"Obamacare" or UHC?

Thunder said:

ACA won't reduce costs.

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Would that be unit costs or overall costs? And what is the reference point from which cost reductions are to be calculated? To be more precise, if I do 10 procedures this year at $10 each, and 12 next year at $9 each, have costs gone up or down? And if costs at some point in the future are higher than they are today, but lower than they would have been extrapolated at current rates of increase from today, have costs gone up or down?

Neomalthusian said:

The more painful you make it, the more incentive they have to simply not pay it. What's government gonna do if they don't?

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Beat them. I thought I'd made that clear in my prior post.

Neomalthusian said:

[1] There is no cost containment incentive, hence costs go crazy.

[2] We're letting health care bankrupt us die to our refusal to restrict it from non-payers.

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1. We need to work on that. I'm no fan of the standard health insurance model, preferring something along the line of catastrophic coverage which ensures that the insured has some skin the game (paying for routine costs and a healthy capped deductible, although I can see incentivizing preventative care).

2. A civilized society will not tolerate letting the indigent, the illegal, or even the indolent die on the curb. Although it can be frustrating, I think that's a Good Thing.

Dittohead not! said:

Libertarian philosophy is not anarchy. It is that the purpose of the government is to protect our rights. What we see in Somalia is anarchy in which no one has any rights.

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Not necessarily to disagree, but to point out that systems of no rights at all and systems of my rights trump everyone else's righs are extremely difficult to distinguish from each other. And if one concedes that at times the rights of one person take precedence over the rights of another, you have started down a slippery slope.

ttwtt78640 said:

Beacuse the TRUE COSTS could not be hidden by doing that. It does not take thousands of pages of law to say keep what medical care insurance you have, make those without it by it from "pools" or exchanges" and give some more folks medicaid access. This is a scam to make the HUGE costs look little, and to delay the big tax bills until 2014 through 2018. Yes he did!

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Well ranted, but unfortunately not offering any actual connection to the reality of either health care or PPACA.

Karl said:

... 2. A civilized society will not tolerate letting the indigent, the illegal, or even the indolent die on the curb. Although it can be frustrating, I think that's a Good Thing.

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So you think the Tea Party thing, where you don't get even ER care if your not going to pay for it is not OK? (But, gosh, I was at a Tea Party demonstration and several of them didn't know that Medicare was government.)

Karl said:

So, he saw Obamacare as a step in that direction...

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He didn't actually see anything. He set out a few basic requirements then threw the ball into Congress's court and asked them to cobble together their best ideas for how to move forward given the disaster that loomed on the horizon as the price of doing nothing. Thereafter, Obama served as POC and negotiator with several major stakeholders to find out first what they felt they needed and then what they felt they could support. That info was made available to Congress. Republicans of course simply quit playing altogether after July of 2009, but in spite of that, well over a hundred Republican amendments appear in the final bill. Keep in mind though that the objective was never to produce a bill that everyone would like. It was to produce a bill where enough people to pass it would be able to say that there's a lot that I don't like in this bill, but there's enough that I do like that I'm going to vote for it anyway.

Karl said:

...and had they been able to keep the Government Option in the package it would have been more of a step in that direction instead of a boon for health insurance companies.

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Everyone has to be brought along. Starting from where they are right now. You cannot kill the insurance companies. You cannot kill major drug and device manufacturers. Without them, people die. The boon for the industry is in those up to 30 million new people with health care coverage. That's a lot of potential new profit, and to help try to get the law passed that would create access to that new profit, they have agreed to and accepted new rules and new cost structues that share the boon with the taxpayer. Has it all been done exactly right? Of course not, but where there once was nothing to work with at all, there are now all those terrible thousands and thousands of pages to go to and make the necessary adjustments. This is a HUGE step forward.

Neomalthusian said:

How much of our health care is provided to people in their last year of life? This could be huge.

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More likely to be stupid. Or are you intending to run for Death Panel Chairman or something? By the way, are you counting the expenses of trying to save an infant who dies before the age of one?

Neomalthusian said:

Wrong. People can opt to pay the tax until they get sick and need tons of medical care. Like waiting until the car accident to take out a policy with GEICO. That leads to astronomical increases.

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Do the math. Are the taxes a greater or smaller "shared responsibility payment" than would have been made absent the provisions of PPACA? I see only an answer to indicate that increases will at the very worst be considerably less "astronomical" than otherwise.

Cardinal Fang said:

Harder than having done nothing at all? That's absurd. And you seriously need to brush up on the levels of exemption, subsidy, and taxation in PPACA. In the meantime, no place else is here. It isn't that people -- well at least the people actually involved -- don't know how national systems in other countries are structured or how and how well they work, but rather that the US isn't any of those places. Just as the national systems of other developed countries are unique and were brought about piece by piece to fit the special needs, preferences, and circmstances of those countries, ours must do the same. The French think the British NHS is a pile of socialist rubbish. But they love their system, and with very good reason.

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Yes I see Obama care as moving farther from a UHC system and entrenching the health insurance plan system. This will make it harder to create any UHC system. In other words I see Obamacare having to be pretty much torn down to go to UHC and I see that as harder to do than having no system at all to remove first. Yes I understand political expediency and only being able to do so much, yet I still think it's a step in the wrong direction. Yes I admit I could could be wrong only time will tell.
I agree you need your own system in the USA, my personal opinion is that Obama care will make it harder to go to UHC again time will tell.
Do I think Canada has the best system possible? Nope I think it can definetly be improved. Some improvements however are/will be hard to do because of the way the system was set up. If we started with a clean slate I think it would be easier to have a better system than we have now but we gotta deal with what we got.

StillBallin75 said:

I'm beginning to think that we should just have a "libertarian opt-out" for everything. Better yet why don't we set aside a parcel of land so that the libertarians can have their own paradise lol. That would be quite an experiment.

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Ever played BioShock? That's what a pure libertarian experiment would look like.

OhIsee.Then said:

So you think the Tea Party thing, where you don't get even ER care if your not going to pay for it is not OK? (But, gosh, I was at a Tea Party demonstration and several of them didn't know that Medicare was government.)

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I'm having trouble parsing your triple negative, but I'm fairly certain that my answer to your question is "yes".

Thanks for the mental gymnastics; this has been the most difficult reply of the day

Karl said:

1. We need to work on that.

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One would think a $1.75 Trillion dollar "affordable care act" WOULD HAVE ****ING WORKED ON THAT!

2. A civilized society will not tolerate letting the indigent, the illegal, or even the indolent die on the curb. Although it can be frustrating, I think that's a Good Thing.

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A civilized society doesn't intentionally bankrupt its citizens by 1) failing epically to suppress costs of the care it's entitling to its whole population, and 2) mandating people keep paying for it regardless of how high those costs go, and then in a monumental act of irony,
call it an "affordable care" act. That is a one-two punch to the junk.

Cardinal Fang said:

He didn't actually see anything. He set out a few basic requirements then threw the ball into Congress's court and asked them to cobble together their best ideas for how to move forward given the disaster that loomed on the horizon as the price of doing nothing. Thereafter, Obama served as POC and negotiator with several major stakeholders to find out first what they felt they needed and then what they felt they could support. That info was made available to Congress. Republicans of course simply quit playing altogether after July of 2009, but in spite of that, well over a hundred Republican amendments appear in the final bill. Keep in mind though that the objective was never to produce a bill that everyone would like. It was to produce a bill where enough people to pass it would be able to say that there's a lot that I don't like in this bill, but there's enough that I do like that I'm going to vote for it anyway. [...]

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While I disgree with your intial statement, I mostly agree with your analysis that followed. I think that Obama's ultimate goal was and is UHC, and that Obamacare -- which I don't think turned out exactly as he envisioned, especially with the missing Public Option -- was envisioned as a currently politically palatable precursor to UHC.

He's taking the long view, moving the ball down the field in a game that I think he realizes will continue beyond his term in office. If I am correct, then that is a refreshing approach for a politician.

Cardinal Fang said:

More likely to be stupid. Or are you intending to run for Death Panel Chairman or something? By the way, are you counting the expenses of trying to save an infant who dies before the age of one?

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Sure, why not? Maybe I should specify further, how many health care dollars are spent on people with very low chances of survival even with the treatments/procedures?

Neomalthusian said:

They should have been advocating for death panels, not freaking out about them.

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We already HAVE Death Panels. We call them "insurance companies". If it looks like profits might be unduly impacted or if a particular adjuster hasn't denied enough claims this month to earn his quarterly bonus, the patient is SOL.

Meanwhile, if you want to restrict services, how be we start with the ones we know full well are unnecessary echos of the inane fee-for-service model. Suppose we also start consolidating your medical records and making them available to any doctor who treats you so that unnecessary diagnostics aren't performed at all and others aren't performed over and over and over again. How be if we track data on patient-centered outcomes and make that info available so that doctors in Boston won't have to wait for years to read about this cheaper treatment that's working so well in Houston.

Cardinal Fang said:

Everyone has to be brought along. Starting from where they are right now. You cannot kill the insurance companies. You cannot kill major drug and device manufacturers. Without them, people die. The boon for the industry is in those up to 30 million new people with health care coverage. That's a lot of potential new profit, and to help try to get the law passed that would create access to that new profit, they have agreed to and accepted new rules and new cost structues that share the boon with the taxpayer. Has it all been done exactly right? Of course not, but where there once was nothing to work with at all, there are now all those terrible thousands and thousands of pages to go to and make the necessary adjustments. This is a HUGE step forward.

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My point was that had the Public Option survived, that would have been the true first step to UHC (via government insurance) other than Medicare without damaging the insurance companies. Without the Public Option, the insurance companies get all of the benefit (all the new insureds) without any of the pain (some of the new and current insureds may have instead gone to the Public Option).

Same with the drug companies -- new insureds without any new group to negotiate pricing (the Public Option group), although I'm uncertain of the amount of negotiating power that a Public Option group would wield (from what little I've read, Medicare does not use its buying power to negotiate drug prices).

I don't know where the insurance companies would fall under UHC... haven't really thought that far ahead.

pilot16 said:

I think a tax on medical devices will be way bigger than people realize and it could be a jobs killer. We have an aging population and there are all kinds of "devices" people need from replacement hips, knees, joints etc plus combined with all the devices found in hospitals and doctors offices, x-rays, cat scans, mri's to name a few. Also I have heard this tax is only placed on American made devices (not sure if true) but if it is, how long before those jobs at Hill-Rom, GE, Strycker will be sent overseas?

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It's an excise tax of 2.3% and it applies to any manufacturer, producer, or importer of covered devices.

Karl said:

I know of no name of any legislation that is not an enormous deception.

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Apparently you've not heard of the Sam D. Hamilton Nonuxee National Wildlife Refuge Act. It renames the Nonuxee National Wildlife Refuge as the Sam D. Hamilton Nonuxee National Wildlife Refuge. That's all. Enormous deception not detected.

Cardinal Fang said:

Apparently you've not heard of the Sam D. Hamilton Nonuxee National Wildlife Refuge Act. It renames the Nonuxee National Wildlife Refuge as the Sam D. Hamilton Nonuxee National Wildlife Refuge. That's all. Enormous deception not detected.

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Shouldn't it have been titled the Sam D. Hamilton Nonuxee National Wildlife Refuge Renaming Act?

The best one I've heard of, and I can't link it so it may be urban legend, is that the Senate took a House revenue bill and removed all language except for the title. They then totally rewrote the bill from scratch -- but with the original House title and bill number -- with their own revenue language, passed it, and sent it back to the House. So much for constitutional checks :lol:

Karl said:

While I disgree with your intial statement, I mostly agree with your analysis that followed. I think that Obama's ultimate goal was and is UHC...

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Yes, he stated as plain as day that he personally felt that a single-payer system would ultimately be the best option, but that he understood that many people had objections and reservations about that.

Karl said:

...and that Obamacare -- which I don't think turned out exactly as he envisioned, especially with the missing Public Option -- was envisioned as a currently politically palatable precursor to UHC.

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There are these examples of failed efforts to accomplish HCR in the past to learn from. Obama took the opposite tack from Clinton, letting Congress sit most of the time in the driver's seat, and Job-1 from start to finish was to craft and then keep a bill that could get 60 votes in the Senate. For a while Reid thought he could include a limited public option and still get there, but he soon had to change his mind about that. Would have been nice to get, but at least all the right-wing howling about how the private sector could never compete successfully against the big, bad bureaucrats was good for a laugh given all the lean, mean private sector efficiency hoopla that they more tpyically over-provide.

Karl said:

He's taking the long view, moving the ball down the field in a game that I think he realizes will continue beyond his term in office. If I am correct, then that is a refreshing approach for a politician.

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I think that's absolutely correct. Okay, the Pentagon is a big ship that's hard to steer, but health care is a much larger ship and has never so much as had a bridge for the captain to steer from before. In my view, he clearly sees this as a work that he will start but that will be left to likely more than one successor to finish, if indeed "finish" is even an appropriate word with respect to in such an undertaking.

Neomalthusian said:

Sure, why not? Maybe I should specify further, how many health care dollars are spent on people with very low chances of survival even with the treatments/procedures?

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More health care dollars are spent on sick, injured, and deteriorating people than on people in other groups. Then again, people who are sick, injured and deteriorating today were in those other groups perhaps not all that long ago, and many in those other groups today will soon be graduating. Be very clear that it is YOU we are talking about here, not THEM.

Cardinal Fang said:

More health care dollars are spent on sick, injured, and deteriorating people than on people in other groups. Then again, people who are sick, injured and deteriorating today were in those other groups perhaps not all that long ago, and many in those other groups today will soon be graduating. Be very clear that it is YOU we are talking about here, not THEM.

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I recently signed a will and advanced directives. I had an option to select "keep me alive indefinitely" in case of unconsciousness an questionable/doubtful chance of full recovery. Not even death can scare me into thinking its financially sustainable to give people that option. But that's only one little example of waste in our free-for-all health care system. No one gets a tough answer, thus expenditures have no ceiling. "Affordable Care" my ***. Straight up doublespeak.

Karl said:

My point was that had the Public Option survived, that would have been the true first step to UHC (via government insurance) other than Medicare without damaging the insurance companies.

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I understand the point and would have liked to see a public option make it through. But it wasn't in the cards and at that point, you play the hand you hold the best you can. VA care and Medicaid might need to be added to Medicare as already existing public systems, but I think one of the plusses of the public option would have come simply in showing people how easy and not un-American such an arrangement could have been. The fabricated horror stories would have been left looking a little silly.

Karl said:

Without the Public Option, the insurance companies get all of the benefit (all the new insureds) without any of the pain (some of the new and current insureds may have instead gone to the Public Option).

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Well, the French have one of the premier national health care systems in the world, and they have a vibrant health insurance industry. It's just a lot smaller than ours and doesn't have anything like the dollars and influence. So, in the beginning we can't, and in the end, we don't need to kill the insurance industry. We need to allow and even help it to shrink down to an appropriate size slowly so as to keep dislocation effects at a manageable level. They are on the hook to stop doing some things and start doing others, and they can't just invent premium hikes anymore. Right now, we have to finish off all the parts so that the whole thing can be in effect in 2014. There will be time after that to see what else the insurance industry can chip in.

Karl said:

Same with the drug companies -- new insureds without any new group to negotiate pricing (the Public Option group), although I'm uncertain of the amount of negotiating power that a Public Option group would wield (from what little I've read, Medicare does not use its buying power to negotiate drug prices).

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Part-D prohibits Medicare from negotiating drug prices. The VA does, and the effects are quite noticeable. But agreement not to axe the prohibition within PPACA was part of the package that brought $80 billion worth of funding through cuts and concessions, so they do have a good bit in the pot.

Karl said:

I don't know where the insurance companies would fall under UHC... haven't really thought that far ahead.

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It would have to depend on how the UHC system was structured.

Karl said:

Shouldn't it have been titled the Sam D. Hamilton Nonuxee National Wildlife Refuge Renaming Act?

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No, that would have implied that the Sam D. Hamilton Nonuxee National Wildlife Refuge was being renamed, which of course would have been an enormous deception.

Karl said:

The best one I've heard of, and I can't link it so it may be urban legend, is that the Senate took a House revenue bill and removed all language except for the title. They then totally rewrote the bill from scratch -- but with the original House title and bill number -- with their own revenue language, passed it, and sent it back to the House. So much for constitutional checks :lol:

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There's no insult to the Constitution there. The Senate can clearly amend a House-originated bill and return it, whether the amendment is a single word or every word. It's not uncommon at all, as followers of H.R. 3590 would have noted.