Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Truean]

You don't have the right to get medical care in the US? Aren't there like international laws about that?

Anyway, isn't the US the only western country without a decent medical/insurance system by now? I'm by no means an expert but that is just the impression I get.

No matter if they are required to treat you or not, they don't have to for free....

Yes, we're utterly pathetic in health care and most people don't know and/or refuse to see it at all.

We have things called "medical bankruptcy." If you or a family member gets sick their medical bills can literally bankrupt you. People just don't talk about it much, except being in the legal field, I know it very much exists.... This also happens to people who have insurance, because after a certain point they cut you off.... http://www.ehow.com/about_6616134_medical-bankruptcy_.html <--- There's an oversimplification for you.

If you're an old person and need a nursing home, then the government will take all your money except a few exempt assets and only then will they pay for anything. This is called "medicaid spenddown" and I do them at work. http://www.ehow.com/facts_5801193_medicaid-spend-down_.html <--- Another oversimplification for you. The exemption amount depends on if one or both spouses are institutionalized. Even then the government will come after your estate when you die for something called "medicaid recovery," http://www.cms.gov/MedicaidEligibility/08_Estate_Recovery.asp. The government will essentially place liens on any real property you own (your house), and anything that isn't exempt. The cheapest halfway decent nursing home I've found around here is $6,000/month. That adds up quick. 12 x 6,000 = $72,000/year.... Yeah....

The fact of the matter is, you can't escape medical cost, because doctors, nurses, lab techs, and everyone else in that field refuses to work for free. The medical supply companies also won't work for free, etc, etc, etc.

We're just refusing to deal with the problem and that won't make it go away.

Concerning the law in question itself. I dunno. The simpler answer to the individual mandate problem is to just tax directly to fund the program. Congress could unquestioningly do that constitutionally if it desired to do so. The problem with the individual mandate is its indirect nature. If the government used the IRS to collect a tax from you to fund this, then no one would dare question the constitutionality with a straight face.

[kaenneth]

The Insurance company profits being capped as a percentage of cost is really scary to me.

What it means is that rising costs can increase absolute profits; it may be in their interest to drive people into the most expensive plans with the highest costs. That is; if everyone is covered, you can't gain more clients, so to increase profits you have to increase per-customer profits; if that's capped as a percentage of something; you need to make that something go up.

I'd rather give them 50% of $100 to buy a generic medication than 20% of $1000 to by the latest name brand that works exactly the same; while the Insurance Co and Pharma Co share half their board members and stockholders.

There would need to be serious oversight, and conflict of interest protection (i.e. one person can't sit on boards of both insurance and care providers) for that aspect of it not to end up inflating costs.

[Knight of Fools]

Of course, I started rambling on about a topic that isn't in the bill. Actual public healthcare isn't provided, and so this is purely a theoretical post, not one pertinent to the specific court case.

I think public healthcare is provided in a limited sense, but only to those who can't afford it, and you do make a few good points.

Corporations are typically bad, sure, but they're in it to make a profit at least. If a business finds an lazy/unprofitable employee, that employee gets fired. It's difficult to be fired in a government job, so people are less inclined to be 'profitable'. It's the same with resources being managed - A government agency is given a check with a certain limit, and if that limit isn't met or exceeded the excess is lost and the agency will receive less the following year and have the excess taken away. There's no incentive to save tax dollars. In a business, saving money is a considered good thing, and waste is limited (But certainly not eliminated). This is why I'd prefer a mildly regulated business over a government agency.


I'm not saying that we should throw all the sick people out in the cold just so I don't have to pay for medical insurance. I love the idea of helping people out, but there should be some degree of personal responsibility (You are responsible for you, etc). Of course, prevention goes hand-in-hand with education about illnesses, so it wouldn't be a bad idea to include less 'do jumping jacks and use condoms' in health class, and more 'this is a symptom of go-to-the-doctor-right-now syndrome'. The more people know about serious illnesses, the more likely they'll be to get treatment when the symptoms present themselves.

Regardless of how good something is, it shouldn't come across so heavy handed. Stretching my orchard example to its limits, I could convince the government to make it law to buy my apples because 1) They're healthy and 2) I donate money to help children with cancer. Sure, neither of those things are inherently bad, but there's the whole "force people to do something" part that unsettles me.

I definitely don't want people to suffer just so I can save money, but at the same time I don't want Big Brother taking that money at gun point. It's like the law is designed to make me feel bad if I don't allow myself to be forced to buy a product.


A somewhat related question, what's the absolute minimum fee for health insurance now-a-days? The answers I got from Google were ambiguous (I know it depends, dummy!) or seemed too large ($6,000 a year for a healthy single person? Do they buy my food, too?).

[Africa]

I still want to hear Knight of Fools explain how Obamacare made him lose his insurance...

[Bauglir]

The point I guess I'm getting at is that the money being forcibly taken from you is a lesser evil than the alternatives.

Again, there are a lot of people who are uninsured because they can't afford to pay for it and/or are unemployed. They already don't have a choice. Why should it be up to anybody else to make it for them? The status quo is that they don't get a choice, and have to suffer as a consequence. It could be changed, at the least, so that they don't get a choice and get something out of it.

[nenjin]

The point I guess I'm getting at is that the money being forcibly taken from you is a lesser evil than the alternatives.

Again, there are a lot of people who are uninsured because they can't afford to pay for it and/or are unemployed. They already don't have a choice. Why should it be up to anybody else to make it for them? The status quo is that they don't get a choice, and have to suffer as a consequence. It could be changed, at the least, so that they don't get a choice and get something out of it.

There are plenty of healthcare systems that accomplish the same thing without resorting to forcing everyone into "shopping." While I don't have abundant faith in our current Congress, government healthcare paid for by taxes as a bare minimum reinforces the whole idea of the social contract more than what is basically a market driven solution. I feel like all this is doing is setting us up to be bound to whatever bottom-dollar shenanigans insurance companies devise to maximize their profits.

But I'll be honest. My main source of mistrust about the mandate comes directly from what I've seen from Obama as a president. The same guy who sold us the bailout has now sold us this, but unlike the bailout, this is an actual constitutional question. And I have a very hard time believing that half of his reasons aren't based on supporting the insurance industry. Which to me is basically the same routine we've been doing, except now it's a federal law that we have to pay into them. I can choose not to do many of the things that federal law requires my interaction with markets. My only recourse in this situation is to be as poor as I can possibly be to avoid it, or die.

So yeah. It's like he gives with one hand, then he punches you in the face with the other.

[Bauglir]

Yeah, I'm in complete agreement about that. Like I said, that was a whole tangent about a theoretical comprehensive and tax-funded system, not the version that's got passed now that combines many of the worst aspects of several approaches, and then has what seem like patched-on fixes that probably aren't going to work as well as one would like (such as the cap on profits, which sounds great but I'm sure has loopholes wide enough to steer a battleship through).

[Mr. Palau]

Well in Singapore's medical saving's account system the poor have their savings toped off, and large expenditures like cancer treatments or chronic illnesses are insured by the gov. The effect that has is that you can't really go bankrupt, since the really expensive stuff is covered, and it amkes you realize how much you are spending so you will try to save money, thereby increasing effeciency in the system and loweering medical infaltion rates.

As for governments being less effecient than private organisations, that usually true but in the realm of health care, in every system but health savings accounts, the government saves the average person a lot of money. Sure this means there is some less money around for medical research but if the government then indepenedantly funded medical research it would acheive the same degree of medical innovation at less of a cost than a private non-health savings account system through the elimination of corporate profits and the use of monopoly power to lower prices.

Doctors and other people would be paid less though. So there is the argument that due to the supply and demand of labor less people would waant to be doctors, or they would be of a lower quality than the current doctors.

Now, you could be advocating that we just let sick people who can't pay just, yanno', die off or be permanently crippled or whatev' but medical practitioners are supposed to swear that little oath (that we really want them swearing) that says they have to help those that come to them.

Medical practitioners are not required to take the Hippocratic Oath and it has no legal bearing even if they do.

Yeah it's mostly the law and the fact that I doubt a doctor of any worth as a person would allow a person to die in fornt of their eyes knowing they could save him.

The point I guess I'm getting at is that the money being forcibly taken from you is a lesser evil than the alternatives.

Again, there are a lot of people who are uninsured because they can't afford to pay for it and/or are unemployed. They already don't have a choice. Why should it be up to anybody else to make it for them? The status quo is that they don't get a choice, and have to suffer as a consequence. It could be changed, at the least, so that they don't get a choice and get something out of it.

There are plenty of healthcare systems that accomplish the same thing without resorting to forcing everyone into "shopping." While I don't have abundant faith in our current Congress, government healthcare paid for by taxes as a bare minimum reinforces the whole idea of the social contract more than what is basically a market driven solution. I feel like all this is doing is setting us up to be bound to whatever bottom-dollar shenanigans insurance companies devise to maximize their profits.

But I'll be honest. My main source of mistrust about the mandate comes directly from what I've seen from Obama as a president. The same guy who sold us the bailout has now sold us this, but unlike the bailout, this is an actual constitutional question. And I have a very hard time believing that half of his reasons aren't based on supporting the insurance industry. Which to me is basically the same routine we've been doing, except now it's a federal law that we have to pay into them. I can choose not to do many of the things that federal law requires my interaction with markets. My only recourse in this situation is to be as poor as I can possibly be to avoid it, or die.

So yeah. It's like he gives with one hand, then he punches you in the face with the other.

Well the insurance system as a whole does an incredibly poor job of keeping costs down, and it lines the medical system with misplaced incentives that drive costs up. It is better than many forms of government care in terms of medical innovation and general quallity of care, although single payer only sacrifices medical innovation and as I metnioned above all you would need to conteract that is some government funding that would cost much less than the savings.

There isn't a real constitutional question as there have been much mroe intrusive laws declarded perfectly constituional by the court and this is a regulation of an entire market which you are in from the time of your birth, and unlike the market for food your choices don't affect other people. You won't hve to eat broccoli after this si found constitutional, don't panic.

[Leafsnail]

The more people know about serious illnesses, the more likely they'll be to get treatment when the symptoms present themselves.

Except they won't, because they can't afford it.  So you'll end up paying for their lifesaving surgery when you could've instead paid for a set of pills.  And in spite of paying for other people's medical bills you won't be covered for most medical interventions yourself.

[Truean]

http://www.hulu.com/watch/345056/the-colbert-report-wed-mar-28-2012#s-p1-so-i0

Relevant

[Knight of Fools]

My issue with the bill isn't that people will no longer be too poor to go to the hospital, my issue is that the government is forcing me to buy a product that I do not want and do not need. If you haven't noticed, I'm alright with people getting healthcare. I'm not alright with the government forcing me to buy stuff, even if it's for something good. Pay taxes? Sure. Be forced to pay a for-profit company for something I probably won't need? Not so much.

I still want to hear Knight of Fools explain how Obamacare made him lose his insurance...

Then just ask.

As a child benefiting from my father's military insurance, under the new healthcare law, I can only receive healthcare from my parents after 18 by being a student. I was serving as a missionary in another country at the time, so I couldn't become a student when that part went into effect. The specifics weren't available to me, but my parents were unable to get me under their insurance until I proved that I was studying at a college.

Now you know as much as I do.

That is, not much.

[GlyphGryph]

Like KoF I'm okay having to pay my fair share towards a government that insures this stuff.

I'm not okay with having to deal with the local fucks that populate the insurance agencies here, I'm not okay with having to give them money for something the government can do better, and I'm not okay with the justifications for why I have to, or with the governments ability to create these sort of mandates on behavior in general. This is, to put it simply, unprecedented in scope, if not in function, on a national level.

That said, I want it to hold up because we need this sort of of law. I just hope the judgement is VERY VERY narrow.

[kaenneth]

Another concern of mine is that yes, rates may go up; and people may actually lose their insurance.

Here is what happened to me: I was on Social Security Disability for a few years, I also paid for medical insurance out of my own pocket (not employer provided) for the last 15 years.

2 years after getting approved for SSD, I became eligible for Medicare; suddenly, my HMO started billing me more than $500 a month instead of the $200 some my normal rate was; in addition, Medicare took $100+ from my monthly SSD check!

For some reason, Medicare when you are on SS Disability is Mandatory; even if you already have insurance; and my HMO as a medicare provider costs twice as much as my regular insurance.

If I were still on SSD, I would be unable to afford insurance that was affordable (with family help) without government 'assistance'; fortunately for me, once I got my SSD back lump-sum payment I was able to pay for treatments to get me back to work, and off SSD, so I got the portion taken by my HMO refunded (I had automatic payments;and the sudden increase caused overdrafts...)

However, overall, we do need to insure everyone, the only question is how.

Personally, I think that medical insurance companies don't have a 'god-given-right' to exist, and if the government were to obsolete them with a tax-funded system, that would be fine.

[nenjin]

http://www.hulu.com/watch/345056/the-colbert-report-wed-mar-28-2012#s-p1-so-i0

Relevant

...or declare me an enemy combatant and execute me with a flying death bot.

And yet even Colbert misses the irony in his own statement, about which president authorized that strategy more than his predecessor and then doubled down on eroding civil other civil liberties. So why not just sign up for the next thing?

Even if you make the argument that universal healthcare is worth the sacrifice, the market which will control healthcare will continue to evolve, change and find new ways to eke more money out of the arrangement and restrict access to healthcare that people signed up to get in the first place. We can't fully predict what position this law will leave Americans in, in 10 years. Because it will mostly be run by an industry that loves to experiment with new ways to get rich.

I'll admit my position is 100% anti-capitalism, but I think given the way Obama's presidency and the last 12 years have gone for America that I have good reason to worry.

To me this somehow feels a lot like considering buying life insurance. About the only difference between health insurance and life insurance is that you're guaranteed to make use of one while you're still alive. For a healthy individual with a good life style, that's a significant chunk of money you'll be paying out over your life time for calamity and decrepitude. (As an aside I wonder how much of these costs the public has to eat comes from people at the end of their lives who still choose to have extended medical treatment?)

I mean Christ, roll it into the tax code just like social security and all the other obligations Americans are willing to accept as part of being a citizen. Why this hard-on for a market-oriented solution? Because the insurance industry is worried they'll be squeezed out by a more service-focused provider like the government? Boo-fucking-hoo. It's like the market is free and fair except when it's not.

I'm kind of hoping that SCOTUS just rules this another form of taxation and kicks it back over to Congress, that can try to legislate in a way that's less likely to play directly into the hands of those who want to profit from us. I don't share the Republican cackling glee that this will probably get killed by SCOTUS, it's really pretty damn tragic. But it's frustrating to me too because it's always this moral/ethical/legal compromise with Obama's policies. And not just of the typical political variety that's part of life, but stuff that truly makes me question who he is going to bat for.

This is all about the method of providing the benefits.

Damn right. And it's a method based on way too much subservience to the insurance industry, or fear of trying to set up a government-run health care system through more taxation, because it's politically unpopular to do so and way more beneficial to groups with lobbyists to do it this way.

I'll grant him that though, Obama probably tried and couldn't sell a solution to Republicans that involved more taxes. But if had used presidential authority to ram through something that didn't come with all this baggage, we'd still be in the same place right now: in front of SCOTUS on some element of the healthcare plan. Except he'd (probably?) have way more support it than he currently does for the mandate. I'm sure Republicans would like nothing more than to have this come back to Congress so they can try to kill it. But with Obama re-elected, he could quit pussyfooting around with Republicans and quit handing us these godawful compromises.

[Mr. Palau]

government can do better, and I'm not okay with the justifications for why I have to, or with the governments ability to create these sort of mandates on behavior in general. This is, to put it simply, unprecedented in scope, if not in function, on a national level.

Actully if you change the word from "Penalty" to "Tax" it would be total alright, so it is merely an issue of sematics really. The federal government has national tax and spend authority, this would simply be a tax on people with out health insurance. It's totaly precedented then, and it's function would be much smaller than other taxes.

This is just a big deal over nothing when it comes to the constitutional question. Unfortanatly the govvernment could provide tax credits to people who provide proof of eating their broccoli, and you would give it over voluntarily so it wouldn't violate privacy, so at the end of the day you must eat your Broccoli!

http://www.hulu.com/watch/345056/the-colbert-report-wed-mar-28-2012#s-p1-so-i0

Relevant

...or declare me an enemy combatant and execute me with a flying death bot.

Even if you make the argument that universal healthcare is worth the sacrifice, the market which will control healthcare will continue to evolve, change and find new ways to eke more money out of the arrangement and restrict access to healthcare that people signed up to get in the first place. We can't fully predict what position this law will leave Americans in, in 10 years. Because it will mostly be run by an industry that loves to experiment with new ways to get rich.

That's like saying we shouldn't come out with a new flu vacceine every year because the virus will just mutate the next year.  The only solution is constant vigilance, always reinforcing the rules and regulations, perhaps a new regulatory authority specilizing in the regulation of the health care market appointed by a indepndent commision.

I'm kind of hoping that SCOTUS just rules this another form of taxation and kicks it back over to Congress, that can try to legislate in a way that's less likely to play directly into the hands of those who want to profit from us. I don't share the Republican cackling glee that this will probably get killed by SCOTUS, it's really pretty damn tragic. But it's frustrating to me too because it's always this moral/ethical/legal compromise with Obama's policies. And not just of the typical political variety that's part of life, but stuff that truly makes me question who he is going to bat for.

If it's another form of taxation that would be constitional and they wouldn't need to kick it back to congress, as I mentioned above. Again it depends largely on whether they decide this is a tax or not. It functions like a tax, but yet it is called a penalty... If it quacks like a duck, my freind it is indeed a duck.

Obama was convinced to go for the indivdual mandate because of the difficulties of passing anything else through the congress. The American public does not want government health care, and apperantly it doesn't want Obamacare either.

Again I just want Health Savings Accounts, which would do away with any insurance market, government or private, and would have the people who can afford to pay for all but the most costly treatments, and top off the savings accounts of the poor for all of their care. This would help lower costs in the market due to the function of supply and demand, as well as normal market functions that work perfectly in every other market but healthcare that is riddled with perverse incentives due to the use of insurance.