Health Care Reform - almost a done deal? DONE

[calculusrocks]

America's health insurance market is not a free market. In fact, it is heavily regulated and controlled by gov't. The most recent bill simply expands these regulations and subsidies, and potentially create a single-payer system. Here is an article about it in http://www.forbes.com/2009/07/28/health-care-reform-obama-opinions-columnists-shikha-dalmia.html" .

 

[mheslep]

This is a ten year trillion dollar disaster. The mandate, and perhaps the 'deeming' non- vote are probably unconstitutional. There are far better ways on the table to reform.

 

[mheslep]

To me, this is just another example of the fact that the free market is not the end-all solution to all problems. We have a free-market healthcare system now

Clearly not. We should actually try a free-market system.

• The government already funds about 50% of every dollar spent in the US health system via Medicare, Medicaid and other programs.
• If you live in Washington state, you are not free to buy perhaps cheaper medical coverage from a company in my state.
• The federal employer-medical tax exemption makes only employer based coverage feasible, meaning most people are hidden from actual costs of the medical care.
• US Tort law allows spurious and trivial malpractice suits.

and it is clear that what we're doing isn't working. From dropped coverage upon illness, to denied coverage for pre-existing conditions, skyrocketing administrative costs in place of patient care costs, runaway patient costs, the looming costs of medicare and medicaid, and the 30 million+ people who have no coverage at all, in painfully real terms for many Americans, what we have now is barely more than a bad joke.

Yes, that doesn't mean this disaster of bill is any way close to being a workable remedy that doesn't make things worse. If one recognizes that Medicare and Medicaid government created plans are broken, it seems to me more scepticism of federally based solutions is the logical course, not of market solutions, and are surely not a recommendation for huge all-in bets on more federal health care plans.

 

[mheslep]

If I do not, then I can get a hefty fine...the same as with the health insurance mandate. So neither one is being "forced" to buy a product, just installing a penalty if you don't.

Like I said before, there is no law requiring you to get auto insurance. You can simply choose not to drive. Auto insurance is required in case you injure someone else. It's a faulty analogy. Even if the analogy wasn't faulty, your conclusion is faulty. The conclusion wouldn't be that neither one forces you to buy a produce. The conclusion would be that both forces you to buy a product. But, you are not forced to buy auto insurance.

The salient difference is the many states have the power to mandate insurance if they choose; the US constitution grants no such power to the federal government without some squinty eyed look at the commerce clause to interpret as meanin ... the federal government can do any dam thing it pleases, anywhere, absent conflict w/ the first five or so amendments.

 

[turbo]

This is a ten year trillion dollar disaster. The mandate, and perhaps the 'deeming' non- vote are probably unconstitutional. There are far better ways on the table to reform.

The problem is that the GOP is adamant and unified in demanding that there be NO reform. The constant harping of "start over" is very tedious, since it is tantamount to saying "not in this generation". The GOP (apart from Sen. Snowe (R-ME)) refused to participate in the crafting of the bill, then complained that they were "shut out" of the process. The problem is that there are plenty of air-heads who watched the obstructionism unfolding, but failed to understand it and actually believe the complaints.

We need health-insurance reform ASAP. And we need to address reforms in health-care, too, though reining in systemic abuses by the insurance companies should be job #1. I am medically disabled, and I have health insurance only because my wife works for a decent company that provides comprehensive health insurance (medical, dental, and eye care) for all employees. If her company were to fail, neither of us would be able to get health insurance under the present system because both of us have pre-existing conditions. If one of us should come down with cancer, experience organ failure, or other debilitating condition, we would be ruined financially. Nobody should lose their life-savings and their homes just because they got sick. The US is the last "modern" country to allow the assets of its citizens to be stripped by catastrophic illness. Thanks, insurance companies.

BTW, in an effort to purge "ineligible" persons from coverage, Anthem required my wife's employer to audit its employees, so that I had to contact my town office and send the insurance company a copy of our marriage certificate (35+ years ago) to prove that we are married. I hope that the town clerk and the justice of the peace spelled everything just right in case Anthem has another round of recissions planned.

 

[ThomasT]

Clearly not. We should actually try a free-market system.

I agree that the health care business isn't a free market system. But a truly free market system would leave many more people without insurance and without emergency room care.

US Tort law allows spurious and trivial malpractice suits.

Yes, it allows them to be filed, but in practice most spurious and trivial malpractice suits get dismissed.

 

[calculusrocks]

The problem is that the GOP is adamant and unified in demanding that there be NO reform.

Anyway, that's where I stopped reading. Do you have a source? Perhaps you should start by investigating the GOP's website for their reform plans.

 

[calculusrocks]

I agree that the health care business isn't a free market system. But a truly free market system would leave many more people without insurance and without emergency room care.

Yes, it allows them to be filed, but in practice most spurious and trivial malpractice suits get dismissed.

Free market capitalism always fills in the gaps. The more self-reliant the citizenry becomes, the more private charities will take it upon themselves. There is little room left for private charity from many people because taxes already take a large share of income and people figure taxes are like charity.

In my opinion, charity will make sure the money goes to the people in need. Gov't will make sure the money goes to people who will enforce more gov't.

 

[mheslep]

The problem is that the GOP is adamant and unified in demanding that there be NO reform.

While the boogie man GOP may be out eating children, the real GOP almost unanimously states it wants medical reform. Though they should have pushed harder years ago, there are now numerous bills, actual legislation drafted:

http://www.roadmap.republicans.budget.house.gov/Issues/Issue/?IssueID=8516"
http://gopleader.gov/UploadedFiles/Summary_of_Republican_Alternative_Health_Care_plan_Updated_11-04-09.pdf"
Republicans Offer Health-Care Plan May 21 2009
http://en.wikipedia.org/wiki/Healthy_Americans_Act"

I'd expect anyone that had seen Maine's government run http://www.nytimes.com/2007/04/30/us/30maine.html?_r=1" up close would have pause before signing up to a national version.

 

[mheslep]

I agree that the health care business isn't a free market system. But a truly free market system would leave many more people without insurance and without emergency room care.

Probably no more so than that many people would starve to death in a free market food supply system, but when most people say free market they don't mean pure laissez faire. They mean, or at least I do, that the mainstream economic body of the country should use a truly free market system, and the unfortunate and the chronically ill be directly funded out of a pool set up specifically for that. The 'high risk pools' are generally what is proposed now along those lines.

Yes, it allows them to be filed, but in practice most spurious and trivial malpractice suits get dismissed.

No, a great many of them are settled out of court, i.e. pay-offs to avoid legal expense and the odd rogue jury. The consequence is higher medical fees and a distortion of reasonable standards on the part of heath professionals.

 

[turbo]

I'd expect anyone that had seen Maine's government run http://www.nytimes.com/2007/04/30/us/30maine.html?_r=1" up close would have pause before signing up to a national version.

Are you aware that Maine is very poor and rural? Are you aware that we have a very large population that can only get seasonal or part-time work and has NO health insurance? Are you aware that our population is aging quite rapidly, as younger people move away to find work? Any attempt to expand health-care coverage in such a climate is bound to face significant hurdles. We need a national initiative, like all the "socialist" (according to Beck and Limbaugh) industrialized nations have adopted. Exposing poor people to poor health-care, and exposing middle-class citizens to bankruptcy in the face of catastrophic illness is the mantra of the GOP. They claim that they want "reform" as long as their patrons are untouched. That can't happen. Health-care reform is not a zero-sum game that can be balanced on the backs of our citizens.

 

[mheslep]

Are you aware that Maine is very poor

Maine GDP per head is ~$35k/year, better than 17 other states.

and rural?

So is most of the US with a national average of 86 people/sq mile, Maine has 42 p/sq-m, higher than ~ten other states.

Are you aware that we have a very large population that can only get seasonal or part-time work and has NO health insurance?

Assume you mean the part-time worker population is large relative to the whole. What needs to be done to get them health care?

Are you aware that our population is aging quite rapidly, as younger people move away to find work?

As is the US as a whole, baby boomers will continue to age the country at large for a couple more decades.

Any attempt to expand health-care coverage in such a climate is bound to face significant hurdles. We need a national initiative, like all the "socialist" (according to Beck and Limbaugh) industrialized nations have adopted.

If one accepts the above rationale ("we're poor, rural", etc) for Dirigo failure, the motivation of going national can only be a desire to have other states pay your way when many of the other states are worse off than Maine.

Exposing poor people to poor health-care, citizens...

If the poor in the US have bad health-care in the US, and I don't know that they necessarily do, the first place to look is with government run Medicaid set up by the government for the poor, and not elsewhere.

 

[russ_watters]

Imo, what is important is that this passes. Let the chips fall where they may. Most people actually support a good part of what's in the bill but they just don't know it. The Dems are betting that once people understand what was passed, more than not, the rest will be forgotten.

I agree that that's what the dems hope, but I think they underestimate the populace: many people support "a good part" of it, but they also oppose "a good part of it", and they know what provisions they support and don't support. But in order to believe they can be re-elected in November, the dems up for re-election have to hope that the populace will forget why they opposed it.

This is part of why the dems are going to get slaughtered in Novemember.

Things can always be amended later.

Don't let the perfect be the enemy of the good.

Pass it now, with all of its warts, and fix it incrementally.

This logic is absolutely apalling to me. Why can't dems (both in office and not) understand that if a bill has significant flaws that require it to be amended later, it should just be done better now? If it was done better now, republicans would support it! So why don't the dems fix those flaws in the bill?

That sort of logic makes me think dems are trying to swindle us.

 

[russ_watters]

You want poor people to keep their individual "liberty" to have no access to preventative care, and rely on ER visits for emergent care when it is (often) too late to hope for positive outcomes, that drive up costs for all of us? Why?

Because I worked for my money and I want to keep it and reap the benefits from it that I earned. It is against the principles of freedom to force one person who has been responsible to care for another who has not.

 

[BoomBoom]

If it was done better now, republicans would support it!

You can't be serious, can you? The republicans have shown thus far that they are not willing to vote on anything, much less vote for anything.

Although, that said, it was encouraging to see that a handful actually voted for the jobs bill.

 

[WhoWee]

Based on the 2008 report, Caterpillar had $51 Billion in revenues with $2.4 Billion in capital expenditures. $100 million represents a 4% increase in expenditures. It was also a record year for profit.
http://www.cat.com/cda/files/2096799/7/Caterpillar 2008 Annual Report - electronic only.pdf

Tell that to the shareholders - it's $100,000,000.00 in government mandated expenses!

 

[WhoWee]

Tell that to the shareholders - it's $100,000,000.00 in government mandated expenses!

And let's not forget about Obama's comments about helping Caterpillar - do I need to post a link to remind you?

 

[calculusrocks]

And let's not forget about Obama's comments about helping Caterpillar - do I need to post a link to remind you?

What you mean http://www.aim.org/don-irvine-blog/cat-ceo-corrects-obama-on-layoffs/" ?

 

[calculusrocks]

Obama put words in the CEO of CAT's mouth, and the CEO had to correct the record.

https://www.youtube.com/watch?v=8fvF2W_fa9I

ADD: This was regarding the stimulus plan.

 

[WhoWee]

It's time to refocus - AGAIN.
http://www.washingtonpost.com/wp-dyn/content/article/2009/10/14/AR2009101403953.html

"In a health-care debate defined by big numbers and confusing details, the prospect of losing benefits such as a free gym membership through the Silver Sneakers program is tangible, and it has spooked some seniors, who are the nation's most reliable voters and have been most skeptical about reform.

Medicare Advantage was established in the 1970s (under a different name) when private insurers convinced Congress that they could deliver care at lower costs than Medicare. The program blossomed in the late 1990s when Congress bolstered it with millions in additional federal subsidies to for-profit HMOs. It has proven popular among younger, active seniors who had managed-care plans as workers, and about a quarter of Medicare's 45 million beneficiaries are enrolled.

Many private plans require no additional monthly premiums, yet the government pays an average of $849.90 in monthly subsidies to insurance companies for a person on Medicare Advantage, according to the Kaiser Family Foundation. That is about 14 percent more than the government spends on people with standard Medicare, according to the nonpartisan Medicare Payment Advisory Commission.

"The promise of Medicare Advantage and Medicare HMOs was to save the government money, to save consumers money, all the while providing additional benefits and coordinating care," said Joseph Baker, president of the Medicare Rights Center. "That promise has been unfulfilled overall because the plans are overpaid by the federal government at this point." "

You can blame this mess on insurance companies until your head explodes. However, the TRUTH is that the Center for Medicare and Medicaid (CMS) runs this program. This is the Government run insurance program. Please note the cost PER PERSON to the Government is $849.90 per month. Then the individual pays co-pays, deductibles, some pay premiums - then we have the Part D prescription costs ($4,550 out of pocket cost to escape the Standard Coverage Gap).

The Government is the problem - not the solution.

 

[hamster143]

I agree that that's what the dems hope, but I think they underestimate the populace: many people support "a good part" of it, but they also oppose "a good part of it", and they know what provisions they support and don't support. But in order to believe they can be re-elected in November, the dems up for re-election have to hope that the populace will forget why they opposed it.

Of all people who oppose it, most oppose the part of it that involves giving government subsidies to the poor. Problem is, as it's been explained repeatedly by the left (e.g. by Krugman), it is a crucial part of any overhaul, in that it's impossible to provide universal healthcare without it. That is the reason no bipartisan agreement with Republicans was reached or could've been reached.

People who oppose it generally have one of three positions.

1) radical conservatives, Mitch McConnell, Rush Limbaugh, etc: "I don't care that poor people don't have health insurance. All that matters to me is that I have mine. They could die for all I care."

2) moderate conservatives: "Sure, it's sad that poor people don't have health insurance, but I refuse to spend my money to support them. Let the Congress debate (for the next 10 years, if necessary) till they find a way to lower the costs of healthcare so that everyone can afford to buy health insurance on their own. "

3) radical liberals: "This bill does not solve all problems because it does not go far enough: it is not single payer and it does not have public option."

 

[calculusrocks]

This might be an opportune time to wiki what a http://en.wikipedia.org/wiki/Strawman" argument is.

 

[Vanadium 50]

Why can't dems (both in office and not) understand that if a bill has significant flaws that require it to be amended later, it should just be done better now?

Because they are out of time.

Putting a new bill together takes 6 months, and anyone with a ruler and a pencil looking at the polls knows that there is no way a health care bill will pass in October with elections in November.

At this point, the logic goes, they are going to get slaughtered at the polls no matter what. The majority of the American people hate the bill, and they hate the imperious attitude of the democratic leadership in ramming it down their throats. (Remember, when Senator Obama was campaigning, he said that 50% plus one vote was not the way he wanted to pass healthcare. This has turned out to be exactly the strategy President Obama is adopting.) At this stage, again, as the logic goes, even a "no" vote will be used against Democrats in the election: everyone knows how well "I was for it before I was against it" plays at the voting booth.

So the Democrats are faced with two options: a serious loss in November with a health care bill, or a serious loss in November without a health care bill. Which do you think they will choose?

 

[calculusrocks]

So the Democrats are faced with two options: a serious loss in November with a health care bill, or a serious loss in November without a health care bill. Which do you think they will choose?

I ***deem*** this analysis spot on.

 

[russ_watters]

You can't be serious, can you? The republicans have shown thus far that they are not willing to vote on anything, much less vote for anything.

*I* a republican and *I* would support it if it were a better bill. If it were a better bill and republican citizens supported it, then it would be republican congressmen on the hot-seat for not supporting it, not democratic congressmen on the hot-seat for supporting it.

Heck, if the democratic congressmen believed that it was a bad bill and republicans wouldn't support a good bill, they should still make it a good bill so they would have real ammo to use at election time! It is pretty weak to accuse the other side of being obstructionist for blocking bad legislation.

 

[turbo]

Russ, apart from Olympia Snowe, not a single Republican participated in crafting the legislation. It is painfully evident that the GOP does not want any health-care reform bill at all. If they did, they would have contributed and helped to shape it into something that they could support. They did not, and McConnell and Boehner take every second of camera-time to tell us repeatedly that the American people do NOT want health-care reform.

Why is it so important to stop meaningful reform that will lower costs, reduce the deficit, and extend basic preventive health care to tens millions of people? Could it be to deny Obama any achievement? Could it be the opportunity to line their pockets with health-insurance lobbyists' money? Maybe it's just a really patriotic resistance to the "socialism" that has gripped every other industrialized society. In any case, it is time that we stopped sacrificing our citizens' health and welfare to the corporate bottom-line.

 

[russ_watters]

Because they are out of time.

Putting a new bill together takes 6 months, and anyone with a ruler and a pencil looking at the polls knows that there is no way a health care bill will pass in October with elections in November.

Agreed, but they put themselves in this situation, so they get no sympathy from me (not implying they would get it from you). They've known for a year what it would take to convince Republicans to suppot such a bill and have chosen not to do it.

To Ivan's point again, since they've known for a year what the flaws are and haven't fixed them, why would one believe they would be willing to fix them later?

At this point, the logic goes, they are going to get slaughtered at the polls no matter what.

Yeah, seems to be: you're screwed either way, so you might as well go out with a bang! It just boggles my mind that that logic has so much traction.

It is truly breathtaking how quickly they proved to be everything the public hated about the Republican controlled government and how quickly the public turned on them for it:

Corrupt back-room deals? Check.
Not listening to the people, but stuffing the bill with pork, special interest deals and lobbyist's wants? Check.
Ignoring the nations immediate problems to go after your pet crusade? Check.

What I don't understand is how some die-hard democrats seem genuinely confused about how we got here!

So the Democrats are faced with two options: a serious loss in November with a health care bill, or a serious loss in November without a health care bill. Which do you think they will choose?

Well I would have expected a politician to be tenacious when it comes to their re-election bid, so it is surprising to me that they are buying into the defeatism that Obama is selling them. Are these dems even plannign to run in November or are they just going to quit?

 

[russ_watters]

Russ, apart from Olympia Snowe, not a single Republican participated in crafting the legislation.

Right, and why is that? It's because the Democrats realized that with a 60 seat supermajority in the Senate, they could do whatever they wanted without letting the republicans have a say.

It is painfully evident that the GOP does not want any health-care reform bill at all. If they did, they would have contributed and helped to shape it into something that they could support.

Saying it over and over again doesn't make it any less wrong than it was the first time. You can't participate in a process you aren't allowed to participate in.

They did not, and McConnell and Boehner take every second of camera-time to tell us repeatedly that the American people do NOT want health-care reform.

The American peopled do not want this healthcare reform bill.

Why is it so important to stop meaningful reform that will lower costs, reduce the deficit, and extend basic preventive health care to tens millions of people?

Well you seemed to acknowledge that you know it has flaws so why don't you tell me? Have you been listening to what Republicans are saying about what the flaws are?

That last paragraph is just blathering rhetoric, turbo-1. They aren't meangingful/useful statements you are making. A small example and I won't address the rest:

line their pockets with health-insurance lobbyists' money

One of the primary "changes" Obama promised was to reduce the influence of lobbyists in Washington, but this bill is a lobbyist's bonanza. Why doesn't it have tort reform in it? Because of the lawyer lobby. Why does it have freebies for unions? Because of the union lobby. Speaking in blathering generalities about lofty principles that this bill supposedly upholds is just not useful for a debate.

 

[Brian_C]

"Poor" people don't need subsidies for health insurance. They can already walk into the emergency room and get all the care they want.

 

[turbo]

The American peopled do not want this healthcare reform bill.

That's pretty silly. Very few people know what's inside the bill, apart from the few talking points that politicians on either side give them. The people who demand NO reform are people who accept the GOP's fear-mongering as truth. Have you seen the tea-baggers decrying health-care reform as "socialism", yet demanding that no changes be made to their Medicare? What kind of logic is that?

At least the CBO has had time to analyze it and come out with their assessment.

As for Republicans being shut out of the legislation, they were not. They refused to participate and tried to pressure all Republicans to do the same. Snowe took all kinds of heat from her party because she participated. She wanted no public option, or failing that, performance measures that would trigger a public option years down the road if the insurance companies didn't clean up their act. The bill might have looked very different if she had not gotten concessions she demanded. What would the bill look like if other Republicans made a good-faith effort at contributing? We'll never know, because the party of "NO" held firm.