Government Shutdown and the Affordable Care Act

[diehardtwinsfan]

I agree with a lot of what you are saying. I don't think that the government is good at running hospitals and I am sorry for your family's experiences with the VA. On the other hand, I look at the Israeli system and like the idea of spending about 50% of what we spend now, and getting better results. I would also note that prior to the ACA, some bozo who abused his freedom by not buying insurance then drunkenly wrecked his car would get emergency room treatment anywhere in the U.S., and those of us who had insurance ended up paying for that. I cannot imagine us going to a system where emergency rooms require proof of ability to pay, and I see the ACA as affirming a conservative principle that people should pay their own way when they can afford to do so, i.e. less freeloading. I don't mind being required to buy car insurance and am glad that if some maniac hits me in L.A. traffic, he will probably have some insurance.

 

Freeloading is largely the result of a broken system in the first place. It's broken because the system has been rigged in such a way to eliminate competition, and forcing everyone to buy insurance (and not allowing them to get cheaper major medical policies) doesn't fix those issues.

 

If you want to lower medical prices, switch to a cash only system and eliminate insurance altogether. Then you will see just how "unaffordable" this really is. ACA isn't going to fix these problems, it's only going to make it worse. It will do nothing but provide a nice subsidy to the medical and pharma industries who are already doing quite well. The real losers are small businesses and self employed people.

 

It also seems to me that maybe we can agree that capitalism can provide the optimum solution. Under the ACA, insurance companies can compete, as in Massachusetts and Israel. In contrast, Medicare has no competition, but gets better rates than insurance companies because of its size and bargaining power. Maybe if Medicare could become a public option for everyone and users could instead opt for private insurance, this would create an even more robust market. I think that ot would also help if hospitals were required to post their billing rates, success rates and other relevant data so that consumers could make more informed choices. Competition is a powerful tool to reduce costs.

 

Both Medicare and SS should have been available as public options, but these "safety nets" are nothing more than Ponzi schemes, and that was the intent from day 1. These are bankrupt because the government took the money in these trust funds and replaced it with government debt. This is going to accelerate the debt problems this country already has because as more people retire these IOUs have to be converted to cash to pay them.

 

Here is the part where I need help -- the passages in the New Testament where the rich guy asks Jesus how to get to heaven and Jesus tells him to sell all of his possessions and give the money to the poor. Then Jesus says that it is easier for a camel to go through the eye of a needle than a rich man to enter heaven.

 

Maybe I am dense, but it seems to me that Jesus was saying that helping poor people is pretty important. I think that means that letting poor children die from cancer and other curable ailments would be a lot worse sin than the sins that the Republicans seem obsessed with, such as premarital sex, abortion, same-sex marriage, drug addiction and welfare fraud. I would be grateful if you would explain to me (in as much detail as you are willing to provide) why this does not mean that we should be doing whatever we can to at least provide health care to all children whose parents cannot afford it on their own. It's not as though this is not working in lots of other countries (some better than others). What are we going to say to St. Peter if he asks us about this?

 

I never said that Jesus said not to help the poor. It is you who is reading more into this than what is there. I'm arguing against 2 things:

 

1. Whether or not the government is an effective tool for this. I'm not just arguing against its ability to fix this either. I'm arguing that the government is the primary cause for things being the way they are and the "fixes" are nothing more than bandaids to allow them to perpetuate the broken system, in large part because it's in the financial best interests of their backers to continue it. This system won't get fixed until there's a return to a true free market with no central bank. Fix this, and there's a lot less poor. Fix this, and helping what poor that remain will be a lot easier to do.

 

2. I'm also arguing against your conclusion of these passages means that a Christian must support universal healthcare. That's a huge reach. If you are concerned about poor children and cancer, see point number 1, as dealing with the root cause will be far more beneficial than ACA. Your last plea here is where I think the big disconnect lies. I'd argue that point 1 will do far more to accomplish what you desire than any kind of government intervention in the current system. You mentioned it works in other places, but you also forget that most of these other places that can afford it also don't maintain a standing army that essentially rules the globe. Do you think Israel could afford their healthcare if the US wasn't sending them billions of dollars a year? What about Europe?

 

Also, minor, ok major, theological note here, but the fate of the believer was sealed by Christ in his sacrifice on the cross. My assurance of salvation has absolutely nothing to do with where I stand on this issue. Peter won't be standing at the gates giving me a quiz about ACA and helping the poor. Believers will be admitted because they were justified by Christ and sanctified by the Spirit.

 

 

My solution is straightforward -- get rid of all of the poor people -- every last one. Give them an opportunity to be productive and reduce benefits to exactly the poverty level for those who refuse to work. Reward those who work hard -- a family where both parents are working full time (or more) should make enough to be comfortable. It seems to me that if we can create a system where almost everyone works, then the extra productivity would benefit everyone and St. Peter would smile when we tell him how we got rid of poverty so that we could all go to heaven (or at least most of us, excluding, of course, Yankees and White Sox fans). Maybe I need to go see a priest or a minister, but I just don't understand how we can get out of helping poor people, especially children, until there are no more people (or at least children) who are poor.

 

Again, I'd love a system like what you describe. ACA is a step in the wrong direction. My challenge to you is to take a hard look at this nation's history, particularly in regards to a central bank. There was far more to the American Revolution than taxation without representation. You want to eliminate poverty, you will need to start there.

[Mike Sixel]

It most certainly did. It was the federal reserve who enabled our Government's debt binge by lowering interest rates to create a debt bubble in the economy in the first place. It was the government that chose to repeal the glass steagle act that created the TBTFs in the first place. Yes, the private sector jumped in there too, but pretending that it was one without the other is absurd. None of this happens if the gov leaves glass-steagle in tact and kept rates where they belonged... none of it.

 

The government removing regulation is somehow the government causing problmes? Isn't that actually evidence that more government oversight was needed, not less?

[TheLeviathan]

The government removing regulation is somehow the government causing problmes? Isn't that actually evidence that more government oversight was needed, not less?

 

Cmon. Why this black and white stuff? Not all regulation is bad and not all of it is good. This is such a flimsy talking point and it completely ignores what was said in order to smash a silly scarecrow.

 

There are clowns in politics that believe all regulation is bad, but no one has said that here.

[Mike Sixel]

Actually the post I responded to stated it was the governments fault because they removed regulation.......I would argue that it is de facto evidence that it was caused by the private sector.* in the absence of regulation! the private sector did things they were not previously allowed to do that at least partially contributed to the problem. How is that a government cause, and not clearly a private sector cause?

 

*no idea if I used de facto right! but I liked typing it.

[TheLeviathan]

Actually the post I responded to stated it was the governments fault because they removed regulation.......I would argue that it is de facto evidence that it was caused by the private sector.* in the absence of regulation! the private sector did things they were not previously allowed to do that at least partially contributed to the problem. How is that a government cause, and not clearly a private sector cause?

 

*no idea if I used de facto right! but I liked typing it.

 

The private sector couldn't have done what they did if not for government action. There is accountability on both sides of it. And it's not as if the government did it out of a sound policy, they did it to win votes and short-sighted objectives.

[Riverbrian]

Because of the Supreme Court's rulings about campaign finance reform, it is going to take a constitutional amendment or some changes in the court to reduce the influence of billionaires and corporations. A constitutional amendment would require a huge grassroots movement, because most politicians nowadays don't seem to want to cut the flow of cash and perks. And a change in the court that favors this could take decades.

 

Did you see 60 Minutes last night? They did a segment about how politicians can legally use campaign funds to take luxury vacations and pay family members to work on their campaigns. I think that this system as a whole comes pretty close to outright bribery in cases where the politician plans to use a lot of the money to line his or her own pockets.

 

I didn't see 60 Minutes but nothing surprises me when it comes to Politicians. The sad part is that I can hardly blame them. They need money to get elected. The Vacations and Nepotism that you mention is just a small part of it all.

 

Money Influences... Money Corrupts... If you happen to throw one of them out for being dirty... The New guy comes in dirty. Meet the New Boss... Same as the Old Boss.

 

I Won't Get Fooled Again.

[Bark's Lounge]

Nothing is certain in the world in which we live. I would consider my wife and myself, middle class - probably on the lower end. At times we give a little charity towards Cancer foundations, but most of our charity is focused towards my sister and her children.

 

The society we live in is reaching a critical mass. I do recognize that there is a good amount of people who actually put a great effort in to helping the poor, destitute, and unfortunate of this country, but I think that self obsession and greed is winning the day.

 

For the most part, we have lost our way in the wilderness of modern times. We are too advanced of a species to let greed and self obsession consume us and to let our fellow man suffer the consequence of not being in the winner's circle.

 

Universal health care for one and all!

 

I grew up in the ghetto and for the majority of the systems in place for the children of these areas, there is no way out, young people need positive guidance, not beaten down parents or drug addict parents... for the most part, these kids follow what they know, and they learn it well, becoming very problematic pieces of our society. These kids need a chance to survive in a safe environment and a chance to survive on terms that are optimistic.

 

I hope that someday soon the Republicans, Democrats, and special interest parties are extinct and we can have a government that truly has the peoples' best interest in mind.

 

I am not sure what the right solution is, but as Americans we need to take care of our own and give them a fighting chance to be healthy and productive... right?

 

Right now, we are doing a **** Job.

[TheLeviathan]

I'm never comfortable with the notion that we're "at a critical mass" or that "modern times" have hurt our ability to help our fellow man.

 

We've been doing that for a long time. If anything, we're helping our fellow man far more now than we ever have in human history. It's hyperbole that detracts from the good reasons to institute universal health care.

 

Where the greed truly lies is in the political class. If there is a point of critical mass, it's because the balancing act of achieving their own power is slowly eroding the foundations of a stable economy/society. We're seeing those issues become more and more severe each time we have to pay the piper on one of those short-sighted, power grabbing moments. And it's both sides doing it.

[Mike Sixel]

The government removing regulation, giving freedom to coroporations, is not the government doing something that makes the companies act one way or the other. The people that run those companies made those choices. I really don't understand your stance at all.

 

On topic of the ACA......and this is my opinion as a person, not an employee of UHG.....

 

I think health care is not like potato chips. You don't get to choose if you are sick or not, and the basic premises of capitalism fall apart in this area. Therefore, while I am generally a capitalist, I think universal healthcare is the most efficient and effective way to do HC. That is clear from the outcomes achieved around the world. We have decades of experimentation around the world, and the nations with universal healthcare produce better outcomes with less resources. This isn't really even debatable. The facts are there for everyone to see.

[Ultima Ratio]

I know the ACA doesn't include dental, but does it include eye care? If not, why not include both dental and eye care? You're going to need it at some time after all and it's probably even the moral (perhaps Christian) thing to do -- perhaps even the constitutional thing to do if your reading of the general welfare clause is such that welfare means the government/tax payers must pay for and provide any service that could possibly be categorized under the broad umbrella of "welfare."

 

1. How many programs, how much money, how big a bureaucracy will it take in order to fulfill this constitutional promise?

 

2. When will we know when we've achieved it?

[Mike Sixel]

for chiildren it includes essential health benefits, of which vision is one.

 

btw, those nations with universal health care spend a lot less money, not more money, than the US......and, they get better outcomes. That data is out there, has been for decades.

[TheLeviathan]

The government removing regulation, giving freedom to coroporations, is not the government doing something that makes the companies act one way or the other. The people that run those companies made those choices. I really don't understand your stance at all.

 

That's like arguing if the government removed murder laws it wouldn't have played a role in a crap-ton of murders happening.

[glunn]

That's like arguing if the government removed murder laws it wouldn't have played a role in a crap-ton of murders happening.

 

So the big lenders were like murderers at a time that murder was legal?

[TheLeviathan]

So the big lenders were like murderers at a time that murder was legal?

 

Absolutely. Bulk of the blame.

[diehardtwinsfan]

I think health care is not like potato chips. You don't get to choose if you are sick or not, and the basic premises of capitalism fall apart in this area.

 

I don't agree with this at all. You can control a lot about your health. Yes, there are some things that you cannot reasonably prevent, but a smoker saying they didn't choose to get lung cancer is kind of silly. A fat person saying they didn't choose to have knee problems is kind of silly. People make lifestyle choices all the time that affect their health, whether that be working too many hours at work, to eating to much, to smoking, etc.

 

Yes, there are some things you can't choose about your health, but the bulk of it does boil down to simple lifestyle decisions.

 

The other thing is that you can also control how you deal with it. Some people don't want to wait in line to see the Dr, so they just go to the ER. That costs more. And a single payer doesn't discourage that. Nor does a single payer encourage innovation to reduce prices. Truth be told, insurance as it's presently implemented doesn't do that either. There's nothing efficient about it. They say this is to reduce prices, but in reality prices will do nothing but go up. Subsidies never lower prices in the long term. They create dependence.

[freshinthehouse]

You mentioned it works in other places, but you also forget that most of these other places that can afford it also don't maintain a standing army that essentially rules the globe.

 

This is the biggest problem in the U.S. right now. Why do we have to be the world's police? Just think if we scaled our military back by 50% (we'd still spend more than any other country at this rate). Just think what that would do for the debt, as well as necessary social programs.

[kab21]

I don't agree with this at all. You can control a lot about your health. Yes, there are some things that you cannot reasonably prevent, but a smoker saying they didn't choose to get lung cancer is kind of silly. A fat person saying they didn't choose to have knee problems is kind of silly. People make lifestyle choices all the time that affect their health, whether that be working too many hours at work, to eating to much, to smoking, etc.

 

Yes, there are some things you can't choose about your health, but the bulk of it does boil down to simple lifestyle decisions.

 

The other thing is that you can also control how you deal with it. Some people don't want to wait in line to see the Dr, so they just go to the ER. That costs more. And a single payer doesn't discourage that. Nor does a single payer encourage innovation to reduce prices. Truth be told, insurance as it's presently implemented doesn't do that either. There's nothing efficient about it. They say this is to reduce prices, but in reality prices will do nothing but go up. Subsidies never lower prices in the long term. They create dependence.

 

It also doesn't work like your proposed change (or someone else's). It was mentioned that if things were pay as you go then costs would be driven down. That's true but the quality of care and amount of preventative care would drastically decline. Doctors and hospitals would start really cutting corners to attract patients since they are now price shopping for everything and people would just skip preventative care (huge long-term consequences). And when someone needed a big dollar operation due to injury or other non-lifestyle illness they simply wouldn't get treated due to not having insurance. Either they would die or they could end up disabled and unable to work. there are massive issues before and after the ACA but the previously proposed system (possibly by you) would be a horrendous step backwards.

 

Do we actually know that E-room visits and regular doctor visits have the same fees? Taiwan (I have National Health Insurance here) had the same fees initially and that was a giant screw-up (obviously) but they raised the E-room fees and my friends had no problems getting admitted into the E-room almost immediately when I took her. basically it became a non-issue.

[Mike Sixel]

So years of proof in other countries, vs what we get, does nothing for you? You really think innovation is only done for the US market? I don't think you've really looked at the facts and data across the world. Healthcare is more expensive here, ALOT more expensive, and gets worse outcomes. That is indisputable. You can disagree if you want, but you have no facts to back up your opinions.

[Mike Sixel]

As for choice, sure, we can choose a lot of our behaviors. But we can't choose falling off a bike, or having a stroke, or other stuff.....And, even as a smoker, you aren't choosing to need healthcare, like choosing to buy doritos. It just isn't the same. Lots of economists have made that point in their work.

 

all of these opinions are mine alone, and do not necessarily reflect any opinion of my employer.....

[Brock Beauchamp]

The other thing is that you can also control how you deal with it. Some people don't want to wait in line to see the Dr, so they just go to the ER. That costs more. And a single payer doesn't discourage that. Nor does a single payer encourage innovation to reduce prices. Truth be told, insurance as it's presently implemented doesn't do that either. There's nothing efficient about it. They say this is to reduce prices, but in reality prices will do nothing but go up. Subsidies never lower prices in the long term. They create dependence.

 

The problem with this is that health care is usually not a true free market situation.

 

If you get sick and have to go to the hospital, you generally don't price-shop hospitals and make an informed decision. Sure, you can do that with general check-ups but that's not where the real costs of health care are found... They're found in surgeries and emergency visits, which offer little or no cost-control opportunity for the consumer.

 

An example of this is TIME finding an example of a hospital in Texas charging ~$7,000 for a procedure.

 

The same procedure was ~$90,000 in a California hospital.

 

There is no rhyme or reason to healthcare pricing because in so many cases, hospitals have a monopolistic control over their patients. If you get hit by a car, you don't get to request "hey, take me to that hospital instead of this hospital... their beds are nicer". The EMTs take you to the closest hospital. In many places, there is only one hospital within a reasonable distance.

 

The free market does a good job of managing many costs and keeping things competitive... But when the consumer base has little or no choice in what products and services they use, the private sector takes the opportunity to charge whatever they want. All rhyme or reason goes out the window in favor of pure profit-grabbing.

[Mike Sixel]

To be fair, from what I can tell, not all hospitals and doctors are about pure profit grabbing, Brock.

 

all of these opinions are mine alone, and do not necessarily reflect any opinion of my employer.....

[Brock Beauchamp]

To be fair, from what I can tell, not all hospitals and doctors are about pure profit grabbing, Brock.

 

all of these opinions are mine alone, and do not necessarily reflect any opinion of my employer.....

 

I didn't mean to imply that.

 

My point is more that without alternatives, there is nothing to stop hospitals from profit-grabbing whenever possible. Without a proper free market, which healthcare doesn't really offer because of the limitations of how it is administered, there is nothing "competitive" about the market at all.

[glunn]

From what I am hearing, most doctors who are general practitioners are not making very much money. On the other hand, hospitals and drug companies seem to be making more than ever.

 

I believe that hospitals should be required to make their rates available on demand so that consumer groups can publish comparisons.

[Brock Beauchamp]

From what I am hearing, most doctors who are general practitioners are not making very much money. On the other hand, hospitals and drug companies seem to be making more than ever.

 

That has reduced the competitive nature of the market to a further degree. Specialists dominate the medical landscape nowadays and GPs are paid less and hard to find (one of my friends is a GP because he felt a social obligation to go that direction, despite it being a "bad career choice").

 

More specialists mean higher costs (but also, better more focused treatment). They're also found only in certain locations and hospitals, which further reduces the ability of the consumer to make a truly free market choice.

 

The deck is stacked against the consumer in the healthcare industry. We need to throw out these notions of "competitive free market" because they don't apply in the reality of today's world. Then we can start finding real solutions that don't exist only in the theoretical.

[diehardtwinsfan]

The problem with this is that health care is usually not a true free market situation.

 

If you get sick and have to go to the hospital, you generally don't price-shop hospitals and make an informed decision. Sure, you can do that with general check-ups but that's not where the real costs of health care are found... They're found in surgeries and emergency visits, which offer little or no cost-control opportunity for the consumer.

 

An example of this is TIME finding an example of a hospital in Texas charging ~$7,000 for a procedure.

 

The same procedure was ~$90,000 in a California hospital.

 

There is no rhyme or reason to healthcare pricing because in so many cases, hospitals have a monopolistic control over their patients. If you get hit by a car, you don't get to request "hey, take me to that hospital instead of this hospital... their beds are nicer". The EMTs take you to the closest hospital. In many places, there is only one hospital within a reasonable distance.

 

The free market does a good job of managing many costs and keeping things competitive... But when the consumer base has little or no choice in what products and services they use, the private sector takes the opportunity to charge whatever they want. All rhyme or reason goes out the window in favor of pure profit-grabbing.

 

I've used this example before Brock. This is part of the problem. This is in large part because these prices aren't posted anywhere. They aren't required to do this so that no one can comparison shop. Most procedures aren't emergencies that need to be done immediately. You can price shop if the prices are public. Switch to a system where insurance only covers emergency situations and this type of stuff will stop rather quick.

[Mike Sixel]

Well, I'd say if insurance covered large financial risk (like, you know, the entire purpose for insurance), we'd be better off.....but most financial risk is not emergency either. That does not mean you can ignore the non-risk parts of the system, though, and leave all of that up to individuals. The incentive device inside our minds does not fully work correctly for the best decisions (for individuals and society) to work for long term things like health. It just doesn't.

 

And, most insurance companies now have cost estimators their members can use. If your's doesn't, something is wrong probably.

 

all of these opinions are mine alone, and do not necessarily reflect any opinion of my employer.....

[TheLeviathan]

Yep. There is no way to objectively look at this situation and say it is Obama's fault.

 

Well, after a few weeks it's clear the shutdown wasn't Obama's fault. But good god, has there been a more incompetently handled piece of legislation in recent memory? The executive branch might as well get out of a tiny car honking horns every time they arrive for a press conference.

[kingDREW]

As an exercise in defiant futility, House Republicans have now voted 33 times to repeal the Affordable Care Act. Their repeated claims that the law is “job killing” and will hike the taxes of the middle-class to unheard of proportions have been refuted in earlier editorials. Many progressive analysts have posited that the unrelenting vehemence of the effort has mostly been about protecting campaign contributions from big insurance and drug companies.

[diehardtwinsfan]

Honestly, I don't see how Obamacare is hurting those companies.  It didn't do anything to solve the cash cow that is medical care which Pharma, hospitals, doctors, and insurance companies have been taking advantage of.