As Obamacare goes into effect, new criticisms leveled [Archive]

nismaratwork

Jan5-11, 08:35 AM

Ah, circling the wagons... joy. This didn't come out of nowhere:

What should we expect when - we no longer require that our representatives actually read the legislation they are voting on - 2,300 pages worth.

By the way WhoWee, I haven't seen anyone suggest that this reading issue be a "forum rule"... Jared just described what he believes is moral equivalency resulting in hypocrisy. Straw man... bad boy!

Russ: Yeah, you don't get paid to read it, and you don't vote directly for it, however we live in a representative democracy: just as we're all at war, you're all in for the outcome of votes. You can violently disagree and even claim that your representative failed to uphold your interests, but the country as a represented whole DID vote the bill in.

And plenty of them didn't read it, nor do I see that candidates are being elected for qualities that would allow them to do so, or comprehend the language. You DID have a vote in Obamacare (call it what you want), it's just that your indirect vote was insufficient to carry your view through. I had a vote in this country going to war in Iraq, but it happens that my vote, as expressed through my congressmen was in the minority. That's what representative democracy is about; we DO have collective power, and therefore responsibility. What ideologues on all sides of issues always seem to forget (when they're losing) is that you can exercise what power you have, lose, and it's STILL OK.

I find it deeply ironic that the people (no, not anyone specific here) who spent so much time telling their fellow Americans to support the war or move to another country fail to turn that logic on themselves. You don't want to pay for Obamacare... move, otherwise you can complain and lobby and vote, but you can't claim that you didn't vote... you did... you just lost.

WhoWee

Jan5-11, 08:39 AM

Ah, circling the wagons... joy. This didn't come out of nowhere:

By the way WhoWee, I haven't seen anyone suggest that this reading issue be a "forum rule"... Jared just described what he believes is moral equivalency resulting in hypocrisy. Straw man... bad boy!

Russ: Yeah, you don't get paid to read it, and you don't vote directly for it, however we live in a representative democracy: just as we're all at war, you're all in for the outcome of votes. You can violently disagree and even claim that your representative failed to uphold your interests, but the country as a represented whole DID vote the bill in.

And plenty of them didn't read it, nor do I see that candidates are being elected for qualities that would allow them to do so, or comprehend the language. You DID have a vote in Obamacare (call it what you want), it's just that your indirect vote was insufficient to carry your view through. I had a vote in this country going to war in Iraq, but it happens that my vote, as expressed through my congressmen was in the minority. That's what representative democracy is about; we DO have collective power, and therefore responsibility. What ideologues on all sides of issues always seem to forget (when they're losing) is that you can exercise what power you have, lose, and it's STILL OK.

I find it deeply ironic that the people (no, not anyone specific here) who spent so much time telling their fellow Americans to support the war or move to another country fail to turn that logic on themselves. You don't want to pay for Obamacare... move, otherwise you can complain and lobby and vote, but you can't claim that you didn't vote... you did... you just lost.

It sounds as though you support any actions the Republicans take in the House now - given the people spoke quite clearly last November?

Galteeth

Jan5-11, 08:43 AM

Jared makes a good point, and as he's ONLY called people on talking about something they haven't bothered to read, and not commenting on it himself, you can't really turn this around on him WhoWee. You can certainly argue the point, but just flipping it as though he had claimed some knowledge of the bill is obvious and gauche, especially when you posted concerns about who read the bill on THIS page.

WhoWee: I haven't noticed an acceleration or abatement of the issues plaguing our healthcare system (in which I work). Doctors are still leaving some states, or limiting practice because of high insurance premiums (read: fear of lawsuits), and I don't blame them... hell I've considered it. Remember when a surgeon only worried about something other than their batting average?

Well, the legislation only recently went into effect. But there has been a run up in drug prices, likely in anticipation of Obamacare.

JaredJames

Jan5-11, 09:01 AM

I didn't have a vote on Obamacare, so it can't be said that I voted for/against something that I haven't read. That's a big difference between them and me. Or, more simply: I pay them for that.

I never said anyone here has voted for/against something they haven't read.

Well for me it comes down to the same thing as the UK ID card debate (I keep coming back to this but it seems to cover a number of points).

I had a house mate who was strongly opposed to it and gave some rather persuasive arguments against them. However, she had never read the full documentation and formed her opinions based on snippets from anti-ID websites.

I sat down and read the entire policy and was able to shoot down every single argument she gave. Her opinions were formed on mis-information and quotes taken out of context. This for me, was enough to make her view point moot and not to be entertained any further.

Now we can discuss anything here, but if people are trying to praise / shoot down a policy without understanding it, they are no different to those politicians who voted it in.

My house mate is in numerous TV reports demonstrating ID cards outside parliament, based on what amounts to no more than fairy tails. She is fighting to get rid of a system she doesn't understand. If you sit here, posting about how bad (or good) the system is without understanding the policy itself, you are no different to her.

For me, this is the downside of a democracy. Firstly, people who have no idea what they are talking about get a say in matters which truly don't concern them (my Scottish sheep farmer campaigning against a third runway at Heathrow example). Secondly, people get a say in matters when they don't fully understand what they are talking about (ID cards).

I think PF should at least have a policy that requires people to have a knowledge of the topic at hand (well technically you do, it wouldn't stand anywhere else in the forums and I don't think it should here).

EDIT: I agree with Nismar, it's hypocrisy (couldn't remember the word).

WhoWee

Jan5-11, 09:02 AM

Well, the legislation only recently went into effect. But there has been a run up in drug prices, likely in anticipation of Obamacare.

You have identified the challenge in this debate - it is very difficult to pinpoint what is "likely in anticipation of Obamacare", what is a direct result of the legislation, and what would have happened without legislation. The determination is further blurred due to the slow (creeping?:yuck:) phase-in of the legislation - over several years.

WhoWee

Jan5-11, 09:05 AM

I never said anyone here has voted for/against something they haven't read.

Well for me it comes down to the same thing as the UK ID card debate (I keep coming back to this but it seems to cover a number of points).

I had a house mate who was strongly opposed to it and gave some rather persuasive arguments against them. However, she had never read the full documentation and formed her opinions based on snippets from anti-ID websites.

I sat down and read the entire policy and was able to shoot down every single argument she gave. Her opinions were formed on mis-information and quotes taken out of context. This for me, was enough to make her view point moot and not to be entertained any further.

Now we can discuss anything here, but if people are trying to praise / shoot down a policy without understanding it, they are no different to those politicians who voted it in.

My house mate is in numerous TV reports demonstrating ID cards outside parliament, based on what amounts to no more than fairy tails. She is fighting to get rid of a system she doesn't understand. If you sit here, posting about how bad (or good) the system is without understanding the policy itself, you are no different to her.

For me, this is the downside of a democracy. Firstly, people who have no idea what they are talking about get a say in matters which truly don't concern them (my Scottish sheep farmer campaigning against a third runway at Heathrow example). Secondly, people get a say in matters when they don't fully understand what they are talking about (ID cards).

I think PF should at least have a policy that requires people to have a knowledge of the topic at hand (well technically you do, it wouldn't stand anywhere else in the forums and I don't think it should here).

There is a new thread discussing the income tax system in the US - should everyone posting first read the entire US tax code? If you intended to derail the thread - you have been successful.

JaredJames

Jan5-11, 09:07 AM

There is a new thread discussing the income tax system in the US - should everyone posting first read the entire US tax code? If you intended to derail the thread - you have been successful.

Just making the point.

If people want to discuss something, they should at least know what they are discussing and not making arguments without correct information.

You brought up the issue of people not reading what they are voting on, and to come here and discuss something you haven't read either (not saying you haven't but who knows) makes you no different.

I'm actually reading through the policy now (or trying to) to see what the fuss is about. Could take a while.

JaredJames

Jan5-11, 09:19 AM

OK, I'll focus on the article only for now.

Starting at the top, this repayment of subsidies.

Can someone point out the problem? From what I've read, if your income goes up mid year, you are expected to refund a certain amount of the subsidies.

OK, so if halfway through the year your income goes up, you are officially no longer entitled to the same level of subsidy (if you get $1000 for up to $20,000 income, once you get above this level midyear, you are no longer entitled to $1000).
If you are now required to refund what you aren't entitled to, let's say the next band is up to $30K income and for that you get $500, now you're in the next band you should pay back $500. I can understand this, as your annual income for that year was in the band above the one you were given the subsidy for.

So basically, if you earn a total of $30,000 in a year you would be entitled to $500 subsidy. But, because you only earned $20,000 the previous year you received $1000. So you've had twice as much as you should have. Why do people think it's wrong to pay it back? Or have I completely missed the point?

(Figures for demonstration only. Post based on the article, still working on the policy.)

Galteeth

Jan5-11, 09:22 AM

You have identified the challenge in this debate - it is very difficult to pinpoint what is "likely in anticipation of Obamacare", what is a direct result of the legislation, and what would have happened without legislation. The determination is further blurred due to the slow (creeping?:yuck:) phase-in of the legislation - over several years.

Right. Here's an article about the run up in drug prices.

http://www.nytimes.com/2009/11/16/business/16drugprices.html

Merck's spokesman Ron Rogers claims it's not related to Obamacare. The economists interviewed disagreed.

WhoWee

Jan5-11, 09:35 AM

Right. Here's an article about the run up in drug prices.

http://www.nytimes.com/2009/11/16/business/16drugprices.html

Merck's spokesman Ron Rogers claims it's not related to Obamacare. The economists interviewed disagreed.

Let's not forget that HHS has made it clear they don't want the insurance companies blaming any increases on the legislation.

WhoWee

Jan5-11, 09:47 AM

JaredJames

Jan5-11, 09:52 AM

Please step back and look at your post (are the details confusing?)- next, please consider the massive expansion of the IRS to oversee these new rules - now consider that currently citizens either purchase insurance or they don't. The freedom to choose has been taken away.

The elected officials tell us this is for our own good and that this will ultimately save money - basically to trust them.

Let's simplify it:

If you get more than you are entitled to, why shouldn't you repay it? It already happens with income tax. It's only fair if you expect a refund if you pay too much tax.

Expansion of the IRS? Surely that's more jobs?

I'm not getting into the debate of whether or not people should be entitled to free healthcare. Suffice it to say though, without knowing the specifics of the medical insurance system in the US, I can't comment on saving money and only say that government funded, NHS style healthcare is a big drain on resources if not managed correctly (as per the UK situation now).

And let's not get me started on 'freedom'.

WhoWee

Jan5-11, 10:07 AM

Let's simplify it:

If you get more than you are entitled to, why shouldn't you repay it? It already happens with income tax. It's only fair if you expect a refund if you pay too much tax.

Part of the problem is the mandates of the legislation may not be legal - the matter is in the courts now. We have a thread on the topic.
http://www.physicsforums.com/showthread.php?t=456324

JaredJames

Jan5-11, 10:21 AM

Part of the problem is the mandates of the legislation may not be legal - the matter is in the courts now. We have a thread on the topic.
http://www.physicsforums.com/showthread.php?t=456324

So what are me discussing here? Is there a discussion of the article to be had or was it just pointing out there are criticisms (as if we believed there wouldn't be any / more)?

Everything I've read in that article doesn't seem unjust to me. In fact, it seems that they are targeting areas which do need looking at.

For example, people claiming too much in subsidies is fraud, whether they knowingly do it or not is a different issue (although you'd be hard pressed proving you didn't know your income increased).

WhoWee

Jan5-11, 10:43 AM

So what are me discussing here? Is there a discussion of the article to be had or was it just pointing out there are criticisms (as if we believed there wouldn't be any / more)?

Everything I've read in that article doesn't seem unjust to me. In fact, it seems that they are targeting areas which do need looking at.

For example, people claiming too much in subsidies is fraud, whether they knowingly do it or not is a different issue (although you'd be hard pressed proving you didn't know your income increased).

I'll go back to my post that started our exchange - because the legislation was rushed through Congress (there was no time to read the Bill) - the specificity of these rules was not known.

Further, Speaker Nancy Pelosi, Majority Leader Harry Reid, and President Obama did not explain in great detail how complicated the subsidies and fines would be - nor did they stress that a major expansion of the size and scope of the IRS would be required to oversee healthcare reform.

JaredJames

Jan5-11, 10:52 AM

I'll go back to my post that started our exchange - because the legislation was rushed through Congress (there was no time to read the Bill) - the specificity of these rules was not known.

OK, I'm going to drop out here because it would appear that we aren't discussing the content, but more the legality of the bill and how quickly it was implemented.

Galteeth

Jan5-11, 10:57 AM

Let's simplify it:

If you get more than you are entitled to, why shouldn't you repay it? It already happens with income tax. It's only fair if you expect a refund if you pay too much tax.

Expansion of the IRS? Surely that's more jobs?

I'm not getting into the debate of whether or not people should be entitled to free healthcare. Suffice it to say though, without knowing the specifics of the medical insurance system in the US, I can't comment on saving money and only say that government funded, NHS style healthcare is a big drain on resources if not managed correctly (as per the UK situation now).

And let's not get me started on 'freedom'.

This is what i wanted to discuss.

The most troubling part to me is the following:

"More chillingly, however, the administration is defining Medicare fraud down to include “unnecessary” and “ineffective” care. And to root this out, it plans to make expanded use of private mercenaries—officially called Recovery Audit Contracts—who will be authorized to go to doctors’ offices and rummage through patients’ records, matching them with billing claims to uncover illicit charges. What’s more, Obamacare increases the fine for billing errors from $11,000 per item to $50,000 without the government even having to prove intent to defraud."

Having deal with government health care, and having gotten completely screwed over, I could see numerous ways this could be disastrous. Of course the devil is in the details, which is why I brought it up.

The tax thing, I think this was the key point:

"This will make it very hazardous for poor working families to get ahead. In the original law, the loss of subsidy with rising income already meant absurdly high effective marginal tax rates—the implicit tax on every additional dollar of income earned. How high? The Cato Institute’s Michael Cannon puts them at 229 percent for families of four who increase their earnings by an amount equal to 5 percent of the federal poverty level or $1,100. In other words, a family that added this amount to an income of $44,700 would actually see its total income fall by $1,419 due to the loss of subsidies."

If I understand that correctly, it means that for some poor families, modest increases in income actually lead to taxes that are in excess of that income increase.

Galteeth

Jan5-11, 11:02 AM

On a further note, when i was dealing with the medicaid system in new jersey, i was encouraged by workers there to give certain answers that were technically fraudelent, as the system is so messed up, this is apparently business as usual. I had to be very careful to answer questions in a way so as that i was not committing fraud, but still giving the "right" answers.
As i said, I got completely screwed by the whole thing (I knew it was a mistake, and I had moral issues with government health care, my dad sort of pressured me into it), and I got no help but wound up owing a hospital $75,000.

EDIT: The reason for this is, at least the jersey system, the rules makes no sense. Literally.

Galteeth

Jan5-11, 11:07 AM

Here is an article that expands on the new fraud provisions.

http://www2.tbo.com/content/2010/jun/18/na-stopping-the-medicare-fraud-gusher/news-opinion-commentary/

WhoWee

Jan5-11, 11:25 AM

Here is an article that expands on the new fraud provisions.

http://www2.tbo.com/content/2010/jun/18/na-stopping-the-medicare-fraud-gusher/news-opinion-commentary/

I'd like to see the (isolated to this topic) CBO analysis of total cost of enforcement versus actual fraud recovery moving forward.

Galteeth

Jan5-11, 02:15 PM

I'd like to see the (isolated to this topic) CBO analysis of total cost of enforcement versus actual fraud recovery moving forward.

I would think those who were actually committing fraud would cover their tracks. It seems like it would be easier to prosecute cases where fraud wasn't the intent, especially since their doesn't seem to be a need for the government to prove intent to commit fraud. In other words, people who weren't intending to commit fraud would show their records and such, whereas those whose intent to commit fraud would likely create fraudelent records.

WhoWee

Jan5-11, 02:25 PM

I would think those who were actually committing fraud would cover their tracks. It seems like it would be easier to prosecute cases where fraud wasn't the intent, especially since their doesn't seem to be a need for the government to prove intent to commit fraud. In other words, people who weren't intending to commit fraud would show their records and such, whereas those whose intent to commit fraud would likely create fraudelent records.

How much money can be "saved" by massively increasing the size and scope of the IRS - if the limitation you described is accurate?

nismaratwork

Jan5-11, 02:28 PM

It sounds as though you support any actions the Republicans take in the House now - given the people spoke quite clearly last November?

No, but I don't pretend that I didn't play my part in our government. To be fair, most of what HAS been done was accomplished by the lame-duckers. It seems that neither party can survive their own majority, and the american people can't stomach them. I haven't been pleased with my government in many ways, but I choose to live here. Support, and vote are different... I support some republican positions, and detest others. I never claim to be somehow involved only in what I see as victories however; politics is the winning AND losing.

Again, this issue was raised by you, and then you ran from it when it was turned on the people in this thread. You can and have argued that your civic responsibility doesn't involve reading legislation... this makes me ask:

1.) When someone tells you that they HAVE read it... how will you know?
2.) Did the sources you use for info individually read it?
3.) Wasn't it adorable when Boehner cried again today?
4.) Was it MORE adorable when Boehner quoted The Bill of Rights; mistaking it for the constitution?

Maybe the trick is not to ACT as though you know and understand the contents of 2300 pages? I'm curious, if our congressmen spent their careers reading legislation, they'd have very little time for debate or any other action.

Galteeth: You'd think killers would too, but that's the nutty thing about criminals!

WhoWee

Jan5-11, 02:37 PM

Again, this issue was raised by you, and then you ran from it when it was turned on the people in this thread. You can and have argued that your civic responsibility doesn't involve reading legislation... this makes me ask:

1.) When someone tells you that they HAVE read it... how will you know?
2.) Did the sources you use for info individually read it?
3.) Wasn't it adorable when Boehner cried again today?
4.) Was it MORE adorable when Boehner quoted The Bill of Rights; mistaking it for the constitution?

Maybe the trick is not to ACT as though you know and understand the contents of 2300 pages? I'm curious, if our congressmen spent their careers reading legislation, they'd have very little time for debate or any other action.

Galteeth: You'd think killers would too, but that's the nutty thing about criminals!

I don't believe I ran from it(?) - did you read this post number 28?

"I'll go back to my post that started our exchange - because the legislation was rushed through Congress (there was no time to read the Bill) - the specificity of these rules was not known.

Further, Speaker Nancy Pelosi, Majority Leader Harry Reid, and President Obama did not explain in great detail how complicated the subsidies and fines would be - nor did they stress that a major expansion of the size and scope of the IRS would be required to oversee healthcare reform. "

I didn't see Boehner cry today (might have??) but I did hear him say that he wants smaller Bills and will make sure members have 3 days to read the proposed legislation. This tells me that (not reading it) is a problem.

Marioqwe

Jan5-11, 02:48 PM

How long does it take to read 2300 pages?

nismaratwork

Jan5-11, 03:16 PM

I don't believe I ran from it(?) - did you read this post number 28?

"I'll go back to my post that started our exchange - because the legislation was rushed through Congress (there was no time to read the Bill) - the specificity of these rules was not known.

Further, Speaker Nancy Pelosi, Majority Leader Harry Reid, and President Obama did not explain in great detail how complicated the subsidies and fines would be - nor did they stress that a major expansion of the size and scope of the IRS would be required to oversee healthcare reform. "

I didn't see Boehner cry today (might have??) but I did hear him say that he wants smaller Bills and will make sure members have 3 days to read the proposed legislation. This tells me that (not reading it) is a problem.

Boehner... wiped his nose with a damned handkerchief... I kid you not. First Pelosi, now him... I feel ill. I don't know about 3 days to read legislation however... he did say it, but that means the congressman and aides together... no one would do that alone.

Marioqwe: It's about the length of a modern "world building" fantasy trilogy, but with many terms of art and other legalese. I would liken reading bills and law to reading a manual instead of a novel... I find the former takes longer if comprehension and attention are a factor.

WhoWee

Jan5-11, 03:18 PM

How long does it take to read 2300 pages?

Probably less time than it took to write 2,300 pages?

nismaratwork

Jan5-11, 03:22 PM

Probably less time than it took to write 2,300 pages?

Hmmmm... I wonder... how many people really had a hand in writing those pages? If many aides per congressperson are involved, then really we're talking about a LOOOOOOT of hours actually worked. If the work of hundreds of hours of writing and drafting legislation has to be read by only the politician in charge of those aides... ouch.

So, yeah, less time to read than write, but it doesn't necessarily help.

WhoWee

Jan5-11, 03:22 PM

I don't know about 3 days to read legislation however... he did say it, but that means the congressman and aides together... no one would do that alone.

You make a good point - perhaps that should be the standard - no Bills longer than a Congressperson and their aides can read AND comprehend in 3 days - sound fair?

nismaratwork

Jan5-11, 03:24 PM

You make a good point - perhaps that should be the standard - no Bills longer than a Congressperson and his aides can read AND comprehend in 3 days - sound fair?

If it can work legally and functionally, I don't see why not. A lot of the language in these bills is the result of re-writes and needless legal verbiage. I'll say this, on a gut level I like that idea.

Hepth

Jan5-11, 04:34 PM

How long does it take to read 2300 pages?

I actually wondered this as well. Average reading speed for an adult with good comprehension is about 200 words per minute. The Am.In Senate version of HR3590 had 328,000 words. Thats over 27 hours of continuous reading, ad 200 wpm.

Obviously some sections can PROBABLY be skimmed, though some would most likely be read more slowly.

Thats a lot of reading to expect someone to do, even in 3 days. (9 hours of your day reading)

mugaliens

Jan5-11, 05:09 PM

As Obamacare goes into effect, new measures are afoot to repeal it in its entirety.

nismaratwork

Jan5-11, 05:50 PM

As Obamacare goes into effect, new measures are afoot to repeal it in its entirety.

Yes... measures which have no hope of passage in the senate. We all know this, yet the people's time is being wasted for the sake of posturing in 2012.

WhoWee

Jan5-11, 06:31 PM

Yes... measures which have no hope of passage in the senate. We all know this, yet the people's time is being wasted for the sake of posturing in 2012.

Would it really be a terrible thing if this Congress does nothing except undo waste and otherwise perpetually increasing deficits? Do we really need any new programs and spending?

Al68

Jan5-11, 07:30 PM

4.) Was it MORE adorable when Boehner quoted The Bill of Rights; mistaking it for the constitution?What do you mean? The Bill of Rights are part of the Constitution, so what "mistake" are you referring to?

Al68

Jan5-11, 07:42 PM

Would it really be a terrible thing if this Congress does nothing except undo waste and otherwise perpetually increasing deficits? Do we really need any new programs and spending?The reality is that Democrats and the President will be the ones demanding things from the Republican congress, not the other way around. Starting with their demand that the U.S. debt ceiling be raised as a matter of course, as if it were merely symbolic and not subject to debate or doesn't require the consent of a majority of congress. If Boehner were to just adjourn congress now, to reconvene in a year, Democrats would scream bloody murder.

Of course that alone would eliminate the deficit. Hmmm.

Galteeth

Jan6-11, 02:31 AM

The thing with reading bills is, it often takes longer then reading other kind of documents, because many long bills amend previous bills subtly, i.e., replace word "x" with word "y" in paragraph seven of page 8, etc.

WhoWe, have you heard of the "Read the bills" act?
http://www.downsizedc.org/read-the-laws

nismaratwork

Jan6-11, 06:57 AM

Would it really be a terrible thing if this Congress does nothing except undo waste and otherwise perpetually increasing deficits? Do we really need any new programs and spending?

I can't honestly say that I know the answer to that, but it seems like a waste of the people's time. If the bill is going to die, I can accept (if not like) that, but to spend 2 years undoing one bill?... I think people who elected congressmen to legislate would be very angry.

Still, I'm not answering your fundamental question, and I don't know that I know enough to do so.

Al68: Sorry, I worded that in a manner that would only be sensible to people familiar with the gaff. He read the opening of the BoR as though it were the opening to the constitution as a whole. You can't substitute amendments for preamble, but you're right and I was unclear.

WhoWee

Jan6-11, 08:03 AM

WhoWe, have you heard of the "Read the bills" act?
http://www.downsizedc.org/read-the-laws

Thanks

WhoWee

Jan19-11, 06:10 PM

Is it possible the House finally read the Bill? Three Democrats voted with the Republicans in the House to repeal the legislation 245 - 189.

http://abcnews.go.com/Politics/house-vote-health-care-repeal-bill-today/story?id=12648281

"House Passes Bill Repealing Health Care Law
Republicans Say Bill Sends a Strong Message, Urge Debate in Senate"

It passed with a margin of 220 - 215. That means the repeal won by a greater margin than the passage - correct?

nismaratwork

Jan19-11, 07:08 PM

WhoWee

Jan19-11, 07:14 PM

What did you expect? It's a new house... sadly for some, the senate remains intractable on the issue.

Some things never seem to change. This doesn't seem to be the civil and toned-down rhetoric President Obama requested?

http://www.politicsdaily.com/2011/01/19/tennessee-democrat-accuses-republicans-of-nazi-big-lie-on-heal/

nismaratwork

Jan19-11, 07:19 PM

Some things never seem to change. This doesn't seem to be the civil and toned-down rhetoric President Obama requested?

http://www.politicsdaily.com/2011/01/19/tennessee-democrat-accuses-republicans-of-nazi-big-lie-on-heal/

Well, the problem of course is that this has made 2 things painfully clear:

1.) Sarah Palin is a narcissist, and an idiot, but she's not the devil or a killer.
2.) You can begin change with a lie, but at some point people have to buy into it... and Loughner is too obviously insane to allow for blame to be taken seriously.

The issue of rhetoric is very real, it just doesn't have anything to do with the reasons it's been raised... thus cynicism, thus failure of the attempt. That doesn't mean however, that hypocrisy of the sources aside, changing the dialogue from faux-psychopath to merely "angry" would be wise. I think, of all the commentary on this issue, the most salient and on-target has been Jon Stewart's; he makes a good case for a change in the environment so that the truly crazy people no longer seem like a kind of norm.

WhoWee

Jan19-11, 07:25 PM

Well, the problem of course is that this has made 2 things painfully clear:

1.) Sarah Palin is a narcissist, and an idiot, but she's not the devil or a killer.
2.) You can begin change with a lie, but at some point people have to buy into it... and Loughner is too obviously insane to allow for blame to be taken seriously.

The issue of rhetoric is very real, it just doesn't have anything to do with the reasons it's been raised... thus cynicism, thus failure of the attempt. That doesn't mean however, that hypocrisy of the sources aside, changing the dialogue from faux-psychopath to merely "angry" would be wise. I think, of all the commentary on this issue, the most salient and on-target has been Jon Stewart's; he makes a good case for a change in the environment so that the truly crazy people no longer seem like a kind of norm.

These comments were made on the House floor before the vote on healthcare repeal.

nismaratwork

Jan19-11, 07:27 PM

These comments were made on the House floor before the vote on healthcare repeal.

...? And? Because politicians are the BEST of us?! Ha!

edit: Politicians say things to and about each that, if a private citizen were to act in the same manner, would result in fines, civil suits, and even jail for terroristic threats, libel, and slander!

mheslep

Jan19-11, 10:53 PM

Some things never seem to change. This doesn't seem to be the civil and toned-down rhetoric President Obama requested?

http://www.politicsdaily.com/2011/01/19/tennessee-democrat-accuses-republicans-of-nazi-big-lie-on-heal/

Rep. Steven Cohen: "just like Goebbels, [...] The Germans said enough about the Jews and people believed it -- and you had the Holocaust" What an ***.

nismaratwork

Jan20-11, 05:17 AM

Rep. Steven Cohen: "just like Goebbels, [...] The Germans said enough about the Jews and people believed it -- and you had the Holocaust" What an ***.

WOW. I'd say more about what I think of this... "man"... making any such comparison, but I don't want to get banned.

WhoWee

Jan20-11, 07:23 AM

Congresswoman Sheila Jackson Lee, D-Texas on the Neil Cavuto show cited a woman on Medicare might die if Obamacare were to be repealed. Cavuto challenged her - because the woman is on Medicare and would not be affected by any change in Obamacare. He told her she was making things up - she said the Republicans didn't read the Bill...blah, blah, blah(IMO)...watch and see.

http://www.theblaze.com/stories/on-air-interview-heats-up-as-rep-claims-obamacare-repeal-would-kill-americans/

nismaratwork

Jan20-11, 07:27 AM

WhoWee

Jan20-11, 07:39 AM

Cavuto also compared the events in Tunisia to incremental rise in cost of food staples in the US. As sources go, I really need something more than Fox-Anything, or MSNB-Anything.

Cavuto is not an elected official. Did you listen to the full exchange? How can a Congressperson not be challenged when they misrepresent the facts? If a Republican held up a photo of a sick worker on a retiree group plan and stated they would lose their specific group coverage under Obamacare (because of the elimination of tax deductions) - would they be challenged and accused of fearmongering?

nismaratwork

Jan20-11, 08:13 AM

Cavuto is not an elected official. Did you listen to the full exchange? How can a Congressperson not be challenged when they misrepresent the facts? If a Republican held up a photo of a sick worker on a retiree group plan and stated they would lose their specific group coverage under Obamacare (because of the elimination of tax deductions) - would they be challenged and accused of fearmongering?

My point is that I'd rather stick a fork in my eye than listen to Cavuto exchange ideas; I'd rather see the man exchange fluids!

If he has valid points, surely there's a source for them that doesn't involve the opinion branch of Fox News.

WhoWee

Jan20-11, 08:24 AM

My point is that I'd rather stick a fork in my eye than listen to Cavuto exchange ideas; I'd rather see the man exchange fluids!

If he has valid points, surely there's a source for them that doesn't involve the opinion branch of Fox News.

Somebody needs to challenge the misinformation this Congresswoman is spreading - it happened to be Cavuto - on Fox. The issue is her assertion that someone on Medicare will die - if Obamacare is repealed. It is a blatant lie - and he called her on it.

nismaratwork

Jan20-11, 10:48 AM

Somebody needs to challenge the misinformation this Congresswoman is spreading - it happened to be Cavuto - on Fox. The issue is her assertion that someone on Medicare will die - if Obamacare is repealed. It is a blatant lie - and he called her on it.

OK, I can accept that possibility, but if he's making a valid argument there should be sources beyond Cavuto himself to support his points. I'm not too proud to beg: if they exist, please share!... I really really REALLY don't want to watch that... man... talk for more than 5 seconds per year.

O'Reilly is wacky, Beck is NUTS, but Cavuto?... What's his excuse? He and Olberman should be locked in a cage with a rabid hyena... a hungry, rabid hyena.

WhoWee

Jan20-11, 10:59 AM

I guess Cavuto is your Soledad O'Brien - ever since Katrina - I can't watch her.

nismaratwork

Jan20-11, 11:09 AM

I guess Cavuto is your Soledad O'Brien - ever since Katrina - I can't watch her.

Yeah, that sounds about right, although to be fair I never could stand O'Brien. I don't believe she has anything to do with news, just "special programming"... which to me just says, "get thee to Lifetime or Hallmark".

PhilKravitz

Jan20-11, 02:59 PM

How does the new system work? Are all required to get health insurance? What happens to those people who are unemployed/underemployed and do not have enough money to buy insurance?

PhilKravitz

Jan21-11, 01:23 PM

I guess none of us know.

WhoWee

Jan21-11, 02:08 PM

How does the new system work? Are all required to get health insurance? What happens to those people who are unemployed/underemployed and do not have enough money to buy insurance?

Where do you want to start? It's phased-in over several years. The taxes start ahead of the benefits. The Obama Administration has granted over 200 waivers to companies thus far - so NO - everyone won't have to follow the rules. We have a few other threads running with a lot of posts. You might want to read through them as well.

This link will give you an idea of the problem with this legislation - not a lot of clarity.
http://docs.house.gov/rules/health/111_ahcaa.pdf

Zefram

Jan21-11, 07:34 PM

I guess none of us know.

If you want a basic introduction to the law, KFF has lots of materials for you (http://healthreform.kff.org/the-basics.aspx). Also note that the legislation linked to in the post above is not the law in question.

WhoWee

Jan21-11, 10:47 PM

If you want a basic introduction to the law, KFF has lots of materials for you (http://healthreform.kff.org/the-basics.aspx). Also note that the legislation linked to in the post above is not the law in question.

Kaiser has published some good information. As for the link - think of it as research notes.

nismaratwork

Jan22-11, 06:30 AM

I'm going to pipe up and say, I think it does no harm to see both sides (and they are SIDES) of this debate, but beyond that there is no substitute for a truly neutral and knowledgeable party. I'm not that party, but there isn't a lot of neutral going around right now, and it's a HUGE bill so if you do find that person or group... please share?

nismaratwork

Jan22-11, 12:15 PM

I feel the criticism is warranted. If it weren't, why were over 200 waivers to Obamacare granted (primarily to politically well-connected unions)? And, why were shady procedural tactics (threatened reconciliation) and blatant buy-offs (Cornhusker kick-back) used to secure passage? In my opinion, from this legislative disaster recovery will be exceedingly slow.

You feel this is somehow different from the way that other legislation is produced?

nismaratwork

Jan22-11, 12:59 PM

Reconciliation has traditionally only been used for passing budgets (which the Democrats refused to do last year). Granted, buy-offs have gone on forever, but you have to admit that a buy-off exempting a state from parts of the legislation itself is pretty blatant.

Oh, it's so blatant I don't recall if it even made it into the final bill! Still, I think the lesson we can take from this has less to do about this bill, than it does with what a concentration of Washington wheeling and dealing looks like. Normally we get ONE bridge to nowhere, or some pork... here we had a HUGE trough, so we had some big old hogs!

As for reconciliation, you could be right, I certainly don't know. I'll tell you what, unless someone else has evidence to the contrary, I'll take your word for it.

Zefram

Jan22-11, 01:38 PM

Oh, it's so blatant I don't recall if it even made it into the final bill!

The permanently increased FMAP for Nebraska didn't make it into the law. It was removed, ironically perhaps, using reconciliation.

nismaratwork

Jan22-11, 01:50 PM

The permanently increased FMAP for Nebraska didn't make it into the law. It was removed, ironically perhaps, using reconciliation.

I'd call that irony! Thanks for the information Zefram.

mheslep

Jan23-11, 02:59 PM

Yes, reconciliation (only 51 votes needed for cloture - instead of 60) had traditionally been used only for passing budgets. The Democrats had threatened to use it to block Bush judicial appointees (the nuclear option), but McCain and others thwarted that effort.Right, the Democrats, in the minority then in 2005, were using the filibuster in the Senate to block Bush judicial appointees when the majority Republicans threatened the "nuclear option" to stop the filibusters by changing Senate rules when McCain stepped in.

mugaliens

Jan24-11, 12:36 AM

If for no other reason than to eliminate the pork and complexity, I vote for a do-over. The bill is about 999 pages too long, and about 1,000% too expensive.

Apparently, Econ wasn't a required course in law school. Apparently, neither was preventative medicine, health ed, or P.E. You can't fix America's health problems by bankrupting the country.

Life just doesn't work that way.

WhoWee

Jan27-11, 03:49 PM

More health care waivers approved.

http://thehill.com/blogs/healthwatch/health-reform-implementation/140647-more-than-50-denied-waiver-requests-hhs-says

"The latest round of approvals bumped the number of waivers from 222 to 729. However, the number of individuals covered by the waivers rose from 1.5 million to just 2.1 million. HHS said it was anticipating the bump because plans were required to file the waiver request before the plan year starts — Jan. 1 for many.

Republicans on the powerful House Energy and Commerce Committee last week asked HHS to disclosed detailed information on waiver requests. HHS said Wednesday night that the waiver process has been transparent. "

mheslep

Jan27-11, 05:31 PM

Testimony couple days ago from the Medicare actuary and Rep McClintock

McCLINTOCK: True or false: The two principal promises that were made in support of Obamacare were one, that it would hold costs down. True or false?

FOSTER: I would say false, more so than true.

McCLINTOCK: The other promise… was the promise that if you like your plan, you can keep it. True or false?

FOSTER: Not true in all cases.
http://www.youtube.com/watch?v=XC9rhGWJA2w&feature=player_embedded

Its over! Repeal and replace the thing already.

nismaratwork

Jan27-11, 07:32 PM

When it comes down to it, just scrap it all, along with entitlements. Cut down the population, lower the deficit... win win.

I'm not trying to be sarcastic either... we don't need so many people, and I, and those I care about have money now. So... cut 'em all loose, but I sure hope hat you have something in the bank.

I'm amazed that anyone on the pro-universal health-care side actually WANTS to pass anything at this point.... don't want it? don't have it! When your cystic fibrosis starts to act up, well... genetics. Cancer bad? Well, lets see the color of your money.

Really... who's lives are you trying to save?... gulls who are moved by the kind of rhetoric quotes in this thread, and espoused by others? :rofl:

USA... a train wreck in slow motion where the passengers are too busy talking to get off the train. It's going to be interesting to watch it happen... train wrecks always are.

WhoWee

Jan27-11, 07:35 PM

nismaratwork

Jan27-11, 08:34 PM

:uhh:Is this a new kind of scare tactic?:wink:

Nope, just something a comedian pointed out: we have all of these "liberals" trying to FORCE unwanted health care on people. OK, cut it.

Seriously, lets try it Rand Paul's way and see what happens, I'm a naturalized citizen with more than one citizenship; this isn't my grave.

I see what doctors are doing in the USA, changing who they take as patients, what they prescribe, and sometimes they move their practices abroad! Your system is terribly broken, and if the best solution right now is nothing... do it.

So... no... not a scare tactic... this is like trying to convince a Jehova's witness to get a transplant if they're set against it. At some point, if they want to die so badly... die already.

PhilKravitz

Jan28-11, 01:35 PM

Federal government future expect liabilities minus future expect revenues equals 202 trillion dollars. So no need to change anything. Just wait and change will come due to reality.

nismaratwork

Jan28-11, 03:13 PM

Federal government future expect liabilities minus future expect revenues equals 202 trillion dollars. So no need to change anything. Just wait and change will come due to reality.

Huh?

CAC1001

Jan28-11, 06:36 PM

Nope, just something a comedian pointed out: we have all of these "liberals" trying to FORCE unwanted health care on people. OK, cut it.

Seriously, lets try it Rand Paul's way and see what happens, I'm a naturalized citizen with more than one citizenship; this isn't my grave.

I see what doctors are doing in the USA, changing who they take as patients, what they prescribe, and sometimes they move their practices abroad! Your system is terribly broken, and if the best solution right now is nothing... do it.

So... no... not a scare tactic... this is like trying to convince a Jehova's witness to get a transplant if they're set against it. At some point, if they want to die so badly... die already.

No one is saying we should do "nothing" about America's healthcare system. It obviously needs reform. But the Democratic party's argument that we had to do "something," and hence Obamacare, well Obamacare was the totally wrong way to go about it and was done in the name of ideology by the Democrats.

WhoWee

Jan28-11, 06:41 PM

This is something I've touched on in previous posts/threads but we don't yet have all of the details. The Class Act is Title VIII of the healthcare law. The Senate passed it 12/24/09, House approved 3/21/10, and President Obama signed it into law on 3/23/10. Now, the Secretary of Health and Human Services is expected to set benefits by October 2012???

http://www.whitehouse.gov/health-care-meeting/proposal/titleviii
"Title VIII. Community Living Assistance Services and Supports Act (CLASS Act)
Establishing a Voluntary, Self-Funding Long-Term Insurance Choice for American Families
The Act provides Americans with a new option to finance long-term services and care in the event of a disability."

We do have a framework - benefits will depend on a person's degree of impairment (min $50/day) expected to average $75/day. Individuals will pay premiums for at least 5 years before they qualify - a 5 year waiting period. We still don't know if this will be classified a "Partnership" plan (insurance term) with the Government - but should be with the various carriers (per state regulations).

Nursing home care is very expensive and a drain on Medicaid. LTC (Long Term Care) typically requires medical underwriting and is designed to protect retirement assets (as well as the house).

nismaratwork

Jan28-11, 06:54 PM

No one is saying we should do "nothing" about America's healthcare system. It obviously needs reform. But the Democratic party's argument that we had to do "something," and hence Obamacare, well Obamacare was the totally wrong way to go about it and was done in the name of ideology by the Democrats.

Someone is; I am. Send it back to the states, if they can afford it, and if not... not.

Al68

Jan28-11, 07:52 PM

Someone is; I am. Send it back to the states, if they can afford it, and if not... not.Or we could fix the problem with each state prohibiting out of state insurance policies. The federal government has no constitutional authority to force people to buy insurance, but they do have the power to regulate interstate commerce, so they could simply pass a law preempting state prohibitions on interstate policies, after repealing Obamacare.

That would immediately and drastically improve competition. And an even bigger advantage to consumers is that it would provide an incentive for states to stop screwing over consumers with their regulations, since a consumer can simply buy a policy not subject to them from another state.

WhoWee

Jan29-11, 11:03 AM

mugaliens

Jan29-11, 11:49 AM

One of the brightest ladies of my high school, a current PhD, came at me with a simple objection to my complaints. When I got what she was getting at, and replied with 53 objections to her points which she claimed did not exist in the health care plan at all, yet in the first 49 pages of a 1,000 page document, she gave up, dissed me from FB, and I haven't heard from her since.

So much for Valedictorians with respect to being able to read government documentation.

I'm retired. She's not. Somehow, I "evolved" between then and now, or I would have been one of the V's.

Still, the documents rest on their own case. I rest on mine.

Zefram

Jan29-11, 12:05 PM

Or we could fix the problem with each state prohibiting out of state insurance policies. The federal government has no constitutional authority to force people to buy insurance, but they do have the power to regulate interstate commerce, so they could simply pass a law preempting state prohibitions on interstate policies, after repealing Obamacare.

That would immediately and drastically improve competition. And an even bigger advantage to consumers is that it would provide an incentive for states to stop screwing over consumers with their regulations, since a consumer can simply buy a policy not subject to them from another state.

These are two very distinct points. If the goal here is primarily deregulation (and given the way these proposals tend to be structured, it generally is), that's one thing. Creating a competitive pressure for insurers to locate in states that have few (or offer to shed existing) consumer protections and encouraging insurers to "separate the wheat from the chaff," so to speak, in interactions with those who benefit to varying degrees from consumer protections is, I think, a bad idea.

The question of attempting to increase consumer choice of insurance policies--decoupled from the notion of deregulating them--is a different story. But it's a more complicated story. There are multiple ways to try and do that without granting states the authority to deregulate each other's insurance markets. As I believe WhoWee is alluding to, states can voluntarily enter into compacts with each other in which ground rules are set. Then insurance policies can be sold across their state lines but without initiating a regulatory race to the bottom.

Another option that will be implemented in a few years is the creation of national plans--insurance policies that can be sold in multiple states but must conform to national standards. Yet another option, in which certain states are currently said to have a very serious interest (Utah is the one that comes to mind immediately), is for states to build multi-state health insurance exchanges. That is, when they construct the new markets for individual insurance policies required by the ACA that market would serve more than one state.

The point here is that opening up health insurance markets across state lines need not go hand-in-hand with the shedding of consumer protections. But you still have to consider the larger question of what you mean by competition. Simply having more insurers serving a given market doesn't necessarily mean health plans get cheaper for the simple reason that those prices aren't set entirely (and, in some markets, even predominately) by insurers. Your premiums reflect a number of things but one of them is certainly the actual dollar amount negotiated for a given claim. If your beef is that there isn't competition to bring down the price of care (as it's ultimately filtered back into your insurance premiums), say because a single hospital chain dominates in your area, increasing competition among payers when the problem actually lies on the provider side may well prove to be counterproductive. That's where the story gets complicated.

Al68

Jan29-11, 02:05 PM

There are multiple ways to try and do that without granting states the authority to deregulate each other's insurance markets.What are you referring to? Are people within a state that state's "insurance market"? Does my ability to buy other products from another state constitute the other state deregulating my state's market? Or is it simply an option for consumers to avoid state regulations they determine to be bad ones.

Is it really not obvious why something gets very expensive when government forcefully replaces the decisions of consumers with its own?The point here is that opening up health insurance markets across state lines need not go hand-in-hand with the shedding of consumer protections.What "consumer protections" are you referring to? The advantage to being able to buy insurance from other states is that a consumer can avoid the states with burdensome regulations. The cost of regulation would be obvious in the price differences between the states.

Better yet would be a complete prohibition on any state trying to control the contents of a private agreement between private parties. Imagine that. What an extreme and radical notion. :eek:

Al68

Jan29-11, 02:20 PM

I think it would be more productive if the states worked to agree on a reasonable standard for policies to be sold (and used) across state lines. The best way to turn away a bad idea is to have a good idea.Then what of the consumers that don't consider that standard so reasonable? That's not much better than Obamacare.

How about both the federal government and the states refrain from interfering in private contracts? Or at least give consumers the option of picking a state that does.

WhoWee

Jan29-11, 02:31 PM

Then what of the consumers that don't consider that standard so reasonable? That's not much better than Obamacare.

How about both the federal government and the states refrain from interfering in private contracts? Or at least give consumers the option of picking a state that does.

The state regulators are closer to the consumers - they hear the problems and deal with insurance issues on a daily basis. I trust the 50 experienced insurance regulators to establish a reasonable set of regulations more than an isolated group of self serving Washington bureaucrats.

Al68

Jan29-11, 02:33 PM

The state regulators are closer to the consumers - they hear the problems and deal with insurance issues on a daily basis. I trust the 50 experienced insurance regulators to establish a reasonable set of regulations more than an isolated group of self serving Washington bureaucrats.I agree. My point was that some states are better than others, and would be even more so if consumers were free to choose between them, without some "standard" applying to them all.

WhoWee

Jan29-11, 02:43 PM

I agree. My point was that some states are better than others, and would be even more so if consumers were free to choose between them, without some "standard" applying to them all.

Insurance regulations are similar to building codes. Some regulations might be more applicable to one region than an another - but everyone can build to the highest standard. If everyone agrees to the same (higher) standards, then all of the (qualified) insurance companies will be able to compete nationwide.

mheslep

Jan29-11, 04:00 PM

We don't shed all consumer protections in the property and hazzard insurance markets when they operate across the states; I fail to see why that most be so with health insurance.

PhilKravitz

Jan29-11, 04:19 PM

How about we limit government medical care to a life time cap of $50,000 per person.

WhoWee

Jan29-11, 04:36 PM

How about we limit government medical care to a life time cap of $50,000 per person.

What would that accomplish? I'll assume you know $50k is a very small amount of medical coverage. In insurance terms, a $50k cash indemnity plan is best sold to someone that doesn't really need coverage - a very healthy 22 year old male that wants to tell his parents he has coverage.

PhilKravitz

Jan29-11, 05:03 PM

What would that accomplish?.

Lower government spending.

Al68

Jan29-11, 06:21 PM

Insurance regulations are similar to building codes. Some regulations might be more applicable to one region than an another - but everyone can build to the highest standard. If everyone agrees to the same (higher) standards, then all of the (qualified) insurance companies will be able to compete nationwide.But unless they are free to offer a non-standard product, it's not really free competition in the sense that the product offered is tailored to consumers instead of government standards.

I have no interest in buying the type of medical insurance that would meet any standard likely to be "agreed on" by third parties. It's my place, not government's, to "agree on" the type of insurance I will buy.

PhilKravitz

Jan29-11, 06:56 PM

nismaratwork

Jan29-11, 09:17 PM

Obamacare is a new tax on the healthy young to pay for medicaid that was bankrupt. It is just a new tax. Nothing more.

So, no freedom for you. You will buy the "insurance" that looks like medicaid for the poor and looks like tax to the working well.

So... why would that be bad? If healthcare worked the way you described, it would be an amazing success; this isn't going to pay for medicaid. I could accept a tax to pay for those who are less fortunate, disguised for sale to the public or not. Getting taxed to NOT fix anything... that's what makes this such a seeming wreck.

I for one, like taxes... well... I hate paying them, but I love roads, and schools to keep children from forming roving bands of lovable cockney thieves... and so forth. The problem isn't taxes, or cutting, it's that for all of the arguing, in the end the R, and D s... well.. one cuts programs, the other spends more. It's a perfect synergy which allows for more predictable elections, but the reality is no one philosophy is enough:

We need to squeeze more money out of some people, but mostly we need to close corporate loopholes. (that 5% idea wasn't terrible). We also need to cut social programs that, in addition to killing our economy, retard development and offer poor service. No one will sell it this way, but we need a period of real upheaval before we can expect meaningful change.

I don't mean that fantasy of militias, or group-love chanting by hippies: I'm saying we have to accept that we've ALREADY failed, live amidst the consequences of that failure for a time while we build a new set of systems and standards. If it's done BEFORE we're bankrupt, then it doesn't have to be traumatic except for the hundreds of congressmen who won't get re-elected.

nismaratwork

Jan29-11, 09:59 PM

If you google 202 trillion there are hundreds of references here is one

http://www.eutimes.net/2010/08/official-us-deficit-put-at-staggering-202-trillion/

But I am happy to use your 40 trillion still way past bankrupt. and what is your reference? please state or retract.

OK... you think I'm trying to play with you, but it's just holding you to the standards you accepted when you registered. Your link actually refutes your point, only citing it as the OPINION of a single professor!

But the situation is actually much, much worse, according to Boston University economics professor Laurence Kotlikoff.

“Forget the official debt,” he tells Aaron in this clip. The “real” deficit – including non-budgetary items like unfunded liabilities of Medicare, Medicaid, Social Security and the defense budget – is actually $202 trillion, the professor and author calculates; or 15 times the “official” numbers.

Bolding is mine... the statistics... you'd have to figure out how he came to those conclusions. As for asking me to cite or retract anything, I'm not making sweeping claims the way you are. As for WhoWee, you ask him if I've ever given him an inch he didn't fight for... he's not in the wrong here AT ALL vis a vis you and your claims.

To your last post, it's not personal; I don't know you. It's targeted in the sense that it seems you have both strong biases, and no real understanding of what you need to do just to get that done. I don't think you're being malicious, I just think you need to take a step back; I've only responded to those few threads where we both post... presumably you're doing this elsewhere (not my job thank you god), and I'm not reporting you, but if you keep it up the mentors WILL have a talk with you.

So... it's personal advice, not a personal grudge.

edit: I don't mind if this is deleted... I took a while typing it, and I didn't realize posts had already been deleted. My apologies.

Zefram

Jan30-11, 09:15 AM

What are you referring to? Are people within a state that state's "insurance market"? Does my ability to buy other products from another state constitute the other state deregulating my state's market? Or is it simply an option for consumers to avoid state regulations they determine to be bad ones.

That "option" is the deregulation. A state's insurance market may have some degree of rating restrictions, or rules around issuance or product standardization, certainly some require certain benefits to be covered. Allowing those rules to apply to some but not all plans sold in the state's individual insurance market threatens to destabilize the market. Folks who (presently) benefit least from those rules are likely to opt for the less-inclusive, less-protected out-of-state plans, while those who need them have little choice but to stick with insurance companies licensed in that state and thus still subject to the state's regulations. This is called adverse selection and it's the bane of risk pools.

What you're envisioning ultimately creates pressure for one of two outcomes (assuming no one wants to see these insurers go bankrupt): 1) the state government relaxes the rules governing insurers licensed in-state, i.e. deregulation, or 2) insurers relocate to more loosely regulated states and sell from there (as credit card companies tended to do in the aftermath of the Marquette decision), i.e. deregulation again.

So yes, your ability to skirt your state's laws undermines and quite possibly ultimately eliminates them. Or at least renders them irrelevant as insurers pack up and move on. You may see that as a good thing but there are several reasons why I don't.

What "consumer protections" are you referring to?

The ones you're seeking to buy out-of-state insurance to avoid.

But unless they are free to offer a non-standard product, it's not really free competition in the sense that the product offered is tailored to consumers instead of government standards.

I have no interest in buying the type of medical insurance that would meet any standard likely to be "agreed on" by third parties. It's my place, not government's, to "agree on" the type of insurance I will buy.

I shared a quote (http://theincidentaleconomist.com/wordpress/my-thoughts-on-rep-paul-ryans-medicare-plan-again/) from Austin Frakt in another thread a while back and I think it's useful once again. The context is Medicare voucherization but the point is a bit broader than that:

The whole point of a market-based system is to harness the power of consumer choice. But consumers can’t send meaningful signals if the market has an incomprehensible structure. One of the conditions for a competitive market is fully informed participants. The notion that seniors–or anyone–can meaningfully shop in a market with an unlimited number of plans that vary in all possible ways is ludicrous. (There is already evidence that beneficiaries don’t optimally select among the scores of Part D plans available now and that reducing the number of available plans would increase welfare.) The Medicare supplement (Medigap) market is a good model of competition within standardization. Making products more similar encourages competition. Allowing them to vary along a small number of dimensions helps consumers make sensible comparisons consistent with individual preference. Isn’t that the point?

Al68

Jan30-11, 03:01 PM

Folks who (presently) benefit least from those rules are likely to opt for the less-inclusive, less-protected out-of-state plans, while those who need them have little choice but to stick with insurance companies licensed in that state and thus still subject to the state's regulations. This is called adverse selection and it's the bane of risk pools.That's right. My purpose for buying medical insurance is to have insurance against the unexpected, not to "pool" my premiums with higher risk consumers. Contrary to what many claim, the purpose of insurance is not to shift one person's expected cost to another under the guise of insurance.What you're envisioning ultimately creates pressure for one of two outcomes (assuming no one wants to see these insurers go bankrupt): 1) the state government relaxes the rules governing insurers licensed in-state, i.e. deregulation, or 2) insurers relocate to more loosely regulated states and sell from there (as credit card companies tended to do in the aftermath of the Marquette decision), i.e. deregulation again.Yep, that's the point. So yes, your ability to skirt your state's laws..That would no more be "skirting my state's laws" than not buying any medical insurance...undermines and quite possibly ultimately eliminates them. Or at least renders them irrelevant as insurers pack up and move on. You may see that as a good thing but there are several reasons why I don't.It's not that I see that as a "good thing", I see it as peaceful coexistence among free people instead of some using force against others to get their way. Liberty itself has immeasurable value, whether that value is recognized by all or not.[INDENT]Making products more similar encourages competition. Allowing them to vary along a small number of dimensions helps consumers make sensible comparisons consistent with individual preference. Isn’t that the point?I have no problem with states defining specific standards of coverage. My problem is when they prohibit policies that don't meet those standards.

We're talking about a private transaction between private parties here. Neither the state or the federal government is a party. If someone wants third party interference from the state, they can choose that option via voluntary state standards, while allowing the rest of us to buy what we choose. Peaceful coexistence in other words.

mugaliens

Jan30-11, 03:28 PM

That's right. My purpose for buying medical insurance is to have insurance against the unexpected, not to "pool" my premiums with higher risk consumers.

BINGO! This is one of the main reasons I got out of the home-owner "investment" markets. Too many folks out there don't realize their insurance premiums are far higher than they need to be because a small portion of their insurance company's clients live in the paths of annual hurricanes, tornados, and on rampant flood plains. Yes, they may pay a slight premium for that "privelage," but what most people don't realize is that by U.S. law, those living in non-hurricane/tornado/flood areas foot the rest of the bill.

BilPrestonEsq

Jan30-11, 04:20 PM

A good question to ask regarding the implementation of some form of nationalized healthcare is this: What significant improvements in the efficiency of dealing with patients will come from free market competition? To say it a better way: What significant healthcare price reductions are going to come from free market competition, that won't take away from the quality of care?

nismaratwork

Jan30-11, 04:25 PM

Al68

Jan30-11, 05:09 PM

In principle I agree with Mugaliens and Al, but in practice who's going to pay for people without insurance when they get smashed by a tornado? OK, they're homeless now, and eligible for all kinds of assistance from the pool of taxes, rather than a private venture.That's a different issue, but you make a good point. Why would we expect private ventures to cure society's problems? Is a private venture "bad" because it doesn't achieve someone's political agenda?

And why is it that the politicians that say so never have any proposal to (fairly) compete with existing private companies? If they are so bad, they should be easy to compete with fairly, ie without the use of force.

And why is it that many politicians openly advocate a complete monopoly with the ability to use force (law-making power) against its customers? Do they think using the words "single payer" instead of "complete monopoly" is really going to fool people? And who in their right mind thinks a complete monopoly will improve health care?

WhoWee

Jan30-11, 05:26 PM

That's a different issue, but you make a good point. Why would we expect private ventures to cure society's problems? Is a private venture "bad" because it doesn't achieve someone's political agenda?

And why is it that the politicians that say so never have any proposal to (fairly) compete with existing private companies? If they are so bad, they should be easy to compete with fairly, ie without the use of force.

And why is it that many politicians openly advocate a complete monopoly with the ability to use force (law-making power) against its customers? Do they think using the words "single payer" instead of "complete monopoly" is really going to fool people? And who in their right mind thinks a complete monopoly will improve health care?

Everyone who understands the single payer is the "taxpayer" - further described as the top 1 or 2 percent of income earners.

mugaliens

Jan30-11, 06:43 PM

...who's going to pay for people without insurance when they get smashed by a tornado?

I have two friends who live in a fairly tornado-proof and very environmentally house. It's low, partially underground, strong, passively solar throughout the winter, and cool throughout the summer.

I have absolutely zero sympathy for anyone in tornado, hurricane, earthquake, or flood country that refuses to build to those standards while sucking my mutually pooled insurance dollars.

By the way, I've actually been in a tornado. It's breathtaking what it does to oak and pine trees 100 feet from you.

nismaratwork

Jan30-11, 07:28 PM

I have two friends who live in a fairly tornado-proof and very environmentally house. It's low, partially underground, strong, passively solar throughout the winter, and cool throughout the summer.

I have absolutely zero sympathy for anyone in tornado, hurricane, earthquake, or flood country that refuses to build to those standards while sucking my mutually pooled insurance dollars.

By the way, I've actually been in a tornado. It's breathtaking what it does to oak and pine trees 100 feet from you.

I think you misunderstand... you and I might take a very rational view of people who live on floodplains and tornado ally substandard... many won't. That has to be part of any considerations involving public policy.

Al68

Jan30-11, 08:05 PM

I think you misunderstand... you and I might take a very rational view of people who live on floodplains and tornado ally substandard... many won't. That has to be part of any considerations involving public policy.Sorry, I have to comment on the phrase "public policy". The basis for most of the objections to Obamacare (and other regulations) is that it prohibits/interferes with private contracts, which are not part of any public or government program or system.

Private agreements between private parties are not part of public policy in a free society.

nismaratwork

Jan31-11, 08:43 AM

Sorry, I have to comment on the phrase "public policy". The basis for most of the objections to Obamacare (and other regulations) is that it prohibits/interferes with private contracts, which are not part of any public or government program or system.

Private agreements between private parties are not part of public policy in a free society.

I understand, but those private contracts couldn't exist without government assurance and oversight, as we saw with AIG for example. Insurance, like vaccination, does hurt some people, but on the whole it's valuable to economic stability. Insurance is a matter of national security in the extreme I believe, because we end up paying for people one way or another if they're indigent.

You pay for medical, you pay in crime, you pay in a hundred other little ways. I'll say again, there needs to be oversight of private contracts which have such vast implications for a nation.

BilPrestonEsq

Jan31-11, 09:20 AM

I understand, but those private contracts couldn't exist without government assurance and oversight, as we saw with AIG for example. Insurance, like vaccination, does hurt some people, but on the whole it's valuable to economic stability. Insurance is a matter of national security in the extreme I believe, because we end up paying for people one way or another if they're indigent. You pay for medical, you pay in crime, you pay in a hundred other little ways. I'll say again, there needs to be oversight of private contracts which have such vast implications for a nation.

Good point.

AL68:Private agreements between private parties are not part of public policy in a free society.

Is a 'free' society one that is ruled by the free market? What happens when corporations are more powerful than government? Are we still 'free' then? What I see a lot lately is this argument that government is too powerful and that the free market will 'naturally' solve are problems. This is incredibly naive. If you believe in limited government you should also believe in a more regulated free market or those same powers will take over in business rather than politics. Except then you will have no vote. People say you can vote with your dollars, right? Well what happens when the markets are cornered by large corporations and you have no choice but to buy there goods in order to survive?

WhoWee

Jan31-11, 10:13 AM

Is a 'free' society one that is ruled by the free market? What happens when corporations are more powerful than government? Are we still 'free' then? What I see a lot lately is this argument that government is too powerful and that the free market will 'naturally' solve are problems. This is incredibly naive. If you believe in limited government you should also believe in a more regulated free market or those same powers will take over in business rather than politics. Except then you will have no vote. People say you can vote with your dollars, right? Well what happens when the markets are cornered by large corporations and you have no choice but to buy there goods in order to survive?

We all know that corporations seek profit for it's shareholders - employee compensation is typically designed to reward performance and increase retention. The deviation to this would be a union contract.

Given this, what is the goal of the Government? How are employees compensated? To what extent does the unionization of Government workers dictate policy? How does the Government reduce costs in a market - when it's primary tool is regulation?

nismaratwork

Jan31-11, 10:46 AM

We all know that corporations seek profit for it's shareholders - employee compensation is typically designed to reward performance and increase retention. The deviation to this would be a union contract.

Given this, what is the goal of the Government? How are employees compensated? To what extent does the unionization of Government workers dictate policy? How does the Government reduce costs in a market - when it's primary tool is regulation?

re bold: In some cases, sure, in many others the strategy is to churn and burn, because there is no shortage of trainable labor. McDonalds is a perfect example of a MASSIVE corporation that really does its employees no favors as as a general rule.

Besides, everyone doesn't hold shares.

I'm reminded of the old 'Bit of Fry and Laurie' sketch in which the UK has been completely privatized (well ahead of Snow Crash :tongue:), much to the dismay of Hugh Laurie.
http://www.youtube.com/watch?v=k6CkltzGAxY
<iframe title="YouTube video player" class="youtube-player" type="text/html" width="480" height="390" src="http://www.youtube.com/embed/k6CkltzGAxY?rel=0" frameborder="0" allowFullScreen></iframe>

WhoWee

Jan31-11, 10:59 AM

re bold: In some cases, sure, in many others the strategy is to churn and burn, because there is no shortage of trainable labor. McDonalds is a perfect example of a MASSIVE corporation that really does its employees no favors as as a general rule.

Besides, everyone doesn't hold shares.

I'm not aware of any company that engages in a strategy of "churn and burn" when it comes to employees. Time spent hiring and training is substantial - even employment tax credits are time specific. A high turnover can increase insurance costs - including unemployment contributions.

As for "no shortage of trainable labor" - are you certain? How many persons will sacrifice extended unemployment or welfare benefits to work part time at a fast food restaurant?

nismaratwork

Jan31-11, 12:32 PM

I'm not aware of any company that engages in a strategy of "churn and burn" when it comes to employees. Time spent hiring and training is substantial - even employment tax credits are time specific. A high turnover can increase insurance costs - including unemployment contributions.

As for "no shortage of trainable labor" - are you certain? How many persons will sacrifice extended unemployment or welfare benefits to work part time at a fast food restaurant?

I gave you a perfect example: McDonalds... you just ignored it... and the evidence seems to indicate that fast-food isn't exactly paralyzed by a drought of employees. You see all of those old folks with their stunning upward mobility at the checkout counter of your grocery store too, right? You're truly acting as though the core of our labor force was not in fact, underpaid, and simply NOT insured.

Besides, training for a job of the type we're talking about is same-day-as-hire... hardly training a B-2 bomber pilot... :rolleyes:

edit: Another factor in the lack of shortage: an endless supply of cheap young labor, and and work by those marginalized due to felony convictions, or whichever is the mark of caine du jour.

WhoWee

Jan31-11, 12:48 PM

I gave you a perfect example: McDonalds... you just ignored it... and the evidence seems to indicate that fast-food isn't exactly paralyzed by a drought of employees. You see all of those old folks with their stunning upward mobility at the checkout counter of your grocery store too, right? You're truly acting as though the core of our labor force was not in fact, underpaid, and simply NOT insured.

Besides, training for a job of the type we're talking about is same-day-as-hire... hardly training a B-2 bomber pilot... :rolleyes:

edit: Another factor in the lack of shortage: an endless supply of cheap young labor, and and work by those marginalized due to felony convictions, or whichever is the mark of caine du jour.

A REAL quick link - I can support further if necessary?
http://jpkc.szpt.edu.cn/english/article/Human%20Resource%20Management.htm

"Employee training at McDonald's is highly structured. Ends-level workers are first taken through the basic Crew Training System. The program consists of on-the job- training and is largely vocational. Each stage of advancement beyond the crew level then entails a new training program, with the skills becoming more complex and generalized.

Training begins immediately with a one-hour orientation on the company. Each restaurant has its own video player and training room. Step--by --step manuals and video tapes cover every detail of the operation, everything from how to make a Big Mao to a shake. Each restaurant has 25 stations from the grill area to the front counter, Trainers use a series of checklists as new crew members move through the restaurant. A level of competency is demonstrated and the activity is checked off on the SOC--Station Observation Checklist. There is a follow-up SOC to get certified on the station.

One a crew trainers has been promoted to swing manager and performed successfully, he or she is eligible for the Management Development Program. It provides technical and functional management skills for employees at the swing manager level and above. The first step is the Basic Operations Course, which takes several months to complete. It is a course Which covers fundamental restaurant opinions. The nab in the sequence is the Basic Management Course, Which teaches leaderships, time planning, and crew recognition. In the intermediate Operations Course, students are trained on crew recruitment and retention, store leadership and decision-making. The final course in this sequence is the Regional Equipment Course.

Once a front-line crew member has progressed to the position of assistant managed, he or she is eligible to attend Hamburger University , the Company's world wide training center for management personnel. Approximately 2,500 managers and potential franchisees take part in the Advanced Operations Course, or AOC. The Management training curriculum at Hamburger University has been altered in scope: almost 80% of the advanced operations Course is now devoted to enhancing communication, interpersonal, and human relations skills. Teaching methods have shifted from lecture format to include role playing with video feedback and small group exercises. All managers are required to receive training from hamburger University at least once every 5 years. New emphases include goal setting, diversity management, team building, and employee development.

The company has plans for a certification program which will govern how employees progress from the crew to the level of restaurant managers. Plans are also in place for a Workplace Skills Certificate. It would be given to crew members who have mastered a set of essential workplace skills, and thus provide a "walkable credential" to enable them to move onto another position within the consumer service industry. McDonald's is a quick service restaurant business committed to 100% satisfaction. Macdonald's independent Franchisees and Company-owned restaurants serve over 22 million customers every day around the world. Each and every one of these customers deserved great services from the moment they approach the counter or drive-thru window until they leave the restaurants. We depend on the employees in the restaurant, whether employed by an independent franchises or by McDonald's Corporation, to provide a fast friendly and courteous experience to all guests so they will visit us again and again. That's why McDonald's Independent Franchisees and McDonald's Corporation look for

individuals who like to have fun While delivering fast accurate and friendly service."

Fast food companies invest heavily in training programs and strive to retain workers - they promote from within to sustain growth.

BilPrestonEsq

Jan31-11, 12:53 PM

A REAL quick link - I can support further if necessary?
http://jpkc.szpt.edu.cn/english/article/Human%20Resource%20Management.htm

"Employee training at McDonald's is highly structured. Ends-level workers are first taken through the basic Crew Training System. The program consists of on-the job- training and is largely vocational. Each stage of advancement beyond the crew level then entails a new training program, with the skills becoming more complex and generalized.

Training begins immediately with a one-hour orientation on the company. Each restaurant has its own video player and training room. Step--by --step manuals and video tapes cover every detail of the operation, everything from how to make a Big Mao to a shake. Each restaurant has 25 stations from the grill area to the front counter, Trainers use a series of checklists as new crew members move through the restaurant. A level of competency is demonstrated and the activity is checked off on the SOC--Station Observation Checklist. There is a follow-up SOC to get certified on the station.

One a crew trainers has been promoted to swing manager and performed successfully, he or she is eligible for the Management Development Program. It provides technical and functional management skills for employees at the swing manager level and above. The first step is the Basic Operations Course, which takes several months to complete. It is a course Which covers fundamental restaurant opinions. The nab in the sequence is the Basic Management Course, Which teaches leaderships, time planning, and crew recognition. In the intermediate Operations Course, students are trained on crew recruitment and retention, store leadership and decision-making. The final course in this sequence is the Regional Equipment Course.

Once a front-line crew member has progressed to the position of assistant managed, he or she is eligible to attend Hamburger University , the Company's world wide training center for management personnel. Approximately 2,500 managers and potential franchisees take part in the Advanced Operations Course, or AOC. The Management training curriculum at Hamburger University has been altered in scope: almost 80% of the advanced operations Course is now devoted to enhancing communication, interpersonal, and human relations skills. Teaching methods have shifted from lecture format to include role playing with video feedback and small group exercises. All managers are required to receive training from hamburger University at least once every 5 years. New emphases include goal setting, diversity management, team building, and employee development.

The company has plans for a certification program which will govern how employees progress from the crew to the level of restaurant managers. Plans are also in place for a Workplace Skills Certificate. It would be given to crew members who have mastered a set of essential workplace skills, and thus provide a "walkable credential" to enable them to move onto another position within the consumer service industry. McDonald's is a quick service restaurant business committed to 100% satisfaction. Macdonald's independent Franchisees and Company-owned restaurants serve over 22 million customers every day around the world. Each and every one of these customers deserved great services from the moment they approach the counter or drive-thru window until they leave the restaurants. We depend on the employees in the restaurant, whether employed by an independent franchises or by McDonald's Corporation, to provide a fast friendly and courteous experience to all guests so they will visit us again and again. That's why McDonald's Independent Franchisees and McDonald's Corporation look for

individuals who like to have fun While delivering fast accurate and friendly service."

Fast food companies invest heavily in training programs and strive to retain workers - they promote from within to sustain growth.

Wow! Where can I sign up? My career dreams have been answered.....Sorry for the sarcasm but, come on...

WhoWee

Jan31-11, 01:00 PM

Wow! Where can I sign up? My career dreams have been answered.....Sorry for the sarcasm but, come on...

I posted this in response to a statement that McDonald's engages in a policy of "churn and burn" with respect to employees - what exactly are you challenging?

Al68

Jan31-11, 01:22 PM

I understand, but those private contracts couldn't exist without government assurance and oversightThey always have, so obviously they can. And I would note that anti-fraud and similar laws are not "oversight", since they don't control the contents of private contracts.You pay for medical, you pay in crime, you pay in a hundred other little ways. I'll say again, there needs to be oversight of private contracts which have such vast implications for a nation.A contract with government "oversight" is not a private contract, by definition.Is a 'free' society one that is ruled by the free market?No. A free society is one that is not ruled.What happens when corporations are more powerful than government? Are we still 'free' then?No. But I'm not advocating any such thing. I think corporations should have zero political power. What I see a lot lately is this argument that government is too powerful and that the free market will 'naturally' solve are problems. This is incredibly naive.Who has suggested such a thing? Free market advocates aren't the ones suggesting that we should restrict liberty to "solve" society's problems or "better" society. We're not the Orwellians here.If you believe in limited government you should also believe in a more regulated free market or those same powers will take over in business rather than politics.Nonsense. Private businesses have no such power in a free market.Well what happens when the markets are cornered by large corporations and you have no choice but to buy there goods in order to survive?You're referring to the exact situation I am opposing: a monopoly. Which could only exist in a government regulated market, not in a free market. You seem to have it backward.

Many markets today are "cornered" by big businesses, oppressive regulations provide a very effective barrier to competition by smaller businesses.

BilPrestonEsq

Jan31-11, 01:39 PM

They always have, so obviously they can.A contract with government "oversight" is not a private contract, by definition.No. A free society is one that is not ruled.No. But I'm not advocating any such thing. I think corporations should have zero political power. Who has suggested such a thing? Free market advocates aren't the ones suggesting that we should restrict liberty to "solve" society's problems or "better" society. We're not the Orwellians here.Nonsense. Private businesses have no such power in a free market.You're referring to the exact situation I am opposing: a monopoly. Which could only exist in a government regulated market, not in a free market. You seem to have it backward.

No, I don't have it backwards! Government intervention is what breaks up a monopoly!
If you believe in an unregulated free market than you must also want to eventually work and shop at WalMart for EVERYTHING. The larger a company grows the more power it has to undercut every other business in the market that is smaller than them. That is a FACT.

"If you believe in limited government you should also believe in a more regulated free market or those same powers will take over in business rather than politics."

Nonsense. Private businesses have no such power in a free market

Private businesses only supply you with everything you need to survive. Where do you get your food? Are you a hunter and gatherer? How do you get to work? I am guessing you use both oil and electricity. They have no power over you?!?! That is why the whole, "let the free market take care of everything" idea is such a joke. If you want control over your life than get control over what keeps you alive! Food, Water, Shelter. HHmmm.... I bet a bank owns the house or building that you live in as well huh? If not, if you live someplace where you own your shelter and can be self sufficient than good for you. But realize that not all of us live in the boonies. You need to rethink your logic and attitude towards both government and business. Keep in mind that as long as the majority stays informed and stays vigil against corruption, government will work for you and not against you. Also as I pointed out the only way to give a government or business power is to let them provide the necessaties of survival because basically that is what it is all about survival.

nismaratwork

Jan31-11, 02:09 PM

Well, a Federal judge in Florida made a similar ruling about central principles we've discussed here being unconstitutional.

Clearly the people, and the judiciary are split: this is going to be up to SCOTUS.

note: I have no link, but it's on the front page of cnn

mheslep

Jan31-11, 02:13 PM

The larger a company grows the more power it has to undercut every other business in the market that is smaller than them. That is a FACT.That is your assertion. See Amazon vs Barnes and Nobel, Google vs Microsoft, etc, etc.

nismaratwork

Jan31-11, 02:18 PM

That is your assertion. See Amazon vs Barnes and Nobel, Google vs Microsoft, etc, etc.

And now Comcast has become a major content provider! Maybe the issue is that our laws and regulation have been systematically gouged During and since Reagan?

Citing rulings is useful, but then you have MS vs. Netscape... and so many others who never really got a chance. Frankly, the world you seem to want isn't one in which very many would live well.

WhoWee

Jan31-11, 02:26 PM

As reported by MSNBC:

http://firstread.msnbc.msn.com/_news/2011/01/31/5961248-florida-judge-rules-health-care-law-unconstitutional-

"A federal judge has ruled that the health care reform bill signed into law by President Barack Obama in March is unconstitutional.

Judge Roger Vinson, a Reagan appointee serving in Pensacola, Florida, ruled that key components of the law are unconstitutional and that the entire law "must be declared void."

Today’s decision is the second ruling by a federal judge against the constitutionality of the health care legislation."

BilPrestonEsq

Jan31-11, 03:43 PM

That is your assertion. See Amazon vs Barnes and Nobel, Google vs Microsoft, etc, etc.

I realize it is not always the case, but it remains a fact that: The larger a company grows the more power it has to undercut every other business in the market that is smaller than them.

Society would be better off if a larger investment capital had no bearing on market competition. Could you agree with that?

That may not be possible since there must be an incentive. I think it is worth some thought.

WhoWee

Jan31-11, 04:01 PM

I realize it is not always the case, but it remains a fact that: The larger a company grows the more power it has to undercut every other business in the market that is smaller than them.

Society would be better off if a larger investment capital had no bearing on market competition. Could you agree with that?

That may not be possible since there must be an incentive. I think it is worth some thought.

As a consumer - why wouldn't you want lower prices for the same goods or services?

BilPrestonEsq

Jan31-11, 04:25 PM

As a consumer - why wouldn't you want lower prices for the same goods or services?

Well if a company gets so big that they sell everything I need at one store cheaper than everyone else. Soon there would be only one store. That one store would then have power over every good they sell. They could charge whatever they want at that point and that doesn't sit well with me. Also how much would the CEO of that company make per year?
The executives would be gods. That scares me.

WhoWee

Jan31-11, 04:37 PM

Well if a company gets so big that they sell everything I need at one store cheaper than everyone else. Soon there would be only one store. That one store would then have power over every good they sell. They could charge whatever they want at that point and that doesn't sit well with me. Also how much would the CEO of that company make per year?
The executives would be gods. That scares me.

Gee - that sounds like a good reason not to be in favor of a single payer healthcare system - doesn't it?

Al68

Jan31-11, 05:58 PM

No, I don't have it backwards! Government intervention is what breaks up a monopoly!LOL. I never said government intervention couldn't break up a monopoly. I said that a monopoly can't exist in a free market to begin with, since there are no barriers to competition. That should be pretty self-evident.If you believe in an unregulated free market than you must also want to eventually work and shop at WalMart for EVERYTHING.Nope. You guessed wrong. Backward again.The larger a company grows the more power it has to undercut every other business in the market that is smaller than them. That is a FACT.Yep, that's right. Free market competition prevents that. Government regulations encourage it by being a barrier to entry in the market. I have nothing against Walmart, but they don't need government's help putting all their competitors out of business and preventing new competitors by regulation.Private businesses only supply you with everything you need to survive.Not in the monolithic sense you imply. Obviously if you define a group as those who I buy food from, then it's true that I buy all my food from that group. But such a conclusion is logically meaningless.They have no power over you?!?!They couldn't in a free market for self-evident reasons. We have discussed this topic many times in this forum, and I don't want to sidetrack this thread any further.That is why the whole, "let the free market take care of everything" idea is such a joke. If you want control over your life than get control over what keeps you alive!The fact that others engage in activity that helps me meet my needs is not a justification to try to control them by force.You need to rethink your logic and attitude towards both government and business.LOL. Well, so far no one has provided any reason for me to do so. Your points in this thread are no different from the nonsensical anti-freedom propaganda that has been rampant worldwide for over a century, from Marx to Stalin to Mao to countless others.

Perhaps you should rethink your ideology. Call it a joke all you want, but libertarian ideology, unlike Marxist ideology, is not only logically coherent, it's consistent with peaceful co-existence between people. It doesn't rely on the fact that most people are far too ignorant of basic economic principles to realize how destructive anti-free market policies are to everyone.

CAC1001

Jan31-11, 06:57 PM

That is why the whole, "let the free market take care of everything" idea is such a joke. If you want control over your life than get control over what keeps you alive!

This is one of the classic socialist fallacies. Socialists, who assume that government can solve most every problem in society, tend to think that supporters of free-market capitalism thus think the 180 degree opposite, that the free-market and private sector can solve every problem in society.

Nothing could be further from the truth. Supporters of market capitalism very much understand that there are things the market either cannot do, or could do but which are better left to the government (this is where the big debate about healthcare lies, some believe that it is better done by government, others say that's nonsense, that the market can do it just fine).

Perhaps you should rethink your ideology. Call it a joke all you want, but libertarian ideology, unlike Marxist ideology, is not only logically coherent, it's consistent with peaceful co-existence between people. It doesn't rely on the fact that most people are far too ignorant of basic economic principles to realize how destructive anti-free market policies are to everyone.

This is also a fallacy that many fall prey to. Marxism is an ideology. It's really an atheist religion. I assume by "libertarian," you mean the classical definition of liberalism (as opposed to the modern American variant that now refers to those who tend to be economically authoritarian). Liberalism, in the classical sense, is not an ideology; it is not "upside-down socialism," so-to-speak. It's not a theory based on dogma or unprovable assumptions.

Liberalism is a set of conclusions based on many observations and hard facts. Unlike socialists, who often set out to build a utopia, liberals understand that there is no such thing as a perfect society. So they compare the various types of society that exist or have existed and seek to draw conclusions from the ones that have functioned the least badly.

Yes, there are free-market ideologues as well, the kind who are literally like inverted socialists, but too many confuse liberals with these.

Al68

Jan31-11, 07:24 PM

This is also a fallacy that many fall prey to. Marxism is an ideology. It's really an atheist religion. I assume by "libertarian," you mean the classical definition of liberalism (as opposed to the modern American variant that now refers to those who tend to be economically authoritarian).No, that's not what I meant by "libertarian", I was referring to the ideology of libertarianism. I'm both a libertarian and a classical liberal, as many are, but they aren't synonyms, even though I have used them almost synonymously myself. You're right that classical liberalism isn't an ideology the way libertarianism is.Liberalism is a set of conclusions based on many observations and hard facts. Unlike socialists, who often set out to build a utopia, liberals understand that there is no such thing as a perfect society.That's exactly right, assuming you're referring to classical liberals. We don't think individual liberty will cure all of society's problems. But at the same time we know government restrictions on liberty don't either.

BilPrestonEsq

Feb1-11, 04:47 PM

LOL. I never said government intervention couldn't break up a monopoly. I said that a monopoly can't exist in a free market to begin with, since there are no barriers to competition. That should be pretty self-evident.Nope. You guessed wrong. Backward again.Yep, that's right. Free market competition prevents that. Government regulations encourage it by being a barrier to entry in the market. I have nothing against Walmart, but they don't need government's help putting all their competitors out of business and preventing new competitors by regulation.Not in the monolithic sense you imply. Obviously if you define a group as those who I buy food from, then it's true that I buy all my food from that group. But such a conclusion is logically meaningless.They couldn't in a free market for self-evident reasons. We have discussed this topic many times in this forum, and I don't want to sidetrack this thread any further.The fact that others engage in activity that helps me meet my needs is not a justification to try to control them by force.LOL. Well, so far no one has provided any reason for me to do so. Your points in this thread are no different from the nonsensical anti-freedom propaganda that has been rampant worldwide for over a century, from Marx to Stalin to Mao to countless others.

Perhaps you should rethink your ideology. Call it a joke all you want, but libertarian ideology, unlike Marxist ideology, is not only logically coherent, it's consistent with peaceful co-existence between people. It doesn't rely on the fact that most people are far too ignorant of basic economic principles to realize how destructive anti-free market policies are to everyone.

Well you are definitely right, that is not what you said at all(monopolies). So, my bad. Actually, you could be right, maybe I am not aware of all the regulations that make it difficult for small businesses to develop and easy for large ones. Could you list some? That does seem important to the thread, maybe you already got into that earlier? With healthcare I don't really see what market competition can do to bring the costs down. I could see more energy efficient hospital buildings possibly? That would help. But what is going to really help to bring the price down?
It is not like you can put patients on a conveyor belt and fire them through the hospital like a manufacturing plant can do to curb costs. Health care costs are going to keep rising anyways as long as inflation grows. If the population grows and the quality of care stays the same, the overall health care costs for the country will rise. If inflation is always rising then the price becomes even higher still. Companies like walmart or homedepot can really make dealing with this inflation pretty easy for us as they have compensated for inflation by lowering the price of all sorts of goods. But they are also relying on cheap labor from China. And efficient manufacturing techniques to lower costs of everyday goods. There is no 'Walmart like' solution for health care. So regardless, rising inflation is going to compound rising healthcare costs due to population increase. Making it one day unnaffordable no matter if it nationalized or not. That is a problem the mainstream fails to recognize. Even if that wasn't true, not everyone has health insurance, we are going to pay for them either way, since you can't be turned down at the emergency room. If those same people that haven't paid for insurance, or can't afford insurance did pay into the system it would mean lower costs for everyone. I am not sure how a counter argument on that can make any sense? Also if we all paid into a tax pool (maybe state managed rather that federal)the money could then be deducted through a electronic healthcare account to credit office or hospital accounts. Also there would have to be a co-pay for non emergency visits or else people would take advantage of the "free" care.

mheslep

Feb1-11, 05:18 PM

LOL. I never said government intervention couldn't break up a monopoly. I said that a monopoly can't exist in a free market to begin with, since there are no barriers to competition. That should be pretty self-evident.If you'll allow me jump in Al - sure they can, monopolies have existed in free markets. Company A finds away to make or distribute a product in either a less expensive way than the competition or makes a superior product. Very rarely such a company could, in the right type of market, before anti-trust laws, come to completely dominate a market, but never for very long. The evidence is that, left to themselves with out government cronyism to support them, they eventually rot, form blind spots to small fry competition and fall apart. Government action to break up monopolies must inevitably be subject to cronyism, corruption from the would be competition to the monopoly.

nismaratwork

Feb1-11, 06:08 PM

If you'll allow me jump in Al - sure they can, monopolies have existed in free markets. Company A finds away to make or distribute a product in either a less expensive way than the competition or makes a superior product. Very rarely such a company could, in the right type of market, before anti-trust laws, come to completely dominate a market, but never for very long. The evidence is that, left to themselves with out government cronyism to support them, they eventually rot, form blind spots to small fry competition and fall apart. Government action to break up monopolies must inevitably be subject to cronyism, corruption from the would be competition to the monopoly.

Really? You must tell the Carnegies, DuPonts, Rockefellers and so forth, they'll be crushed to learn that the massive wealth accrued is now... oh wait, it's still just as good.

Ooooh, and Bill Gates... and Comcast shareholders! Yep... anti-trust has sure done its job... no vertical monopolies with content providers "merging" with the content. I think the point, as we've seen, is that a monopoly doesn't have to last very long to make a group wealthy for generations, and to do great harm to many. You can't simply ignore the history which led to creation of anti-trust laws in the first place, and the Robber-Baron era.

Al68

Feb1-11, 06:11 PM

Well you are definitely right, that is not what you said at all(monopolies). So, my bad. Actually, you could be right, maybe I am not aware of all the regulations that make it difficult for small businesses to develop and easy for large ones. Could you list some? That does seem important to the thread, maybe you already got into that earlier?It's been discussed in other threads, but most government regulations, I think have that effect. But that belongs in a different thread, and I don't want to further hijack this one.Making it one day unnaffordable no matter if it nationalized or not. That is a problem the mainstream fails to recognize. Even if that wasn't true, not everyone has health insurance, we are going to pay for them either way, since you can't be turned down at the emergency room. If those same people that haven't paid for insurance, or can't afford insurance did pay into the system it would mean lower costs for everyone. I am not sure how a counter argument on that can make any sense?Well, that's mixing up two different issues. But purposely hiding that cost in the premiums of others only drives prices even higher. Hiding the cost of something, in general, prevents that cost from being lowered by innovation and efficiency.

The market price of a good or service serves a very important purpose in capitalism: it provides valuable information about supply and demand, quality, efficiency, etc. to everyone. That information results in better efficiency, innovation, competition where it is lacking, etc. Hiding the cost of one thing in the price of another completely undermines the value of that info. And that information is far more valuable than most people realize as it affects future costs. There is a reason the most regulated industries in the U.S. (health care, insurance, banking, finance, etc) are the ones that have the most problems.

And certainly the use of government coercion to sell a product, with other costs purposely hidden in the price, does even more damage, for the same reason. Not to mention the obvious unconstitutionality, and authoritarian anti-liberty aspects of the issue.

Al68

Feb1-11, 06:16 PM

Al68

Feb1-11, 06:20 PM

You can't simply ignore the history which led to creation of anti-trust laws in the first place, and the Robber-Baron era.You mean the history of government interference helping create monopolies? You're right, we shouldn't ignore that history, or allow it to be re-written by anti-free market authoritarians.

nismaratwork

Feb1-11, 06:22 PM

Sure, but large, or even almost complete, market share isn't automatically a monopoly. It's only a monopoly if potential competitors can't enter the market, not if a single company is so cheap and efficient that others choose not to compete for that reason.

And in a free market, you're right, such a company could only maintain its market share as long as they stayed cheaper and more efficient than potential competitors.

...Or through influence peddling, abusive practices, and sheer market power.

"Алты́нного во́ра ве́шают, а полти́нного че́ствуют."

nismaratwork

Feb1-11, 06:24 PM

You mean the history of government interference helping create monopolies? You're right, we shouldn't ignore that history, or allow it to be re-written by anti-free market authoritarians.

See: Influence peddling, bribery, and other "abusive practices". Of course, the government is involved with any sufficiently large enterprise; that is clearly not the point I was making or the lesson of that history. You're a conservative battleaxe, I'll give you that, so I don't expect to convince you of anything. "Пле́тью о́буха не перешибёш." = "Can't break an axe with a whip."

Al68

Feb1-11, 06:49 PM

See: Influence peddling, bribery, and other "abusive practices".I specifically said "in a free market", where there is no one to bribe or influence, since no one has any coercive power. Obviously those things contribute to monopolies in a regulated market, such as the U.S. currently.You're a conservative battleaxe, I'll give you that, so I don't expect to convince you of anything.LOL. Well you don't have to convince me of things I already know, like how the things you mention are very relevant in a regulated market, and can lead to monopolies, or reduced competition at least.

But I'll repeat, I was referring to a free market, ie one in which no one has any coercive power.

nismaratwork

Feb1-11, 06:52 PM

I specifically said "in a free market", where there is no one to bribe or influence, since no one has any coercive power. Obviously those things contribute to monopolies in a regulated market, such as the U.S. currently.LOL. Well you don't have to convince me of things I already know, like how the things you mention are very relevant in a regulated market, and can lead to monopolies, or reduced competition at least.

But I'll repeat, I was referring to a free market, ie one in which no one has any coercive power.

How does a free market immunize people against bribery and influence? Where people can find a reason to cooperate, they can find a reason to influence people to and improve their environment.

If you can show me free markets that actually exist and function in that fashion, I'd be thrilled, but I'm not buying that this economy is it. As for bribery, the SEC snorting drugs off strippers with the people they were supposed to regulate doesn't count? Wow.

Al68

Feb1-11, 07:24 PM

How does a free market immunize people against bribery and influence?In a free market, there is no one with any coercive power to be bribed or influenced. That's what "free market" means.If you can show me free markets that actually exist and function in that fashion, I'd be thrilled, but I'm not buying that this economy is it.Of course this economy isn't it. Who said that? This is a regulated market, not a free market. Did you misunderstand my posts?As for bribery, the SEC snorting drugs off strippers with the people they were supposed to regulate doesn't count?It not only counts as bribery, it counts as me suddenly desiring a career with the SEC. :biggrin:

Seriously, that's my point. We can find countless examples of corruption in government regulated markets. And your example is a perfect one to illustrate how a regulated market is biased toward big companies against their smaller competition, who can't afford as much drugs and strippers. Did I mention I'm considering a career with the SEC?

nismaratwork

Feb1-11, 07:29 PM

In a free market, there is no one with any coercive power to be bribed or influenced. That's what "free market" means.Of course this economy isn't it. Who said that? This is a regulated market, not a free market. Did you misunderstand my posts?It not only counts as bribery, it counts as me suddenly desiring a career with the SEC. :biggrin:

I understand, but the kind of free market you're describing naturally gives rise to groups designed to protect mutual interests. Those groups then try to regulate and even the playing field, and bam... you're back at regulation, only now the inmates are running it. When you add the complete lack of attachment that many multinational corporations have with a given nation, the interests of a free market such as you decide would be unacceptably fluid.

In addition, without regulation of some kind, external or internally based... investors will be wary of fraud, Ponzi Schemes, and the other ills regulation REDUCES.

Seriously, that's my point. We can find countless examples of corruption in government regulated markets. And your example is a perfect one to illustrate how a regulated market is biased toward big companies against their smaller competition, who can't afford as much drugs and strippers. Did I mention I'm considering a career with the SEC?

No, I understand that the US is a regulated market, but by the same token... if not the SEC than an industry group. I don't see how your vision of a market can be, without cabals and internal forces which seek to change the nature of the market and exert influence.

I don't disagree that in the ideal model you propose, that what you said would be true... it's the existence or even POSSIBLE existence or practicality of such a market that I question.

Al68

Feb1-11, 08:33 PM

I understand, but the kind of free market you're describing naturally gives rise to groups designed to protect mutual interests. Those groups then try to regulate and even the playing field, and bam... you're back at regulationNot if no one has coercive power. And preventing that is the legitimate function of government in a free market.only now the inmates are running it.As opposed to what?In addition, without regulation of some kind, external or internally based... investors will be wary of fraud, Ponzi Schemes, and the other ills regulation REDUCES.The word "regulation" isn't typically used to mean anti-fraud laws. Anti-fraud laws, and law and order in general to protect liberty, is essential to a free market. Free doesn't mean free from laws, it means free to conduct honest business. I was using the word "regulation" to refer to restrictions on honest business, not laws against fraud, etc.

A free market isn't anarchy.I don't disagree that in the ideal model you propose, that what you said would be true... it's the existence or even POSSIBLE existence or practicality of such a market that I question.It, like many things, has never existed in an ideal sense, but the U.S. was fairly close prior to early last century. The same period of time that we went from literally nothing to the greatest economic power in history.

And people can decry "robber barons" all they want, the important point is the increased standard of living of poor and working people. That tremendous and fantastic result of (almost) free market capitalism was even acknowledged by Marx.

That is what raised the standard of living of most people from working hard and dying young just to get to eat on days they were lucky, to most people getting to eat every day, to a situation in which we use the word "poverty" to describe people with a higher standard of living than 99.999% of humans who ever lived.

That's what's at stake here. Far too many people just don't understand the dynamics at work that result in orders of magnitude differences in the standard of living of people over time. That's the kind of progress that government regulation stands in the way of.

Some have said that if the world had always been free (economically), our current standard of living would have been common thousands of years ago, and our standard of living today would be beyond our imagination. I don't think that's much of an exaggeration.

CAC1001

Feb1-11, 09:30 PM

My personal philosophy is that a market economy needs, overall, light and efficient regulation. Regulation is not any panecea and too much of it just hamstrings the economy and lets big corporations dominate the economy. But a total complete lack of regulation I wouldn't want either. I look at regulation like government, both necessary evils that you want in a limited manner, as in excessive amounts they are bad.

Some have said that if the world had always been free (economically), our current standard of living would have been common thousands of years ago, and our standard of living today would be beyond our imagination. I don't think that's much of an exaggeration.

I think it's a little more complex than that though. I would modify the statement to be more along the lines of: "If modern liberal democracy and market capitalism had been known as the best means to organize society thousands of years ago, than our current standard of living would have existed back then and our standard of living today would be beyond our imagination."

Remember also, we have WAR to thank for a lot of stuff we have today: a lot of the technologies that modern consumer electronics and computers are based off of, were developed with funding from DARPA. The Internet was originally started by the military. The Global Positioning System, also was started by the military (and the space program to launch the satellites into space was government too).

With a lack of the money from defense, one could probably expect that these would all eventually have been developed by the private-sector, but it likely would have taken a lot longer.

In general though, I agree fully that if a society has a market economy and liberal democracy for government, and the government keeps a fairly hands-off policy regarding the economy, then the collective imagination of the people will result in phenomenal levels of creativity that lead to a very high standard of living for the people.

WhoWee

Feb7-11, 10:07 AM

Presidential hopeful, Mitch Daniels, weighed in on healthcare:
http://www.theindychannel.com/news/26774576/detail.html

""Unless you're in favor of a fully nationalized health-care system, the president's health-care reform law is a massive mistake," Daniels wrote. "It will amplify all the big drivers of overconsumption and excessive pricing."

In the column, Daniels claims the health care law "will add trillions to the federal deficit," and will amount to a government takeover of health care."

He went on to discuss the mandated cost to his state.

ParticleGrl

Feb13-11, 10:27 PM

Market based healthcare solutions are based on a myth- there is no market for healthcare. The demand for life-saving care is completely inelastic. Information is completely asymmetric between doctor and patient, and in an emergency, patients can't chose which state, hospital, provider, etc, they end up with.

Without state support (medicare), the insurance model would be completely broken. Over a long enough time scale, everyone becomes incredibly risky. Hence, Daniels' arguments are broken. More privatization = more inefficiency in this case. Insurers have a huge layer to evaluate risk, which the government does not need.

Further, he ignores the best part of Obama's bill- the focus on evidence based medicine. A planned push for empirically successful treatments is the only way to bring down costs AND improve outcomes.

WhoWee

Feb13-11, 10:42 PM

ParticleGrl

Feb13-11, 11:33 PM

Care to support any of your comments - or is it all opinion?

Most of what I listed are basic facts of the system. i.e. no consumer choice in an emergency- for obvious reasons you go to the nearest treatment center. Completely inelastic demand for life saving care- people want to live, the price is not an object. Changing the price in no way changes demand. Asymmetrical information- Doctors are highly trained professionals with much specific knowledge. Any discussion of treatment will always be asymmetrical between Doctor and patient (unless the patient themselves is a Doctor). This is all basic, obvious stuff. The healthcare sector has none of the requirements needed for an actual,efficent market.

I'm especially interested in your statement "Without state support (medicare), the insurance model would be completely broken." Do you care to elaborate?

On a long enough time scale, everyone's risk of catastrophic health failure goes to 1. How do you manage your risk in such a situation? Insurance companies will be forced to extract more from a person over their lifetime than they put out in costs, so whats the point of insurance?

Proton Soup

Feb13-11, 11:56 PM

Further, he ignores the best part of Obama's bill- the focus on evidence based medicine. A planned push for empirically successful treatments is the only way to bring down costs AND improve outcomes.

don't we already have empirically based medicine? don't injury lawsuits lead to development of protocols?

WhoWee

Feb14-11, 12:01 AM

I'm not trying to challenge everything you've posted.

But, when you posted
"Without state support (medicare), the insurance model would be completely broken."

It was not obvious what you were trying to say. Now to clarify, you've stated:

On a long enough time scale, everyone's risk of catastrophic health failure goes to 1. How do you manage your risk in such a situation? Insurance companies will be forced to extract more from a person over their lifetime than they put out in costs, so whats the point of insurance?

I'm still not connecting how Medicare - a Federal Government program - prevents the insurance model from being broken? As for the insurance model itself - I'm not certain insurance was ever intended to pay all of the costs of health care. Insurance doesn't work that way in any other industry - does it?

Does your car insurance pay for tune-ups, oil changes, brake jobs, and tire rotation? Does your homeowners insurance pay for light bulbs, paint, and lawn care?

Why should anyone expect their health insurance to pay for doctor visits, blood work, and prescriptions?

Insurance is typically purchased to guard against catastrophic loss - that is the insurance model.

As for consumer choice, you (or your employer) typically choose an insurance plan based upon network - each with doctor and hospital choices.

ParticleGrl

Feb14-11, 12:59 AM

I'm still not connecting how Medicare - a Federal Government program - prevents the insurance model from being broken? As for the insurance model itself - I'm not certain insurance was ever intended to pay all of the costs of health care. Insurance doesn't work that way in any other industry - does it?

You are missing the point, this isn't an issue of a deductible. Insurance works by spreading the risk of catastrophic payment over many people. However, as we get older, our risk of catastrophic failure heads to 1. IF every single person insured will have a catastrophic failure at some point, than the insurance company cannot hedge that risk. The only way to turn a profit is to extract from every person enough money to pay for that catastrophic health failure (at which point, why be insured?). The alternative is to simply not insure the elderly. However, the elderly are the biggest consumers of actual medical services, if they weren't insured and couldn't afford treatment, the healthcare industry would collapse.

What does medicare do? It removes the elderly from the risk pool. Since the majority of people will have their catastrophic health care costs late in life, the risk of catastrophic failure amongst the remaining pool is much lower.

As for consumer choice, you (or your employer) typically choose an insurance plan based upon network - each with doctor and hospital choices.

Yes, but this small amount of choice, far removed from the actual product (health care procedures) does not make for an efficient market. Before people advocate market remedies, they need to ask themselves "is there actually a market?"

don't we already have empirically based medicine? don't injury lawsuits lead to development of protocols?

Most of the US medical data is disjoint and hard to put together. By creating a national medical database, the health care bill will create a massive amount of data. A large database of treatments and outcomes will give us a chance to do empirical medicine on an incredible scale, which will drive down costs.

As an example, there is currently no statistical evidence that spinal fusions alleviate back pain, but we've been doing them for decades. That is a lot of waste.

WhoWee

Feb14-11, 07:27 AM

You are missing the point, this isn't an issue of a deductible. Insurance works by spreading the risk of catastrophic payment over many people. However, as we get older, our risk of catastrophic failure heads to 1. IF every single person insured will have a catastrophic failure at some point, than the insurance company cannot hedge that risk. The only way to turn a profit is to extract from every person enough money to pay for that catastrophic health failure (at which point, why be insured?). The alternative is to simply not insure the elderly. However, the elderly are the biggest consumers of actual medical services, if they weren't insured and couldn't afford treatment, the healthcare industry would collapse.

What does medicare do? It removes the elderly from the risk pool. Since the majority of people will have their catastrophic health care costs late in life, the risk of catastrophic failure amongst the remaining pool is much lower.

Every single person does not have a catastrophic failure and subsequent health care insurance claim - do they? Some people die in accidents, others have strokes or heart attacks and die instantly, some people never get sick and die of old age - don't they?
With Medicare, it's not that simple. First, Part A is funded through payroll deductions over a worker's life. Part B has a premium - for 2010 enrollees it's $110.50 per month unless income exceeds $85,000. Part D is the prescription benefit and Part C is Medicare Advantage (MA). The MA combines A & B, and can include Part D (MAPD). Medigap is the insurance that (basically) is designed to pay the 20% cost share that Medicare leaves behind (no prescriptions - need a Part D). Worth mentioning, Medicare covers only the first 100 days in a Skilled Nursing Facility.

If a beneficiary needs to be placed in a nursing home - they are on their own. Once their assets are depleted (house and savings/investments) most are dependent on Medicaid - a funded by Federal and State contributions. The insurance designed to cover is named Long Term Care Insurance. LTC protects assets.

Then, we need to consider the reality of death, some people purchase life insurance - as everyone dies (either natural or un-natural causes) - that is certain.

ParticleGrl

Feb14-11, 09:03 AM

Every single person does not have a catastrophic failure and subsequent health care insurance claim - do they?

No, but the risk heads to 1, because nearly everyone does. For this argument, the details of medicare aren't important- what is important is that medicare reduces the risk to insurance companies to manageable levels.

Then, we need to consider the reality of death, some people purchase life insurance - as everyone dies (either natural or un-natural causes) - that is certain.

Thats why many life insurance policies are term- they don't last for life. Similarly, many whole life policies are accidental death and won't cover natural causes. This reduces the risk, and creates a pool of premiums that can help pay the cost of whole policies. Even still, the premium on a whole policy escalates rapidly in the later years.

mheslep

Feb14-11, 09:41 AM

This is all basic, obvious stuff. No, it's just stuff. Are you really so convinced that health care is so singular? Consider that other fields have asymmetric information and critical needs challenges, yet have been long served by markets and been studied ad nauseum in the economics literature. Your posts in this line suggest none of this is true without reference, though you've been asked for backup.

WhoWee

Feb14-11, 09:46 AM

No, but the risk heads to 1, because nearly everyone does. For this argument, the details of medicare aren't important- what is important is that medicare reduces the risk to insurance companies to manageable levels.

Thats why many life insurance policies are term- they don't last for life. Similarly, many whole life policies are accidental death and won't cover natural causes. This reduces the risk, and creates a pool of premiums that can help pay the cost of whole policies. Even still, the premium on a whole policy escalates rapidly in the later years.

Before we go any further, I'm going to disclose (again) that I'm very active in the insurance industry. I have substantial industry experience and familiar with all forms of life, variable annuity, accident, and health policies. I have extensive Medicare/Medicaid experience.

Medicare really doesn't reduce the risk to the insurance company. A Medigap plan covers the 20% that Medicare doesn't pay - the risk exposure to the insurance company remains 20% regardless of the claim amout. If a beneficiary pays $100 per month for a Plan F and incurrs $5 million in bills - the Medigap insurance company will pay $1,000,000 - Medicare doesn't cover a penny of this 20%.

A Medicare Advantage plan pays INSTEAD of Medicare. Medicare pays a fixed amount (last figure I saw was $849.95) per month - about $10,000 per year - to the insurance company. The insurance company is responsible for all of the costs as per their Summary of Benefits that describes the beneficiaries co-pay and cost sharing requirements. The beneficiary (has typically already paid for Part A through payroll deductions) pays a Part B premium (new enrollees $110.50 per month) to Medicare.

Basically, Medicare has collected Part A payments over time and continues to collect Part B premiums - then re-insures under Part C.

As for life insurance - I'm not sure what your point is -term coverage typically has a lower premium.

nismaratwork

Feb14-11, 09:48 AM

No, it's just stuff.

What does that mean?

mugaliens

Feb14-11, 01:43 PM

A Medicare Advantage plan pays INSTEAD of Medicare[/B]. Medicare pays a fixed amount (last figure I saw was $849.95) per month - about $10,000 per year - to the insurance company.

Interestingly, that's almost identical to what my brother pays for his family medical insurance (him, his wife, his son). Is that Medicare Advantage plan for one person, or a family?

WhoWee

Feb14-11, 02:03 PM

Interestingly, that's almost identical to what my brother pays for his family medical insurance (him, his wife, his son). Is that Medicare Advantage plan for one person, or a family?

All Medicare plans are individual. The premium could exceed that amount - it's an average. To clarify a bit, if the amount of the insurance contract with Medicare exceeds the amount Medicare agrees to pay - the beneficiary would pay the difference. For instance, if the monthly contract premium is $870 and Medicare agrees to pay $850 - the premium requirement for the beneficiary would be $20 - the amount can be deducted from the Social Security check or billed via coupon book (typically). These Medicare Advantage (MA) plans can offer hospital A and medical B or they can include Part D and be labeled "MAPD". The premiums on MAPD's typically range from $0 to $100 per month - varies by county. Some plans will actually reduce the Part B premium up to the full amount. This means the beneficiary would receive more money in their Social Security check. Other plans might cost more than $200 per month - again, it varies by location.

If $10,000 sounds expensive - it actually tracks from the groups approaching retirement age with comparable coverage.

ParticleGrl

Feb14-11, 04:55 PM

Consider that other fields have asymmetric information and critical needs challenges, yet have been long served by markets and been studied ad nauseum in the economics literature.

Please, give references to well functioning markets with little consumer choice,large asymmetric information, etc. All of the economics papers I've read (largely theory papers) suggest these are impediments to market efficiency. In the extreme case, the market ends up a market for lemons, and the bad drives out the good (see Akerlof's famous paper).

Before we go any further, I'm going to disclose (again) that I'm very active in the insurance industry. I have substantial industry experience and familiar with all forms of life, variable annuity, accident, and health policies. I have extensive Medicare/Medicaid experience.

Thats fine, but lets not bog this down by too many details, and make it simple. Surely you agree that elderly are extremely risky to insure? Surely, you agree that the state's agreement (via medicare) to cover 80% mitigates this risk?

With your insurance experience, if you had to underwrite a (non-state subsidized) plan for an average 65 year old (say an 80/20 plan, to be concrete), what premium would you have to charge? How quickly would the premium have to grow, year by year, to eat the risk?

nismaratwork

Feb14-11, 05:40 PM

I'm enjoying this very much, but if I might ask for the sake of clarification: WhoWee has a background in Health care/Insurance.

@Particlegrl: You sound like you're coming from the macroeconomic theory angle? I'm curious, not because I'm questioning credentials or anything like that, but it's rare to see two people with serious knowledge of this kind of subject... one practice, one theory. I just want to be sure that's the case, and I'm not missing even more than I know I already am.

WhoWee

Feb14-11, 07:12 PM

Surely you agree that elderly are extremely risky to insure? Surely, you agree that the state's agreement (via medicare) to cover 80% mitigates this risk?

With your insurance experience, if you had to underwrite a (non-state subsidized) plan for an average 65 year old (say an 80/20 plan, to be concrete), what premium would you have to charge? How quickly would the premium have to grow, year by year, to eat the risk?

It does cost more to cover an elderly person. I should have been more descriptive when I posted that premiums track to this level as people reach retirement age.

What I meant was a relatively health non-smoking male, age 64, taking no meds and with comparable deductibles and co-pays would expect to pay between $600 and $800 per month. Worth mentioning, many of the MAPD plans include prescription coverage.

I think the details are important and I did a quick comparison to post.

Accordingly, I just went onto a (competitive) major carrier site and entered these same details. To stay out of trouble on marketing rules and disclosures, I won't name the carrier or the location AND I must stipulate this is NOT to be considered an offer to sell insurance.
The 80/20 (In-network - 60/40 out of network) plans offered consistent $35 primary/$50 specialist co-pays and a range of deductibles: from $0 to $1,000 on prescriptions and from $1,000 to $6,000 on medical.

The $0 deductible prescription plan with $1,000 medical deductible priced at $967.68/mos and the $0 deductible prescription plan with $2,500 med deductible was priced at $637.28

By comparison, the $500 deductible prescription plan with a $3,500 medical deductible is priced at $495.47 per month.
The "most affordable" plan was the $1,000 prescription deductible (6 office visits per year max) and a $6,000 medical deductible is priced at $349.99 per month.

Next, I checked the same carrier for a Medicare plan in the same zip code.
Premiums ranged from $61 to $291 per month and included prescription coverage. The medical deductibles are $0, but the hospital deductible on both the $61 plan and the $291 plan mirror original Medicare at $1,132 for days 1-60, then $283 per day from days 61-91, and $566 per day from day 91-150 (under original Medicare beneficiary pays 100% days 151 and beyond). Both of these plans also have a $310 prescription deductible. Doctors are 20% same as orig Medicare.

The $71 premium plan featured a hospital co-pay of $220 per day for days 1-8, a $15 primary doctor co-pay and $35 for a specialist.

Last, I pulled a Medigap Plan F (different carrier with a competitive rate) in the same zip code and no prescription coverage - only the 20% that Medicare doesn't pay - along with the hospital coverage. Plan F is the most comprehensive of the supplement plans. The premium would be $144.55 per month.

--------------
To answer you question - these are real costs - concrete.

Now, we also have to remember that Medicare sets the reimbursement rates and has to approve every aspect of these plans before they can be offered. These plans are also subject to state regulation.

Does Medicare mitigate the risk?
To the insurance carrier - NO
To the beneficiary - YES

As for premium increases - it varies. My best guess is about $25/month average across the board from 2010 to 2011 plans.

The next level of details to consider would delve deeper into the particulars of coverage. Many MAPD's include health club memberships, some dental, and some vision. Then, quite a few dual eligible plans (people with both Medicare and Medicaid) include transportation and very low drug costs ($1.10 to $6.50) with no "donut hole".

mheslep

Feb14-11, 07:24 PM

Please, give references to well functioning markets with little consumer choice, large asymmetric information, etc.As to examples of markets with asymmetric information, where to begin? Car maintenance and repair - the asymmetry between the consumer and the mechanic. Financial investments: buying and selling of securities and the like - the asymmetric between you and the pros. Yes the asymmetries in these situations present challenges to the market, but consumers have found multitudes of solutions to deal with them - financial advisors, warranties, word of mouth in the community. I don't accept the notion that the public has little choice with respect to doctors and hospitals. Emergency needs are a small portion of national health expenditures.

All of the economics papers I've read (largely theory papers) suggest these are impediments to market efficiency. In the extreme case, the market ends up a market for lemons, and the bad drives out the good (see Akerlof's famous paper).
Yes conditions as described by Arrow and Akerlof no doubt create challenges for the market, though Akerlof is hardly the last word on the subject (http://resources.metapress.com/pdf-preview.axd?code=h3h8530156276515&size=largest):
It is shown that the economic literature is divided on whether a lemons market actually exists in used vehicles.
In any case it certainly does not follow from Arrow/Akerlof that working markets under such conditions simply can not exist as asserted above as a matter of fact:
Market based healthcare solutions are based on a myth- there is no market for healthcare. The demand for life-saving care is completely inelastic. Information is completely asymmetric between doctor and patient, and in an emergency, patients can't chose which state, hospital, provider, etc, they end up with.
...
Most of what I listed are basic facts of the system.
...
Changing the price in no way changes demand

Also: I grant insurance doesn't make sense in all situations especially for chronic illnesses, and the market based reforms on the table recently all prefer risk pools over insurance for those cases. But I can't fathom how one can be aware of and cite the case of life insurance on the one hand where the eventual end is certain, and then imagine that somehow insurance can't deal with high risk illnesses in the case of health care.

ParticleGrl

Feb14-11, 07:59 PM

Car maintenance and repair - the asymmetry between the consumer and the mechanic.

A market that historically has been ripe with fraud and inefficiency. Everyone knows the anecdotes of shady mechanics. What empirical studies demonstrate this market is actually efficient? Also, its different in a key way- health care is the only thing I know of where the demand is so inelastic. This breaks important market principles.

Financial investments: buying and selling of securities and the like - the asymmetric between you and the pros.

There is a huge difference here. The biggest participants in the market are professionals. Hence, the symmetry of information between the largest players sets the price for everyone.

Even still, some have argued that asymmetrical information (between major players like Goldman and AIG) and fraud in the derivatives market has been largely responsible for the present financial crisis. See anything recent by Galbraith. I'm not sure I buy it, but at the same time, it seems crazy that AIG took the market position it did with swaps.

Yes the asymmetries in these situations present challenges to the market, but consumers have found multitudes of solutions to deal with them - financial advisors, warranties, word of mouth in the community. I don't accept the notion that the public has little choice with respect to doctors and hospitals.

Lets agree to disagree for now on the financial market (which I consider to be the purest market economist can study), and focus on car maintenance and repair- why should we believe this market is fair or efficient?

mheslep

Feb14-11, 08:50 PM

...A market that historically has been ripe with fraud and inefficiency. Everyone knows the anecdotes of shady mechanics. Yes it is in the nature of people that some of them are shady. Some economic approaches accept this as a given, others, not so wise in my view, attempt to anoint some of the same fallible people and put them in charge of the daily lives of the rest, because, well, they might be shady. What empirical studies demonstrate this market is actually efficient?The tactic of asking for references to disprove claims, while providing none, won't move the discussion along.

... and focus on car maintenance and repair- why should we believe this market is fair or efficient?The useful question is compared to what? Government run car repair? Look at what the repair market, such as it is, currently does: repairs nearly any imaginable car problem, on over a thousand different make-model combinations, generally within a couple days, across the entirety of the US, from typically several hundred to a couple thousand dollars. Among the tens of thousands of mechanics, we'll have some combination of crooks and innocent incompetents ( I can say from being in the business as a teen that the problems are overwhelmingly due to incompetence). On top of that we have tens of thousands of auto parts stores for the do-it-yourselfer, fierce competition among vehicle manufacturers for the best warranties, and now in addition we have the internet, Craigs list, etc, etc.

nismaratwork

Feb14-11, 09:03 PM

As to examples of markets with asymmetric information, where to begin? Car maintenance and repair - the asymmetry between the consumer and the mechanic. Financial investments: buying and selling of securities and the like - the asymmetric between you and the pros. Yes the asymmetries in these situations present challenges to the market, but consumers have found multitudes of solutions to deal with them - financial advisors, warranties, word of mouth in the community. I don't accept the notion that the public has little choice with respect to doctors and hospitals. Emergency needs are a small portion of national health expenditures. <Snip>

re bold especially: I have to agree with this, although I think consumers are generally still playing catch-up. I think airlines and hotels are an example we're not disgustingly familiar with thanks to William Shatner and a dozen other sites like the one he hocks. Those are a fine example of a way that consumers literally bypass the asymmetry and use it to utterly turn the tables. Some don't use this service, but it's not for lack of it being on offer.

Health-Care though... you're in a fairly unique situation with your health, don't you think? It may be that those inequalities can't be allowed to fester until consumers are allowed or figure how to "catch up". In addition, at this point, it doesn't seem as though the consumer can do much to effect the market... it is HAPPY to dump your sick tush. You're also very vulnerable when seriously ill, and this isn't a hotel or a sport... you take care of yourself or die early/live badly.

To be blunt, Health Care is unlike most markets in terms of impact on the individual and family, and life in general. Lets be blunt... it can be the difference between living or dying, and the quality of life. I'd like to see a comparison of the Q-TWIST say, of a given cancer patient on various types of health insurance, and none. Compare that to other consumer "choices", and I'm not sure it's something that's so easily grouped.

Health, Food, Shelter, Comfort, Company, etc... some measure of ALL this is needed if you want a decent life. When my car breaks down, it may ruin a lot of things, but it doesn't make me suffer and die.

ParticleGrl

Feb14-11, 10:18 PM

The tactic of asking for references to disprove claims, while providing none, won't move the discussion along.

We both agree asymmetry of information is a difficulty for a market.

You suggested that in the specific case of car maintenance and repair, this problem is solved, I'd like some positive proof of this. I'd argue its not solved- some proportion of crooked dealerships stay in business.

The useful question is compared to what? Government run car repair?

Its not about comparing to the government. If we look at the main topic we are discussing (health care), the government is obviously more efficient because it does not have to evaluate risk (a large part of insurance). http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf.

Its about the efficiency of the specific market- over time do crooked dealers go out of business and honest dealers prosper? In an efficient market, this is what happens. In a market-for-lemons situation, the crooked dealers will thrive and drive out the honest dealers. You are making a positive claim- the market has solved the asymmetrical information problem inherent in car repair.

When I have time to type up some mathematics, I'll lay out the broader case for health insurance risk being dramatically reduced by medicare.

WhoWee

Feb15-11, 08:17 AM

Its not about comparing to the government. If we look at the main topic we are discussing (health care), the government is obviously more efficient because it does not have to evaluate risk (a large part of insurance). http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf.

(my bold)
The Government uses the Medicare Advantage plan to offset some of their risk. They have evaluated risk. The Federal Government has expanded Medicaid recently - this forces a share of the cost onto the states - are the states evaluating that risk?

Original Medicare is paid through Payroll deductions for Part A and a premium payment for Part B. The Part B premium was increased from $96.50 to $110.50 in 2010 - because the risk was evaluated - wasn't it?

There are at least a dozen possible healthcare outcomes when a person reaches age 65.
1.) Original Medicare only
2.) Original Medicare plus Part D
3.) Either 1 or 2 above plus a Medigap Supplement
4.) Original Medicare plus Medicaid (multiple levels)
5.) Original Medicare plus Part D with LIS (multiple levels)
6.) Part C Medicare Advantage (MA)
7.) Part C Medicare Advantage with Prescription (MAPD)
8.) no Medicare coverage (Group/Private or nothing at all)
9.) no Medicare coverage - Medicaid only
10.) VA only
11.) VA in combination with something from above
12.) TRICARE (multiple)

There are other cost sharing and specialized (ESRD) plans (for instance).

Other than people with Group/Private insurance, the only insurance scenario that eliminates risk to the Federal Government is the Medicare Advantage program. The Government pays a fixed amount to a 3rd party insurance carrier that pays instead of Medicare. Every other scenario puts the Government at risk. The Government does not have unlimited resources (believe it or not). I've posted several links previously that estimate long term deficits from Social Security, Medicare, and Medicaid spending approaching $86 Trillion. The Federal deficit is currently $14 Trillion - up almost $5 Trillion in the past 5 years - there are limits to the risk Government can cover. Government does have to evaluate risk.

I've posted multiple times in the various healthcare debate threads on this topic. This is a condensed version of my OPINION. The Government needs to fund facilities (including large ticket equipment), including local clinics - perhaps convert some of the Post Offices that are closing. Provide tax incentives to doctors to volunteer in the clinics. The goals would be to address routine and preventative issues and to eliminate non-emergency Medicaid visits to emergency rooms. Next, the Government can create high risk insurance pools to cover catastrophic claims/pre-existing above a certain limit - $5 million (IMO). This will give the insurance industry a $5 million maximum risk to address. The next level of concern is leveling the playing field for carriers. We need to standardize insurance regulations (to some of the higher standards) across the 50 states, D.C., Guam, Puerto Rico, etc. to allow more companies to participate and reduce the administrative (nightmare and) cost. There are other concerns including an evaluation of the cost of litigation (including Doctors ordering unnecessary tests to protect themselves). Medicare already sets the reimbursement rates - need evaluation. The Government also needs to address the costs of bringing a drug to market. Insurance is the "demon", not the problem. Again - IMO.

mheslep

Feb15-11, 10:10 AM

We both agree asymmetry of information is a difficulty for a market.Yes agreed, a difficulty. It doesn't make markets untenable, at least not in many cases.

Its not about comparing to the government. If we look at the main topic we are discussing (health care), the government is obviously more efficient because it does not have to evaluate risk (a large part of insurance). http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf. Where in that 167 page document is the government shown to be obviously more efficient?

Its about the efficiency of the specific market- over time do crooked dealers go out of business and honest dealers prosper? In an efficient market, this is what happens. In a market-for-lemons situation, the crooked dealers will thrive and drive out the honest dealers. You are making a positive claim- the market has solved the asymmetrical information problem inherent in car repair. Let's not turn this around. I entered the discussion to suggest there were obvious exceptions to your positive claims:

Market based healthcare solutions are based on a myth- there is no market for healthcare. The demand for life-saving care is completely inelastic. Information is completely asymmetric between doctor and patient, and in an emergency, patients can't chose which state, hospital, provider, etc, they end up with.

Without state support (medicare), the insurance model would be completely broken. Over a long enough time scale, everyone becomes incredibly risky. Hence, Daniels' arguments are broken. More privatization = more inefficiency in this case.I take exception with every sentence of the above.

ParticleGrl

Feb15-11, 10:44 PM

Where in that 167 page document is the government shown to be obviously more efficient?

Medicare loses about 4% in overhead, to insurance's 11%. Further, look at:

http://www.cms.gov/NationalHealthExpendData/downloads/tables.pdf

Medicare's cost per beneficiary has been rising about 9% per year since 1970. Private insurers have seen premium rise 10% per year. Also, these rapid growths underscore that we don't simply have out of control medicare growth. We have out of control health care expense.

I take exception with every sentence of the above.

The lack of market is made up of each of the supporting points:

On price elasticity see the famous RAND health insurance experiment. It is the largest study I know of, and concludes a price elasticity of about -0.2. Its not quite 0, but its pretty close : http://www.rand.org/health/projects/hie.html

On asymmetry of information, we seem to agree- correct me if I'm wrong?

Also, do we need to argue about whether patients in an emergency have choice?

The question then, is can a market operate efficiently in these situations.

talk2glenn

Feb16-11, 03:35 AM

Medicare loses about 4% in overhead, to insurance's 11%.

This is complete nonsense. Forget for a moment that relative administrative overhead costs tell us nothing of practical value about efficiency of healthcare delivery; let's pretend for a moment that having an advantage in administrative services is necessary or sufficient to lend a given firm a comparative advantage.

What exactly are we talking about when we say Medicare spends (the money is spent, by the way, not "lost")? This means that 4% of the premiums collected by Medicare are spent on administration, with the remaining 96% spent elsewhere - specifically, mostly on covering medical bills. It is also true, then, that private insurance likewise spends its remaining 89% elsewhere - specifically, mostly on covering medical bills.

Does this corollary (Medicare spends 96% of its revenues paying medical bills, and private insurance spends only 89%) prove that private insurance has an efficiency advantage in paying medical bills relative to Medicare? I gather you'd reject that claim. And you'd be right to do so on the basis of this statistical sleight of hand - in fact, I've proven no such thing.

Medicare, by design, covers the elderly, and they are a much riskier portion of the population. Even if Medicare and private insurance companies spent an identical real dollar amount per patient on administrative costs, the relatively higher medical expenditures in Medicare would make administrative costs a smaller percentage of overall costs. When we actually look at the per patient administrative costs for Medicare versus private insurance, we find that they are not equal. In fact, Medicare spends far more per patient than the private sector, despite the fact that private firms must pay taxes, fees, marketing and regulatory costs that Medicare simply does not have.

On price elasticity see the famous RAND health insurance experiment. It is the largest study I know of, and concludes a price elasticity of about -0.2. Its not quite 0, but its pretty close : http://www.rand.org/health/projects/hie.html

A PPD of -0.2 is not at all close to the perfectly inelastic case of 0, which does not exist in real markets. In fact, there are an infinite number of real values between 0 and 0.2 on the number line.

In real terms, this figure tells us that the price elasticity of demand for healthcare is relative inelastic, but still elastic - a 1% rise in prices, ceters perebus, results in 0.2% less consumption. This is more than sufficient to create viable markets. For comparison, the market for eggs is relatively more inelastic than the market for healthcare, by a factor of 2. Consumers are twice as responsive to changes in the cost of healthcare than to changes in the cost of eggs!

This is a far cry from your original claims - that dieing people will spend anything on life saving treatments, and that therefore healthcare is not a marketable good. Shall we nationalize the egg market next?

On asymmetry of information, we seem to agree- correct me if I'm wrong?

I don't! I haven't seen any argument that the market for healthcare is more prone to moral hazard or adverse selection than any other technical or specialized marketplace. The existence of asymmetries in healthcare makes the sector neither special nor unworkable. Consumers and suppliers deal with information scarcity constantly; this fact alone is not sufficient to establish market failure. Rational market participants are understood to invest the resources necessary to inform their decisions before they make them. Where they cannot, they price in risk premiums. If they cannot, the transactions don't occur.

This is confirmed by most studies which attempt to measure the adverse impact of information asymmetries on real world markets; in practice it's virtually impossible to find and measure statistically. Do so on a systematic basis, and you'd probably win a Nobel prize. Good luck, though; I think you'll find market mechanisms are remarkably self-preserving.

Also, do we need to argue about whether patients in an emergency have choice?

Of course patients in emergency have choice. That patient may prefer immediacy of care, all things being equal, but this is not determinant. If the nearest hospital is closed, the consumer certainly won't choose it on the basis of distance. Likewise if the nearest hospital only accepts Visa and he carries Mastercard, or if it only treats cancer patients and he is having a heart attack. These points might seem absurd, but they serve to make the point. Indeed, critical patients are routinely routed to medical centers other than the closest for myriad reasons.

You seem to imagine that the healthcare market is some extreme, fantastic place full of zeros and infinites. In the real world, you simply don't find that, and if your theory suggests you ought to, there's probably something wrong with the theory.

ParticleGrl

Feb16-11, 11:14 AM

This is complete nonsense. Forget for a moment that relative administrative overhead costs tell us nothing of practical value about efficiency of healthcare delivery;

How do you define efficiency of healthcare delivery? I would argue that in the context we are discussing, the administrative costs are a good measure.

What exactly are we talking about when we say Medicare spends (the money is spent, by the way, not "lost")? This means that 4% of the premiums collected by Medicare are spent on administration, with the remaining 96% spent elsewhere - specifically, mostly on covering medical bills. It is also true, then, that private insurance likewise spends its remaining 89% elsewhere - specifically, mostly on covering medical bills.

For the case of medicare, the remaining money is spent mostly on medical bills, obviously. For private insurance, the rest of the money won't be spent on medical bills, some of it is profit. It is obviously unfair to count profit as inefficiency.

Medicare, by design, covers the elderly, and they are a much riskier portion of the population. Even if Medicare and private insurance companies spent an identical real dollar amount per patient on administrative costs, the relatively higher medical expenditures in Medicare would make administrative costs a smaller percentage of overall costs. When we actually look at the per patient administrative costs for Medicare versus private insurance, we find that they are not equal. In fact, Medicare spends far more per patient than the private sector, despite the fact that private firms must pay taxes, fees, marketing and regulatory costs that Medicare simply does not have.

Per patient administrative costs is obviously not a good metric. If I insure a pool of 22 year olds who makes no claims in an average year, my administrative cost can approach 0. The per CLAIM administrative cost would be a better number, but we can't get it from the CBO data above.

BUT, what we can do is directly compare medicare advantage plans (through private companies) to the similar pool of medicare. Now we have the same demographics, I hope you would agree? What do we find- between 3 and 4% administrative costs for medicare, and about 11% for the private medicare advantage plans. Comparing these similar demographics, we find private companies spend more in administration per patient of the same demographic.

A PPD of -0.2 is not at all close to the perfectly inelastic case of 0, which does not exist in real markets. In fact, there are an infinite number of real values between 0 and 0.2 on the number line.

Of course the perfectly inelastic case doesn't exist. Generally, anything between 0 and -1 is considered inelastic. I would say -0.2 is extremely inelastic.

Consumers are twice as responsive to changes in the cost of healthcare than to changes in the cost of eggs!

Yes, eggs are famously inelastic. Largely because they are among the cheapest proteins, so there are no close substitutes, to follow the econ 101 logic (although I don't know an actual study of their inelasticity, could you provide one?) . Of course, if the price of eggs jumped above the price of chicken or beef, elasticity would set in. With health care, what do you think can explain the inelasticity? Is there a price where health care becomes more elastic? Given that it is obviously a necessity, with no substitutes, might the relative elasticity be due to people who are priced out of the market all together?

This is a far cry from your original claims - that dieing people will spend anything on life saving treatments, and that therefore healthcare is not a marketable good. Shall we nationalize the egg market next?

First, the PPD I quoted is across all health care, not simply life saving care. I still contend that the demand for life saving care is very nearly perfectly inelastic. For life saving care, if you arrive at the hospital the hospital is obligated, both morally and legally, to treat you, regardless of price.

Rational market participants are understood to invest the resources necessary to inform their decisions before they make them. Where they cannot, they price in risk premiums. If they cannot, the transactions don't occur.

Yes, all rational participants in the health care market invest the resources to get the MD required to understand the best course of action, and successfully negotiate with their provider and insurance company.

Of course patients in emergency have choice. That patient may prefer immediacy of care, all things being equal, but this is not determinant. If the nearest hospital is closed, the consumer certainly won't choose it on the basis of distance. Likewise if the nearest hospital only accepts Visa and he carries Mastercard, or if it only treats cancer patients and he is having a heart attack. These points might seem absurd, but they serve to make the point. Indeed, critical patients are routinely routed to medical centers other than the closest for myriad reasons.

Right, but the routing is done by the ambulance, not the patient, on the basis of medical reasoning, not patient choice. If you call 911, you are going to where the ambulance takes you, whether or not they are in your provider network, or take whatever payment you have on you, etc. The choice is whether or not to call 911.

nismaratwork

Feb16-11, 11:29 AM

I would add... by definition some emergencies don't leave you in a position to make choices, or make them known. The economics... I am steering clear of, but the point about emergent care is also accurate. You can refuse treatment doctor to patient, but your going to have a hell of a lot of explaining to do if ALL of your doctors do it. There might be whispers of it being "policy", and that would be *sounds of axe falling*.

WhoWee

Feb16-11, 04:25 PM

Medicare loses about 4% in overhead, to insurance's 11%. Further, look at:

http://www.cms.gov/NationalHealthExpendData/downloads/tables.pdf

Medicare's cost per beneficiary has been rising about 9% per year since 1970. Private insurers have seen premium rise 10% per year. Also, these rapid growths underscore that we don't simply have out of control medicare growth. We have out of control health care expense.

It's not clear how much of "insurance's" overhead is due to Medicare/CMS and state regulations compliance - any idea?

Just in the context of Medicare (not group or individual or group Medicare or Medigap), in order for a company to offer a Medicare Advantage (usually 1 basic MA plan per state), a Part D prescription plan (most file 2 or 3 -plans per state), a Medicare Advantage plan with prescription coverage (typically HMO's, PPO's, PFFS's, and possible SNP's - typically 3 to 4 per state) - the insurance company must file a specific plan for each county in the state - some vary by zip code. As an example, Ohio has 88 counties. This process has to be repeated for each and every state in which the company intends to offer plans. The CMS must approve the plans each year - plans are then subject to state oversight. The insurance companies must also re-train and certify their entire sales force in every state - every year - for each product line. Again, this must be done in every state.

Next are the marketing restrictions - must be approved by CMS and each state. There are also records management and disclosure requirements. In order to talk to a Medicare beneficiary, an insurance agent needs to file a "scope of appointment" form. Basically, it's a document that states the beneficiary requested the meeting and has agreed to discuss specific plans - nothing else can be discussed. This document must be kept on file for 10 years. Next are telephonic records management - calls are recorded and kept on file for 10 years. The greatest challenge to complete documents in a timely manner - some 24 hour and 48 hour restrictions. There are MANY other regulations - many subject to FBI inspection under HIPPA and MIPPA. (Almost forgot the annual agency meetings with HIPPA/MIPPA attorneys - more certifications.)

nismaratwork

Feb16-11, 05:38 PM

WhoWee

Feb16-11, 05:49 PM

WhoWee... have you considered making something for the PF library, or a sticky based on this? You have a hell of a lot of facts on hand, and when we've taken all ideology out of the mix as you seem to naturally do with your business... it's very sound. I can't help but think you could write a guide to some of these entities that would inform future discussion.

There is a lot of information to consider - a quick CMS link - a few downloads:

https://www.cms.gov/ManagedCareMarketing/03_FinalPartCMarketingGuidelines.asp

"Downloads
2012 Revised Draft Medicare Marketing Guidelines Memo, 1/06/2011 [pdf, 62Kb]

2012 Draft Medicare Marketing Guidelines [zip, 1Mb]

2011 Medicare Marketing Guidelines Memo, 6/04/2010 [pdf, 223 Kb]

2011 Medicare Marketing Guidelines [pdf, 1.5Mb]

Allowable Use of Medicare Beneficiary Information Obtained from CMS & Prohibition on Using Federal Funds for Non-Plan Related Activities [zip, 73Kb]

Clarification of MMG and Appeals Related Error in Annual Notice of Change/Evidence of Coverage Templates [pdf, 76Kb]

Clarification of Medicare Marketing Guidelines Requirements and Outbound Enrollment Verification Policy [pdf, 81kb] "

WhoWee

Feb16-11, 06:01 PM

Sorry - here's a working link:

https://www.cms.gov/ManagedCareMarketing/Downloads/2011_MMG_060410.pdf

Skim from page 145 to 165 - just for fun.

ParticleGrl

Feb16-11, 06:05 PM

It's not clear how much of "insurance's" overhead is due to Medicare/CMS and state regulations compliance - any idea?

I have no idea how you could begin to pull it from the data in the report. I know the administrative cost data does not include the marketing costs, etc, but it certainly includes the cost of complying with regulations.

On the flip side, the cost of overseeing the regulations shows up in the medicare administrative costs.

Either way, since its once yearly, and more or less cost-fixed, I'd be willing to bet its a very small percentage of administrative costs on both sides.

nismaratwork

Feb16-11, 07:19 PM

There is a lot of information to consider - a quick CMS link - a few downloads:

https://www.cms.gov/ManagedCareMarketing/03_FinalPartCMarketingGuidelines.asp

"Downloads
2012 Revised Draft Medicare Marketing Guidelines Memo, 1/06/2011 [pdf, 62Kb]

2012 Draft Medicare Marketing Guidelines [zip, 1Mb]

2011 Medicare Marketing Guidelines Memo, 6/04/2010 [pdf, 223 Kb]

2011 Medicare Marketing Guidelines [pdf, 1.5Mb]

Allowable Use of Medicare Beneficiary Information Obtained from CMS & Prohibition on Using Federal Funds for Non-Plan Related Activities [zip, 73Kb]

Clarification of MMG and Appeals Related Error in Annual Notice of Change/Evidence of Coverage Templates [pdf, 76Kb]

Clarification of Medicare Marketing Guidelines Requirements and Outbound Enrollment Verification Policy [pdf, 81kb] "

Thank you very much! To say that I have reading to do would be a grotesque understatement, but you've given links to someone who will read this. I still think you could put something together that would be a valuable guide, but this is certainly a fantastic place to start.

mheslep

Feb16-11, 11:38 PM

On asymmetry of information, we seem to agree- correct me if I'm wrong?
If you standby your original claim on the subject no we do not agree. I granted asymmetric info exists, it creates challenges, and went on to provide some examples of how people routinely work around them. You stated information for patient-doctor is "completely" asymmetric , which I read as saying no work arounds are possible, especially if one goes on to conclude there "there is no market for healthcare." because of asymmetric information.

I'll get back to the rest of your reply time permitting.

mheslep

Feb17-11, 12:45 AM

Medicare loses about 4% in overhead, to insurance's 11%. Further, look at:

http://www.cms.gov/NationalHealthExpendData/downloads/tables.pdf
Some more research on the subject will show you otherwise. That CMS overheard figure was the first go-to figure cited during the US healthcare legislation debate and it was shown to be at least superficial, and possibly misleading:

1. The CMS table gives 6.6% as the overhead figure in 2009, though I'd also read 3-4% elsewhere. Where did you get 4%?

2. Medicare doesn't include the huge fraud costs in that figure, some $60 billion last year according to AG Holder and the WSJ. To prevent that, Medicare would have have to staff a lot more qualified medical personnel - just like the private insurers do.
Advocates of government-run health insurance like to point to Medicare's low administrative costs (which, as I noted yesterday, is a controversial claim). But even if that factual claim were true, the argument would hardly be dispositive as to the greater efficiency of a publicly run system. As I put it in my recent Times article, "True, Medicare’s administrative costs are low, but it is easy to keep those costs contained when a system merely writes checks without expending the resources to control wasteful medical spending."
...
By taking the fraud and abuse problem seriously this administration might be able to save 10% or even 20% from Medicare and Medicaid budgets. But to do that, one would have to spend 1% or maybe 2% (as opposed to the prevailing 0.1%) in order to check that the other 98% or 99% of the funds were well spent. But please realize what a massive departure that would be from the status quo. This would mean increasing the budgets for control operations by a factor of 10 or 20. Not by 10% or 20%, but by a factor of 10 or 20.
http://gregmankiw.blogspot.com/2009/07/costs-versus-efficiency.html
http://online.wsj.com/article/SB124649425934283347.html
http://www.usdoj.gov/opa/pr/2009/May/09-ag-491.html

3.Medicare serves a market, the elderly, that has a high medical cost per patient, and since overhead scales on a per-patient basis, overhead is lower for the elderly:
Medicare beneficiaries are by definition elderly, disabled, or patients with end-stage renal disease. Private insurance beneficiaries may include a small percentage of people in those categories, but they consist primarily of people are who under age 65 and not disabled. Naturally, Medicare beneficiaries need, on average, more health care services than those who are privately insured. Yet the bulk of administrative costs are incurred on a fixed program-level or a per-beneficiary basis. Expressing administrative costs as a percentage of total costs makes Medicare's administrative costs appear lower not because Medicare is necessarily more efficient but merely because its administrative costs are spread over a larger base of actual health care costs.
http://www.heritage.org/Research/Reports/2009/06/Medicare-Administrative-Costs-Are-Higher-Not-Lower-Than-for-Private-Insurance

This last one is not about overhead, but still goes to an evaluation of efficiency:
4. Medicare costs shifts onto the private system, paying only 85-95% of the going health care rate.
http://www.physicsforums.com/showpost.php?p=2344564&postcount=799

ParticleGrl

Feb17-11, 09:22 AM

1. The CMS table gives 6.6% as the overhead figure in 2009, though I'd also read 3-4% elsewhere. Where did you get 4%?

I got it from the CBO report linked above.

2. Medicare doesn't include the huge fraud costs in that figure, some $60 billion last year according to AG Holder and the WSJ. To prevent that, Medicare would have have to staff a lot more qualified medical personnel - just like the private insurers do.

To my knowledge, this keeps getting revised down, so its not quite 60 billion. Further, that fraud number includes privately administered plans like medicare advantage. Look at http://paymentaccuracy.gov/high-priority-programs

Consider that medicare advantage has an improper payment rate of about 14%, compared to traditional fee-for-service improper rates of about 10.5%. The privately administered plans are seeing more fraud, not less, despite higher overhead cost.

3.Medicare serves a market, the elderly, that has a high medical cost per patient, and since overhead scales on a per-patient basis, overhead is lower for the elderly:

I dealt with this above, by using the CBO numbers to compare Medicare Advantage (which are private) plans to traditional Medicare. The numbers are still the same.

Also, overhead doesn't scale on a per patient basis, as I discussed above. If you only insure a pool of 22 year olds who never file any claims, you can push your overhead costs down to 0. It scales on a per claim basis.

especially if one goes on to conclude there "there is no market for healthcare." because of asymmetric information.

I concluded that all of the points together- extreme inelasticity, lack of consumer choice, large asymmetry of information, add up to create a market that doesn't operate efficiently, and shouldn't be expected to.

WhoWee

Feb17-11, 09:29 AM

Further, consider that medicare advantage has an improper payment rate of about 14%, compared to traditional fee-for-service improper rates of about 10.5%. The privately administered plans are seeing more fraud, not less, despite higher overhead cost.

Let's take a look at how that 14% breaks down - specifically, what benefits are most likely to have a problem? Is any of it allocated to prescriptions? The "traditional fee-for-service" plan is Original Medicare - no prescription coverage included.

ParticleGrl

Feb17-11, 09:41 AM

Let's take a look at how that 14% breaks down - specifically, what benefits are most likely to have a problem? Is any of it allocated to prescriptions? The "traditional fee-for-service" plan is Original Medicare - no prescription coverage included.

Fraudulent and improper payments are extremely had to estimate. It is my (admittedly limited) understanding that accurate numbers for improper prescription payouts haven't been compiled, which is also why medicare D improper payment numbers don't exist.

If someone else has these numbers, chime in.

nismaratwork

Feb17-11, 09:48 AM

I'm just accepting that here, I can only read and learn... I'm so far out of my depth I can't see daylight.

WhoWee

Feb17-11, 10:00 AM

Fraudulent and improper payments are extremely had to estimate. It is my (admittedly limited) understanding that accurate numbers for improper prescription payouts haven't been compiled, which is also why medicare D improper payment numbers don't exist.

If someone else has these numbers, chime in.

Are you suggesting these are estimates - rather than hard data? (my bold)

"Consider that medicare advantage has an improper payment rate of about 14%, compared to traditional fee-for-service improper rates of about 10.5%. The privately administered plans are seeing more fraud, not less, despite higher overhead cost. "

Also, please note the private plans operate under significant regulatory and compliance cost as noted in earlier posts.

Does anyone know what CMS means when they categorize something "an improper payment"? (Hint - look up medical billing/coding) Also look up the MIPPA/HIPPA and ARRA funding references posted earlier.

WhoWee

Feb17-11, 10:03 AM

nismaratwork

Feb17-11, 10:39 AM

BTW - please also note MEDICARE ADVANTAGE plans pay INSTEAD of Medicare - excessive cost in a MAPD does not increase the cost to Medicare. Again, Medicare pays a FIXED amount to the private carriers each month for the MAPD's.

OK... how the hell are elderly and sick people supposed to figure out ANY of this? I'm catching up, but I'm healthy and interested and I still find it painful to read through. When you add these twists and turns, why the hell is Medic.* considered a liberal "gift" to anyone?! Bankrupting ourselves while turning healthcare into something we need CPAa to slog through ist nicht KOSHER!

ParticleGrl

Feb17-11, 10:56 AM

Are you suggesting these are estimates - rather than hard data? (my bold)

Please review the link above, for full information on methodology. The way to estimate fraud and improper payment rates is by careful auditing of a representative pool of beneficiaries, and extrapolation of those results to the whole.

Does anyone know what CMS means when they categorize something "an improper payment"?

It includes legitimate accounting mistakes and fraud, again see the link above. Its also worth noting that dropping the improper payment numbers to 0 won't recover the full amount. i.e. if a doctor erroneously receives $2000 instead of $1000, its an improper payment of $2000. However, only $1000 is recoverable.

please also note MEDICARE ADVANTAGE plans pay INSTEAD of Medicare - excessive cost in a MAPD does not increase the cost to Medicare.

The fixed payment from medicare for advantage plans is risk adjusted. Private companies get more money from medicare for sicker people- more cost on the private side will eventually lead to more cost on the public side.

WhoWee

Feb17-11, 10:56 AM

I'm going to throw some gasoline on this fire:

https://www.humana-medicare.com/Plans/compare/details.aspx

"Physician and Hospital Costs:

Explains details for Physician and Hospital Costs Primary Care Physician: Specialist: Hospitalization:

$0.00 Copay per visit $0.00 Copay per visit $0.00 per admission

Amounts apply after any applicable deductible.

--------------------------------------------------------------------------------

Outpatient Mental Health Care
General
Information for Outpatient Mental Health CareAuthorization rules may apply.
In-Network
Benefits for Outpatient Mental Health Care$0 copayment for each Medicare-covered individual or group therapy visit.
Outpatient Services/Surgery
General
Information for Outpatient Services/SurgeryAuthorization rules may apply.
In-Network
Benefits for Outpatient Services/Surgery$0 copayment for each Medicare-covered ambulatory surgical center visit.
$0 copayment for each Medicare-covered outpatient hospital facility visit.
Ambulance Services
General
Information for Ambulance ServicesAuthorization rules may apply.
In-Network
Benefits for Ambulance Services$0 copayment for Medicare-covered ambulance benefits.
Emergency Care
General
Information for Emergency Care$35 copayment for Medicare-covered emergency room visits.Worldwide coverage.If you are admitted to the hospital within 24-hour(s) for the same condition, you pay $0 for the emergency room visit
Outpatient Rehabilitation Services
General
Information for Outpatient Rehabilitation ServicesAuthorization rules may apply.
In-Network
Benefits for Outpatient Rehabilitation Services$0 copayment for Medicare-covered Occupational Therapy visits.
$0 copayment for Medicare-covered Physical and/or Speech and Language Therapy visits.
$0 copayment for Medicare-covered Cardiac Rehab services.
Durable Medical Equipment
General
Information for Durable Medical EquipmentAuthorization rules may apply.
In-Network
Benefits for Durable Medical Equipment$0 copayment for Medicare-covered items.
Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies
General
Information for Diabetes Self-Monitoring Training, Nutrition Therapy, and SuppliesAuthorization rules may apply.
In-Network
Benefits for Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies$0 copayment for Diabetes self-monitoring training.
$0 copayment for Nutrition Therapy for Diabetes.
$0 copayment for Diabetes supplies.
Colorectal Screening Exams
In-Network
Benefits for Colorectal Screening Exams$0 copayment for Medicare-covered colorectal screenings.
Immunizations
In-Network
Benefits for Immunizations$0 copayment for Flu and Pneumonia vaccines.
No referral needed for Flu and pneumonia vaccines.
$0 copayment for Hepatitis B vaccine.
Mammograms (Annual Screening)
In-Network
Benefits for Mammograms (Annual Screening)$0 copayment for Medicare-covered screening mammograms.
Inpatient Hospital Care
In-Network
Benefits for Inpatient Hospital CareNo limit to the number of days covered by the plan each benefit period.
$0 copaymentExcept in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.
Skilled Nursing Facility (SNF)
General
Information for Skilled Nursing Facility (SNF)Authorization rules may apply.
In-Network
Benefits for Skilled Nursing Facility (SNF)Plan covers up to 100 days each benefit period
No prior hospital stay is required.
$0 copayment for SNF services
Home Health Care
General
Information for Home Health CareAuthorization rules may apply.
In-Network
Benefits for Home Health Care$0 copayment for each Medicare-covered home health visit.
Chiropractic Services
In-Network
Benefits for Chiropractic Services$0 copayment for each Medicare-covered visit.Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers."

This Medicare Advantage Plan is for Medicare beneficiaries in Puerto Rico.
This is the link to the plans detailed Summary of Benefits - please review.

https://www.humana-medicare.com/BenefitSummary/2011PDFs/H4007012SBOSB11.pdf

nismaratwork

Feb17-11, 12:20 PM

WhoWee

Feb17-11, 12:36 PM

Chiropractic with HOME HEALTH!

Unless I'm missing details here, that list doesn't seem reasonable for the government to provide, and I do believe in the idea of the dreaded, "public option". I'm not for the public "magic" option though... holy <censored> mother of <worse> <incompressible swearing>. :grumpy:

What genius put that together... oh right... committees. "A cul-de-sac down which ideas are lured and then quietly strangled." (John A. Lincoln)

The benefits in Puerto Rico are quite generous, the Miami-Dade county plans and some of the Katrina-impacted areas in LA are also quite favorable.

My point is that Medicare pays a fixed premium to this carrier. The costs associated with use of the benefits are paid by the insurance company.

nismaratwork

Feb17-11, 12:38 PM

The benefits in Puerto Rico are quite generous, the Miami-Dade county plans and some of the Katrina-impacted areas in LA are also quite favorable.

My point is that Medicare pays a fixed premium to this carrier. The costs associated with use of the benefits are paid by the insurance company.

I see another problem there... Miama-Dade is "pill central"... coincidence?

Al68

Feb17-11, 12:57 PM

...When you add these twists and turns, why the hell is Medic.* considered a liberal "gift" to anyone?! Bankrupting ourselves while turning healthcare into something we need CPAa to slog through ist nicht KOSHER!I can answer that one. Making politically advantageous "entitlements," as well as the tax code, too complicated to understand allows power hungry politicians to deceive people about them, and any potential changes to them, in order to gain political power. Sounds cynical, I know.

Personally, I think congress should repeal the entire U.S. code, effective after a year, and adopt a policy that no law can pass that can't be read aloud during session. Then they can re-enact whatever portion of the U.S. code they think is important enough, or they can simplify enough, to read aloud, or allow exceptions only with a 3/4 vote in both houses.

And laws that cannot be reasonably understood by those they apply to should be prohibited with no exception. As many times as I've heard "ignorance of the law is no excuse", how is ignorance of the law optional, given the law? The laws are purposely designed to make ignorance of them mandatory, which effectively gives government unlimited power to prosecute people at will, despite the fact that there is no reasonable reason to expect them to know what is or isn't illegal in many cases.

nismaratwork

Feb17-11, 01:27 PM

I can answer that one. Making politically advantageous "entitlements," as well as the tax code, too complicated to understand allows power hungry politicians to deceive people about them, and any potential changes to them, in order to gain political power. Sounds cynical, I know.

No... that sounds just about right based on observation and human nature.

Personally, I think congress should repeal the entire U.S. code, effective after a year, and adopt a policy that no law can pass that can't be read aloud during session. Then they can re-enact whatever portion of the U.S. code they think is important enough, or they can simplify enough, to read aloud, or allow exceptions only with a 3/4 vote in both houses.

And laws that cannot be reasonably understood by those they apply to should be prohibited with no exception. As many times as I've heard "ignorance of the law is no excuse", how is ignorance of the law optional, given the law? The laws are purposely designed to make ignorance of them mandatory, which effectively gives government unlimited power to prosecute people at will, despite the fact that there is no reasonable reason to expect them to know what is or isn't illegal in many cases.

This is where I'm less effective... you seem to be adressing elements of the problem, but how to make it happen?

WhoWee

Feb17-11, 01:40 PM

The solution to the healthcare issue is simple. Use a proven method to solve the problem - here's one:

http://teacher.pas.rochester.edu/phy_labs/appendixe/appendixe.html

nismaratwork

Feb17-11, 01:55 PM

The solution to the healthcare issue is simple. Use a proven method to solve the problem - here's one:

http://teacher.pas.rochester.edu/phy_labs/appendixe/appendixe.html

Ah yes... and yet so hard to apply in politics. You try, and suddenly you're a "technocrat", or one of O'Reilly's "pinheads". How can the scientific method be implemented when the culture of at least one party is essentially anti-intellectual when they sell to the south/mid-west?

ParticleGrl

Feb17-11, 02:02 PM

Unless I'm missing details here, that list doesn't seem reasonable for the government to provide, and I do believe in the idea of the dreaded, "public option".

First, why not? The private company thinks it can turn a profit on the spread between what medicare will pay them and what services the beneficiary will actually use.

Second, and this is important- the same thing that is driving medicare costs up is ALSO driving up private costs. The data shown earlier actually demonstrates that private costs are going up FASTER than medicare costs. Its important to realize that we don't simply have a medicare problem, we have a HEALTH CARE problem.

And, we aren't alone, many countries are feeling the strain of rapidly escalating costs.

The solution to the healthcare issue is simple. Use a proven method to solve the problem - here's one:

http://teacher.pas.rochester.edu/phy_labs/appendixe/appendixe.html

I could not agree more. Luckily this is built right into the new law. The creation of large data sets on which to perform evidence based analyses will allow for the identification of effective treatments. The problem with medicare is the same as the problem with healthcare- the costs are growing too rapidly to be sustainable. Hopefully, scientifically identifying effective treatments will turn this around.

My point is that Medicare pays a fixed premium to this carrier. The costs associated with use of the benefits are paid by the insurance company.

Its worth noting, of course, that the private carrier is turning a profit with this type of plan. I also don't understand what your point is with this plan? Some medicare advantage plans pay out to much? Some private companies create lavish plans in order to extract more medicare dollars? Puerto Rico has a different risk analysis?

Al68

Feb17-11, 02:19 PM

How can the scientific method be implemented when the culture of at least one party is essentially anti-intellectual when they sell to the south/mid-west?Just the south/midwest? How about the whole nation? The messages of the Democratic Party are consistently and specifically tailored for constituents who are ignorant about the issues, in every state.

WhoWee

Feb17-11, 02:21 PM

Its worth noting, of course, that the private carrier is turning a profit with this type of plan. I also don't understand what your point is with this plan? Some medicare advantage plans pay out to much? Some private companies create lavish plans in order to extract more medicare dollars? Puerto Rico has a different risk analysis?

Every Medicare Advantage plan must address the same coverage issues as explained in the Summary of Benefits shown above. The plans must be submitted and approved by the CMS/Medicare. To claim the companies "create lavish plans in order to extract more medicare dollars" - please be more specific. How much more does Medicare pay for this very generous plan in Puerto Rico?

Again, the national average cost to Medicare for a Medicare Advantage (Part C) plan approximates $10,000 per year - this includes the plan shown.

A "lavish" plan that has a $0 deductible and $0 co-pay for a hospital stay and doctor visits is clearly going to cost the insurance carrier more money to service.

ParticleGrl

Feb17-11, 02:26 PM

To claim the companies "create lavish plans in order to extract more medicare dollars" - please be more specific. How much more does Medicare pay for this very generous plan in Puerto Rico?

No doubt, this plan gets more than the national average, as its riskier to the insurance company. But I didn't actually make the claim, I asked you- what is your point? This plan exists, what conclusions am I supposed to draw from it?

nismaratwork

Feb17-11, 02:43 PM

Just the south/midwest? How about the whole nation? The messages of the Democratic Party are consistently and specifically tailored for constituents who are ignorant about the issues, in every state.

Yes, but ignorance does have a regional componant.

WhoWee

Feb17-11, 02:50 PM

No doubt, this plan gets more than the national average, as its riskier to the insurance company. But I didn't actually make the claim, I asked you- what is your point? This plan exists, what conclusions am I supposed to draw from it?

I posted the plan to demonstrate the rich benefits - $0 deductible and lots of $0 co-pays. I don't believe the insurance companies are in favor of this plan structure - regardless of the contract amount.

Perhaps I should have posted a plan to compare it with - here's a $0 premium plan from the Cleveland, OH area - hospital is $220 per day for the first 8 days:

"Physician and Hospital Costs:

Explains details for Physician and Hospital Costs Primary Care Physician: Specialist: Hospitalization:

$10.00 Copay per visit $40.00 Copay per visit $220.00 per day, days 1-8

Amounts apply after any applicable deductible.

--------------------------------------------------------------------------------

Outpatient Mental Health Care
General
Information for Outpatient Mental Health CareAuthorization rules may apply.
In-Network
Benefits for Outpatient Mental Health Care$40 copayment for each Medicare-covered individual or group therapy visit.
Outpatient Services/Surgery
General
Information for Outpatient Services/SurgeryAuthorization rules may apply.
In-Network
Benefits for Outpatient Services/Surgery$150 copayment for each Medicare-covered ambulatory surgical center visit.
$50 to $200 copayment or 20% of the cost for each Medicare-covered outpatient hospital facility visit.
Ambulance Services
General
Information for Ambulance ServicesAuthorization rules may apply.
In-Network
Benefits for Ambulance Services$100 copayment for Medicare-covered ambulance benefits.
Emergency Care
General
Information for Emergency Care$50 copayment for Medicare-covered emergency room visits.Worldwide coverage.If you are admitted to the hospital within 24-hour(s) for the same condition, you pay $0 for the emergency room visit
Outpatient Rehabilitation Services
General
Information for Outpatient Rehabilitation ServicesAuthorization rules may apply.
In-Network
Benefits for Outpatient Rehabilitation Services$40 to $150 copayment for Medicare-covered Occupational Therapy visits.
$40 to $150 copayment for Medicare-covered Physical and/or Speech and Language Therapy visits.
$40 to $150 copayment for Medicare-covered Cardiac Rehab services.
Durable Medical Equipment
General
Information for Durable Medical EquipmentAuthorization rules may apply.
In-Network
Benefits for Durable Medical Equipment20% of the cost for Medicare-covered items.
Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies
General
Information for Diabetes Self-Monitoring Training, Nutrition Therapy, and SuppliesAuthorization rules may apply.
In-Network
Benefits for Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies$0 copayment for Diabetes self-monitoring training.
$0 copayment for Nutrition Therapy for Diabetes.
$0 to $10 copayment or 20% of the cost for Diabetes supplies.
Colorectal Screening Exams
In-Network
Benefits for Colorectal Screening Exams$0 copayment for Medicare-covered colorectal screenings.
Immunizations
In-Network
Benefits for Immunizations$0 copayment for Flu and Pneumonia vaccines.
No referral needed for Flu and pneumonia vaccines.
$0 copayment for Hepatitis B vaccine.
Mammograms (Annual Screening)
In-Network
Benefits for Mammograms (Annual Screening)$0 copayment for Medicare-covered screening mammograms.
Inpatient Hospital Care
In-Network
Benefits for Inpatient Hospital CareNo limit to the number of days covered by the plan each benefit period.
For Medicare-covered hospital stays:
Days 1 - 8: $220 copayment per day
Days 9 - 90: $0 copayment per day
$0 copayment for each additional hospital day.Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.
Skilled Nursing Facility (SNF)
General
Information for Skilled Nursing Facility (SNF)Authorization rules may apply.
In-Network
Benefits for Skilled Nursing Facility (SNF)Plan covers up to 100 days each benefit period
No prior hospital stay is required.For SNF stays:
Days 1 - 8: $0 copayment per day
Days 9 - 100: $50 copayment per day
Home Health Care
General
Information for Home Health CareAuthorization rules may apply.
In-Network
Benefits for Home Health Care$0 copayment for each Medicare-covered home health visit.
Chiropractic Services
General
Information for Chiropractic ServicesAuthorization rules may apply.
In-Network
Benefits for Chiropractic Services$10 copayment for each Medicare-covered visit.Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers."

Here is the Summary of Benefits link:

https://www.humana-medicare.com/BenefitSummary/2011PDFs/H8953002SBOSB11.pdf

The residents of Puerto Rico would clearly pay less for medical services than the people of the Cleveland, OH area - even though both would enjoy a $0 premium. Unfortunately, we don't know the contract amount for either plan.

ParticleGrl

Feb17-11, 04:19 PM

I posted the plan to demonstrate the rich benefits - $0 deductible and lots of $0 co-pays. I don't believe the insurance companies are in favor of this plan structure - regardless of the contract amount.

Then why do they offer it? If they couldn't make money with it, they wouldn't offer it.

nismaratwork

Feb17-11, 04:36 PM

Then why do they offer it? If they couldn't make money with it, they wouldn't offer it.

That... is a very good point.

WhoWee

Feb17-11, 04:37 PM

Then why do they offer it? If they couldn't make money with it, they wouldn't offer it.

It seems there are 25 total Medicare Advantage plans with prescription benefitss included, available in Puerto Rico.

http://www.medicare.gov/find-a-plan/results/planresults/plan-list.aspx

talk2glenn

Feb17-11, 09:15 PM

How do you define efficiency of healthcare delivery? I would argue that in the context we are discussing, the administrative costs are a good measure.

Even if I took that argument as given (which I don't, for obvious reasons administrative costs are a poor measure of efficiency of anything other than administration, including by definition efficiency of healthcare delivery), it is not true that administrative costs are lower in Medicare than in the private sector. Quite the opposite; they are substantially higher.

For the case of medicare, the remaining money is spent mostly on medical bills, obviously. For private insurance, the rest of the money won't be spent on medical bills, some of it is profit. It is obviously unfair to count profit as inefficiency.

This is silly. Forget for a moment than profit margins for private health insurance companies are tiny; what, pray tell, do you imagine profit is? It seems to me that the uneducated imagine "profit" to be some sort of wasteful, unnecesarry corporate overhead largesse thrown fruitlessly at fat cats, and that in its absence everybody could work much more efficiently.

Of course, in real life, profit is nothing more than payment for capital. Do even the tiniest bit of reasoning, and you'll realize that non-profits (charities and government offices) have capital costs that must be paid. Yes, they don't attract capital by investment; in the case of Medicare, it is borrowed or seized. In either case, there are costs. If seized by tax, we can look at the opportunity costs of the foregone alternatives. But the far more interesting case, in this context, is what happens when the government borrows.

In the private sector, we call debt servicing a capital cost, and build it into the health insurance industries administrative costs. Medicare does not internalize payments on government debt when accounting for its own costs, however. According to one source I found, if it did, administrative costs immediately rise 7 points to 10% of total cost:

First, Medicare's "capital costs" are not included in government estimates of Medicare spending. Here is a simplistic, but revealing example: federal net interest payments to the public -- the government's overall capital cost -- totaled $160 billion in fiscal year 2004. In that year, Medicare benefits (net of premiums collected from beneficiaries) comprised about 12 percent of federal non-interest spending. Therefore, Medicare's share of the government's debt-service costs could be estimated at about $19 billion in 2004. Adding these payments alone would boost Medicare's administrative cost rate by almost 7 percentage points, to just under 10 percent.

http://www.ahipresearch.org/pdfs/Administrative_Costs_030705.pdf

Note also that profits are usually internalized as well in studies of industry costs, such that the data usually reads "Administrative costs and profits".

Per patient administrative costs is obviously not a good metric. If I insure a pool of 22 year olds who makes no claims in an average year, my administrative cost can approach 0. The per CLAIM administrative cost would be a better number, but we can't get it from the CBO data above.

No, they can't, as explained above. A significant portion of overall administrative costs are consumed by activities other than paying claims.

BUT, what we can do is directly compare medicare advantage plans (through private companies) to the similar pool of medicare. Now we have the same demographics, I hope you would agree? What do we find- between 3 and 4% administrative costs for medicare, and about 11% for the private medicare advantage plans. Comparing these similar demographics, we find private companies spend more in administration per patient of the same demographic.

No, we don't. Normalize the comparison by excluding costs incurred only by the private sector, and incurring public sector capital costs, and you'll find the Medicare is significantly more expensive than private plans, assuming your initial numbers are accurate.

Of course the perfectly inelastic case doesn't exist. Generally, anything between 0 and -1 is considered inelastic. I would say -0.2 is extremely inelastic.

Er, no, it is not. It is considered relatively inelastic, as in, relative to everything greater than 1. Independently, you can't make any kind of value judgments - you can only say that it is elastic by definition.

Yes, eggs are famously inelastic. Largely because they are among the cheapest proteins, so there are no close substitutes, to follow the econ 101 logic (although I don't know an actual study of their inelasticity, could you provide one?) . Of course, if the price of eggs jumped above the price of chicken or beef, elasticity would set in. With health care, what do you think can explain the inelasticity? Is there a price where health care becomes more elastic? Given that it is obviously a necessity, with no substitutes, might the relative elasticity be due to people who are priced out of the market all together?

Eggs are a famous case, but there are innumerable goods and services with transaction point price elasticities between 0 and 0.2, approaching infinity. It is impossible and pointless to try and track them all; it varies by consumer, market, good, time, etcetera.

Eggs are famous only because they are useful to make a point - point price elasticity tells us very little about aggregate behavior over significant terms, does not imply that prices can or will rise to infinity, does not imply any kind of market failure or necesitate corrective action, and that there is no "magic number" at which we have acceptable and unacceptable price response behaviors.

Yes, all rational participants in the health care market invest the resources to get the MD required to understand the best course of action, and successfully negotiate with their provider and insurance company.

Is this serious, or satire? Is it really your claim that I need an advanced degree in architecture before I can choose a home? Real estate before I can buy it? Agriculture before I can shop for produce? Engineering before I can buy a car? Automotive mechanics before I can hire someone to repair it? Law before I can pick an attorney or make informed legal decisions?

Should I continue?

Right, but the routing is done by the ambulance, not the patient, on the basis of medical reasoning, not patient choice. If you call 911, you are going to where the ambulance takes you, whether or not they are in your provider network, or take whatever payment you have on you, etc. The choice is whether or not to call 911.

That's not the point; choices are made at some point by consumers to effectively maximize their utility. In a strategic game (defined as a game with more than one player - in this case, patients and ambulance drivers) it is elementary that the players' welfare can be increased by restricting their decisions. We call this the value of commitment.

In this case, patients choose to limit their choice of destination in an emergency ahead of time, and to let ambulance drivers know. This informs the decisions of ambulance drivers, and increases the payoff at the end of the game for everyone.

But this is all distraction: the point is, there exists strategic decision making, or "choices".

ParticleGrl

Feb17-11, 10:52 PM

it is not true that administrative costs are lower in Medicare than in the private sector. Quite the opposite; they are substantially higher.

Even if we include the cost of government borrowing, as you suggest below, medicare still comes out a lower percentage than the private companies.

Since you don't agree that administrative costs are a good measure of efficiency, propose another measure.

Normalize the comparison by excluding costs incurred only by the private sector, and incurring public sector capital costs, and you'll find the Medicare is significantly more expensive than private plans, assuming your initial numbers are accurate.

Prove it- link me to such a study. There is a tremendous amount of data in the CBO report linked above, which I used in generating my percentages. Even including the cost of borrowing, Medicare comes out comparable to, and slightly lower than, the private medicare advantage plans.

Also, subtracting out costs only incurred by the private sectors removes the reasons to believe that medicare is a more efficient deliverer of care- it doesn't have to pay for marketing, assessing risk, etc.

Eggs are famous only because they are useful to make a point - point price elasticity tells us very little about aggregate behavior over significant terms, does not imply that prices can or will rise to infinity, does not imply any kind of market failure or necesitate corrective action, and that there is no "magic number" at which we have acceptable and unacceptable price response behaviors.

Except medical costs, both public and private, are growing 7+% per year, and have been since the 70s. Demand still is not markedly dropping. The only limit to the demand for services seems to be people who get priced out all together, which seems morally problematic.

But this is all distraction: the point is, there exists strategic decision making, or "choices".

By who? At no point do the people calling the ambulance have any choice- they don't chose where they fall ill or have an emergency. Once they call the ambulance, they have no choice on where they go. There is no opportunity to comparison shop, etc.

Btw, these are not new ideas, Kenneth Arrow (no lightweight) pointed out that the standard assumptions underlying a competitive market are violated in the case of healthcare. Non-market institutions are needed to maximize efficiency.

WhoWee

Feb17-11, 11:20 PM

Has anyone considered the administrative costs charged to HHS, CMS, Medicaid, and Social Security in this discussion? The operations of all four are interlinked with Medicare along with the 50 state insurance agencies and Medicaid offices, plus DC, PR, Guam, etc.

Al68

Feb18-11, 08:06 AM

It seems to me that the uneducated imagine "profit" to be some sort of wasteful, unnecesarry corporate overhead largesse thrown fruitlessly at fat cats, and that in its absence everybody could work much more efficiently.People have been convinced of this by power hungry politicians, who themselves know that providing the same product for the same price without profit is impossible, which is why they haven't done it already.

I constantly notice that Democrats complain about profits, yet have no interest in trying to sell the same product, competing with for-profit businesses fairly, ie without the use of government force. Democrats know they can't actually offer consumers a better deal, it's just propaganda for the economically ignorant to gain power over them.

nismaratwork

Feb18-11, 08:14 AM

People have been convinced of this by power hungry politicians, who themselves know that providing the same product for the same price without profit is impossible, which is why they haven't done it already.

I constantly notice that Democrats complain about profits, yet have no interest in trying to sell the same product, competing with for-profit businesses fairly, ie without the use of government force. Democrats know they can't actually offer consumers a better deal, it's just propaganda for the economically ignorant to gain power over them.

Change that to: "Excessive Profits not placed into the future wellbeing of the corporation, or the country." They're allowed to fight for every dollar, and we're allowed to try and tax or otherwise squeeze it back out.

The results speak for themselves; neither approach is working, but one side is doing well, and the other is in debt.

ParticleGrl

Feb18-11, 09:10 AM

People have been convinced of this by power hungry politicians, who themselves know that providing the same product for the same price without profit is impossible, which is why they haven't done it already.

Maybe not in this country, but countries with larger public sectors of healthcare spend less on healthcare, AND have better outcomes. Many countries are getting a better product, at less cost, without profit.

http://www.photius.com/rankings/total_health_expenditure_as_pecent_of_gdp_2000_to_ 2005.html
http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate
http://www.businessweek.com/technology/content/sep2006/tc20060920_545838.htm

WhoWee

Feb18-11, 09:35 AM

Maybe not in this country, but countries with larger public sectors of healthcare spend less on healthcare, AND have better outcomes. Many countries are getting a better product, at less cost, without profit.

http://www.photius.com/rankings/total_health_expenditure_as_pecent_of_gdp_2000_to_ 2005.html
http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate
http://www.businessweek.com/technology/content/sep2006/tc20060920_545838.htm

Healthcare spending as a percentage of GDP - do you have a breakdown of that spending?

What percentage is allocated to the following; R&D, continuing education, certification, regulatory compliance including HIPPA/MIPPA, capital investment, elective procedures, publishing, marketing, plus all of the Government related expenses - about 50% (???) of the total?

Again - please prepare an apples to apples comparison of cost and results. Is the cost of CDC allocated evenly to all who benefit (for instance)? Also, how much of the university medical budgets are included? Without specificity - these numbers are trash.

ParticleGrl

Feb18-11, 10:26 AM

Healthcare spending as a percentage of GDP - do you have a breakdown of that spending?

The NIH and CDC budget together are a small drop in the bucket, maybe 40 billion out of the more than 2 trillion we spend on health care. This basically captures all the R&D and university medical research budgets.

Enrollment in medical schools is not considered part of the health care expense in these numbers, so continuing education and certification costs are likely trivial, but there isn't an obvious way to break them down.

As to subdividing the private costs, how do you propose to do this? If you have a point you want to make about these numbers- by all means do so.

WhoWee

Feb18-11, 10:36 AM

The NIH and CDC budget together are a small drop in the bucket, maybe 40 billion out of the more than 2 trillion we spend on health care. This basically captures all the R&D and university medical research budgets.

Enrollment in medical schools is not considered part of the health care expense in these numbers, so continuing education and certification costs are likely trivial, but there isn't an obvious way to break them down.

As to subdividing the private costs, how do you propose to do this? If you have a point you want to make about these numbers- by all means do so.

One quick question. Do you agree the US Government accounts for about $1.1 Trillion of the direct spending on healthcare?

ParticleGrl

Feb18-11, 11:00 AM

Yes, of course I do. The majority of the spending is medicare, followed by medicaid, and then health services for public employees. Of that, as we've discussed above, an average of 4% are administrative costs (which includes the government spending on complying with HIPPA, etc).

nismaratwork

Feb18-11, 11:29 AM

So... WhoWee... you answer her question now?

WhoWee

Feb18-11, 11:46 AM

So... WhoWee... you answer her question now?

Which one - not being trite.

WhoWee

Feb18-11, 12:10 PM

Since we used a few Humana MAPD's in earlier examples - let's continue to look at them.

http://www.dailyfinance.com/company/humana-inc/hum/nys/10-Q/101155326/html/sec-filings

"Humana Inc.

CONDENSED CONSOLIDATED STATEMENTS OF INCOME

(Unaudited)

Three months ended
September 30, Nine months ended
September 30,
2010 2009 2010 2009
(in thousands, except per share results)
Revenues:

Premiums
$ 8,134,645 $ 7,444,122 $ 24,673,259 $ 22,557,943
Administrative services fees
121,815 133,732 374,441 368,308
Investment income
87,250 74,861 252,495 219,745
Other revenue
80,938 64,104 217,768 181,373

Total revenues
8,424,648 7,716,819 25,517,963 23,327,369

Operating expenses:

Benefits
6,637,470 6,111,351 20,304,590 18,748,206
Selling, general and administrative
1,074,188 1,047,773 3,363,021 3,115,918
Depreciation and amortization
64,557 62,088 196,603 180,580

Total operating expenses
7,776,215 7,221,212 23,864,214 22,044,704

Income from operations
648,433 495,607 1,653,749 1,282,665
Interest expense
26,143 26,259 78,679 79,605

Income before income taxes
622,290 469,348 1,575,070 1,203,060
Provision for income taxes
229,069 167,829 583,005 414,044

Net income
$ 393,221 $ 301,519 $ 992,065 $ 789,016

Basic earnings per common share
$ 2.35 $ 1.80 $ 5.90 $ 4.72

Diluted earnings per common share
$ 2.32 $ 1.78 $ 5.84 $ 4.67 "

To update a bit - Humana was one of the companies that slashed sales expenses at the end of 2010 - independent agent commissions were cut by about 50% on non-Medicare health plans. The Medicare commission structure is much less (only 20% to 40% of regular rates).

ParticleGrl

Feb18-11, 01:03 PM

So there are some numbers- put them into perspective for me. What conclusions am I supposed to draw from your numbers?

WhoWee

Feb18-11, 01:46 PM

So there are some numbers- put them into perspective for me. What conclusions am I supposed to draw from your numbers?

It's not specific enough either - looking for additional info such as a breakdown by policy type or industry segment.

nismaratwork

Feb18-11, 05:32 PM

Which one - not being trite.

No problem: http://www.physicsforums.com/showpost.php?p=3144407&postcount=222

At the end. (I wouldn't think you'd be trite btw)

Al68

Feb18-11, 06:32 PM

Change that to: "Excessive Profits not placed into the future wellbeing of the corporation, or the country."You mean all those excess profits that nobody else wants? So much extra profit that there are no rich people greedy enough to compete for it? Profits so high that Democrats are unable to provide the same service for the same price without government force? My point was "put up or shut up". If Democrats really thought they could offer a better deal to consumers, they would do it (sans force) instead of bashing the companies they are unable to compete with, or trying to pass laws.They're allowed to fight for every dollar, and we're allowed to try and tax or otherwise squeeze it back out.We are? What claim do we have on the privately obtained wealth of others, obtained through completely voluntary private transactions? Other than billing them appropriately for services rendered (police, defense, fire protection, etc)?

This is one question nobody seems able to give a straight answer to. How is something that would be universally considered theft in the absence of a law authorizing it magically not theft because it was legalized? (I'm obviously not using the legal definition of theft here).

Is an action automatically not theft if government does it, despite the fact that the same exact action is universally considered theft if done by anyone else?

I can't help but be reminded of a Frederic Bastiat (http://quotes.liberty-tree.ca/quotes_by/frederic+bastiat) quote, in this same exact context: "When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."

It's difficult to improve of those words written by a dying Frenchman 160 years ago, that describe the U.S. Democratic Party to a T.

WhoWee

Feb18-11, 07:07 PM

I'm not so sure there are "excess profits" in this discussion -
$ 789,016 in profit on $23,327,369 in revenue or about 3.3% sounds reasonable?

nismaratwork

Feb18-11, 07:22 PM

You mean all those excess profits that nobody else wants? So much extra profit that there are no rich people greedy enough to compete for it? Profits so high that Democrats are unable to provide the same service for the same price without government force? My point was "put up or shut up". If Democrats really thought they could offer a better deal to consumers, they would do it (sans force) instead of bashing the companies they are unable to compete with, or trying to pass laws.We are? What claim do we have on the privately obtained wealth of others, obtained through completely voluntary private transactions? Other than billing them appropriately for services rendered (police, defense, fire protection, etc)?[quote]

Profits so high and concentrated in individuals that the it can be used to create lobbies and keep other from competing... or at least retard the process. Beyond that, there is no "right" to wealth, or poverty, or anything in between. It's all about what you can GET, for the people making profits, and those squeezign them for it.

The problem is the squeezing is largely ineffective. When there are hundreds of people with money in the bank that could bail out every state in the union, it's hard to take a kind view. When profits for the private sector explode, but that isn't re-invested into the this country, then we're just redistributing our wealth in the opposite of the 'dreaded' socialism. Then again, it seems that some are happier in an oligarchy than a democracy.

[quote=Al68]This is one question nobody seems able to give a straight answer to. How is something that would be universally considered theft in the absence of a law authorizing it magically not theft because it was legalized? (I'm obviously not using the legal definition of theft here).

Because we can; the same reason profits are made, and because the alternative to giving people the illusion that they are "digging" into the wealthy is revolt and crime. See piracy, and other black markets. Why can an entity like AIG be allowed to exist, and how can everyone involved in its destruction not be executed? (not under existing law of course). We live in a RARE country which dangles a dream that few can or will achieve. Why do you think the lottery is so popular, and why do you think it's so very preferable to have a nation with no future, but one that is easy to fleece?

If I were running a multinational now, I'd be thinking about how to best loot the USA in preparation for competing in Asia.

Is an action automatically not theft if government does it, despite the fact that the same exact action is universally considered theft if done by anyone else?

No, it's law, and to quote some 'great' right-wing "thinkers", "If you don't like it, git oooouuuuuttt." That goes for corporations too... pity they take jobs and wealth with them. Say, do you think that using Aruba as a grotesque tax shelter is theft, even though laws and regulations don't act properly?

I can't help but be reminded of a Frederic Bastiat (http://quotes.liberty-tree.ca/quotes_by/frederic+bastiat) quote, in this same exact context: "When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."

It's difficult to improve of those words written by a dying Frenchman 160 years ago, that describe the U.S. Democratic Party to a T.

It describes both parties, and above all what Eisenhower warned against... to quote him again...

A vital element in keeping the peace is our military establishment. Our arms must be mighty, ready for instant action, so that no potential aggressor may be tempted to risk his own destruction...
This conjunction of an immense military establishment and a large arms industry is new in the American experience. The total influence — economic, political, even spiritual — is felt in every city, every statehouse, every office of the federal government. We recognize the imperative need for this development. Yet we must not fail to comprehend its grave implications. Our toil, resources and livelihood are all involved; so is the very structure of our society. In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist. We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted. Only an alert and knowledgeable citizenry can compel the proper meshing of the huge industrial and military machinery of defense with our peaceful methods and goals so that security and liberty may prosper together.

I think he has it on the Frenchman.

nismaratwork

Feb18-11, 07:30 PM

I'm not so sure there are "excess profits" in this discussion -
$ 789,016 in profit on $23,327,369 in revenue or about 3.3% sounds reasonable?

I specifically am talking about a far more global set of executives and private interests, including the private sector of health care. I'm also talking about the inability to negotiate pharmaceutical prices with Canada under the rubric of "safety"... which makes me laugh in a truly bitter way.

At every turn on the peripheries, everything related to health care is outsized in its cost, beyond the reasonable (and very high) R&D, in part because of the federal government. As both parties are "ladies of ill repute" for these interests, the profound lack of care shown to individual states is clear.

Here's a better question: Why are we still pretending that there is such a thing as "trickle-down economics" at play here? These companies have only a temporary interest in the USA, and have demonstrated their complete lack of morality and trustworthiness in the past. WWII provides excellent examples of profiteering at any expense, just as history will probably find some nasty bits in the BILLIONS lost in Iraq and Afghanistan. When I say lost, I mean LITERALLY lost; unaccounted for... not just the swath of no-bid contracts which have failed in so many ways, or the adventure itself.

ParticleGrl

Feb18-11, 08:05 PM

If Democrats really thought they could offer a better deal to consumers, they would do it (sans force) instead of bashing the companies they are unable to compete with, or trying to pass laws.

You seem to have missed the numbers I posted above. Generally, other countries provide health care to a larger percentage of their population, with better outcomes for less cost. Many do it with a single-payer option (Canada). Some do it with highly regulated private insurance companies (the Netherlands). If it can be done in other countries, it can be done here.

What claim do we have on the privately obtained wealth of others, obtained through completely voluntary private transactions? Other than billing them appropriately for services rendered (police, defense, fire protection, etc)?

How do you plan to bill for defense? For fire? For police? Maybe instead of reading Ayn Rand you should read Rousseau's Social Contract. You are free to opt out of the American social contract and move anywhere else in the world.

Consider, companies in the US rely on American educated workers for staffing, American roads to ship their goods, etc. An educated populace helps everyone by spurring innovation, increasing productivity, hence growing GDP. Well maintained roads help everyone- would Walmart's business model be possible without a well maintained highway network?

How is something that would be universally considered theft in the absence of a law authorizing it magically not theft because it was legalized?

Consider your taxation a bill for all those services that you implicitly use on a daily basis.

Al68

Feb18-11, 08:16 PM

Profits so high and concentrated in individuals that the it can be used to create lobbies and keep other from competing..Except that neither you or anyone else has provided any reason whatsoever to believe anyone is prevented from competing, except for the barriers caused by government regulation.Beyond that, there is no "right" to wealth, or poverty, or anything in between. It's all about what you can GET, for the people making profits, and those squeezign them for it.That's not what it's about to honest people. Honest people don't take the property of others by force, they obtain everything they get through voluntary transactions. That's the difference between an honest transaction and theft.When profits for the private sector explode, but that isn't re-invested into the this country, then we're just redistributing our wealth in the opposite of the 'dreaded' socialism.What? Who's wealth? If you voluntarily give someone your dollar for a product, that dollar is now theirs, and you have no legitimate claim on it regardless of how much money they have or how little you have. They obtained it through a voluntary private transaction, making it theirs, not yours. Not "ours". Using force to "take back" money that you voluntarily traded for a product is theft. Neither buyers remorse nor wealth envy changes that.Then again, it seems that some are happier in an oligarchy than a democracy.Nope. A institutionalized theft-free society is not an oligarchy. An oligarchy is a country ruled by the wealthy, not a country that declines to steal from the wealthy. And no, failure to succeed in thievery does not constitute being "ruled" by the intended target.Because we can; the same reason profits are made..That makes no sense. It's not theft because "we can" engage in it? The difference between an honest transaction and theft is whether or not "we can" do it? That's not any definition of theft I ever heard. It describes both parties...Yes, it does. Democrats because it's their primary agenda, and Republicans for going along with it in the name of "compromise".

Al68

Feb18-11, 08:25 PM

You seem to have missed the numbers I posted above.Nope.Generally, other countries provide health care to a larger percentage of their population, with better outcomes for less cost. Many do it with a single-payer option (Canada). Some do it with highly regulated private insurance companies (the Netherlands). If it can be done in other countries, it can be done here.I never said that couldn't be done. You seem to have missed my point entirely.How do you plan to bill for defense? For fire? For police?Taxation. Property taxes, excise taxes, etc.Maybe instead of reading Ayn Rand you should read Rousseau's Social Contract. You are free to opt out of the American social contract and move anywhere else in the world.I'm not a party to the "social contract" envisioned by Democrats. And the actual legal charter for the U.S. government prohibits that agenda. And while Rousseau differed from other (far better) philosophers in many aspects, he agreed that government (and the law) is not itself the social contract. Passing a law doesn't create an additional social contract in that sense, regardless of the form of government. You can't just justify any law you want on the basis that if you advocate it, then it's part of the social contract. And in this case, the law you are advocating grossly and obviously violates the social contract recognized by honest societies for centuries, the social contract of classical liberalism, of centuries of American common law, and of the U.S. constitution. Private property ownership, and the right to voluntarily buy, sell, and trade private property is the social contract between honest citizens. You cannot refer to an agreement of some to use force to take from others that which was obtained honestly, with no basis other than the recipients "need it" from those that "can afford it", as a social contract.

And you can't justify government action on the basis that people can leave the country to avoid it. Hopefully that's obvious enough that I don't have to explain.Well maintained roads help everyone- would Walmart's business model be possible without a well maintained highway network?I made no objection to billing Walmart accordingly. Why is it that roads are so often used to try to justify taxation for things other than roads, when nobody is objecting to taxation for roads? That's the epitome of a red herring.

And it should be obvious that you can't logically justify B on the basis that A is justified and B uses the same means of collection (taxation) as A. Consider your taxation a bill for all those services that you implicitly use on a daily basis.In that case I only actually owe a small fraction of it. Think the IRS will buy that argument?

nismaratwork

Feb18-11, 08:26 PM

Except that neither you or anyone else has provided any reason whatsoever to believe anyone is prevented from competing, except for the barriers caused by government regulation.That's not what it's about to honest people. Honest people don't take the property of others by force, they obtain everything they get through voluntary transactions. That's the difference between an honest transaction and theft.What? Who's wealth? If you voluntarily give someone your dollar for a product, that dollar is now theirs, and you have no legitimate claim on it regardless of how much money they have or how little you have. They obtained it through a voluntary private transaction, making it theirs, not yours. Not "ours". Using force to "take back" money that you voluntarily traded for a product is theft. Neither buyers remorse nor wealth envy changes that.Nope. A institutionalized theft-free society is not an oligarchy. An oligarchy is a country ruled by the wealthy, not a country that declines to steal from the wealthy. And no, failure to succeed in thievery does not constitute being "ruled" by the intended target.That makes no sense. It's not theft because "we can" engage in it? The difference between an honest transaction and theft is whether or not "we can" do it? That's not any definition of theft I ever heard. Yes, it does. Democrats because it's their primary agenda, and Republicans for going along with it in the name of "compromise".

Al... we can't derail this thread so much to get into another ideological debate about who restricts what. If you think that the government runs Pharmaceutical companies, and not the other way around, I'm not sure how to proceed. Microsoft's history springs to mind however, as one very obvious example.

As for honest people, when you find one you let me know; it will probably be around the same time that Bernie Madoff pays back his victims, and the CEO of Goldman-Sachs is executed in a burning tub of tar (Guy Fawlkes reference).

As for force... Der Wille zur Macht. You know me... here's a list of what I DON'T believe in:

G-d
Complete honesty
The value of absolute trust
Ideology of any kind, and yes, that includes Nietzsche
Absolute morality
Intrinsic Rights
...ect.

You're making a moral argument in the realm of Realpolitik, and setting up any action you disagree with ideologically as "theft". I'm willing to play on those grounds... if you can keep it, great, if not, you lose. You're looking for reasons where only the realities of what must be done to survive, and what others are willing to do for the sake of profit.

As for "voluntarily" giving money... you just answered your own question about theft: you choose to live here, on the grid, in accordance with the law. It is a volunatary choice you make... far more so than someone facing death or a medical procedure.

Hi, I'm a moral relativist, but not a nihilist. Pleased to meet you. I believe in the need for artifical constructs so that society can thrive, but when you dig into it, you'll just find air. We do these things because it works, and because now it's self-sustaining.

Al68

Feb18-11, 09:53 PM

If you think that the government runs Pharmaceutical companies, and not the other way around, I'm not sure how to proceed.Huh? Neither is the case, but the former is partially true. It's easy prove that laws exist that restrict the actions of pharmaceutical companies. Can you provide evidence of a pharmaceutical company using force to restrict the actions of government? And failure of government to restrict a pharmaceutical company's action's in some certain way doesn't constitute "ruling" of the government by the pharmaceutical company. That's not what the word "rule" means.You know me... here's a list of what I DON'T believe in:....Ideology of any kind....That makes no sense given what the word ideology (http://en.wikipedia.org/wiki/Ideology) means.You're making a moral argument in the realm of Realpolitik, and setting up any action you disagree with ideologically as "theft".No, you misunderstand. I use the word theft to refer to using force to unjustifiably take private property, not to generically refer to "things I'm against".you choose to live here, on the grid, in accordance with the law. It is a volunatary choice you make..No, I choose to live here. I never joined any "grid". And you can't justify any law you want on the basis that people can leave their own country if they want. Using the word "voluntary" that way renders the word effectively meaningless.I believe in the need for artifical constructs so that society can thrive..Me too. I'm just against institutionalized theft. And you seem to have my rationale backward: I'm against certain things because I consider them to be theft, not the other way around.

ParticleGrl

Feb18-11, 10:47 PM

Can you provide evidence of a pharmaceutical company using force to restrict the actions of government?

Since force is a meaningless word in this context, I'll say yes. Medicare plan D, won with much lobbying effort (force), explicitly forbids the government from negotiating bulk rates for prescriptions. This is obviously a major boon to pharmaceutical companies, and is part of the reason the US pays more per pill than other nations.

I use the word theft to refer to using force to unjustifiably take private property, not to generically refer to "things I'm against".

In what way is taxation for roads, police and education fundamentally different than taxation for healthcare?

WhoWee

Feb19-11, 11:15 AM

Since force is a meaningless word in this context, I'll say yes. Medicare plan D, won with much lobbying effort (force), explicitly forbids the government from negotiating bulk rates for prescriptions. This is obviously a major boon to pharmaceutical companies, and is part of the reason the US pays more per pill than other nations.

In what way is taxation for roads, police and education fundamentally different than taxation for healthcare?
Part D is a valid issue of concern.
Accordingly, does the 2,000+ page "healthcare reform" legislation (that nobody had time to read) address this issue decisively and permanently - if so - how?

ParticleGrl

Feb19-11, 12:03 PM

Part D is a valid issue of concern.
Accordingly, does the 2,000+ page "healthcare reform" legislation (that nobody had time to read) address this issue decisively and permanently - if so - how?

Unfortunately, no. That is one of my largest complaints about the bill. Also, why is "healthcare reform" in quotes?

However, what the bill does accomplish is using scientific analysis to identify effective treatments. This WILL reduce cost.

Finally- you yourself advocated the use of the scientific method- so how do you feel about a shift to more evidence based medicine?

nismaratwork

Feb19-11, 12:03 PM

Huh? Neither is the case, but the former is partially true. It's easy prove that laws exist that restrict the actions of pharmaceutical companies. Can you provide evidence of a pharmaceutical company using force to restrict the actions of government? And failure of government to restrict a pharmaceutical company's action's in some certain way doesn't constitute "ruling" of the government by the pharmaceutical company. That's not what the word "rule" means.That makes no sense given what the word ideology (http://en.wikipedia.org/wiki/Ideology) means.No, you misunderstand. I use the word theft to refer to using force to unjustifiably take private property, not to generically refer to "things I'm against".No, I choose to live here. I never joined any "grid". And you can't justify any law you want on the basis that people can leave their own country if they want. Using the word "voluntary" that way renders the word effectively meaningless.Me too. I'm just against institutionalized theft. And you seem to have my rationale backward: I'm against certain things because I consider them to be theft, not the other way around.

I don't know how we can even agree on the terrain here... you believe in rights, I don't. You believe that the government is seperate from and not made OF the people, and I don't. Finally, you seem to think that pharmaceutical companies don't spank the USA on a regular basis, I'd just point you to Part D again.

We're fighting a war on illegal drugs, while legal ones are now overtaking as a cause of death. Doctors make money, but there's a cieling based on how many people they can see and MASSIVE DEA oversight. Illegal activity still benefits the pharmaceutical company... it's just a ledger at the end of the day, and here I'm speaking from experience in biotech from startups to multinational interests.

So, when I see pushes to treat the FDA like it works on magic and unicorn farts, who stands to GAIN from that? Not me, and not you...

WhoWee

Feb19-11, 12:28 PM

Unfortunately, no. That is one of my largest complaints about the bill. Also, why is "healthcare reform" in quotes?

However, what the bill does accomplish is using scientific analysis to identify effective treatments. This WILL reduce cost.

Finally- you yourself advocated the use of the scientific method- so how do you feel about a shift to more evidence based medicine?

I emphasized "healthcare reform" because it's a joke (IMO). I don't believe a single piece of legislation (that nobody read) can address all of the issues. I'm for scrapping the legislation completely and moving forward with a real analysis of the existing problems and focused solutions. If that means we need to spend five or six years working through problems and solutions in a series of smaller Bills and reforms - fine. We need leadership at the highest levels - not political games and rhetoric. When Nancy Pelosi said they needed to pass the legislation first - before the details would be known - I said "enough".

nismaratwork

Feb19-11, 12:34 PM

I emphasized "healthcare reform" because it's a joke (IMO). I don't believe a single piece of legislation (that nobody read) can address all of the issues. I'm for scrapping the legislation completely and moving forward with a real analysis of the existing problems and focused solutions. If that means we need to spend five or six years working through problems and solutions in a series of smaller Bills and reforms - fine. We need leadership at the highest levels - not political games and rhetoric. When Nancy Pelosi said they needed to pass the legislation first - before the details would be known - I said "enough".

I admit, this is the area we really do agree on. If it takes 2000 pages, FINE, but it seems insane to overhaul nearly half of our spending without READING it. I've been on both sides of this issue, but I can't think of a truly logical reason for the "don't read it" side. I can only conclude that it appeals to the element of my personality that wants reform NOW, and that screams, "political manipulation", or games as you say.

Al68

Feb19-11, 01:28 PM

Since force is a meaningless word in this context, I'll say yes. Medicare plan D, won with much lobbying effort (force), explicitly forbids the government from negotiating bulk rates for prescriptions.Lobbying isn't force. Force would be a meaningless concept if we accept that definition. I'm against that law, but it's a government action. You can't logically blame a lobby for its success because of a law passed by congress, who, unlike the lobby, is supposed to represent us.In what way is taxation for roads, police and education fundamentally different than taxation for healthcare?The means (taxation) is the same, which was my point. Using the same means for two different things does not equate those things.

Al68

Feb19-11, 01:32 PM

You believe that the government is seperate from and not made OF the people, and I don't.Nope. Government is separate from, and made of the people.Finally, you seem to think that pharmaceutical companies don't spank the USA on a regular basis, I'd just point you to Part D again.That's government spanking itself. Government passed that law. Government is the spanker.

ParticleGrl

Feb19-11, 02:47 PM

I emphasized "healthcare reform" because it's a joke (IMO). I don't believe a single piece of legislation (that nobody read) can address all of the issues.

I've read it. I'm sure at least a few others have. I don't think anyone argues that it covers all the issues, rather that it is a step in the right direction.

Further, why is it a joke? Your complaints are entirely general- specifically, what do you think this bill does wrong? "Its long" is not a reasonable complaint.

1. Is the focus on evidence based medicine a good idea? Will it reduce costs?
2. Should people with pre-existing treatments have some medical safety net? Should this safety net be a single-payer system, or a market system?

ParticleGrl

Feb19-11, 02:49 PM

Lobbying isn't force. Force would be a meaningless concept if we accept that definition.

I was using force in the same broad sense in which you are using it.

The means (taxation) is the same, which was my point. Using the same means for two different things does not equate those things.

What is fundamentally different about health care vs. roads? Or police services?

nismaratwork

Feb19-11, 02:51 PM

Nope. Government is separate from, and made of the people.That's government spanking itself. Government passed that law. Government is the spanker.

I disagree in principle with your first point, and the second is kowtowing to the pressure of lobbies. Lobbying isn't force, but it's effective, and it's inherently asymmetric for the average person.

Four score and seven years ago our fathers brought forth on this continent, a new nation, conceived in Liberty, and dedicated to the proposition that all men are created equal.

Now we are engaged in a great civil war, testing whether that nation, or any nation so conceived and so dedicated, can long endure. We are met on a great battle-field of that war. We have come to dedicate a portion of that field, as a final resting place for those who here gave their lives that that nation might live. It is altogether fitting and proper that we should do this.

But, in a larger sense, we can not dedicate -- we can not consecrate -- we can not hallow -- this ground. The brave men, living and dead, who struggled here, have consecrated it, far above our poor power to add or detract. The world will little note, nor long remember what we say here, but it can never forget what they did here. It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us -- that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion -- that we here highly resolve that these dead shall not have died in vain -- that this nation, under God, shall have a new birth of freedom -- and that government of the people, by the people, for the people, shall not perish from the earth.

Bolding mine.

mugaliens

Feb19-11, 05:54 PM

I disagree in principle with your first point, and the second is kowtowing to the pressure of lobbies. Lobbying isn't force, but it's effective, and it's inherently asymmetric for the average person.

Bolding mine.

I like your bolding. I hate lobbying. I loathe the fact that SCOTUS gave the same fiscal rights to influence our government to corporations as we citizens used to enjoy, and I'll bet our founding fathers all turned over in their graves, en masse, on that one.

I'm pushing for a bill which would mandate all corporations provide quarterly and annual statements of all monies it's given in support of any local, state, or federal political effort, and to which person, party, or platform it's given those funds.

That we, we PEOPLE would know which corporations to boycott.

ETA: Lincoln's publically given Gettysburg Address is far more substantive evidence that corporations should not be considered as persons than Thomas Jefferson's private letter to the Danbury Baptists supports Separation of Church and State. Why did SCOTUS base it's decision on the latter while excluding the former?

nismaratwork

Feb19-11, 06:07 PM

I like your bolding. I hate lobbying. I loathe the fact that SCOTUS gave the same fiscal rights to influence our government to corporations as we citizens used to enjoy, and I'll bet our founding fathers all turned over in their graves, en masse, on that one.

I'm pushing for a bill which would mandate all corporations provide quarterly and annual statements of all monies it's given in support of any local, state, or federal political effort, and to which person, party, or platform it's given those funds.

That we, we PEOPLE would know which corporations to boycott.

ETA: Lincoln's publically given Gettysburg Address is far more substantive evidence that corporations should not be considered as persons than Thomas Jefferson's private letter to the Danbury Baptists supports Separation of Church and State. Why did SCOTUS base it's decision on the latter while excluding the former?

I haven't the faintest... to me it's simply absurd, and appears to be a matter of party/ideology.

Al68

Feb19-11, 06:46 PM

I was using force in the same broad sense in which you are using it.If you think I was using it in that sense, you misunderstood my post. I was referring to real, physical force, such as that used by government to enforce laws.What is fundamentally different about health care vs. roads?I don't even know how to answer that without just stating the obvious. Public roads are built and maintained by government by billing those that use them via fuel tax and/or tolls. My health care is none of government's business whatsoever. But I must be misunderstanding your question, since the differences are obvious.

Al68

Feb19-11, 06:55 PM

I disagree in principle with your first point, and the second is kowtowing to the pressure of lobbies. Lobbying isn't force, but it's effective, and it's inherently asymmetric for the average person......government of the people, by the people, for the people...Bolding mine.I'm not sure why you disagree that government is separate from the people. That's the obvious assumption in the phrase "of the people, by the people, for the people". It would make no sense to make such a statement about the people: "The people are of the people" is illogical, and so is Lincoln's quote unless government is an entity separate from the people.

As far as lobbying, I never said it wasn't effective, or asymmetric. But congressmen, not lobbyists, are responsible to the people for their votes.

Gokul43201

Feb19-11, 07:10 PM

But congressmen, not lobbyists, are responsible to the people for their votes.In the modern era of electoral history, one could argue that Congresspersons are responsible to their lobbies to a significant extent (possibly even a greater extent than to which they feel responsible to their constituents), since money largely determines a campaign's ability to rally the electorate.

Al68

Feb19-11, 07:29 PM

In the modern era of electoral history, one could argue that Congresspersons are responsible to their lobbies to a significant extent....One could argue that a congressperson may "feel" responsible to lobbies, but they are not. They are responsible to the people via the constitution for their votes.

nismaratwork

Feb19-11, 07:33 PM

One could argue that a congressperson may "feel" responsible to lobbies, but they are not. They are responsible to the people via the constitution for their votes.

The legislative evidence supports Gokul's assertion AFAIK. In theory you're right, but we live in practice...

WhoWee

Feb19-11, 08:43 PM

I've read it. I'm sure at least a few others have. I don't think anyone argues that it covers all the issues, rather that it is a step in the right direction.

Further, why is it a joke? Your complaints are entirely general- specifically, what do you think this bill does wrong? "Its long" is not a reasonable complaint.

1. Is the focus on evidence based medicine a good idea? Will it reduce costs?
2. Should people with pre-existing treatments have some medical safety net? Should this safety net be a single-payer system, or a market system?

I have not read or heard a single argument against finding a way to cover pre-existing conditions - anywhere - have you?

ParticleGrl

Feb19-11, 08:48 PM

So then, again, what specific problems do you have with the law?

Al68

Feb19-11, 09:28 PM

The legislative evidence supports Gokul's assertion AFAIK. In theory you're right, but we live in practice...You seem to have misread my post, again. My point was that congressmen are responsible to the people instead of lobbyists. I made no assertion about who had more influence.

nismaratwork

Feb20-11, 09:09 AM

You seem to have misread my post, again. My point was that congressmen are responsible to the people instead of lobbyists. I made no assertion about who had more influence.

I'd argue that given the history of lobbying and legislation, while in principle you're right, in practice they are in fact responsible to their lobbies. It's not legal, but it is reality, and that's all I've ever been arguing about here.

WhoWee

Feb20-11, 10:09 AM

So then, again, what specific problems do you have with the law?

I've posted an estimated 200 times in the discussion of healthcare legislation reform on a variety of PF threads. With this noted, my primary concern is the legislation does not address the current problems - instead - it overlays a new set of regulations on top of a failing system.

Al68

Feb20-11, 01:51 PM

I'd argue that given the history of lobbying and legislation, while in principle you're right, in practice they are in fact responsible to their lobbies. It's not legal, but it is reality, and that's all I've ever been arguing about here.It seems you're using a non-standard definition of "responsible". I have to assume you do not believe they are responsible to lobbyists instead of the people using the standard definition.

nismaratwork

Feb20-11, 02:18 PM

It seems you're using a non-standard definition of "responsible". I have to assume you do not believe they are responsible to lobbyists instead of the people using the standard definition.

Correct, I'm talking about their practical interests and actions, not their legal and (if you believe in it) moral responsibilities to those who elected them. Of course, you could argue that the largest participents in elections are not people voting, but external factors such as money, which case their constinuancy truly isn't the people.

ParticleGrl

Feb20-11, 02:25 PM

I've posted an estimated 200 times in the discussion of healthcare legislation reform on a variety of PF threads. With this noted, my primary concern is the legislation does not address the current problems - instead - it overlays a new set of regulations on top of a failing system.

Believe it or not, I've read every word of this thread. I don't have the time or inclination to revisit every thread on healthcare legislation.

Be specific- what current problems aren't being addressed by the law? I think most would agree that the single greatest current problem is the runaway growth in cost, which is largely at the hospital/treatment end of things. Using scientific methods to identify effective treatment is, in my mind, the best long term way to reduce cost. This is a big part of the law. Do you feel this isn't an effective way to address cost? What is it about this area of the law that you dislike?

The other major problem, most would agree, is the high percentage of uninsured. Luckily, much of the legislation is involved in expanding the number of insured by making it easier to get individual insurance. Of course, this only will work if the individual mandate to purchase is upheld by the courts. We will have to see. Do you feel this doesn't effectively address the problem? Is it too market driven? Would you prefer a sweeping expansion of medicade or medicare to cover these people?

Are there other problems you feel aren't being addressed by the law? What are they?

Al68

Feb20-11, 02:26 PM

Correct, I'm talking about their practical interests and actions, not their legal and (if you believe in it) moral responsibilities to those who elected them. Like I said, non-standard definition. The word "responsible" means the latter, not the former. It's an adjective, not a verb, and doesn't refer to any actions or interests of its subject.

The only way "responsible" is effectively a verb is as an adverb with a modifier, such as "acting responsibly" or "accepting responsibility", neither of which was used.

Man, I hate arguing semantics.

nismaratwork

Feb20-11, 02:49 PM

Like I said, non-standard definition. The word "responsible" means the latter, not the former. It's an adjective, not a verb, and doesn't refer to any actions or interests of its subject.

The only way "responsible" is effectively a verb is as an adverb with a modifier, such as "acting responsibly" or "accepting responsibility", neither of which was used.

Man, I hate arguing semantics.

I made it pretty clear in this thread and elsewhere what my beliefs are... I'm not sure why you're surprised. I don't think it is semantics, I think it's a profoundly different view of the world.

WhoWee

Feb20-11, 02:59 PM

Believe it or not, I've read every word of this thread. I don't have the time or inclination to revisit every thread on healthcare legislation.

Be specific- what current problems aren't being addressed by the law? I think most would agree that the single greatest current problem is the runaway growth in cost, which is largely at the hospital/treatment end of things. Using scientific methods to identify effective treatment is, in my mind, the best long term way to reduce cost. This is a big part of the law. Do you feel this isn't an effective way to address cost? What is it about this area of the law that you dislike?

The other major problem, most would agree, is the high percentage of uninsured. Luckily, much of the legislation is involved in expanding the number of insured by making it easier to get individual insurance. Of course, this only will work if the individual mandate to purchase is upheld by the courts. We will have to see. Do you feel this doesn't effectively address the problem? Is it too market driven? Would you prefer a sweeping expansion of medicade or medicare to cover these people?

Are there other problems you feel aren't being addressed by the law? What are they?

The individual mandate - enforced by the IRS - is a concern.

ParticleGrl

Feb20-11, 03:33 PM

The individual mandate - enforced by the IRS - is a concern.

Why? be specific. Should people with pre-existing conditions be coverable by insurance? How is that possible without an individual mandate? How else would a mandate be enforced?

Is an individual mandate preferable to a sweeping overhall of medicare/medicaid? Either the public or private sectors have to pick these people up. What is the alternative?

nismaratwork

Feb20-11, 03:34 PM

The individual mandate - enforced by the IRS - is a concern.

Not being trite, but how is it different from mandating car insurance? If this is a state's rights issue, there are ways to make this less than a mandate, and use funding as a cudgel instead. Nasty, but legal and common (drinking age for example).

WhoWee

Feb20-11, 06:47 PM

Not being trite, but how is it different from mandating car insurance? If this is a state's rights issue, there are ways to make this less than a mandate, and use funding as a cudgel instead. Nasty, but legal and common (drinking age for example).

There are two points. First, you are not required to have a car or a drivers license. Second, you are required to purchase the insurance to protect other people and their property - not yours.

WhoWee

Feb20-11, 06:58 PM

Why? be specific. Should people with pre-existing conditions be coverable by insurance? How is that possible without an individual mandate? How else would a mandate be enforced?

Is an individual mandate preferable to a sweeping overhall of medicare/medicaid? Either the public or private sectors have to pick these people up. What is the alternative?

There are 4 reasons people don't purchase individual health insurance currently:
1.) don't want it
2.) don't need it
3.) can't afford it
4.) can't have it - pre-existing

Next, other than the mandate, this legislation does not address all of the "gaps" in coverage. The most significant problem is long term care. Medicare does not cover nursing homes. Nursing home care is expensive, it consumes assets (houses) and places a major burden on Medicaid.

nismaratwork

Feb20-11, 07:25 PM

There are two points. First, you are not required to have a car or a drivers license.

...and just like that, I feel like an idiot. You have a free "duh" to use on me anytime you wish. :redface:

Second, you are required to purchase the insurance to protect other people and their property - not yours.

Hmmm... all of that being true... is it still not possible to use federal funds as a goad to induce states to "volunteer"? Again, much like the drinking age and higheway funds. I'm not arguing the morality of it, just the legality.. would that have potential?

ParticleGrl

Feb20-11, 08:26 PM

There are 4 reasons people don't purchase individual health insurance currently:
1.) don't want it
2.) don't need it
3.) can't afford it
4.) can't have it - pre-existing

Next, other than the mandate, this legislation does not address all of the "gaps" in coverage.

I've never in my life met a "don't want it", and further "don't need it" is naive and irrational. An accident can wrack up millions of dollars of medical fees. I think we can agree that these two groups are at most a trivial percentage of the uninsured.

Three and four are certainly the largest group of uninsured. The bill certainly covers 4, you agree? Now, how well it covers 3 is a matter of debate- but certainly the hope is that as more people are required to enroll, everyone's premium will go down.

The most significant problem is long term care.

The CLASS section of the health care bill does address long term care. Do you have a problem with the voluntary long-term-care insurance type solution?

I'm still not hearing actual, specific complaints from you. You have a vague issue with the individual mandate but you haven't outlined why. Even in this post- you say that the insurance doesn't address gaps in coverage, without outlining why you think that.

WhoWee

Feb20-11, 09:07 PM

I've never in my life met a "don't want it", and further "don't need it" is naive and irrational. An accident can wrack up millions of dollars of medical fees. I think we can agree that these two groups are at most a trivial percentage of the uninsured.

Three and four are certainly the largest group of uninsured. The bill certainly covers 4, you agree? Now, how well it covers 3 is a matter of debate- but certainly the hope is that as more people are required to enroll, everyone's premium will go down.

The CLASS section of the health care bill does address long term care. Do you have a problem with the voluntary long-term-care insurance type solution?

I'm still not hearing actual, specific complaints from you. You have a vague issue with the individual mandate but you haven't outlined why. Even in this post- you say that the insurance doesn't address gaps in coverage, without outlining why you think that.

The don't want it types might have an accident plan. The group would include world travelers and people who live in very remote areas. Wealthy people might also fit into this group or might opt for a high deductible - maybe $25,000 or more?

Wealthy people might also fit into the don't need it group along with military personell, employer and small groups, association groups, retiree groups, etc. These are some of the people who might be forced into individual policies if the mandate survives the courts.

As a business owner, I can asssure you companies will compare the cost of the penalty to the increased costs of the policies due to the new coverage mandates.

Al68

Feb20-11, 09:30 PM

I made it pretty clear in this thread and elsewhere what my beliefs are... I'm not sure why you're surprised. I don't think it is semantics, I think it's a profoundly different view of the world.In this case, it's both. We have a profoundly different view of the world, and you interpreted my post very different from its intended meaning.

But this seems to be very common. As I pointed out in another thread, it's somewhat similar to a language barrier, where the errors in translation are unrecognized, leading to the result that what is heard is very different from what is said.

Regardless, I was not using the word "responsible" to refer to any action, interest, or belief of congressmen.

nismaratwork

Feb20-11, 09:32 PM

In this case, it's both. We have a profoundly different view of the world, and you interpreted my post very different from its intended meaning.

But this seems to be very common. As I pointed out in another thread, it's somewhat similar to a language barrier, where the errors in translation are unrecognized, leading to the result that what is heard is very different from what is said.

Regardless, I was not using the word "responsible" to refer to any action, interest, or belief of congressmen.

Well, the important thing is that we manage to stick with these things until clarity is achieved, and in the future we don't need to retread this.

Al68

Feb20-11, 09:44 PM

I've never in my life met a "don't want it", and further "don't need it" is naive and irrational.While very few people would not want or need any medical insurance, you can put me, and many people I know, into the "don't want it and don't need it" category for the type of health plan required by Obamacare to avoid the penalty.

It's just plain wrong to refer to an unwillingness to buy an "Obamacare approved health care plan" as if it were equivalent to an unwillingness to buy medical insurance in general.

Especially when the new law prohibits every kind of medical insurance I have ever had any interest in buying. They can't outlaw something then blame me for not having it, when their "substitute plan" is very different, and very much more expensive.

And yes, if I have an accident without insurance it is the fault of Obamacare for outlawing the type of medical insurance that I do want and need: the cheap kind that covers major unexpected medical bills only.

ParticleGrl

Feb20-11, 11:56 PM

The don't want it types might have an accident plan. The group would include world travelers and people who live in very remote areas. Wealthy people might also fit into this group or might opt for a high deductible - maybe $25,000 or more?

Wealthy people might also fit into the don't need it group along with military personell, employer and small groups, association groups, retiree groups, etc. These are some of the people who might be forced into individual policies if the mandate survives the courts.

Travelers aren't subject to the mandate anyway. Also, its worth noting, the vast majority of people are covered by plans through their employers, and won't fall under the individual mandate. Niether will military personel, who are still covered, etc.

So far- the only specific complaint you have against the health care legislation is that wealthy people with high deductible plans might have to spend slightly more to purchase lower deductible plans, depending on the specifics of their current plan.

Also, I'd be surprised if the mandate didn't survive the courts. There is precedent-the US has already had a federal health insurance mandate in the past- some of the framers of the constitution enacted it: http://blogs.forbes.com/rickungar/2011/01/17/congress-passes-socialized-medicine-and-mandates-health-insurance-in-1798/

WhoWee

Feb21-11, 05:53 AM

Travelers aren't subject to the mandate anyway. Also, its worth noting, the vast majority of people are covered by plans through their employers, and won't fall under the individual mandate. Niether will military personel, who are still covered, etc.

So far- the only specific complaint you have against the health care legislation is that wealthy people with high deductible plans might have to spend slightly more to purchase lower deductible plans, depending on the specifics of their current plan.

Also, I'd be surprised if the mandate didn't survive the courts. There is precedent-the US has already had a federal health insurance mandate in the past- some of the framers of the constitution enacted it: http://blogs.forbes.com/rickungar/2011/01/17/congress-passes-socialized-medicine-and-mandates-health-insurance-in-1798/

Please explain why a corporation will choose to pay a premium that costs more than a penalty? Also, have you noticed that hundreds of companies have requested special treatment already?
By the way please support your assertion that travelers aren't subject to the mandate anyway - please clarify. As for "wealthy" people who want a high deductible plan - this is what is known as "insurance" - protection against a catastrophic loss. To eliminate the truest form of the product from the table is incorrect. Further, pre-Obama, the fastest growing type of plan was the health savings account (there are several varieties). Basically a combination tax, insurance, and savings product that lowered premiums, expanded care (mostly PPO), increased the savings rate and allowed the funds to roll over. This plan helped people save and kept money in local banks. An average person might start with a $5,000 deductible and build to a $15,000 or $25,000 deductible if healthy. Whatever the strategy, adults should be free to have choices.

Vanadium 50

Feb21-11, 06:26 AM

and further "don't need it" is naive and irrational.

You have touched on a key question of political philosophy, one that has been debated for at least two thousand years: "In a free society, are people allowed to make decisions that the government feels are irrational or unwise? If so, what responsibility does this government have to protect these people from the consequences of these actions?"

Note that people make irrational decisions all the time: "I'd like to date this person and not that person". "I'd like to be a baker, even though there is more money in being a plumber." "I'd rather have the flashy sports car than the sensible minivan". And even "I'll take the green one."

WhoWee

Feb21-11, 06:46 AM

The CLASS section of the health care bill does address long term care. Do you have a problem with the voluntary long-term-care insurance type solution?

I want to address this separately. You've waded into the deep water of healthcare and to say it's "addressed" is comparable to stating that space travel is "addressed" - accurate - but not "correct".
-------
First a little background:
http://assets.aarp.org/external_sites/caregiving/options/nursing_home_costs.html

"What it Costs
Brace yourself. Most people already know nursing home care can be expensive. Although the average cost is more than $50,000 a year and climbing, it can vary widely depending on where you live. Employee health insurance does not pay for nursing home care. About a third of nursing home residents pay all of their nursing home costs from their own funds. Extended nursing home care can eat up your or your loved one's savings quickly—many people exhaust their finances after just six months. A fraction of them—about 5 percent—buys long-term care insurance, which covers the cost of a nursing home or other extended care. Medicare, the federal health insurance program for older persons and some younger ones with disabilities, pays for short-term nursing home stays."
-----
Please note - the average for newer and more modern facilities is approaching $70,000 per year.

Now stats (albeit dated) a must read:
http://www.efmoody.com/longterm/nursingstatistics.html
"Consumer Reports recommends that if you can set aside about $160,000 (or enough to cover four years of care), you may not need long-term care insurance. Frankly, I don't think that is much different than stating that if you got $250,000 (or whatever), you don't need to buy fire insurance for your house. Or if you got $1,000,000, don't bother with liability insurance.

Insurance is a dirty word with many people but it simply is a way of playing the odds and spreading them over a very large group. You do NOT want to commit large sums. You want to commit small sums where you may never get a return of premiums because the problems (loss, sickness, accident, etc) never befall you. And another gem from Consumer's Union. "If you buy a policy early, you may want to make sure that it contains a non-forfeiture clause. Under most policies, if you let your coverage lapse, you get nothing for all the premiums you've paid in the past." True, but it may cost you 15%+ more. And I'll state the obvious once again. You don't get anything back if your house does not burn down. I have not had an auto accident in over 30 years. I ain't getting any of my premiums back. That's O.K.- I didn't want an accident in the first place. Consumer Reports seems to have forgotten what insurance is and how it is supposed to work- long term care or otherwise

NURSING HOME COSTS: (1998) The cost of nursing home care rose an average of 9.7% a year between 1985 and 1994. Average length of long term care nationally is about 2 years.

NURSING HOME COSTS: 2000 (Pete Peterson) Per capita nursing home spending on the frail elderly aged eighty-five and over is OVER TWENTY TIMES HIGHER than spending on the young elderly, aged sixty-five to sixty-nine. Second, the number of these frail elderly is expected to triple or quadruple as America ages. We have no choice but to close loopholes that allow seniors to qualify for Medicaid through subterfuge--for instance, by transferring assets to their children.

NURSING HOME PATIENTS: (2000) About 2/3rd's of people in nursing homes have no living relatives. And about 70% of all nursing home patients are women."
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Please note the hourly wage component when this was written stated "Nurses aids average wage is $6.65 per hour".
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Next, is the program CLASS - community living assistance services and support.
You said "The CLASS section of the health care bill does address long term care. Do you have a problem with the voluntary long-term-care insurance type solution?

I'm still not hearing actual, specific complaints from you. You have a vague issue with the individual mandate but you haven't outlined why. Even in this post- you say that the insurance doesn't address gaps in coverage, without outlining why you think that. "
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http://newoldage.blogs.nytimes.com/2010/03/24/a-new-long-term-care-insurance-program/
"The Class Act, a legacy of Senator Edward M. Kennedy, the Massachusetts Democrat whose widow and son were present to see the president sign it into law, sets up a voluntary government-run long-term care insurance program available through employers. Those who participate will pay monthly premiums. After five years, they’ll be covered and can receive benefits if they need care — whether they are 20-somethings in snowboard accidents or 80-somethings with Parkinson’s disease.

The program is not designed to pay the entire cost of long-term care, which can reach horrifying levels, but it will provide substantial help. And because participants will receive cash — $50 a day or more, depending on how disabled they are — they can buy the kind of assistance that makes sense to them. One person may choose to retrofit his home so he can remain there; another may hire a home care aide or a family member who wants to help but can’t afford to forgo income. People can use their Class benefits for assistive devices, adult day programs, assisted living or nursing homes."
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When I said there were "gaps" and cited Long Term Care - this program was taken into consideration. Some states have premium matching programs for LTC insurance, etc.

I'm involved with these issues on a daily basis. While CLASS and other programs "address" some issues - there are still plenty of "gaps" to fill.

nismaratwork

Feb21-11, 07:58 AM

You have touched on a key question of political philosophy, one that has been debated for at least two thousand years: "In a free society, are people allowed to make decisions that the government feels are irrational or unwise? If so, what responsibility does this government have to protect these people from the consequences of these actions?"

Note that people make irrational decisions all the time: "I'd like to date this person and not that person". "I'd like to be a baker, even though there is more money in being a plumber." "I'd rather have the flashy sports car than the sensible minivan". And even "I'll take the green one."

This is where her call for scientific examination of these issues makes so much sense, "evidence-based medicine", to quote. The idea is to render the opinions of individuals AND the government moot in the face of evidence... in practice...

*lights a Gauloises... absurdly deep inhale* "Ahhh... Life..."

WhoWee

Feb21-11, 08:07 AM

This is where her call for scientific examination of these issues makes so much sense, "evidence-based medicine", to quote. The idea is to render the opinions of individuals AND the government moot in the face of evidence... in practice...

*lights a Gauloises... absurdly deep inhale* "Ahhh... Life..."

Can we agree medicine and insurance make strange bedfellows?

IMO - the doctors should have more input. We especially need to listen to them when they complain of the high cost of malpractice claims/insurance and the need to practice defensive medicine - none of this is a productive use of resources. Unfortunately, the Government does not make "efficiency" a priority - does it?

nismaratwork

Feb21-11, 08:13 AM

Can we agree medicine and insurance make strange bedfellows?

IMO - the doctors should have more input. We especially need to listen to them when they complain of the high cost of malpractice claims/insurance and the need to practice defensive medicine - none of this is a productive use of resources. Unfortunately, the Government does not make "efficiency" a priority - does it?

Yes we can, and yes we do, and I even agree with your last point.

Over time any sufficiently large body becomes bogged down in its own bureaucracy, but a government's is by definition, not subject to any authority except its own, or a massive mandate from voters that is sustained.

Al68

Feb21-11, 08:40 AM

This is where her call for scientific examination of these issues makes so much sense, "evidence-based medicine", to quote. The idea is to render the opinions of individuals AND the government moot in the face of evidence... in practice...Vanadium 50 was referring to the private decisions, not opinions, of individuals. The point was that individuals in a free society are free to make bad decisions. And especially decisions that are considered bad by government.

nismaratwork

Feb21-11, 08:45 AM

Vanadium 50 was referring to the private decisions, not opinions, of individuals. The point was that individuals in a free society are free to make bad decisions. And especially decisions that are considered bad by government.

We don't live in a society that free.

Al68

Feb21-11, 11:01 AM

We don't live in a society that free.I agree 100%. But this thread, and politics in general, is about what government should or shouldn't do, not simply to state what it currently does and doesn't do.

And even if laws were completely "evidence-based", free from politics, that might make my opinion moot, but it won't make my private decisions moot. And it wouldn't make it moot whether or not government uses force to restrict individual liberty.

nismaratwork

Feb21-11, 02:10 PM

I agree 100%. But this thread, and politics in general, is about what government should or shouldn't do, not simply to state what it currently does and doesn't do.

And even if laws were completely "evidence-based", free from politics, that might make my opinion moot, but it won't make my private decisions moot. And it wouldn't make it moot whether or not government uses force to restrict individual liberty.

I believe that a discussion of politics isn't a discussion of what we personally wish for, unless that's the topic of the discussion. Anything less is ideology taking over your argument.

Al68

Feb21-11, 04:42 PM

I believe that a discussion of politics isn't a discussion of what we personally wish for, unless that's the topic of the discussion.I'm not sure what you mean by this. Politics is about what government should and shouldn't do. If you're referring to me using myself as an example, it was just for convenience. This is about the freedom of a nation, not just me.Anything less is ideology taking over your argument.Not sure what you mean by that, but you can't advocate the use of force to change, better, or control society, then accuse opponents of being too ideological because they oppose it.

Any political position has its root in ideology, by definition (http://en.wikipedia.org/wiki/Ideology#Political_ideologies), but it seems self-evident to me that those who advocate using force to control others are far more ideologically driven than those who don't.

nismaratwork

Feb21-11, 05:04 PM

I'm not sure what you mean by this. Politics is about what government should and shouldn't do. If you're referring to me using myself as an example, it was just for convenience. This is about the freedom of a nation, not just me.Not sure what you mean by that, but you can't advocate the use of force to change, better, or control society, then accuse opponents of being too ideological because they oppose it.

Sure I can, it even has a name: Realpolitik http://en.wikipedia.org/wiki/Realpolitik

Any political position has its root in ideology, by definition (http://en.wikipedia.org/wiki/Ideology#Political_ideologies), but it seems self-evident to me that those who advocate using force to control others are far more ideologically driven than those who don't.

True, but some cling to it and others try to be free of it, while most just struggle in the grey areas. I try to be as grey as possible, not on any given issue, but as a statistical spread. It helps to be a moral relativist, and not believe in absolutes, yet also not being nihilistic.

Al68

Feb21-11, 05:12 PM

Sure I can, it even has a name: Realpolitik http://en.wikipedia.org/wiki/RealpolitikAuthoritarian pragmatism is an ideology by definition (http://en.wikipedia.org/wiki/Ideology#Political_ideologies). "The ends justify the means" is an especially notable ideology. Moral relativism is an ideology.

How about if I just deny that libertarianism is an ideology? Can I then just say that I don't have an ideology? Can I then say my opposition to authoritarianism is non-ideological?

nismaratwork

Feb21-11, 05:18 PM

Authoritarian pragmatism is an ideology by definition (http://en.wikipedia.org/wiki/Ideology#Political_ideologies). "The ends justify the means" is an especially notable ideology. Moral relativism is an ideology.

How about if I just deny that libertarianism is an ideology? Can I then just say that I don't have an ideology? Can I then say my opposition to authoritarianism is non-ideological?

I suppose you could, but am I ALWAYS morally relative? No, I try to be. Am I always pragmatic? No.

As I was trying to point out with the "grey" comment, there is a difference between what you take from ideologies, and being an ideologue.

I would argue that Libertarianism in the sense that it's used today is nihilism with a touch of arch-conservatism... in other words, a pastiche of dung. I don't think it IS a cohesive ideology, just a general sense of oppositon with semantic shielding.

Al68

Feb21-11, 05:22 PM

I would argue that Libertarianism in the sense that it's used today is nihilism with a touch of arch-conservatism... in other words, a pastiche of dung. I don't think it IS a cohesive ideology, just a general sense of oppositon with semantic shielding.That makes no logical sense whatsoever. Is this "opposite day"? :confused:

nismaratwork

Feb21-11, 05:50 PM

That makes no logical sense whatsoever. Is this "opposite day"? :confused:

I think our world-views, while not mutually hostile, are utterly incompatible. So... in a way... yes.

WhoWee

Mar8-11, 08:04 AM

There's more (apparently): my bold
http://www.newsmax.com/InsideCover/BachmannBlastsHidden105BObamacareTab/2011/03/08/id/388679

"Rep. Michele Bachmann, R-Minn., says she is willing to see the government shut down unless a $105 billion appropriation the Obama administration and the Democratic Congress hid in Obamacare is returned and the GOP House leadership will meet Tuesday afternoon to consider its next step. Her comments came on the heels of her making the funding-deception revelation in an exclusive Newsmax interview.

Bachmann said members of Congress didn’t know the money to implement Obamacare was in the healthcare legislation until a Congressional Research Service report came out in February, because they couldn’t read the bill before they voted and it passed.

“This is an enormous sum of money – this was tucked away inside the Obamacare bill,” Bachmann Monday said on Fox News. “People say: ‘Well, what’s wrong with you members of Congress, why didn’t you know it’s there?’ It’s because we didn’t get the bill until literally a couple of hours before we were supposed to vote on it, and it’s 2,900 pages long.

“What they did is they took the bill – this amount of money – split it up and put it in different sections of the bill,” she said. “Nobody knew until February when it [the report] came out. We had an eagle eye from the Heritage Foundation, Ernest Istook, a former [Oklahoma] member of Congress, found this in this report – he wrote a few blog posts. One of my colleagues, [Rep.} Steve King from Iowa, also found out about this, and we’ve been trying to do everything we can to alert people and say: Give the money back!”

Bachmann said she thinks the deception was intentional. "