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Interesting debate.
I'm with Shifty, though. Here in the UK we have the National Health Service, and while it has it's problems, it's a very efficient system. Anything goes wrong with my health, the NHS is there. I have never bothered with private health insurance, because I have never needed it. Private health care is quite cheap here as it rests on the NHS's bedrock. In other words, I probably have more choice than you have in the USA.
Now the reason for the USA's health care changes is the cost of health care to the economy, as I understand it. So comparing prices, total health care costs the UK 9.8% of GDP. That may look like a lot, but in the USA at the moment the cost of healthcare is 17.6% of GDP, with a GDP larger than we have. Is it effective? Well I can expect to live a year longer than if I lived in the USA, so I would guess so. Bottom line, I pay more taxes than you do in the USA, but in return I have pay out less for health care from my own pocket.
I like that system, and why wouldn't it work in the USA? You have now the same kind of system we had before we brought in the NHS.
Do you generally think that mandatory health care insurance is a good idea, or a bad idea? Why so?
What does happen these days if somebody without any health care is in an emergency situation (say, a heart attack)? That the person recieves emergency treatment is a given, I think. Who pays for it? If the patient needs some sort of long-time care after the emergency, what happens then?
Hustonj, agree or disagree with this statement:
All poor people are poor because of their own failures in life.
Of course what the SCOTUS says about the bill is meaningless since they don't actually have the power to determine the constitutionality of law.This argument again.
If the SC doesn't rule on constitutionality, who does? Is anything the Congress passes and the President signs presumed Constitutional with no further check?
What happens when someone is arrested and charged under a law barring free speech, for example? When he argues in court that the Constitution guarantees him that right, do the Justices just shrug their shoulders and say "Yeah we read it that way to, but you still broke the law, so you'll have to do your 30 years." ?
I thought about this last time it came up. Before Madison v Marbury, would not judicial review have fallen to the states or ultimately to the people v ia jury nullification?
I know. That's why it is so delightful to call it Romneycare.
I thought about this last time it came up. Before Madison v Marbury, would not judicial review have fallen to the states or ultimately to the people v ia jury nullification?Of course what the SCOTUS says about the bill is meaningless since they don't actually have the power to determine the constitutionality of law.This argument again.
If the SC doesn't rule on constitutionality, who does? Is anything the Congress passes and the President signs presumed Constitutional with no further check?
What happens when someone is arrested and charged under a law barring free speech, for example? When he argues in court that the Constitution guarantees him that right, do the Justices just shrug their shoulders and say "Yeah we read it that way to, but you still broke the law, so you'll have to do your 30 years." ?
So each state court gets to decide what the US Constitution means? Gun rights, free speech, freedom of religion, each mean different things in each state? Not to mention what happens in cases that start in the federal system?
I suppose jury nullification could work, but it would be on a case by case basis. Even if one found you not guilty of possession of a firearm (to change my example), another jury could convict the next guy under the same circumstances. The law still stands, still can be used to convict people and everyone will have to go to the expense and trouble of a court trial.
Which is why I dont have too much of a problem with judical review. Jury Nullification would be the greatest thing in the world ever......in a perfect world. In 1960's Alabama, not so much.
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Baby, I can't hold it much longer
Goblins do it in the street!
Hustonj, agree or disagree with this statement:
All poor people are poor because of their own failures in life.
Irontruth, agree or disagree with this statement:
All absolutes are inherently false.
I am not a 4 year old to be confused and confounded by basic linguistic traps. Argue rationally or have your discussion points treated as irrational.
Well, based on your previous statements, that's what you seem to be implying. That people are poor because of their own faults. If I'm wrong, feel free to correct me.
Oh baby! I need your lovin'
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Actually, I disagree with the whole assertion that SCOTUS claimed that the mandate was a tax. What they said is that is covered under the taxing power of congress. I believe that fines and penalties are also covered under this power.
As far as people freaking out about the mandate, I guess I am confused. All people who could afford insurance were already paying for everyone else anyway. Hospitals raise their prices on people who can pay to cover those who couldn't. Insurance companies increased premiums based on the increased costs. How is this different than what will happen under the ACA, except that there is a method to go after people who willingly do not carry healthcare who can afford it. For conservatives, this seems to me to be the kind of "go after the deadbeats" mentality that they are always espousing.
Finally, our president never called people who make 250,000 dollars a year the middle class. Please. If you don't want to be treated like a 4yr old, don't post out of context hyperbole that makes it sound like you can't think for yourself. Your other arguments were too well thought out (even if I disagree) to stoop to that kind of sillyness.
I can't help but be baffled by the logic of the whole "Obama-Romneycare" thing.
I couple of years ago, I got a very good taste of the US healthcare system. My take was that the hospitals were passable, the doctors were great, and that the entire billing/insurance things was a total disaster.
So what would be the logical way to fix things?
Have the people at the center of the dis-functionality write the new laws! The same people who came up with those great ideas about discriminating against victims of domestic abuse and kicking people off for reaching a "life-time limit". The people who are the #1 cause of household bankruptcy. This law put the most greedy bastards in charge of people's healthcare.
The only thing more amazing is how people actually think this is some form of communism! (Yes, I saw a Obamacare bumper sticker with the hammer and sickle logo the other day!) The government forcing you to buy things from a for-profit company is basically Mussolini's definition of fascism, and the opposite of communism, or even government sponsored healthcare you can get!
PS, Thanks to loosing my job and residence a few months before my hospital experiences, almost the entire thing was paid for by the government as part of emergency Medicaid. If it had not been, there is NO WAY I could have ever paid for even a 1/10th of it, so I would have declared bankruptcy.
I think the most ironic thing is that we have a national healthcare tax already in place, that everyone has paid into for generations, and very few are complaining about the constitutionality of it. It is called Medicare and most people can't even use it unless they are disabled or 64&1/2yrs old. The Obama/Romney care plan is nowhere near as universal in mandating coverage as Medicare is, but the vast majority of people are scared to death of losing it.
Also, I do want to say that I believe that the democrats did an absolutely horrible job of explaining the ACA. They let their opponents drive the conversation to the point that there are more half-truths (end of life discussions being labeled "death panels") or outright lies ("biggest tax increase in history") than there are facts out there for people to understand what it is and what it does/doesn't do.
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One it's not government healthcare. It's a program to deal with the uninsured in this country whose healthcare IS ALREADY A COST TO TAXPAYERS and the insured.. Due to the fact that hospitals can not turn away patients who need emergency care.
For the vast majority of people little to nothing will change. What the intent of the program is to change how costs of the uninsured are handled.
The only sane method to deal with this problem is to get everyone on board. To make insurance available for the uninsured and get these costs more evenly balanced out.
Almost everything LazarX just said, I believe to be true. But I'd like to make a couple observations, as a multi-year employee of the local licensee of a national health insurance company. (Which does not mean I know any more than anyone else; I probably know less, but this is the context of my comments.)
Mandatory treatment for the uninsured (not the "government insured," but the "uninsured") is, indeed, passed on to others, including taxpayers, but not as a "tax." Rather, it's passed on in the form of increased prices for health care, which is a limited, consumable good.
The error in the plan (and, for the record, I support the idea of nationally-mandated insurance, but am vehemently opposed to this particular iteration of it) is that it addresses the pseudo-crisis of availability. I say pseudo-crisis because, as LazarX pointed out, no one in need of urgent care can be denied that care (though it can be made challenging for them to receive it). It does not address the actual crisis of cost.
Let's say you make jellybeans. You make very, very tasty jellybeans, but you live in a small town where very few people know about your jellybeans. You produce a fixed amount, based on your capacity, and you sell them at a reasonable profit. Then a national distributor finds out about your jellybeans, and suddenly, you have people from all over the country clamoring for them, and willing to pay you more than the local consumers for first crack at each new batch.
This is the first (well, one of the first) things I learned in my Economics classes. When you increase demand without increasing supply, prices increase. As a jellybean manufacturer, you can technically buy a bigger factory, or more equipment, and expand your capacity, so that supply keeps up with demand. But increasing health care capacity is a bit more complicated--you can only instantly acquire new doctors (or nurses, or phlebotomists, or whatever) equal to the number of currently-unemployed doctors (or whatever). After that, it takes time and resources to train each new additional doctor.
So, there's one problem. Here's another: people who don't have insurance tend to avoid going to the doctor. In some cases, this is a bad thing--people could spare themselves long-term, debilitating illness with proper early detection and treatment. But there are people who, once they have the opportunity and the means to do so for little or no cost, will run to the doctor (or worse, the ER) for every little thing--even things that don't require treatment. The net result at our company was negative to us (we paid out more to providers), and naturally, we passed this on to our customers (yes, we are big and evil).
Our underwriters determined that, for example, removing the copays for preventitive care led to an average premium increase of 0.9 percent from last year to this year. Raising the age for dependent coverage led to an average premium increase of 0.6 percent. Factoring in all the currently-applicable pieces of the law, the total increase was about 2.5 percent, just from those items. So, if you were "supposed" to get a 10 percent increase from last year to this year, instead, you got a 12.5 percent increase. This is the difference in going from $400 per month to $450 per month instead of $440. Maybe $10 a month isn't a big deal--it certainly isn't to CEO's or VP's. But to the line worker making $12 an hour? Maybe that's a little harder to manage.
I'd also like to discuss Massachussets a bit, because we did some specific research in this area. In the first year of what we will call Romneycare, the average price increase was consistent with what we observed in New York. However, at the very same time, spending by insurance companies SKYROCKETED. Almost every insurance company participating in the exchange lost profitability; two of them lost so much money that they were put into receivership. Tracking the long-term performance of these plans: they have begun to rebound, but the biggest increases in profitability (still below their pre-Romneycare levels) were enjoyed by insurers with the smallest share of Romneycare-eligible insurees. I don't remember the exact correlation number, but it was statistically significant to a p-value of about 0.03 (two-sided).
I guess my concern is that the current plan will not balance out costs, unless any of you believe that the providers will voluntarily lower their costs to reflect the fact that the government will now pay for what was previously "bad debt" attributable to the uninsured. Show of hands: who believes that will happen? There has been some talk of shifting provider payments to a percentage-above-medicare reimbursement, but it has not gone far enough. Our own underwriting experience shows us that.
In essence, unless the government figures out a way to address cost as well as access, this thing is doomed to implode. The problem: the people who need to make those decisions (i.e., Members of Congress) get paid an awful lot of money by organizations dedicated to protecting providers' interests (e.g., the AMA), so it's not really in their best interest to do so.
So, we have my sole point of respectful disagreement with LazarX--some people will not feel any change, and largely it will be people already making large amounts of money. Some people WILL feel a change--and it will be the people making the least amount of money, and therefore least able to adjust to it.
When I get that feeling...
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Why?
Shouldn't it be even better given that its supposed to be a competent 1st world nation with a significantly greater economy of scale?
There's every reason to assume it works the same way.
Competent? The US government? I think maybe you should, as you advised someone else, get informed before forming an opinion. And, I really hate to break it to you, but our "health care" law isn't single payer, it doesn't have a public option, and is nothing more than a payout to Big Pharma and the insurance industry here (clue: they're the ones who actually wrote the bill).
Seriously, the US government couldn't find its ass with both hands.
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I am wondering why one would overly tax one of the few industries we have that is successful for the United States during a recession.
Seems to me a means of not helping us get out of the recession. Just my two cents.
Taxes do impact growth, but the effect is actually relatively minor.
It's like crowd noise at a football game. Sometimes it gives players that extra motivation, or it prevents good communication between the visiting team, but the two teams relative skill levels have a far greater effect on the outcome of the game.
Sweden has a tax burden of about 47.9% their GDP. Yet they experienced over 4% growth last year.
The US has about a 26.9% of our GDP goes to government revenue. But we experienced 2% growth.
Other factors, like the consumer confidence and the number of consumers increasing their spending, have a much greater effect on the economy.
Home sales for example are plagued by:
- the number of foreclosed homes for sale (excess supply)
- banks not giving out loans (reduced demand)
- people can't refinance their current homes or sell them without major losses (reduced demand)
Taxes have an impact on home sales, but they're extremely minor compared to those other factors.
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Right now people in the U.S. are paying huge insurance premiums. Even then they might not be covered in all cases and can go bankrupt for something they have no control over. Also lots of people don't have insurance/can't afford insurance and usually end up costing a whole lot more when they eventually get hospitalized with one or more things they've put off for far too long. And you're paying to companies whose only motivation is more profit, not your health and well-being.
Contrast that with a universal system where people would pay the same, or most likely less, because you eliminate the for-profit motive - although it would be drawn as a tax instead. No fear of going bankrupt. You're covered no matter what your ailment is and what income bracket you're in. You'll have more people getting regular check-ups, thus hopefully preventing or at least catching serious ailments before they get out of control.
It should be a no-brainer to choose the second version, but so many in the U.S. is against it because of some misguided fear of the "evil government" - it's mind boggling for the rest of us in the industrialized world how a country as advanced as the U.S. is so utterly backwards in this area.
Did you know we would already have single-payer health care if the Democrats hadn't f!@&ed it up?
It's true (or, at least, it's something I read somewhere): Nixon was toying with the idea back in the seventies (you know, like when we got abortion rights and a reprieve on the death penalty for a few years) and it got nixed by Ted f$+@ing Kennedy because he wanted to use it as his campaign issue.
Then there was this incident by a river...
Thanks Teddy, you dead fat f&*~.
It should be a no-brainer to choose the second version, but so many in the U.S. is against it because of some misguided fear of the "evil government" - it's mind boggling for the rest of us in the industrialized world how a country as advanced as the U.S. is so utterly backwards in this area.
Well, in their defense, the American government is pretty evil.
He's later said it was his biggest political regret.
That fat f*~+!
But I probably do have the details garbled.
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I don´t think that something as essential as health care should be solely left to companies that need to make a profit, the same reason I would not want the police or the firefighters being some private company. I think that these essentials should be provided for by public service and paid for by taxes (or however you choose to call it - fees, dues, contributions, insurance premiums). These taxes should be set in a way that everybody contributes in accordance to their income. The treatment recieved would by necessity be basic, but covering the essentials. That way, nobody would be denied medical treatment because they reached some arificial limit or get his insurance canceled when he probably needs it the most - which in my eyes is an abomination in a rich an civilized society.
The only problem I wonder about: other than "because it's the right / moral thing to do," what would be the incentive / motivation for a company and/or organization to continue research in new programs and procedures to help improve healthcare? There's a lot of things available to us today that I wonder whether it would exist if it weren't something to be made out of furthering it. And sometimes along the way, new things are discovered quite by accident that bore more promise than what the research was initially set up to do for something completely unrelated to the outcome.
If it becomes in the hands of the state, we all know what happens when there's bureaucratic red-tape involved. Look at NASA.
And you're paying to companies whose only motivation is more profit, not your health and well-being.
Not 100% true. The state of Minnesota is a not-for-profit state, in regards to health care. The famous Mayo Clinic is headquartered here. They were held up as a model of how to do Medicare better (their costs for providing care in the last 3 years of a patients life was 54% lower than other regional hospitals) while still achieving excellent results.
As a non-profit, they have something like 70 hospitals and clinics and over 50,000 staff. They've been ranked one of the best hospitals in the country for 20 years, and listed as one of the best 100 companies to work for for 8 years in a row. It's also a teaching AND research hospital, with something like 40% of their budget spent on research.
After the ACA was passed, the Mayo responded saying that it would do nothing to improve quality or reduce costs. It had just been watered down too much.
But then we have states like Mississippi, which ranks 51st for health care. They don't advertise where clinics are, what hours they're open and turn you away if you have the wrong form. Something like 77% of the people turned away from Mississippi Medicare clinics are actually eligible for care.
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NASA's actually been really beneficial to the economy. Conservative estimates think that we've gotten a 2:1 or 3:1 return on our investment in space research. Higher estimates put it around 14:1.
The telecommunications industry would not exist the way it does now, without NASA.
Then there are the giant list of inventions that were made for NASA because of their specific requirements... that are now standard household items. Like cordless tools.
Your analysis is good, Antimony, but it's got a few key gaps.
The error in the plan (and, for the record, I support the idea of nationally-mandated insurance, but am vehemently opposed to this particular iteration of it) is that it addresses the pseudo-crisis of availability. I say pseudo-crisis because, as LazarX pointed out, no one in need of urgent care can be denied that care (though it can be made challenging for them to receive it). It does not address the actual crisis of cost.Emphasis on urgent. Emergency rooms are the only ones who can't turn away an urgent case, and the emphasis, here, is on urgent. If you have a chronic or debilitating disease, there is nobody with any obligation to treat you in the US. If you have diabetes and are not now in diabetic shock, there is little an emergency room can do for you. If you have cancer, there's not much they can do for you unless you're dying of it right now. Also, even urgent cases can demand significant aftercare, which leads to the same situation as chronic patients.
Good point, and I agree in principle. By that I mean that I agree with what you are saying, and that it needs to be addressed, but stand by my opposition to this particular law because it is does not address all sides of the dilemma.
So, there's one problem. Here's another: people who don't have insurance tend to avoid going to the doctor. In some cases, this is a bad thing--people could spare themselves long-term, debilitating illness with proper early detection and treatment. But there are people who, once they have the opportunity and the means to do so for little or no cost, will run to the doctor (or worse, the ER) for every little thing--even things that don't require treatment. The net result at our company was negative to us (we paid out more to providers), and naturally, we passed this on to our customers (yes, we are big and evil).This is a good thing. This improves health outcomes. People who run to the doctor "for every little thing" not only get screened for potentially more-serious illness, but also get better advice on simple methods to improve overall health (like diet, exercise, and mental health). This is, in fact, one of the most important factors in improving overall health outcomes.
Again, I agree in principle. However, our experience has been that there are three discrete groups of people in the wake of changes we made to our health plans:
1) Those who don't radically change their healthcare consumption. Probably about 50 percent.
2) Those who make significant changes and receive measurable benefit from it. This is between 20 - 35 percent. (Depends on what report we look at.)
3) Those who make radical changes because "it's free" and do not receive benefit. The remaining 15 - 30 percent. These are the people who go to the doctor for a condition, let's say indigestion. They are told that they are overweight and need to make more healthy choices. They do not make those changes. Then they are back at the doctor, for the same indigestion, two weeks later. And two weeks after that. This also includes people who make irresponsible choices, like going to the Emergency Room for non-life threatening congestion, instead of their doctor, or even an Immediate Care facility.
The problem is that the people in Category 3 produce an immediate increase in aggregate expense, without a corresponding long-term decrease due to improved health. Sometimes these immediate increases are substantial, because there are no controls in place regarding what sort of treatment they receive and how much can be charged for it. This is anecdotal, but I am thinking specifically of an insuree whose records (scrubbed for HIPPA purposes) I saw. The ER bill was in the range of $5,000 to $6,000 for various tests, scans, panels, screens, and what not. The end diagnosis was something like "a stress-induced abrasion of the upper epidermal layers with resultant fluid retention." (I forget the exact phrasing.) In short: a blister.
Point is, unless costs are controlled as well as access, or unless we can trust providers to voluntarily police themselves and avoid excessive charges, those increased expenses will either (a) threaten the stability of insurers or (b) lead to increased premiums, both of which we've already seen.
Then again, who's to say what an "excessive" charge is? Maybe the hospital thought they were justified in running all the tests necessary to ensure the blister was just a blister, and not a serious skin condition or symptom of a disease? This is something that any reform law needs to address, too: general standards for care, and malpractice tort reform to reduce "defensive" disgnosis and treatment, which our underwriting department estimates cost upwards of $32 million last year, just on our pool of insurees.
This is the first (well, one of the first) things I learned in my Economics classes. When you increase demand without increasing supply, prices increase. As a jellybean manufacturer, you can technically buy a bigger factory, or more equipment, and expand your capacity, so that supply keeps up with demand. But increasing health care capacity is a bit more complicated--you can only instantly acquire new doctors (or nurses, or phlebotomists, or whatever) equal to the number of currently-unemployed doctors (or whatever). After that, it takes time and resources to train each new additional doctor.This is within the federal government's power to do tomorrow. The number of residencies nationwide is strictly controlled, and falls far short of both the number of eligible med students and the need for residents.
On this issue, you clearly have information I do not, so I happily concede the point.
Of course much of the basic research is done in public institutions and/or with government money already. Then it's taken and developed into products by private companies.
I believe drug companies, for example, spend more on marketing than on research.
And perhaps if more of the R&D wasn't driven by the profit motive we'd have more actual cures and less viagra.
Again, this is something we've got quite a bit of research on, so I'd like to weigh in.
From what we have seen (note, our information is not exhaustive, so it may be wrong), drug companies spend far more money on research than marketing, but only a fraction of drugs they research make it through the lengthy trials to reach the market. Thus, prescription drugs are expensive, because they have to recoup the money not only for the research into that drug, but the nine other drugs that didn't make it out of initial trials. And they have a limited time to do it, because once their patent expires, other manufacturers can reproduce the drug at a much lower cost, since they did not need to cover the cost of research and development.
This is another good example of where I believe the current law may have missed the mark. If it set up a pool of federal grant dollars to fund all drug research--or better yet, if all drug research was funded by the World Health Organization--prescription drug costs could be lowered significantly from day one at market. (Assuming everything else remains equal, and all that.)
The only problem I wonder about: other than "because it's the right / moral thing to do," what would be the incentive / motivation for a company and/or organization to continue research in new programs and procedures to help improve healthcare? There's a lot of things available to us today that I wonder whether it would exist if it weren't something to be made out of furthering it. And sometimes along the way, new things are discovered quite by accident that bore more promise than what the research was initially set up to do for something completely unrelated to the outcome.
If it becomes in the hands of the state, we all know what happens when there's bureaucratic red-tape involved. Look at NASA.
Lots of health programs and procedures are funded by government money.
At teaching universities there are lot of programs and doctors/med students who do procedure research.Denmark: Universal-type health care system, also has a thriving private medical research industry (both drugs and other health care products). So the two aren't in any way mutually exclusive.
NASA's actually been really beneficial to the economy. Conservative estimates think that we've gotten a 2:1 or 3:1 return on our investment in space research. Higher estimates put it around 14:1.
The telecommunications industry would not exist the way it does now, without NASA.
Then there are the giant list of inventions that were made for NASA because of their specific requirements... that are now standard household items. Like cordless tools.
Agreed. I won't argue that. But I'm looking at it from the position it is in now and it seems that it will be the private sector that will be the motivator in expanding beyond where things are now due to politics and/or budget cuts.
True, but that's a problem with politics and the current state of affairs in our country, not a problem with NASA.
From what we have seen (note, our information is not exhaustive, so it may be wrong), drug companies spend far more money on research than marketing, but only a fraction of drugs they research make it through the lengthy trials to reach the market. Thus, prescription drugs are expensive, because they have to recoup the money not only for the research into that drug, but the nine other drugs that didn't make it out of initial trials. And they have a limited time to do it, because once their patent expires, other manufacturers can reproduce the drug at a much lower cost, since they did not need to cover the cost of research and development.
This is another good example of where I believe the current law may have missed the mark. If it set up a pool of federal grant dollars to fund all drug research--or better yet, if all drug research was funded by the World Health Organization--prescription drug costs could be lowered significantly from day one at market. (Assuming everything else remains equal, and all that.)
One thing I find amusing about our trade agreements with China and NAFTA has to do with prescription drugs. Apparently, it's alright for companies to become multinational and do operations outside the US in order to decrease cost from within, which does include sending jobs elsewhere overseas as the cost of research and/or low tiered employees have less of a burden of cost against the profit margin.
But if the consumer does essentially the same thing by crossing the border to obtain cost efficient prescription drugs for personal use, it's a crime. One could argue semantics about the safety and/or the prevention of distribution to undermine the retail market, but simply, it all boils down to protecting the corporate interests versus that of the welfare (health) of the individual.
I'm all for better / easier access to quality health care. I'm one of those individuals who currently do not have insurance, but I don't fall at the poverty line to obtain government aid. Unless things are urgent, I simply have to suffer the non-life threatening maladies by means of OTC or stubbornness.
I guess I'm cynical of honest intentions and actual consequences. :/
Lots of health programs and procedures are funded by government money.
At teaching universities there are lot of programs and doctors/med students who do procedure research.
Denmark: Universal-type health care system, also has a thriving private medical research industry (both drugs and other health care products). So the two aren't in any way mutually exclusive.
Given that a lot of the world news tend to be Ameri-centric, you don't really hear much in the way of revolutionary / pioneering medical advancements coming out of Denmark. Or if there are, it does pause me to think whether there's American investments for their own self-interests.
Mind you, I'm being cynical and is no way in attack or a disagreement on what needs to be overhauled. It is more that typical entrepreneurship in a capitalistic market tends to be id driven versus super-ego and the ego is saddled in red-tape.