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The Sad Case of the Patient Protection and Affordable Care Act

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

The founders fail to live up to this definition of "conservative," too. In 1776, the "trusting wisdom of elders" position would have been Tory/Loyalist. Thank goodness our founding fathers had their own novel, liberal ideas.

Thanks for the clarification. My choice of "founding fathers" was an ambiguous term, as technically I meant something a bit different than what I actually said.

Firstly, many of the people involved in the initial bid for independence (e.g Sam Adams and Thomas Paine, most notably) I'd consider "radicals" not "conservatives"; it was an unlikely alliance between radicals like Sam and conservatives like the well-to-do merchants who wanted to keep the tax dollars here rather than repatriate them out of the country, that fought side by side during the American Revolution. Jefferson in my taxonomy is clearly a "liberal" and not a "conservative", as well, and The Declaration of Independence, along with Martin Luther King Jr's "I have a dream" speech, are probably two of the most significant and eloquent expressions of "liberal" philosophy you can find anywhere, any time.

As I'm sure you recall, the first attempt at a central government, the Articles of Confederation, was not working as well as some people would have liked. That first "central" government did not have the necessary authority (in their view) adequately to referee conflicts between the states nor collectively to represent the states in foreign affairs. Many feared that the nascent nation would founder, rent asunder by internal conflicts, too weak to defend itself against an external foe.

Many historians call the enactment of the US Constitution the "conservative counter-revolution."

By "founding fathers" I was thinking more of luminaries like Hamilton, Madison, Jay (see The Federalist Papers), Washington, Franklin, "conservatives" all, the people whose writing and proselytizing convinced people to adopt the US Constitution, which is very much a "conservative" document. As I believe Rover pointed out, Washington "freed" his slaves in his will only after his wife's death.

And so, yes, our "first wave" of "founding fathers" was a nice mix of radicals, liberals, and conservatives, and even a few "monarchists" (who wanted to make Washington our first king!); which subsequently was upstaged by the persuasiveness of the solid "conservative" bloc that followed ten years later.



PS it does seem to be a truism that today's successful radicals become tomorrow's hide-bound conservatives! I think that drives some people crazy; because "the wisdom of your elders" keeps evolving. :)
 
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Re: The Sad Case of the Patient Protection and Affordable Care Act

How could they have liberal ideas? The term "liberal" didn't come aboot until the mid 19th century in British Parliament. ;)

You don't know your history very well, I guess, some historians consider the Magna Carta one of the very first "liberal" documents. I guess it depends upon whether you say "anyone who meets these criteria" is x vs anyone who calls themselves x is actually giving themselves an accurate label! Adam Smith's The Wealth of Nations also is seen as a significant "liberal" document as well. It is quite interesting that The Declaration of Independence and The Wealth of Nations were both published in 1776; six or seven decades prior to the time you reference.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

You don't know your history very well, I guess, some historians consider the Magna Carta one of the very first "liberal" documents. I guess it depends upon whether you say "anyone who meets these criteria" is x vs anyone who calls themselves x is actually giving themselves an accurate label! Adam Smith's The Wealth of Nations also is seen as a significant "liberal" document as well. It is quite interesting that The Declaration of Independence and The Wealth of Nations were both published in 1776; six or seven decades prior to the time you reference.

The term "liberal" (at least in reference to the party) came around aboot the 1860's. It netted me 1000 points in a recent trivia game. Just because a document could be seen as "liberal" doesn't mean the term was used at the time.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Wow. Even Gingrich is going bankrupt because of Health Care.

The Gingrich Group, also known as the Center for Health Transformation, filed for Chapter 7 bankruptcy in federal court in Atlanta on Wednesday. The bankruptcy filing marks an abrupt turn for a group that raised millions of dollars just a few years ago to support and promote Gingrich's health care ideas.

http://www.boston.com/news/politics/articles/2012/04/05/gingrichs_think_tank_files_for_bankruptcy/
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

And so, yes, our "first wave" of "founding fathers" was a nice mix of radicals, liberals, and conservatives, and even a few "monarchists" (who wanted to make Washington our first king!); which subsequently was upstaged by the persuasiveness of the solid "conservative" bloc that followed ten years later.

I believe John Adams wanted life terms for the President, and for him to be referred to as his "majesty".
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

The term "liberal" (at least in reference to the party) came around aboot the 1860's. It netted me 1000 points in a recent trivia game. Just because a document could be seen as "liberal" doesn't mean the term was used at the time.

duh. so does that mean the Nazis really were "socialists" too just because that was in their formal name? :p
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

I don't think you need to deny them care in true emergency situtations. You just need to be willing to stick them with the bill. Make it so the hosiptal can garnish their wages or receive a portion of their gov't benefits if they don't pay. Doesn't take care of all senarios, but he does provide a disincentive for many of them.
This is the current scenario except garnishing wages. They can't get that right for deadbeat Dads who owe boatloads of $ and are supposed to be paying for kid's insurance. I can't imagine the quagmire of doing this for thousands of people a yr. Yikes!

My head might asplode!! Of course we aren't supposed to weigh kids or tell them they are overweight - Privacy and all that. (Fun fact- research shows most parents have difficulty recognizing their kid is obese even when they are markedly obese) We cut the amount of recess, have school lunches that are an audiovisual aide for poor nutrition and a promotion of unhealthy food, we don't address nutrition and health is schools. Now they think we should do something? There are 2 generations of people who have been indoctrinated into poor eating, less exercise and affordable food being nutritiously bankrupt. Ahhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh!!!!!

And in other news- In this last work week I have been taking care of a string of people who have medical conditions that are wildly out of control because they cannot afford their medication. I keep thinking of this thread. It sucks that HIPPA makes it impossible for me to give specific examples but I wish some of you could see the result of having no medication despite people needing to get treatment. 'Catastrophic' plans include plans with 6000$ deductables. Yes 6K. This is obscene. Who the F is going to have 6K to meet this before they get it to kick in. When things get out of control this means loss of work. Less $ to make a deductible. I can't change the plan, I can't access samples to fill the gap. I can't get a case worker to help manage things. I can't even predict when disaster will happen because the meds are sporadically available. I have to watch as the person heads toward disaster because although I know what they need to do they can't do it. The only thing I can do is watch like waiting for a train wreck to happen. After the 3rd person in less than 2 days I was ready to quit and go work at McDonalds.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

This is the current scenario except garnishing wages. They can't get that right for deadbeat Dads who owe boatloads of $ and are supposed to be paying for kid's insurance. I can't imagine the quagmire of doing this for thousands of people a yr. Yikes!

My head might asplode!! Of course we aren't supposed to weigh kids or tell them they are overweight - Privacy and all that. (Fun fact- research shows most parents have difficulty recognizing their kid is obese even when they are markedly obese) We cut the amount of recess, have school lunches that are an audiovisual aide for poor nutrition and a promotion of unhealthy food, we don't address nutrition and health is schools. Now they think we should do something? There are 2 generations of people who have been indoctrinated into poor eating, less exercise and affordable food being nutritiously bankrupt. Ahhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh!!!!!

And in other news- In this last work week I have been taking care of a string of people who have medical conditions that are wildly out of control because they cannot afford their medication. I keep thinking of this thread. It sucks that HIPPA makes it impossible for me to give specific examples but I wish some of you could see the result of having no medication despite people needing to get treatment. 'Catastrophic' plans include plans with 6000$ deductables. Yes 6K. This is obscene. Who the F is going to have 6K to meet this before they get it to kick in. When things get out of control this means loss of work. Less $ to make a deductible. I can't change the plan, I can't access samples to fill the gap. I can't get a case worker to help manage things. I can't even predict when disaster will happen because the meds are sporadically available. I have to watch as the person heads toward disaster because although I know what they need to do they can't do it. The only thing I can do is watch like waiting for a train wreck to happen. After the 3rd person in less than 2 days I was ready to quit and go work at McDonalds.

Anyone remember when it was a good recommendation to have at least 5 grand in the bank for emergency situations? I know that's another thread, but seriously...
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Anyone remember when it was a good recommendation to have at least 5 grand in the bank for emergency situations? I know that's another thread, but seriously...
Ha. The avg joe should have 5K or more in the bank but if you bleed that out or more every yr most people can't sustain that. You can't save for the next yr when you aren't keeping up with this yr. :( The cost of healthcare is just so crazy these people (who do work, a lot, to keep up) aren't making it.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Anyone remember when it was a good recommendation to have at least 5 grand in the bank for emergency situations? I know that's another thread, but seriously...
Just keep in mind that for a lot of people, 5 grand is about 3 months income. If 5 grand is 3 months income, there's not a snowball's chance in hell of saving it.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Anyone remember when it was a good recommendation to have at least 5 grand in the bank for emergency situations? I know that's another thread, but seriously...
I woke up thinking about this comment this morning. This sounds OK but take a reasonable scenario and see how it wouldn't be enough.

Meet Mr. X, a 30 yr old man who has squirreled away about 7K. He works hard at his job as a delivery man as well as a second job on the side doing some carpentry. The second job allows him to put aside $ for a rainy day. He has insurance with a 5K deductible because he is a healthy guy with no problems. He walks out onto the back steps one AM, slips on a patch of ice, and goes down a flight of stairs wrong way up. On the way down he badly fractures his right ankle and when he grips the bannister to stop his fall, wrecks his right shoulder and lacerates his forehead as he strikes his head and briefly loses conciousness. He badly enough hurt that he needs to ride in an ambulance. Lucky for him he just needs the ride and not much more attention (250$ (this is probably 2ce that))

ER visit- CT of head (1000$), xrays of neck, spine, ankle, shoulder and upper arm (1000$ to be minimist), Dr eval- (250+), Pain meds (another 200). They determine he has a concussion but no bleed, needs surgery on ankle with the placement of a plate and a few screws and has a minimal rotator cuff tear. He gets stitches in his head (100). He needs to stay in the hospital overnight waiting for the OR and a surgeon for his ankle (300 for the room and board, 7K for the surgery if we are being really nice/no complications. Oops there goes his nest egg but Yeay for him, he has met his deductible and only has a 250$ for copay and his coverage requires him to pay the first 1K for hospitalization). He gets discharged home in a cast after another day (300 + another 200 charged for various meds and IVs) with crutches, a wheelchair because he can't crutch too well with a bum shoulder (500$ this is not covered, excluded in his insurance). He can't work. He can't drive until after he is cleared by ortho in about 4-6 weeks if he heals amazingly well. He can't do his carpentry because altho he can get someone to drive him and his shoulder doesn't need surgery he has enough pain he can't use his arm consistanty. He didn't think he needed disability insurance because he was healthy. His job gives him 3 weeks of earned time for sick and vacation. He needs PT for both the ankle and shoulder 3 times a week for about 4 weeks because he has both ankle and shoulder issues (200/visit but his insurance only has a 50$ copay X 12). He will probably need PT after he returns to work once a week for a few weeks (50 X2) He needs to see the ortho for post op f/U (200 but only a 50$ copay) and again in 4 weeks (another 200 but he has a 50$ copay). He sees the primary care for removal of the stitches in his head (30$ copay). He needs a cast change in the middle of that (100 but only a copay of 50). He also has HA from the concussion that is persisting after 2 weeks so sees primary for that (30).

Meanwhile he is now out of work for 6 weeks because of his dual injry to shoulder and ankle. He has no income for 3 wks of it. This guy is probably not going to be able to tolerate 2 jobs for about 5-6 months, even if he is Superman, without ending up out again. If he is lucky he won't have lost his job but will probably lost some of his carpenty customer base. He will have residual pain and some loss of function no matter how good the outcome.

This is a best case scenario- the guy has no co-morbidities, doesn't end up needing shoulder surgery (which they would wait to do until he was mobile and would take 6 more weeks of out of work, PT, etc), his post concussive sx go away and he has a nice recovery from his surgery. He has no sick or vacation time left so he better not get sick or have any complications from the injuries because he can't take further time off and get paid.

Work out the math (I hate math so you can do it). This isn't an actual case but a composite of things I have seen with none of the complications that usually show up because they have dog's luck. I have probably underestimated most of the costs.

If the guy is uninsured the $ are even scarier. Go ahead and attach his pay. How much do you want of it % wise? How long do you think it will take for it to be paid off? How long is it going to take to build up a contingency fund of 5K for him, if he can?

This is a trauma, not a sudden dx of a chronic illness such as diabetes. If it was a chronic illness it require an equal amt or more of $ for testing/hospitalization but then require chronic expenditure for meds, follow up, testing etc. Most likely, despite absolute compliance on the patient's part sequelae occur which will increase the cost as more meds/treatment/testing occur. If it was your kid, not you, you would need to take time out from work to do all of that.

Think about it.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

Thanks for the clarification. My choice of "founding fathers" was an ambiguous term, as technically I meant something a bit different than what I actually said.

Firstly, many of the people involved in the initial bid for independence (e.g Sam Adams and Thomas Paine, most notably) I'd consider "radicals" not "conservatives"; it was an unlikely alliance between radicals like Sam and conservatives like the well-to-do merchants who wanted to keep the tax dollars here rather than repatriate them out of the country, that fought side by side during the American Revolution. Jefferson in my taxonomy is clearly a "liberal" and not a "conservative", as well, and The Declaration of Independence, along with Martin Luther King Jr's "I have a dream" speech, are probably two of the most significant and eloquent expressions of "liberal" philosophy you can find anywhere, any time.

As I'm sure you recall, the first attempt at a central government, the Articles of Confederation, was not working as well as some people would have liked. That first "central" government did not have the necessary authority (in their view) adequately to referee conflicts between the states nor collectively to represent the states in foreign affairs. Many feared that the nascent nation would founder, rent asunder by internal conflicts, too weak to defend itself against an external foe.

Many historians call the enactment of the US Constitution the "conservative counter-revolution."

By "founding fathers" I was thinking more of luminaries like Hamilton, Madison, Jay (see The Federalist Papers), Washington, Franklin, "conservatives" all, the people whose writing and proselytizing convinced people to adopt the US Constitution, which is very much a "conservative" document. As I believe Rover pointed out, Washington "freed" his slaves in his will only after his wife's death.

And so, yes, our "first wave" of "founding fathers" was a nice mix of radicals, liberals, and conservatives, and even a few "monarchists" (who wanted to make Washington our first king!); which subsequently was upstaged by the persuasiveness of the solid "conservative" bloc that followed ten years later.



PS it does seem to be a truism that today's successful radicals become tomorrow's hide-bound conservatives! I think that drives some people crazy; because "the wisdom of your elders" keeps evolving. :)

Good post.

I would also add that though I like your distinction between the Revolutionary Wave and the Federalist Wave, a Third Wave that wiped out the Federalists came shortly on the heels of the second. I would call that third wave the "Democratic Wave," not in the sense of the current party (obviously) but in the sense of Jeffersonian elitist agrarian liberalism opposing itself to Hamiltonian elitist industrial conservatism. The Fourth Wave would then be the "Populist Wave," which began the process of extending rights to the general population in a sense that we would understand it as a modern democratic people, roughly like (and coeval with) the Chartist Movement in England.

Though the American tradition of political freedom starts even before the Revolution (I recommend Bernard Bailyn's "Ideological Origins of the American Revolution" as a good intro to the precursor movements in the state legislatures, town councils, and congregational organizations), the American traditional of political equality really only takes hold with Jackson.

I have to say, when you're not being copy-paste polemical you're one of the more interesting political posters on the board. More good stuff, less bad stuff, please! :)
 
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Re: The Sad Case of the Patient Protection and Affordable Care Act

I woke up thinking about this comment this morning. This sounds OK but take a reasonable scenario and see how it wouldn't be enough.

Meet Mr. X, a 30 yr old man who has squirreled away about 7K. He works hard at his job as a delivery man as well as a second job on the side doing some carpentry. The second job allows him to put aside $ for a rainy day. He has insurance with a 5K deductible because he is a healthy guy with no problems. He walks out onto the back steps one AM, slips on a patch of ice, and goes down a flight of stairs wrong way up. On the way down he badly fractures his right ankle and when he grips the bannister to stop his fall, wrecks his right shoulder and lacerates his forehead as he strikes his head and briefly loses conciousness. He badly enough hurt that he needs to ride in an ambulance. Lucky for him he just needs the ride and not much more attention (250$ (this is probably 2ce that))

ER visit- CT of head (1000$), xrays of neck, spine, ankle, shoulder and upper arm (1000$ to be minimist), Dr eval- (250+), Pain meds (another 200). They determine he has a concussion but no bleed, needs surgery on ankle with the placement of a plate and a few screws and has a minimal rotator cuff tear. He gets stitches in his head (100). He needs to stay in the hospital overnight waiting for the OR and a surgeon for his ankle (300 for the room and board, 7K for the surgery if we are being really nice/no complications. Oops there goes his nest egg but Yeay for him, he has met his deductible and only has a 250$ for copay and his coverage requires him to pay the first 1K for hospitalization). He gets discharged home in a cast after another day (300 + another 200 charged for various meds and IVs) with crutches, a wheelchair because he can't crutch too well with a bum shoulder (500$ this is not covered, excluded in his insurance). He can't work. He can't drive until after he is cleared by ortho in about 4-6 weeks if he heals amazingly well. He can't do his carpentry because altho he can get someone to drive him and his shoulder doesn't need surgery he has enough pain he can't use his arm consistanty. He didn't think he needed disability insurance because he was healthy. His job gives him 3 weeks of earned time for sick and vacation. He needs PT for both the ankle and shoulder 3 times a week for about 4 weeks because he has both ankle and shoulder issues (200/visit but his insurance only has a 50$ copay X 12). He will probably need PT after he returns to work once a week for a few weeks (50 X2) He needs to see the ortho for post op f/U (200 but only a 50$ copay) and again in 4 weeks (another 200 but he has a 50$ copay). He sees the primary care for removal of the stitches in his head (30$ copay). He needs a cast change in the middle of that (100 but only a copay of 50). He also has HA from the concussion that is persisting after 2 weeks so sees primary for that (30).

Meanwhile he is now out of work for 6 weeks because of his dual injry to shoulder and ankle. He has no income for 3 wks of it. This guy is probably not going to be able to tolerate 2 jobs for about 5-6 months, even if he is Superman, without ending up out again. If he is lucky he won't have lost his job but will probably lost some of his carpenty customer base. He will have residual pain and some loss of function no matter how good the outcome.

This is a best case scenario- the guy has no co-morbidities, doesn't end up needing shoulder surgery (which they would wait to do until he was mobile and would take 6 more weeks of out of work, PT, etc), his post concussive sx go away and he has a nice recovery from his surgery. He has no sick or vacation time left so he better not get sick or have any complications from the injuries because he can't take further time off and get paid.

Work out the math (I hate math so you can do it). This isn't an actual case but a composite of things I have seen with none of the complications that usually show up because they have dog's luck. I have probably underestimated most of the costs.

If the guy is uninsured the $ are even scarier. Go ahead and attach his pay. How much do you want of it % wise? How long do you think it will take for it to be paid off? How long is it going to take to build up a contingency fund of 5K for him, if he can?

This is a trauma, not a sudden dx of a chronic illness such as diabetes. If it was a chronic illness it require an equal amt or more of $ for testing/hospitalization but then require chronic expenditure for meds, follow up, testing etc. Most likely, despite absolute compliance on the patient's part sequelae occur which will increase the cost as more meds/treatment/testing occur. If it was your kid, not you, you would need to take time out from work to do all of that.

Think about it.

You could keep tacking stuff onto your story, and it'd be like the cartoon where the two enemies repeatedly pull out bigger and bigger guns to top each other. Sure, 5 grand may not be enough in this day and age (might be up to at least 10 grand), but I would think it'd be up to the person to decide the safety net they need, do what they need to achieve it, and accept the resulting consequences (whether good or bad). Savings techniques need to be brought back at a young age (for example, do you REALLY need to go to that $10 viewing of Harry Potter with your buddies). It's like the old Aesop fable about the grasshopper and the ant.
 
Re: The Sad Case of the Patient Protection and Affordable Care Act

It's like the old Aesop fable about the grasshopper and the ant.
The question has always been, can we have a solution where people are expected to be responsible but are also covered in the case of catastrophe. That's the whole point of insurance, after all.

There are two problems: the risk of getting wiped out and the moral hazard of having free riders. I think what advocates on each side are saying is you

BTW, did anybody else know there is an alternative Ant and Grasshopper Greek fable where the ant is the bad guy? I sure didn't -- very interesting.
 
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Re: The Sad Case of the Patient Protection and Affordable Care Act

The question has always been, can we have a solution where people are expected to be responsible but are also covered in the case of catastrophe. That's the whole point of insurance, after all.

BTW, did anybody else know there is an alternative Ant and Grasshopper Greek fable where the ant is the bad guy? I sure didn't -- very interesting.

I don't know if you can, because true enforcement of that (i.e. keeping it from being abused) brings in a lot of subjectivity, which is not something a law should have. There's probably a way you could do it, like offering an insurance policy where you have a maximum deductible that exists for all associated costs over a moving 14-day period (or however long would be a reasonable period for two large payments associated with the same catastrophe). This is one reason why I mentioned the government should simply come out with an insurance plan funded by those who choose to participate (NOT by stealing from people that don't qualify).

There were all sorts of those alternatives, like where Cinderella's stepsisters would cut off part of their foot in order to make the slipper fit.
 
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