The Great Universal Health Care Debate w/Poll (note: it just passed both houses)

[exhelodrvr]

Depends on how you want to define the term "health care." If by "health care" you mean the ability to receive walk-in treatment at an ER, than yes, health care is already available to everyone, because many hospitals are legally obligated to treat those who present at their ERs, regardless of ability tp pay. This is arguably the most expensive way to treat disease, and it drives up costs for everybody. On the other hand, if by "health care" you mean being enrolled in a plan of insurance with half-decent benefits (i.e. covers preventative care and doesn't have a $15,000 annual deductible), than this is soemthing that has not been available to everyone.

My previous post was meant to point out that the 37 million + people referenced by jarhead who are not enrolled in an insurance plan (second definition above) are already players in and absolutely do have an impact on the overall health care system and the cost of providing medical services to all Americans. Supposedly, one of the major cost savings of the legislation will come about because expensive ER care for the previously unenrolled will become the exception rather than the norm.

Many of those 37M already pay their health care costs, because they can afford to, and are in the age range where it makes financial sense to NOT have insurance.

 

[jarhead]

...words... Supposedly, one of the major cost savings of the legislation will come about because expensive ER care for the previously unenrolled will become the exception rather than the norm.

I get that part of the HCR, that preventitive care should mean less people at the ER thus reducing overall health care costs...

I guess my question is where are we going to shit more Family Practice Doctors/General Practitioners/Pediatricians, etc with 37 million new people looking for their preventitive care? ...or are we just going to have to accept longer waits...

I'm not trying to debate... I got a D in debate in HS, plus I don't have the time to read all 2,309 pages of this bill. I'm just looking to "tighten" myself up with some knowledge (and not from some regurgitated drivel from Glenn Beck or Keith Olbermann)

SF

 

[OnTopTime]

Many of those 37M already pay their health care costs, because they can afford to, and are in the age range where it makes financial sense to NOT have insurance.

I know I'm very conservative financially, but to me there isn't any age range where it makes financial sense to not have health insurance, IF you can afford it. If someone told me that they had the income/resources to buy health insurance but declinced to do so because they were in a certain age range, I would tell them they were stupid.

Where do you come up with the fact that many of those 37 million can afford health insurance but choose to (and presumably are capable of) pay out of pocket?

 

[HercDriver]

There is a difference I'd say between being zealous to pass a massive health bill that allows them to increase control over the system and economy and being zealous to truly reform healthcare. This bill also federalizes the student loan program.

Well, it depends on your definition of reform. I would say the ability to get insurance with a pre-existing condition, having dependent children under 26 go on their parent's insurance, and closing the Medicare prescription drug "donut hole" are reform.

The two primary ways in which to control society are to control healthcare and energy. You can also control education and finance.

The Obama administration seems on a course to grab control of all four.

Once the "government is paying" for your healthcare, they get to regulate, tax, and dictate to you in all sorts of new ways.

For example, here in New York state, they are trying to push through legislation to severely curtail the salt used in restaurants. Why? Because "it will help reduce healthcare costs in the state."

So you just gave an example of a (state) government pushing through legislation, even though it has nothing to do with your "wait til the government signs the checks 'cuz they will do all kinds of awful things to tax & control you". Or is the salt ban only for those getting NY state subsidies on their health insurance?

I wonder how we in the military and all of those seniors on Medicare who have gov't-controlled heathcare have not decided to march on Washington right now, demanding to go to privatized insurance and away from the current "government is paying" system, effectively throwing off the bonds of Gov't control. Perhaps it's the fluoride in the water that has weakened our resolve?:icon_wink

Obama said he wanted to change America in three fundamental ways: healthcare, education, energy.

Healthcare via quasi-nationalizing the healthcare system.

Education via a government takeover of the student-loan program

(they just did the above two with this bill)

Quasi, indeed as this is a private market plan. If it were single payer, I would (almost) take the "OMG, Big Brother will be your Dr, Comrade" stuff a bit more seriously, but that was compromised away. Also, the federal gov't already had control of the student loan program through default guarantees to lending institutions, providing student loans (why do you think the interest rates are so low?)

Energy via carbon cap-and-trade to control carbon emissions, thus rationing energy and controlling the economy in this sense (in Britain, some want to mandate a "carbon card" in which every time any citizen makes a purchase, they draw from their mandated yearly carbon ration). Congress won't do cap-and-trade it seems, so the administration wants to place control of regulating carbon under the EPA.

There is a fourth area of control however, which is finance. Because of this crises, we now have fewer, and even more massive, financial institutions.

Financial regulatory reform is up next.

If you are wondering why regulatory reform is up next, the answer lies in your previous sentence.

The government, if they write the regulations right, could place these massive financial institutions, a very concentrate industry, under such regulatory control that these institutions become appendages of the government.

Then they would control the pricing and allocation of credit, the lifeblood of capitalism.

And of course we all know Democrats would love to pass the Fairness Doctrine to regulate free speech and nationalize the oil industry to control energy in this sense as well ("every other country in the industrialized world" has a nationalized oil industry).


So the party that wants government to control healthcare, education, energy, finance, and free speech, they then rail they are not socialists.

"The Government, if they write the the regulations right, could..." You lost me at if and could. I'm all for hypotheticals, but they don't bolster this argument.

The myth that the Dems collectively want to pass the Fairness Doctrine was dispelled on here before. Please, do a search.

As for your nationalization of the oil industry, I'm guessing you have something to cite, or are you drunk posting?

As an aside, I enjoy the dark, Beckian, conspiratorial musings.

 

[HercDriver]

That's one of the main problems with the bill. It's very specific about how it plans to grant access to health care to everyone, something you admit is already available. It does not specify where the cost controlling measures of health care reform come from, and completely ignores others. Tort reform, open competition among insurers, etc etc are not laid out clearly in the bill, and could have had immediate effects on the cost of health care.

The CBO was tasked by Pres Bush to study limiting tort liability for medical malpractice and found:

Savings of that magnitude would not have a significant impact on total health care costs, however. Malpractice costs amounted to an estimated $24 billion in 2002, but that figure represents less than 2 percent of overall health care spending. Thus, even a reduction of 25 percent to 30 percent in malpractice costs would lower health care costs by only about 0.4 percent to 0.5 percent, and the likely effect on health insurance premiums would be comparably small.

Not significant, IMO.
http://www.cbo.gov/doc.cfm?index=4968&type=0

 

[exhelodrvr]

I know I'm very conservative financially, but to me there isn't any age range where it makes financial sense to not have health insurance, IF you can afford it. If someone told me that they had the income/resources to buy health insurance but declinced to do so because they were in a certain age range, I would tell them they were stupid.

Where do you come up with the fact that many of those 37 million can afford health insurance but choose to (and presumably are capable of) pay out of pocket?

There have been a number of studies on that. A lot healthy people choose to accept the risk, will pay the out-of-pocket expenses when necessary, and spend the money elsewhere.

"but to me there isn't any age range where it makes financial sense to not have health insurance"
The fact that insurance companies make money on it (albeit about 3%, nothing close to the kind of profits Pres Obama pretends they make) is proof that it makes financial sense. Just like it would make financial sense not to purchase life insurance, and invest the money instead.

 

[exhelodrvr]

The "defensive medicine" that results from the malpractice issue is where the majority of that cost comes from, not from malpractice costs themselves. And the estimates are that from 5-10 % of medical costs fall into that category. That is separate from the costs of malpractice insurance and the effect that has on decreasing availability of medical services to patients.

 

[mmx1]

There have been a number of studies on that. A lot healthy people choose to accept the risk, will pay the out-of-pocket expenses when necessary, and spend the money elsewhere.

But this "risk" also assumes that they will receive emergency medical care without regard for their ability to pay, through an infrastructure subsidized by those who do pay into the healthcare system. Remove that security net, and the risk calculus shifts significantly.

"but to me there isn't any age range where it makes financial sense to not have health insurance"
The fact that insurance companies make money on it (albeit about 3%, nothing close to the kind of profits Pres Obama pretends they make) is proof that it makes financial sense. Just like it would make financial sense not to purchase life insurance, and invest the money instead.

Insurance companies make money on car and homeowner's insurance too, are those bad financial decisions? Life insurance is slightly different - if you have no dependents it's just a lousy lottery ticket. If you have family that depend on you as a primary wage-earner, I think it'd be irresponsible not to have life insurance.

 

[HercDriver]

The "defensive medicine" that results from the malpractice issue is where the majority of that cost comes from, not from malpractice costs themselves. And the estimates are that from 5-10 % of medical costs fall into that category. That is separate from the costs of malpractice insurance and the effect that has on decreasing availability of medical services to patients.

From the same report:

Advocates or opponents cite other possible effects of limiting tort liability, such as reducing the extent to which physicians practice "defensive medicine" by conducting excessive procedures; preventing widespread problems of access to health care; or conversely, increasing medical injuries. However, evidence for those other effects is weak or inconclusive.

Several studies have found that various types of restrictions on malpractice liability can indeed reduce total awards and thereby lead to lower premiums for malpractice insurance. By themselves, however, such changes do not affect economic efficiency: they modify the distribution of gains and losses to individuals and groups but do not create benefits or costs for society as a whole. The evidence for indirect effects on efficiency--through changes in defensive medicine, the availability of medical care, or the extent of malpractice--is at best ambiguous.

Effects on Defensive Medicine

Proponents of limiting malpractice liability have argued that much greater savings in health care costs would be possible through reductions in the practice of defensive medicine. However, some so-called defensive medicine may be motivated less by liability concerns than by the income it generates for physicians or by the positive (albeit small) benefits to patients. On the basis of existing studies and its own research, CBO believes that savings from reducing defensive medicine would be very small.

 

[SkywardET]

Besides opinion, what do you base this on? Just curious.

I don't necessarily agree that this bill was exclusively about increasing government control. I think that President Obama had initiative and ambition (obviously) and wanted to get something done. Then the moneyed interests got involved, wrote the bill, and we have a result that does so relatively little to address the initial concerns (lack of access and spiraling cost primary among them) that we should all be deeply saddened.


I saw mention of the Swiss system previously on this thread, and thought that this article on the Scandinavian situation might be appropriate. For the tl;dr crowd, it essentially says that yes those countries such as Switzerland have substantial welfare states, but they also have among the most business-friendly governments on the planet (Switzerland being better than the US and improving, while the US is falling) and very limited military expenditure, which is diametrically opposed to ours, the largest ever in history. Starting and operating a business is very straightforward in those countries, so the tax burden is ameliorated.

 

[Random8145]

Well, it depends on your definition of reform. I would say the ability to get insurance with a pre-existing condition, having dependent children under 26 go on their parent's insurance, and closing the Medicare prescription drug "donut hole" are reform.

Individual reforms are nice, but this is a 2,000+ page bill. There is a good chance it will blow a hole in the budget. Not wise to seek to fix one problem by creating another.

So you just gave an example of a (state) government pushing through legislation, even though it has nothing to do with your "wait til the government signs the checks 'cuz they will do all kinds of awful things to tax & control you". Or is the salt ban only for those getting NY state subsidies on their health insurance?

The point is that whenever the government is paying for something, they can tax or regulate it. State-level is one thing, but when the national government starts doing it, then you see more control.

I wonder how we in the military and all of those seniors on Medicare who have gov't-controlled heathcare have not decided to march on Washington right now, demanding to go to privatized insurance and away from the current "government is paying" system, effectively throwing off the bonds of Gov't control. Perhaps it's the fluoride in the water that has weakened our resolve?:icon_wink

Many in them ilitary I have spoken to abhor the military healthcare system; others are okay with it. As for Medicare, it's going bankrupt, that's one of the core issues. It really doesn't matter what the people on it "want" or "think," it's is there a means to pay for it.

Also, Medicare is a program to provide seniors, people who in theory have worked throughout their lives to provide and produce for this nation, with healthcare now that they are at a stage of their lives where they likely cannot continue to earn significant money.

I see nothing wrong with having programs that do what Medicare and Social Security do (and even Medicaid, as many seniors are on that, my grandma included), but the way in which they are done is very bad.

Quasi, indeed as this is a private market plan. If it were single payer, I would (almost) take the "OMG, Big Brother will be your Dr, Comrade" stuff a bit more seriously, but that was compromised away.

Quasi-nationalized doesn't mean the government doesn't control it.

Also, the federal gov't already had control of the student loan program through default guarantees to lending institutions, providing student loans (why do you think the interest rates are so low?)

Then why in the healthcare bill are they putting the government in charge of the student loan program?

If you are wondering why regulatory reform is up next, the answer lies in your previous sentence.

I'd say what the sentence shows is how complicated an issue it really is. What they should do, IMO, is break up these massive financial institutions. The alternative is to regulate them heavily, because they can never be allowed to fail, and thus will always act like quasi-nationalized institutions regardless in this sense, so you can reason, "Since you are backed by the taxpayer, the price of that is heavy regulation," BUT, the government could use this as a convenient means to essentially turn these big financial institutions into appendages of the government, thus giving the government control over credit.

So to me that's a very dangerous thing. The government needs to break up these big firms, which I believe Paul Volcker has said he is for as well. Regulation is just a scheme for control.

"The Government, if they write the the regulations right, could..." You lost me at if and could. I'm all for hypotheticals, but they don't bolster this argument.

Why not? if the government authors the regulations extensively and in the "right" manner, they will gain massive control over these institutions, thus turning them into appendages of the government.

The myth that the Dems collectively want to pass the Fairness Doctrine was dispelled on here before. Please, do a search.

So what? The Democrats didn't want to collectively pass this health reform either. They didn't have the traditional sixty vote majority needed, they rammed it through via reconcilation, and that was after doing a lot of bribing to get the votes.

Our President also is for the Fairness Doctrine (or was).

As for your nationalization of the oil industry, I'm guessing you have something to cite, or are you drunk posting?

There are various statements Democrats have made over the years regarding their desire to nationalize the oil industry. And given that they want to control healthcare, education, carbon emissions, etc...I don't find it surprising at all.

As an aside, I enjoy the dark, Beckian, conspiratorial musings.

Except these aren't conspiratorial.

Obama himself was a supporter of the Fairness Doctrine

Obama supports union card check

Obama wants the carbon cap-and-trade regulation, despite the fact it will wreck the economy and is based on a very under-developed scientific claim; it also gives the government tremendous control over our economy.

Obama wants government control over healthcare---he himself has said he prefers a single-payer healthcare system, but you cannot convert the entire system to single-payer overnight, so you do it gradually, through things like a public option say. This current bill was a public option, just done in a different manner.

Obama now wants "financial regulatory reform," well why regulate them? Why not just break them up?

None of this is conspiratorial. Obama is a socialist. No, he is not Vladirmir Lenin or Joseph Stalin or Chairman Mao, but he would have fit in quite easily with the various democratic socialists, like the British Labour party pre-Blair, the German Social Democrats, the French Socialists, etc...he believes it should be the government that is the prime controller and director in the economy.

I think he is much like a French-style socialist. France has a socialist party, but they are not socialist as the Soviet Union was. But to America, they are very far to the Left.

 

[Random8145]

For the tl;dr crowd, it essentially says that yes those countries such as Switzerland have substantial welfare states, but they also have among the most business-friendly governments on the planet (Switzerland being better than the US and improving, while the US is falling)

Switzerland and Iceland I know are very business-friendly, not as sure about the others. Norway gets 25% of their GDP from oil exports. Let's also remember that many of these nations are very small, so it is easier to manage a welfare state.

and very limited military expenditure, which is diametrically opposed to ours, the largest ever in history.

That's because we have been subsidizing their security for many years (Europe never would have stood firm against the Soviet Union on its own), and we underwrite global security, keep the sea lanes open, etc... We piggybacked off the British Empire when they were the main ones doing this back in the 19th century too.

 

[exhelodrvr]

But this "risk" also assumes that they will receive emergency medical care without regard for their ability to pay, through an infrastructure subsidized by those who do pay into the healthcare system. Remove that security net, and the risk calculus shifts significantly.

Insurance companies make money on car and homeowner's insurance too, are those bad financial decisions? Life insurance is slightly different - if you have no dependents it's just a lousy lottery ticket. If you have family that depend on you as a primary wage-earner, I think it'd be irresponsible not to have life insurance.

People without health insurance, but who could afford it, still have to pay when they get medical services. You're confusing what is a "responsible" choice with what makes financial sense. Some people are willing to take that risk, some aren't. But the fact is that the odds are in your favor.

 

[OnTopTime]

People without health insurance, but who could afford it, still have to pay when they get medical services. You're confusing what is a "responsible" choice with what makes financial sense. Some people are willing to take that risk, some aren't. But the fact is that the odds are in your favor.

If you're young and healthy and can afford health insurance but don't buy it, the odds may be in your favor, but if you roll the dice and lose it can be a hell of a large bet to pay off. Buying health insurance (or homeowner's insurance or car insurance) is not a zero sum game; you shouldn't expect to get paid in benefits over the course of your enrollment an amount that equals the sum of the premiums you have paid. On the other hand, if you are one of the unlucky few who suffers a catastrophic injury or comes down with a serious medical condition, having insurance coverage could literally be a life saver or life extender, or at the very least protect your quality of life. What rational person with the ability to pay for health insurance would take that gamble for themself, not to mention family members? Would you?

 

[Flash]

Then why in the healthcare bill are they putting the government in charge of the student loan program?

To save a lot of money and to make sure more of the taxpayers money goes to the students getting the loans instead of the middlemen.

So what? The Democrats didn't want to collectively pass this health reform either. They didn't have the traditional sixty vote majority needed, they rammed it through via reconcilation, and that was after doing a lot of bribing to get the votes.

Then why did they vote for it then?

Our President also is for the Fairness Doctrine (or was).

A moot point, I haven't seen any serious movement on reinstating it or him supporting it lately.

There are various statements Democrats have made over the years regarding their desire to nationalize the oil industry. And given that they want to control healthcare, education, carbon emissions, etc...I don't find it surprising at all.

A couple of outliers have said as much but there is no serious movement at all to do so. Stop being silly.

Obama is a socialist. No, he is not Vladirmir Lenin or Joseph Stalin or Chairman Mao, but he would have fit in quite easily with the various democratic socialists, like the British Labour party pre-Blair, the German Social Democrats, the French Socialists, etc...he believes it should be the government that is the prime controller and director in the economy.

When has he said that?

I really don't get where people think he is a socialist, I think the definition has been twisted to be the new bogeyman instead of liberal. The government directly controls a tiny portion of the economy and there has been no serious suggestion to greatly expand the government's control of private industry in this country, outside health care if you want to count it as such. The governments takeover of the two auto companies was due to dire financial circumstances and will likely not last too much longer and has proven an exception to the rule. Tighter regulation in some cases but regulation is not the same as control, especially when you consider that in some aspects the economy and much of the financial industry is more loosely regulated than it used to be.

Some of the President's opponents seem to often seem to prophesize apocalyptic scenarios that just don't seem to pan out in the end. I will work for a while but after people don't see them panning out in the end it will lose it's effect.