The PPACA - Implementation Phase I

Re: The PPACA - Implementation Phase I

Miami Herald

WASHINGTON -- As the battle over the healthcare law grinds on — Republicans no closer to victory than when they forced the government shutdown — a different fight was rising on a recent Saturday from inside Sharkey’s, a bar near the campus of Virginia Tech, 260 miles away.

Lured by free beer, gift cards and the chance to win an iPad, 100 students heard a pitch from the young staffers of a group named Generation Opportunity: Obamacare is a bad deal, and you should opt out.

---

Generation Opportunity, which formed in 2011 and gets funding in part from the conservative Koch brothers, is about to embark on a tour of 20 college towns nationally, including a Nov. 9 stop at the University of Miami. The pitch is that you shouldn’t feel compelled by the government to buy insurance, and that it may be cheaper outside the marketplaces.

A blueprint for an upcoming tailgate calls for games such as beer pong and cornhole, free Taco Bell and beer. Pictures of people signing petitions to opt out would be sent over Twitter, Facebook and Instagram.

The group, and more recognizable conservative organizations such as Americans for Prosperity and FreedomWorks, show how the fight has shifted from Congress to the grassroots. Young people are among the law’s most ardent supporters, but at the same time many are unaware of the benefits, providing an opening for critics.

Not sure I want to play "Cornhole"

[walrus]

Do you know how to tell a fake Obama care website?


The fake one works

[FreshFish]

Re: The PPACA - Implementation Phase I

Write a living will that spells out what kind of care you want and what kind of "life-saving" or "heroic" measures you want medical personnel to take….

….or not take.

Yes, but if you haven't made the decision to write a living will..., then you *are* making an economic decision.

Choosing not to decide is still making a choice.

or to be more precise, choosing not to decide is a tacit way to authorize the government to make a choice for you.



In every US jurisdiction, if a person dies without a will, his/her debts are settled and property is allocated according to that jurisdiction's "laws of intestacy." Typically an administrator is appointed, charges "reasonable and customary" fees for his/her time, determines which debts are valid, then distributes whatever is left to various relatives by default. ¹

We can probably all agree that there certainly is a valid concern whether the federal government would in this situation try to pre-empt all state laws and impose a single uniform federal law upon everyone.



Now, let's make an analogy between a will and a "living will." Everyone should have one of each, granted. Many of us would prefer that both situations be regulated by state law, and not to allow the federal government to supersede them.

if you strip away the hysteria about "death panels" you will find in some cases a very reasonable concern: does PPACA tacitly assert federal jurisdiction over end-of-life care (i.e., does it pre-empt state end-of-life care laws somehow)? might it even eventually be used to assert federal jurisdiction to pre-empt individuals' living wills too and dictate a single uniform end-of-life care standard imposed on everyone regardless of their wishes otherwise? even if you think the latter unlikely, wouldn't you prefer that the answer be "of course not" ?

Yet even an attempt to request this minor clarification gets rebuffed. If in fact it does get rebuffed ought to make all reasonable people nervous (except Rover of course ).





¹ From time to time you read about a scandal at a local office: administrators' fees are too high, or administrator alerts a buddy to present a claim asserting a debt against the estate, administrator does not verify said debt but merely pays it to the buddy and splits the proceeds with him/her; administrator finds a buddy and sells off estate assets at below-market value, buddy then sells assets and splits profits with administrator; etc.

So not only do you want a will to make sure your property eventually goes to whom you designate, you also make sure that people you trust hold interim title between your death and the ultimate distribution of your asets.

Similar concerns no doubt if you have a default administrator of a living will as well!

[LynahFan]

Re: The PPACA - Implementation Phase I

Agree and spot on. What I don't want is a 3rd party making the decision based on economic or similar reasons. *I* or my designees can make it, but not a somebody who does not have a vested interest in my life.

SCTV clip: http://youtu.be/8LQYBXQwD_s

Yes, but if you haven't made the decision to write a living will and you don't have insurance that will cover "heroic" end of life care, then you *are* making an economic decision. If you rack up $400,000 in end of life care, you're saying, "it's worth it for enough tax payers to work long enough and hard enough to pay $400,000 in taxes (a heck of a lot of labor hours) just so I can lie in a lousy hospital bed for a few extra weeks." Why should *you* be entitled to make that choice, which affects the economics of dozens and dozens (if not hundreds) of tax payers?

Choosing not to decide is still making a choice.

[joecct]

Re: The PPACA - Implementation Phase I

Write a living will that spells out what kind of care you want and what kind of "life-saving" or "heroic" measures you want medical personnel to take. My living will is on file with three hospitals, my doctor's office and in the family's safe. It takes five minutes to complete and is a piece of cake.

Agree and spot on. What I don't want is a 3rd party making the decision based on economic or similar reasons. *I* or my designees can make it, but not a somebody who does not have a vested interest in my life.

SCTV clip: http://youtu.be/8LQYBXQwD_s

Re: The PPACA - Implementation Phase I

Agree with you that it is a broader-based exercise about moral reasoning in general, disagree to the extent that this kind of moral reasonal also does have significant implications for allocation of scarce healthcare resources as well. It's already an issue in organ transplants, for example; and it will become even more acute as the older age cohorts become more heavily represented in the population at large.

However, I do think we need to counterbalance the overheated "death panel" rhetoric somewhat. Many people and families would prefer not to expend significant resources on end-of-life care for terminally ill. There is a backlash growing from people who'd prefer hospice care over forced incremental longevity that costs hundreds of thousands of dollars and drastically reduces the "quality of life" for the recipient (bed-ridden, tubes permanently stuck in veins, etc.) Apparently the doctors and hospitals feel compelled to exert such treatments and some of the patients and their families sometimes have to go to some lengths to say "thanks but no thanks."

No links handy at the moment but I've seen articles about the subject.

Write a living will that spells out what kind of care you want and what kind of "life-saving" or "heroic" measures you want medical personnel to take. My living will is on file with three hospitals, my doctor's office and in the family's safe. It takes five minutes to complete and is a piece of cake.

[joecct]

Re: The PPACA - Implementation Phase I

Agree with you that it is a broader-based exercise about moral reasoning in general, disagree to the extent that this kind of moral reasonal also does have significant implications for allocation of scarce healthcare resources as well. It's already an issue in organ transplants, for example; and it will become even more acute as the older age cohorts become more heavily represented in the population at large.

However, I do think we need to counterbalance the overheated "death panel" rhetoric somewhat. Many people and families would prefer not to expend significant resources on end-of-life care for terminally ill. There is a backlash growing from people who'd prefer hospice care over forced incremental longevity that costs hundreds of thousands of dollars and drastically reduces the "quality of life" for the recipient (bed-ridden, tubes permanently stuck in veins, etc.) Apparently the doctors and hospitals feel compelled to exert such treatments and some of the patients and their families sometimes have to go to some lengths to say "thanks but no thanks."

No links handy at the moment but I've seen articles about the subject.

Yep. Keep me comfortable, feed me, and hydrate me. But beyond that, it's my wishes as to what degree of care and maintenance I want.

[FreshFish]

Re: The PPACA - Implementation Phase I

Yawn. We did the exact same exercise when I was a kid (early '80s) except it was a lifeboat with only 6 seats. It's a generic exercise in ethical and moral reasoning, not a specific indoctrination about health care.

Agree with you that it is a broader-based exercise about moral reasoning in general, disagree to the extent that this kind of moral reasonal also does have significant implications for allocation of scarce healthcare resources as well. It's already an issue in organ transplants, for example; and it will become even more acute as the older age cohorts become more heavily represented in the population at large.

However, I do think we need to counterbalance the overheated "death panel" rhetoric somewhat. Many people and families would prefer not to expend significant resources on end-of-life care for terminally ill. There is a backlash growing from people who'd prefer hospice care over forced incremental longevity that costs hundreds of thousands of dollars and drastically reduces the "quality of life" for the recipient (bed-ridden, tubes permanently stuck in veins, etc.) Apparently the doctors and hospitals feel compelled to exert such treatments and some of the patients and their families sometimes have to go to some lengths to say "thanks but no thanks."

No links handy at the moment but I've seen articles about the subject.

[LynahFan]

Re: The PPACA - Implementation Phase I

Thoughts?

http://www.ijreview.com/2013/10/8618...h-panels-work/

Yawn. We did the exact same exercise when I was a kid (early '80s) except it was a lifeboat with only 6 seats. It's a generic exercise in ethical and moral reasoning, not a specific indoctrination about health care.

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Thoughts?

http://www.ijreview.com/2013/10/8618...h-panels-work/

You could take this a couple ways. You could see it as critical thinking of what life is more important, you could see it as a practical example of why such a shortage is such an awful thing, or you could see it as the downsides to communism and how your quickness to act no longer matters.

[FreshFish]

Re: The PPACA - Implementation Phase I

EXCLUSIVE: Just 51,000 people completed Obamacare applications during the website's first week, out of tens of millions of Americans in 36 states
Obamacare's main signup engine attracted just 6,200 new customers on its launch day and 51,000 after the first week.
MailOnline's sources are two Health and Human Services workers who have access to the data as it's crunched

Read more: http://www.dailymail.co.uk/news/arti...#ixzz2hV2eQKOm
Follow us: @MailOnline on Twitter | DailyMail on Facebook

Re: The PPACA - Implementation Phase I

Thoughts?

http://www.ijreview.com/2013/10/8618...h-panels-work/

This doesn't already happen everyday?

[joecct]

Re: The PPACA - Implementation Phase I

Thoughts?

http://www.ijreview.com/2013/10/8618...h-panels-work/

[FreshFish]

Re: The PPACA - Implementation Phase I

There were no enrollments in Delaware in three days. North Carolina got one enrollee. In Kansas ObamaCare was unable to report a single enrollment. A senior Louisiana state official told me zero people enrolled the first day, eight the second.

so says Peggy Noonan at least. grill her about her sources (which "senior Louisiana official"?)

[FreshFish]

Re: The PPACA - Implementation Phase I

New state-run health-insurance exchanges have largely fixed their technical problems, marking a sharp contrast with the federal government more than a week after the centerpiece of the Affordable Care Act opened for business.

only 14 [states] chose to fully run their own, leaving the federal government responsible for the other 36.

The federal exchange at HealthCare.gov has been plagued by problems from opening day, including error messages and long wait times.

State officials appeared to be more nimble than the federal government.

Source.