What Is Your Take on Health Care Reform?

I vote conservative and I tend to view the ACA as inevitable, regardless of how the decision turned out. Our president hasn't been shy about having justice decline to enforce laws that he views as bad. Justice Roberts hit the nail on the head when he said that SCOTUS is not responsible for protecting the people from the consequences of their political choices. Having said that, I personally must disagree that congress has the authority to tax me for not buying something. This point will surely be litigated further. This is but one step toward the ultimate goal of single-payer for most of the left, so I don't see the ACA as much more than a stepping stone for them.

If we can't repeal it and come up with a better thought out, more vetted reform solution, perhaps we can work within the framework as we see what the ultimate results of the ACA will be.

A state has the right to tax/fine you for not having insurance on your car. You can choose to not have a car, but most people do have them, and if you choose not to cover it with insurance you can even be thrown in jail. I am hopeful that it helps solve some of the issues regarding the emergency treatment mandate that Reagan enacted in 86. If people can get in to see a regular doc instead of waiting for it to become an ER issue, or don't have to go to the ER at all, costs 'in theory' should go down... I personally would favor a single-payer system, but people here seem to completely lose it regarding that...

SBB2016 said:

I am hopeful that it helps solve some of the issues regarding the emergency treatment mandate that Reagan enacted in 86. If people can get in to see a regular doc instead of waiting for it to become an ER issue, or don't have to go to the ER at all, costs 'in theory' should go down.

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It makes sense in theory, but unfortunately the experience we've had here in Massachusetts doesn't support it. Almost a year ago, a study came out that found that ER visits have actually INCREASED since our universal health coverage law was enacted. (The authors also found that the percentage of non-urgent visits has slightly decreased, although anecdotally it doesn't seem that way!)

People have debated the reasons for this increase in ER visits, but probably the most popular explanation (which I agree with) is that a lot of it is because having insurance doesn't guarantee that you'll be able to get a PCP appointment. If it takes you two months to get an appointment for your sore throat or your kid's ear infection, what are you going to do? People even come to our ER for completely non-urgent things like getting their blood pressure medication prescriptions refilled. Also, if someone is depressed and threatens/attempts suicide or is publicly intoxicated, guess where they end up? Being drunk is not generally an emergency, but there aren't enough detox facilities even assuming the patient wants to go to one, and there certainly aren't enough psych beds/appointments for all the psych patients who need them.

I predict that ER utilization will continue to rise, and the one potentially good thing that may come from this is that we may get paid a pittance for the uninsured patients who we currently treat for no pay at all. But unless we get a massive influx of PCPs into this state, and maybe even if we do, the patients will still keep coming to the ER. No matter how busy and overcrowded the ER is, we don't have the option to turn anyone away or even to tell them to come back tomorrow. But PCPs can always just send their surplus patients to us, and they do.

Independent/don't know here as well.

I really don't think anyone will know what will be the sum effect of these reforms for a number of years. I think the financing of medicare for keeping Baby Boomers marginally alive into their 80's-90's is the question that trumps all others including any of these recent upheavals in our field. Although mandating young, healthy buy in to plans that would support them is perhaps related. Lucky us, we may just be able to support them before the system is exhausted and spent.

Nervous Ned said:

It makes sense in theory, but unfortunately the experience we've had here in Massachusetts doesn't support it. Almost a year ago, a study came out that found that ER visits have actually INCREASED since our universal health coverage law was enacted. (The authors also found that the percentage of non-urgent visits has slightly decreased, although anecdotally it doesn't seem that way!)

People have debated the reasons for this increase in ER visits, but probably the most popular explanation (which I agree with) is that a lot of it is because having insurance doesn't guarantee that you'll be able to get a PCP appointment. If it takes you two months to get an appointment for your sore throat or your kid's ear infection, what are you going to do? People even come to our ER for completely non-urgent things like getting their blood pressure medication prescriptions refilled. Also, if someone is depressed and threatens/attempts suicide or is publicly intoxicated, guess where they end up? Being drunk is not generally an emergency, but there aren't enough detox facilities even assuming the patient wants to go to one, and there certainly aren't enough psych beds/appointments for all the psych patients who need them.

I predict that ER utilization will continue to rise, and the one potentially good thing that may come from this is that we may get paid a pittance for the uninsured patients who we currently treat for no pay at all. But unless we get a massive influx of PCPs into this state, and maybe even if we do, the patients will still keep coming to the ER. No matter how busy and overcrowded the ER is, we don't have the option to turn anyone away or even to tell them to come back tomorrow. But PCPs can always just send their surplus patients to us, and they do.

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I am going into FM, I have no doubts... BUT... I won't be in MA!

Can I tell my patients that if they aren't dying at that moment they can't go to the ED??

SBB2016 said:

Can I tell my patients that if they aren't dying at that moment they can't go to the ED??

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You could, but you won't, for at least three reasons. One, your office will be as overcrowded as everyone else's. You're not going to want to live there 24-7, and you'll send your Friday afternoon patients to the ER because otherwise they won't get seen by you until Monday at the earliest. Two, you will send patients to the ER as a fast and convenient way to get testing or specialist services that can't be done in your office. If you want your patient to have an echo, you can either set them up for an outpatient appointment in a few weeks, or you can send them to the ER to get it tonight. Even if you wanted to wait, your patient won't want to. Third, you'll be worried about your liability. You think you won't let the possibility of getting sued influence your practice, but you will, because we all do. So when your answering service (or you) takes a night or weekend call from someone who has what sounds like a trivial complaint, you'll always tell them to go to the ER to be seen.

I honestly know very very little about it and I don't know where to get started on catching up. Suggestions are welcome!

I voted "independent in favor." Basically, I am a pretty hardcore liberal, but I am also smart enough that I don't want to be shown as an Obama fanboy. Anyway.

I am generally in support, however it is far from perfect in my eyes. I don't understand this "exchange" thing. I have looked into it a bunch. The problem is that it isn't much of a change. There are some things that are great including the ability to stay on parents insurance until 26, people not being denied for preexisting conditions, and much more. The 80/20 rule I think will end up being neutral and not good like every democrat claims. I hope the mandate will relieve some burden and I think it is a good idea regardless of it being a conservative idea. I still have a problem with it being linked so much with employers. I also think it needs to include some kind of "cradle to grave" reform because it would get insurance companies to actually push preventative care more. The "for profit" health care system is a bummer.

In short, I wish it did a lot more, however this does not mean I am a fan of socialized medicine. Personally, I think the answer is a government regulated "non profit" coverage plan available to and paid for by everyone which is basic and covers everything that would be covered in a socialized system, plus a "for profit" system on top of that where you can spend more for better coverage. Yes it would be a tiered system, but it would make everyone happy. also the affordable care act lacks tort reform and I think this would be huge. no to defensive medicine, but no to doctors being handcuffed in a socialized system. i am sure evidence based medicine works for many, but the body doesn't act exactly like the textbooks say all of the time, so I think that would be a detriment to patients.

anyway, I don't plan on arguing with anyone about politics on this issue. but this is my brief opinion on the affordable care act. and if you don't think it is brief, trust me. it is.

MedPR said:

I honestly know very very little about it and I don't know where to get started on catching up. Suggestions are welcome!

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This video does a great job with a quick rundown:

[YOUTUBE]http://www.youtube.com/watch?v=3-Ilc5xK2_E[/YOUTUBE]

FrkyBgStok said:

This video does a great job with a quick rundown:

[YOUTUBE]http://www.youtube.com/watch?v=3-Ilc5xK2_E[/YOUTUBE]

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Great vid! Thanks

I am technically a registered Republican, but lean towards the left. Today's Republican party has driven off of a cliff and are a bunch of crazy lunatics. I guess I am a fiscal conservative and social liberal... I guess that makes me a Libertarian??? Whatever. I stay registered as a Republican so I can vote for the least insane Republican candidate in the primaries.

I do believe that health care is a basic human right. Before the recession, the number one cause of bankruptcy in the US was medical bills. People should not lose everything they have because they got sick or had an accident. As such, I am very much in favor of universal health care.

I'm happy about the decision. Why Republicans--who ultimately came up with the heart of this legislation in the first place--would be upset about it is beyond me. Politics trumps policy here. I hope it can be built upon in the future. Excited to see how Vermont's single-payer program develops.

curt656 said:

I am technically a registered Republican, but lean towards the left. Today's Republican party has driven off of a cliff and are a bunch of crazy lunatics. I guess I am a fiscal conservative and social liberal... I guess that makes me a Libertarian??? Whatever. I stay registered as a Republican so I can vote for the least insane Republican candidate in the primaries.

I do believe that health care is a basic human right. Before the recession, the number one cause of bankruptcy in the US was medical bills. People should not lose everything they have because they got sick or had an accident. As such, I am very much in favor of universal health care.

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I was a staunch republican my whole life until they turned on me (google Ohio senate bill 5) and now I'm just somewhere off in lala land, not really committing to any party.

I voted independent/don't know. Many in healthcare feel they are on the front lines of medicine and I am also in that camp. We see people prehospital, most of them pre-physician and without primary care, and in my running district, the vast majority of them are either Medicaid or self-pay. I feel I have a pretty good grasp of what's truly wrong with healthcare today, but I don't have the power or influence to do anything about it.

Bottom line, I think healthcare reform is long overdue and quite necessary. I don't know that this is the exact right plan, but I give Obama credit for having the balls to stand up and try SOMETHING, otherwise we'd continue to talk and theorycraft for decades to come with no one doing anything about it. At least we have a start now.

I sympathize with what doctors are facing right now. They suddenly find themselves in the crosshairs, everyone insisting that they are greedy and should happily slash their paychecks for the greater good.

I think it's a good base to work off of. American politics is absolutely byzantine, so the only way to make progress is by these very incremental, very marginal steps.

The only reasons the Republicans were against this bill is because it came from a Democratic administration. The entire bill is based off of what Romney did in MA and what the Heritage Foundation wrote in the 80s and 90s. And there are many great things about this bill, such as the end of recission, pre-existing conditions, and 80% of all premiums paid must go to healthcare spending otherwise insurance companies have to issue rebates. This bill should also make doctor pay go up, not down because now everyone should have insurance and thus total reimbursements should go up. That is independent of the increases being paid out to primary care physicians.

Deekle said:

I vote conservative and I tend to view the ACA as inevitable, regardless of how the decision turned out. Our president hasn't been shy about having justice decline to enforce laws that he views as bad. Justice Roberts hit the nail on the head when he said that SCOTUS is not responsible for protecting the people from the consequences of their political choices.

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Roberts is pathetic. Obama opposed his nomination, now he turns around and bends over backward for his administration. And now he's saying "SCOTUS is not responsible for protecting the people from the consequences of their political choices?" Funny, I somehow doubt he'd apply the same principle to Brown v. Board of Education, or Roe v. Wade, or Loving v. Virginia, or Romer v. Evans, or Lawrence v. Texas, or Griswold v. Connecticut, or any of the other "landmark" Supreme Court decisions which are accurately touted as victories by the cultural left, in which an activist court invalidated the people's political choices, in their minds "protecting" us from the alleged tyrannies (i.e., restrictions on individual autonomy) resulting from those choices.

curt656 said:

I am technically a registered Republican, but lean towards the left. Today's Republican party has driven off of a cliff and are a bunch of crazy lunatics. I guess I am a fiscal conservative and social liberal... I guess that makes me a Libertarian??? Whatever. I stay registered as a Republican so I can vote for the least insane Republican candidate in the primaries.

I do believe that health care is a basic human right. Before the recession, the number one cause of bankruptcy in the US was medical bills. People should not lose everything they have because they got sick or had an accident. As such, I am very much in favor of universal health care.

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Exhibit #8432988750 in the case that libertarians are basically liberals. You're not a fiscal conservative. You believe health care is a basic human right, and are in favor of universal health care? You're a fiscal liberal.

Trismegistus4 said:

Exhibit #8432988750 in the case that libertarians are basically liberals. You're not a fiscal conservative. You believe health care is a basic human right, and are in favor of universal health care? You're a fiscal liberal.

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Wow someone is a little touchy, huh? Well by your logic neither is the Republican party who loves spending all the money on war and the military industrial complex. I don't want the government to spend more money, I want them to spend it where it matters the most. I would rather they took the vast majority of military spending and spent it on healthcare. The US needs to stop meddling in other countries affairs and keep the money here by spending it on Americans who need it most.

Gee, if memory serves, the last president to balance the budget (with a surplus mind you) was good ole Mr, Clinton. Then comes W who decided to cut revenue and ramp up spending by lying to Americans and putting us in Iraq essentially mortgaging the United States to China. The Republicans have turned in to a bunch of gas bags who say one thing and do another. They prefer to help corporations instead of people. I will always choose for our government to help people who need it versus helping corporations and CEO's get richer and richer.

curt656 said:

Wow someone is a little touchy, huh? Well by your logic neither is the Republican party who loves spending all the money on war and the military industrial complex. I don't want the government to spend more money, I want them to spend it where it matters the most. I would rather they took the vast majority of military spending and spent it on healthcare. The US needs to stop meddling in other countries affairs and keep the money here by spending it on Americans who need it most.

Gee, if memory serves, the last president to balance the budget (with a surplus mind you) was good ole Mr, Clinton. Then comes W who decided to cut revenue and ramp up spending by lying to Americans and putting us in Iraq essentially mortgaging the United States to China. The Republicans have turned in to a bunch of gas bags who say one thing and do another. They prefer to help corporations instead of people. I will always choose for our government to help people who need it versus helping corporations and CEO's get richer and richer.

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There is so much truth to this that I feel like clapping out loud and cheering for you.

I am an independent voter (not a fan of either party) and I voted that I oppose the ACA. While I am a proponent of universal health care, I don't believe that this bill is a step in the right direction.

While there are many parts of the bill that are good, I disagree with the mandate. This will not move us towards a single-payer system, which is what I feel is the only solution, but actually cement us in the private health insurance system that we currently have. Lots of money can be saved by moving away from private health insurance to medicare for all (see http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/), and the mandate portion of the bill is in effect a handout to the insurance companies. It's no surprise, it was originally proposed by the Republicans, and much of it's base was written by and is being implemented by a former VP of WellPoint, a private insurer.

http://prwatch.org/news/2011/05/10709/are-health-insurers-writing-health-reform-regulations

http://www.salon.com/2010/07/15/fowler_4/

Like many others, I'll be watching Vermont to see how their experiment with a single-payer system goes.

I really dislike the car insurance analogy. Car insurance is mandatory only as a liability. You are not required to protect your car, only the damage you might (and cannot guarantee you won't) do to the cars of others. That is fine with me. Additionally if you show you have a secured a minimal required amount put away for this liability purpose, you are not required to buy this insurance. Of course few chose to do that, but they are free to do so.

Here we have a different situation, you are required to protect your own body.
Can you guarantee you won't get seriously sick? No.
Does your sickness hurt property/well being of others? Maybe in case of infectious deceases. But that's hard to track. What if a person is rich enough to have enough money put away for unexpected treatment?

It just doesn't hold up. This is a pure socialist policy and it is unfortunate this is happening in this country.

I also agree with a comment someone made in one of the threads who actually was a strong opponent of what I am saying: "You don't use insurance to buy gas. Why use insurance for routine medical expenses?" I have a medical savings account that I max out every year with pretax contributions. Those can also be willed to your children etc. One of the videos also said that one of the main problems today is that uninsured people are quoted a massively larger price than what insurance companies actually end up paying for an insured person. This is def a problem. It is called collusion/price fixing. This sort of thing should be legally persecuted to fix this, not by passing socialist legislature that punishes high income people.

I do not belong to any party but i am a sympathizer with the democrats on most issues. Over all the seem to be for things that i am passionate about. I like the republicans on many issues as well and i hope that one-day they drop their obsessions with social issues and intrusion into peoples lives so that i can vote for them.

With that cleared up I am for the ACA, I think we need universal healthcare, I have lived through one before and although it has its downside I think overall it works better than what we currently have. I like our system but it too expensive and leaves us at the mercy of the insurer. The system is too expensive, we need to get rid of the middle man "the Insurer" who adds no significant value to the supply chain. I have often queried myself of the significance of insurance companies and yet to come up with a good one. No system is perfect and we will never have a perfect system but ACA is a start. It took Canada decades after the province of Saskatchewan started the trend for a federal system to emerge, there was not universal agreement either but today it is not a political issue because all politicians accepts that talking about getting rid of it is a losing issue. I am confident that one day that will happen here

LoLCareerGoals said:

It just doesn't hold up. This is a pure socialist policy and it is unfortunate this is happening in this country.

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I don't think you know what the word socialist means. This is a very free market piece of legislation. The very core of the ACA came from the Heritage Foundation, a very right leaning think tank. The individual mandate is exactly what the Republicans were touting back in the '80s and '90s as an alternative to single-payer/public option that the Democrats were pushing for.

This legislation is about as far from socialism as you can get without saying "**** you I got mine."

I don't really care what party it came from. Is it not 250K+ers who are footing the bill? Higher taxation of one group to help the other is .... **** you I got mine?
Also it is a form of "people are too stupid to do this on their, let the government step in and and tell you what to do you unintelligent citizen".
Government will directly intervene with business practices under this law. They say they will promote competition. We used to promote competition by breaking up trusts and persecuting price fixing/collusion. Why is that not an option today?

LoLCareerGoals said:

I don't really care what party it came from. Is it not 250K+ers who are footing the bill? Higher taxation of one group to help the other is .... **** you I got mine?

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The taxes on top earners are the lowest they've been ever since the implementation of the income tax. Even under Reagan, top earners were paying effective rates of 30-40% vs 15-25% today. We have 30 years of data that shows that lower taxes on top earners doesn't do anything but concentrate wealth in those brackets. During the '50s and '60s, effective rates were >50% on top earners and we had the greatest economic expansion in history. Ever since the '80s, top rates have come down, deficits have ballooned in response and we have had nothing but phantom growth to show for this.

Also it is a form of "people are too stupid to do this on their, let the government step in and and tell you what to do you unintelligent citizen".

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False. The ACA levels the playing field for most people. It removes vastly unpopular measures such as recission, pre-existing conditions and lifetime limits. It's not that people are too stupid or unintelligent. The system was literally setup to be against you. You had people paying 2k+ a year to maintain COBRA in order to stay insured, otherwise, these people would become uninsurable because of pre-existing conditions. Something like 80% of all medical bankruptcies happened to people with health insurance. The system was simply broken.

The only way to have these popular provisions is to require everyone to buy insurance. The individual mandate is more akin to car insurance, which is a requirement in most states in order to drive. Health care is in the unique position because everyone will eventually require some level of care.

Government will directly intervene with business practices under this law. They say they will promote competition. We used to promote competition by breaking up trusts and persecuting price fixing/collusion. Why is that not an option today?

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Maybe, maybe not. We have to see exactly what comes out of ACOs and the like. People have been fed tons of misinformation and garbage regarding the PPACA.

slp2doc said:

Again, Republican or Democrat idea, PPACA is just awful. Medicare/aide was the slippery slope that led us here, which is only a short pit stop on the way to socialized healthcare. I shudder to think that by the time I graduate residency, I will do so as a capitulating government employee, or not at all.

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Then what's the alternative? You do know that before Medicare, close to 90% of all seniors could not afford medical care. And that was in the '60s. Do we just let all those people die or remain sick? Do we let the poor and indigent simply waste away because they can't afford medical care? I never hear any alternatives from the Right/GOP. To the ACA, there is none. The ACA was the GOP alternative.

notbobtrustme said:

The taxes on top earners are the lowest they've been ever since the implementation of the income tax. Even under Reagan, top earners were paying effective rates of 30-40% vs 15-25% today. We have 30 years of data that shows that lower taxes on top earners doesn't do anything but concentrate wealth in those brackets. During the '50s and '60s, effective rates were >50% on top earners and we had the greatest economic expansion in history. Ever since the '80s, top rates have come down, deficits have ballooned in response and we have had nothing but phantom growth to show for this.

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Who cares what happened in 50s 60s? Besides it is not like you can autocorrelate the 2 just because they were happening at the same time. This isn't an exact science.
Also 15-20 is for non salaried capital gains earning super rich. I think it is OK if that is classified as regular income. Be happy with 40% because it used to be 70%. Yeah black people be happy to be segregated because you used to be slaves.

The discussion was weather or not I am familiar with what "socialism" is.
I do understand basic principles of taking from group A, giving to group B.

notbobtrustme said:

False. The ACA levels the playing field for most people. It removes vastly unpopular measures such as recission, pre-existing conditions and lifetime limits. It's not that people are too stupid or unintelligent. The system was literally setup to be against you. You had people paying 2k+ a year to maintain COBRA in order to stay insured, otherwise, these people would become uninsurable because of pre-existing conditions. Something like 80% of all medical bankruptcies happened to people with health insurance. The system was simply broken.

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I do sympathise with people who are in dealt a bad hand (serious pre-existing conditions). I do think there is a huge difference between being born with one (or developing one while still a child) and then being denied coverage and developing one as an adult and THEN seeking insurance. In the later case, you are responsible.

Some sort of a mandatory insurance (that parents are required to buy before they have
children) that protects children/newborns and guarantees them care if they have such a condition I think would be fair. If you are bringing a human being into the world and you cannot guarantee that he/she will not have a serious condition thus you are (with some probability) causing another human being suffering and hence should be required to insure yourself from that. This insurance should also be optional if you can show sufficient cash reserves put away for this purpose(just like with car insurance) This is analogous to car insurance example few posts above.

Parents then should be required to maintain it (only on their children, not themselves) until some "adult" age. If a child is born with a condition, premium cannot go up (except due to inflation etc.) At some adult age, now adult children should however be given a choice: stay on the plan or quit. If they quit, fine don't complain later. This is sort of like dropping full coverage once you fully own the car. Your call.

Requiring adults having insurance on themselves is like saying "you are too stupid to know better, do what I say".

notbobtrustme said:

The only way to have these popular provisions is to require everyone to buy insurance. The individual mandate is more akin to car insurance, which is a requirement in most states in order to drive. Health care is in the unique position because everyone will eventually require some level of care.

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Don't see the analogy except for the case with kids.

notbobtrustme said:

the taxes on top earners are the lowest they've been ever since the implementation of the income tax. Even under reagan, top earners were paying effective rates of 30-40% vs 15-25% today. We have 30 years of data that shows that lower taxes on top earners doesn't do anything but concentrate wealth in those brackets. During the '50s and '60s, effective rates were >50% on top earners and we had the greatest economic expansion in history. Ever since the '80s, top rates have come down, deficits have ballooned in response and we have had nothing but phantom growth to show for this.



False. The aca levels the playing field for most people. It removes vastly unpopular measures such as recission, pre-existing conditions and lifetime limits. It's not that people are too stupid or unintelligent. The system was literally setup to be against you. You had people paying 2k+ a year to maintain cobra in order to stay insured, otherwise, these people would become uninsurable because of pre-existing conditions. Something like 80% of all medical bankruptcies happened to people with health insurance. The system was simply broken.

The only way to have these popular provisions is to require everyone to buy insurance. The individual mandate is more akin to car insurance, which is a requirement in most states in order to drive. Health care is in the unique position because everyone will eventually require some level of care.



Maybe, maybe not. We have to see exactly what comes out of acos and the like. People have been fed tons of misinformation and garbage regarding the ppaca.

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exactly!

LoLCareerGoals said:

Who cares what happened in 50s 60s? Besides it is not like you can autocorrelate the 2 just because they were happening at the same time. This isn't an exact science.
Also 15-20 is for non salaried capital gains earning super rich. I think it is OK if that is classified as regular income. Be happy with 40% because it used to be 70%. Yeah black people be happy to be segregated because you used to be slaves.

The discussion was weather or not I am familiar with what "socialism" is.
I do understand basic principles of taking from group A, giving to group B.

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You really should care about the past because those who don't are destined to repeat it. Go back to the Great Depression. Right before the GD, there was a tremendous amassing of wealth by the top 1% (sound familiar?). There was over investment in housing and other securities creating a bubble that caused the crash (sound familiar?). Debt vs GDP ha reached levels never seen again until now (sound familiar? Thanks Bush!). Income tax rates were at the lowest levels ever seen at the time ( sound familiar?). Banks were largely unregulated allowing them to crash the global economy (sound familiar?). I could keep going. You'd think we were in the great depression now!

But what saved us this time??

Virtually every economist would agree that the Great Depression started out as a recession which ballooned because the government failed to inject liquidity into the banking system. Can you see a difference between then and now?

What brought us back from the toilet that was the Great Depression??

The three main catalysts of the recovery were:

Increasing income tax to keep the rich from hoarding all the money. Poor and middle class people spend and stimulate the economy. The rich are driven by making money and holding on to it. The rich preach and benefit from Capitalism but practice Oligarchy.

The government putting people to work via projects in infrastructure and civil service vis a vie the New Deal, which includes Social Security.

And... Wait for it... Regulating the living **** out of the banks.

I am not really interested in having a pseudo-scientific (read economics/history) discussion. Those type of arguments can neither be won nor lost. Experiences will shape perceptions and any "evidence" can be cooked up to serve many sets of those perceptions.

I am however interested in a logical argument brought up here that I think can be won. (by me obv )
That argument being: is this policy socialist? (yes imo)
Is it anything like mandatory car insurance? (no, except for kid cases described above)
Those are the only 2 points I intended to challenge.

Further discussion whether socialism is good or bad and in what doses and how different pseudo-evidence supports/or does not support it is not interesting to me.

LoLCareerGoals said:

I am not really interested in having a pseudo-scientific (read economics/history) discussion. Those type of arguments can neither be won nor lost. Experiences will shape perceptions and any "evidence" can be cooked up to serve many sets of those perceptions.

I am however interested in a logical argument brought up here that I think can be won. (by me obv )
That argument being: is this policy socialist? (yes imo)
Is it anything like mandatory car insurance? (no, except for kid cases described above)
Those are the only 2 points I intended to challenge.

Further discussion whether socialism is good or bad and in what doses and how different pseudo-evidence supports/or does not support it is not interesting to me.

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And as stated before, you don't seem to know what a socialist policy is. This isn't even close to it. Not sure what point you have for your second argument. Without addressing the mandate (because you keep saying policy, not mandate) please explain exactly how the ACA is a socialist policy?

For people that have insurance, nothing changes. This penalty is projected to directly affect about 2% of the population. And having cash stores on hand? How much is adequate? What if you get something that depletes it completely? It isn't worth putting it into policy because enough cash stores would be hundreds of thousands of dollars. That is going to be feasible for about 7 people in the nation.

The problem is that republicans say "no mandate" dems say "your idea, what about compassion" libertarians say "let the uninsured die" but everything changes when it becomes real. If people are playing football knowing full well that injury can occur, no one stands around and makes fun of the person that breaks their neck because it "sucks to them."

Before the ACA, it is polled that about 80% of america wanted health care reform. In politics, that is almost the highest number you can hope to achieve. So if the ACA isn't good, what is better?

So I postulate this idea. If the ACA were repealed and the system we have continues, insurance companies will continue to get worse as they have been doing until it gets to the point were Americans are so fed up, a real socialist plan passes. This mandate is preventing that. Entirely speculation on my part, but I feel like this is what can happen. Often times people get quite pissed.

So instead of whining how socialist this non-socialist plan is, what is a better idea? How would you solve the health care issue that is cheaper, better, addresses the problems America has, and insures more?

Edit: and I am legitimately asking for a better plan, not just a degrading setup.

FrkyBgStok said:

And as stated before, you don't seem to know what a socialist policy is. This isn't even close to it. Not sure what point you have for your second argument. Without addressing the mandate (because you keep saying policy, not mandate) please explain exactly how the ACA is a socialist policy?

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Anything that isn't financed equally by everyone yet is accessible equally by everyone is socialist. Top earners will take on a lot of the burden. This was already addressed several posts above. I am guessing for you to call something socialist it has to be "highly socialist", I am not arguing dosage merely whether or not it is so. It is a step to the left, not arguing how large of a step it is. How about I use a less threatening term like "collectivist"? I yes I was talking about the mandate.

As for my 2nd point. I simply dislike false logic and when it is used to validate an argument. If I ever get a passage like:

"The author likened health insurance to car insurance, write a passage explaining why you agree or disagree"

on MCAT I'll be ready

LoLCareerGoals said:

Anything that isn't financed equally by everyone yet is accessible equally by everyone is socialist. Top earners will take on a lot of the burden. This was already addressed several posts above. I am guessing for you to call something socialist it has to be "highly socialist", I am not arguing dosage merely whether or not it is so. It is a step to the left, not arguing how large of a step it is. How about I use a less threatening term like "collectivist"? I yes I was talking about the mandate.

As for my 2nd point. I simply dislike false logic and when it is used to validate an argument. If I ever get a passage like:

"The author likened health insurance to car insurance, write a passage explaining why you agree or disagree"

on MCAT I'll be ready

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Ok but I fail to see how top earners will take on more burden. The mandate is coming as a tax penalty. So if you have health insurance, you don't pay it. All the top earners likely have health insurance, so nothing changes, how are they taking on more burden? Even if we used your definitely of socialist, it still isn't a socialist policy. Regardless of how you feel about the mandate, it isn't a tax increase, it is a tax penalty. So likening it to car insurance, it is that $400 ticket you get if you don't have car insurance. If you have it, you won't ever get the ticket.

LoLCareerGoals said:

Anything that isn't financed equally by everyone yet is accessible equally by everyone is socialist.

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Here's the Merriam-Webster definition of socialism:

1
: any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods

Since the ACA isn't creating any government-owned insurance company which you are obligated to be covered under, I don't know how you can infer that it is a socialist policy....

You still must buy insurance from a corporation, such as Wellpoint, a publicly-traded corporation. If you want to attach a buzzword to the ACA, probably the best one in my opinion is "corporatist" considering a lot of it was developed and written by insurance companies and their lobbyists.


On the other hand, if you want to see an example of what socialized medicine looks like for comparison, you can read this article:

http://www.time.com/time/magazine/article/0,9171,1376238,00.html

Ok but increasing the applicant pool does nothing for the healthcare problems including dropping for pre existing conditions, going bankrupt because of healthcare, the lack of preventative care, the lack of responsibility to the providers, etc. etc. etc. All it does is reduce costs, and that isn't the largest problem. It makes it more affordable, but it doesn't help the families struggling to pay for rent, food, and more. It doesn't change the fact that companies have shareholders they need to appease with profits.

FrkyBgStok said:

Ok but increasing the applicant pool does nothing for the healthcare problems including dropping for pre existing conditions, going bankrupt because of healthcare, the lack of preventative care, the lack of responsibility to the providers, etc. etc. etc. All it does is reduce costs, and that isn't the largest problem. It makes it more affordable, but it doesn't help the families struggling to pay for rent, food, and more. It doesn't change the fact that companies have shareholders they need to appease with profits.

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You're right, increasing the applicant pool doesn't address those things, that's why there are other provisions in the ACA:

1. Pre-existing conditions: After January 1, 2014 The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, it eliminates the ability of insurance companies to charge higher rates due to gender or health status.

http://www.healthcare.gov/law/timeline/index.html#event46-pane

2. Going bankrupt because of healthcare costs: The Affordable Care Act prohibits health plans from putting a lifetime dollar limit on most benefits you receive. The law also restricts and phases out the annual dollar limits a health plan can place on most of your benefits — and does away with these limits entirely in 2014.

http://www.healthcare.gov/law/features/costs/limits/index.html

3. Preventative Care: Under the Affordable Care Act, you and your family may be eligible for some important preventive services — which can help you avoid illness and improve your health — at no additional cost to you.

http://www.healthcare.gov/law/features/rights/preventive-care/index.html

4. Insurance profits: The law requires insurers selling policies to individuals or small groups to spend at least 80% of premiums on direct medical care and efforts to improve the quality of care. Insurers selling to large groups (usually 50 or more employees) must spend 85% of premiums on care and quality improvement.

http://www.healthcare.gov/law/features/costs/value-for-premium/index.html

AND

The Affordable Care Act creates a Rate Review program in your state to help protect individuals and small businesses from unreasonable health insurance rate increases. Starting on September 1, 2011, health insurers must justify any rate increase of 10% or more before the increase takes effect.

http://www.healthcare.gov/law/features/costs/rate-review/index.html.

5. Helping struggling families: Expansion in 2014. Starting in 2014, the Affordable Care Act will expand the Medicaid program to cover people under age 65, including people with disabilities, with income of about $15,000 for a single individual (higher incomes for couples and families with children).

http://www.healthcare.gov/using-insurance/low-cost-care/medicaid/index.html#howmed

FrkyBgStok said:

Ok but I fail to see how top earners will take on more burden. The mandate is coming as a tax penalty. So if you have health insurance, you don't pay it. All the top earners likely have health insurance, so nothing changes, how are they taking on more burden? Even if we used your definitely of socialist, it still isn't a socialist policy. Regardless of how you feel about the mandate, it isn't a tax increase, it is a tax penalty. So likening it to car insurance, it is that $400 ticket you get if you don't have car insurance. If you have it, you won't ever get the ticket.

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Is there no provision to raise taxes via increase of what amount is subject to Medicaid taxation or otherwise for people earning over 250k?

I haven't had health insurance since I turned eighteen and I've never needed it. I'm upset that the government now has the right to force me to buy health insurance that I don't want. If they have this right, then in the future they could make you and me buy anything, including forced purchases of Grey's Anatomy DVDs.

Chip N Sawbones said:

I haven't had health insurance since I turned eighteen and I've never needed it. I'm upset that the government now has the right to force me to buy health insurance that I don't want. If they have this right, then in the future they could make you and me buy anything, including forced purchases of Grey's Anatomy DVDs.

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Seriously?

I haven't had health insurance since I turned eighteen and I've never needed it.

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How do you pay for your healthcare or do you not get any? If the latter, I find it rather disturbing that someone who doesn't find regular preventative healthcare to be important is planning to become a doctor.

LingoLaine said:

How do you pay for your healthcare or do you not get any? If the latter, I find it rather disturbing that someone who doesn't find regular preventative healthcare to be important is planning to become a doctor.

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Well, I never get really sick, so that's a good start. The last time I needed to go to the hospital in the US was about seven years ago when I caught a splinter in the eye. That set me back $500. $500/7 works out to $71 of average annual health costs, plus a little extra for some antibiotics and more eyeball splinter removal I got when I was overseas. Those expenses wouldn't be covered by Obamacare anyhow, so I won't count them. I don't know how much insurance will cost when the government makes me buy it, but I do know it will be a heck of a lot more than $71 a year.

FiremedicMike said:

Seriously?

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Seriously. I don't actually believe the government will make me buy Grey's Anatomy, but if they can make me buy health insurance than I can see them making me buy other things I don't want, such as an electric car, life insurance, or a gun. Maybe when everyone realizes how much government-funded health care will cost, the government will attempt to lower costs by fighting obesity through a policy of making everyone buy more vegetables. I'm not saying these things will happen, only that the health care act means that they could happen. I don't trust the government to carefully restrain its new power to control my life.

Chip N Sawbones said:

Well, I never get really sick, so that's a good start. The last time I needed to go to the hospital in the US was about seven years ago when I caught a splinter in the eye. That set me back $500. $500/7 works out to $71 of average annual health costs, plus a little extra for some antibiotics and more eyeball splinter removal I got when I was overseas. Those expenses wouldn't be covered by Obamacare anyhow, so I won't count them. I don't know how much insurance will cost when the government makes me buy it, but I do know it will be a heck of a lot more than $71 a year.

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I'm not sure what your exposure to healthcare is to date, but the fact is you are the minority. A huge chunk of uninsured people utilize billions of dollars per year in healthcare with no intention or ability to pay for those services. Those costs then get pushed off on those of us who have insurance and are fiscally responsible for our lives, and is patently unacceptable. Mandating healthcare for all drives down the costs for all and also puts more money in the pool available to be collected by physicians for performing the services that are already being performed. Don't want to play? That's fine, pay the government your tax so they can use that money to help diffuse the already out of control defaulting on healthcare costs and you can do whatever you want.

Seriously. I don't actually believe the government will make me buy Grey's Anatomy, but if they can make me buy health insurance than I can see them making me buy other things I don't want, such as an electric car, life insurance, or a gun. Maybe when everyone realizes how much government-funded health care will cost, the government will attempt to lower costs by fighting obesity through a policy of making everyone buy more vegetables. I'm not saying these things will happen, only that the health care act means that they could happen. I don't trust the government to carefully restrain its new power to control my life.

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This isn't the first time the government has mandated a purchase of it's citizens, as a matter of fact it's kind of funny that you mentioned guns, seeing as that very mandate was made at one point in time.

FiremedicMike said:

This isn't the first time the government has mandated a purchase of it's citizens, as a matter of fact it's kind of funny that you mentioned guns, seeing as that very mandate was made at one point in time.

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Second Militia Act of 1792 forced every free white male from ages 18-45 to join a militia and provide themselves with a musket, among other things.

Well, as a SCOTUS nerd (in a former life, I wanted to study con law) I'm frankly fascinated by the conservative majority's decision not to uphold the law on Commerce Clause grounds, as that changes a whole bunch of precedent going back to the early 40s and Wickard v Fillburn -- and frankly I have always disliked and been wary of a lot of the Commerce Clause powers the gov't has granted itself in the past 100 years or so.

That said, I am far from a conservative; I'm actually pretty far to the left, despite viscerally disliking most leftists (as distinguished from liberals). I am a beneficiary of the ACA ruling, as it means I will keep my health insurance, vital for me since I have a number of "pre-existing conditions." Nevertheless, I don't like the ACA and I think it's bad law, for a number of reasons.

The biggest reason is that I think the ACA will create more, rather than less, bureaucracy, and therefore will create more, rather than less, overhead expenditure, so that savings from the law will end up being offset by the inefficiencies which the ACA exacerbates rather than fixes. I would prefer some kind of coherent system. The system pre-ACA was incoherent, and the system as it is now is incoherent. I'd be happy with a German or Japanese-style universal health insurance system, or with single-payer; I suspect the German system would work best in the US, since it's less socialized than a lot of other universal health care systems. Funnily, everyone in my family, from the Reagan Republican to the neo-con to the NPR liberal to ex-Marxist Feminist me supports single payer; but we've never really toed the line politically.

---

One other thing that I'd love to pick the brain of an economist about ---

People on the left are fond of citing the statistics that, as a percentage of GDP, the US health care costs vastly outstrip those of countries with universal health care. But what I haven't seen is whether health care costs as a percentage of national expenditures - of the budget - are lower. Because it seems to me it's quite possible that the US could lower health care costs as a percentage of GDP while increasing health care costs as a percent of the budget, which would be ruinous.

Everyone interested in this topic (which should be everyone going into medicine) should take a look at UPenn's free online course at https://www.coursera.org/ Sign up and just listen to the lectures and do the reading if you wish. Other interesting stuff there too.

BTW, the US does have universal healthcare. It's just not that universal. It's there if you're a citizen and young, old, or disabled. Or really really really poor. And health care IS like cars. You participate. Period. Even if you don't own a car I bet you hope that driver hopping the curb and mowing you down has insurance. If you survive, that is.

OK, that last line wasn't a direct analogy. But it was fun to write.