Now that our season is over...

[kaelistus]

It's free-rider only insofar as we guarantee treatment to those who cannot pay for it. If I choose not to buy insurance and can't pay my medical bills then my medical treatment should stop, except when the providers are will to provide it pro bono. If 'm a twnetysomething professionalwho chooses to take the risk and not buy insurance then I should face the potential financial ruin if my bet goes bad.

IMHO this doesn't work this way. If I need to get, say $10,000 to survive, I will try EVERYTHING to get that money. Lie, cheat, steal, start a revolution, whatever. Because I want to live. I'm pretty sure many twentysomething professionals would do the same. They won't just lie down ad go to sleep.

Secondly, it's important to note that we absolutely do not have a health care system where you can just pay for the medical treatment. If I were to not have insurance and get medical service, I would be paying 3 or 4 times the cost that the insurance company is paying. For pretty much everyone (but maybe the top 1%), your options are: Health insurance, or get sick and go bankrupt (even if you could afford the real cost of your treatment). And heck, It's not even that - since I can't even get affordable health care insurance unless I belong to a corporation or somehow join some other powerful group (AARP when I retire) because they take a cut there.

I'm not sure how the U.S. health care system came about. I do know that it doesn't work and we need something else. Given that the corporations have mainly shaped the current system, I would be willing to say that they have failed and let the government give it a try. Maybe they can do better. I can't imagine them doing much worse, to be honest.

[Rosey]

...the Constitution is pretty well meaningless these days, as it means whatever nine people in black robes say so rather than what the text plainly says...

If only it were ever so simple as plain language interpretation.

They could at least try to get the low-hanging fruit correct.  Like the parts of the Bill of Rights that incorporate something like "Congress shall make no law..." or "...shall not be infringed."  Those parts seem pretty damn clear.

[mnagowski]

...the Constitution is pretty well meaningless these days, as it means whatever nine people in black robes say so rather than what the text plainly says...

If only it were ever so simple as plain language interpretation.

They could at least try to get the low-hanging fruit correct.  Like the parts of the Bill of Rights that incorporate something like "Congress shall make no law..." or "...shall not be infringed."  Those parts seem pretty damn clear.

Is Massachusetts quartering troops in your residence again? I hate it when that happens. The soldiers are always leaving mud all over the kitchen tile.

[cth95]

I feel that I am in the middle of most of you guys politically.  I can almost always see good and bad points to any Republican or Democratic proposals.   Normally, if my choice doesn't win an election, I am bummed but I don't worry too much.  There are usually enough checks and balances and every candidate is usually moderate enough that nothing is done too far out of line for me.  For the first time in my life, the current president and congressional leadership have gotten me very frustrated, angry, and even a little bit worried.

As far as the health care goes, I do think that we need to make some tweaks to the system to prevent the preexisting conditions exclusions and to cut cost.  What drives me crazy, though, is the way this government has gone about it.  

I feel that our government has gone about the health care changes completely wrong.  I didn't bulldoze my house and build a new one to fix the leaky windows it had.  I replaced the windows.  Obama doesn't seem to operate that way.  Rather than making a few minor changes to the best health-care system in the world to make it even better (and, on a larger scale, the United States of America), he has completely changed the focus of the whole system.  Everyone talks about reducing costs, but this "reform" only succeeds in transferring the costs from private payments over to taxes.  There is nothing in here addressing tort reform or improving choice and therefore competition by allowing individuals to shop across state lines.

My wife works for a health insurance company here (nonprofit by the way as are many) in Vermont.  Because of the high level of regulations and small population, only 3 companies are willing to provide  insurance here.  She said their systems are 2-3 generations behind those of the company she used to work for near Boston. There are also many more glitches and SNAFUs implementing policies here compared to in MA.  What's the difference?  There are many companies all heavily competing and therefore driving the quality of the service they provide in MA.  If you still have complaints after being with all 3 companies in VT, all you can do is start over again.  I'm sure customer service and efficiency will really improve if some people get their way of having a single, government provided program with no other options.  How would you like to have only 3 car companies or 3 cell companies to choose from?  For that matter, how would any of us have liked it if all colleges were run by the government and provided the exact same experience with no options?


One of the biggest problems with health care costs is low-deductible plans which encourage people to abuse their insurance by getting checked for every cough or sniffle.  Companies with plans offering little-to-no-deductible often see high rate increases because people use them when they really don't need to.  Have we addressed this by encouraging people to take on plans with a little higher deductible which might make them think twice before running down to the emergency room?  Of course not.  Instead we are going to be fined if our plans don't meet certain limits imposed by the government.  Why shouldn't I be allowed to choose a high-deductible, catastrophic plan if I so choose?  If I have some sort of health issue or lead a high-risk life like a race car driver or extreme skier, I can pay the higher premium since I will be more likely to use it at some point.

I am all for improving our health care system by restricting exclusions based on preexisting conditions, eliminating the connection between jobs and health care plans, reducing costs by addressing tort reform to reduce the ridiculously high malpractice insurance, and increasing competition of private companies to drive efficiency and better service.  I also think we need to find a way to increase individual responsibility and hold people accountable for their own actions affecting their health risk.  

What drives me crazy with our current government is their encouragement of an entitlement society.  I'm all for helping anyone who is down on their luck, but their are enough people out there living off the government (and therefore those of us who work hard and pay taxes) without Obama acting as an enabler by acting like the government is a parent- watching out for our every step to make sure we don't fall and get hurt.  If we never fall down, we never learn how to get back up.

This country has succeeded through innovative ideas and the hard work and dedication to implement them.  

There is a big difference between the government being there to give everyone an equal opportunity to succeed and the goverment making everyone's success equal.

[mnagowski]

My wife works for a health insurance company here (nonprofit by the way as are many) in Vermont. Because of the high level of regulations and small population, only 3 companies are willing to provide insurance here. She said their systems are 2-3 generations behind those of the company she used to work for near Boston. There are also many more glitches and SNAFUs implementing policies here compared to in MA. What's the difference? There are many companies all heavily competing and therefore driving the quality of the service they provide in MA. If you still have complaints after being with all 3 companies in VT, all you can do is start over again. I'm sure customer service and efficiency will really improve if some people get their way of having a single, government provided program with no other options. How would you like to have only 3 car companies or 3 cell companies to choose from? For that matter, how would any of us have liked it if all colleges were run by the government and provided the exact same experience with no options?

It's striking that you are pointing to Massachusetts as a model for the country to follow considering that Obamacare is essentially following Massachusetts's model.

I feel that our government has gone about the health care changes completely wrong. I didn't bulldoze my house and build a new one to fix the leaky windows it had. I replaced the windows. Obama doesn't seem to operate that way. Rather than making a few minor changes to the best health-care system in the world to make it even better (and, on a larger scale, the United States of America), he has completely changed the focus of the whole system. Everyone talks about reducing costs, but this "reform" only succeeds in transferring the costs from private payments over to taxes. There is nothing in here addressing tort reform or improving choice and therefore competition by allowing individuals to shop across state lines.

Couple of things:

1) Under no objective measure does the U.S. have the best healthcare system in the world. Perhaps we have the best medical technology, but there is no proof that the technology is actually providing something of value (except for maybe hope, which can come a lot cheaper in the form of religion). We're currently spending a lot of money to pay people how to figure out how to not insure sick people, and yet you call that "the best health care system in the world".

2) Nobody is bulldozing anything with the health care changes. (And that's why the bill has a received a lot of criticism from the left.) The (asinine) employer-based system is still the mainstay. Private insurance companies can still profit off of health insurance premiums. Doctors are still making all of their decisions with the patient (and the insurance company looking over their shoulder.) The small-group and individual insurance markets are still not going to be very deep or competitive markets.

3) Cost controls are very much embedded in the health care reform bill. For one, Medicare Advantage plans are going to have to be a lot more accountable and can't stop fleecing unsuspecting retirees. For two, we're now going to be funneling a lot of previously uninsured people into inexpensive primary care and away from the emergency rooms. This will help lower costs dramatically because now we;ll be able to treat diabetics instead of waiting for them to show up in the ER with acute renal failure. Three, we're going to start taxing the most expensive health care plans in an attempt to limit the amount of no-deductible "Cadillac plans" that cause some of the costs to continue to increase every year. There are other plans in the bill as well, including comparative effectiveness research as well as provider incentives that will hopefully keep doctors from doing high-risk, low-benefit (but high profit!) surgeries.

4) You say there are some things in the system that require changing. I imagine you are probably referring to the fact that insurers can deny people with pre-existing conditions and can choose to drop people who get sick. My sense is that you can't get rid of these practices unless you spread the risk pool around some more (or else everything becomes very expensive) and that you can't spread the risk pool around unless you mandate individual coverage. And you can't mandate individual coverage unless you can make certain that it's affordable for folks to pay for health insurance. Because I don't think a lot of your average freelance carpenter or plumber (with hypertension or what have you) with a family of four can afford premiums on the individual policy market with the wages they are making.

[cth95]

It's striking that you are pointing to Massachusetts as a model for the country to follow considering that Obamacare is essentially following Massachusetts's model.

I am referring to MA solely to emphasize the need for competition of private industries.  The companies in MA run more efficiently and provide better customer service than those in Vermont where overbearing regulations and redtape have reduced the choices to only three companies.  When competition is removed, there is not much incentive for companies (or the government) to provide a better product.

The vast majority of opinions I hear coming from MA regarding the state run aspect of MA health care complain about the cost to the state and how it is not sustainable.  I think the election of Scott Brown in such a liberal state speaks better than anything I can say regarding the success of government run health care there.

[KeithK]

Kyle already said some of what I had in mind from reading your responses. But this does deserve a response. You're essentially telling me that I'm ignorant because I haven't read so and so and their different notions of freedom. I am aware that there are other theories out there. I wasn't surprised to hear someone talk about collective freedom. I simply reject the concept. I disagree.

I've focused on property rights because they are particularly relevant to this case. As a general rule I don't believe in positive rights (I don't recognize a right to health care, for instance) so that eliminates (from my POV) a lot of other rights/freedoms that you might bring up. Not that you did, of course. You just said "[ I]t is unclear to me that you have thought of any other rights or freedoms" and then told me to go read so and so. You come off as a bit snide and insulting.

I have hundreds of people who have studied the issue for decades on my side. Can you at least agree that the majority has spoken and health care reform is legal?

Appeal to authority. I happily admit that there are plenty of folks who agree with you.  There are plenty who disagree with you too. Even if it was 99-1 against me I'm still going to make up my own mind.

I agree that the majority of the current members of Congress have spoken. (Which isn't the same as the majority of people, who oppose the bill according to polls. But we don't live in a direct democracy.) I don't agree that the bill as passed is legal because I think that at least the mandate is unconstitutional. (That pesky Constitution that you mentioned.) Even if SCOTUS upholds the law I will support candidates who will work to repeal the bill because I don't agree with it.

I don't believ that costs will be lower this way. I'm not willing towait 20 years to find out before passing judgement.

That's a really fantastic argument. Filled with facts and reason (and typos).

This is my favorite part of your post. Dripping with insult. You know, it can be funny to point out someone's typos when we're just playing around. It tends to detract from actual discussion. Especially when I'm obviously not some dumb ass troll on this board whose constant typos tell you you should just ignore him. (For the record, my typing suffers when I'm spewing out thoughts right before running off to do something productive at work.)

My disbelief in the cost numbers isn't a matter of conservative faith. I don't believe the cost estimates because 1) very few government cost estimates are ever correct 2) especially health care cost estimates (see Medicare) 3) the bill has budget gimmicks to make it look palatable (e.g. many benefits don't kick in for four years after revenue streams kick in) and 4) I have read analyses (summaries anyway) that disagree with the estimates. There's some subjectivity there obviously - which sources do you believe? But that's always the case.

[RichH]

Is it okay to demand that this thread be moved to JSID now?

[KeithK]

Is it okay to demand that this thread be moved to JSID now?

Come on, this is totally a sports discussion!

And do you really have a right to demand anything here? :-P

[Robb]

3) Cost controls are very much embedded in the health care reform bill. For one, Medicare Advantage plans are going to have to be a lot more accountable and can't stop fleecing unsuspecting retirees. For two, we're now going to be funneling a lot of previously uninsured people into inexpensive primary care and away from the emergency rooms. This will help lower costs dramatically because now we;ll be able to treat diabetics instead of waiting for them to show up in the ER with acute renal failure. Three, we're going to start taxing the most expensive health care plans in an attempt to limit the amount of no-deductible "Cadillac plans" that cause some of the costs to continue to increase every year. There are other plans in the bill as well, including comparative effectiveness research as well as provider incentives that will hopefully keep doctors from doing high-risk, low-benefit (but high profit!) surgeries.

This is nonsense.  None of these things are going to lower the % of GDP that we collectively spend on healthcare.

Your "stop fleecing unsuspecting retirees," is "forcing a one-size-fits-all solution to Medicare Advantage plans so that consumers no longer have choices about what they would like included in their plans and letting the market price those choices accordingly" to me.  

Getting people to primary care instead of waiting for them to turn up in the ER may or may not save cost.  What if you prevent a guy from needing $500k of renal failure care but that extends his life long enough that he later has a $1M heart attack?  We're all going to die someday; therefore, we're all going to need serious care at some point in our lives - that cost is roughly fixed.

Adding new taxes just shifts money from being paid to private companies to being paid to the government.  Where's the cost savings there?

We currently spend ~16% of GDP on health care, and under the status quo that was projected to rise to ~20% by 2020.  Come back in 10 years, and if we're spending less than that due to this bill, I'll eat my hat.

4) You say there are some things in the system that require changing. I imagine you are probably referring to the fact that insurers can deny people with pre-existing conditions and can choose to drop people who get sick. My sense is that you can't get rid of these practices unless you spread the risk pool around some more (or else everything becomes very expensive) and that you can't spread the risk pool around unless you mandate individual coverage. And you can't mandate individual coverage unless you can make certain that it's affordable for folks to pay for health insurance. Because I don't think a lot of your average freelance carpenter or plumber (with hypertension or what have you) with a family of four can afford premiums on the individual policy market with the wages they are making.

The problem with this argument is that we're NOT going to be spreading the risk pool out very much more.  We're only going to be increasing the number of people in the system by ~10-15%, which is not nearly enough larger of a pool to spread out the additional costs that all these new users (ESPECIALLY those with pre-existing conditions) will incur.  Clearly, if you force companies to accept people with pre-existing conditions, then forcing people to buy insurance does help spread the cost to some degree, but I've never read anything that convinces me it's a slam-dunk that the additional costs will be spread thin enough to reduce the overall amount spent on health care.  Don't forget that now that you're forcing perfectly healthy people to buy insurance, they'll start using health care services at a much greater rate themselves, so the premiums they pay is not just free money for the health insurance companies.

[Trotsky]

For all but the last fraction of recorded human history, raping and pillaging was a completely acceptable way of acquiring property rights. But that doesn't mean it's okay.

Mmmmkay.  I suspect that's not really true, since the people raped/pillaged were likely involuntary parties.  But thanks for playing.

Can you just come right out and call me and/or Keith a Nazi?  At least then we could Godwin the thread and save us all from more of your emotional invective and logical fallacies.

For fuck's sake, if it will kill this thread, then Hitler, Hitler, Hitler.

[ugarte]

One of the biggest problems with health care costs is low-deductible plans which encourage people to abuse their insurance by getting checked for every cough or sniffle.  Companies with plans offering little-to-no-deductible often see high rate increases because people use them when they really don't need to.

This is what classical economics and "moral hazard" would suggest - and it is insurance industry cant - but, for the record, there is very little evidence that this is true when it comes to health care. It isn't true with low deductible plans and it isn't true with actual socialized medicine. The pay the typical person loses from not working, not to mention the inconvenience of office visits, swamps the effects of a low deductible. High deductible plans serve the purpose of cost shifting much more than they control behavior for the vast majority of insured.

[Rosey]

For all but the last fraction of recorded human history, raping and pillaging was a completely acceptable way of acquiring property rights. But that doesn't mean it's okay.

Mmmmkay.  I suspect that's not really true, since the people raped/pillaged were likely involuntary parties.  But thanks for playing.

Can you just come right out and call me and/or Keith a Nazi?  At least then we could Godwin the thread and save us all from more of your emotional invective and logical fallacies.

For fuck's sake, if it will kill this thread, then Hitler, Hitler, Hitler.

[mnagowski]

For fuck's sake, if it will kill this thread, then Hitler, Hitler, Hitler.

It wasn't a part of an argument, so I don't think it counts.

I've focused on property rights because they are particularly relevant to this case. As a general rule I don't believe in positive rights (I don't recognize a right to health care, for instance) so that eliminates (from my POV) a lot of other rights/freedoms that you might bring up. Not that you did, of course. You just said "[ I]t is unclear to me that you have thought of any other rights or freedoms" and then told me to go read so and so. You come off as a bit snide and insulting.

I don't see how property rights are relevant to the health care talk at all. People are decrying the mandate and the tax, but mandatory taxation to provide public goods has been a part of this country for a long time. This was an issue settled 200 years ago.

Positive rights are more than just the right to ensure a certain standard of living, or a right to health care. The much more basic positive right is being able to have a role in choosing who governs the society (and how it is governed) of which one is a part. It's the right to be a social being and be able to interact with others to come to agreements about governance. I suppose you might suggest that this is really just a reflection of property rights and everything can be a contractual agreement between parties, but what happens if you have no property?

I agree that the majority of the current members of Congress have spoken. (Which isn't the same as the majority of people, who oppose the bill according to polls. But we don't live in a direct democracy.) I don't agree that the bill as passed is legal because I think that at least the mandate is unconstitutional. (That pesky Constitution that you mentioned.)

For what it is worth, the bill has been tracking at around a 50/40/10 favorable/unfavorable/no opinion rate in unbiased popular polls since it has been passed. (http://www.usatoday.com/news/washington/2010-03-23-health-poll-favorable_N.htm) And if you think the mandate is unconstitutional, I imagine you must think that a lot of other things must be unconstitutional, like that act from the 1790s that taxed ship captains to provide for the hospitalization of their crews. But how about a compromise -- I'll agree to to get rid of a mandate provided we provide a public option to buy-in to Medicare.

My disbelief in the cost numbers isn't a matter of conservative faith. I don't believe the cost estimates because 1) very few government cost estimates are ever correct 2) especially health care cost estimates (see Medicare) 3) the bill has budget gimmicks to make it look palatable (e.g. many benefits don't kick in for four years after revenue streams kick in) and 4) I have read analyses (summaries anyway) that disagree with the estimates. There's some subjectivity there obviously - which sources do you believe? But that's always the case.

Well, now there's an actual argument. To respond to your arguments:

1) very few budget forecasts are ever correct, but we need to work with the best of what's available, and this forecast shows that we'll actually be reducing the deficit in the long run, unlike any other piece of legislation passed in the last decade.

2) I think everybody knows that Medicare is on a rapidly unsustainable path. That's why the Democrats realized they had to do something about it, unlike the Republicans who actually started to defend Medicare benefits tooth and nail. But other government estimates aren't really that bad provided it is coming from the CBO or the Congressional Research Service and not the political parties. That's why a lot of us knew that Bush's tax cuts or the Iraq War or Medicare Part D were massive blunders before they even happened.

3) I'm really not certain what budget gimmicks you are talking about. The front-loading of taxes is really just a Republican talking point and not the truth. Here's a chart from the CBO:

http://www.princeton.edu/~pkrugman/holtz.png

4) That's fair. You are certain to believe any source that you want. I tend to believe sources that have a clear sense of objectivity and don't have an obvious political agenda working on their side. Like the Congressional Budget Office.

Getting people to primary care instead of waiting for them to turn up in the ER may or may not save cost. What if you prevent a guy from needing $500k of renal failure care but that extends his life long enough that he later has a $1M heart attack? We're all going to die someday; therefore, we're all going to need serious care at some point in our lives - that cost is roughly fixed.

Adding new taxes just shifts money from being paid to private companies to being paid to the government. Where's the cost savings there?

We currently spend ~16% of GDP on health care, and under the status quo that was projected to rise to ~20% by 2020. Come back in 10 years, and if we're spending less than that due to this bill, I'll eat my hat.

I disagree that the cost is fixed. A lot of other first-world countries aren't spending the same amount of money as us, with often better health outcomes as well.

I hope that we don't reach 20% of GDP, but it might very well happen due to the amount of excessive private-sector bureaucracy we are leaving in the system to deal with billing and enrollments and advertising and all that. A public option would have definitely been cheaper for us.

Clearly, if you force companies to accept people with pre-existing conditions, then forcing people to buy insurance does help spread the cost to some degree, but I've never read anything that convinces me it's a slam-dunk that the additional costs will be spread thin enough to reduce the overall amount spent on health care.

I don't think anybody has been talking about reducing the overall amount spent on health care. That would require single-payer to get rid of the bureaucratic bloat that exists. Or rationing. What most studies I have read about the bill think it will do is start to curb the annual increases we see in rising costs. This is because of a) the preventive health measures that will pay dividends down the future, b) the programs that are in place that encourage doctors to be more efficient in their practices. Some communities in this country are spending three times more than other communities with the same health and economic characteristics for the same health outcomes? Why? Some doctors follow the 'best-practices' better than others.

Don't forget that now that you're forcing perfectly healthy people to buy insurance, they'll start using health care services at a much greater rate themselves

This doesn't make much sense to me. Perfectly healthy people choose to go to the doctor just to chat? Or are they going to start demanding open heart surgery just because they have insurance? Perhaps they are going to start getting tested for their cholesterol levels every other year, but that is not what is causing health care costs to skyrocket. It's end of life care.

[Rosey]

I don't see how property rights are relevant to the health care talk at all. People are decrying the mandate and the tax, but mandatory taxation to provide public goods has been a part of this country for a long time. This was an issue settled 200 years ago.

How is individual health a public good?