Canadian Healthcare vs. Obamacare

[Isoprop]

I understand the points made, and no I don't spit in hobo's faces. I love helping people (otherwise I wouldn't be in health care), but I just think it's ridiculous that 50% of the population is going to cover the cost of 100%. I'm okay with medicare (although I loathe their crooked hoops you have to jump through for them to pay anything) and I'm okay with tri-care (our military people deserve coverage for them an their families - i mean they go into Iraq for 30k/yr)

My problem is not the people who ACTUALLY can't work - my problem is the idiots that have jumped on that bandwagon and come up with bottomless excuses so they don't HAVE to work and get everything handed to them.

I think 1/2 our problems would be solved if we would screen people who want everything paid for them rather than screen the people who are paying $500/mo for insurance. I mean someone submits a form that shows they make $18k/yr and they get everything handed to them - why not ask why they don't work at the ripe young age of 25? Instead we ask the 40 year old who has worked since he was 18 and pays outrageous premiums for insurance why he hasn't tried medication A before medication B? Or tell him he needs to try antibiotics before a CT of the head when he's had dizziness, unilateral vision loss, and facial drooping (actual patient in the clinic). Or tell him that you won't cover a certain medication?

Are you suggesting that lazy people should be banned from receiving quality, basic health care?

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[Paladin7]

Are you suggesting that lazy people should be banned from receiving quality, basic health care?

Kaous did not suggest that. No rational person would suggest that.

By all means, all people should have access to healthcare. It wouldn't be right to ban people from receiving basic healthcare under any circumstances that I can think of. But is it right for the government to take the money from people's earned income to fund it? Some people think the money could and should come from other sources besides the income of hard-working Americans.

 

[Isoprop]

Kaous did not suggest that. No rational person would suggest that.

By all means, all people should have access to healthcare. It wouldn't be right to ban people from receiving basic healthcare under any circumstances that I can think of. But is it right for the government to take the money from people's earned income to fund it? Some people think the money could and should come from other sources besides the income of hard-working Americans.

Okay, so where can and should the money come from?

 

[Paladin7]

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[morning]

Why not food and water? They are even bigger necessities. It'd be even cheaper to provide that to everyone before we give them healthcare. You have to draw the line somewhere.

You can grow your own food and even make your own shelter. You can't handcraft your own chemotherapy, blood pressure medications, prenatal care, or dialysis. I don't know why this is so difficult for people to understand - you can't simply come up with healthcare on your own. You don't grow it in a garden. You can't stuff it into your coat and run out of the dollar store with it. It is totally different than the other basic necessities of human survival in that it absolutely HAS to come from someone else.

I understand the points made, and no I don't spit in hobo's faces. I love helping people (otherwise I wouldn't be in health care), but I just think it's ridiculous that 50% of the population is going to cover the cost of 100%. I'm okay with medicare (although I loathe their crooked hoops you have to jump through for them to pay anything) and I'm okay with tri-care (our military people deserve coverage for them an their families - i mean they go into Iraq for 30k/yr)

If you're including children and the elderly into that equation, sure, maybe 50% of the country doesn't work...but I can't imagine anyone actually believing that we shouldn't be providing healthcare to children, the elderly, and the disabled who can't work at all. Other than that, the unemployment rate is 9.6%. I know there are people who are not looking for work and aren't on the unemployment rolls, but it's certainly not 40.4% of the country.

 

[Pons Asinorum]

You can grow your own food and even make your own shelter. You can't handcraft your own chemotherapy, blood pressure medications, prenatal care, or dialysis. I don't know why this is so difficult for people to understand - you can't simply come up with healthcare on your own. You don't grow it in a garden. You can't stuff it into your coat and run out of the dollar store with it. It is totally different than the other basic necessities of human survival in that it absolutely HAS to come from someone else.

Just to clarify, you're argument is that the same cohort that currently lacks health care coverage of any kind (Medicaid, Medicare, Tricare, VA, private insurance) is a group that is capable of growing its own food and building their own shelter? What portion of that working-but-not-too-poor do you think are landowners? I don't think you're serious in laying that out as an argument for further federalizing or socializing or whatever the U.S. health care system. And I think that Khaos05's point is the fact that the top 50% of earners pay ~97% of all federal income taxes. The bottom 50% already contribute nothing from their income to funding the current federal health care systems.

 

[Pons Asinorum]

... I don't "have it all figured out."

Neither does anyone else. That's one of my biggest pet peeves with the debate, the absolute assurance that some have that if we would just enact X, Y or Z plan, all our health care problems would go away. We have huge generational problems, as do all first-world nations, in that our inflows of young wage earners is far too small to fund the entitlements of older generations at levels that they feel they've earned and have planned for for decades. No amount of bending the Medicare cost curve at the margins is going to change that. Promises unfortunately will have to be broken. To see what that looks like, keep an eye on California and Illinois over the next few years and see what happens when you take a pension away from a retiree that they were promised, by a politician who unfortunately never had any intention of being around when the bill came due. It will not be pretty.

 

[Parts Unknown]

I feel like a mosquito in a nudist colony:

You certainly wasted no time in sucking.

This legislation is in direct violation of even the most liberal interpretation of the commerce clause,

If such a direct and egregious violation exists then I am sure that element of the law will be firmly stuck down through legal challenges. I won't hold my breath, but you are welcome to.

I closed my eyes, imagined your pejorative situation, and made an observation: I would rather pay for my own parents' medical bills than pay for your parents' medical bills. I can know and verify my parents health and medical decisions, I can't say the same for others.

Nice dodge. The simple fact is that for all of Medicare's flaws, we are in a far better place as a profession and a society with some form of socialized insurance for older Americans.

With regard to your observation, perhaps the thought of monitoring the health and personal decisions of your parents so as to avoid bankruptcy sounds appealing to you, but it doesn't do much for me. How long we live, how well we live, and how much we cost before dying is fairly complex issue. Your parents could have a decent set of genes, exercise, eat right, and send you to the poorhouse when they develop progressive dementia in their 90's. Conversely, I did an autopsy last month on a gentleman who was morbidly obese, ate like hell, smoked like a chimney, drank like a fish, didn't tend his diabetes or high blood pressure (despite a CABG x 4), and died at the ripe old age of 62. He didn't cost Medicare a dime.

My "grand solution" is to turn over all decisions about money and healthcare to citizens.

We did. They are called our elected officials, and they are American citizens who are products of the American society.

The functions of these organizations are better executed by the private sector. That is my point.

And it's highly debatable.

Your last point shows how you view public policy with partisan blinders. Politicians screw up healthcare legislation, not just those in the GOP.

Forgive me, but when it comes to Medicare Part D I am unwilling to call a spade anything other than a spade. If you peer into the reasons why it is a horrible piece of policy you will find a host of priorities far more often ascribed to the Republican party than the Democrats. I'll let Alan Wolfe take over:

But Republicans were just as unwilling to design a sensible program as they were unable to eliminate the existing one. To prove their faith in the market, they gave people choices, when what they wanted was predictability. To pay off the pharmaceutical industry, they refused to allow government to negotiate drug prices downward, thereby vastly inflating the program's costs. To make sure government agencies didn't administer the benefit, they lured in insurance companies with massive subsidies and imposed almost no rules on what benefits they could and could not offer. The lack of rules led to a frustrating chaos of choices. And the extra costs had to be made up by carving out a so-called "doughnut hole" in which the elderly, after having their drug purchases subsidized up to a certain point, would suddenly find themselves without federal assistance at all, only to have their drugs subsidized once again at a later point. Caught between the market and the state, Republicans picked the worst features of each. No single human being could have designed a program as unwieldy as this one. It took the combined efforts of every faction in today's conservative movement to produce a public policy so removed from common sense.

 

[Pons Asinorum]

SDN could use more arguments like Parts Unknown's above. I will say that the legal attack is actively happening, and having some initial success in process, so you might not have to hold your breath too long...

Parts Unknown:

Quote:
Originally Posted by catalase
This legislation is in direct violation of even the most liberal interpretation of the commerce clause,

If such a direct and egregious violation exists then I am sure that element of the law will be firmly stuck down through legal challenges. I won't hold my breath, but you are welcome to.

 

[Lokhtar]

It would be so hilarious if the individual mandate were struck down (it won't - it's written as a tax, which the federal government has the powers to impose , but just in case it is). Then the insurance companies would have to accept people and there'd be no incentive for anyone to get insurance until they need it.

Insurance companies go belly up,welcome single payor. It would be the new definition of 'EPIC FAIL' on part of the conservatives.

 

[Pons Asinorum]

It would be so hilarious if the individual mandate were struck down (it won't - it's written as a tax, which the federal government has the powers to impose , but just in case it is). Then the insurance companies would have to accept people and there'd be no incentive for anyone to get insurance until they need it.

Insurance companies go belly up,welcome single payor. It would be the new definition of 'EPIC FAIL' on part of the conservatives.

You seem to be under the impression that the Democrats who wrote the bill would rather enact single-payer than get re-elected. I think that that's false. The argument against the individual mandate is that the federal government does not have the authority to tax an individual's decision NOT to participate in interstate commerce. If you don't want car insurance, fine, just don't drive a car. If you don't want health insurance, you're forced to pay a "tax" on money you choose not to spend? If the courts strike down the power of the individual mandate, it will be back to the drawing boards for all sides involved about the same time that the revised CBO scoring of the bill hits the front page of your local newspaper. And the solution certainly WON'T be any Democrat this side of Bernie Sanders rolling out their long-dreamed-for NHS equivalent. I should add that I'm in favor of a much stronger individual mandate as well as community rating for group policies. My problem is that the only proven way that has been included in the current bill is to reduce the cost of health care is the continued erosion of physician wages, in accordance with declining CMMS formulary payments. Our health care system's problems aren't that we pay physicians too much. It's that people have no skin in the game. It's the way medicine is practiced to avoid tort action. It's the lack of any rational discussion on what our society believes about end-of-life care. There are problems with this bill. Current public polling tells me that single-payer isn't likely to be the solution proffered by a re-election-seeking politician any time soon.

 

[Lokhtar]

You seem to be under the impression that the Democrats who wrote the bill would rather enact single-payer than get re-elected.

No, I don't think that's true actually. A plurality of democrats do support a public option (it did pass the house, and had 50 votes in the Senate but not 60, and by the time they used the budget reconciliation, it was too late to insert it back in) and I bet a large amount of them do support a single payer. But I don't think enough of a majority support such a thing for it to pass (and they'd all have to support it, considering the united opposition).

The argument against the individual mandate is that the federal government does not have the authority to tax an individual's decision NOT to participate in interstate commerce. If you don't want car insurance, fine, just don't drive a car. If you don't want health insurance, you're forced to pay a "tax" on money you choose not to spend? If the courts strike down the power of the individual mandate, it will be back to the drawing boards for all sides involved about the same time that the revised CBO scoring of the bill hits the front page of your local newspaper.

Or they could re-write it as a tax on everyone and a refund if you meet certain criteria. Or everyone pays a certain tax, and if you want to buy insurance, the government will subsidize a certain amount (The government is certainly not inexperienced with taxes and subsidies). Etc, etc. There are lots of ways to write taxes and refunds.

And the solution certainly WON'T be any Democrat this side of Bernie Sanders rolling out their long-dreamed-for NHS equivalent.

Not immediately, certainly not. The issue is the same thing that happened when Social Security was enacted, or medicare. It had a lot of loopholes and it was a shadow of the program it is now. However, try finding a Republican who is running right now who is calling for a repeal of medicare. Why? Once people expect the benefits, good luck getting them to vote for you to take it away. Once people are getting the benefit of not being dropped by insurance carriers, good luck passing a bill to let the insurance companies start to discriminate again. And if there is no incentive on people to get insurance, combined with the inability of the insurance companies to drop or deny coverage, there isn't anywhere but the toilet for that industry. People will demand options, like Medicare age from 65 to 55, and steps such as that. Eventually, I do think that Medicare will cover everyone from birth -> death.

 

[Pons Asinorum]

People will demand options, like Medicare age from 65 to 55, and steps such as that. Eventually, I do think that Medicare will cover everyone from birth -> death.

I agree that something like this is in the cards. I just think that when it gets rolled out, it will be unavoidable to bypass serious talk of spending and costs the way that was done with the current bill. When younger people see how much it really costs to keep the cohort >55 years old in the health care they think they've earned from paying a pittance into Medicare for decades, I think there will be a significant backlash. Politicians don't like backlash, so it's hard to see how we get from point A to point B. Just never underestimate the ability of the political class to shirk their responsibility to fund the entitlement checks they write. Living in California will do that to a person...

 

[Lokhtar]

Probably won't be a big deal, if people compare it to, say, the trillion dollar defense budget. But they won't - funding another carrier group seems to be sacrosanct while giving people healthcare...not so much.

Oh, and I think you're underestimating the ability of politicians to avoid talking about spending. If it comes down to A) vote for a bill that would take away healthcare from people who just got it vs. B) increase spending....well it's won't be much of a choice.

 

[morning]

Just to clarify, you're argument is that the same cohort that currently lacks health care coverage of any kind (Medicaid, Medicare, Tricare, VA, private insurance) is a group that is capable of growing its own food and building their own shelter? What portion of that working-but-not-too-poor do you think are landowners? I don't think you're serious in laying that out as an argument for further federalizing or socializing or whatever the U.S. health care system. And I think that Khaos05's point is the fact that the top 50% of earners pay ~97% of all federal income taxes. The bottom 50% already contribute nothing from their income to funding the current federal health care systems.

First off, there are many people who can afford health insurance but CANNOT RECEIVE IT because they have a pre-existing condition. This is something HCR was meant to fix, although I don't think it will, because I think insurance companies will be more likely to take the fine than sell their insurance to someone with a serious illness in their past.

Secondly, there are many gaps in eligibility for entitlements. Think of financial aid - there are people who make too much for their child to get good aid, but they can't afford to pay the EFC, either. There are people who don't qualify for Medicaid or Medicare, but can't afford private insurance, which is getting more expensive by the year (aso analogous to tuition...)

Finally, I don't think "grow your own food" or "build your own shelter" is realistic, but at the same time, it's not IMPOSSIBLE. Ever seen a tent city? They're certainly not preferable, but they do exist. It is absolutely impossible for a person who is really dirt, dirt poor to procure their own dialysis, whereas it's NOT impossible for a person who is that poor to take advantage of a squat, dumpster dive (this is something a few people I know in college do as well 😱), or otherwise ensure their survival. But there's no way in hell they can be their own doctor. It just cannot happen.

No, I don't think that's true actually. A plurality of democrats do support a public option (it did pass the house, and had 50 votes in the Senate but not 60, and by the time they used the budget reconciliation, it was too late to insert it back in) and I bet a large amount of them do support a single payer. But I don't think enough of a majority support such a thing for it to pass (and they'd all have to support it, considering the united opposition).

The public option was very popular in the polls as well, and at one point there were 55 senators willing to vote for it. Unfortunately, the Republicans blocked it via the threat of a filibuster...their favorite tool.

What you said about the pre-existing conditions and the loss of mandates never occurred to me before, and I think you're right. Insurance is no different than any other mode of healthcare delivery - it depends on a pool of healthy people subsidizing the unhealthy people. And, of course, once the unhealthy folks lose their jobs, they will never be able to purchase insurance on the free market ever again.


Congrats to Parts Unknown on the Attending title!

 

[Parts Unknown]

Congrats to Parts Unknown on the Attending title!

Thanks! That first paycheck was... nice.