting involved, but I wish-and I get that I may as well wish for a Pony too- it was a little more mature.

Feel free to post your own concerns, observations and links here as well folks.

[Ampere]

I think that our (US) media is so wrapped up in who they owe their allegiance to (who is paying their bills: The Left or The Right) and shooting for ratings by embracing the extremes of one side or another...that the real meat and potatoes of the issue is being lost to the vast majority in the middle (somewhere in the middle).

I think our media is a joke.

We've got asshats on both sides of this (and I imagine every) argument and of course the media latches on to the loudest assholes they can find, whether they are fucktards or not.

I'm totally glad that people are talking and protesting. Different views are a good thing. The last thing I want to see is a one-party system. A two-party system sucks, but a single party system is orders of magnitude worse.

I guess I wish there was a third or more parties in the picture. Unfortunately until an Independent or another party outside the Reps and Dems gains a large enough % in the presidential elections we're stuck with this bi-polar crap.

[Serious Paul]

I'm sort of hoping that this whole debate sickens American's so much that we do find a viable third party Candidate.

[3278]

I still don't understand the debate. It seems like a whole lot of people want access to a very high level of health care without having to spend a whole lot of money to get it, and their solution to this is to have the government give them all health care. Jesus, even Sal is behind this.

[Salvation122]

I still don't understand the debate. It seems like a whole lot of people want access to a very high level of health care without having to spend a whole lot of money to get it, and their solution to this is to have the government give them all health care. Jesus, even Sal is behind this.

I don't demand a 'very high level' of health care, and I do not necessarily support a public plan - it would depend entirely on how that plan was structured. I'm far more supportive of something like the Dutch/Swiss system, where insurance is private but minimum coverage and deductibles are heavily regulated and required to be open to all, than an expansion of (say) Medicaid to everyone. (In truth, I've been without health insurance for two years, and the only things I've wished I had it for is low copays on my meds - generic Wellbutrin is running me $120 a month, which is ridiculous - and coverage when I got new glasses.)

I also think there are serious economic gains to be made through a revamp of our healthcare system. The US pays roughly 200% the OECD mean on healthcare (including both private and public spending.) That's, you know, a shitload of money. A more integrated system - alongside other reforms, such as a reduction in medical school costs and barriers to entry, tort reform, and less obfuscation of healthcare pricing - would be vastly more efficient than what we have now.

I'm far more interested in the efficiency aspect than the moral imperative, although I do think it shitty that people who actually have health insurance are still often a single bad case of pneumonia away from suckin' dick behind Olive Garden to make ends meet.

[Serious Paul]

I know one thing. I'm sick of everyone who seems to know what we should do, spouting off their sides "facts" like it's a universal truth, or citing their own experiences like it's a one size fits all life. I'm sick of know-it-alls who think they can make decisions for me, and everyone else.


Apparently it's no longer a patriotic, or responsible thing to actually want to know what you're signing on for, or getting into.

[DV8]

Not only is it considered unpatriotic to not just trust what's being said, but it's also nearly impossible to get a straight answer. Especially in the US (but certainly not exclusively) there are so many special interest groups that benefit from misinformation being circulated through the constituency, it's really hard to know who to believe. I've never seen it quite as bad as it's happening right now regarding US healthcare reform.

[Salvation122]

I know one thing. I'm sick of everyone who seems to know what we should do, spouting off their sides "facts" like it's a universal truth, or citing their own experiences like it's a one size fits all life.

I'm going to need examples of the "facts" you take issue with. A lot of the issues being discussed are quantifiable.

I'm sick of know-it-alls who think they can make decisions for me, and everyone else.

That's sort of government in a nutshell.

Apparently it's no longer a patriotic, or responsible thing to actually want to know what you're signing on for, or getting into.

No, it absolutely is. And certainly I can understand being irritated with the amount of obfuscation being thrown around this issue.

Especially in the US (but certainly not exclusively) there are so many special interest groups that benefit from misinformation being circulated through the constituency, it's really hard to know who to believe.

Including the parties themselves. Failure to get effective health care reform passed would be a major blow to the administration, and Republicans are (understandably scared shitless of the midterm elections coming up in a year. If they can prevent it from passing it'll decrease the enthusiasm of Democrats, resulting in less of them showing up at the polls, making for better odds of Republican wins in tight districts.

[Serious Paul]

Wow, a know it all dick! I really want to engage, and have a one sided discussion with you Sal! Why don't you save me the trouble, call me a few names and go bother someone else.

[3278]

I don't demand a 'very high level' of health care...

It's possible we have differing ideas of "very high level." You're taking Welbutrin; I'd call that a product of the very high level of health care in this country. And maybe you don't "expect" everyone to be able to have Welbutrin, but you complained on Animalball about having a $3000 deductible on your plan, indicating that you thought you should be able to have a lower deductible, which of course you could if you paid for a better health insurance plan, indicating to me that you want a lower deductible without having to pay for it. I don't understand that.

(In truth, I've been without health insurance for two years, and the only things I've wished I had it for is low copays on my meds - generic Wellbutrin is running me $120 a month, which is ridiculous - and coverage when I got new glasses.)

Well, aside from the recommendation that you should shop around a bit, I don't think $4 per day is very much at all to pay for the possibility of personal happiness, and if you don't think it's worth it, you should stop taking it.

I definitely think you and I have different ideas of the level of expected health care if you think that's an unreasonable expense. It's like Brasky saying 5 percent of his gross income was too much to pay for insurance coverage that paid for the medical costs - including repeated surgeries - for his 10 person family. That expectation seems absolutely distorted to me. If health care is so important, shouldn't we expect to pay rather a lot for it?

I also think there are serious economic gains to be made through a revamp of our healthcare system.

Give control of any given system to a single idealized agency and there will be increases in efficiency and likely extraordinary economic gains. We could have Universal Food, too, and we'd get cost and efficiency savings...if all went ideally. But I don't personally want to live anywhere like that. Every time you give up a responsibility, you lose some rights, and I have yet to see a government-provided health care system that doesn't cost me some rights. I'd rather take responsibility for my own health care, and keep those rights mine.

I do think it shitty that people who actually have health insurance are still often a single bad case of pneumonia away from suckin' dick behind Olive Garden to make ends meet.

I think it's reasonable to expect that bad diseases will have bad effects, but I understand the concept of insurance is designed to protect you from that. So my question would be, if your health insurance didn't cover a single bad case of pneumonia, why didn't you get some other health insurance? That sounds like a bad product decision to me, and I don't understand why the free market can't make such bad products unprofitable.

[Eliahad]

I don't know how this is going to help the discussion, but I'm going to say it for me.

Doctors Visits + Medications > What I can afford without insurance and still want to pay for:

Food, Mortgage, Instrument Upkeep, Travel, Maintaining my Career.

With (the right) insurance I could afford the doctors visits and the medications and still do those things except that the Cost of the Premium + the Doctors Visits + Medications is then greater than what I can afford and still want to have food, a house, an instrument, be able to get to gigs, etc.

Now, it could be that I've picked the wrong career because I get no benefits. It could also be because I have two pre-existing conditions that prevent me from having affordable/decent health insurance (not catastrophe insurance) in the first place because I'm a 'risk.' (ADD + Deviated Septum = lose) I still have three years to go before I can actually "re-apply" without having to mention either of those conditions. But there's no way in hell I'm giving up a career that I've worked very hard to be successful at and that I'm happy doing, and I can't get rid of my pre-existing conditions. Which, people will answer, "Then Health Care isn't that important to you."

Well, no, that's bullshit. Because I've researched my options and been turned down a bunch of times. So I'm stuck. I'm the small business guy that's looking at the health care debate saying, "Yes! Please! Do something to help me!" Not a lot, I don't want a lot. I just want it a little easier. Just a little something that helps me get a foot in the door. Something that I can belong to that gives me a hope in hell of having any health insurance at all. It is, in fact, possible to be in entirely the wrong income bracket. Not quite poor enough to qualify for the programs that are already in place but low-middle class enough to make it difficult to afford 'the real thing.'

[Salvation122]

Wow, a know it all dick! I really want to engage, and have a one sided discussion with you Sal! Why don't you save me the trouble, call me a few names and go bother someone else.

I really didn't do shit to deserve that response.

I don't demand a 'very high level' of health care...

It's possible we have differing ideas of "very high level." You're taking Welbutrin; I'd call that a product of the very high level of health care in this country. And maybe you don't "expect" everyone to be able to have Welbutrin, but you complained on Animalball about having a $3000 deductible on your plan, indicating that you thought you should be able to have a lower deductible, which of course you could if you paid for a better health insurance plan, indicating to me that you want a lower deductible without having to pay for it. I don't understand that.

I would gladly have paid for a lower deductible. My options were "$120 a month, and a $3000 deductible" or "nothing," since private plans fuck you up the ass for absolutely no reason other than "they can." Which, sure, they can, but it also makes them fuckers of the highest order. Fuck 'em.

Well, aside from the recommendation that you should shop around a bit, I don't think $4 per day is very much at all to pay for the possibility of personal happiness, and if you don't think it's worth it, you should stop taking it.

Given that the alternative is "be a completely useless asshole," it's worth it. I'm also getting gouged. The two are not exclusive.

I definitely think you and I have different ideas of the level of expected health care if you think that's an unreasonable expense. It's like Brasky saying 5 percent of his gross income was too much to pay for insurance coverage that paid for the medical costs - including repeated surgeries - for his 10 person family.

I think there's a difference between "five percent of gross for bunches of surgeries and coverage for a dozen people" and "ten percent of gross for a single prescription."

Granted, there's probably something like a tenfold difference in income between me and Brasky. Regardless,

Give control of any given system to a single idealized agency and there will be increases in efficiency and likely extraordinary economic gains.

Administrative costs are not the only savings (and considering how highly consolidated the health insurance market is I'm rather skeptical of those who say we'll save huge percentages by switching to single-payer, which I don't support anyway.) A healthier populace is a more productive populace. Just as there are strong economic interests that
compel the government to maintain an effective road system, there are strong economic interests that argue that health should be treated as a public good.

Ironically, this really only holds for those who are members of the workforce; we'd be better off (economically, anyway) taking all that Medicare and SCHIP money and giving it to people who are actually being productive.

It's also worth noting that the federal tax exemption for employer-provided health benefits already costs the federal government roughly a quarter trillion dollars a year. Coincidently, this is the same amount we took on in additional debt for the 2008 budget.

Every time you give up a responsibility, you lose some rights, and I have yet to see a government-provided health care system that doesn't cost me some rights.

At the moment there is no public plan in the legislation. Due to the spread in the Senate it is unlikely that there will be a subsidized plan. I would be very hesitant to accept a public plan with open arms, sight unseen, but the public plan that's being discussed in the House would be self-sufficient (an initial endowment aside.)

I really don't see any infringement of liberties in the current legislation, even if we include a hypothetical optional public plan, unless you want to count marginal tax hikes.

That sounds like a bad product decision to me, and I don't understand why the free market can't make such bad products unprofitable.

Because costs in medical care are highly obfuscated, and the insurance agencies perform as an oligopoly. For all practical purposes the market in health care isn't very free at all.

[DV8]

Wow, a know it all dick! I really want to engage, and have a one sided discussion with you Sal! Why don't you save me the trouble, call me a few names and go bother someone else.

I sympathize with Your point here, Paul, but I don't think there was any animosity or smart-assery in Sal's post. I also think that a discussion is nearly impossible if one of your points remains that the situation is too complex for people to know what they are talking about and talk about it with some sense of authority as a result of it. As long as Sal's not immediately dismissive of your point of view, I don't see what the problem is.

One of the repeating points of why Bulldrek is worth coming to, even after all these years is that people don't get offended and all opinions are if not accepted then at least valid enough to be heard. Please don't shout anyone down or ridicule their statements even if their statements are ridiculous.

[Serious Paul]

I'm not shouting anyone down. Let's save the hysterics for drama class.

[UncleJoseph]

I would gladly have paid for a lower deductible. My options were "$120 a month, and a $3000 deductible" or "nothing,"

That seems a little ridiculous. Unless you have a catastrophic claim, a $3,000 deductible is awfully high considering your monthly payment. Most people don't have $3,000 worth of medical bills each year. So if you're basically paying $120/month just for catastrophic coverage, perhaps that is a bit high. It's worse than car insurance. But then, car accidents usually don't go into the hundreds of thousands of dollars when you make a claim.

My wife and I are getting stung with an increase in our copays for medications right now. They just doubled/tripled/quadrupled. For example, we no longer are able to get a 90-day supply of medications through the mail with one copay. It's now 2 copays for the same supply, and the copays themselves have doubled. My maintenance meds (the ones I take every day, for the rest of my life) have just quadrupled in cost for me. I now have to spend nearly $200/month for medications, when I used to spend about $30.

Plus our doctor's visit copays have just doubled. ER copays, which didn't exist anymore, are now $50. And we're paying out of our paycheck monthly, instead of having it fully covered.

Now don't get me wrong, we're still very fortunate to have the coverage we have compared to lots and lots of folks. But it is taking a much larger bite out of our bottom line than it used to. So we've had to make some adjustments.

[DV8]

What's a copay?

[UncleJoseph]

What's a copay?

You are being facetious, right?

[DV8]

What's a copay?

You are being facetious, right?

Nee, ik zit niet te grappen. Soms vind ik het lastig om een goede definitie te vinden van een term die eigenlijk alleen maar in de Verenigde Staten gebruikt wordt, zeker als het gaat om een veld waar ik niet in thuis ben, namelijk die van verzekeringen. Ik weet dat ik je taal redelijk beheers, maar dat betekent niet dat ik alles maar begrijp. Snap je?

But yeah, Googled it. Got it now.

[3278]

I would gladly have paid for a lower deductible. My options were "$120 a month, and a $3000 deductible" or "nothing," since private plans fuck you up the ass for absolutely no reason other than "they can."

Actuarial math isn't very complicated, and the economics of insurance companies stems directly from it. You determine premiums based on the expected level of payout for a person of that risk factor, plus operating costs, plus some percentage of profit. Market pressure [through competition] works to keep operating costs at the lowest possible level, so if you're looking for lower premiums but higher expected level of payout for a given risk factor, the only number in that equation that can change is the percentage of profit.

You say private plans "can" fuck you up the ass; why? Why isn't competition working to keep the level of profit in the above equation to its lowest level? Why is it, in this case, that the market isn't doing what we'd expect it to do? And is there a way to solve that problem, rather than instituting a government alternative that market?

Given that the alternative is "be a completely useless asshole," it's worth it. I'm also getting gouged. The two are not exclusive.

I don't understand. Given the benefit of the product, how is the price too high? Why isn't it okay, in this case, to let the market determine the value of the product based on its supply and demand?

I think there's a difference between "five percent of gross for bunches of surgeries and coverage for a dozen people" and "ten percent of gross for a single prescription."

So if I do the math, you're bringing home about $14,500 a year. And you're expecting the same medication the multi-millionaire takes, at a lower percentage of your personal income than you're spending now. He can afford a better house, a better boat, a better car than you; why should health care be any different? Why does this market deserve special treatment? And if it's because this is a market of survival - which I think is arguable in any case - then why don't we have universal food and water?

A healthier populace is a more productive populace. Just as there are strong economic interests that compel the government to maintain an effective road system, there are strong economic interests that argue that health should be treated as a public good.

That's a perfectly valid argument for legislating the amount of calories we take in and the amount of exercise we do, too. Are you prepared to require those things, just because they'll produce a more productive populace? What is the level of individual freedom you're willing to sacrifice in the pursuit of public good?

It's also worth noting that the federal tax exemption for employer-provided health benefits already costs the federal government roughly a quarter trillion dollars a year.

I think "the federal tax exemption for employer-provided health benefits" might also be the answer to those questions I asked above, about why the market isn't working on health care.

[Marius]

Why does this market deserve special treatment?

Because, in general, a greater need for healthcare causes a decreased ability to pay for it.

[DV8]

You say private plans "can" fuck you up the ass; why? Why isn't competition working to keep the level of profit in the above equation to its lowest level? Why is it, in this case, that the market isn't doing what we'd expect it to do? And is there a way to solve that problem, rather than instituting a government alternative that market?

From what I understand the US government wants to (among other things) add a government run option for those people who'd otherwise not get any insurance at all, right? While they're not supposed to steal clients from operating insurance companies since the clients the government run option is going to pick up weren't clients to begin with - and weren't going to be clients any time soon due to the high cost of healthcare. It's a bit naive to think that they won't completely leave the insurance companies' client base untouched, but I sincerely doubt that insurance companies can't compete with a non-profit organisation like the government at all, especially considering what all these doomsayers claim will happen to healthcare once it falls into government hands (by which they ignore the possibility for people to take out an insurance from a private company.) I know it can work, since there are several non-profit insurance companies operating on the Dutch market, and the for-profit companies are doing just fine.

One of the things that always leaves me dumbfounded is the shit that insurance companies seem to get away with. "Pre-existing condition" isn't even a term that's used in the health insurance landscape here (though that might change, of course), and it seems bordering on felonious to deny someone medical care just because cancer runs in the family, because they were born with hypertension or because they fell off their bike one time and have a deviated septum ever since. I think the reason why the market isn't doing what it's supposed to is because of something I recently found out; it turns out that many insurance companies and banks that operate in the US are actually wholly owned by Dutch banks and insurance companies that start operating there because of a very lenient consumer protection guidelines. They do there what they can't get away with here. I know many of you are opposed to government involvement and want to keep government as small as possible, but there should be some ombudsman type organisation that keeps track of and punishes repeated offenders of general guidelines and ethics, and I think government could (and perhaps should) have a hand in setting up and reinforcing those guidelines.

One of the things that bothers me is that many companies are required, by law, to maximise shareholder value and show due diligence in doing so. To not squeeze every dollar out of a transaction is negligent and punishable, and so the race to increase profit margins begins. Cutting corners and drafting illegible contracts with clauses and stipulations that deny coverage are, in this case, completely acceptable and even encouraged. And it seems to me that what Sal said earlier, that a healthy workforce is also a more productive workforce is nothing short of sacrosanct.

I don't understand. Given the benefit of the product, how is the price too high? Why isn't it okay, in this case, to let the market determine the value of the product based on its supply and demand?

Somehow I have the feeling that the health insurance market in the US has nothing to do with supply and demand. Demand is very high -- very high, given the ever-increasing corpulence of the nation -- and supply isn't increased to meet the demand, and that's not because there aren't enough doctors and hospitals to go around. There's a vacuum, now, which hasn't been filled up by up-and-coming companies that cater to the high number of people who can't afford healthcare, and now that the government wants to step in to fill that vacuum people are up in arms.

[Marius]

Somehow I have the feeling that the health insurance market in the US has nothing to do with supply and demand. Demand is very high -- very high, given the ever-increasing corpulence of the nation -- and supply isn't increased to meet the demand, and that's not because there aren't enough doctors and hospitals to go around.

Well, not quite. All markets have to with supply and demand, but you're right in that the production of U.S. health care is a very screwed up "market." Speaking economically, demand requires both the ability and willingness to pay for something. Among those with the ability to pay for health care, demand is very high, particularly because our system of insurance shields many people from any consideration of cost - most especially those whose abilities to pay are courtesy of the government through Medicare or Medicaid. Among those without the ability to pay for it, demand is meaningless.

But health care does not operate in a simple market. Those without the ability to pay go and recieve health care anyway, and simply never pay for it. There's also a very high 'pseudodemand,' then, in what is no longer really a market of any sort.

While they're not supposed to steal clients from operating insurance companies since the clients the government run option is going to pick up weren't clients to begin with - and weren't going to be clients any time soon due to the high cost of healthcare. It's a bit naive to think that they won't completely leave the insurance companies' client base untouched . . .

See, they can't just pick up the people that couldn't get healthcare any other way, because that group is going to be - or is going to very quickly become - a pool of people it's completely impossible to provide "insurance" to. These will be the people you absolutely do not want in your risk pool, a sea of "pre-existing conditions."

[AtemHutlrt]

Why does this market deserve special treatment?

Because this is a 'market of survival', and, as Marius pointed out, health care is on an uneven need/cost spectrum. Food doesn't become more expensive as your need increases, but, generally, health care does. In addition, The food market has a range of options to fill a single need, and there are options at every cost level that fill the need perfectly. You can buy some vegetables at the farmer's market for $1.50, or order a pile of vegetables at the Amway Grand for $20, and receive effectively the same nutrition value. In the health care market there is, generally but with many exceptions, only the option to receive or not receive care.

I'm hugely fiscally conservative, but I support some degree of federal universal health care because it is in the severe best interest of a nation to ensure (possibly even...insure) its population is not underproductive because of lack of health care, and unable to participate robustly in the economy because of extreme debt. Both of those things are clearly happening, and federal health care is the best solution I have. The fact that every test case available suggests a federal solution, though flawed, is generally quite successful supports this.

[3278]

Why does this market deserve special treatment?

Because, in general, a greater need for healthcare causes a decreased ability to pay for it.

Well, if I'm dying of thirst or starving to death, it's going to be harder for me to get work, too, isn't it?

Food doesn't become more expensive as your need increases, but, generally, health care does.

That's certainly true, and it's one difference between, say, food and health care. Another difference is the spectrum of costs; cancer costs millions of dollars, while the most extraordinary thirst can be quenched for mere pennies. But to imply that the only response to this is government intervention is to make health care - and thus health, a right of the citizenry. Not just "not being killed by other people," but life itself, a right, even unto the greatest duress of illness or disease, at the expense of all other citizens. That makes me uncomfortable.

In addition, The food market has a range of options to fill a single need, and there are options at every cost level that fill the need perfectly. You can buy some vegetables at the farmer's market for $1.50, or order a pile of vegetables at the Amway Grand for $20, and receive effectively the same nutrition value. In the health care market there is, generally but with many exceptions, only the option to receive or not receive care.

Why is it that there's not a range of pricing options? Is it the ubiquity of group insurance, the required licensing for practitioners, what? I can get my car fixed for $40 an hour or $260 an hour; why not my spleen?

Of course, I think any health care plan predicated on allowing a lower level of service to those who can't afford the highest levels is probably doomed to failure on moral grounds, but I still can't help but wonder, even when the only choice is, "to receive or not receive care," if you can't afford the cure for cancer, why should you receive it, and at the expense of all other citizens?

I'm hugely fiscally conservative, but I support some degree of federal universal health care because it is in the severe best interest of a nation to ensure (possibly even...insure) its population is not underproductive because of lack of health care, and unable to participate robustly in the economy because of extreme debt.

I have to caution again against the ramifications of this argument. I know our government already tampers with the food market, essentially exactly for this reason, but I don't support that, either. Having the government make the decision of what's best for everyone, rather than allowing the individual to choose their own actions, is the sort of thing I like to limit, and while I know we do it all the time - it's the point of government - I just don't see health care as being a mandate of the government.

[3278]

From what I understand the US government wants to (among other things) add a government run option for those people who'd otherwise not get any insurance at all, right?

This debate, more than any other, suffers from a lack of simplicity and clarity. I couldn't summarize the government's current plan[s], and I'm never really sure what someone else means when they say they support health care reform. I couldn't tell you what most of the people in this thread support, only that I seem to be against it.

...it seems bordering on felonious to deny someone medical care just because cancer runs in the family, because they were born with hypertension or because they fell off their bike one time and have a deviated septum ever since.

I don't think it's unreasonable, personally, but then I'd also expect that there'd be products available which would cover even these high-risk cases. For instance, after the state took my driver's license a few times, very few insurance companies would cover me, but I could always find one to cover me, whose costs made worthwhile the risk I implied. I don't know if this just isn't available in the US, or if people are just objecting to the high expense of such plans.

I know many of you are opposed to government involvement and want to keep government as small as possible, but there should be some ombudsman type organisation that keeps track of and punishes repeated offenders of general guidelines and ethics, and I think government could (and perhaps should) have a hand in setting up and reinforcing those guidelines.

This is a lot like the legislation of protections for the banking industry, and while it runs counter to my intuition, I've seen reasonable arguments supporting such legislation. I'm not personally big on consumer protection, but asserting a certain minimum standard of services is common enough, and not entirely objectionable to me.

One of the things that bothers me is that many companies are required, by law, to maximise shareholder value and show due diligence in doing so. To not squeeze every dollar out of a transaction is negligent and punishable, and so the race to increase profit margins begins.

Excellent point, and applicable to all corporate America, and more generally, capitalist systems, as well.

[Marius]

Well, if I'm dying of thirst or starving to death, it's going to be harder for me to get work, too, isn't it?

Those are both conditions that require immediate health care.

[3278]

Well, if I'm dying of thirst or starving to death, it's going to be harder for me to get work, too, isn't it?

Those are both conditions that require immediate health care.

Well, at the very least, you're going to need some water, or some food. The question is if I should have to give them to you, even if you can't afford them, in perpetuity.

[Marius]

Well, at the very least, you're going to need some water, or some food. The question is if I should have to give them to you, even if you can't afford them, in perpetuity.

You mean if a person remains in a state of disabling starvation or dehydration? Then, uh, yes. It's generally agreed upon that people have a positive right to the minimal requirements of life.

But that's not your question, is it? You're asking if you should keep paying for something that's not immediately life-saving, for which the examples of disabling hunger or thirst aren't relevant, and for which an assertion of a positive right might not be relevant either. (Although nearly everyone thinks that there is a positive right to some amount of health care, and a disturbing number of people seem to think that there's a positive right to comprehensive health care.) I answer that differences in the market for healthcare vs. other goods are significant enough that it be treated differently.*

* I haven't yet gone through your last few replies line by line, so may be missing several arguments.

[Eliahad]

Isn't food subsidized by the government and that's why I can buy a potato for $ .99/lb?

[Bonefish]

Isn't food subsidized by the government and that's why I can buy a potato for $ .99/lb?

Sugar too. We've got liek a 50 year* surplus of sugar, stored up. Just waiting. I guess it's preperation for Diabetic Soviet tanks.

* It's not literally 50 years of sugar, but we do have a helluva-lot of sugar that the government subsidizes.

[3278]

Isn't food subsidized by the government and that's why I can buy a potato for $ .99/lb?

Absolutely it is. I'm usually against that, too.

[Salvation122]

Isn't food subsidized by the government and that's why I can buy a potato for $ .99/lb?

Food is subsidized by the government so that farmers maintain a minimum quality of life because of the primaries in Iowa.

In many cases this ends up actually making food costs more expensive due to trade barriers. We pay an absolutely ridiculous amount of money for cane sugar, for example; meanwhile, price floors promote overproduction of corn, which is why we have HFCS in everything instead of sugar.

[Salvation122]

You say private plans "can" fuck you up the ass; why? Why isn't competition working to keep the level of profit in the above equation to its lowest level? Why is it, in this case, that the market isn't doing what we'd expect it to do? And is there a way to solve that problem, rather than instituting a government alternative that market?

From what I understand the US government wants to (among other things) add a government run option for those people who'd otherwise not get any insurance at all, right?

Just as a point of clarification, a government-subsidized health plan is not currently in the bill on the floor of the House, nor has such a measure passed committee in the Senate. Taking the legislation as is, it is almost entirely new regulation, not new funding.

That said, there is discussion (particularly in the House, which swings more to the extremes of whichever party is in power) of adding a public option, with several legislators threatening to vote the bill down if it does not include one. Exactly what shape that plan would fall into hasn't really been discussed, except that proposals for a single-payer system similar to Canada and several European countries have been pretty much shut down. Personally, I don't think it's likely we'll see a strong subsidized health plan from the legislation under consideration now, if only because it would require some strong-arming in the Senate and very loud and sizable minorities are very loudly against it.

While they're not supposed to steal clients from operating insurance companies since the clients the government run option is going to pick up weren't clients to begin with - and weren't going to be clients any time soon due to the high cost of healthcare. It's a bit naive to think that they won't completely leave the insurance companies' client base untouched, but I sincerely doubt that insurance companies can't compete with a non-profit organisation like the government at all, especially considering what all these doomsayers claim will happen to healthcare once it falls into government hands (by which they ignore the possibility for people to take out an insurance from a private company.) I know it can work, since there are several non-profit insurance companies operating on the Dutch market, and the for-profit companies are doing just fine.

The issue is that the most commonly discussed source for funding the public plan would be to slash the tax exemption on employer-provided health insurance. This would, in general, make employer-provided health insurance significantly less common and quite possibly out of reach of the average American household. (Such an [effective] tax hike also has a lot of externalities that are really weird and complicated that I don't fully understand.)

"Pre-existing condition" isn't even a term that's used in the health insurance landscape here (though that might change, of course), and it seems bordering on felonious to deny someone medical care just because cancer runs in the family, because they were born with hypertension or because they fell off their bike one time and have a deviated septum ever since.

As I understand it, in the Dutch system (post-2006), a company's overall risk pool is assessed and companies with a low-risk clientèle pay into a "risk fund" that companies with high-risk clientèle draw from. Since risk is spread over the entire industry, there's no need to screen for pre-existing conditions for basic health insurance, and to do so is in fact illegal. (This does not hold true for supplemental insurance.) This diluting of risk would be highly beneficial in the American market, but I haven't heard anything regarding such regulation in the current House bill/Senate proto-bill.

Cutting corners and drafting illegible contracts with clauses and stipulations that deny coverage are, in this case, completely acceptable and even encouraged.

Well, to a point. A suitably pissed-off judge could find against the company for doing such stupid shit and ream them on punitive damages, so the insurance companies have to be careful to only put their collective dicks halfway up our keister.

And it seems to me that what Sal said earlier, that a healthy workforce is also a more productive workforce is nothing short of sacrosanct.

And let me also make real clear that I definitely believe there are diminishing marginal returns on this. Telling a guy with a stomach flu to go home, man up, and drink a shitload of water or OJ or whatever is okay. Asking a carpenter which finger he'd like reattached because his insurance cap is below the cost of reattaching both of them is probably not.

[Salvation122]

So there was this big speech last night.

There wasn't anything in there that I overwhelmingly disagreed with, although I'm somewhat skeptical of his cost accounting and funding methods. Very cautiously optimistic.

[3278]

Well, fuck. There goes a lot of my money into something I didn't choose, didn't want, and probably won't benefit from overall. Fuck.

[paladin2019]

a lot of my money

Does the gov't see enough of your income to fall into the category of payer or subsidised?

[3278]

I don't know what those things mean. I'm not very good at things involving governments; for a long while, we had a standing arrangement: they left me alone, and I didn't overthrow them. So I'm not real good with tax terminology, and benefits, and stuff like that. What do you mean?

[Salvation122]

I don't know what those things mean. I'm not very good at things involving governments; for a long while, we had a standing arrangement: they left me alone, and I didn't overthrow them. So I'm not real good with tax terminology, and benefits, and stuff like that. What do you mean?

Edit: Wrong graph, fixed now. Worth noting that those salary numbers are for 0 dependents, they'd be about 50% higher for you

[3278]

Ah ha hahaha! They can go fuck themselves. It would literally be the end of us, economically. I'll happily not-pay the not-fine, thanks. Jesus fucking stupid fucking Christ. Weren't these people supposed to be the party for poor people?

Are none of the rest of you going to get completely fucked by this?

[Serious Paul]

I'm kind of in that middle group, that may have their employer fuck them or if they decide to be decent get a small refund.

I think that this is a pretty poor "bill" overall, but I can see where if they can keep it alive, and funded, and working where eventually it becomes a springboard to more comprehensive programs. I'm not so sure I desire that, but I can see that. However that does make the presumption that supporters of the bill can actually get to that point.

I also think that the fine's will be changed down the road, and given more "teeth." Although I couldn't give you the slightest prediction as to how. My bet is they'll fuck the poor, so you 3278, first. "You bitches got down, but look what Uncle Sam has for you now!"

This is kind of a halfassed program really. I'd gripe about parts of it, but in the end no one who's voting on this, or can really do something about it actually cares what I think. I also wish the rhetoric on both sides would be toned down a little. I'm sick of hearing how this will put all of America into a prison, or that had Jesus had this coverage he'd be hosting the tonight show right now. As usual the real answer is somewhere in between those two extremes.

[Raygun]

The thing that confounds me most about the recent events of this, is the apparent gullibility people are expressing regarding Roberts' "shift to the left" on this issue. I just may be super cynical, but it appears to me that he just performed the single biggest push to get Romney elected so far. He made Obama look like an asshole by supporting the bill's constitutionality only under the assumption that the penalties involved were in fact a tax (which they clearly all ways were, it's just the administration did not want that said too loudly). We're so shy about any kind of taxation here in the US, I see this becoming a big stink. Seeing as Romney is saying he'll get rid of it, I'm betting a lot of moderates are going to move Republican this election.

Prepare for another loud, obnoxious, nasty election season.

[Salvation122]

Ah ha hahaha! They can go fuck themselves. It would literally be the end of us, economically. I'll happily not-pay the not-fine, thanks. Jesus fucking stupid fucking Christ. Weren't these people supposed to be the party for poor people?

Are none of the rest of you going to get completely fucked by this?

Remember that dependents up to 18 are covered under SCHIP. Exact qualifications (how much your premium is, how broke you have to be to qualify) varies by state because lolfederalism; regardless, you will not have to pay 2*Cost_Listed for a plan for yourself and your daughter.

[Salvation122]

The thing that confounds me most about the recent events of this, is the apparent gullibility people are expressing regarding Roberts' "shift to the left" on this issue. I just may be super cynical, but it appears to me that he just performed the single biggest push to get Romney elected so far. He made Obama look like an asshole by supporting the bill's constitutionality only under the assumption that the penalties involved were in fact a tax (which they clearly all ways were, it's just the administration did not want that said too loudly). We're so shy about any kind of taxation here in the US, I see this becoming a big stink. Seeing as Romney is saying he'll get rid of it, I'm betting a lot of moderates are going to move Republican this election.

Prepare for another loud, obnoxious, nasty election season.

Obama is not vulnerable to Romney on this issue in any meaningful way.

[Raygun]

We'll see.

[paladin2019]

Ah ha hahaha! They can go fuck themselves. It would literally be the end of us, economically. I'll happily not-pay the not-fine, thanks. Jesus fucking stupid fucking Christ. Weren't these people supposed to be the party for poor people?

Again, how much of your income is the government aware of (a rhetorical question, of course)? Will you be in the category that pays or gets fully paid?

Are none of the rest of you going to get completely fucked by this?

No, I've got Tricare.

[3278]

Ah ha hahaha! They can go fuck themselves. It would literally be the end of us, economically. I'll happily not-pay the not-fine, thanks. Jesus fucking stupid fucking Christ. Weren't these people supposed to be the party for poor people?

Again, how much of your income is the government aware of (a rhetorical question, of course)? Will you be in the category that pays or gets fully paid?

Pays what? Pretend you're talking to a tiny, tiny child: I'm genuinely profoundly ignorant about the day-to-day relations between citizens and the government.

[Salvation122]

Ah ha hahaha! They can go fuck themselves. It would literally be the end of us, economically. I'll happily not-pay the not-fine, thanks. Jesus fucking stupid fucking Christ. Weren't these people supposed to be the party for poor people?

Again, how much of your income is the government aware of (a rhetorical question, of course)? Will you be in the category that pays or gets fully paid?

Pays what? Pretend you're talking to a tiny, tiny child: I'm genuinely profoundly ignorant about the day-to-day relations between citizens and the government.

See above. If you're making below 400% of the poverty line, adjusted for dependents, the government subsidizes your purchase of healthcare to satisfy the mandate. Assuming your daughter qualifies as a dependent - that is, you claim her as such on your taxes, which I'd presume you do since you have primary custody - the magic number is $15,130 (gross, not AGI or after-tax.)

Up to $20,122.90, you get Medicaid, so you pay nothing. Above that, you pay between 3% of gross income and ~$3,391, depending on how much you make; there's a scaling subsidy.

[3278]

If you're making below 400% of the poverty line, adjusted for dependents, the government subsidizes your purchase of healthcare to satisfy the mandate.

Oh, yeah. They'll pay for some of it, but not enough. I'm in the 250-300 percent bracket, so I'd be looking at $200-$300 a month, which is utterly untenable for us.

Assuming your daughter qualifies as a dependent - that is, you claim her as such on your taxes, which I'd presume you do since you have primary custody - the magic number is $15,130 (gross, not AGI or after-tax.)

Well, this year I'm taking her as a dependent, because I'm sick of paying more than 50 percent of the cost, while not getting the tax credit - her mother's been fucking me for a while on that - but I don't have primary custody, even though she lives with me more than half the time. [Yeah, you're not wrong: I'm getting fucked.] But I think it's the "dependents" part that counts for this, anyway.

[Salvation122]

Where are you working that you're making $38k-45k and not getting health insurance?

It's quite possible that your employer will make health insurance available to you at a cost lower than that of the exchanges by the time the penalty goes into effect; companies with over 50 employees that don't offer insurance (or offer insurance more expensive than the exchanges) get fined. More flowcharts!



Edit: That's hard to read, I'll spell out the penalties:

First Tier: If the employer has 25 or fewer employees and an average wage of $50,000 or lower, it may be eligible for a health insurance tax credit [to provide its employees with health insurance.]

Second Tier: Penalty is $2k*[Number of full-time employees - 30] annually. Penalties adjust yearly by the percent increase in health insurance premiums.

Third Tier: Penalty is $3k*[Number of full-time employees receiving tax credit], to a maximum total of $2k*[Number of full-time employees - 30] annually. Penalties adjust yearly by the percent increase in health insurance premiums.

[3278]

Where are you working that you're making $38k-45k and not getting health insurance?

: I'm...not? I think you're probably doing the math with my daughter in there? Anyway, I make something like $30,000 - maybe a little more this year - and work for a company with basically zero employees; the few people who work for the company are all 1099 employees, and no one gets health care. The company is typically no more than a month from closing its doors at any time, so it's not like it can afford to subsidize: actually, my boss [the owner] mentioned the possibility once, but I'd rather have a job than a month of health insurance and then a bankruptcy case, you know?

More flowcharts!

We have one owner, and three or four 1099ed employees. We won't be offering health insurance any time soon.

First Tier: If the employer has 25 or fewer employees and an average wage of $50,000 or lower, it may be eligible for a health insurance tax credit [to provide its employees with health insurance.]

And in this case, if the tax credit is large enough, we might try it. Our tax accountant - I don't do tax stuff, only internal accounting - will have to be consulted as the time draws near.