The timing of the health care law

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jbuck919
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Re: The timing of the health care law

Post by jbuck919 » Thu Mar 29, 2012 4:05 pm

Here's the article:

Health Law Dispute Hinges on Timing
March 28, 2012

Exclusive: After three days of oral arguments before the U.S. Supreme Court, most analysts agree that the five Republican justices are likely to deliver a body blow to Democratic President Obama by declaring his landmark health-reform law “unconstitutional.” But the key issue is really quite narrow, Sam Parry says.

By Sam Parry

So, the defining legal argument over health-care reform comes down to whether the federal government has the power to determine WHEN individuals will be charged for the health care services that they will, over the course of their lives, require.

After the Supreme Court’s oral arguments about the Affordable Care Act on Tuesday, that timing question appeared to be the single constitutional question left to answer, but it obviously was a big one because the Act would require people to sign up for insurance and not wait for a medical emergency to get it.

U.S. Supreme Court Justice Clarence Thomas

Everyone in the courtroom seemed to agree that Congress has the authority to require Americans who are otherwise uninsured to buy insurance at the point of sale – i.e. when they are in the emergency room and in need of medical care. That authority is clearly granted to Congress under the Commerce Clause of the Constitution – you are transacting, therefore you can be regulated. (That appeared to be the consensus, though Justice Clarence Thomas, as usual, didn’t say anything, so it’s hard to guess what he’s thinking.)

In other words, this is not a question over whether you interpret the Commerce Clause as granting a broad or a more limited power to Congress. The issue is whether Congress has the authority to require that individuals buy insurance before they need the medical care that, everyone knows, they will require at some undetermined point in the future.

It’s a question of timing. It’s a “when” question, not an “if” question. Plain and simple. That’s because the health care market, unlike every other market, is:

–Universal: Virtually all of us will need medical care at various points in our lives;

–Unpredictable: We have no way of knowing when we’ll need medical care; and

–Expensive: The cost of providing medical care has skyrocketed to the point that most Americans simply can’t afford it without some form of insurance. And when Americans can’t pay for their own care, those costs get shifted directly to the rest of us who do have health care insurance.

So, when do we force Americans to pay for their health care? Is it before they get sick, or after they get sick? That’s the only significant question left for the Supreme Court to decide, pertaining to the individual mandate. But it may be the issue that the five Republican justices cite to gut the law and essentially send the country back to square one in the health-care debate.

Everything else – including broccoli – is an intellectual sideshow that serves to set the outer limits of the theoretical debate over boundaries of congressional authority. They are perhaps entertaining debates, but they are not germane to the Affordable Care Act, which makes no mention of broccoli and which hinges on the use of an individual mandate to rationalize a market that is, everyone agrees, badly malfunctioning. (Though, again, [we're] not exactly sure where Justice Thomas stands on anything.)

From what I have read elsewhere, he is apparently right about point-of-service being part of the main argument. So we would have had the Affordable Health Care Act without any opposition from the Republicans if it had just changed that one (crucial) thing, right? And if the Supreme Court overturns the law then they'll pass a new one with just that change, right? Baloney. If this law is overturned there will be no new health care law at all, and we will, at best, limp along dysfunctionally as before probably at least for the remainder of my life. This case is do or die.

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Re: The timing of the health care law

Post by John F » Fri Mar 30, 2012 8:21 am

One unreal passage in the oral arguments was when it was suggested, apparently in all seriousness, that patients could constitutionally be compelled to buy insurance at the moment they need the care (the "point of sale") but not before. What do these people think insurance is, anyway? Suppose you wait until you're finally OK for a heart transplant and then apply for "insurance" to cover the cost. Guess what the premium will be: the same as the cost of the procedure and associated care, plus a mark-up to cover the insurance company's overhead. You have to pay out of pocket, and then some.

The justices can't possibly be that naive, lacking basic knowledge of the world and how it works. Their false naivété is profoundly unserious and disturbing in a case of such extraordinary seriousness.
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Re: The timing of the health care law

Post by jbuck919 » Fri Mar 30, 2012 8:31 am

John F wrote:One unreal passage in the oral arguments was when it was suggested, apparently in all seriousness, that patients could constitutionally be compelled to buy insurance at the moment they need the care (the "point of sale") but not before. What do these people think insurance is, anyway? Suppose you wait until you're finally OK for a heart transplant and then apply for "insurance" to cover the cost. Guess what the premium will be: the same as the cost of the procedure and associated care, plus a mark-up to cover the insurance company's overhead. You have to pay out of pocket, and then some.

The justices can't possibly be that naive, lacking basic knowledge of the world and how it works. Their false naivété is profoundly unserious and disturbing in a case of such extraordinary seriousness.
Some of what is coming from that bench is no better than elbow-bending-over-the-bar talk, and makes me wonder how they ever got to be lawyers let alone Supreme Court Justices.

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Re: The timing of the health care law

Post by living_stradivarius » Tue Apr 03, 2012 1:48 pm

John F wrote:One unreal passage in the oral arguments was when it was suggested, apparently in all seriousness, that patients could constitutionally be compelled to buy insurance at the moment they need the care (the "point of sale") but not before. What do these people think insurance is, anyway? Suppose you wait until you're finally OK for a heart transplant and then apply for "insurance" to cover the cost. Guess what the premium will be: the same as the cost of the procedure and associated care, plus a mark-up to cover the insurance company's overhead. You have to pay out of pocket, and then some.

The justices can't possibly be that naive, lacking basic knowledge of the world and how it works. Their false naivété is profoundly unserious and disturbing in a case of such extraordinary seriousness.
The justices aren't naive - the cost argument is irrelevant to the legal bases they are evaluating.
The timing argument is extremely relevant in this case. It marks the distinction between auto insurance and health insurance. The former is regulated from the point in time which one chooses to drive, whereas the latter is regulated without regard to the individual's choices.
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Re: The timing of the health care law

Post by jbuck919 » Tue Apr 03, 2012 2:11 pm

living_stradivarius wrote: The justices aren't naive - the cost argument is irrelevant to the legal bases they are evaluating.
The timing argument is extremely relevant in this case. It marks the distinction between auto insurance and health insurance. The former is regulated from the point in time which one chooses to drive, whereas the latter is regulated without regard to the individual's choices.
Nonsense. The point of time at which one needs health care as an independent individual is birth, not one's first operation to remove a malignant tumor to be followed by chemotherapy. However, I agree that the argument from auto to health insurance is a false one, though not in the direction that would help people who don't want mandatory health insurance. Driving is an option, if usually a practical necessity, and people who do not drive should not be and are not required to obtain car insurance. Nobody can opt out of the human state of requiring health care, beginning, as I stated, at birth. The problem with the right-wing argument against universal health insurance is that it falsely assumes that medical care is optional like driving and income-dependent like the kind of car or house one owns. That underlying false assumption is part of a peculiar American mentality which, as has been noted recently in several places, also looks upon death as though it were optional.

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Re: The timing of the health care law

Post by living_stradivarius » Tue Apr 03, 2012 4:16 pm

jbuck919 wrote:The point of time at which one needs health care as an independent individual is birth, not one's first operation to remove a malignant tumor to be followed by chemotherapy.
Health care is not health insurance ;). Mandating that government-provided health care services be available to everybody is different from mandating that everybody pay for those services.
The problem with the right-wing argument against universal health insurance is that it falsely assumes that medical care is optional like driving and income-dependent like the kind of car or house one owns.
Why do you consider it to be false?
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Re: The timing of the health care law

Post by jbuck919 » Tue Apr 03, 2012 4:54 pm

living_stradivarius wrote:
jbuck919 wrote:The point of time at which one needs health care as an independent individual is birth, not one's first operation to remove a malignant tumor to be followed by chemotherapy.
Health care is not health insurance ;).
Driving is also not car insurance. You are being ridiculous.
Mandating that government-provided health care services be available to everybody is different from mandating that everybody pay for those services.
Again ridiculous. Mandating anything (such as defense, for instance) is different from making everybody pay for it, but one can't happen without the other. (The elder fancy-educated person is tempted here to lose patience with the younger if that's the best you can do.)

If you don't want the individual mandate, fine. You have a lot of company. But you are not entitled to assume that everything will be hunky-dory without it. We will continue to have every problem we have because millions of people do not have access to affordable health care. Tell me that you accept that set of problems as part of the price for what you (don't) want, and I won't bother with your posts on this topic anymore.

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Re: The timing of the health care law

Post by living_stradivarius » Tue Apr 03, 2012 5:28 pm

jbuck919 wrote: Again ridiculous. Mandating anything (such as defense, for instance) is different from making everybody pay for it, but one can't happen without the other.
Funding a program through general tax revenue does not make the same imposition on individuals that a purchase mandate does.

The precedent this type of mandate establishes gives Congress the power to impose a disproportionate burden on significantly large, but non-majority/non-electorally salient groups.
The obvious example is young people who don't want or need health insurance are disproportionately burdened by such a policy. Other disparities can arise from gender, race, and even behavior - people who exercise daily have to foot the bill for those who sit and watch TV all day? No thanks.
We will continue to have every problem we have because millions of people do not have access to affordable health care. Tell me that you accept that set of problems as part of the price for what you (don't) want, and I won't bother with your posts on this topic anymore.
Fix it by taking the money out of our defense budget.
Sorry, but I just don't buy the argument that I am somehow responsible for someone else's health for refusing to buy something I don't need in a country where the average uninsured person gets better care in this day and age than John D. Rockefeller did in his time with all his wealth. If you want to take it to that level, then the capital saved from not buying insurance could be going towards developing some invaluable medical innovation that would never come to fruition because of such a mandate.
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Re: The timing of the health care law

Post by jbuck919 » Tue Apr 03, 2012 7:06 pm

living_stradivarius wrote:
jbuck919 wrote: Again ridiculous. Mandating anything (such as defense, for instance) is different from making everybody pay for it, but one can't happen without the other.
Funding a program through general tax revenue does not make the same imposition on individuals that a purchase mandate does.

The precedent this type of mandate establishes gives Congress the power to impose a disproportionate burden on significantly large, but non-majority/non-electorally salient groups.
The obvious example is young people who don't want or need health insurance are disproportionately burdened by such a policy. Other disparities can arise from gender, race, and even behavior - people who exercise daily have to foot the bill for those who sit and watch TV all day? No thanks.
We will continue to have every problem we have because millions of people do not have access to affordable health care. Tell me that you accept that set of problems as part of the price for what you (don't) want, and I won't bother with your posts on this topic anymore.
Fix it by taking the money out of our defense budget.
Sorry, but I just don't buy the argument that I am somehow responsible for someone else's health for refusing to buy something I don't need in a country where the average uninsured person gets better care in this day and age than John D. Rockefeller did in his time with all his wealth. If you want to take it to that level, then the capital saved from not buying insurance could be going towards developing some invaluable medical innovation that would never come to fruition because of such a mandate.
Then drop the pretense that you think it would be all right if it were a tax--you know perfectly well that you would not be willing to pay that, either, just as in the past you have said you resent Social Security. Also stop pretending that you want to reduce national defense, as much an arrangement for collective good not always translated to identifiable individual benefit as health care if not more so, so the latter can be paid for collectively. The need to pay for a public good is separate from its wise administration in order to keep costs reasonable. Let's face it: You just don't want to be taxed for something whose benefit you do not sense accrues to your own interest in the present, even though almost everything the government does falls under that category to one degree or the other.

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Re: The timing of the health care law

Post by living_stradivarius » Tue Apr 03, 2012 8:19 pm

jbuck919 wrote:Then drop the pretense that you think it would be all right if it were a tax--you know perfectly well that you would not be willing to pay that, either, just as in the past you have said you resent Social Security. Also stop pretending that you want to reduce national defense, as much an arrangement for collective good not always translated to identifiable individual benefit as health care if not more so, so the latter can be paid for collectively.
Where's the pretense? It should have been a tax policy proposal (and rightfully rejected) from the getgo instead of being a huge waste of time and resources that had to go all the way to SCOTUS to get shut down.
The need to pay for a public good is separate from its wise administration in order to keep costs reasonable.
I disagree. It has everything to do with how the government handles it.
Let's face it: You just don't want to be taxed for something whose benefit you do not sense accrues to your own interest in the present...
Who does?
even though almost everything the government does falls under that category to one degree or the other.
Yet we pay more in taxes than the government delivers as public goods (that predominantly go to Red states).
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Re: The timing of the health care law

Post by jbuck919 » Tue Apr 03, 2012 8:59 pm

living_stradivarius wrote: -There would be no constitutional question if it were a solely tax-based policy rather than a mandate. Health care reform should have gone that route from the very beginning to save us the inevitable smackdown from SCOTUS.
You and I and all sensible people :wink: know that a single-payer system paid for out of taxes would be the preferred solution, and if Medicare is any evidence also the cheaper one. However, you are letting the perfect be the enemy of the good. You know as well as I do that Medicare for everyone will not fly under any circumstances we can currently envision, so we have to settle for something else which is still better than what we've got now. The constitutional argument is specious and is the expediency of choice of people who don't think the government should do anything directly to people's benefit at all all but leave it up to trickle-down from private wealth. Arguing that we should not have the individual mandate because someone else has made a constitutional issue of it which has unfortunately found important support is like saying that we should not have stood fast against Communism in the Cold War because Russia and China were formidable opponents.

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Re: The timing of the health care law

Post by living_stradivarius » Tue Apr 03, 2012 9:10 pm

jbuck919 wrote:Arguing that we should not have the individual mandate because someone else has made a constitutional issue of it which has unfortunately found important support is like saying that we should not have stood fast against Communism in the Cold War because Russia and China were formidable opponents.
I could say the same about your assumption that "Medicare for everyone will not fly under any circumstances we can currently envision". ;)
You and I and all sensible people :wink: know that a single-payer system paid for out of taxes would be the preferred solution, and if Medicare is any evidence also the cheaper one.
Sure... if they used decades-old medical technology and procedures. The price of care has continuously gone down. It just seems high because everyone's wants state-of-the-art care without paying for the costs associated with developing it.
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Re: The timing of the health care law

Post by John F » Wed Apr 04, 2012 2:03 am

living_stradivarius wrote:
John F wrote:The justices can't possibly be that naive, lacking basic knowledge of the world and how it works. Their false naivété is profoundly unserious and disturbing in a case of such extraordinary seriousness.
The justices aren't naive - the cost argument is irrelevant to the legal bases they are evaluating.
The timing argument is extremely relevant in this case. It marks the distinction between auto insurance and health insurance. The former is regulated from the point in time which one chooses to drive, whereas the latter is regulated without regard to the individual's choices.
Forgive me, but that observation is naive as well. As jbuck919 says, we have no choice but to obtain health care - or rather we do have a choice, but the alternative is to sicken and die, barring divine intervention. The cost argument is central to the issue that the court is considering, the requirement that every one of us have health insurance to ensure that we can cover the health care costs nearly all of us will inevitably incur. If no costs were involved, commerce wouldn't be involved either, the issue would be moot, and the case would never have come to the court.

I certainly hope the justices aren't so naive as not to understand how the commercial market for health insurance and health care works. If so, what we heard from some of them last week was false naivété, the pretense that the way commerce actually works is irrelevant to the case. Justice Scalia may well maintain this pose, but now that the deliberations have moved behind closed doors, I sure hope he's the only one and that his colleagues on the right will show better sense.
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Re: The timing of the health care law

Post by living_stradivarius » Wed Apr 04, 2012 12:53 pm

John F wrote:Forgive me, but that observation is naive as well. As jbuck919 says, we have no choice but to obtain health care - or rather we do have a choice, but the alternative is to sicken and die, barring divine intervention. The cost argument is central to the issue that the court is considering, the requirement that every one of us have health insurance to ensure that we can cover the health care costs nearly all of us will inevitably incur. If no costs were involved, commerce wouldn't be involved either, the issue would be moot, and the case would never have come to the court.
Costs simply need to be present but the logic involved in how they're aggravated is secondary priority to the issue of personal choice. But if you do want to involve a discussion about how insurance is supposed to work, then the legislation is doing it wrong - insurance is all about people paying proportionally to their level of risk, not subsidizing others who have higher risk or can't pay their premiums.
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Re: The timing of the health care law

Post by jbuck919 » Wed Apr 04, 2012 1:23 pm

living_stradivarius wrote: Costs simply need to be present but the logic involved in how they're aggravated is secondary priority to the issue of personal choice. But if you do want to involve a discussion about how insurance is supposed to work, then the legislation is doing it wrong - insurance is all about people paying proportionally to their level of risk, not subsidizing others who have higher risk or can't pay their premiums.
Which is why it is misleading to pigeonhole the Health Care Act according to any previous model (other than the successful one in Massachusetts on which it is based). The court's decision should not be based on the novelty of the act in comparison with previous ways of paying for a needed national service. This model was suggested originally by the Heritage Foundation, so there is no inherent reason a conservative court should be eager to shoot it down for the reason you state or any other consideration that is no better than "we've never done this before." Every equally historically important thing to come out of Congress--and they have been few and far between--is something that has not been done before.

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Re: The timing of the health care law

Post by living_stradivarius » Wed Apr 04, 2012 1:36 pm

Like I said, this type of "fundraising" establishes a pretty dangerous precedent for Congress. There's nothing to prevent Congress from creating new "insurance" markets or modifying existing markets that force people to pay in. This is especially the case for markets that adversely affect certain groups in favor of others.

And why create another level of bureaucracy that will be mismanaged when you can (try) to achieve the same result through general tax revenue and funding allocation?
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Re: The timing of the health care law

Post by jbuck919 » Wed Apr 04, 2012 1:49 pm

living_stradivarius wrote:Like I said, this type of "fundraising" establishes a pretty dangerous precedent for Congress. There's nothing to prevent Congress from creating new "insurance" markets or modifying existing markets that force people to pay in. This is especially the case for markets that adversely affect certain groups in favor of others.

All insurance is already heavily regulated. Nobody has much of a problem with actuarial and other risk models for other types of insurance. The arguments with regard to health care--the ones the government is actually using, and not just what I might think up out of my head--are based on health care being a unique situation, as indeed it is, or it would not require a solution that does not line up with the way insurance and other kinds of markets operate. We've had a traditional market approach to this for decades, and it hasn't worked, while no one questions that auto and life insurance work well as they are.

Conservatives use the real but easily exaggerated possibility of an unforeseeable perverse consequence to argue against every progressive development. That does not make much more sense than making no home improvements because they will need repair and maintenance, but in the political struggle it is a way of taking advantage of people's fear of the unknown. In the present case we can see that the model has worked in Massachusetts without precipitating a flood of market meddling by the state government.

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Re: The timing of the health care law

Post by living_stradivarius » Wed Apr 04, 2012 2:00 pm

The arguments with regard to health care--the ones the government is actually using, and not just what I might think up out of my head--are based on health care being a unique situation, as indeed it is, or it would not require a solution that does not line up with the way insurance and other kinds of markets operate.
"Unique situation" is just another way of saying the insurance model is not applicable to health care when it comes to intentionally subsidizing certain groups by forcing others to pay in.
jbuck919 wrote:In the present case we can see that the model has worked in Massachusetts without precipitating a flood of market meddling by the state government.
We haven't seen invasive crap like the Patriot Act or the NDAA on the MA state level either.
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Re: The timing of the health care law

Post by jbuck919 » Wed Apr 04, 2012 2:34 pm

living_stradivarius wrote:
The arguments with regard to health care--the ones the government is actually using, and not just what I might think up out of my head--are based on health care being a unique situation, as indeed it is, or it would not require a solution that does not line up with the way insurance and other kinds of markets operate.
"Unique situation" is just another way of saying the insurance model is not applicable to health care when it comes to intentionally subsidizing certain groups by forcing others to pay in.
Um, right. That's the whole point. It's called taxes (or the stand-in therefore) as the cost of living in a civilized society. Welcome to the human race for resenting not getting immediate personal gratification out of it. If you want to keep things fair and expenses within reasonable boundaries, then vote for candidates who will know how to modify the Health Care Act (assuming it survives) in those directions. But collective responsibility for national health care is here to stay in the western world, and I would not be proud of helping to make it the next test case of how long the US can hold out after everyone else has long subscribed to the idea.
jbuck919 wrote:In the present case we can see that the model has worked in Massachusetts without precipitating a flood of market meddling by the state government.
We haven't seen invasive crap like the Patriot Act or the NDAA on the MA state level either.[/quote]

Look, evidently you were the head of the debating society at your high school and possibly at Stanford as well. Congratulations. But the lesson you learned is that any argument can be countered by deflection to an area of questionable relevance and faulty logic, putting the opponent momentarily off guard. Only the federal government can make a Patriot act, ergo the federal government will find a way to abuse the precedent of the Health Care Act--there is no logic in that, and your debating opponent from Berkeley would have been quick to point that out. May I resign from this one now? I'm getting too old to have the stamina for this kind of thing.

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Re: The timing of the health care law

Post by living_stradivarius » Wed Apr 04, 2012 2:53 pm

jbuck919 wrote:It's called taxes (or the stand-in therefore) as the cost of living in a civilized society.
The whole point is that is not an stand-in equivalent of general taxation. It is not even close to being as transparent and susceptible to public pressure that tax policy is - the mandate completely bypasses the budgetary process. All tax revenue allocation is deliberated upon and subject to the democratic process, as convoluted as it may be; it's something called taxation with representation.

Secondly this "cost of living in a civilized society" is severely overestimated by folks who think they should receive the latest and greatest in care. Sure, we should have a basic safety net in health care for the indigent, and that gets budgeted from our general revenue pool but this health insurance mandate imposes Congress' arbitrarily high assessment of the cost of care.

Your vision of collective responsibility needs to arise in the arena where ideas and policies openly compete, not from an imposition on personal choice.
jbuck919 wrote:Only the federal government can make a Patriot act, ergo the federal government will find a way to abuse the precedent of the Health Care Act.
It is already abusing it by forcing young people to pay for the health insurance of old people and people who are health conscious to pay for those who are negligent about their health.
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Re: The timing of the health care law

Post by John F » Wed Apr 04, 2012 3:17 pm

living_stradivarius wrote:
John F wrote:The cost argument is central to the issue that the court is considering, the requirement that every one of us have health insurance to ensure that we can cover the health care costs nearly all of us will inevitably incur.
Costs simply need to be present but the logic involved in how they're aggravated is secondary priority to the issue of personal choice.
"Aggravated"? I don't know what you mean. Anyway, I repeat, we have no personal choice as to whether or not we will need health care at some time or other, in some degree or other, which neither we nor anyone else can predict. What then is all this talk about personal choice whether to have health insurance? Or in other words, whether to pay for health care when we eventually receive it? How is health care different from most other transactions in which we personally pay for services received, or pay others to pay for us?
living_stradivarius wrote:But if you do want to involve a discussion about how insurance is supposed to work, then the legislation is doing it wrong - insurance is all about people paying proportionally to their level of risk, not subsidizing others who have higher risk or can't pay their premiums.
The level of risk changes from day to day. On Monday, as far as I or my insurance company knows, there's nothing wrong with me; on Tuesday, I'm diagnosed with a form of cancer that can only be treated very expensively over a long period. Health risk to an individual can only be crudely and imperfectly assessed, then. And when it's assessed by the insurance companies, their self-interest leads to policies and practices which any disinterested parties would find inequitable and sometimes outrageous.

How, then, in your opinion, would legislation do it right?
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Re: The timing of the health care law

Post by living_stradivarius » Thu Apr 05, 2012 2:44 pm

John F wrote:Anyway, I repeat, we have no personal choice as to whether or not we will need health care at some time or other, in some degree or other, which neither we nor anyone else can predict. What then is all this talk about personal choice whether to have health insurance? Or in other words, whether to pay for health care when we eventually receive it? How is health care different from most other transactions in which we personally pay for services received, or pay others to pay for us?
"In some degree or other"? Health care isn't simply a sliding gradient of less or more, it is a verbal construct that involves a multitude of varying services (which can very well change over time to include unnecessary services), none of which are needed by everybody. The broader you make it, the more inclusive it will seem, but at no point is any particular service in "health care" needed by everybody (except perhaps maternity/neo-natal services but even that isn't absolute). I'll be lenient and say for the moment that neo-natal care was indeed absolute - why then, can the pool of money involved such an absolute and ubiquitous service ALSO be allocated towards treating conditional cardiovascular diseases in middle-aged adults? If Congress had that kind of power, we could eventually mandate insurance that paid for treadmills and Atkins diet books in every home.
living_stradivarius wrote:The level of risk changes from day to day. On Monday, as far as I or my insurance company knows, there's nothing wrong with me; on Tuesday, I'm diagnosed with a form of cancer that can only be treated very expensively over a long period. Health risk to an individual can only be crudely and imperfectly assessed, then.
There are health risks that are more accurately assessed and should be factored into the premiums people pay for insurance.
As for insurance that covers serious cancer and unpredictable acute diseases, then you pay for those based on your personal risk tolerance assessment.
How, then, in your opinion, would legislation do it right?
Pay for this so-called insurance through general tax revenue, not through a mandate.
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Re: The timing of the health care law

Post by Teresa B » Thu Apr 05, 2012 3:19 pm

living_stradivarius wrote:Pay for this so-called insurance through general tax revenue, not through a mandate.
Ah, the single-payer plan! I'm with you, I'm with you.

Teresa
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Re: The timing of the health care law

Post by living_stradivarius » Thu Apr 05, 2012 3:20 pm

Teresa B wrote:
living_stradivarius wrote:Pay for this so-called insurance through general tax revenue, not through a mandate.
Ah, the single-payer plan! I'm with you, I'm with you.

Teresa
If we take it out of our defense budget, I won't mind.
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Re: The timing of the health care law

Post by rwetmore » Fri Apr 06, 2012 8:24 am

living_stradivarius wrote:If we take it out of our defense budget, I won't mind.
OK, fine. Now, why can't they say this is what they want to do, campaign on it, get elected on it, and advance this agenda? This is how the democratic process is supposed to work, right? This is how people who fundamentally believe in and revere this basic process would proceed, right?

In fact, this is largely what nationalizing health care is about. To bring down the US as military super power and weaken its ability to defend itself and wage war (if necessary). This is a perfect example of something the unwashed masses are not aware of (they actually think it's entirely about healthcare). Once you have healthcare nationalized, the rhetoric quickly becomes 'we're not spending enough on health care....we're spending too much on the military...we need to cut so military spending so we can provide more people the health care they need and deserve, etc., etc."
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Re: The timing of the health care law

Post by John F » Fri Apr 06, 2012 8:54 am

living_stradivarius wrote:"In some degree or other"? Health care isn't simply a sliding gradient of less or more, it is a verbal construct that involves a multitude of varying services (which can very well change over time to include unnecessary services), none of which are needed by everybody. The broader you make it, the more inclusive it will seem, but at no point is any particular service in "health care" needed by everybody (except perhaps maternity/neo-natal services but even that isn't absolute). I'll be lenient and say for the moment that neo-natal care was indeed absolute - why then, can the pool of money involved such an absolute and ubiquitous service ALSO be allocated towards treating conditional cardiovascular diseases in middle-aged adults? If Congress had that kind of power, we could eventually mandate insurance that paid for treadmills and Atkins diet books in every home.
Sorry, I don't understand what you're saying. Are you proposing that people buy health care insurance for each individual possible need, from migraines to a heart transplant? I'm sure not, that would be absurd, but I don't get what you are proposing.
living_stradivarius wrote:As for insurance that covers serious cancer and unpredictable acute diseases, then you pay for those based on your personal risk tolerance assessment.
I don't understand this either. How, for example, can an insurance company assess my personal risk of being hit by a bus? Or being infected by anthrax in a terrorist attack? And to return to what I said earlier, which you haven't answered, why should I trust an insurance company, which will have to pay for my care, to make an honest assessment of my risk that's fair to me and not just advantageous to the company's bottom line?
living_stradivarius wrote:Pay for this so-called insurance through general tax revenue, not through a mandate.
According to the oral arguments by the government, the mandate is essentially a tax under another name, as it's justified under Congress's constitutional ability to raise taxes. Nomenclature aside, what's the substantive difference?
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Re: The timing of the health care law

Post by Teresa B » Fri Apr 06, 2012 12:41 pm

rwetmore wrote:
living_stradivarius wrote:If we take it out of our defense budget, I won't mind.[/quote

In fact, this is largely what nationalizing health care is about. To bring down the US as military super power and weaken its ability to defend itself and wage war (if necessary). This is a perfect example of something the unwashed masses are not aware of (they actually think it's entirely about healthcare). Once you have healthcare nationalized, the rhetoric quickly becomes 'we're not spending enough on health care....we're spending too much on the military...we need to cut so military spending so we can provide more people the health care they need and deserve, etc., etc."
You've gotta be kidding. You can't be that paranoid. You could literally take any government budget issue and say "We need to spend more on --- so we should cut military spending".

Teresa

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Re: The timing of the health care law

Post by living_stradivarius » Fri Apr 06, 2012 12:52 pm

John F wrote: Sorry, I don't understand what you're saying. Are you proposing that people buy health care insurance for each individual possible need, from migraines to a heart transplant? I'm sure not, that would be absurd, but I don't get what you are proposing.
Different health insurance companies provide different coverage options, and yes, many of these clearly segregate coverage for migraines from that of heart transplants.
Congress would regulate its own arbitrary version "health care" with no respect for market choices or actual need. Massachusetts already has this very problem.
John F wrote: According to the oral arguments by the government, the mandate is essentially a tax under another name, as it's justified under Congress's constitutional ability to raise taxes. Nomenclature aside, what's the substantive difference?
If you read my response to jbuck above:
The whole point is that is not a stand-in equivalent of general taxation. It is not even close to being as transparent and susceptible to public pressure that tax policy is - the mandate completely bypasses the budgetary process. All tax revenue allocation is deliberated upon and subject to the democratic process, and as convoluted as it may be, it's something called taxation with representation.

Secondly, the mandate opens the door for the imposition of mandates that adversely affect specific groups disproportionately. Mandates can effectively force a minority racial group to subsidize treatment for a disease that was specific and prevalent for another group. If such a tax policy were proposed, it could very easily be contested by the minority group in Congress. A general mandate already passed as law can only be contested through the courts.
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Re: The timing of the health care law

Post by jbuck919 » Fri Apr 06, 2012 1:55 pm

living_stradivarius wrote:If you read my response to jbuck above: The whole point is that is not a stand-in equivalent of general taxation. It is not even close to being as transparent and susceptible to public pressure that tax policy is - the mandate completely bypasses the budgetary process. All tax revenue allocation is deliberated upon and subject to the democratic process, and as convoluted as it may be, it's something called taxation with representation.

Secondly, the mandate opens the door for the imposition of mandates that adversely affect specific groups disproportionately. Mandates can effectively force a minority racial group to subsidize treatment for a disease that was specific and prevalent for another group. If such a tax policy were proposed, it could very easily be contested by the minority group in Congress. A general mandate already passed as law can only be contested through the courts.
You are fishing, Henry. From other parts of your responses and from what I know from your past postings, it seems clear that you just don't want to pay a tax or any other kind of assessment that you perceive benefits a group with which you do not (yet) identify. You think the sick should take care of the sick, and the old of the old, and, possibly, non-Asians of non-Asians (see below). John F would not remember this, but I recall that for you this is family values, since your own parents evidently did not or do not intend to avail themselves of any retirement income, for example. Goody for them, and baddy for you for generalizing to the country from a sample of one. Your distaste for shared responsibility across generations and levels of need is sending you on a hunt for specious reasons (reasons that are not even proposed by the unfortunately mainstream political element that is fighting so vigorously against the mandate) to cover up your basic position (which implies that you may not be comfortable frankly stating it), which is not much more than a selective tax protest.

To say that taxes are subject to democratic oversight and the mandate is not is entirely misleading. Anything about the mandate can be changed by the same process of representative democracy (which is admittedly not terribly responsive to resentful individuals) as can a direct tax. As for your raising of a supposed issue of discrimination, I can think of two reasons for it: (1) It is a disingenuous and opportunistic attempt to attract even one person from the left to your argument by proposing that it is the minority group that would suffer from paying for health needs of other people, or (2) You mean Chinese-Americans because you have information that they don't suffer as much from some diseases that are more common in the general population; this position may help explain your resentment, but it does not pass the you-think-you-are-so-special test for relief from an assessment any more than does your present youth and good health. Also consider that the opposite case is much more likely to happen: Only people of African-American ancestry have sickle-cell anemia, for instance, and I don't hear anyone proposing that this group should be self-insuring and excluded from the general pool for that condition, though in fact that heartless and impractical policy would be consistent with what you otherwise say you want.

None of this would matter to you, I imagine, if we were talking about an additional $100 from you each year. What you really can't stand is that this is going to be darn expensive, and you're trying to figure out justifications for why it should cost you less than other people. In fact, the burden will always be differentially born by different people because of limitations on coverage, treatments that would be defined as elective, and, mainly, co-pays. The mandate levels things out so that you are not required to pay $50 while my 91-year-old mother is required to pay $50,000, and if you cannot see that as a matter of social justice necessary to the cohesion of a civilized society, then there is nothing I can say to you. On the other hand, your argument that the expense of health care is a factor in this country at least has company. I present the following without for the moment either endorsing or denouncing it. I wouldn't want you to think I'm out only to win a debate against you personally on all points.

The New York Times


March 31, 2012
The Genius of the Mandate
By ROSS DOUTHAT

WHEN the Obama White House set out to make the liberal dream of universal health coverage a reality, it faced two obvious political obstacles. The first was the power of the interlocking interest groups — insurance companies, physician associations, pharmaceutical companies — that potentially stood to lose money and power in a comprehensive reform. The second was the price tag of a universal health care entitlement, which promised to be high enough to frighten vulnerable members of Congress.

The key to overcoming both obstacles, it turned out, was the mandate to purchase health insurance.

In arguments before the Supreme Court last week, the health care mandate was defended as a kind of technocratic marvel — the only policy capable of preventing the complex machinery of reform from leaking smoke and spitting lug nuts.

But the mandate is actually a more political sort of marvel. In the negotiations over health care reform, it protected the Democratic bill on two fronts at once: buying off some of the most influential interest groups even as it hid the true cost of universal coverage.

The mandate offered the interest groups what all entrenched industries desire: a fresh and captive market for their products. For the insurance companies, it promised enough new business to offset the cost of covering Americans with pre-existing conditions. For the health care sector as a whole, it guaranteed that disposable income currently being spent on other goods and services would be spent on its instead.

This explains why the health care bill was ultimately backed by so many industry lobbying groups, from the Pharmaceutical Research and Manufacturers of America to the American Medical Association. It explains why the big insurers, while opposing the final legislation, never attacked it as vigorously as they did Bill Clinton’s ill-fated reform effort.

At the same time, by requiring the private purchase of insurance, the mandate kept the true cost of the health care expansion off the government’s books, and largely out of the Congressional debate. As the Cato Institute’s Michael Cannon has noted, during the Clinton era the Congressional Budget Office scored an individual mandate as a form of government spending, which pushed the official cost of the Clinton bill into the trillions. But the Obama White House was savvier in its mandate design, and the C.B.O. was more compliant in its scoring. As a result, a bill that might require over $2 trillion in new health care spending — private as well as public — over its first decade was sold with a $900 billion price tag.

So the mandate was politically brilliant, in a sense. But its brilliance was evanescent. Founding a new entitlement on an insider-friendly sleight-of-hand made the bill much easier to pass. But it’s made it harder to defend thereafter, both in the court of law and the court of public opinion.

The mandate’s constitutionality is a thorny issue, and conservatives normally skeptical of judicial activism should probably be a little less eager to see major legislation set aside by a 5-to-4 majority. But the provision is unpopular enough that it’s unlikely to survive in the long run even if Anthony Kennedy flips a coin and decides to uphold it.

Liberals are counting on the fact that “only” seven million Americans will be initially exposed to the mandate’s requirements. But as the economist Tyler Cowen notes, there’s every reason to think that rising health care costs will make the mandate more burdensome with time. And a provision that’s already become a symbol of government overreach seems unlikely to become more popular once there are thousands of individuals and businesses with concrete grievances against it.

The reality is that the more treatments advanced medicine can offer us (and charge us for), the harder it becomes to guarantee the kind of truly universal, truly comprehensive coverage that liberals have sought for years. The individual mandate conceals these realities, but it doesn’t do away with them. If it’s repealed or swept aside, both left and right might be able to focus on a more plausible goal: not a perfectly universal system, but more modest reforms that would help the hardest-pressed among the uninsured.

For conservatives, these reforms might look like the proposals that James Capretta and Robert Moffit outline in the latest issue of National Affairs — a tax credit available to people whose employers don’t offer insurance, better-financed high-risk pools and stronger guarantees of continuous coverage for people with pre-existing conditions.

Liberals, for their part, would probably focus on gradually expanding Medicaid and Medicare to cover more of the near-elderly and the near-poor, creating a larger public system alongside the private marketplace. Indeed, the White House apparently considered switching to exactly this approach in the aftermath of Scott Brown’s surprise Senate win.

In the end, incrementalism wasn’t ambitious enough to satisfy President Obama. But given the drift of last week’s Supreme Court arguments, he may be wishing that he’d settled for something less ideal, but more sustainable, than the bill the mandate built.

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Re: The timing of the health care law

Post by living_stradivarius » Fri Apr 06, 2012 2:14 pm

Anything about the mandate can be changed by the same process of representative democracy (which is admittedly not terribly responsive to resentful individuals) as can a direct tax.
Incorrect. A mandate in place will have to be challenged through the courts.
As for your raising of a supposed issue of discrimination, I can think of two reasons for it: (1) It is a disingenuous and opportunistic attempt to attract even one person from the left to your argument by proposing that it is the minority group that would suffer from paying for health needs of other people, or (2) You mean Chinese-Americans because you have information that they don't suffer as much from some diseases that are more common in the general population; this position may help explain your resentment, but it does not pass the you-think-you-are-so-special test for relief from an assessment any more than does your present youth and good health. Also consider that the opposite case is much more likely to happen: Only people of African-American ancestry have sickle-cell anemia, for instance, and I don't hear anyone proposing that this group should be self-insuring and excluded from the general pool for that condition, though in fact that heartless and impractical policy would be consistent with what you otherwise say you want.
1) It is a logical conclusion with no attempt to kiss anyone's fanny. I'm one to think for myself, not to recycle and spout political talking points brought up by either party.
2) Subsidies covering genetic or congenital disparities should never be forcibly mixed with costs related to behavior. Behavior is the major driver in the cost of care. If you've payed attention to any of my past posts, the primary source of contention for me personally is that people who are health conscious will wind up having to pay for people who sit on their behinds all day. You wind up forcing people with sickle-cell anemia to compete for the same resources as people who are lazy and fat or people who have unprotected sex or unplanned pregnancies.

The other major issue for me is forcing the young to pay for the old. It is demographically unsound and imposes an unnecessary burden on generations that will be the key to advancing medical science among other forms of human progress.

I stand by my position that no one group, whether it is classified by race, gender, age, or whatnot should be forced to subsidize the costs imposed by another. Some of these types of subsidies effectively already exist in our tax code, but at least we have the forum and transparency to consider each case with representation as Congress allocates our federal budget. Collective responsibility for health care is very different from that of other public institutions like education or basic infrastructure because of the greater disparity in the ways in which it applies to different groups.

I have no particular affinity for Asians in health care or any other issue for that matter - any other assumptions about my reasoning you've conjured up in that fancy imagination of yours is bull crap and frankly quite racist.

The mandate levels things out so that you are not required to pay $50 while my 91-year-old mother is required to pay $50,000, and if you cannot see that as a matter of social justice necessary to the cohesion of a civilized society, then there is nothing I can say to you.
She had plenty of time in her youth to make that $50k in preparation for old age. You won't hear me complaining when I'm 91 that some 20 year-old isn't paying for my health care, because I'll be planning for it. Even if I fail at doing so, I'm not one to make that kind of imposition on someone else's future.

In fact, the burden will always be differentially born by different people because of limitations on coverage, treatments that would be defined as elective, and, mainly, co-pays.
Which is why Congress has no place regulating these differences with a blanket mandate over the private market.

On the other hand, your argument that the expense of health care is a factor in this country at least has company.
It is only an issue because we have advanced medical technology beyond that of any other country and people are claiming a right to it. Destroy the incentives to advance medical technology and we might as well be delivering 1960s standard of care to everybody.
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Re: The timing of the health care law

Post by jbuck919 » Fri Apr 06, 2012 3:28 pm

living_stradivarius wrote:It is a logical conclusion with no attempt to kiss anyone's fanny. I'm one to think for myself, not to recycle and spout political talking points brought up by either party.
All I can say about your bizarre positions is that they have the virtue of being wrong-headed in an idiosyncratic way, which means that at least you are not part of the politically powerful organized mainstream cause against universal health care. The Tea Party wouldn't understand a word you are saying, though it would happily mindlessly repeat your arguments because they lead to the same place as what they want. (They might skip the part about it being my mother's fault that she cannot afford a $50,000 premium, not because they don't actually think that, but because of the repercussions if they said so out loud.)

And BTW, it would be racist if I said that it was typical of Chinese Americans to think the way you do. I was speculating on why you might hold the curious position of wanting to divide the country up into an unspecified number of condition-specific risk groups based on a variety of demographic characteristics including, presumably, racial background (since you mentioned minorities). The narrow-self-interest explanation naturally occurred to me, since your entire position is based on narrow self-interest. I'll accept that my speculations were wrong, but that doesn't make it any easier to understand such an off-the-wall position.

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Re: The timing of the health care law

Post by living_stradivarius » Fri Apr 06, 2012 4:46 pm

It's not so hard to figure out when you start thinking about the kinds of logical arguments SCOTUS will have to consider when evaluating the "timing" claim that proponents are putting forth to justify Congressional regulation under the Interstate Commerce Clause. The discussion of the disparate treatment of minorities and majorities is especially relevant when considering Constitutional issues and has nothing to do with any predispositions of mine.

I'm not going around speculating on why you think what you think based on your race, gender, background or age even.
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Re: The timing of the health care law

Post by jbuck919 » Fri Apr 06, 2012 8:37 pm

living_stradivarius wrote:The discussion of the disparate treatment of minorities and majorities is especially relevant when considering Constitutional issues and has nothing to do with any predispositions of mine.
You can't actually believe that anti-discrimination has anything to do with the thinking of the opponents of the Health Care Act. They are the same people who go around trying to figure out how much discrimination they can still inject into public policy in all sorts of ways and get away with it.
I'm not going around speculating on why you think what you think based on your race, gender, background or age even.
Good for you. I will continue to wonder out loud what reasons there might be for you take the extraordinary position that you do. I assume that it is not because you have good employer health insurance, which like millions of others you could keep under the Health Care Act, but rather think arrogantly that you are the spokesman for the interests of all those who do not have and cannot afford such coverage for the arbitrary reason that they don't have an employer who offers it. If you care to tell me that you are in fact covered by a good group plan, then obviously I am wrong, but then I will wonder why you think it's any skin off your nose to extend the coverage pool to those less fortunate.

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Re: The timing of the health care law

Post by living_stradivarius » Fri Apr 06, 2012 8:43 pm

jbuck919 wrote:You can't actually believe that anti-discrimination has anything to do with the thinking of the opponents of the Health Care Act. They are the same people who go around trying to figure out how much discrimination they can still inject into public policy in all sorts of ways and get away with it.
It's a question of law and Constitutionality, not policy or political expediency. Whatever else these other people try to inject into public policy should be considered separately. How about getting rid of due process while we're at it so that law enforcement can do its job more effectively?

I won't indulge your curiosity about whether or not I have health insurance because that's very much irrelevant to this discussion.

Costs seem high today because we have advanced treatments that everyone wants without paying for them (or for the furtherance of modern medicine for that matter).
If people think health insurance covering modern treatments is too darn expensive, then they need to move to an insurance policy with a provider network that offers slightly older, less-expensive forms of treatment. If such a network is hard to come by, then be the entrepreneur to form one. As for the completely indigent, there's Medicaid.

Food stamps weren't designed to pay for luxury dinners; as such, government-provided health insurance shouldn't provide the equivalent in medicine.
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Re: The timing of the health care law

Post by jbuck919 » Sat Apr 07, 2012 9:41 pm

living_stradivarius wrote:If people think health insurance covering modern treatments is too darn expensive, then they need to move to an insurance policy with a provider network that offers slightly older, less-expensive forms of treatment. If such a network is hard to come by, then be the entrepreneur to form one. As for the completely indigent, there's Medicaid.
That is beside the point. The whole reason for having a mandate is that there are tens of millions of people who have no insurance, cannot afford same, and yet do not qualify for Medicaid, which as you yourself state is or should be a last resort of the all-too-numerous desperate. If everybody was insured by compulsion there would be a self-regulating market based on coverage with differential premiums, just as people who have employer plans or who can afford private plans can now choose differentially among various options. The question would be what the government could require to be covered and what it could leave up to individual option, a debatable topic that could be addressed by the representative legislature which you falsely state can only deal with direct taxes. But your idea that people should not have guaranteed access to your bête noire of supercare ignores the fact that many of them have no access to reasonable, including affordable, care even at the level of (without endorsing your exact wording) "older, less expensive forms of treatment."

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Re: The timing of the health care law

Post by living_stradivarius » Sun Apr 08, 2012 3:31 pm

jbuck919 wrote:The whole reason for having a mandate is that there are tens of millions of people who have no insurance, cannot afford same, and yet do not qualify for Medicaid, which as you yourself state is or should be a last resort of the all-too-numerous desperate... But your idea that people should not have guaranteed access to your bête noire of supercare ignores the fact that many of them have no access to reasonable, including affordable, care even at the level of (without endorsing your exact wording) "older, less expensive forms of treatment."
They do - it's called the ER, and for many care is provided for free there, even for minor symptoms like fevers. If people are so concerned about those who fall into Medicaid "donut holes" then be the entrepreneur and start a private insurance policy that is cheaper and accessible that uses older, less expensive forms of treatment. It's too bad the populace asking for all these things lacks the entrepreneurial spirit to do so.
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Re: The timing of the health care law

Post by jbuck919 » Sun Apr 08, 2012 5:05 pm

living_stradivarius wrote:
jbuck919 wrote:The whole reason for having a mandate is that there are tens of millions of people who have no insurance, cannot afford same, and yet do not qualify for Medicaid, which as you yourself state is or should be a last resort of the all-too-numerous desperate... But your idea that people should not have guaranteed access to your bête noire of supercare ignores the fact that many of them have no access to reasonable, including affordable, care even at the level of (without endorsing your exact wording) "older, less expensive forms of treatment."
They do - it's called the ER, and for many care is provided for free there, even for minor symptoms like fevers. If people are so concerned about those who fall into Medicaid "donut holes" then be the entrepreneur and start a private insurance policy that is cheaper and accessible that uses older, less expensive forms of treatment. It's too bad the populace asking for all these things lacks the entrepreneurial spirit to do so.
You're being silly, perhaps squirming even (increasingly so with each post which attempts to circumnavigate your personal desire not to pay premiums). Use of the ER for reasons other than emergencies is a huge part of our health care problem, both in terms of effective health care delivery and expense. And it is no more reasonable to base policy on the expectation that an entrepreneur exists who can solve a problem than it is to assume that a scientific discovery is about to be made which will do the same.

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Re: The timing of the health care law

Post by living_stradivarius » Sun Apr 08, 2012 7:12 pm

jbuck919 wrote:Use of the ER for reasons other than emergencies is a huge part of our health care problem, both in terms of effective health care delivery and expense.
This whole "expense" problem you're citing is an illusion. The care being provided by ERs is a product of modern medical advancement and is therefore expensive. Scale down the level of technology offered and it becomes affordable - it's too bad no one is taking the initiative to create an insurance policy that does so because everyone feels entitled to the latest and greatest, despite having contributed nil to its inception. Mandating that we pay for the delivery of said care to everybody is not fiscally practical lest we break the bank or destroy innovation in medical technologies, apart from the legal/values issues brought up earlier.
And it is no more reasonable to base policy on the expectation that an entrepreneur exists who can solve a problem than it is to assume that a scientific discovery is about to be made which will do the same.
It is no more reasonable to base policy on the expectation that the federal government deliver. It makes more sense for an entrepreneur to get such a cheaper insurance policy going and get the uninsured who don't qualify for Medicaid to forego their iPhone and iPad plans and pay into a cheaper version of health insurance.
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Re: The timing of the health care law

Post by jbuck919 » Sun Apr 08, 2012 8:05 pm

living_stradivarius wrote:It is no more reasonable to base policy on the expectation that the federal government deliver. It makes more sense for an entrepreneur to get such a cheaper insurance policy going and get the uninsured who don't qualify for Medicaid to forego their iPhone and iPad plans and pay into a cheaper version of health insurance.
But iPhones and iPads are less expensive than health insurance.

If you think that what I just said misses the point and/or is an argumentative diversion from the topic that you feel resentful at having to address or perhaps are too fed up to address at all, then you have some idea of the impression your own posts have been making.

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Re: The timing of the health care law

Post by living_stradivarius » Sun Apr 08, 2012 8:08 pm

jbuck919 wrote:But iPhones and iPads are less expensive than health insurance.
Not when you scale back the level of medical technology and standard of care. The latest medical technologies will always be too expensive for most of the populace to afford.
Last edited by living_stradivarius on Sun Apr 08, 2012 8:12 pm, edited 1 time in total.
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Re: The timing of the health care law

Post by nut-job » Sun Apr 08, 2012 10:10 pm

living_stradivarius wrote:
jbuck919 wrote:Use of the ER for reasons other than emergencies is a huge part of our health care problem, both in terms of effective health care delivery and expense.
This whole "expense" problem you're citing is an illusion. The care being provided by ERs is a product of modern medical advancement and is therefore expensive. Scale down the level of technology offered and it becomes affordable - it's too bad no one is taking the initiative to create an insurance policy that does so because everyone feels entitled to the latest and greatest, despite having contributed nil to its inception. Mandating that we pay for the delivery of said care to everybody is not fiscally practical lest we break the bank or destroy innovation in medical technologies, apart from the legal/values issues brought up earlier.
You think it makes sense that a poorly insured individual who comes into the ER with a suspected subdural hematoma isn't entitled to a MRI scan because they "contributed nil to its inception?" Those machines are reserved for diagnosing bursitis in wealthy people's elbows because the economic impact on the tennis racquet industry is more significant to the economy?

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Re: The timing of the health care law

Post by John F » Mon Apr 09, 2012 12:39 am

living_stradivarius wrote:This whole "expense" problem you're citing is an illusion.
To the contrary, it's your notion of rationing the best available care that's an illusion. It's not the doctor's role to assess a patient's ability to pay and prescribe only the medicine and methods he/she can afford. That would be unethical and may be illegal, if the patient is so poor he/she can't afford anything and is therefore left to suffer and die. No, the doctor is supposed to diagnose the patient's illness or injury and prescribe the most effective, safest, and when relevant the quickest means of curing or at least relieving it. I can't believe I'm having to say this.

I realize started this subtopic by asking what you would prefer instead of the legal obligation for all to have at least a minimum level of health insurance. But I certainly didn't expect this!
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Re: The timing of the health care law

Post by nut-job » Mon Apr 09, 2012 1:03 am

I'm certainly sensitive to the issue of cost. But the current US system (pre-Obamacare) seems to waste half of the money that it spends (based on a comparison of cost with other countries, and some published studies). A lot of unnecessary tests are done in order to protect against lawsuits, a lot of people defer treatment they can't afford, only to need much more expensive treatment in emergency rooms. A system which spreads the risk and eliminated inefficiencies would be a lot less costly overall and make the US a more competitive economy. Whether Obamacare is a significant improvement is another question. My view is that it is better than nothing, but a lot worse than the best that could have been done. The myriad special interest groups make it impossible to do that truly smart thing.

As far as the mandate is concerned, I saw a commentary (don't quite remember where) by someone who said the mandate was a mistake, because it is unpopular with a large segment of the population. An equivalent policy could have been formulated in a more palatable way (as a tax penalty for opting out, or something along those lines). No one is going to be put in jail for not having insurance. The "mandate" amounts to a tax break for having health insurance.

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Re: The timing of the health care law

Post by living_stradivarius » Mon Apr 09, 2012 1:12 am

nut-job wrote: You think it makes sense that a poorly insured individual who comes into the ER with a suspected subdural hematoma isn't entitled to a MRI scan because they "contributed nil to its inception?" Those machines are reserved for diagnosing bursitis in wealthy people's elbows because the economic impact on the tennis racquet industry is more significant to the economy?
If we gave everyone NMR-MRI scans back in the 80s we wouldn't even something close to the diagnostic technology we have today. One day in the future we'll be diagnosing and treating hematomas even more effectively and the MRI we have today will be cheaply available to the poorly insured, but to get to that stage the incentives driving medical innovation need to be sustained, just as they have been over the past century.
The "mandate" amounts to a tax break for having health insurance.
It's not just a matter of palatability. It completely skirts the budgetary process -- something called taxation with representation.
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Re: The timing of the health care law

Post by living_stradivarius » Mon Apr 09, 2012 1:16 am

John F wrote:To the contrary, it's your notion of rationing the best available care that's an illusion.
Health care rationing an illusion? The reason the US is so far ahead in medical technology, diagnosis, and treatment over other countries is because of it.

Expense is an illusion. Sixty years ago there was no treatment for lymphoma, so people who had it simply died. How much would they have valued a cure back then? It would have been infinitely valuable for such a cure to exist, of course. Then we had a major breakthrough in bone-marrow transplants in the 60s and 70s that made a cure possible. Sure, it seemed expensive given all the time, money, research, and energy to come up with it, but that's hell of a lot cheaper than being infinitely valuable and non-existent.

People who go abroad to India for surgery can't afford the surgery in the US because the methods used in the US are decades ahead of India. This is why a secondary provider and insurance market to provide older technologies/standards of care is so viable in the US - an entrepreneur simply has to take the initiative to do it.
John F wrote:It's not the doctor's role to assess a patient's ability to pay and prescribe only the medicine and methods he/she can afford.
Who said it was the doctor's role? Many are simply responsible for diagnosis and the delivery of care, and only some are involved in the invention of new medical technologies. Give those medical technologies away for free?
That would be unethical and may be illegal, if the patient is so poor he/she can't afford anything and is therefore left to suffer and die.
If the patient is that poor, s/he is covered by Medicaid.

Had we disrupted the cycles of innovation by freely distributing the latest and greatest medical technologies forty years ago, a lot more people would be dead or dying today, uninsured or insured.
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Re: The timing of the health care law

Post by John F » Mon Apr 09, 2012 11:14 am

living_stradivarius wrote:If you read my response to jbuck above: The whole point is that is not a stand-in equivalent of general taxation. It is not even close to being as transparent and susceptible to public pressure that tax policy is - the mandate completely bypasses the budgetary process. All tax revenue allocation is deliberated upon and subject to the democratic process, and as convoluted as it may be, it's something called taxation with representation.
There are taxes and taxes. The kind of tax which the mandate penalty is analogous to is the FICA tax that pays for Social Security and basic Medicare benefits for the elderly. This too bypasses the budgetary process and the revenue from it is not allocated according to what you call the democratic process, except that FICA itself was passed by the democratic process - as was the Affordable Care Act including the insurance coverage mandate and the penalty for evading it. Boston Tea Party rhetoric about taxation with representation is beside the point.
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Re: The timing of the health care law

Post by living_stradivarius » Mon Apr 09, 2012 12:06 pm

John F wrote:The kind of tax which the mandate penalty is analogous to is the FICA tax that pays for Social Security and basic Medicare benefits for the elderly. This too bypasses the budgetary process...
Which is a huge problem.
As for the Constitutional issue, Social Security and FICA are nonetheless different from mandates on the individual because they necessarily operate through employers. If I operate a LLC and sell services hiring only independent contractors, no Social Security or FICA tax is levied.

The ironic thing is proponents of the mandate could have certainly tried to go this employer-exclusive route to levy yet another tax to avoid the Constitutional issue altogether, especially since full-time employees are the predominantly the ones who would be footing the bill anyways, but since the mandate was designed by Heritage folks to make "free riders" pay, they followed that design and now are at the mercy of SCOTUS.
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Re: The timing of the health care law

Post by Teresa B » Mon Apr 09, 2012 1:37 pm

living_stradivarius wrote:
jbuck919 wrote:Use of the ER for reasons other than emergencies is a huge part of our health care problem, both in terms of effective health care delivery and expense.
This whole "expense" problem you're citing is an illusion. The care being provided by ERs is a product of modern medical advancement and is therefore expensive. Scale down the level of technology offered and it becomes affordable - it's too bad no one is taking the initiative to create an insurance policy that does so because everyone feels entitled to the latest and greatest, despite having contributed nil to its inception. Mandating that we pay for the delivery of said care to everybody is not fiscally practical lest we break the bank or destroy innovation in medical technologies, apart from the legal/values issues brought up earlier.
I think you're missing the boat here as far as the use of the ER as John (jbuck) is describing. Yes, it's very expensive to be treated in the ER--partly because of medical advancements, but these advancements are also expensive when done in a non-emergency facility. It's the use of the expensive ER by those who have no insurance and are using the ER for non-emergencies that we need to change. Since the ER takes all comers, and many cannot pay, you and I are indirectly covering the expense. It is extremely expensive, too, as all hospital care is, because the insured patients are covering a lot of costs for the uninsured.

There are no better "medical advancements" in the ER to evaluate and treat somebody's sore throat or bladder infection. These things would be ever so much more logically treated in a non-emergency facility at way less cost. If we all had insurance, ER's could be properly reserved for emergencies.

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Re: The timing of the health care law

Post by living_stradivarius » Mon Apr 09, 2012 1:42 pm

Teresa B wrote: There are no better "medical advancements" in the ER to evaluate and treat somebody's sore throat or bladder infection. These things would be ever so much more logically treated in a non-emergency facility at way less cost.
Which is why I mentioned that we need to create a secondary and cheap insurance market using less advanced technology and treatments without grouping expensive technologies into premium levels to cover sore throats and bladder infections when they arise. One of the problems with health insurance today is that there is a tendency to group many different levels of care into one or two policies, which results in lower premiums for super expensive treatments but higher premiums for simple problems. De-couple those treatments in a market specific for those who fall in the gap between Medicaid and being insured, and you solve that problem. It can be solved by the private market if someone takes the initiative to do it.
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