From a doctor's perspective, is it better to repeal or keep healthcare reform

[Dave89]

To be fair, a lot of Republican positions are currently nuts. There's far more cognitive dissonance in the Republican party right now than the Democratic party.

You can't simultaneously be for deficit reduction and tax cuts, even if you believe in the Laffer curve it has limits.

Doesn't that depend on the extent of the cuts? If we cut 1 trillion in spending and cut tax revenue by 200-300 billion, making this country more business-friendly, I think it's a good trade. I don't care so much if the tax cuts are on businesses or across the board. Point is, the government is a bottomless money pit. (See Milton Friedman quote in my signature. You know it's true )

There's also the disconnect between limiting government control over corporations/states and increasing government control over individuals (particularly regarding sex).

The idea that the GOP wants to control individuals regarding sex is completely overhyped. For example, advocating institutions' (religious or otherwise) freedom to not include contraceptives does not constitute control over sex; in fact, the so-called liberals are truly the ones who want to control sex.

The Democrats have their blind spots too (lawyers, unions), but you're less likely to see outright hypocrisy on the left partially because there's less of an effort to make everyone tow the same line. Plus they're a bunch of ineffectual wusses.

There's a reason comedians make fun of Republicans more, and it's not because there's a left wing comedian conspiracy.

I think we all know that reason. It's easier to make jokes based on a simpleton's view of the world than it is to use logic. Logic (or at least attempting its employment) isn't very funny.

See, an entertainer can, for purposes of a joke, work on the premise that Republicans hate poor people, don't care if they die, and all are trust fund babies who don't want to part with that extra 10 million dollars. In fact, that sentence was pretty much a Bill Maher punch line.

Whereas it's hard to make a joke: "Maybe government control of healthcare isn't what we should be trying for. The thing with Democrats is, they think government regulations assure better outcomes than the free market. HAHAHAHA... See? Not so funny.

It's just that Republican politicians are more prone to behaving ridiculously. The current required mantra for candidates in the Republican primary is so incoherent that they either need to be liars (Romney) and pretend they believe in it, idiots/clowns (Cain), or nuts (Bachmann).

If you think Romney is any more of a liar than most Democrats, you're mistaken. Here's Barack Obama ATTACKING HILLARY FOR INSURANCE MANDATE: http://www.youtube.com/watch?v=jM2Ee17Nyrc

Won't catch that hypocrisy on CNN, MSNBC, or ABC...

I dislike the party system and wish we had more choices. But the truth is, if you look at a different country like Australia for example, the entire spectrum of their left and right fits inside the current Democratic party. The Republican party had gone off the deep end, and even a few Republicans have started to admit it (eg David Frum).

That's the point, though. America wasn't intended to fit into the mold. This is supposed to be an experiment in freedom. I know it may sound cheesy, but it's true. Just because Europe and its satellites have decided to take a more centralized approach doesn't mean we ought to follow suit.

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[SteinUmStein]

That's the point, though. America wasn't intended to fit into the mold. This is supposed to be an experiment in freedom. I know it may sound cheesy, but it's true. Just because Europe and its satellites have decided to take a more centralized approach doesn't mean we ought to follow suit.

This experiment in freedom is about to get really interesting if the ACA goes down. What if you lose your insurance due to a job loss and can't afford independent coverage, then are diagnosed with a serious illness or get in a car accident? How free will you feel declaring bankruptcy and losing your home over a medical bill? This isn't straightforward, and neither Dems nor Republicans are completely wrong or right. I hate to say it, but government IS the only solution to many of our problems. Nobody else has that kind of power. There's a reason we don't live in an anarchist state with no taxes or laws - if you really think about it, it would be a short and miserable existence.

 

[Dave89]

This experiment in freedom is about to get really interesting if the ACA goes down. What if you lose your insurance due to a job loss and can't afford independent coverage, then are diagnosed with a serious illness or get in a car accident? How free will you feel declaring bankruptcy and losing your home over a medical bill? This isn't straightforward, and neither Dems nor Republicans are completely wrong or right. I hate to say it, but government IS the only solution to many of our problems. Nobody else has that kind of power. There's a reason we don't live in an anarchist state with no taxes or laws - if you really think about it, it would be a short and miserable existence.

Of course. That's the reason for Article 1 Section 8.

BTW a great partial solution to the insurance mess would be to reform medical insurance to be essentially limited to catastrophic illnesses and emergencies. The idea that our annual visits to the family doctor (or going to a doctor because your throat hurts, etc.) are covered by medical insurance is incredibly stupid. Verilli mentioned in his arguments that insurance has become the way we pay for medical care in this country. This is insanity. It hurts patients and doctors.

But then, insurance companies have much better-funded lobbyists in Washington. Also, they lobby for their own interests, whereas the AMA is run by a bunch of fools who care far more about hospitals' bottom lines than doctors' ability to do their jobs. There are of course many other things which could be done to make healthcare and health insurance cheaper. E.g. tort reform. But since lawyers all flock to Congress... that's not gonna happen anytime soon.

You must understand, while the individual mandate is certainly objectionable to many conservatives and Republicans, they are not protesting it so strongly because they care so much about the $1000 they'd be fined if they didn't buy health insurance. The key objection to this mandate is that, if government can force you to buy health insurance, what can it NOT force you to do?

Verilli was completely unable to answer this question, and frankly it's a question many progressives never want to address. What are the limits to government power? Today it's healthcare. Who is to say tomorrow it won't be banning of foods with a certain percentage of trans fats? And then forcing people to buy fuel-efficient cars...

These are legitimate questions, and ones which should plague true liberals. Many who claim to be liberals denounced GWB as a "fascist", but they seem to be unaware of the slippery slope an individual mandate puts us on.

A government big enough to give you everything you want is a government big enough to take from you everything you have. - Gerald Ford

 

[deleted103644]

Doesn't that depend on the extent of the cuts? If we cut 1 trillion in spending and cut tax revenue by 200-300 billion, making this country more business-friendly, I think it's a good trade. I don't care so much if the tax cuts are on businesses or across the board. Point is, the government is a bottomless money pit. (See Milton Friedman quote in my signature. You know it's true )

That's just the thing - it was never about deficits. The real goal is to reduce the size of government via "starve the beast". If deficit reduction was the primary goal, you would have spending cuts without tax reduction (or with tax increases).

in fact, the so-called liberals are truly the ones who want to control sex.

Honestly not sure what you're referring to here, mind giving an example? Keep it short though - hard to read long posts on iPhone App.

If you think Romney is any more of a liar than most Democrats, you're mistaken. Here's Barack Obama ATTACKING HILLARY FOR INSURANCE MANDATE: http://www.youtube.com/watch?v=jM2Ee17Nyrc

Won't catch that hypocrisy on CNN, MSNBC, or ABC...

Did I say that? I think that's funny too, and evidence Obama doesn't really care about enforcement of the mandate. You know the mandate is a conservative idea, right? It's the only way to get a market-based solution for universal coverage.

And I specifically used Australia as an example because it's more conservative than Europe. It's where Murdoch comes from after all. Still, their conservatives would sit within the spectrum of views in the Democratic party.

 

[phltz]

You must understand, while the individual mandate is certainly objectionable to many conservatives and Republicans, they are not protesting it so strongly because they care so much about the $1000 they'd be fined if they didn't buy health insurance. The key objection to this mandate is that, if government can force you to buy health insurance, what can it NOT force you to do?

We've been over this many times before. The PPACA does not force anyone to buy health insurance. There is no force. There is a financial incentive embedded in the tax code. And it's long been accepted in the US that the government can institute almost any tax incentives within reason. Your whole object is nonsensical.

Look, I'm not happy about the tax money I'm paying because I don't have a home mortgage. I'm not thrilled that I'm paying tax money that some rich bastard doesn't have to because he's donating money to an absurdly wealthy organization like Harvard University or the Catholic Church. While those tax deductions may be bad policy, though, I recognize that they are solidly within the realm of what's permissible under the constitution. If I really want to get rid of them, I need to lobby my congressman, senator, etc, and try to build momentum to change things in the legislature.

 

[SteinUmStein]

Of course. That's the reason for Article 1 Section 8.

BTW a great partial solution to the insurance mess would be to reform medical insurance to be essentially limited to catastrophic illnesses and emergencies. The idea that our annual visits to the family doctor (or going to a doctor because your throat hurts, etc.) are covered by medical insurance is incredibly stupid. Verilli mentioned in his arguments that insurance has become the way we pay for medical care in this country. This is insanity. It hurts patients and doctors.

But then, insurance companies have much better-funded lobbyists in Washington. Also, they lobby for their own interests, whereas the AMA is run by a bunch of fools who care far more about hospitals' bottom lines than doctors' ability to do their jobs. There are of course many other things which could be done to make healthcare and health insurance cheaper. E.g. tort reform. But since lawyers all flock to Congress... that's not gonna happen anytime soon.

You must understand, while the individual mandate is certainly objectionable to many conservatives and Republicans, they are not protesting it so strongly because they care so much about the $1000 they'd be fined if they didn't buy health insurance. The key objection to this mandate is that, if government can force you to buy health insurance, what can it NOT force you to do?

Verilli was completely unable to answer this question, and frankly it's a question many progressives never want to address. What are the limits to government power? Today it's healthcare. Who is to say tomorrow it won't be banning of foods with a certain percentage of trans fats? And then forcing people to buy fuel-efficient cars...

These are legitimate questions, and ones which should plague true liberals. Many who claim to be liberals denounced GWB as a "fascist", but they seem to be unaware of the slippery slope an individual mandate puts us on.

A government big enough to give you everything you want is a government big enough to take from you everything you have. - Gerald Ford

I had a whole post ready to go but I realized that my logic is not going to work here. Ok, I'm ready to listen. What would you suggest we do to make this monstrosity we call a health care system functional? I'm all ears. Assume ACA is completely overturned and Romney wins in November. We'll say it's still a split legislature, House R and Senate narrowly D. What would you do?

 

[JackShephard MD]

You must understand, while the individual mandate is certainly objectionable to many conservatives and Republicans, they are not protesting it so strongly because they care so much about the $1000 they'd be fined if they didn't buy health insurance. The key objection to this mandate is that, if government can force you to buy health insurance, what can it NOT force you to do?

Verilli was completely unable to answer this question, and frankly it's a question many progressives never want to address. What are the limits to government power? Today it's healthcare. Who is to say tomorrow it won't be banning of foods with a certain percentage of trans fats? And then forcing people to buy fuel-efficient cars...

These are legitimate questions, and ones which should plague true liberals. Many who claim to be liberals denounced GWB as a "fascist", but they seem to be unaware of the slippery slope an individual mandate puts us on.

A government big enough to give you everything you want is a government big enough to take from you everything you have. - Gerald Ford

One thing that puzzles me about this stance, do you think that the government in Massachusetts is abusing government power by having a mandate for health insurance?

The reason I ask is because I always hear, "well it's a state thing, so that's completely different, yada yada yada." Followed by an argument of states regulating commerce and federal power being misused... I'm not interested in that.

The question is, do you think it's a good or bad thing for a governing body in general (any state or nation) to have a mandate for insurance?

 

[deleted103644]

One thing that puzzles me about your stance, do you think that the government in Massachusetts is abusing government power by having a mandate for health insurance?

The reason I ask is because I always hear, "well it's a state thing, so that's completely different, yada yada yada."

The question is, do you think it's a good or bad thing for a governing body (of a single state or nation) to have a mandate for insurance?

Yeah, I don't get that distinction either.

I really don't care about states' rights, I only care about individual rights.

People complain about corruption in the federal government, it's so much more prevalent at the state level (probably has more to do with cost - much more expensive to buy a Senator's favor than a state legislator's - and degree of scrutiny, not any core ethical difference).

I don't trust my state government as far as I could throw it.

 

[SteinUmStein]

Yeah, I don't get that distinction either.

I really don't care about states' rights, I only care about individual rights.

People complain about corruption in the federal government, it's so much more prevalent at the state level (probably has more to do with cost - much more expensive to buy a Senator's favor than a state legislator's - and degree of scrutiny, not any core ethical difference).

I don't trust my state government as far as I could throw it.

It's a common conservative talking point, but I've never understood why a state government is inherently better or more capable than the federal government. My state having more rights certainly doesn't improve my situation. I guess it's more local, but it's not local enough to make a difference in my opinion.

 

[deleted103644]

It's a common conservative talking point, but I've never understood why a state government is inherently better or more capable than the federal government. My state having more rights certainly doesn't improve my situation. I guess it's more local, but it's not local enough to make a difference in my opinion.

I assume it's mainly a hold-over from the Confederacy/Jim Crow, Southern states still feel an over-developed sense of federal encroachment on their sovereignty.

Personally, I think that Reconstruction ended 100 years too early. To hell with Afghanistan, we should still be occupying Alabama.

 

[Dave89]

One thing that puzzles me about this stance, do you think that the government in Massachusetts is abusing government power by having a mandate for health insurance?

The reason I ask is because I always hear, "well it's a state thing, so that's completely different, yada yada yada." Followed by an argument of states regulating commerce and federal power being misused... I'm not interested in that.

The question is, do you think it's a good or bad thing for a governing body in general (any state or nation) to have a mandate for insurance?

I don't think it's an abuse of government power, as states were meant to be individualistic experimental labs. And if Massachusetts residents want to live like that, fine. But I do think it's a bad idea.

Look, the states are, in fact free to screw themselves. 67-84% of Massachusetts like the plan (http://mittromneycentral.com/resources/romneycare/), and that's fine. As long as a state doesn't expect others to bail it out, it can go nuts.

I'm not sure why people belittle or ignore the argument that states' abilities are far different from the federal government's. It's really a crucial issue.

 

[Dave89]

Yeah, I don't get that distinction either.

I really don't care about states' rights, I only care about individual rights.

People complain about corruption in the federal government, it's so much more prevalent at the state level (probably has more to do with cost - much more expensive to buy a Senator's favor than a state legislator's - and degree of scrutiny, not any core ethical difference).

I don't trust my state government as far as I could throw it.

Perhaps the US is not the greatest "match" for you. What I mean is that the country was founded on the basis of states' rights. It sounds like you prefer a system which is not as fragmented.

Please understand I say this with respect. There are plenty of good people in more socialistic/progressive countries. And Canadians are almost generally smarter than Americans. But it's a different mentality on governance... And I'm certainly not saying you should move. But if you live in a country based on different principles than your own... well, you're really setting yourself up for disappointment.

 

[JackShephard MD]

I don't think it's an abuse of government power, as states were meant to be individualistic experimental labs. And if Massachusetts residents want to live like that, fine. But I do think it's a bad idea.

Look, the states are, in fact free to screw themselves. 67-84% of Massachusetts like the plan (http://mittromneycentral.com/resources/romneycare/), and that's fine. As long as a state doesn't expect others to bail it out, it can go nuts.

I'm not sure why people belittle or ignore the argument that states' abilities are far different from the federal government's. It's really a crucial issue.

I see the state or the federal government as government.

If you say that it's appropriate for small government to do action X but larger government shouldn't do action X because... well it's larger. That really isn't a good argument.

So in other words, if all 50 states decided a mandate is great and we want to "screw ourselves" (your words, not mine) then that's fine and appropriate use of government power because its done at a state level. Yet, the same action done by a larger governing body is abuse of power and corrupt?

I guess my question to you would be, "If the states can do this, what will they do next?" To which your answer appears to be, "If the states want to screw over their people, that's an appropriate use of government power, because it's a state and not federal government."

 

[SteinUmStein]

You can easily reductio ad absurdum the argument that states are free to screw over their own citizens if there is a majority vote for it. If 51% of Alabamans say they want to evict all persons of color from their state, that's not going to fly with the federal government. This is not a country founded entirely on states' rights. We have a strong central government for a reason.

 

[deleted103644]

Perhaps the US is not the greatest "match" for you. What I mean is that the country was founded on the basis of states' rights. It sounds like you prefer a system which is not as fragmented.

Please understand I say this with respect. There are plenty of good people in more socialistic/progressive countries. And Canadians are almost generally smarter than Americans. But it's a different mentality on governance... And I'm certainly not saying you should move. But if you live in a country based on different principles than your own... well, you're really setting yourself up for disappointment.

I could be a Son of the Revolution if I wanted to be one. My family's been here longer than yours has, maybe you should leave first?

Even if your statement about this country were incontrovertibly true (it's not) I'd rather stay here and try to change it than leave. I love this country not just for what it is and what it has been but what it could be.

If the states were free to do anything they wanted, there would have been no Civil War.

 

[Dave89]

I see the state or the federal government as government.

If you say that it's appropriate for small government to do action X but larger government shouldn't do action X because... well it's larger. That really isn't a good argument.

So in other words, if all 50 states decided a mandate is great and we want to "screw ourselves" (your words, not mine) then that's fine and appropriate use of government power because its done at a state level. Yet, the same action done by a larger governing body is abuse of power and corrupt?

I guess my question to you would be, "If the states can do this, what will they do next?" To which your answer appears to be, "If the states want to screw over their people, that's an appropriate use of government power, because it's a state and not federal government."

The "screw themselves" was not referring specifically to the mandate, but to a broader application.

And the whole crux of the issue is that not all the states would introduce a mandate. The deeply conservative states certainly wouldn't. And that's the point. Some states would have socialized healthcare, while others would have to find free-market mechanisms to keep costs low. And states could all benefit from each other's ideas. Sort of like - gasp - a free market.

But, hypothetically: yes, a country can vote itself into a soft tyranny. To take it to an extreme: if a country wants a dictator, it'll get one (see: Nazi Germany).

 

[SteinUmStein]

No need to tussle over this, it's spelled out crystal clear in the Constitution:

"This Constitution, and the Laws of the United States which shall be made in pursuance thereof; and all treaties made, or which shall be made, under the authority of the United States, shall be the supreme law of the land; and the judges in every state shall be bound thereby, anything in the constitution or laws of any state to the contrary notwithstanding."

- the Supremacy Clause of the US Constitution

tl;dr - Federal laws and authority > state laws and authority.

 

[Dave89]

I could be a Son of the Revolution if I wanted to be one. My family's been here longer than yours has, maybe you should leave first?

Even if your statement about this country were incontrovertibly true (it's not) I'd rather stay here and try to change it than leave. I love this country not just for what it is and what it has been but what it could be.

If the states were free to do anything they wanted, there would have been no Civil War.

As I suspected might happen, it seems my comment was misunderstood. I was not telling you "to leave."

I wonder, how does one love something for what it could be? I can understand having high hopes or aspirations, but isn't love based on either a present or past condition? Serious question.

And BTW that bit about the Civil War is not quite so simple. No, I don't have a Confederate flag and I don't go around yelling "The South shall rise again!" But the issue is really a grapple: why didn't the Southern states have a right to secede?

 

[Dave89]

No need to tussle over this, it's spelled out crystal clear in the Constitution:

"This Constitution, and the Laws of the United States which shall be made in pursuance thereof; and all treaties made, or which shall be made, under the authority of the United States, shall be the supreme law of the land; and the judges in every state shall be bound thereby, anything in the constitution or laws of any state to the contrary notwithstanding."

- the Supremacy Clause of the US Constitution

tl;dr - Federal laws and authority > state laws and authority.

What's spelled out?

 

[SteinUmStein]

The "screw themselves" was not referring specifically to the mandate, but to a broader application.

And the whole crux of the issue is that not all the states would introduce a mandate. The deeply conservative states certainly wouldn't. And that's the point. Some states would have socialized healthcare, while others would have to find free-market mechanisms to keep costs low. And states could all benefit from each other's ideas. Sort of like - gasp - a free market.

Example please? I hear this over and over from conservative news sources and I really want to know what these magical free-market mechanisms involve and why they still haven't been put forth to the public by the Republican establishment.

 

[SteinUmStein]

What's spelled out?

That federal law precedes state law.

 

[JackShephard MD]

The "screw themselves" was not referring specifically to the mandate, but to a broader application.

And the whole crux of the issue is that not all the states would introduce a mandate. The deeply conservative states certainly wouldn't. And that's the point. Some states would have socialized healthcare, while others would have to find free-market mechanisms to keep costs low. And states could all benefit from each other's ideas. Sort of like - gasp - a free market.

But, hypothetically: yes, a country can vote itself into a soft tyranny. To take it to an extreme: if a country wants a dictator, it'll get one (see: Nazi Germany).

This seems intellectually dishonest to me, although it is consistent with our constitution.

The states putting in government regulated healthcare would not be a free market, it would be government regulation.

It's really a silly argument you've laid out. A smaller government engaging in socialist governmental activities is a free market, but a larger government engaging in socialist governmental activities is socialist and not a free market.

Again, this seems intellectual dishonest.

 

[SteinUmStein]

This seems intellectually dishonest to me, although it is consistent with our constitution.

The states putting in government regulated healthcare would not be a free market, it would be government regulation.

It's really a silly argument you've laid out. A smaller government engaging in socialist governmental activities is a free market, but a larger government engaging in socialist governmental activities is socialist and not a free market.

Again, this seems intellectual dishonest.

It makes me wonder where the line is. Could all the liberal northeastern states band together (through democratically elected state officials and state laws) and form an independent insurance market with an individual mandate that is put in place at the state level, but in all of those states? Or is that interstate commerce that could be regulated by the federal government? What if all 50 states put together such a system, but at the state level (theoretically, since it would never happen in the South).

 

[deleted103644]

It makes me wonder where the line is. Could all the liberal northeastern states band together (through democratically elected state officials and state laws) and form an independent insurance market with an individual mandate that is put in place at the state level, but in all of those states? Or is that interstate commerce that could be regulated by the federal government? What if all 50 states put together such a system, but at the state level (theoretically, since it would never happen in the South).

The North just needs to reinvade.

 

[SteinUmStein]

The North just needs to reinvade.

Apparently we weren't thorough enough the first time...

 

[Dave89]

Example please? I hear this over and over from conservative news sources and I really want to know what these magical free-market mechanisms involve and why they still haven't been put forth to the public by the Republican establishment.

These solutions are a mix of federal/state actions, and were taken from http://www.americanthinker.com/2009/06/a_real_free_market_health_care_1.html

1. Don't pass any of the Democrat health care plans. Savings of at least $3 trillion over the next five years.
2. Immediately do away with Medicare, Medicaid, and The Center for Medicare and Medicaid services. No other major industrialized nation has a separate system for the elderly, disabled and the poor. Scrap the Joint Commission on Hospital Accreditation. Savings of nearly $1 trillion in federal tax dollars yearly, $1 trillion in savings for states and billions in savings by dissolving the tyrannical Joint Commission.
3. People should be responsible for purchasing their own health care, not the government or the employer, making health insurance completely portable. Scrap Hillary Clinton's HIPAA act at a savings of billions yearly. Let's make it HIPAA-posthumous.
4. A Health Insurance Company must offer a good basic low-cost health care plan with expanded health savings accounts. Taxpayer cost zero dollars.
5. No health exclusions for three years. Taxpayer cost zero dollars.
6. Health plans should promote healthy practices and preventive health. Taxpayer cost zero.
7. For the poor, government should subsidize the premiums, not be involved in paying providers. Taxpayer costs by my estimate around $600 billion per year.
8. Retired people of lower means should be helped as above but should not have a separate insurance plan run by the government. Sorry, Medicare is dead. Promises were broken, but we are mature people and we need to get over it. Let's not let it happen again! Taxpayer cost around $300 billion per year.
9. End tax penalties for individuals purchasing individual health insurance. Taxpayer cost zero dollars as these penalties are merely punitive, designed to make people dependent.
10. The health insurance companies in each state should have the option of creating a risk pool from some of their premium funds. Taxpayer cost zero dollars.
11. Laws should be changed to allow for private health co-ops to be formed as an option for those so inclined. Taxpayer cost zero dollars.
12. Patients should be free to change insurance plans at least twice yearly and since their insurance would not be controlled by their employer or the government no permission is needed from them. Taxpayer cost zero dollars.
13. There should be no legal right for insurance plans to dismiss competent and qualified contracted physicians for "no cause", when that no cause is really due to the physician acting as a patient advocate.
14. Tort reform with penalties for frivolous lawsuits and the loser paying some of the costs.


Well, there you have it. The savings for taxpayers over three years: Nearly $5 trillion. Not requiring bills hundreds of pages long: Priceless! A few short regulations and we have a viable health care system for the future covering over 99% of the population, devoid of the treachery of Medicare and without dependence on the federal government. It's very simple, very sensible, and so easy even a government official can understand it. It's even short enough for Congress members to read fully, though some may require several days. Oh, yes, Mr. Obama, I want our $600 billion back.

Frank S. Rosenbloom, M.D.

Also, check out http://www.nationalreview.com/articles/221346/against-universal-coverage/editors

 

[Lysinee]

Is it time to update the U.S. Constitution?

Draft a new one. Opinions.

"So we could use the ideas of social media that were actually invented in this country to suggest a set of amendments to modernize the Constitution for the 21st Century. Such a plan is not unheard of in American history."


http://globalpublicsquare.blogs.cnn.com/2011/06/20/is-it-time-to-update-the-u-s-constitution-2/

 

[Dave89]

Is it time to update the U.S. Constitution?

Draft a new one. Opinions.

"So we could use the ideas of social media that were actually invented in this country to suggest a set of amendments to modernize the Constitution for the 21st Century. Such a plan is not unheard of in American history."


http://globalpublicsquare.blogs.cnn.com/2011/06/20/is-it-time-to-update-the-u-s-constitution-2/

Oh, Good Lord. I was right in the middle of the article and I suddenly just knew that this was Fareed Zakaria's handiwork. I look up to the top of the page and there he is...

No. Bad idea. Particularly in the current political environment.

Also, the man clearly has no idea why the system was set up that way. "One man, one vote" was not the intent.

 

[Lysinee]

Oh, Good Lord. I was right in the middle of the article and I suddenly just knew that this was Fareed Zakaria's handiwork. I look up to the top of the page and there he is...

No. Bad idea. Particularly in the current political environment.

Ideas from Facebook and Youtube?

He is weird and not a good interviewer.

 

[deleted103644]

Dave, there are some serious problems with your plan without even attempting to correct the mathematical errors.

Health insurance pools are inherently unstable without a mechanism to force healthy people to join. Otherwise, no one would buy health insurance until they needed it and it would become unsustainably expensive. The alternative to something like a mandate is to exclude "pre-existing conditions", do you really want to bring those back?

Also, you forgot to mention EMTALA. Are you still going to require hospitals to pick up the tab for patients without money or insurance who show up in the ER? If you really want a free market based approach, you need to repeal that as well. (Better allocate some money for body disposal though...)

I'll stop arguing now, you're clearly not going to listen.

 

[deleted103644]

Yeah, can't change the constitution in current climate, it would be disastrous.

The states should back away from winner take all for the electoral college. It would need to be done in a balanced manner though to avoid giving one side or the other a huge advantage (eg NY and TX, not NY and CA).

Each state should allocate 2 votes for the statewide winner and 1 for each congressional district winner. That would make the electoral vote more true to the popular vote while still giving small states proportionately more of a voice like the founders intended.

 

[Dave89]

Dave, there are some serious problems with your plan without even attempting to correct the mathematical errors.

Health insurance pools are inherently unstable without a mechanism to force healthy people to join. Otherwise, no one would buy health insurance until they needed it and it would become unsustainably expensive. The alternative to something like a mandate is to exclude "pre-existing conditions", do you really want to bring those back?

I'll stop arguing now, you're clearly not going to listen.

http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/107xx/doc10781/11-30-premiums.pdf

 

[pupster]

I want my money back too

These solutions are a mix of federal/state actions, and were taken from http://www.americanthinker.com/2009/06/a_real_free_market_health_care_1.html

1. Don't pass any of the Democrat health care plans. Savings of at least $3 trillion over the next five years.
2. Immediately do away with Medicare, Medicaid, and The Center for Medicare and Medicaid services. No other major industrialized nation has a separate system for the elderly, disabled and the poor. Scrap the Joint Commission on Hospital Accreditation. Savings of nearly $1 trillion in federal tax dollars yearly, $1 trillion in savings for states and billions in savings by dissolving the tyrannical Joint Commission.
3. People should be responsible for purchasing their own health care, not the government or the employer, making health insurance completely portable. Scrap Hillary Clinton's HIPAA act at a savings of billions yearly. Let's make it HIPAA-posthumous.
4. A Health Insurance Company must offer a good basic low-cost health care plan with expanded health savings accounts. Taxpayer cost zero dollars.
5. No health exclusions for three years. Taxpayer cost zero dollars.
6. Health plans should promote healthy practices and preventive health. Taxpayer cost zero.
7. For the poor, government should subsidize the premiums, not be involved in paying providers. Taxpayer costs by my estimate around $600 billion per year.
8. Retired people of lower means should be helped as above but should not have a separate insurance plan run by the government. Sorry, Medicare is dead. Promises were broken, but we are mature people and we need to get over it. Let's not let it happen again! Taxpayer cost around $300 billion per year.
9. End tax penalties for individuals purchasing individual health insurance. Taxpayer cost zero dollars as these penalties are merely punitive, designed to make people dependent.
10. The health insurance companies in each state should have the option of creating a risk pool from some of their premium funds. Taxpayer cost zero dollars.
11. Laws should be changed to allow for private health co-ops to be formed as an option for those so inclined. Taxpayer cost zero dollars.
12. Patients should be free to change insurance plans at least twice yearly and since their insurance would not be controlled by their employer or the government no permission is needed from them. Taxpayer cost zero dollars.
13. There should be no legal right for insurance plans to dismiss competent and qualified contracted physicians for "no cause", when that no cause is really due to the physician acting as a patient advocate.
14. Tort reform with penalties for frivolous lawsuits and the loser paying some of the costs.


Well, there you have it. The savings for taxpayers over three years: Nearly $5 trillion. Not requiring bills hundreds of pages long: Priceless! A few short regulations and we have a viable health care system for the future covering over 99% of the population, devoid of the treachery of Medicare and without dependence on the federal government. It's very simple, very sensible, and so easy even a government official can understand it. It's even short enough for Congress members to read fully, though some may require several days. Oh, yes, Mr. Obama, I want our $600 billion back.

Frank S. Rosenbloom, M.D.

Also, check out http://www.nationalreview.com/articles/221346/against-universal-coverage/editors

 

[pupster]

The alternative to something like a mandate is to exclude "pre-existing conditions", do you really want to bring those back?

Yes, I do. Why the frack should I have to pay for some person who didn't buy health insurance when he was healthy and then suddenly wants it when he's sick? Umm...that's like not buying car insurance until after you've totaled your car!

 

[SteinUmStein]

Yes, I do. Why the frack should I have to pay for some person who didn't buy health insurance when he was healthy and then suddenly wants it when he's sick? Umm...that's like not buying car insurance until after you've totaled your car!

Of course you think that, Dr. Dermatologist. The chances of you being laid off and losing coverage are <0.0001%. How about the millions of Americans with pre-existing conditions who receive coverage through their job who could be laid off at any time? Lose job -> lose coverage -> bankruptcy and complete ruin from medical bills.

Even less dramatic than this, if you have a pre-existing condition that isn't devastating, say asthma, thyroid disease, bipolar disorder, diabetes - not cancer or heart failure. Getting independent coverage after you lose your job may be prohibitively expensive for you when you can't get it through your employer. So you may be uninsured not through negligence, but sheer inability to afford premium costs that would put you on the street.

 

[pupster]

Lose job -> lose coverage -> bankruptcy and complete ruin from medical bills.

Even less dramatic than this, if you have a pre-existing condition that isn't devastating, say asthma, thyroid disease, bipolar disorder, diabetes - not cancer or heart failure. Getting independent coverage after you lose your job may be prohibitively expensive for you when you can't get it through your employer. So you may be uninsured not through negligence, but sheer inability to afford premium costs that would put you on the street.

Oh sheeze...geezus...of COURSE if you have been paying in to the system while you're healthy, there should be some assistance to help you continue to receive medical insurance. Romney's proposed this already. I'm specifically targeting those people who don't.

 

[SteinUmStein]

Oh sheeze...geezus...of COURSE if you have been paying in to the system while you're healthy, there should be some assistance to help you continue to receive medical insurance. Romney's proposed this already. I'm specifically targeting those people who don't.

And what should we do with those dirty freeloaders who dare ask us for medical care? Wait until they turn up in our ED's with MI's, or with a gangrenous leg and blindness from lack of diabetic control? I'm sure that saves us lots of money.

Or should we just do what many conservatives really want deep down... repeal EMTALA and keep a ready stash of body bags so they don't pile up and start smelling outside the ED.

 

[ResIpsaLoquitur]

The NEJM just came out with a really nice overview of the Supreme Court arguments and their interpretation of the more likely outcomes. Give it a read if you have a chance.

It was a cautiously written piece. I am actually fearful of a verdict that arrives at deference to Congress because we continue to be witnesses to the schizotypy that characterizes law-making on Capitol Hill. Whereas the SCOTUS has long been a political tool that reliably votes along party lines, I am beginning to think we'd rather have them pass a ruling that will force politicians to stop bickering on this issue, and get on with the business of solving the crisis guided only by the indispensable precedent set in the court's judgement.

 

[ResIpsaLoquitur]

I had a whole post ready to go but I realized that my logic is not going to work here. Ok, I'm ready to listen. What would you suggest we do to make this monstrosity we call a health care system functional? I'm all ears. Assume ACA is completely overturned and Romney wins in November. We'll say it's still a split legislature, House R and Senate narrowly D. What would you do?

LOL...I am chuckling rather demurely here because you have also arrived at my logic. I can't imagine that this scenario is repeated on a steroidal scale in congress every day!

 

[ResIpsaLoquitur]

I assume it's mainly a hold-over from the Confederacy/Jim Crow, Southern states still feel an over-developed sense of federal encroachment on their sovereignty.

Personally, I think that Reconstruction ended 100 years too early. To hell with Afghanistan, we should still be occupying Alabama.

You had me laughing hysterically with this line of thought!!

 

[ResIpsaLoquitur]

I could be a Son of the Revolution if I wanted to be one. My family's been here longer than yours has, maybe you should leave first?

Even if your statement about this country were incontrovertibly true (it's not) I'd rather stay here and try to change it than leave. I love this country not just for what it is and what it has been but what it could be.

If the states were free to do anything they wanted, there would have been no Civil War.

I see that you have been slapped with the 'this is the America way and if you don't like it, this country is not for you' argument.

 

[redsquareblack]

You must understand, while the individual mandate is certainly objectionable to many conservatives and Republicans, they are not protesting it so strongly because they care so much about the $1000 they'd be fined if they didn't buy health insurance. The key objection to this mandate is that, if government can force you to buy health insurance, what can it NOT force you to do?

Jeebus Christmas, Dave. The answer is in the post I wrote above (which you seem to have ignored). It can NOT force you to do things that are unrelated to interstate commerce.

Since the health care market is commerce among the states, it can regulate it.

 

[deleted103644]

Yes, I do. Why the frack should I have to pay for some person who didn't buy health insurance when he was healthy and then suddenly wants it when he's sick? Umm...that's like not buying car insurance until after you've totaled your car!

What about someone born with a genetic disorder? Who would offer then affordable care after they could no longer be covered by their parents?

Okay, fine, make an exception for that. How about someone who became crippled by a childhood accident?

I'm fine with people being selfish, they just need to admit that these kinds of policies lead to poor people dying without care. If you can admit that, I'll respect your position (if a bit cold). If you don't, you're not thinking things through.

 

[SteinUmStein]

I'm fine with people being selfish, they just need to admit that these kinds of policies lead to poor people dying without care. If you can admit that, I'll respect your position (if a bit cold). If you don't, you're not thinking things through.

Exactly, I actually have a lot more respect for Republicans who readily admit that they are voting completely for their own interests at the expense of the less fortunate, as opposed to those who are either in denial or who are dishonest and say things like, "The market will take care of the problem. Those people will be fine." No, those people will not be fine. They will have increased morbidity and mortality, and their lives will be a constant struggle against the system we have built to save ourselves money.

 

[SurfingDoctor]

"One man, one vote" was not the intent.

Uh, it wasn't the intent because of slavery. The whole point of the electoral college was so that slave holding states would have a relatively equal share in the elections because their slaves only counted as 3/5 a person.

"There was one difficulty however of a serious nature attending an immediate choice by the people. The right of suffrage was much more diffusive in the Northern than the Southern States; and the latter could have no influence in the election on the score of Negroes. The substitution of electors obviated this difficulty and seemed on the whole to be liable to the fewest objections." - James Madison

 

[SurfingDoctor]

But, hypothetically: yes, a country can vote itself into a soft tyranny. To take it to an extreme: if a country wants a dictator, it'll get one (see: Nazi Germany).

Actually, in the 1932 presidental election, Hilter only received approximately 32% of the votes. Hindenberg won approximately 50% and the presidency. Only after coercion and assassination by the National Socialists and the SA, did Hitler take power. He was never really "voted" in and whether Germany "wanted" a dictator is entirely a matter of opinion.

Granted, this has nothing to do with the PPACA, but if you're going to quote historical references, you should quote them correctly.

 

[SteinUmStein]

Actually, in the 1932 presidental election, Hilter only received approximately 32% of the votes. Hindenberg won approximately 50% and the presidency. Only after coercion and assassination by the National Socialists and the SA, did Hitler take power. He was never really "voted" in and whether Germany "wanted" a dictator is entirely a matter of opinion.

Granted, this has nothing to do with the PPACA, but if you're going to quote historical references, you should quote them correctly.

Very true. Hitler was far from a true democratically-elected leader.

http://en.wikipedia.org/wiki/Adolf_Hitler's_rise_to_power

 

[SurfingDoctor]

No need to tussle over this, it's spelled out crystal clear in the Constitution:

"This Constitution, and the Laws of the United States which shall be made in pursuance thereof; and all treaties made, or which shall be made, under the authority of the United States, shall be the supreme law of the land; and the judges in every state shall be bound thereby, anything in the constitution or laws of any state to the contrary notwithstanding."

- the Supremacy Clause of the US Constitution

tl;dr - Federal laws and authority > state laws and authority.

Actually, nothing is really "spelled out" in the Constitution. Much of it is open to interpretation. If things were so clearly spelled out, there would be no need for the Supreme Court to "interpret" it, whose decisions again are a matter of opinion.

See "Plessy v Ferguson" and "Brown v Board of Education" <-- 2 Supreme Court rulings that contradict one another. If the PPACA is found unconstitutional, this ruling would contradict the findings of "Steward Machine Company v Davis" which held that it was constitutional to require states to tax individuals for the purpose of unemployment payments (the Social Security Act).

 

[SteinUmStein]

By the way, those of you hoping to see the end of Medicare and Medicaid are going to be waiting a while. There's no way Romney is going to preside over the end of Medicare, he's busy defending it and criticizing Obama for threatening it.

http://www.huffingtonpost.com/2012/04/04/mitt-romney-medicare-president-obama_n_1403267.html

And thanks SurfingDoctor, I'm not a lawyer or legal expert by any stretch of the imagination, I just like to play one on the internet.

 

[SurfingDoctor]

And thanks SurfingDoctor, I'm not a lawyer or legal expert by any stretch of the imagination, I just like to play one on the internet.

Ha, I'm no expect either, but I do read way too much historical stuff.