News Health Care Reform - almost a done deal? DONE

[Choronzon]

I really can not summon any emotion but contempt for this bill, for its crafters, and those who support it. They actually think the can legislate the insurance industry to do nothing less but provide unlimited health care. I'm not allowed to retroactively purchase collision insurance for my already wrecked car, so you shouldn't be able to purchase insurance to pay for your already wrecked body.

It really, truly baffles me how Americans can seriously believed that they are entitled to their fellow citizens effectively carrying them through life. People on this very board think that for a negligible monthly payment, a corporation should pay your health care in perpetuity with no annual or lifetime caps—not to mention that they have to accept you, regardless of your condition.

Seriously, people? You think you should be able to go up to someone and say "Hi! I'm going to give you say $500 a month, and in exchange you're going pay hundreds of thousands, if not millions of dollars in my medical costs. Why? Because it's my right!"

If you do think you're entitled to this, I don't know how you can live with the shame.

 

[Vanadium 50]

Agreed, but they put themselves in this situation

Well, they aren't going to change the past.

If the original House bill was just enough more centrist to gain the votes of the 39 democrats who defected, there would be health care today. There would also most likely be a jobs bill passed instead of the spectacle of the President holding the jobs bill hostage until a health care bill passes. People would be comparing Obama favorably to FDR rather than unfavorably to Carter.

The Democrats are doing their best to blame this on the Republicans, but the fact of the matter is that had the original bill been acceptable to every Democrat, it would be the law of the land today.

But that's not what happened, and that's why there is such a mess. As I argued in my last message, given where they are today, "ram it through" is not an irrational strategy.

If I were a Democratic Congressman about to lose an election, I wouldn't worry too much. Both parties have traditionally taken care of members who have lost elections because they voted with the party and not with their constituents. Embassies around the world are full of such people. What I would be worried about is running roughshod over the structures that exist to preserve the influence of the minority party right before the election that might very well place my party in the minority. Perhaps the recent rejection of "deem and pass" is a sign they are thinking this way.

 

[Brian_C]

I really can not summon any emotion but contempt for this bill, for its crafters, and those who support it. They actually think the can legislate the insurance industry to do nothing less but provide unlimited health care. I'm not allowed to retroactively purchase collision insurance for my already wrecked car, so you shouldn't be able to purchase insurance to pay for your already wrecked body.

It really, truly baffles me how Americans can seriously believed that they are entitled to their fellow citizens effectively carrying them through life. People on this very board think that for a negligible monthly payment, a corporation should pay your health care in perpetuity with no annual or lifetime caps—not to mention that they have to accept you, regardless of your condition.

Seriously, people? You think you should be able to go up to someone and say "Hi! I'm going to give you say $500 a month, and in exchange you're going pay hundreds of thousands, if not millions of dollars in my medical costs. Why? Because it's my right!"

If you do think you're entitled to this, I don't know how you can live with the shame.

Exactly. The people who think health care is a "civil right" should sail back to Europe. This country wasn't founded on Marxist ideals.

 

[calculusrocks]

I really can not summon any emotion but contempt for this bill, for its crafters, and those who support it. They actually think the can legislate the insurance industry to do nothing less but provide unlimited health care. I'm not allowed to retroactively purchase collision insurance for my already wrecked car, so you shouldn't be able to purchase insurance to pay for your already wrecked body.

It really, truly baffles me how Americans can seriously believed that they are entitled to their fellow citizens effectively carrying them through life. People on this very board think that for a negligible monthly payment, a corporation should pay your health care in perpetuity with no annual or lifetime caps—not to mention that they have to accept you, regardless of your condition.

Seriously, people? You think you should be able to go up to someone and say "Hi! I'm going to give you say $500 a month, and in exchange you're going pay hundreds of thousands, if not millions of dollars in my medical costs. Why? Because it's my right!"

If you do think you're entitled to this, I don't know how you can live with the shame.

Yup.

 

[Brian_C]

I am sick and tired of hearing Obama whine about the problems his mother had with the insurance companies. This woman didn't even live in the United States for much of her adult life and probably contributed little to the American economy. People like that don't "deserve" health coverage with no strings attached.

 

[WhoWee]

Does anyone know what a "health insurance exchange" looks like? Take a look at Medicare.gov and open up a few of the plans. When you are finished, please recall THESE plans cost YOU about $850 per month per person.

http://www.medicare.gov/MPPF/Include/DataSection/Questions/ListPlanByState.asp

Just for fun, look at a few $0 premium plans and a couple "Special Needs" (SNP-Dual Eligible) plans.

 

[Office_Shredder]

What? I went on the website and asked it to show me some plans. The most expensive premium was like 125 dollars a month. Am I missing something?

 

[mheslep]

[...]Competition between who? Insurance companies? I take it from your across-state-lines comment that this is what you're getting at. But the reality is that this isn't necessarily true. In fact, in some circumstances greater fragmentation among payers leads to higher reimbursement rates (i.e. costs) because no payer has the bargaining power to negotiate down rates with providers. There was a paper in Heath Affairs recently detailing how unchecked provider clout in California is driving up costs in the state. The Massachusetts AG's office also released a report recently indicating that the same thing is happening in Massachusetts. The same force at work in very different states, one small and one with a population larger than that of Canada. And in neither would further fragmentation of the payer side of the equation address the influence of providers on reimbursement rates.

It appears to me your changing the subject in these references. The issue at hand is interstate insurance, i.e. giving payers the ability to shop out of state to get away from provincial monopolies. These references, at quick glance, talk about the concentrated power of insurance companies in states where the payers are prevented from going elsewhere.

We've discussed this theme before, and I completely disagree as before. The list below contains goals. While there may be small areas of common ground, the Republican bill differs completely from the current Senate bill in the means to achieve these goals. The bills (e.g. Ryan's and the Senate bill) are completely different in character. I address the ones the jump out at me:

• Elimination of pre-existing conditions as a pre-text for denying coverage (mentioned in Bobby Jindal's op-ed)

• 
  Differs in means. Dems intend to simply force insurance companies to cover everyone, i.e. the chronically ill, something an insurance company is ill designed to do. Ryan's bill and others would create high risk pools for them.
  
  

  [*]The individual mandate (Republican leaders have since reversed themselves on this). For example, the lead Republican negotiator on the Senate Finance Committee, Chuck Grassley, http://www.washingtonmonthly.com/archives/individual/2009_09/020072.php: "As recently as a month ago, Chuck Grassley, the same senator bashing the idea of a mandate yesterday, announced that the way to get universal coverage is 'through an individual mandate.' He told Nightly Business report, 'That's individual responsibility, and even Republicans believe in individual responsibility.' Earlier this year, Grassley told Fox News that there wasn't 'anything wrong' with mandates even if some may view them 'as an infringement upon individual freedom.'"

  Yes and Romney did mandates in Massachussets. So? Many people say lots of things. Some Democrats considered canning the employer - health benefits tax exemption in the Senate - a very good idea - but it's not in this bill in except in extremis. Of the dozen or so Republican drafted bills, I've seen none with a mandate to buy insurance at the federal level.
  
  

  [*]The creation of health insurance exchanges (these figured heavily into the Republican Patient's Choice Act of 2009).

  For the STATES! And people won't be forced on to them. C'mon.
  

  Creates State Health Insurance Exchanges to give Americans a one‐stop marketplace to compare different health insurance policies and select the one that meets their unique needs

  [*]Continuing the stimulus bill's support of health information exchange

  They might support the info exchange, but one can not reasonably claim via the stimulus bill, since no Republicans voted for the stimulus bill in the House and only 1-2 Senators.
  

  Indeed, we can look just at the Republican substitute (http://gopleader.gov/UploadedFiles/Summary_of_Republican_Alternative_Health_Care_plan_Updated_11-04-09.pdf ) offered this time around and find that most of the ideas Republicans want in a bill appear in some form in the Democratic legislation.
  
  Republicans participated in all of the markups (all three in the House, both in the Senate) and had numerous amendments accepted. But they generally preferred to play games than to craft policy: watch this gem from the Senate HELP committee markup.
  
  The reality is that this is a moderate bill that's bipartisan in content, if not support.

  This is misinformation. We know how bipartisan federal legislation is crafted in this country. For centuries the manner has been to have members of both parties sponsor the legislation. McCain-Feingold. Wyden-Bennet. Webb-Alexander. That is bipartisan legislation. Such has not happened here, and that is the responsibility solely of the Democratic party.

 

[WhoWee]

(Take a look at the plans in Louisiana and Florida (Miami-Dade) if you want a dose of reality)Consider this - "health care reform" is going to insure 30 million (?) additional people and cut costs - right?

According to Obama, there will be NO pre-existing conditions, and no limit to coverage.

The specifics of that coverage mandate is VERY similar to these Medicare Advantage plans that cost YOU the taxpayer $850 per person per month to fund.

Let's see, 30,000,000 X $850.00 = $25,500,000,000 per month = $306,000,000,000 per year. Hmmm an extra $306 billion per year in Government expenditures.?

Next, let's also recall that Medicaid (State programs partially funded by Fed) will be called upon to fund the insured persons monthly share of the premiums, co-pays, and deductibles. Then, if the program mirrors Medicare, perhaps Social Security can pay for their prescriptions. Gee, I wonder how much each person's premiums, co-pays and deductibles will cost each year - especially if they are encouraged to use their benefits.

How can this plan POSSIBLY reduce the deficit? How will this strategy cut costs? Does ANYONE believe cutting payments to Doctors is a realistic option to paying for the plan?

Best of all, NOBODY making less than $250,000 per year will have their taxes raised?

 

[Angry Citizen]

That is bipartisan legislation. Such has not happened here, and that is the responsibility solely of the Democratic party.

The Republican party has made its platform into the "Party of No". If a Republican were attached to any major piece of Obama legislation, he would bear the stigma associated with it. The level of partisanship in this country is such that a bipartisan effort on the bill was impossible.

As was shown in the bipartisan meeting (which I watched start to finish), the Republicans repeatedly made references toward "starting over". It's a stall tactic designed to ensure that Democrats have an extraordinarily large political defeat, wasting political capital and making them look like ineffectual fools.

I'm a libertarian (no, not like Beck), so I really don't like either party very much, but an interesting trend emerges when we consider socialized medicine. Countries with socialized medicine tend to be healthier, and the expenses paid per capita are drastically lower. The Obama bill is nowhere close to socialized medicine (even the vaunted public option is removed), but it is a trend towards something that has a noticeable track record of working. I may be a libertarian, but I'm not so married to my ideology that I cannot make an exception. Perhaps you should too.

 

[calculusrocks]

I'm a libertarian (no, not like Beck), so I really don't like either party very much, but an interesting trend emerges when we consider socialized medicine. Countries with socialized medicine tend to be healthier, and the expenses paid per capita are drastically lower. The Obama bill is nowhere close to socialized medicine (even the vaunted public option is removed), but it is a trend towards something that has a noticeable track record of working. I may be a libertarian, but I'm not so married to my ideology that I cannot make an exception. Perhaps you should too.

No you are not a libertarian. You are a closet liberal, who supports big liberal gov't.

 

[mheslep]

As was shown in the bipartisan meeting (which I watched start to finish), the Republicans repeatedly made references toward "starting over". It's a stall tactic designed to ensure that Democrats have an extraordinarily large political defeat, wasting political capital and making them look like ineffectual fools.

That's the Dem's fault. If they had started on with, e.g., a Ryan+Some Dem bill we'd have a good health care bill now. They chose to go it alone.

I'm a libertarian (no, not like Beck), so I really don't like either party very much, but an interesting trend emerges when we consider socialized medicine. Countries with socialized medicine tend to be healthier, and the expenses paid per capita are drastically lower. The Obama bill is nowhere close to socialized medicine (even the vaunted public option is removed), but it is a trend towards something that has a noticeable track record of working. I may be a libertarian, but I'm not so married to my ideology that I cannot make an exception. Perhaps you should too.

So what's the logic here? What makes you think the pending legislation promising vast increases in federal involvement in the heath system will improve anything, especially when the government controls so much of it already? US health is indeed far too expensive, but why don't you take a real look at medical outcomes in other countries before casually talking about how good they are. I have, in great detail, with real personal health consequences on the line.

 

[WhoWee]

I can't believe CBO hasn't snatched you right up.

Just having fun.

 

[Angry Citizen]

No you are not a libertarian. You are a closet liberal, who supports big liberal gov't.

Argh! Here I lie, skewered by your rebuttal, the likes of which has not been seen since Voltaire himself!

I support one policy, and I'm suddenly a 'closet liberal'. Classy. Now, if I were as classy as you, I'd rebut that you are a closet conservative, who supports big conservative government. Oh, what's that? Conservatives don't support big government? Well, it sure wasn't my party that supported the Department of Homeland Security, the War On Drugs and the PATRIOT Act.

 

[Angry Citizen]

So what's the logic here? What makes you think the pending legislation promising vast increases in federal involvement in the heath system will improve anything, especially when the government controls so much of it already? US health is indeed far too expensive, but why don't you take a real look at medical outcomes in other countries before casually talking about how good they are. I have, in great detail, with real personal health consequences on the line.

Because a trend towards federal control historically tends to increase health standards and decrease costs. You recall, of course, that the legislation which started the major rise in health costs occurred under Ronald Reagan, yes? I am referring, of course, to the bill stipulating that a person cannot be refused emergency treatment. We the taxpayer already pay for this 'liberal' bill. If you were serious about ending government health care, you would've been against the Reagan bill from the outset.

 

[calculusrocks]

Argh! Here I lie, skewered by your rebuttal, the likes of which has not been seen since Voltaire himself!

I support one policy, and I'm suddenly a 'closet liberal'. Classy. Now, if I were as classy as you, I'd rebut that you are a closet conservative, who supports big conservative government. Oh, what's that? Conservatives don't support big government? Well, it sure wasn't my party that supported the Department of Homeland Security, the War On Drugs, the institution of the Federal Reserve and the PATRIOT Act.

Look, there are some libertarian who support a small government with functions for police, fire, military. They are the pragmatists. But, there are no libertarians who support health care as one of those functions. None. Libertarians are opposed to statism in all forms. You have no libertarian rationale for your support of universal health care. Instead, you drop the same talking points as the liberals. If it walks like a duck, talks like a duck, then guess what. It is a duck.

"The republicans are the party of no..."
"I'm not blinded by ideology..."

 

[mheslep]

Really? Wyden-Bennett has a federal mandate (Republican co-sponsors: Robert Bennett, Lamar Alexander, Mike Crapo, Lindsey Graham, Judd Gregg). The http://thomas.loc.gov/cgi-bin/bdquery/z?d103:s.01770: (in 1993) had both an individual and an employer mandate (as I already indicated above, the Republican sponsors still in the Senate are: Kit Bond, Bob Bennett, Orrin Hatch, Dick Lugar, and Chuck Grassley).

I missed the W-B mandate, thanks for pointing that out.

Ryan's bill (and H.R. 3400 in a slightly different fashion) has auto-enrollment in place of a mandate.

In place of? What's with the specious word play? The former is nothing like the latter.

The exchanges in H.R. 3590 are state-administered. States that can achieve superior results in another way can get a waiver to do so.

State administered Federal rules that people are going to be forced on by the millions. Saying the 3590 Federal exchanges are a Republican idea is akin to painting strips on a horse and calling it a zebra.

Shocking. The HITECH Act is one of the true keys to value-based delivery system reform in this country and we have almost no Republicans to thank for it.

I'll take that as a snarky self-correction of your earlier claim this was also a Republican supported idea.

 

[mheslep]

Because a trend towards federal control historically tends to increase health standards and decrease costs.

You mistake cause and effect. One might as well say the increase in the Stork population tends to increase health standards.

You recall, of course, that the legislation which started the major rise in health costs occurred under Ronald Reagan, yes?

I would say that EMTALA occurred under Tip O'neil, and I know the major rise in US health costs began with WWII wage controls, creating employer provided tax exempt insurance.

 

[Angry Citizen]

Look, there are some libertarian who support a small government with functions for police, fire, military. They are the pragmatists. But, there are no libertarians who support health care as one of those functions. None. Libertarians are opposed to statism in all forms. You have no libertarian rationale for your support of universal health care. Instead, you drop the same talking points as the liberals. If it walks like a duck, talks like a duck, then guess what. It is a duck.

"The republicans are the party of no..."
"I'm not blinded by ideology..."

What a terrible justification for your labelling crusade. In your mind, there are no libertarians who support universal health care, because anyone who supports universal health care is not a libertarian. Like I said, there is no libertarian rationale for my support of universal health care. My beliefs coincide with libertarian philosophy in a great many cases. They do not coincide with libertarian philosophy in all cases. I think for myself based on the situation in question. Like I said, I am not blinded by my ideology. I give due credence to historical trends in all forms. If this were a debate on socialism itself, I would be attacking the leftist view based on the same historical trends, which overwhelmingly show that socialism is a very poor economic model for long term sustainability.

When you're so blinded by your party label that you become immune to the lessons of history, of logic and of compromise, you doom yourself to hateful rhetoric, relentless opposition, and staggeringly illogical standpoints -- such as your crass and brutish blanket label of anyone on the other side of the fence on one bloody issue.

Hilariously, you point to the one justification behind it: pragmatism. What the hell is so different about socialized law enforcement, socialized fire and emergency medical services, and socialized military? Maybe they should be privatized too -- just to fall in lock-step with our ideology.

 

[Angry Citizen]

You mistake cause and effect. One might as well say the increase in the Stork population tends to increase health standards.

Are you saying that health care and health are unrelated? Maybe cancer has nothing to do with the mortality rate of individuals 65 years and older.

 

[mheslep]

Well, it sure wasn't my party that supported the Department of Homeland Security, the War On Drugs and the PATRIOT Act.

Yes the libertarian position would be to oppose those creations, but both parties have supported them to varying degrees and continue to do so.

 

[mheslep]

Are you saying that health care and health are unrelated? Maybe cancer has nothing to do with the mortality rate of individuals 65 years and older.

Lets not throw strawmen around. Your statement was

Because a trend towards federal control historically tends to increase health standards and decrease costs

It is fallacy to conclude from that statement that federal control increases health standards.

 

[Angry Citizen]

It is fallacy to conclude from that statement that federal control increases health standards.

That is hardly fallacious. Countries with higher levels of centralized, governmental control of health care tend to have longer average lifespans and lower rates of infant mortality. I am eager to see how this correlation does not imply causation.

 

[WhoWee]

Thank you Angry Citizen - for once again - taking the focus off of the specifics of the debate.

If health care "reform" were a scientific problem, would ANY OF YOU look at it this way?

 

[calculusrocks]

...

 

[calculusrocks]

What a terrible justification for your labelling crusade.

You're the one that labels yourself as a libertarian in the first place. Nonsense.

In your mind, there are no libertarians who support universal health care, because anyone who supports universal health care is not a libertarian.

Yup. It advocates the use of force and coercion.

Like I said, there is no libertarian rationale for my support of universal health care. My beliefs coincide with libertarian philosophy in a great many cases. They do not coincide with libertarian philosophy in all cases. I think for myself based on the situation in question. Like I said, I am not blinded by my ideology.

Libertarianism is rooted in ideology. Here's a YouTube for those curious. https://www.youtube.com/watch?v=muHg86Mys7I

I give due credence to historical trends in all forms. If this were a debate on socialism itself, I would be attacking the leftist view based on the same historical trends, which overwhelmingly show that socialism is a very poor economic model for long term sustainability.

So in this paragraph you attack the socialists on economy, but yet you support the annexation of 1/6 of the US Economy. Really! I know a duck when I see a duck.

 

[mheslep]

What the hell is so different about socialized law enforcement, socialized fire and emergency medical services, and socialized military?

These are all things that are to be avoided as much as possible as they have great carrying costs, are inefficient, and lead to abuses. However, most of them have no alternative and they are necessary. Or, per Washington,

Government is not reason, it is not eloquence, it is force; like fire, a troublesome servant and a fearful master.

Societal life requires we use the fearful master, but it should be as little as possible.

 

[calculusrocks]

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.

I thought this was an excellent post.

 

[Angry Citizen]

So in this paragraph you attack the socialists on economy, but yet you support the annexation of 1/6 of the US Economy. Really! I know a duck when I see a duck.

Of course. Socialist policies are not socialism. Socialism and social democracies are two very different things. 1/6 of the US economy has already been annexed. If legislation to pay for it and ensure it is universal are such terrifying concepts, then so be it. I'd rather have good health care than ascribe to an inflexible ideology. If you're against universal health care just because it's the evil guvmnt, then you're against it for all the wrong reasons. If there were an historical trend towards lower health standards and greater costs inherent in socialized medicine, naturally I would be against it. Unfortunately, the trend is against you here. You are, essentially, supporting the same thing the socialists support: a system that is proven to be ineffective and inefficient.

 

[mheslep]

That is hardly fallacious.

Yes it is unless one shows the connection between the two, as you are now attempting to do here:

Countries with higher levels of centralized, governmental control of health care tend to have longer average lifespans and lower rates of infant mortality. I am eager to see how this correlation does not imply causation.

That's a Wikipedia level look at the topic. For instance, lifespans are obviously impacted by many things other than health care. If you want to know about quality health care, take a detailed look as I suggested above, at survival rates for cancer, heart disease, i.e. what happens to you if you actually get sick and see a doctor. You'll find most often the best place to be is in the US. If you want to know about lifespan causes start with McDonalds and car wrecks.