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Thread: Can the states by themselves now unravel ObamaCare?

  1. #41
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    Re: Can the states by themselves now unravel ObamaCare?

    Quote Originally Posted by Harry Guerrilla View Post
    Do you realize that they may reject the program, because of very expensive future costs.
    The same rational was applied to a worthless HSR line.
    From 2020 onward, the feds are still picking up 90% of the costs of the Medicaid expansion. "Very expensive future costs" for the states does not seem to be an issue at any point in the foreseeable future. I think libertarians/conservatives should be more worried about the opposite outcome: the federalization of Medicaid.
    Last edited by Kandahar; 07-04-12 at 11:41 PM.
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    Re: Can the states by themselves now unravel ObamaCare?

    Quote Originally Posted by Neomalthusian View Post
    I get the impression that the way you think it should work is that states should clamor, elbow and vacuum up as much federal funding as they possibly can.

    What's so wrong about states trying to stop contributing the problem of an increasingly bloated federal government?
    It's still a Prisoner's Dilemma for the states. Even if some governors honestly believe that the nation as a whole would be better off without the Medicaid expansion (or any other source of federal funding to the states), no state wants to be the sucker that turns down money while other states participate. Each individual state would be better off with that money, regardless of their ideology.
    Last edited by Kandahar; 07-04-12 at 11:42 PM.
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  3. #43
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    Re: Can the states by themselves now unravel ObamaCare?

    Quote Originally Posted by Kandahar View Post
    It's still a Prisoner's Dilemma for the states. Even if some governors honestly believe that the nation as a whole would be better off without the Medicaid expansion (or any other source of federal funding to the states), no state wants to be the sucker that turns down money while other states participate. Each individual state would be better off with that money, regardless of their ideology.

    Only if you believe that the Federal government reigns supreme over the states...Because that is the track record of this lying administration...They dole out money we don't have, then tell you what to do.
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    Re: Can the states by themselves now unravel ObamaCare?

    Quote Originally Posted by Kandahar View Post
    It's still a Prisoner's Dilemma for the states. Even if some governors honestly believe that the nation as a whole would be better off without the Medicaid expansion (or any other source of federal funding to the states), no state wants to be the sucker that turns down money while other states participate. Each individual state would be better off with that money, regardless of their ideology.
    States turn down federal programs all the time, especially when they are unfunded mandates or going to cost them in the long run. Some governors are smart enough to avoid the loss-leader (retail sales term for an item sold at a loss to entice the buyer in).

    Governors know that by participating they hook their people on increased federal taxation forever (to pay for the money they're paying the state for these exchanges). Where, if they resist, there's a chance the tax and the program will be overturned. Once the people are on the system, it's virtually impossible to kill. Even the worse federal programs, if allowed to live beyond their controversy, are unkillable. They zombie on forever. Governors know this, some of their people do too.

    As for the expenses of health care in the last month of life - well DUH! That's like saying you finally found your keys in the last place you looked (well, let's just hope you didn't keep looking after you found them ).

  5. #45
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    Re: Can the states by themselves now unravel ObamaCare?

    Quote Originally Posted by Helix View Post
    i've heard all of the talking points against the PPACA. the only good thing i can say about it is that it eliminates some slimy insurance practices. those should have been passed in a different bill, though.

    to fix our health care problems, we need basic coverage for all Americans, and the coverage should in no way be tied to specific employment. also, we have to vastly increase the number of primary care physicians, which is artificially low. we have to expand our medical schools and make them more affordable. and we have to reduce the cost of bringing a drug to market, which means patients are going to have to accept a higher degree of risk.

    put simply, our system is failing, and it's taking down other sectors with it. a mandate to buy private insurance is barely a band aid. the starting point of negotiations should have been medicare for all, and the compromise should have been a public option for everyone who fell through the cracks. but, unfortunately, the opposition wanted either nothing or a bill that was so fatally flawed that it couldn't possibly work, so we got the mandate.

    at least it's a step. eventually, people will tire of going bankrupt over their kid's broken arm when that's not the status quo in any other first world country. at that point, maybe we'll really try to solve the problem.
    I agree with the bolded but I dont think government taking it over is the solution. I think government can kick employers out of the healthcare business by just removing the huge tax break companies get on insurance premiums and transfer it to individuals only. Give insurance watchdogs in each state teeth so they can penalize them when they try to abuse honest customers and toughen up the penalties for insurance fraud. There are a lot of simple baby step solutions that will get us moving in the right direction. Right now there is no way costs are going to go down with the amount of increased government cost baked into this bill.

  6. #46
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    Re: Can the states by themselves now unravel ObamaCare?

    Quote Originally Posted by Kandahar View Post
    It's still a Prisoner's Dilemma for the states. Even if some governors honestly believe that the nation as a whole would be better off without the Medicaid expansion (or any other source of federal funding to the states), no state wants to be the sucker that turns down money while other states participate. Each individual state would be better off with that money, regardless of their ideology.
    WRONG. What is free, at first, is not GUARANTEED to remain so, even 10% (due from third year on) is HUGE for the states, as they must either cut other state services or raise taxes to fund it FOREVER. Unlike Obama, that can simply borrow and promise, states have REAL budgets that they actually have to balance. If they were so SURE to take it, then why did the law threaten to yank ALL medicad funding if they did not? The same may happen with the "state" exchanges, if they are not run by the states then the federal gov't must run them, at no cost to the state EVER.
    Last edited by ttwtt78640; 07-05-12 at 04:39 PM.
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    Re: Can the states by themselves now unravel ObamaCare?

    Quote Originally Posted by OpportunityCost View Post
    I agree with the bolded but I dont think government taking it over is the solution. I think government can kick employers out of the healthcare business by just removing the huge tax break companies get on insurance premiums and transfer it to individuals only. Give insurance watchdogs in each state teeth so they can penalize them when they try to abuse honest customers and toughen up the penalties for insurance fraud. There are a lot of simple baby step solutions that will get us moving in the right direction. Right now there is no way costs are going to go down with the amount of increased government cost baked into this bill.
    It is easier to just drive the "private" medical care insurance companies out of business (or their premium cost WAY up), forcing employers to "choose" to pay the fine instead, giving their employees a lot more pay instead of insurance and then the federal gov't gets all that extra tax revenue from FICA and FIT on that "raise". ;-)
    “The reasonable man adapts himself to the world: the unreasonable one persists to adapt the world to himself.
    Therefore all progress depends on the unreasonable man.” ― George Bernard Shaw, Man and Superman

  8. #48
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    Re: Can the states by themselves now unravel ObamaCare?

    Quote Originally Posted by Kandahar View Post
    From 2020 onward, the feds are still picking up 90% of the costs of the Medicaid expansion. "Very expensive future costs" for the states does not seem to be an issue at any point in the foreseeable future. I think libertarians/conservatives should be more worried about the opposite outcome: the federalization of Medicaid.
    I hope you understand how crappy of a program Medicaid is.
    Providers have been limiting medicaid recipients for years because of under market payments.
    Several years ago, I was helping a woman find an OB that took Medicaid in Atlanta.
    The results were disheartening for her.

    I'm more concerned that the feds will increase spending, to get providers to actually accept the program, which in turn will cause greater medical cost inflation.
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    Re: Can the states by themselves now unravel ObamaCare?

    Quote Originally Posted by ttwtt78640 View Post
    WRONG. What is free, at first, is not GUARANTEED to remain so, even 10% (due from third year on) is HUGE for the states, as they must either cut other state services or raise taxes to fund it FOREVER.
    Please -- there are no guarantees in life. If the feds change the rules of the game in five years then the states can opt out in five years. In the meantime, if a state opts out, it will forego tens of billions of dollars in benefits for its citizens but the states' citizens will still have to contribute to the benefits that OTHER states will receive.
    "The necessaries of life occasion the great expense of the poor. They find it difficult to get food, and the greater part of their little revenue is spent in getting it. The luxuries and vanities of life occasion the principal expense of the rich, and a magnificent house embellishes and sets off to the best advantage all the other luxuries and vanities which they possess. ... It is not very unreasonable that the rich should contribute to the public expense, not only in proportion to their revenue, but something more than in that proportion."

    -- Adam Smith

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    Re: Can the states by themselves now unravel ObamaCare?

    Quote Originally Posted by Harry Guerrilla View Post
    I hope you understand how crappy of a program Medicaid is.
    Providers have been limiting medicaid recipients for years because of under market payments.
    Several years ago, I was helping a woman find an OB that took Medicaid in Atlanta.
    The results were disheartening for her.

    I'm more concerned that the feds will increase spending, to get providers to actually accept the program, which in turn will cause greater medical cost inflation.
    I'm pretty sure that Medicaid is better than nothing, which is the alternative.
    "The necessaries of life occasion the great expense of the poor. They find it difficult to get food, and the greater part of their little revenue is spent in getting it. The luxuries and vanities of life occasion the principal expense of the rich, and a magnificent house embellishes and sets off to the best advantage all the other luxuries and vanities which they possess. ... It is not very unreasonable that the rich should contribute to the public expense, not only in proportion to their revenue, but something more than in that proportion."

    -- Adam Smith

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