Health Care Reform - almost a done deal? DONE

[Ivan Seeking]

Okay, if I understand this correctly - after thinking about it for a bit - the assistance for premiums based on income is already in the tax code. The new plan apparently sets lower ceilings in order to be eligible, and for tax credits, not just a deduction. But the cost of medical expenses has long been deductible once it exceeds a certain percentage of one's income.

 

[Greg Bernhardt]

It's interesting that the Amish (250k pop) will be exempt, but Muslims will have to buy.
http://www.wnd.com/index.php?fa=PAGE.view&pageId=137221

 

[turbo]

It's interesting that the Amish (250k pop) will be exempt, but Muslims will have to buy.
http://www.wnd.com/index.php?fa=PAGE.view&pageId=137221

Interesting distinctions in that argument. Thanks. I didn't know about this.

 

[mheslep]

Rubbish.
...
Please don't make stupid, unjustified assertions like "If one corrects for those factors, the US comes out at or near the top of a longevity ranking." It simply isn't true and it debases the discussion.

Run the numbers yourself instead talking about what you suspect. If one assumes the average age of the homicides and car wrecks is 25, by itself that moves the longevity of the entire US population down by nearly year, and we only talking about a couple years of difference.
http://www.aei.org/docLib/20061017_OhsfeldtSchneiderPresentation.pdf , table 1-5

 

[CRGreathouse]

I would be interested in seeing more numbers on this, if either side would care to contribute.

 

[Al68]

The last time I checked, one the biggest complaints is that this penalizes people who don't have insurance and who refuse to purchase insurance through the low-cost insurance pool.

Just pointing out that it penalizes people who decide not to participate in the new system, regardless of the fact they it is this law that will prevent them from keeping/obtaining the insurance (private non-system) that they want to buy.

This includes many, like me, who have good insurance now, and want to keep it, but will be prohibited from doing so.

 

[Al68]

It's interesting that the Amish (250k pop) will be exempt, but Muslims will have to buy.
http://www.wnd.com/index.php?fa=PAGE.view&pageId=137221

The Amish are exempt from many things due to their religious beliefs. This law exempts anyone who is a member of a recognized group with religious beliefs that prohibit their participation. Muslims are not a recognized group for this purpose.

One more constitutional strike against this law, it discriminates based on religious beliefs.

 

[CRGreathouse]

One more constitutional strike against this law, it discriminates based on religious beliefs.

How is that unconstitutional? It's not a law "respecting an establishment of religion, or prohibiting the free exercise thereof". Unless of course you meant that the right to so discriminate is "reserved to the States respectively, or to the people"?

 

[TheStatutoryApe]

How is that unconstitutional? It's not a law "respecting an establishment of religion, or prohibiting the free exercise thereof". Unless of course you meant that the right to so discriminate is "reserved to the States respectively, or to the people"?

Amendment 14 Section 1. "All persons born or naturalized in the United States ... nor deny to any person within its jurisdiction the equal protection of the laws."

Commonly the "Equal Protection Clause". Its arguable but the supreme court is unlikely to accept it as a violation.

Edit: and the "Establishment Clause" is commonly interpreted as prohibiting any law which gives preference to any religious group or institution.

 

[mheslep]

This isn't a feature unique to the Massachusetts system. Roughly 30 states require premium increases to be approved by state insurance regulators. Recent (i.e. in the last few years) raises have been rejected or challenged in a number of states--Maine, Connecticut, and Washington come to mind immediately and I'm sure some of you have heard about the recent challenge (and subsequent delay) to premium increases in the individual market in California.

Well the insurance regulators denied the initial rate incrrease requests but they were eventually http://online.wsj.com/article/SB10001424052748703315004575073013721784050.html" to some degree:

After initial rejections from local insurance regulators, Mr. Fluegel said WellPoint wound up with a 17.5% increase in Connecticut and a 10.5% increase in Maine.

As far as I know the refusal of health insurers to offer any new policies is indeed unique to Massachusetts, as the highest in the nation premiums brought on by the state rules are causing people to game the system and jump in and out insurance policies, or put another way Mass. rules have blown apart the risk pool and taken all the slack out of the system.

 

[CRGreathouse]

Amendment 14 Section 1. "All persons born or naturalized in the United States ... nor deny to any person within its jurisdiction the equal protection of the laws."

Commonly the "Equal Protection Clause". Its arguable but the supreme court is unlikely to accept it as a violation.

I agree that the Supreme Court is unlikely to consider that a violation.

Edit: and the "Establishment Clause" is commonly interpreted as prohibiting any law which gives preference to any religious group or institution.

That's a clear misreading of the Constitution. It seems to be quite common, though; I'm not sure why. Aside from the elastic clause, it seems to be the most heavily reinterpreted clause of the whole document. (I shouldn't complain too loudly, though; I consider the dormant commerce clause an important facet of law, but it's really just another stretch/interpretation/misreading...)

 

[mheslep]

I would be interested in seeing more numbers on this, if either side would care to contribute.

Here are some more relevant figures.

Percentages of the male population with a http://en.wikipedia.org/wiki/Body_mass_ind" :

• Japan 2.8 (Japan is at the top of the life expectancy rankings)
• France 9.8
• Germany 14.4
• Canada 17.0
• U.K. 22.7
• U.S. 31.1

My larger point is that it is very difficult to cleanly separate out all of the non-medical care related life expectancy causes, and given we can directly to medical care numbers why try? We have readily available numbers for the treatment of various diseases - cancer, heart disease - which are directly and almost solely dependent on medical care quality, it becomes a waste of time to try and make something of a 5% difference in life expectancy. A similar argument (unrelated causes) applies to a difference of two or three deaths per thousand in infant mortality.

 

[CRGreathouse]

That's percentage overweight, not the BMI itself, of course.

Becker and Posner have discussed this several times; some links for those interested:
http://uchicagolaw.typepad.com/beckerposner/2010/02/on-consumer-competence-becker.html
http://www.becker-posner-blog.com/2009/05/a_tax_on_sodas.html
http://www.becker-posner-blog.com/archives/2007/08/social_obesityp.html

 

[mheslep]

That's percentage overweight, not the BMI itself, of course.

Oops, yes, corrected.

 

[Ivan Seeking]

... In Obama's Deal, veteran FRONTLINE producer Michael Kirk (Bush's War, Dreams of Obama) takes viewers behind the headlines to reveal the political maneuvering behind Barack Obama's effort to remake the American health system and transform the way Washington works. Through interviews with administration officials, senators and Washington lobbyists, Obama's Deal reveals the dramatic details of how an idealistic president pursued the health care fight -- despite the warnings of many of his closest advisers -- and how he ended up making deals with many of the powerful special interests he had campaigned against...

Watch online:
http://www.pbs.org/wgbh/pages/front...iewpage&utm_medium=toparea&utm_source=toparea

 

[Al68]

How is that unconstitutional? It's not a law "respecting an establishment of religion, or prohibiting the free exercise thereof". Unless of course you meant that the right to so discriminate is "reserved to the States respectively, or to the people"?

I think the tax penalty qualifies as "prohibiting the free exercise thereof", since there will be a federal penalty imposed on some but not others based on their religious beliefs.

Does the penalty have to be death or prison to qualify?

 

[Sea Cow]

Run the numbers yourself instead talking about what you suspect. If one assumes the average age of the homicides and car wrecks is 25, by itself that moves the longevity of the entire US population down by nearly year, and we only talking about a couple years of difference.
http://www.aei.org/docLib/20061017_OhsfeldtSchneiderPresentation.pdf , table 1-5

The fact that the US is an extremely violent place in which large numbers of people appear to drive like maniacs does indeed reduce the life expectancy. In comparison to most of the countries in the report you link to, the difference is worth, as you say, the best part of a year – up to 0.8 assuming 40,000 extra deaths per year and average age of death in murder/car crash of 25.

However, that is not what table 1-5 says. It makes the swing in difference due to fatal injuries between Japan and the US 4.3 years. Now, perhaps unsurprisingly, they don't show their workings in that report. Could that be because they've made their figures up?

It would mean not 40,000 extra deaths per year, but 220,000. Given that about 60,000 people are murdered/die in car crashes each year in the US, this must mean that 160,000 (adjusted for size of population) are resurrected in such incidents in Japan each year. I haven't checked Japan's latest figures, but I doubt this is correct.

BTW I'm assuming you've abandoned your third criterion, genetics? This is a science forum after all. I'm also not quite sure how the murder/road death rate affects infant mortality, in which the US performs very poorly. Are mothers going into labour on the road, perhaps? I can see how the distraction of childbirth might cause them to crash.Facetiousness aside, beware internet 'reports' of dubious provenance. They are likely to be full of crap.

 

[Sea Cow]

My larger point is that it is very difficult to cleanly separate out all of the non-medical care related life expectancy causes, and given we can directly to medical care numbers why try? We have readily available numbers for the treatment of various diseases - cancer, heart disease - which are directly and almost solely dependent on medical care quality, it becomes a waste of time to try and make something of a 5% difference in life expectancy. A similar argument (unrelated causes) applies to a difference of two or three deaths per thousand in infant mortality.

You are ignoring the single most important factor in life expectancy – primary health care.

This is where the US, in particular, falls down. Left to our own devices, we will tend to scrimp on health care until we fall seriously ill, at which point we plough everything we have into trying to prolong our lives. This is one reason why health care ought to be provided communally. We're very bad, in the most part, as individuals at judging risk and making rational assessments of how we should spend today to save tomorrow. Sometimes it is good for us all to take such decisions together. This doesn't mean a loss of freedom. In fact, it is quite the reverse.

 

[mheslep]

? This is a science forum after all.

Yes it is. In that vein, you might lay off the polemics and make some posts based on referenced information on actual medical outcome statistics. I am not at all interested in what you may or may not find personally dubious.

 

[Sea Cow]

Yes it is. In that vein, you might lay off the polemics and make some posts based on referenced information on actual medical outcome statistics. I am not at all interested in what you may or may not find personally dubious.

The report you linked to is wrong. Address that point.

Can you explain the 4.3-year swing between the US and Japan in the table you directed the thread to?

 

[mheslep]

The report you linked to is wrong. Address that point.

I am not interested in what you may or may not hand waive away as wrong without argument or reference.

 

[Sea Cow]

I am not interested in what you may or may not hand waive away as wrong without argument or reference.

Did you read my post? I took the trouble to read the link you provided and I have pointed out what is wrong in it and how it is wrong. That is not hand waving. It's fairly simple arithmetic.

Yes, I was sarcastic. I probably shouldn't do that. It is in fact quite a serious problem that such reports are out there and that people are believing them.

 

[Al68]

You are ignoring the single most important factor in life expectancy – primary health care.

This is where the US, in particular, falls down. Left to our own devices, we will tend to scrimp on health care until we fall seriously ill, at which point we plough everything we have into trying to prolong our lives. This is one reason why health care ought to be provided communally. We're very bad, in the most part, as individuals at judging risk and making rational assessments of how we should spend today to save tomorrow. Sometimes it is good for us all to take such decisions together. This doesn't mean a loss of freedom. In fact, it is quite the reverse.

An individual having his decisions made by the community instead of himself isn't a loss of freedom?

I can only assume that's some kind of weird joke.

As for the point, a claim that an individual is likely to make bad decisions for himself doesn't justify using force to deny his liberty, despite the fact that such claims have been used by oppressors many times historically.

 

[TheStatutoryApe]

I think the tax penalty qualifies as "prohibiting the free exercise thereof", since there will be a federal penalty imposed on some but not others based on their religious beliefs.

Does the penalty have to be death or prison to qualify?

This would hinge more rightly on the Establishment Clause I believe. I think that the USSC would likely discern a difference here between religious preference and exemption based on nonparticipation. If the law specifies the Amish without exemption for any other members of a group with some form conscientious nonparticipation the court would likely simply state that the law may not discriminate and any persons seeking nonparticipation in the general health care system should be granted exemption status.

Edit: I mentioned the Equal Protection Clause. I think that this would be where the strongest argument would be (my opinion). One could argue that allowing the right of privilege to exemption for some perforce denies that right to others and further does so based on religion in violation of the Establishment Clause. In my opinion though the court would likely say that it must weigh the protected rights of the Amish (and others of a similar mind) against the alleged denial of rights to the population at large and would weigh in favour of the protected rights.

 

[mheslep]

An individual having his decisions made by the community instead of himself isn't a loss of freedom?

I can only assume that's some kind of weird joke.

As for the point, a claim that an individual is likely to make bad decisions for himself doesn't justify using force to deny his liberty, despite the fact that such claims have been used by oppressors many times historically.

Or, from a similar conversation:
"Why do you resist? We only wish to raise quality of life, for all species."
"I like my 'species' the way it is!"
"A narrow vision."

- Locutus of Borg to Lt Worf

 

[Sea Cow]

An individual having his decisions made by the community instead of himself isn't a loss of freedom?

The individual makes the decision as part of the community, rather than individually.

You appear to have a weird idea of freedom that includes the freedom not to be helped by others, the freedom to drown on your own, the freedom to be exploited by those that make ownership claims to resources you need, the freedom to carry the biggest stick you can find.

As for your point about force, all I can say is: eh? You are already forced to pay taxes. If communal provision is paid for out of taxation, the only 'force' is a change in that level. In terms of health care, the US currently has the most expensive system in the world, which provides not very good outcomes overall. Many on this thread seem not to care about the US's overall poor outcomes because the outcomes for the richest in the US are good, they themselves consider themselves well insured, and, well, basically, stuff everyone else. That's your freedom for you.

Remember that we are not all born free. We are all born helpless, and some of us are born into better environments than others in the lottery of life. This is basic stuff, really. If you wish to advocate freedom, you need to do better than this simplistic nonsense. You only seem interested in 'freedom to act'. You seem to ignore 'freedom not to be acted upon'.

To go back to the point, if everyone else is taking poor decisions and pouring too much of their health care money into the crisis at the end of their lives, under your system, that leaves me, the individual, in a worse position. The primary care infrastructure that I may want will not be there. The poor decisions of others acting individually have impinged upon my freedom to not to be acted upon.

Services such as health care are, necessarily, provided communally. Everyone doesn't have their own hospital with staff they've trained themselves, handing out drugs they've come up with in their garden shed. It's a massive collective enterprise. You think you have an effective voice in how that massive collective enterprise is run under your system? Really? You tell the insurance companies how to run things? Where's the accountability? A real, effective say in a communal decision is greater freedom than no say at all.

 

[Sea Cow]

Or, from a similar conversation:
"Why do you resist? We only wish to raise quality of life, for all species."
"I like my 'species' the way it is!"
"A narrow vision."

- Locutus of Borg to Lt Worf

Your quote begs the question: Do you consider those unable to afford decent health care insurance to be part of your species?

Can you explain the 4.3-year swing between the US and Japan in the table you directed the thread to?

Well?

 

[mheslep]

You are ignoring the single most important factor in life expectancy – primary health care.

This is where the US, in particular, falls down. ...

Nicely visualized here:


I'd respond further but at the moment I have go drive like a 'maniac' spewing 'rubbish' out the window while running down the lesser of my species.

 

[Al68]

This is basic stuff, really. If you wish to advocate freedom, you need to do better than this simplistic nonsense. You only seem interested in 'freedom to act'. You seem to ignore 'freedom not to be acted upon'.

This is basic stuff. You are the one ignoring 'freedom not to be acted upon'. You are insisting on 'acting on me' while I have no interest in 'acting on you'.

To go back to the point, if everyone else is taking poor decisions and pouring too much of their health care money into the crisis at the end of their lives, under your system, that leaves me, the individual, in a worse position. The primary care infrastructure that I may want will not be there. The poor decisions of others acting individually have impinged upon my freedom to not to be acted upon.

Failure to meet your needs isn't 'acting on' you.

Services such as health care are, necessarily, provided communally.

Obviously false. Too obvious to debate.

Everyone doesn't have their own hospital with staff they've trained themselves, handing out drugs they've come up with in their garden shed. It's a massive collective enterprise.

No, it's not. In the U.S., it's thousands of different enterprises. Do you really not know this?

You think you have an effective voice in how that massive collective enterprise is run under your system? Really? You tell the insurance companies how to run things? Where's the accountability? A real, effective say in a communal decision is greater freedom than no say at all.

You are the one advocating a "massive collective enterprise", not me. I don't want any kind of "system" at all. I want individual private insurance companies to compete for my business.

 

[Sea Cow]

I don't want any kind of "system" at all. I want individual private insurance companies to compete for my business.

That is a system.

 

[Sea Cow]

Failure to meet your needs isn't 'acting on' you.

It is if your needs are not met because someone else has taken a giant share of limited resources. Your concept of freedom requires infinite resource availability.

 

[Al68]

That is a system.

It's not a system in the sense relevant to this discussion. The individual enterprises involved are operated independently, not under common management or control.

It is if your needs are not met because someone else has taken a giant share of limited resources. Your concept of freedom requires infinite resource availability.

This makes no sense. What limited resource are you talking about? What health care resource is running out that can't be produced any more?

What relevant natural resource isn't "infinitely available" as a practical matter for these purposes?

As far as "my" concept of freedom, here I'm using it as a synonym of "liberty". I didn't make it up.

 

[Char. Limit]

I don't want any kind of "system" at all. I want individual private insurance companies to compete for my business.

The problem is, they don't compete for your business. They put prices as high as they want, because they know that eventually, you'll come to them.

It's the underlying principle of most human activities... greed. Can't escape it.

 

[CRGreathouse]

The problem is, they don't compete for your business. They put prices as high as they want, because they know that eventually, you'll come to them.

I'm reluctant to post, but I see this reasoning often and felt the need to address it.

*****

This is clearly not the case, and it shows a lack of understanding of even basic microeconomics. If companies *can* charge any price they want (they can), and they would make more money by doing so, why wouldn't they be charging more *right now*? After all, they are driven by greed, as you say. Why would they charge $800 per month when they could charge $8000 per month?

The reasoning is flawed on two levels. First, even if they were the only company in the business, there are limits on what they'd charge. There's some point at which so many people would be priced out of the market that they would prefer to charge a lower rate (to more people) than a higher. This is what's called the monopoly price. Now if there were many firms competing, so many that no individual firm had pricing power*, then they would charge a lower rate; this is the competitive price. At present, rates are between the two: oligopoly pricing. This happens when there are enough firms to keep the prices well below monopoly rates, but not so many that firms lose their pricing power altogether.

But the real problem, IMO, is not the number of companies or their market power. It's the power the companies have (collectively) over the government itself: regulatory capture, government failure, etc.

Personally I hate health insurance companies, and I dislike buying insurance. (It's worth the price after the employer subsidy so I do buy it... but I don't think it's a good deal at face value, or even half of face value.) But if we're to find a reasonable alternative, we should look at the current system fairly.

* Suppose the going price for wheat was $4.90 per bushel and someone offered to sell you wheat at $5.00 per bushel. You'd decline, obviously -- you could get wheat from anyone else at $4.90. That seller has no market power. On the other hand, a drug company supplying patented medicine has absolute pricing power. They charge monopoly prices (not infinite prices!) because they are able to do so.

 

[NeoDevin]

The reasoning is flawed on two levels. First, even if they were the only company in the business, there are limits on what they'd charge. There's some point at which so many people would be priced out of the market that they would prefer to charge a lower rate (to more people) than a higher. This is what's called the monopoly price. Now if there were many firms competing, so many that no individual firm had pricing power*, then they would charge a lower rate; this is the competitive price. At present, rates are between the two: oligopoly pricing. This happens when there are enough firms to keep the prices well below monopoly rates, but not so many that firms lose their pricing power altogether.

The problem with this reasoning is that major hospitals, emergency response crews, and many of the highly specialized fields of medicine have an effective monopoly at the "point of sale". When someone is dying of a disease/injury, they (often) don't have the option of saying "No thanks, I'll take the next ambulance, they offer better rates." or "Drive me to the hospital 2 counties over, it's cheaper." Furthermore, the "monopoly price" is not determined by what individuals can afford, but rather what the insurance companies/medicare can afford.