The Sad Case of the Patient Protection and Affordable Care Act

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I am definitely not in favor of a single-payor plan. Our memories and our attention spans are so short. It seems to me that any guarantee of any level of material well-being is well-intentioned and ill-considered. The Rights specified in the Constitution and the Declaration of Independence are all abstract, not tangible. Envy is a terrrible thing.

 

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

The easiest thing to do is look at car insurance. You are essentially part of the overall group that the entire company insures. What keeps costs down is other insurance companies competing for your business. Your personal risk is factored in, but you certainly aren't out there on an island. Its also true insurance. They don't pay for your oil changes. If we were to get rid of the mandates and go back to true "insurance" there would be plans that would be very affordable and more likely to keep costs down going forward.

+ 10. Very well put.

 

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

But, far from opposing Ryan's plan, I think it should pass. Its a document for an electorate circa 1980, not the one the GOP will be facing in 2012. With Millenials now being the largest generation and entering the voting population by the millions, I'm guessing trying to stick them with the bill for The Whiniest Generation might be a recipe for electoral doom.

I haven't read Ryan's Plan (didn't even know it existed), but speaking as a Gen-Y, I'm sure you could understand why people should be responsible for their own bills. Forcing me to pay for your health care because you couldn't prepare on your own is not only asinine, but whiny on your part. Given FreshFish's description of Ryan's plan, it doesn't sound like too bad of an idea. In fact, we should consider doing the exact same thing for Social Security and everything else. Here's an idea: Take the hit on the 1930's retirees now, and switch over to this new plan. Either you go with the government or invest on your own. None of this forced investing, because you're not "borrowing from us" for your own personal gain.

 

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I haven't read Ryan's Plan (didn't even know it existed), but speaking as a Gen-Y, I'm sure you could understand why people should be responsible for their own bills. Forcing me to pay for your health care because you couldn't prepare on your own is not only asinine, but whiny on your part. Given FreshFish's description of Ryan's plan, it doesn't sound like too bad of an idea. In fact, we should consider doing the exact same thing for Social Security and everything else. Here's an idea: Take the hit on the 1930's retirees now, and switch over to this new plan. Either you go with the government or invest on your own. None of this forced investing, because you're not "borrowing from us" for your own personal gain.

Selfish, unworkable and short sighted. Your juvenile take on things is that everybody has the means to pay for both retirement and health care, but those who end up short have needlessly squandered it. Again maybe that's true in fantasyland, but I find that few amongst the population have the money to pay for cancer treatments or heart surgery out of pocket. In fact that's a ridiculous notion. If people like yourself ruled the day during WWII with your everyone's on their own attitude, half the world would be speaking German right now.

 

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

The easiest thing to do is look at car insurance. You are essentially part of the overall group that the entire company insures. What keeps costs down is other insurance companies competing for your business. Your personal risk is factored in, but you certainly aren't out there on an island. Its also true insurance. They don't pay for your oil changes. If we were to get rid of the mandates and go back to true "insurance" there would be plans that would be very affordable and more likely to keep costs down going forward.

And for the first retort I know is coming. There are already laws on the books that insurance companies can't drop you just because you get sick as long as you are current in your payments.

Way too simplistic. My first retort is that whether you choose to drive or not isn't a life or death decision. If you can't get insurance, or if its too expensive, not having a car won't literally kill you. If you need medical care and you can't get insurance, you're screwed. Comments like this always bring me back to the thought that you're still in high school. Your pre-existing condition analogy falls into the same category. What according to you happens when you lose your job, and hence you coverage, and then try to get new coverage with a pre-existing condition? How does this relate to auto insurance.

 

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Selfish, unworkable and short sighted. Your juvenile take on things is that everybody has the means to pay for both retirement and health care, but those who end up short have needlessly squandered it. Again maybe that's true in fantasyland, but I find that few amongst the population have the money to pay for cancer treatments or heart surgery out of pocket. In fact that's a ridiculous notion. If people like yourself ruled the day during WWII with your everyone's on their own attitude, half the world would be speaking German right now.

Someone has to pay for it. Your thinking of it being funded by magic truly is fantasyland.

 

[MinnFan]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Way too simplistic. My first retort is that whether you choose to drive or not isn't a life or death decision. If you can't get insurance, or if its too expensive, not having a car won't literally kill you. If you need medical care and you can't get insurance, you're screwed. Comments like this always bring me back to the thought that you're still in high school. Your pre-existing condition analogy falls into the same category. What according to you happens when you lose your job, and hence you coverage, and then try to get new coverage with a pre-existing condition? How does this relate to auto insurance.

Right now, you lose your job and you automatically lose your coverage. In this senario, you'd at least be able to keep the same coverage since you are funding it yourself. In most cases people are usually only out of work for a few months so there is a good chance they'd be able to bridge the gap.

Funny how you call me juvenile, but you can't make the simple leap to see how a "system" of insurance works and instead make a direct comparison. BTW, how did people ever survive through up through the 60's since more had to pay for their own insurance? Just because people like you have become dependant on gov't doesn't mean that there aren't better options out there.

I would think that low income people would rather be in a system where they have choice about what insurance they get instead of just being thrown in Medicare which is all the Dems seem to want to do with them.

 

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Right now, you lose your job and you automatically lose your coverage. In this senario, you'd at least be able to keep the same coverage since you are funding it yourself. In most cases people are usually only out of work for a few months so there is a good chance they'd be able to bridge the gap.

Funny how you call me juvenile, but you can't make the simple leap to see how a "system" of insurance works and instead make a direct comparison. BTW, how did people ever survive through up through the 60's since more had to pay for their own insurance? Just because people like you have become dependant on gov't doesn't mean that there aren't better options out there.

I would think that low income people would rather be in a system where they have choice about what insurance they get instead of just being thrown in Medicare which is all the Dems seem to want to do with them.

Big government liberals, especially the troll ones I've had to deal with, are inherently lazy. They don't actually want to do anything, and make other people do things for them. This is why they want the government programs, so they don't actually have to put forth any effort.

 

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Right now, you lose your job and you automatically lose your coverage. In this senario, you'd at least be able to keep the same coverage since you are funding it yourself. In most cases people are usually only out of work for a few months so there is a good chance they'd be able to bridge the gap.

Umm....you have heard of COBRA right? No, not the snake, but the program that already allows you to keep your insurance for a short period of time (18 months maybe) after you lose your job if you pay for it. I come again to your lack of understanding indicates someone of young age.

Funny how you call me juvenile, but you can't make the simple leap to see how a "system" of insurance works and instead make a direct comparison. BTW, how did people ever survive through up through the 60's since more had to pay for their own insurance? Just because people like you have become dependant on gov't doesn't mean that there aren't better options out there.

If auto insurance and health insurance were so alike, don't you think someone would have thought of that long before yourself? You always have the choice of not driving. The stakes aren't as high. If you have a serious illness, not getting care if you can't afford it really isn't an option, now is it? Aside from that minor point though (the part about dying)....

People in the 60's lived shorter lives. Look it up. Does that answer your question? Also health care was cheaper, as if you had an illness such as a bad heart you most likely just died as opposed to getting life saving treatment (see Cheney, Dick).

Lastly, as I almost assuredly make more money than yourself most likely it'll be you depending on govt largesse and not me, but we'll chalk that up to TBD.

I would think that low income people would rather be in a system where they have choice about what insurance they get instead of just being thrown in Medicare which is all the Dems seem to want to do with them.

I would think low income people want coverage first and foremost. Your plan is give them choice but charge them much more than they can afford. As they do pay for Medicaid (everyone who draws income pays the tax, a little fact cons tend to overlook when they claim only the wealthy are paying taxes) they should get some of the benefit. If they could afford pricey plans, they wouldn't be considered low-income, right?

 

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Way too simplistic. ...[ complain, criticize, generally tear down ] ....

and your positive contribution on what would make a good plan?

 

[WeWantMore]

Yes. That sort of thing.

Ha. Yep, I set my watch, knew that response was coming.

But I'm not sure it weakens my point at all. You don't think that type of reporting was helpful to Obama do you? Of course not.

I wasn't saying, look at those Democrats, playing dirty, while Republicans are fine upstanding honest politickers. Far from it. The question asked was why Ryan (and Wyden - he seems to be curiously forgotten) didn't include current seniors. I answered it.

 

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

But I'm not sure it weakens my point at all. You don't think that type of reporting was helpful to Obama do you? Of course not.

It's not meant to "weaken your point," it's meant to agree with it. It represents the very thing you are talking about -- as soon as any politician proposes any change, partisan opportunists will immediately mount emotional attacks to undercut them regardless of the content of the proposal. They will never stop doing that, so the impetus for compromise has to come from the adults in the room.

The problem with the current GOP isn't that there are no adults. It's that the adults are terrified of the fringe of their own party, so they either slink away from the debate entirely so as not to be on the record, or they join the Children's Chorus that insists that any compromise with Obama is cutting a deal with the Great Satan.

 

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

A University of Chicago economist weighs in on what ails the current health insurance marketplace and some reasonable fixes.

The country can have a vibrant market for individual health insurance. Insurance proper is what pays for unplanned large expenses, not for regular, predictable expenses. Insurance policies should be "guaranteed renewable": The policy should include a right to purchase insurance in the future, no matter if you get sick. And insurance should follow you from job to job, and if you move across state lines.

Why don't we have such markets? Because the government has regulated them out of existence.

Most pathologies in the current system are creatures of previous laws and regulations. [emphasis added]

.....

Start with the tax deduction employers can take for their contributions to group health-insurance policies—but which they cannot take for making contributions to employees for individual, portable insurance policies. This is why you have insurance only so long as you stay with one employer, and why you face pre-existing conditions exclusions if you change jobs.

Continue with the endless mandates (both state and federal) on insurance companies to provide all sorts of benefits people would otherwise not choose to buy. It sounds great to "make insurance companies pay" for acupuncture. But that raises the premiums, and then people choose not to buy the insurance. Instead of these mandates, at least allow people to buy insurance that only covers the big expenses. [ emphasis added ]

....

The main argument for a mandate before the Supreme Court was that people of modest means can fail to buy insurance, and then rely on charity care in emergency rooms, shifting the cost to the rest of us. But the expenses of emergency room treatment for indigent uninsured people are not health-care's central cost problem. Costs are rising because people who do have insurance, and their doctors, overuse health services and don't shop on price, and because regulations have salted insurance with ever more coverage for them to overuse.

If we had a deregulated, competitive market in individual catastrophic insurance, that market would be so much cheaper than what's offered today that we would likely not even need the mandate. [emphasis added]

 

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

That actually seems like an argument for greater regulation, and at the point of sale of medical charges, not insurance.

The main problem with medical costs is that providers, not patients, milk the system. In a deregulated system, the pressure from the private sector to keep up the gravy train from federal payments won't diminish. If anything, removing government oversight without also removing the government payment pool will increase abuses and thus costs.

The only way to remove the facehugger completely is to sever public payment of medical costs for people who can't pay for it themselves, and the only way to do that in a pure free market is to discard those people on the social Darwinist scrap heap. You can try to get that passed, but I won't be voting for it and I doubt you'll get a majority.

I have never quite understood why the alternative isn't to have the provision of free medical care for people who can't pay for it, means test the ef out of it, and spending a few million dollars on aggressive federal watchdogs to prevent billions of dollars being lost to private sector abuses. But we as a country never seem to be able to wrap out heads around the concept of a pure welfare system, maybe because we don't want to admit that our ideals of social mobility and unfettered individualism are in direct conflict.

 

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

A University of Chicago economist weighs in on what ails the current health insurance marketplace and some reasonable fixes.

Sounds like a right winger's wet dream. Allow me to refute...

"Why don't we have such markets? Because the government has regulated them out of existence.

"Most pathologies in the current system are creatures of previous laws and regulations. " Pure opinion, no evidence that this is actually happening. Next.


"Instead of these mandates, at least allow people to buy insurance that only covers the big expenses. " - This makes zero sense. Basically people should be charged full price for regular exams and birth control for example, but only have insurance for "big ticket" items. Sounds wonderful, right? Problem is catching illnesses early and preventing unwanted or unplanned pregnancies actually brings health care costs down! Furthermore, how would having insurance for big expenses change the cost of providing those expenses? If insurance is covering it, why not charge up to the hilt anyway?

"But the expenses of emergency room treatment for indigent uninsured people are not health-care's central cost problem. Costs are rising because people who do have insurance, and their doctors, overuse health services and don't shop on price, and because regulations have salted insurance with ever more coverage for them to overuse. " Some #'s would be nice, because indigent care is pretty expenses. Regardless, regulations aren't the problem. Its the way Medicare is paid out (by procedure instead of based on the total care of the patient). Some state that already has universal coverage is going down this road since they've already solved problem #1, that of everybody having coverage.

"If we had a deregulated, competitive market in individual catastrophic insurance, that market would be so much cheaper than what's offered today that we would likely not even need the mandate." - yes it would be cheaper for insurance because it wouldn't cover much and you'd be paying the rest out of pocket or just skipping doctors visits until you reached a crisis point. However, health care costs would be unaffected.

Anything else?

 

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

and your positive contribution on what would make a good plan?

Start with the current law (Obamacare). Everybody gets insurance, plus exchanges are set up in each state to shop around.

First, crack down on fraud. In fact, I would enlist the private sector on this. Simply put, govt hires fraud detection service to sniff out hucksters and pays out a % of the savings once recovered. Solves the problem of people screaming about govt getting too big if they had to bring on more people to do it themselves.

Next, as Mass is now doing, incentivize care on patient basis instead of paying per procedure.

After that, yes tort reform ought to be part of the package. Dems/libs/whatever aren't against this, but correctly argued that this wasn't the magical solution righties made it out to be.

Lastly, I also think the advent of the so called "minute clinics" in CVS for example are an important and cheaper way to get people routine car and ease wait times to see medical professionals. This also needs to be encouraged or better yet restrictions preventing it happening need to be cleared (for example high school dropout Boston mayor was against this practice for a time and threatened to ban them from the city).

With the problem of access to insurance solved, the cost of delivery and the ease of getting care can now be focused on.

 

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Allow me to refute...[ complain, criticize, generally tear down ] ....

do you have any positive contribution on what would make a good plan?



EDIT: looks like I wrote this at the same time you were posting..."crossed in the mail" so to speak.

 

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

do you have any positive contribution on what would make a good plan?

ummm....look a minute before you posted.

 

[joecct]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Rover

Except Les has big problems with Romneycare. The theory is OK, but when the legislature (esp the Massachusetts legislature) gets involved in making health care rules, that's like doctors and nurses making rules on, oh I don't know, tax reform.

Can somebody who has experience with the French system give a critique? A lot of what I have read makes it seem like a pretty good idea.

 

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

An interesting view from one of my favorite bloggers (who I defy anyone to try and label).