Realistic implementation of universal healthcare in the US

[PrideNeverDie]

taken from another message board:

"this is my personal take on universal healthcare. the government actually can implement universal healthcare changes that will be fiscally sensible if an expert was allowed to make changes without outside influences. however, the whole country will be watching closely and everything will be blown out of proportion.

if any senior citizen prescription benefits or end-of-life care will be compromised, there will be an uproar and the Democrats will not allow any of those changes to be implemented and risk losing the elderly support. the same could be said about any illegal immigrant reduction of benefits or any change that might unintentionally hurt a minority. this will create an increase in coverage without a reduction in benefits. the US already treats their patients with substantially more diagnostic imaging than any first world country.

this is going to lead to force politicians to either increase taxes which would cost them a lot of votes or drastically cut physician salaries which would cost them powerful lobbyists. i think the insurance companies will land on their feet and adapt with minimal losses. also, Medicare cuts will lower residency positions which are desperately needed for the increased demand. i think a lot of doctors will be forced into primary care for a lot lower salary.

i think when the government implements federal changes based on appeasing certain voting demographics instead of being given carte blanche to do what is best for the country that it will end up as a giant failure. i believe that is what happened with almost all the major government programs (social security, welfare, Medical, Medicare). the ideal is great, but the reality is that we will get another broken government program that is manipulated by politicians to look like it doesn't increase the deficit and/or the funds are taken to be used in other projects which is what happened to Medicare.

also, i'd like to point out that i'm blaming the Republicans as well. their refusal to compromise on taxes is what is ultimately going to hurt the implementation of this. we need the Republicans to allow an increase of taxes and the Democrats to give up benefits. neither side will do that.

a quick glance at the stats show that 35 CT scanners per million population and 26 MRI machines per million population which is 3rd and 1st, respectively (SOURCE: http://oregoncatalyst.com/uploads/Chart-health-scanners.jpg). using the WHO ranking system from 2000, the closest country to us is Germany with only 81 million people and they have 1/2 the CT scanners per million population and 1/4 the MRI machines per million population.

if we do not decrease benefits for universal healthcare, the costs for our healthcare system will be many times any other country in a much bigger scale (4x). however, imagine the uproar if a voting demographic had reduced benefits. the only one i can see politicians getting away with is the college age kids who have shown to be largely apathetic, but that might galvanize them to vote. based on this, i believe that we have no choice but to raise taxes."

do you guys think universal healthcare will end up being like he suggests? or is it a moot point because the supreme court will strike it down

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[officedepot]

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[NH14]

The Supreme Court is debating whether or not there can be a forced mandate to purchase a commercial product - healthcare.

The Court's decision will set-back adoption of a universal system, but definitely will not outlaw universal healthcare.

I'm shocked how many of you forget that Medicare, Medicaid, Veterans Administration, and the Federal Employee Health system is ALL government run healthcare, is funded by taxation, and is NOT unconstitutional.

All you need is incremental changes in Medicare (lower age requirements) and Medicaid (increase age requirements - Medicaid frequently is used to fund state-specific child health programs) to achieve universal coverage.

It all should be funded by corporate taxes. Individual laborers pay the lion's share of the federal tax revenue. Corporations do not. In fact, corporations pay less in taxes than ever. Evidence: http://www.taxpolicycenter.org/briefing-book/background/numbers/revenue.cfm

 

[eHombre]

That guy is an idiot. Don't worry about anything. Obamacare will be declared unconstitutional in June, obama will lose reelection in November, and we will pretty much won't have to deal with this for a long time.

The main problem with US healthcare system is that costs are far to high. Obamacare doesn't even address costs. Also be wary of numbers on health care spending because lots of that probably includes elective procedures, research development, excess tests by people who can afford it (e.g. yearly cxr for rich people), etc. Also don't neglect the jobs provided by this huge interconnected market. Once obamacare is gone Romney can go back to the drawing board with guys like paul ryan and craft something that will actually work and probably only be 10 pages in length.

Lol . Paul Ryan's a joke. Anyway, the Court would only strike down the mandate. You don't really need a mandate to solve the free-rider problem, though it's the most effective alternative. A limited enrollment period with penalties for late enrollment is one option, for example.

http://www.insurancejournal.com/news/national/2011/03/29/192080.htm

And Obamacare does address costs, perhaps just not in the way you'd prefer (ACOs, bundled payments, preventive care, etc.). Those measures may or may not lower costs in the end, but you can't say that health costs aren't addressed by the PPACA.

 

[officedepot]

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[Dave89]

The Supreme Court is debating whether or not there can be a forced mandate to purchase a commercial product - healthcare.

The Court's decision will set-back adoption of a universal system, but definitely will not outlaw universal healthcare.

I'm shocked how many of you forget that Medicare, Medicaid, Veterans Administration, and the Federal Employee Health system is ALL government run healthcare, is funded by taxation, and is NOT unconstitutional.

All you need is incremental changes in Medicare (lower age requirements) and Medicaid (increase age requirements - Medicaid frequently is used to fund state-specific child health programs) to achieve universal coverage.

It all should be funded by corporate taxes. Individual laborers pay the lion's share of the federal tax revenue. Corporations do not. In fact, corporations pay less in taxes than ever. Evidence: http://www.taxpolicycenter.org/briefing-book/background/numbers/revenue.cfm

(Sigh) When will people learn that taxing "corporations" is not free? Corporations ARE people, and if corporation tax goes up, shareholder gains go down. Pretty simple really, but it doesn't quite jive with the common narrative about those "evil corporations."

 

[officedepot]

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[SteinUmStein]

That guy is an idiot. Don't worry about anything. Obamacare will be declared unconstitutional in June, obama will lose reelection in November, and we will pretty much won't have to deal with this for a long time.

Got anything to back up those massive assumptions? I think people grossly overestimate Romney's electability.

http://www.realclearpolitics.com/epolls/2012/president/us/general_election_romney_vs_obama-1171.html

http://www.intrade.com/v4/markets/contract/?contractId=743474

 

[littlefaster]

Just ignore that guy. He's a clueless young pre-med. He knows absolutely nothing.

Yeah, because a premed couldn't possibly know as much as you, the omniscient med student. Condescending much?

 

[NH14]

. I'm not just an 'idiot' premed.

Read this: http://www.amazon.com/Health-Policy-Issues-Economic-Perspective/dp/1567934188

 

[auburnO5]

Hmmmm....VA, Medicare, Medicaid = Health Insurance (with limitations, nothing is perfect). Current system = 50 million Americans with NO insurance, annual premiums increasing at double-digit percentages, crippling health care cost to small employers, individuals going bankrupt due to medical bills, inefficient care, etc., etc. I must be an idiot.

Btw, here's my syllabus from JH Bloomberg Public Health. I've read everything listed from front to back. I kindly suggest you do the same. Oh yeah, and this was our textbook: http://www.amazon.com/Health-Policy-Issues-Economic-Perspective/dp/1567934188. However, it was an earlier version from 2010, we still discussed the proposed effect of the ACA (aka 'Obamacare' to the less informed/right-winged folk).

You should probably just stop posting now.

 

[officedepot]

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[NH14]

And NH14, I don't mean to be really condescending but it sounds like you simply don't understand basic things about how healthcare and the economy work. You just think with your emotions. Of course I wish everyone was able to afford healthcare. That's the goal and utopia. But it will never be the reality. And thinking we can just force others to completely subsidize someone else's care who cannot afford it (which "rich people" already do by the way... re: cost shifting) is extremely naive and misguided. If it doesn't work now why would it work if we make it worse...

I'm sorry I'm idealistic. People should never have dreams. Right?

I obviously don't believe any system would be 'perfect'. Given the political atmosphere, it's obvious that the US will only support incremental changes to health care policy, which is why it has been suggested that a way of getting in done is with modification of Medicare and Medicaid.

That being said, I do believe that there are realistic and practical solutions to make the system better. For one, I support the PPACA, although I also acknowledge it doesn't go far enough - particularly without a government option. I do support the idea of having subsidized high-risk pools and starting state healthcare exchanges. Both of these incremental solutions are a part of the PPACA. I would support the idea of having a 'lower' corporate tax rate on the books, with the caveat of closing loopholes and eliminating corporate subsidies - which would increase the effective corporate tax rate.

What are your ideas? Just saying 'your wrong' provides no alternative solutions, and is terribly counterproductive. But of course, this is an online forum and I have low expectations for a reasonable debate...

Also, please refrain from providing patient vignettes or anecdotes as if it were actual scientific evidence. In clinic practice, vignettes are used more to illustrate established clinical science or to present an anomalous case or new condition. Vignettes, anecdotes, or testimonials NEVER should be substituted as real evidence or analysis. I'm glad you've talked with a lot of frustrated patients and all, but its easy to see how this should not be considered as evidence for or against state or national health policies.

 

[officedepot]

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[SteinUmStein]

Where were all these fiscal conservatives hiding when Bush was blowing through our $850 billion surplus from the Clinton years? Wish you guys would have come out of the woodwork 8 years sooner, we'd be in much better shape in every way possible.

http://en.wikipedia.org/wiki/File:CBO_Forecast_Changes_for_2009-2012.png

 

[Dave89]

Where were all these fiscal conservatives hiding when Bush was blowing through our $850 billion surplus from the Clinton years? Wish you guys would have come out of the woodwork 8 years sooner, we'd be in much better shape in every way possible.

http://en.wikipedia.org/wiki/File:CBO_Forecast_Changes_for_2009-2012.png

The reality for Obama is much worse than that estimate. The CBO only counted up to 2012. Obamacare only kicks in in 2014, and believe me it'll be a doozie (if it's upheld).

 

[NH14]

my ideas to be brief and nonspecific (since it will take far too long to say how such things could be done): create incentives, not penalities for people to purchase health insurance. Allow health insurance to be sold across state lines (not through a government controlled exchange which forces insurers to offer specific plans). Lower taxes and decrease regulations on hospitals, pharm industry, etc overall making it cheaper for these organizations to run and develop their products (obviously getting drugs approved wouldn't change a whole lot except possibly speeding the process up). Cutting spending on superfluous programs to better fund medicare/medicaid to increase reimbursements. I think keeping medicare/medicaid for the time being but generally allowing a person to begin to set aside money into private accounts set up for their own health care would be good. These are just a few quick ideas.

I like you better when you're not personally attacking me. Thanks. Some of these ideas are good, however I would caution against deregulation.

In my opinion, applying free market principles to health insurance (not pharma, devices,etc) is not the best way to cut down costs. Health insurance is a unique product - it's not an iPad or a pair of jeans - everyone WILL consume it within their lifetimes. Further, a free market assumes that the consumer has access to and can utilize the full information pertaining to the product they are purchasing - including cost. Obviously, patients can't diagnose or treat themselves, or know which treatment is the best for their condition, and 99% of the time, don't know what everything actually costs. For these reasons and others, healthcare is a special 'product' if you chose to refer to it that way.

We've also seen what deregulation does - lifetime cost limits, denial of benefits due to pre-existing conditions, differential premiums for males vs. females, 'cherry picking' healthy beneficiaries, etc. Private health insurance companies have to make money. In order to do this, someone has to be overcharged.

 

[DoctwoB]

So much misinformation on this thread. Medstudents (of all ends of the political spectrum) should be smart enough to be educated and not just regurgitate soundbites.


One thing I don't get. Affordable and effective healthcare has been obtained by many countries using a single payer system. Has any country done the same using the market/private insurance based healthcare system?

 

[DoctwoB]

But honestly the fundamental problem with healthcare does not reside in the healthcare industry. There is simply a cultural mindset that people think things will just be paid for and they don't have to worry about it. People are not taught to think ahead. They are not taught to be personally responsible. It's a fundamental issue in society and is the overarching problem. And don't neglect that the healthcare industry is intertwined with the overarching economy. Obama's overall policies are not helping the economy and increasing government debt is crippling the country.

Increasing government debt is not crippling the country. It certainly may down the line, but right now government spending is propping up the economy.

Econ 101: Boost spending during a recession, cut spending during a boom period. Just because Bush made the mistake of spending way too much during a boom period doesn't mean we should torpedo the economy now by drastically removing government stimulus.

And do tell, what are these magical economic policies that republicans would have used? Let me guess. Cut taxes on "job creators" and businesses. Can you name ONE time when trickle down economics has proven to be effective? Not to mention that would also run up a massive deficit that the republicans seem to abhor soo much when they're not in power.

Cutting government funding also isn't going to bring us to this magical utopian world where everyone is responsible and takes responsibility for all their own actions.

 

[SoundofSilver]

I'm shocked how many of you forget that Medicare, Medicaid, Veterans Administration, and the Federal Employee Health system is ALL government run healthcare, is funded by taxation, and is NOT unconstitutional.

This is a poor argument that I've heard over and over again. The difference between medicare, etc. and the individual mandate is that medicare is a government program funded through a tax. Congress is constitutionally entitled to levy taxes.

The individual mandate is not a tax. It is a law that forces you to buy a product (health insurance) from a private company or face a penalty if you do not comply. And for those who are wondering what the difference is between this and auto insurance: well, no one forces you to buy a car. Once you own a car, the government can regulate how you use that car (i.e. compel you to buy auto insurance).

Those arguing that the act is constitutional are doing so through the commerce clause "the congress shall have the power to regulate commerce with foreign nations, and among the several states, and with the Indian tribes".

If the act is found constitutional, it basically means that congress has the power to create commerce in order to regulate it, giving them unprecedented power.

 

[Barcu]

So much misinformation on this thread. Medstudents (of all ends of the political spectrum) should be smart enough to be educated and not just regurgitate soundbites.


One thing I don't get. Affordable and effective healthcare has been obtained by many countries using a single payer system. Has any country done the same using the market/private insurance based healthcare system?

Switzerland. But the have higher costs than the rest of Europe and pretty high out-of-pocket. Still, they seem to do a better job than the US in regards to costs, and they offer choice and flexibility of private plans. Republicans have actually used Switzerland as a model for reform.

But the catch: Switzerland also has a number of key Obamacare (we're all calling it that now right) provisions including individual mandate and no denying for pre-existing conditions.

Obviously, good reform would take compromise. So, it probably won't happen anytime soon.

 

[SteinUmStein]

Switzerland. But the have higher costs than the rest of Europe and pretty high out-of-pocket. Still, they seem to do a better job than the US in regards to costs, and they offer choice and flexibility of private plans. Republicans have actually used Switzerland as a model for reform.

But the catch: Switzerland also has a number of key Obamacare (we're all calling it that now right) provisions including individual mandate and no denying for pre-existing conditions.

Obviously, good reform would take compromise. So, it probably won't happen anytime soon.

You're right, and Switzerland is much closer to an Obamacare-type system than what we would have without it. Republicans loved to hold up Switzerland as an alternative model to what the rest of Europe, Canada, and every other wealthy country were doing until they all took the crazy kool-aid in the late 90's/early 2000's. Now any Republican suggesting we reform to Switzerland's model would be a left-wing RINO.

http://www.npr.org/templates/story/story.php?storyId=92106731

 

[SteinUmStein]

If the act is found constitutional, it basically means that congress has the power to create commerce in order to regulate it, giving them unprecedented power.

This is simply not true, if they do manage to uphold the law it will be with health care as a special case of commerce, and it will carry very little weight in setting a precedent to create and regulate future commerce.

JUSTICE KENNEDY: And the government tells us that’s because the insurance market is unique. And in the next case, it’ll say the next market is unique. But I think it is true that if most questions in life are matters of degree, in the insurance and health care world, both markets — stipulate two markets — the young person who is uninsured is uniquely proximately very close to affecting the rates of insurance and the costs of providing medical care in a way that is not true in other industries.

 

[SoundofSilver]

This is simply not true, if they do manage to uphold the law it will be with health care as a special case of commerce, and it will carry very little weight in setting a precedent to create and regulate future commerce.

JUSTICE KENNEDY: And the government tells us that's because the insurance market is unique. And in the next case, it'll say the next market is unique. But I think it is true that if most questions in life are matters of degree, in the insurance and health care world, both markets — stipulate two markets — the young person who is uninsured is uniquely proximately very close to affecting the rates of insurance and the costs of providing medical care in a way that is not true in other industries.

I don't disagree that the insurance market is unique. But compelling someone to buy private insurance is still an act of creating commerce and if the law is upheld, it has then been found constitutional for congress to create commerce. Period. Even if it is a "special" case.

 

[SteinUmStein]

I don't disagree that the insurance market is unique. But compelling someone to buy private insurance is still an act of creating commerce and if the law is upheld, it has then been found constitutional for congress to create commerce. Period. Even if it is a "special" case.

No, that's the definition of special case. Not applicable to non-healthcare commerce. Period.

The point is that future Supreme Courts can't take this case as precedent to support future Congresses that are trying to create and regulate non-healthcare commerce. It's a special case situation, not generally applicable to all commerce.

In other news, we have "no money" for healthcare or education, but we've got $1.45 trillion for these babies:

http://www.reuters.com/article/2012/03/29/us-lockheed-fighter-idUSBRE82S03L20120329

ಠ_ಠ

 

[SoundofSilver]

In other news, we have "no money" for healthcare or education, but we've got $1.45 trillion for these babies:

http://www.reuters.com/article/2012/03/29/us-lockheed-fighter-idUSBRE82S03L20120329

ಠ_ಠ

I can certainly agree with you on this. Lots of wasted dollars.

 

[SteinUmStein]

I can certainly agree with you on this. Lots of wasted dollars spent on defense.

Honestly I wouldn't mind spending that kind of money on defense if we had a hyperaggressive advanced, wealthy country with superior military capability threatening our domestic safety and independence. But in almost every case where our military has been involved in the past 50 years, we are that hyperaggressive advanced wealthy country.

This is not acceptable for a country as indebted as ours. We are far more threatened by our domestic and long-term financial problems than we are by some external military threat.

http://upload.wikimedia.org/wikipedia/en/timeline/54b770fbce96cc92949e63d70886ba58.png

http://en.wikipedia.org/wiki/List_of_countries_by_military_expenditures

 

[SurfingDoctor]

unlike a great majority of pre-meds 3rd year med students and beyond actually see this stuff first hand. I've been to the VA inpatient and primary care so I understand the problems. I've rotated at private upscale hospitals. Been to inner city hospitals. Seen hundreds of patients from all walks of life and income. How many pre-meds have done this? And NH14, I don't mean to be really condescending but it sounds like you simply don't understand basic things about how healthcare and the economy work.

Sorry, but medical school actually teaches very little about the practice of medicine and being a 3rd year medical school does not gift you with the experience of knowing how to practice medicine and the policies associated with it, in any sense. If you think it does, you will be in for a shock.

 

[SurfingDoctor]

This is a poor argument that I've heard over and over again. The difference between medicare, etc. and the individual mandate is that medicare is a government program funded through a tax. Congress is constitutionally entitled to levy taxes.

The individual mandate is not a tax. It is a law that forces you to buy a product (health insurance) from a private company or face a penalty if you do not comply.

People are "forced" to provide for the military budget, pay for public education or pay for roads through taxes (which are sometimes provided by private companies) and if you don't pay for those "products" you pay back taxes or go to jail. That sounds like a penalty to me. Most of the people who are required to by healthcare will get government subsized health insurance like Medicaid, not a Blue Cross PPO.

 

[dyeguy21]

People are "forced" to provide for the military budget, pay for public education or pay for roads through taxes (which are sometimes provided by private companies) and if you don't pay for those "products" you pay back taxes or go to jail. That sounds like a penalty to me. Most of the people who are required to by healthcare will get government subsized health insurance like Medicaid, not a Blue Cross PPO.

Great. It still stands that they are forcing you to buy a product and Scalia's argument is valid. If they allow it now, where does it end? Can they force me to buy a cell phone for emergencies? Can they force me to purchase flood insurance if I live close to a shore or river? Can they force me to buy broccoli if its health benefits are proven supreme? (The last one is a little bit of hyperbole, but it proves the point of the slippery slope)

Pure and simple, it doesn't matter that "a lot of people" will be buying a government product. A lot of other people will be buying a private product. In addition, do you want it to be okay for the government to force you to buy something they make because they say its good for you, even if you have chosen not to?

I directly benefit from the military and public education. Also, roads are paid for by excise taxes on gas. Thus, if I'm driving a car, I'm using gas and therefore directly benefiting from road creation and maintenance.

 

[SteinUmStein]

Great. It still stands that they are forcing you to buy a product and Scalia's argument is valid. If they allow it now, where does it end? Can they force me to buy a cell phone for emergencies? Can they force me to purchase flood insurance if I live close to a shore or river? Can they force me to buy broccoli if its health benefits are proven supreme? (The last one is a little bit of hyperbole, but it proves the point of the slippery slope)

Pure and simple, it doesn't matter that "a lot of people" will be buying a government product. A lot of other people will be buying a private product. In addition, do you want it to be okay for the government to force you to buy something they make because they say its good for you, even if you have chosen not to?

I directly benefit from the military and public education. Also, roads are paid for by excise taxes on gas. Thus, if I'm driving a car, I'm using gas and therefore directly benefiting from road creation and maintenance.

Obviously the ruling has not been made yet, but I think we can safely surmise that if the law is indeed upheld, it will certainly be with the caveat that this is a unique and special case of the commerce clause. Read up about how precedents are used in court cases; you cannot use a precedent that tangentially applies to your case or that was used in a special circumstance that is not generally applicable.

The broccoli argument is bogus because in any ruling that keeps the individual mandate in place, it will almost certainly be explicitly stated to be a special case of the commerce clause, and not one that can be broadly applied to any kind of commerce. Yes, you can do this. Yes, it has been done before numerous times.

http://en.wikipedia.org/wiki/Case_law

Edit: this is a better overview - http://en.wikipedia.org/wiki/Precedents

 

[SurfingDoctor]

Can they force me to purchase flood insurance if I live close to a shore or river?

Actually yes. In order to own property, many places require you to buy insurance from common natural disasters. This doesn't apply really to what we are taking about because you can choose not to have a home, but you can't choose to get ill with a disease like leukemia, but yes, they can and do force personal property insurance. And if you "choose" to not have it, which in some places you can't, and all your stuff gets destroyed, who pays for your food and shelter? FEMA, which you get through taxes and directly costs others. Thus the purpose of mandated insurance. Cell phones are a bad example as they only help the user directly. There is no benefit to society. Same with the brocolli. You not eating brocolli only hurts you, not others. Anyway, this is a bit off subject.

I directly benefit from the military and public education. Also, roads are paid for by excise taxes on gas. Thus, if I'm driving a car, I'm using gas and therefore directly benefiting from road creation and maintenance.

Roads are not only paid for through taxes on gas, but that may have been a bad example. I've directly benefited from education too, though people who go to private school can't say they benefited, but they still pay into the system. And I've never directly benefited from the military, the police or firefighters, but I pay into the system because they provide a safety net for all members of society.

 

[SteinUmStein]

Perfect timing, this article was just released today and summarizes the main points really well.

http://blogs.reuters.com/great-debate/2012/03/29/heres-why-health-insurance-is-not-like-broccoli/

Here's the gist for those who don't want to read the whole thing:

These two differences between broccoli and health insurance translate into the important limiting principle that the justices were seeking: As part of its Commerce Clause powers, Congress can compel people to purchase a good or service when, because of market failure, the market collapses as a result of their refusal to participate and when they themselves will definitely need the good or service and would otherwise transfer the cost of using the service to the rest of us.

The difference between broccoli and health insurance is simple. It leads to a clear limiting principle. Congress can urge people to eat their broccoli, but not compel them to buy it, because the broccoli market will function regardless of what people do. Congress can compel people to buy their health insurance because otherwise there will be no health insurance market.

 

[crmellon]

Perfect timing, this article was just released today and summarizes the main points really well.

http://blogs.reuters.com/great-debate/2012/03/29/heres-why-health-insurance-is-not-like-broccoli/

Here's the gist for those who don't want to read the whole thing:

The only forseeable issue I have with that article, is that the Healthcare Market will continue to exist regardless is Congress compels the citizenry to purchase it or not. So, this really still isn't a justificant for use of the Commerce Clause.

Thoughts?

 

[SteinUmStein]

Depends on how you define market. The vast majority of the healthcare "market" is inaccessible to the average American without health insurance, without the rest of the system (i.e. all of us) taking a financial hit and subsidizing their care (as we do at every ED in the country right now). That's part of why the ACA defense rests on the continued existence of the health insurance market, rather than the healthcare "market" itself, whatever that may be.

It's also important to note that the continued existence of the healthcare market is irrelevant to the arguments made by the defense. Their argument is that the health insurance market will collapse if the mandate is struck down. No one tried to state that the healthcare market itself will collapse.

 

[crmellon]

Honestly I wouldn't mind spending that kind of money on defense if we had a hyperaggressive advanced, wealthy country with superior military capability threatening our domestic safety and independence. But in almost every case where our military has been involved in the past 50 years, we are that hyperaggressive advanced wealthy country.

This is not acceptable for a country as indebted as ours. We are far more threatened by our domestic and long-term financial problems than we are by some external military threat.

http://upload.wikimedia.org/wikipedia/en/timeline/54b770fbce96cc92949e63d70886ba58.png

http://en.wikipedia.org/wiki/List_of_countries_by_military_expenditures

Are you seriously insinuating you'd rather have healthcare over Railguns and Lasers?!

 

[SteinUmStein]

Are you seriously insinuating you'd rather have healthcare over Railguns and Lasers?!

Touché.

 

[batch5000]

I say we cut our military budget down to about 10% of what is currently is and focus solely on the defense of our borders. Bring the troops home. Close down the overseas bases. Then use some of that to expand Medicare to a larger percentage of the population. End Medicaid and fold those people into the Medicare program. I think this would work similarly to France's system, where about 75% of care is paid by the gov't (compared to the US where I believe 40% is paid by the gov't.) Additionally, physicians and hospitals could remain private entities, like most do in France. This would avoid the loss of autonomy that many of us fear going to a NHS-like system where most docs are employees of the state. As for the defense, we should be able to protect our borders with significantly less funding. But we will have to stop our adventurism throughout the world. Europe of course will be left to protect itself, but what American likes their tax dollars to go toward protecting other nations when we have our own programs that need funding? It might be difficult for European nations to fund their healthcare programs as well as they do now if they were suddenly to have to pay for the defense that we Americans subsidize for them. But we can't pay for everyone. We might even have a little left over to give the middle class a tax break!

 

[SteinUmStein]

Any plan even approaching that would be a welcome change. It'd be nice to have a Defense Department that actually focused on defense rather than American Freedom Adventures of Awesomeness and Oil with massive bloated kickbacks to every major defense contractor.

 

[MT Headed]

Actually yes. In order to own property, many places require you to buy insurance from common natural disasters.

I just wanted to point out that the lien holder on the mortgage forces people to purchase flood insurance (along with fire insurance, etc). The only time the government forces people to purchase flood insurance is when the government participated in the mortgage in the first place.

Nobody is forced to purchase flood insurance for property if they have clear title to it.

 

[JackShephard MD]

Agreed that military spending is out of control.

 

[dyeguy21]

The problem of agreeing on military spending is a question of what you believe in. There is the realist and the liberal points of view.

Realist says we can do as much as we can to promote free trade, but people are still going to use militaristic force and unfair market pressures to gain an advantage in the global market, thus we always require a large safety force in order to combat that.

Liberal states that if we can obtain true free trade such that every nation depends on another for some good, there should be no need for war as we will become an inter-dependent world.

I'm not going to pass judgement on those that whole heatedly believe in the liberal view because I believe in free market principles and that they have powerful effects in the global economy. However, we sort of cheat at this because we subsidize a lot of products, but we only do it because everyone else does. The thing that pushes me towards realist is the presence of crazy rulers/leaders/dictators.

People like Kim Jong Un, Ahmadinejad, Putin, Hugo Chavez, and Bashar al-Assad scare me, because they are unpredictable and the goal of economic peace does not interest them. Even when we agree to reduce our nuclear stockpiles with Russia, they will never go down to zero. Why? Because you can't trust the other guy telling you what cards he has.

Thus, I am all for making our military one of the most technologically frightening so that attempting a true militaristic assault on the USA would be hopefully unimaginable, but certainly unfeasible. I genuinely did not like the decision made by our current president to cut funding to Future Combat Systems, because most of what they had in the pipeline sounded absolutely awesome.

 

[NH14]

This is a poor argument that I've heard over and over again. The difference between medicare, etc. and the individual mandate is that medicare is a government program funded through a tax. Congress is constitutionally entitled to levy taxes.

The individual mandate is not a tax. It is a law that forces you to buy a product (health insurance) from a private company or face a penalty if you do not comply. And for those who are wondering what the difference is between this and auto insurance: well, no one forces you to buy a car. Once you own a car, the government can regulate how you use that car (i.e. compel you to buy auto insurance).

Those arguing that the act is constitutional are doing so through the commerce clause "the congress shall have the power to regulate commerce with foreign nations, and among the several states, and with the Indian tribes".

If the act is found constitutional, it basically means that congress has the power to create commerce in order to regulate it, giving them unprecedented power.

dude, i said taxation is constitutional and the individual mandate would be an extension of federal power, i know that... read my quote...

Further, the individual mandate ruling will all come down to Roberts or Kennedy's decision in June/early July. We have to wait and see. Even if they strike down the individual mandate, much of the ACA can still be enacted. Further, taxation is still an option for funding health care reform in future efforts. I understand how constitutional law can strike down the individual mandate. However, I support the idea that the government should mandate that ALL us citizens should participate in health insurance. This would could be easily be constitutional if that mandate was raised through taxation. However, short-sighted Republicans shot down the government option, watering down health reform to what seems to be a corporate health insurance handout taking form as the individual mandate.

 

[Gut Shot]

do you guys think universal healthcare will end up being like he suggests?

Probably not. There is simply too much resistance to enact top-down universal coverage at the federal level in the foreseeable future. Even lowering the age of entry for Medicare would be met with incoherent screams of "death panels".

There is perhaps a more realistic scenario, bearing in mind that we have 50 health care laboratories in this country, and keep your eyes on Vermont. Last year Vermont voted to establish a single payer system, although there is still some uncertainty as to when they can begin in earnest.

If Vermont can set up a system that takes advantage of the inherent administrative simplicity of single payer, while providing adequate coverage, and (this is important) not burning providers, other states are likely to take notice. Vermont will also suddenly find itself incredibly business-friendly, allowing companies within its borders to throw off the yoke of employer-based health insurance.

Under such a situation I could see the federal government offering carrots to other states that wish to pursue a similar course. Viola, we may stagger towards the direction of socialized health insurance just yet.

 

[SoundofSilver]

dude, i said taxation is constitutional and the individual mandate would be an extension of federal power, i know that... read my quote...

Further, the individual mandate ruling will all come down to Roberts or Kennedy's decision in June/early July. We have to wait and see. Even if they strike down the individual mandate, much of the ACA can still be enacted. Further, taxation is still an option for funding health care reform in future efforts. I understand how constitutional law can strike down the individual mandate. However, I support the idea that the government should mandate that ALL us citizens should participate in health insurance. This would could be easily be constitutional if that mandate was raised through taxation. However, short-sighted Republicans shot down the government option, watering down health reform to what seems to be a corporate health insurance handout taking form as the individual mandate.

I agree that a single payer type program funded through taxation would be more "constitutional" than an individual mandate as it would just resemble another medicare type entitlement. And medicare has apparently been constitutional for its 40+ years of existence.

My biggest problem with the law is that it forces you to buy a product from a private institution (rather than paying a tax and receiving a service from a public institution). I realize that having everyone on health insurance will theoretically lower costs by spreading risk more evenly. I also think that everyone should have access to healthcare. It's just the individual mandate approach that gives me pause.

Back when the constitution actually mattered, they would have had to create an amendment to do something like this. Alcohol prohibition required an amendment, but drug scheduling and outlawing schedule 1 drugs did not? Amend the constitution but do not treat it as a "living document".

"[There's] the argument of flexibility and it goes something like this: The Constitution is over 200 years old and societies change. It has to change with society, like a living organism, or it will become brittle and break. But you would have to be an idiot to believe that; the Constitution is not a living organism; it is a legal document. It says something and doesn't say other things . . . [Proponents of the living constitution want matters to be decided] not by the people, but by the justices of the Supreme Court . . ." - Justice Scalia

 

[Gut Shot]

My biggest problem with the law is that it forces you to buy a product.

That's one way of looking at it. Another is that the law would give a relatively small segment of the population a choice: purchase health insurance through an exchange or pay a penalty. See Eliot Spitzer's interesting piece in Slate.

As for being forced to buy a product, how is it that different from other aspects of life? I am currently forced to buy car insurance, homeowner's insurance, flood insurance, and malpractice insurance. By virtue of my work I am forced to own shirts, slacks, and ties. We are all forced to buy a lot of things in order to participate in normal, functioning society. We all pay to play.

On the other side of the coin, one could argue that invalidating the individual mandate sanctions theft, as it allows that segment of population mentioned above to push costs onto the rest of the country. Is that any more desirable than making sure everyone has skin in the game?

 

[vayntraubinator]

Switzerland. But the have higher costs than the rest of Europe and pretty high out-of-pocket. Still, they seem to do a better job than the US in regards to costs, and they offer choice and flexibility of private plans. Republicans have actually used Switzerland as a model for reform.

But the catch: Switzerland also has a number of key Obamacare (we're all calling it that now right) provisions including individual mandate and no denying for pre-existing conditions.

Obviously, good reform would take compromise. So, it probably won't happen anytime soon.

Consider that Switzerland is tiny. Countries that are smaller tend to be in much better shape because of proximity to legislate and exercise power & also have the advantage of basic speed of transportation. Kuwait with half Switzerland's population has the lowest death rate in the world (2.11/1000 people).

 

[startoverat40]

http://www.nytimes.com/2012/04/25/b...lted-for-tough-tactics-in-hospitals.html?_r=1


ever more reason to remove "insurance" companies from the delivery of medical care and the compensation of doctors and hospitals for providing that service. the people of this country have the right to pool their money and collectively pay the doctors and hospitals for their service. no other entity has the right to make a profit out of this transaction! the majority of Americans want a single-payer system, as so do the majority of doctors. there is no reason why all of the people of this country and all of the physicians can't kick the useless profit makers out of the way so they can have this transaction of compassion and service between each other!

 

[johnmendes]

I watched "Sicko" today, and I took it as a grain of salt, but as an European, I find it quite disgusting the way the system in the states is run. It's also revolting the indifference that some doctors (who took the hippocratic oath) show.

 

[Dave89]

I watched "Sicko" today, and I took it as a grain of salt, but as an European, I find it quite disgusting the way the system in the states is run. It's also revolting the indifference that some doctors (who took the hippocratic oath) show.

Sicko should be taken with a MOUNTAIN of salt.

http://www.nationalreview.com/articles/221451/skipo/deroy-murdock