American Health Care Reform

Politics US Politics
1

This topic has been discussed in numerous threads, but I thought it deserved its own. Here is an article from Senator Jeff Merkley, which I think deserves to be quoted in its entirety:

[quote]Dear Friends,

At 7 am this morning, a short time ago, I voted for the Patient Protection and Affordable Care Act. It passed.

If you are like me, it is hard to respond with uninhibited celebration. It is hard to celebrate when you are mourning. I am mourning the loss of the national public option. I am mourning the infringement on women’s constitutional right to choose.

And there is much more about which I am frustrated. The bill does not, for example, adjust the discrimination in Medicare reimbursement rates that afflicts states like Oregon and Minnesota and Iowa. As a consequence, in Oregon it is hard for our Medicare card holders to get in a doctor’s door! The bill doesn’t address the outrageous prices Americans pay for drugs. The important health care marketplaces established in this bill don’t get set up for four long years – way too long! And I could go on.

But I voted for this bill today because, while there is a lot this bill doesn’t do, there is also much that is right and good in this bill. Because of this bill:

  • 30 million Americans will gain access to affordable health care.
  • 10,000 additional communities will get community health centers.
  • A new Health Care Bill of Rights will:
    ** ban the practice of barring health insurance to citizens with pre-existing conditions;
    ** ban the practice of dumping policy holders who get sick or injured;
    ** enable children to stay on their parents’ policies through age 25;
    ** ban discrimination based gender or health histories; and
    ** ban lifetime coverage caps.
  • Insurance purchasing pools (exchanges) will give individuals and small businesses–who have been lambs to the slaughter when trying to buy insurance–access to fair rates.
  • Insurance companies must spend at least 80%-85% of premiums on health services (higher than the current national average).
  • America will invest far more in prevention and disease management.

These are good things. And there is a lot more. One of my favorites–in part, I confess, because I led the fight for it–is the amendment that guarantees every mother returning to work the privacy and flexibility in break time needed to nurse her child or pump breast milk. Breastfeeding is great for the baby’s and the mother’s health, and is a big factor in emotional bonding as well. Another good feature is that a host of preventive services will be provided without any fees or co-pays. Yet another is the pilot projects on integrated health care, to expand bundled payment strategies and replace the ever-more-expensive fee-for-service arrangements. There are requirements in this bill that will produce a flood of health information that will help us launch future reforms. This bill does a lot to take on the health care workforce shortages driven by boomer demographics. And this bill opens the door to state-crafted public health plans that could have a huge impact.

And here is a fundamental accomplishment: Because of this bill, health care in the United States of America is no longer a privilege, it is a right.

When I joined the Senate in January this year, I asked Senator Ted Kennedy if he would consider advocating for my membership on the Senate’s Health, Education, Labor, and Pensions committee. He did, and I’ve been honored to serve on his committee and to fight for the goal that was his biggest ambition: affordable, quality health care for every single American. When we gathered with Senator Kennedy in his hide-away office earlier this year to debate strategy, he knew the size of the challenge. At that point, the Democrats didn’t have 60 votes in the Senate: Arlen Specter was still a Republican and Al Franken hadn’t yet won his seat over Norm Coleman. We didn’t know if we would be able to win the Republican votes necessary to end debate and hold a final vote on the bill. We didn’t know how we could make the bill deficit neutral. We didn’t know how we would overcome the charged issues of immigration and reproductive rights. But we decided to push forward with every ounce of our hearts and minds, sensing that there was a generational opportunity that we had to seize.

Senator Kennedy had served in the Senate for 47 years and had never had the opportunity to vote for universal health care on the floor of the Senate. Due to the road he paved over decades, and the spirit he showed throughout this year until his death, I have had that opportunity after only 12 months in office. I can report to you that a short while ago the U.S. Senate passed a universal health care bill. This bill, for all its shortcomings, will provide affordable, quality health care to virtually all Americans.

That is a big deal. But to secure this victory, we must still come back in January and win passage of amendments proposed by the House or by the Conference Committee. The fight continues.

I hope that all of you in the progressive community will keep mourning the battles that we lost this year on drug prices and single-payer and public option and Medicare. We must draw from our frustration and anger the power to keep organizing and keep fighting so that we can win battles to improve on the work done this year. The fight for justice is never over.

But also take a moment to recognize that the progressive elections you won in Senate races across the country–including mine in Oregon–made a big difference. Without them, we wouldn’t have made history this morning - passing legislation containing the Health Care Bill of Rights, the community health centers, the purchasing pools for individuals and small businesses, the investment in prevention and disease management, and the promise that every American is entitled to affordable care. What we have done is take a long stride toward economic and social justice. I think Senator Kennedy would be pleased.[/quote]

I think that fairly well sums up my thoughts on the bill. Particularly frustrating is that the healthcare exchanges won’t be created for four years. Four years! Why the delay?

The entire civilized world has enjoyed some form of universal healthcare for decades. Now we’re finally getting there, but with a flawed bill, riddled with contradictions. Health insurance companies can still charge triple for senior citizens - gender discrimination is banned but age discrimination is not. The House bill is a better choice, but we all know that the House/Senate committee bill will essentially mirror the Senate version. Otherwise the bill will not pass and we’ll be back to square one.

When President Obama addressed Congress earlier this year on the topic of healthcare, he advocated taking advantage of the existing private insurance infrastructure. Previously I had been an advocate of a single-payer system, but I believe Obama is correct that we should improve on what we have. Converting to a single-payer system would put tens of thousands of health insurance workers on the streets, and is probably not necessary. The Dutch have done well with maintaining their private insurance schema. I think we can too, but not when our aging population can’t afford the mandatory coverage. I suppose it depends on how generous the government stipend is. As I understand it, Dutch government has some kind of risk equalization system whereby the government subsidizes private insurers who take on elderly and other high risk patients. That seems a more efficient system than subsidizing individuals.

Anyways, I think it is a near certainty now that a final health care bill will be passed and signed. It is imperfect, but a step in the right direction.

2

There are just too many issues involved in ‘one issue’ like this. It’s impossible to have it perfect and it will need to be refined, debated and refined many times again. I am happy to see these first steps in the right direction. Nothing would ever get passed if every single line item had to perfect and unanimously agreed upon.

3

That’s true. I know that many on the left are disappointed that President Obama did not fight harder for the public option. But if he had done that, it may have galvanized the right to prevent any bill from passing. There are just too many fiscally conservative Democrats who feared a government “takeover” of healthcare.

Senator McCain recently made a public statement criticizing the bill, noting that the tax hikes will take effect immediately but the good parts of the bill won’t go into effect for four years. That is an apt criticism shared by many. Perhaps we need four years of increased tax revenues to fund the creation of the insurance exchanges? I don’t know.

4

One of the procedural tactics the Republicans used against the bill was to pass a measure declaring the mandate to purchase health insurance unconstitutional. But the Democrats canned that quickly.

I imagine the Democrats are enjoying a bit of schadenfreude seeing the Republicans so utterly helpless, after the Republicans had been in power for so long. But what bothers me is that most of those Senators hail from states with mandates to purchase auto insurance. And outside of a few select cities with good public transportation, virtually every working person has to drive. So how is the mandate to purchase health insurance any different? The logic behind both mandates is similar. But I’m sure they know that and they’re just doing the best they can.

I find the Republican oppositionism a bit irritating. As I noted in another thread, some Republicans sponsored bipartisan committee bills for universal health insurance. Using different mechanisms, but with the same result of universal coverage. So why not get onboard and vote for a bill that is less liberal? I think this is simply a political strategy to show that the Republicans were united against “big government.” And they accuse the Democrats of putting partisanship before governance. But, I’m sure their strategy will serve them well in the 2010 elections.

5

[quote=“Gao Bohan”]One of the procedural tactics the Republicans used against the bill was to pass a measure declaring the mandate to purchase health insurance unconstitutional. But the Democrats canned that quickly.

I imagine the Democrats are enjoying a bit of schadenfreude seeing the Republicans so utterly helpless, after the Republicans had been in power for so long. But what bothers me is that most of those Senators hail from states with mandates to purchase auto insurance. And outside of a few select cities with good public transportation, virtually every working person has to drive. So how is the mandate to purchase health insurance any different? The logic behind both mandates is similar. But I’m sure they know that and they’re just doing the best they can.
[/quote]

That’s because an insurance mandate is unconstitutional. There is nothing in the constitution that requires citizens to purchase commercial products whether or not they will use it. The comparison between a required health insurance and required auto insurance isn’t correct because driving isn’t a right, its a privilege. Your driver’s license can be taken away if you get too many traffic infractions whereas a right cannot be.

Drivers are required to have at least liability insurance to protect others in case of an accident. If you choose not to own a car, and instead ride the bus or a bicycle to work, you aren’t required to purchase auto insurance even though you could get into an accident with an automobile. That’s why the comparison isn’t correct. You can choose not to drive, even though its true that it’s very inconvenient or impossible in most metropolitan areas. This mandate may provide equal coverage, but not equal usage. The young and healthy don’t need as much health care as the older and sick. If premiums are capped on the old and sick, then to balance out their risk everyone else pays more. That means the young are going to be subsidizing the old, the healthy subsidizing the sick. Why if I do everything right (eating healthy, drinking in moderation, not smoking and exercising regularly) should I be forced to cover someone else who spent a lifetime doing everything wrong? Reversing that, why should others have to pay because I made poor life choices by smoking two packs a day and drinking a fifth for breakfast?

[quote=“Gao Bohan”]
Senator McCain recently made a public statement criticizing the bill, noting that the tax hikes will take effect immediately but the good parts of the bill won’t go into effect for four years. That is an apt criticism shared by many. Perhaps we need four years of increased tax revenues to fund the creation of the insurance exchanges? I don’t know.[/quote]

The reason for delaying parts of the bill by four years was to keep costs down and get public support for the bill. The Democratic numbers include 10 years of taxes but only 6 years of spending. By delaying the benefits by four years, they reduce the outlays under the 2010 to 2019 time frame. Under that time frame there is a 132 billion dollar reduction, but it’s not based on a full 10 years of spending. Only about 1% of the spending takes place in those first 4 years. The next 6 years have the rest of that 848 billion dollar bill. When you look at the time period of 2014 to 2023, which is the first 10 years of both taxes and spending, the total costs rise to 1.8 trillion. The 132 billion saved is wiped out by the actual costs of the bill when it goes into full effect, and those costs are continuously increasing over time (like Social Security).

This bill hinges on the Democrats being able to get the taxes from the “Cadillac health plans” and make the cuts to Medicare. The taxes from the Cadillac health plans are iffy at best. If the insurance companies are going to be hit with a tax increase for that particular plan, they will either pass it onto you in higher costs or reduce the value of the plan to fall under the line. Consumers will choose a little less coverage for a lot less cost every time.

The other half is the cuts to Medicare. They need to make 200 billion in cuts to Medicare while avoiding any cuts to doctor’s reimbursement rates or else doctor’s won’t see patients with Medicare. The current plan is to keep the doctor’s reimbursement rates out of the health care bill but either way it will be 200 billion in cuts to Medicare. Medicare is popular with the elderly, who vote. That constituency doesn’t want to see their entitlement get reduced any. I wouldn’t count on Congress to actually following through on those Medicare cuts.

6

Just because “there is nothing in the constitution that requires…” something doesn’t make a law “unconstitutional” - for it to be unconstitutional, the law has to violate something in the constitution. I’ve reviewed the arguments by conservatives that the bill is unconstitutional, but there is nothing explicit in the constitution, or in their arguments, that requiring someone to pay for a service is unconstitutional. Here is an article in factcheck.org analyzing this.

http://www.factcheck.org/2009/10/health-care-overhaul-constitutional/

Politifact has a reasoned analysis of this statement as well, concluding “It’s true that the taxes kick in first, before many of the bill’s biggest expenses get started. But the editorial doesn’t mention that the CBO projects the largest cost savings for the bill’s final four years, and that the bill appears to be self-sustaining starting around 2017. So we rate the statement Half True.”

http://www.politifact.com/truth-o-meter/statements/2009/nov/06/wall-street-journal-editorial-page/house-health-care-bill-pays-itself-over-long-run/

Once a law passes and is deemed constitutional, and until it is repealed, a payment mandated by the government is essentially a tax or fee for service, even if that payment doesn’t go directly to the government or through the government. I don’t particularly like the fact that my tax dollars go towards new nuclear weapons or biological warfare agents or subsidizing the oil and car and banking industry, and I don’t particularly like the fact that I work 60 or more hours a week and some schmo gets a tiny welfare check or whatever they’re calling it now and can barely scrape by (though I once read that 2/3 of welfare money pre-Clinton went towards children). But we don’t get line-item vetoes on our taxes, and thank god for that. It’s also worth noting that the ridiculously high expenses from health care come from terminal diseases and elderly stuff, and a lot of those have nothing to do with smoking or taking cocaine (how about eating fat food?). Chances are we’re all gonna get one or more of them someday, so the young and healthy and rich(er) paying for the older and sicker and poor(er) is appropriate because we’re likely to be one or more of the latter someday too.

7

So this is a victory? I’d sure hate to see what defeat looks like.

  1. So we have a 2000+ page bill that no one has read nor understands
  2. The taxes are front loaded to make the program look deficit neutral in such a manner that Exxon’s shady accounting practices look benign.
  3. We have actual bribes to senators to pass the bill i.e. Landrieu’s $300 million for Louisianna and Nelson’s masterful selling of deeply held principles for quite a load for Nebraskans.
  4. This is predicated on savings from medicare that have never appeared and is a deeply flawed program open to huge amounts of fraud.
  5. Now forces people with financial penalties and jail time if they do not buy a product.
  6. Probably covers illegal immigrants(Joe Wilson will be making a lot of people eat crow if it does)

It still has to get through the House unmolested(we’re crossing our fingers there since DeMint objected to conference) and has to be signed by Obama who is now signaling that he thinks jobs are really important despite never having ran anything but his mouth.

This is a :popcorn: for conservatives.

The Senate GOP leadership is pathetic and will probably face an open revolt in the not too distant future especially after they folded like a cheap lawn chair over healthcare

8

[quote=“Okami”]So this is a victory? I’d sure hate to see what defeat looks like.

  1. So we have a 2000+ page bill that no one has read nor understands[/quote]

This is a good point, it was rushed through the Senate. But then, we both know Senators and Representatives rarely read or even directly write legislation.

Already corrected by factcheck. The bill will be deficit-neutral in 2017. Other bills proposed by bipartisan commissions had similar deficit neutral dates (the one Graham supported was deficit neutral by 2014).

This is the normal legislative process. Republicans do this too, so let’s not pretend this is anything new. Sickening as it is.

[quote]4. This is predicated on savings from medicare that have never appeared and is a deeply flawed program open to huge amounts of fraud[/quote].

I agree on this one. There is no chance in hell Congress will reap that much savings from Medicare. As Graham noted, Congress can’t cut Medicare by 8 billion much less 500 billion. Besides, what is the point in cutting one federal healthcare program to finance another?

[quote]5. Now forces people with financial penalties and jail time if they do not buy a product[./quote]

I believe it is just fines, not jail time. And we already face that if we don’t buy auto insurance in most states.

I sure as hell hope not.

He’s running the United States of America. I hope that was helpful.

What do you mean? They pulled out all the stops against this bill but were helpless to stop it. What could they have done?

9

[quote=“lbksig”]That’s because an insurance mandate is unconstitutional. There is nothing in the constitution that requires citizens to purchase commercial products whether or not they will use it. The comparison between a required health insurance and required auto insurance isn’t correct because driving isn’t a right, its a privilege. Your driver’s license can be taken away if you get too many traffic infractions whereas a right cannot be.

Drivers are required to have at least liability insurance to protect others in case of an accident. If you choose not to own a car, and instead ride the bus or a bicycle to work, you aren’t required to purchase auto insurance even though you could get into an accident with an automobile. That’s why the comparison isn’t correct. You can choose not to drive, even though its true that it’s very inconvenient or impossible in most metropolitan areas.[/quote]

Wrong on all accounts. I cannot “choose” not to drive. I must drive to get to work and make a living. The city I work in has no public transportation and I cannot hope to afford the expensive condos within walking/cycling distance of work. This is the case for me and millions and millions of others all over the country. You talk about this like this a theoretical discussion - it isn’t. The necessity of driving is a reality for most Americans. Privilege? Inconvenience? You really must be joking. No, most Americans must be able to drive to get work and earn a living. And the government forces us to buy auto insurance in all but a few states. This is not a choice. If we fail to comply, the government will fine us, take away our licenses, and effectively prevent us from working. We will not be able to afford a home or feed our families.

Haha, I know exactly what you mean! Why should I be forced to subsidize the cretins who drive like maniacs and constantly get in wrecks?

10

My feeling on this is that it is so highly politicised that it’s impossible to keep perspective. It’s like they’re trying to paint an elephant while studying a vase! All involved law makers should be stripped of their health insuance until they come up with, and pass, a fair and workable health plan.

Right now, I pay more than 3 hundred US dollars a month to have my son on my health insurance and still must pay a 20-30 dollar co-pay when he sees the doctor, plus drug costs; and since I have the “good” insurance now, the doctors just love to prescribe top shelf antibiotics or antihistamines that cost a fortune!

Before I had this job, I was working half time and going to school full time. Arkansas has a state health insurance for children, called ARkids, which my son had. The most I ever paid for a doctor visit, or medicine, was $10, and usually nothing at all. My son was only once prescribed a medicine that was not generic (and that was at my request and expense), and sometimes I couldn’t find a doctor who would accept the state insurance because it paid so much less that other plans.

I now make $6000 dollars a year over what the state considers poverty level for a household of two, so my son doesn’t qualify for the state program any more.

Either way, you can see that there are really no good health care options for many Americans. What blows me away are the many, many, seemingly very good, intelligent, people here who seem so afraid of a national health care plan. But most of them have never lived outside of the States–again, they have no perspective!

I like this thread. Thanks for posting it, Gao.

11

Sounds good to me. To be fair, it was the stated goal of the Democrats to implement a public health care plan on par with the Congressional plan. The conservative Democrats crushed that option.

[quote]Right now, I pay more than 3 hundred US dollars a month to have my son on my health insurance and still must pay a 20-30 dollar co-pay when he sees the doctor, plus drug costs; and since I have the “good” insurance now, the doctors just love to prescribe top shelf antibiotics or antihistamines that cost a fortune!

Before I had this job, I was working half time and going to school full time. Arkansas has a state health insurance for children, called ARkids, which my son had. The most I ever paid for a doctor visit, or medicine, was $10, and usually nothing at all. My son was only once prescribed a medicine that was not generic (and that was at my request and expense), and sometimes I couldn’t find a doctor who would accept the state insurance because it paid so much less that other plans.

I now make $6000 dollars a year over what the state considers poverty level for a household of two, so my son doesn’t qualify for the state program any more.[/quote]

Thanks for sharing, housecat. To those of living in the US, this is a real issue, not a theoretical exercise. It’s amazing that the state health insurance plans generally receive bipartisan support, but a comparable system for adults? That’s Communism! :roll: Right now my wife and I are well covered by our employers’ plans. But what happens if we lose our jobs? We’d have to dip into savings to afford COBRA, and when that runs out, private insurance is not an option with a family that has no income and a mortgage to deal with. What if an accident occurs or one of us gets very sick? We’d burn our savings and be plunged into bankruptcy. But we can’t have national healthcare, oh no! Shades of Stalin and all that.

Even better are the conservatives posting in these various threads who oppose national health care in the US but enjoy it in Taiwan. One of them openly praises the NHS while opposing a similar system for the US. Go figure that one out. :loco:

12

Just because “there is nothing in the constitution that requires…” something doesn’t make a law “unconstitutional” - for it to be unconstitutional, the law has to violate something in the constitution. I’ve reviewed the arguments by conservatives that the bill is unconstitutional, but there is nothing explicit in the constitution, or in their arguments, that requiring someone to pay for a service is unconstitutional. Here is an article in factcheck.org analyzing this.

http://www.factcheck.org/2009/10/health-care-overhaul-constitutional/
[/quote]
Perhaps you could direct me to the Article and Section of the Constitution that grants the federal government to require me to purchase a certain product, like a GM produced car. I can see you take the position that the Constitution is a living, breathing document amendable to change. If Congress passes an amendment that gives the government the ability to institute an insurance mandate then we have something to argue over. As is, there isn’t anything in the Constitution that gives them that authority. That’s clear in the text of the 10th Amendment, that:

[quote=“Bill of Rights”] “The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.”.
[/quote]

The text of the Constitution specifically stands to limit the power given to the federal government. It was written to constrain the powers of Congress, and the other branches of our federal government, not give Congress carte blanche to do what it wishes. That’s why all powers not specifically written for Congress into the Constitution are reserved for the states. Congress has the power to regulate the sale of interstate commerce, not require the purchase of a product. If Congress doesn’t have the power to do so, they can’t do it. That in the minimum exceeds Congressional authority and most likely makes their attempt unconstitutional, i.e. not consistent or in accordance with the US Constitution.

Constitutional Implications of an “Individual Mandate” in Health Care Reform (pdf)

Why the Personal Mandate to Buy Health Insurance Is Unprecedented and Unconstitutional

Politifact has a reasoned analysis of this statement as well, concluding “It’s true that the taxes kick in first, before many of the bill’s biggest expenses get started. But the editorial doesn’t mention that the CBO projects the largest cost savings for the bill’s final four years, and that the bill appears to be self-sustaining starting around 2017. So we rate the statement Half True.”

http://www.politifact.com/truth-o-meter/statements/2009/nov/06/wall-street-journal-editorial-page/house-health-care-bill-pays-itself-over-long-run/
[/quote]

Yes, but Politifact also noted that those projected numbers by the CBO depends on Congress behaving itself, which is something that it certainly rarely does. The CBO is correct when saying that there is substantial uncertainty as to predicting the costs of a program a decade in advance. Politifact can only evaluate the truthfulness of the statement presented, that it will be self-sustaining given certain conditions, but can’t address what will happen if those conditions don’t come true. The CBO can only evaluate how the bill will affect the budget and the deficit based on what is in the bill, not whether or not Congress will follow through with the cuts or if the taxes will materialize. However, you only need to look at other government programs (Social Security, Medicare) to get an idea of what is going to happen, mainly that costs will exceed projections, every year the budgets will get expanded and deficit spending will continue indefinitely.

Making deep spending cuts to Medicare is going to be unpopular as hell, and Congress has an aversion to doing unpopular things that may get them voted out of office. Further, the taxes are highly subjective to the idea that the rich will keep purchasing insurance despite the higher cost that they will have to pay. That doesn’t account for the consumer being rational and purchasing less health insurance coverage. Bill Gates will still purchase the same amount of health coverage regardless of the cost because he can afford it. He is an outlier though, whereas the majority of the purchasers will be nearer to that line between being taxed and not being taxed. They will have a behavioral response to the tax of reducing consumption of health insurance by purchasing a cheaper plan and avoiding the tax. That will open up a huge budget hole in the bill.

Once a law passes and is deemed constitutional, and until it is repealed, a payment mandated by the government is essentially a tax or fee for service, even if that payment doesn’t go directly to the government or through the government. I don’t particularly like the fact that my tax dollars go towards new nuclear weapons or biological warfare agents or subsidizing the oil and car and banking industry, and I don’t particularly like the fact that I work 60 or more hours a week and some schmo gets a tiny welfare check or whatever they’re calling it now and can barely scrape by (though I once read that 2/3 of welfare money pre-Clinton went towards children). But we don’t get line-item vetoes on our taxes, and thank god for that. It’s also worth noting that the ridiculously high expenses from health care come from terminal diseases and elderly stuff, and a lot of those have nothing to do with smoking or taking cocaine (how about eating fat food?). Chances are we’re all gonna get one or more of them someday, so the young and healthy and rich(er) paying for the older and sicker and poor(er) is appropriate because we’re likely to be one or more of the latter someday too.[/quote]

What do you think smoking two packs of cigarettes a day causes, other than a terminal illness? I have read the reports where the majority of the health care costs come in the last two years of an individuals life. Cancer treatments are expensive, but not as expensive as dialysis for someone who was morbidly obese most of their life. The difference lies in the fact that a cancer treatment works and saves the person, or doesn’t work and they die. Cancers sometimes come out of remission, but dialysis can be an ongoing cost for decades in some cases. You can actually do something about obesity related illnesses (which are growing to an ever larger share of the healthcare expenditures), but not since Congress took out enforcement mechanisms out of the bills. If you can’t deny someone because of preexisting conditions, can’t raise their rates because they are higher risk, and can’t force them to change their behavior pattern (Fastfood Nation), then you have no way in which to keep costs from increasing.

Your reverse pyramid scenario for healthcare is exactly like what we have in Social Security right now. Social Security needs an ever growing population base to keep each individual’s contribution manageable. If you have a huge population boom in one generation, and then a decrease in the next, you create a population “bubble” for lack of a better term. That bubble, aka the baby boomer generation, is still going to want their benefits but it’s being drawn from a smaller pool of payees. That means each person in the younger generations is going to have to pay more vis a vis higher taxes.

13

You’re confusing “can’t” with “choose not to” or “it would be incredibly hard if not impossible to”. I’m sorry that your city has no public transportation or that the housing near work is extremely expensive. I get that driving is practically required to live in any major city in the US. I live in Los Angeles. I have to drive to work every day, but that doesn’t change the fact that driving is a privilege. There is no right to drive and your license can be taken away from you. Look at individuals who get convicted of DUI’s, or who get too many points on their license. Those individuals do indeed lose the privilege of driving when their license gets suspended and or revoked. So yes, the government requires liability buy insurance if you drive, but it isn’t required to have liability insurance to ride in someone else’s vehicle, ride a bike, ride on a bus or a train.

[quote=“Gao Bohan”]
Haha, I know exactly what you mean! Why should I be forced to subsidize the cretins who drive like maniacs and constantly get in wrecks?[/quote]

You aren’t GBH. Private auto insurance companies can raise their rates in line with the driver’s risk of driving like a maniac and getting in wrecks. Get a speeding ticket and your rates go up. Get into a collision and your rates go up. Get too many and insurance becomes too expensive for you to continue driving. With the analogy to healthcare, if you have a BMI of 40 then your private health insurance rates will go up. If you start smoking, your risk factors go up and so do your monthly premiums. Under the government’s plan, individuals can’t be price-discriminated against for pre-existing conditions, can’t be price-discriminated against for poor choices. There is no mechanism in the public plan, unlike private, to get someone to change their behavior. The private plan hits you in the wallet. The public plan hits someone else in the wallet.

14

Here’s a question for you fine Forumosan minds. Why is it that the other developed nations can manage to have universal healthcare programs, spent thousands less per capita than the US, and yet still have equal or better metrics in most medical service categories?

And I am deeply disappointed in the Medicare cuts. First off, it’s doubtful it will happen because Congress has repeatedly demonstrated an inability to reduce Medicare spending even by modest amounts. So there goes the alleged savings. Secondly, it’s counterproductive to the stated purpose of national healthcare. What a disaster. What is it that other countries are doing right that we’re doing wrong?

15

[quote=“lbksig”]
Once a law passes and is deemed constitutional, and until it is repealed, a payment mandated by the government is essentially a tax or fee for service, even if that payment doesn’t go directly to the government or through the government. I don’t particularly like the fact that my tax dollars go towards new nuclear weapons or biological warfare agents or subsidizing the oil and car and banking industry, and I don’t particularly like the fact that I work 60 or more hours a week and some schmo gets a tiny welfare check or whatever they’re calling it now and can barely scrape by (though I once read that 2/3 of welfare money pre-Clinton went towards children). But we don’t get line-item vetoes on our taxes, and thank god for that. It’s also worth noting that the ridiculously high expenses from health care come from terminal diseases and elderly stuff, and a lot of those have nothing to do with smoking or taking cocaine (how about eating fat food?). Chances are we’re all gonna get one or more of them someday, so the young and healthy and rich(er) paying for the older and sicker and poor(er) is appropriate because we’re likely to be one or more of the latter someday too.

What do you think smoking two packs of cigarettes a day causes, other than a terminal illness? I have read the reports where the majority of the health care costs come in the last two years of an individuals life. Cancer treatments are expensive, but not as expensive as dialysis for someone who was morbidly obese most of their life. The difference lies in the fact that a cancer treatment works and saves the person, or doesn’t work and they die. Cancers sometimes come out of remission, but dialysis can be an ongoing cost for decades in some cases. You can actually do something about obesity related illnesses (which are growing to an ever larger share of the healthcare expenditures), but not since Congress took out enforcement mechanisms out of the bills. If you can’t deny someone because of preexisting conditions, can’t raise their rates because they are higher risk, and can’t force them to change their behavior pattern (Fastfood Nation), then you have no way in which to keep costs from increasing.

Your reverse pyramid scenario for healthcare is exactly like what we have in Social Security right now. Social Security needs an ever growing population base to keep each individual’s contribution manageable. If you have a huge population boom in one generation, and then a decrease in the next, you create a population “bubble” for lack of a better term. That bubble, aka the baby boomer generation, is still going to want their benefits but it’s being drawn from a smaller pool of payees. That means each person in the younger generations is going to have to pay more vis a vis higher taxes.[/quote]

I have a question. If someone without insurance has a medical emergency, I understand that hospitals are legally obliged to provide treatment even if that person has no ability to pay. This treatment then has to be paid for by people who did purchase insurance. The logic is the same as requiring drivers to purchase third party insurance cover. If an uninsured driver causes an accident and has no means to pay for the damages, the drivers who do purchase insurance have to pay in the end through higher premiums.

In the case of medical insurance, I can see only two consistent solutions-either removing the obligation to provide emergency treatment to the uninsured, or forcing everyone to purchase insurance. What would you suggest?

16

That’s simple: because even though the law that’s going through now is pretty wimpy by other western countries’s standards, it’s still only going through because the Democratic congress and Obama pushed it through with the barest of margins. In just about any other year, there would be at least one or two more (if not 20 more) republicans and libertarians to prevent this law and we wouldn’t even get this far.

Getting what other western countries have - and what Americans ought to have if there was a more educated and less ignorant citizenry who listen to the rantings of the right (see “Death Panels”) - would be considered “socialism” in the US, it’s as simple as that. The fearmongerers would be out in triple force to the lies you see them spewing now.

One of the best arguments I’ve heard against the current system (and likely against the new system as it comes in) is the fact that “health insurance” as it is now in the US is not actually insurance, because insurance is for something you don’t expect to happen, but if it does, it would be really bad and costly. Thus even though everyone has car accidents, they are not expected and individually highly unpredictable, so “automobile insurance” is a true insurance: everyone pays a relatively small sum and then is covered when the big unexpected happens.

“Health insurance” then should be insurance against the big unexpected things - like cancers and diseases and such. But it is not insurance at all when it is used for “preventative care” and “end of life care”. Preventative care - going regularly for check ups and diagnoses of symptoms - is absolutely crucial to a healthy society, and it should be done by everyone from birth to death. So it is not unexpected at all and it happens all the time, and should not be covered by “insurance”. The same with end of life care, care for the elderly: barring the unexpected and costly diseases and viruses and accidents, everyone else will get old and need extra health care and assistance. This is expected and regular, so it should not be covered by “insurance”.

The fact is, everyone except the richest among us needs both - coverage for the regular and expected, and coverage for the unexpected and costly - and since people who don’t have the current “health insurance” in one way or the other are still taken care of (albeit without the preventative care that would have reduced or eliminated the likelihood of some of the costlier problems) at the cost of those who do pay, there is only one solution: mandate through taxation, preferably government run if it can be run efficiently (despite being government-run, Medicare and Medicaid have significantly lower overhead than private health insurance organizations for obvious reasons - no advertising, no profit, etc) - that’s what the so-called “public option” might have started to bring into being.

But that’s called “socialism” in America (despite Medicare, Medicaid, and Veteran’s hospital type stuff technically being “socialism” as well), so the best we can get right now is this “mandate through private insurance” half-way. I’ll take what I can get and fight for more when the opportunity comes again.

17

Individual factors - smoking. drinking, poor eating, living in a polluted area - are not the point: what is required is coverage for all, no matter what you’ve gone and done.

Before we go off on a discourse about “personal responsibility”, in practice, unless you’re willing to have health insurers (government or otherwise) monitor the eating habits and smoking habits and drinking habits and so on of each person on a regular basis - and then charge them rates accordingly - then you have to cover everyone regardless. My guess is that anyone who argues for personal responsibility as a reason against mandated health coverage for everyone through pooling would definitely not want their bodies scrutinized every month so their rates could be adjusted - how’d that be for “privacy guaranteed by the constitution”?

So what it comes down to is: everyone on their own with profit-taking high-overhead insurance companies that a large percentage of the population can’t afford and often can’t get when they are out of work, or else management and reduced costs by the government, either through government services (so-called “socialized medicine”) or through mandated insurance (what we’ll start to get now). The current system only works when you’ve got a good enough job to get insurance and when you have a policy that includes preventative care and unexpected crisis care, and that means it doesn’t work for a large part of the population through no fault of their own, and it could happen to any of us simply through downsizing at our companies.

18

Although the amount of end of life care you need can vary greatly. You might drop dead of a heart attack at 70, but you might also end up in an expensive nursing home for 10 years. But I guess in the US much of this is covered by Medicare.

Isn’t medicare “socialism” anyway? Or is “socialism” allowed in the United States when you reach 65?

19

If only that were so…

Lots of things in the US, like Medicare, public schools, public libraries, highways, etc. are indeed “socialism” if you adhere to the American right-wing definition of the term. And that’s part of the hypocrisy of the right.

20

That’s why it has to be done through the government - they are not meant to make a profit or even break even, that is a fallacy perpetuated by the right and libertarians. There is absolutely nothing wrong with a government running a debt (though how much debt is arguable), and in fact that’s one thing a government is for - doing things that are not profitable and should not be put in the hands of profit-making enterprises. Sure health insurance will cost a lot, add a lot of debt at times, but so what? That’s what defense does. Government debt dos not imply irresponsibility in the same way that extreme personal debt does - sure it can get out of hand and become irresponsible, but running programs in the red surely does not.

And calling it a pyramid scheme is missing the point: the fact that people from their 20’s to 50’s pay for kids 1 to 18 and the elderly is a natural function of the way western society is - the middle year people do the bulk of the work and so pay the bulk of the taxes which pay for government services, whatever they are determined to be. Calling it a pyramid scheme seems to me to be just a pejorative way of getting out of society’s constraints.

Social security is another beast entirely - there are many reasons Social Security has problems now and the “pyramid scheme” aspect of not the main one - how about all the money that was supposed to be in the SS fund being double counted and used as part of the general fund, which was spent years ago, so now the general fund owes all that money back but can’t and won’t repay it? But that’s for a different thread and it’s Sunday so I only do one thread today…