waiting

[dblack]

Hey Old I just gave you a thanks. Not because your post was was so useful, it is after all old information that is readily available and is regularly ignored by those on the right.

It's not "information", it's an opinion. And the reason it's ignored (and not just by those on the "right", btw) is because there is a lot of equivocation on the meaning of the term free market. From my perspective, what we have now - and have had for some time - is a far cry from a free market. Further, the biggest problems we have with health care are directly attributable to regulation and tax policies that have moved us away from a free market. They distort our use of insurance and accelerate health care inflation.

I'd agree with that mostly.

I guess that sooner or later we have to answer the current question: Should health care be governed by "free market" principles?

I'm wondering what you think of as 'free market principles'. For me, those principles are the same as the principles of free society in general, namely voluntary cooperation and self-ownership.

What sort of principles would you have govern health care?

 

[eflatminor]

The french are rated best in the world.

Oh well, if the United Nations says so

By the way, how is the French debt situation these days? All those entitlements working out well for the people? From your own link: "It will be the generation now entering the workforce who will pay for the years of deficit spending through some mix of higher taxes and reduced access."

Lovely, even more taxes and less care. Yea, we should shoot for that.

While I may agree France's healthcare system is better than other socialist systems, that does not mean our quasi-socialist approach should take that final step towards central control. Instead, we could stop tying healthcare insurance to jobs, stop forcing everything under the sun to be covered in policies issued, stop telling insurance carriers how much than can charge, make "loser pays" the standard for all lawsuits, and for heaven's sake, stop regulating the death out of the industry.

"Socialist" is defined as the ownership and control of the production facilities.

France is not a socialist system

You do realize that the US is the only system in the world that is driven by profit? Where are all those benefits this is supposed to bring?

Driven by profit, hamstrung by central planner meddling. There is no need to continue a discussion with someone who thinks our current healthcare system represents anything close to a free market.

 

[Luddly Neddite]

As time trickles out with the Supreme court staggering to a healthcare decision I wish to remind the GOP that this is a lose/lose situation.

Many of the provisions of obamacare are already in place and are hugely popular. The GOP leadership is already running about trying to find ways to salvage these.

Today I heard two of my state (GOP) senators proclaiming that we ought to adapt Romney care for our state. Odd since just last week they were denouncing it as an abomination, forgetting that it was a GOP inspired plan as far back as the nineties.

Whatever the court decides the GOP loses. If the entire bill is struck down that will give absolute ownership of this broken down system to them. They alone will be required to find a way out. That will be interesting since there is no escape short of national health care.

If the bulk of the program remains intact they must then explain why they made such a fuss about a constitutional bill. (not the the ussc gives a damn what is or is not really constitutional)

Meanwhile he idiot GOP base grows restless.

Conservatives Give GOP Hell On Health Care, Taxes As Crises Loom | TPMDC

Like what ?

I haven't read the rest of the posts so don't know if anyone has posted the answer for you BUT

How is it possible that so many rw's really don't seem to know that they could be making/saving a pile of money because of the Affordable Care Act? Some has been in force for more than two years !!Why haven't you and others LOOKED IT UP??? My insurance company informed me and sent me a check. And, I've posted my other savings in the past so won't post that again. But, here's the timeline.

Implementation Timeline - Kaiser Health Reform

As for the op, I agree that the pubs are gonna have some big time esplainin' to do to a lot of people, including me. Pisses me off that, with an unknowing and uncaring wave, a bunch of rich old men will take money away from me.

And, if mitt is elected, I'll lose even more.

I don't have the words to express how much I despise the GObP/pubs/bags.

 

[Luddly Neddite]

You do realize that the US is the only system in the world that is driven by profit? Where are all those benefits this is supposed to bring?

Money-Driven Medicine
[ame]http://www.amazon.com/Money-Driven-Medicine-Reason-Health-Costs/dp/006076533X[/ame]

The history is interesting. It was at the end of WWII that most other countries set about making their own system work for the benefit of the people while we put our money into making a bigger and bigger military and just sort of let the citizenry fight for themselves. Now, insurance companies are so powerful, they literally decide who gets care and who does not. The R's hope to make them even more powerful by giving them and employers decide what coverage you get.

I have no doubt the activist and very corrupt conservative scotus will overturn the AHA and its constitutionality will have nothing at all to do with it. They see it as an opportunity to slap the president and that's all that matters to the R. The people of the United States are not their concern. They have said so, repeatedly.

 

[Not2BSubjugated]

...there is no escape short of national health care.

Of course, because free markets are out of the question.

A free market health care system in this nation has given us the highest per capita costs of any nation for a system that has vastly inferior results compared to the other rich industrial nations. In fact, the only people really gaining from the present system are the very rich that make profit off of other peoples misery.

Free market? A system where it's illegal for a hospital to turn someone away from their ER who has a legitimate medical emergency and no way to pay for care. . . that's a free market?

And before you fire back at me for being heartless, understand that I'm not arguing the morality of this point, simply that it's a fairly glaring contradiction to your claim that America's health care system is a free market.

 

[asterism]

Wow? You don't know? Here are a couple . Children can stay on parent's policy until age 26.

Cannot be refused for preconditions. Look it up you will be gratified.

Of course they're popular, it's free to the people.

Unfortunately, it's not *free* to the state, and the state can't afford it.

A government programm is not free but it is multiple times cheaper than the private system is only because profit is not required.

15 to 35 percent of our private system premiums go to overhead. (administration and profit)

Overhead for medicare is 3%.

That's misleading. Medicare acts as an asset transfer system, not an insurance company. Healthcare organizations are paid by medicare for allowed procedures at a set schedule which includes overhead. Insurance companies break it out separately and do not necessarily pay on the same lofty schedule.

A practice of which I was familiar because I built their financial accounting system had one billing clerk for 60% of their revenue from patients using cash and private insurance. They had three medicare and medicaid billing clerks, 40% of the billing.

 

[asterism]

facts dont permeate their braincases

More on Medicare's "efficiency:"

 

[oldernwiser]

It's not "information", it's an opinion. And the reason it's ignored (and not just by those on the "right", btw) is because there is a lot of equivocation on the meaning of the term free market. From my perspective, what we have now - and have had for some time - is a far cry from a free market. Further, the biggest problems we have with health care are directly attributable to regulation and tax policies that have moved us away from a free market. They distort our use of insurance and accelerate health care inflation.

I'd agree with that mostly.

I guess that sooner or later we have to answer the current question: Should health care be governed by "free market" principles?

I'm wondering what you think of as 'free market principles'. For me, those principles are the same as the principles of free society in general, namely voluntary cooperation and self-ownership.

What sort of principles would you have govern health care?

I meant free market principles in the most capitalistic sense where health care is largely or entirely privately owned and operated for a profit and structured on the process of capital accumulation. In general, investments, distribution, income, and pricing is determined by markets - to borrow a bit from Wikipedia.

We seem to have a twisted view of supply and demand when it comes to health care. There is no point where supply and demand will ever reach equilibrium without the death of many people - at which point demand would surely diminish.

If I could answer that last question, I'd start a war chest and run for office myself.

 

[dblack]

We seem to have a twisted view of supply and demand when it comes to health care. There is no point where supply and demand will ever reach equilibrium without the death of many people - at which point demand would surely diminish.

Hmm.... not sure what you're getting at, or what you're seeing as "twisted", other than perhaps our unrealistic expectations, as a nation, regarding health care.

Every single one of us will reach a point where we can't afford enough health care. And for most of us, there will be a point where it is decided, either by our doctors or our families or ourselves, that it's not worth it to spend any more money fighting the inevitable.

My own father made such a call, deciding to avoid a prolonged, expensive death in the hospital. He might have a squeezed another few months - maybe even a year or two - out of his life if he'd been willing to pull out all the stops. But, instead, he chose to spend his remaining days with my mom, and leave her with something left in their nest egg.*

The point is, the idea that the demand for health care is somehow infinite is false. And so is the idea that people can't make sound relative value judgments when it comes to health care decisions.

We artificially limit the supply of health care, regulating away low-cost (and, yes, lower-quality) health care. We further discourage the development of inexpensive health care by promoting insurance plans (as I've been discussing) that do away with consumer demand for lower-cost options.

So, I don't think there's a solid case for the idea that health care supply and demand can't find equilibrium. In any case, it behooves us to remove the barriers that currently inhibit that goal.


*for an interesting read regarding realistic end-of-life issues, check this out.

 

[Political Junky]

The individual mandate's Republican roots: A guide - The Week

The Right is working overtime to kill ObamaCare's central component — even though Mitt Romney and other GOP leaders once trumpeted the individual mandate

 

[dblack]

The individual mandate's Republican roots: A guide - The Week

The Right is working overtime to kill ObamaCare's central component — even though Mitt Romney and other GOP leaders once trumpeted the individual mandate

so?

 

[Political Junky]

The individual mandate's Republican roots: A guide - The Week

The Right is working overtime to kill ObamaCare's central component — even though Mitt Romney and other GOP leaders once trumpeted the individual mandate

so?

So ...here's the rest of the article that you didn't read.

The future of President Obama's health-care overhaul now rests in the hands of the Supreme Court. And many legal experts predict that the court's conservative majority will kill the Affordable Care Act by declaring its linchpin, the individual mandate (the requirement that virtually all Americans buy health insurance), unconstitutional. Liberals find that prospect galling, especially since, as they assert, the mandate was "originally a conservative idea." Is that true? Here's what you should know:

Who came up with the idea?
Conservative economists developed the concept in the late 1980s, when they were searching for a market-based alternative to the government-sponsored, universal health-care system liberals were proposing. Mark Pauly, a professor at the University of Pennsylvania's Wharton School of Business, suggested offering tax credits to help everyone buy at least minimal "catastrophic" insurance, and he proposed making it mandatory to get coverage. The conservative Heritage Foundation latched onto the idea, and pitched it to Republicans in Congress.

And did Republican leaders support it?
Some did, and when President Bill Clinton started pushing his failed health-care reform plan in the 1990s, the GOP presented the Heritage Foundation approach as an alternative. Twenty Republican co-sponsors supported a Senate bill that formally proposed the individual mandate, but the idea faded when Clinton's effort failed. In 2004, Mitt Romney, then governor of Massachusetts, revived the idea as part of a health-care overhaul for his state, which he signed into law in 2006. Romney, the GOP frontrunner for the 2012 election, is now vowing that, if elected president, he'll scrap Obama's federal version of the mandate.

Why have Republicans turned on the idea?
Out of political expedience, according to critics. Until ObamaCare came along, says David Frum at The Daily Beast, conservatives insisted the idea was "the secret to a well-functioning national health-care system." Now some of those same people claim "a health-care mandate is tantamount to the extinction of economic freedom" because it's convenient to say so. Still, let's not overstate the individual mandate's conservative roots, says Ramesh Ponnuru at National Review. A minority of think-tank types have always liked the idea, and some Republicans embraced it when they were forced to find an alternative to "HillaryCare." But this was never part of the GOP platform.

Sources: Daily Beast, National Review, Outside the Beltway, Policymic, Washington Post

 

[dblack]

The individual mandate's Republican roots: A guide - The Week

The Right is working overtime to kill ObamaCare's central component — even though Mitt Romney and other GOP leaders once trumpeted the individual mandate

so?

So ...here's the rest of the article that you didn't read.

The future of President Obama's health-care overhaul now rests in the hands of the Supreme Court. And many legal experts predict that the court's conservative majority will kill the Affordable Care Act by declaring its linchpin, the individual mandate (the requirement that virtually all Americans buy health insurance), unconstitutional. Liberals find that prospect galling, especially since, as they assert, the mandate was "originally a conservative idea." Is that true? Here's what you should know:

Who came up with the idea?
Conservative economists developed the concept in the late 1980s, when they were searching for a market-based alternative to the government-sponsored, universal health-care system liberals were proposing. Mark Pauly, a professor at the University of Pennsylvania's Wharton School of Business, suggested offering tax credits to help everyone buy at least minimal "catastrophic" insurance, and he proposed making it mandatory to get coverage. The conservative Heritage Foundation latched onto the idea, and pitched it to Republicans in Congress.

And did Republican leaders support it?
Some did, and when President Bill Clinton started pushing his failed health-care reform plan in the 1990s, the GOP presented the Heritage Foundation approach as an alternative. Twenty Republican co-sponsors supported a Senate bill that formally proposed the individual mandate, but the idea faded when Clinton's effort failed. In 2004, Mitt Romney, then governor of Massachusetts, revived the idea as part of a health-care overhaul for his state, which he signed into law in 2006. Romney, the GOP frontrunner for the 2012 election, is now vowing that, if elected president, he'll scrap Obama's federal version of the mandate.

Why have Republicans turned on the idea?
Out of political expedience, according to critics. Until ObamaCare came along, says David Frum at The Daily Beast, conservatives insisted the idea was "the secret to a well-functioning national health-care system." Now some of those same people claim "a health-care mandate is tantamount to the extinction of economic freedom" because it's convenient to say so. Still, let's not overstate the individual mandate's conservative roots, says Ramesh Ponnuru at National Review. A minority of think-tank types have always liked the idea, and some Republicans embraced it when they were forced to find an alternative to "HillaryCare." But this was never part of the GOP platform.

Sources: Daily Beast, National Review, Outside the Beltway, Policymic, Washington Post

Yeah. Old news. Once again, so what?

I couldn't care less which idiots came up with the idea. Do YOU think it's good policy? I don't.

 

[Not2BSubjugated]

Cannot be refused for preconditions.

Now if we can only get that for homeowner's insurance. That way, you wouldn't have to buy insurance until your house is actually on fire. That will certainly be GREAT for the insurance industry, homeowners, and the banks that lend money on those homes.

how does refusing health care to sick people make this country better?

Refusing health -INSURANCE- to people who are already sick (i.e. aren't looking for insurance, are looking for someone to pay for their current problem) improves this country by enabling insurance companies to achieve a profit margin with significantly lower rates offered to those responsible people who are actually looking for insurance (by its actual definition).

You feel that it's damaging to this country not to force people in the insurance business to pay for the care of the sick. I feel that it's damaging to this country to enslave people to each other. What factual basis do you have to claim that your morals are superior to my morals?

 

[Jackson]

Like what ?

Wow? You don't know? Here are a couple . Children can stay on parent's policy until age 26.

Cannot be refused for preconditions. Look it up you will be gratified.

But what else is in there that we DON'T need or want? Nobody said there were some good things in this, but what about all the rest? Why would the SC even look at this if they didn't think something is wrong?

If this gets the thumbs down, it's because there are parts of it that are not lawful. Not lawful includes fining people for not having insurance! If getting rid of this part of it forces the whole thing to be scrapped, then that's just too bad.

We do need health reform, but not the kind Obama has given us. Next time they need to involve everyone and not shut the doors on the republicans. Remember Pelosi saying "We need to pass it so you can see what's in it"? Unbelievable! And it never would have passed if the Michigan congressman STUPAK hadn't taken Obama's bribe. A bribe that he promised then backed out on.

You are exactly right, Caroljo. The libs point to two paragraphs of the thousands of pages and billions of dollars to scream success. The overwhelming majority of the citizens do not want this boondoggle and they know it. The SCOTUS will strike down this law and Obama's crowning glory will be deemed unconstitutional just as much of his action done while president.

If the Republicans were allowed to participate in a bipartisan effort, we may have had a legal law that could have incorporated those same two items without the unlawful stutes that will bring down this law. At a cost that the country could afford, I might add.

 

[chicklet]

Stay on your parents policy till age 26, great idea except that the cost is paid by all insured members in the risk pool. So-called adult children added to their parents policies drive up the cost for everyone else, especially people without kids in their 20s who work at a place where they are plentiful.

So we all pay when your co-worker adds her kids, even though these kids can buy a policy with no pre-existing conditions in nearly all states. We already subsidize women with 6 kids who want a surrogate mother to have some more, unlimited physical therapy for people with backaches, laws mandate expensive brand name drugs when there are 8 generic drugs available--- our legislators stick these mandates into the law and the price of the average policy goes up 25%, at least here in NJ.

Nothing is free, don't you get it? If our lawmakers add a few dozen 'requirements' or 'mandates' into insurance law the cost is spread over all policies. We all pay more when states add mandates, we all pay more to subsidize Mary's 'adult children' who could buy their own policy (or get Medicaid if they can't afford it). Employers pass the cost to us by reducing coverage (yes, your $40 co-pay is part of the subsidy to Mary's kids...) or eliminating benefits.

We also get less choice because doctors fees are cut too, many good doctors simply won't take insurance if they are paid $50 for a $75 service. Nothing is free, mandates add up to 60% to a policy in some liberal states- this contributes to lack of job growth and higher costs for everbody.

The CBO has confirmed this a dozen times, all these mandates increase cost, decrease quality and patient choice and add to the deficit. Laws like this coming from the mountain top don't work, but they are popular with the 24 year old democratic voters who get more stuff for 'free'. Bah.

 

[oldernwiser]

Stay on your parents policy till age 26, great idea except that the cost is paid by all insured members in the risk pool. So-called adult children added to their parents policies drive up the cost for everyone else, especially people without kids in their 20s who work at a place where they are plentiful.

So we all pay when your co-worker adds her kids, even though these kids can buy a policy with no pre-existing conditions in nearly all states. We already subsidize women with 6 kids who want a surrogate mother to have some more, unlimited physical therapy for people with backaches, laws mandate expensive brand name drugs when there are 8 generic drugs available--- our legislators stick these mandates into the law and the price of the average policy goes up 25%, at least here in NJ.

Nothing is free, don't you get it? If our lawmakers add a few dozen 'requirements' or 'mandates' into insurance law the cost is spread over all policies. We all pay more when states add mandates, we all pay more to subsidize Mary's 'adult children' who could buy their own policy (or get Medicaid if they can't afford it). Employers pass the cost to us by reducing coverage (yes, your $40 co-pay is part of the subsidy to Mary's kids...) or eliminating benefits.

We also get less choice because doctors fees are cut too, many good doctors simply won't take insurance if they are paid $50 for a $75 service. Nothing is free, mandates add up to 60% to a policy in some liberal states- this contributes to lack of job growth and higher costs for everbody.

The CBO has confirmed this a dozen times, all these mandates increase cost, decrease quality and patient choice and add to the deficit. Laws like this coming from the mountain top don't work, but they are popular with the 24 year old democratic voters who get more stuff for 'free'. Bah.

Well... kinda...
But you're also glossing over a few facts.
First, a family plan is almost 3x more premiums paid into the pool. Granted that a family of 6 gets a small advantage, but...
Younger children (and the ones under 26 too), tend to use less of the insurance pool on average - this is a good thing. The more healthy individuals paying premiums into the pool, the more resources that insurance companies can pay out to those in need and at a lower cost to everyone.

Employers right now pay, on average, around 80% of your premiums. But, what you don't seem to understand is that this a group policy with coverage that's negotiated between your employer and the insurance carrier. In the case of large employers, they are a pool unto themselves (small businesses are pooled together, but it all works out the same). There is a financial cap as to how much a carrier will pay for the expenses of the group. If your employer sets a rate that's too low, then the medical loss ratio increases, causing employers to either raise rates, raise co-pays, or cut coverage - sometimes a combination of all 3. What people don't see is that if the loss ratio approaches 100% (they're paying out more than what they take in from premiums), employers have to make up the difference, so yes, they can either pay the bill or cut back on their employees - particularly those who drain the pool the quickest. This is hardly a "subsidy".

You're right about some doctors not honoring certain insurance company's policies, but it goes deeper than only getting paid $50 for a $75 visit - in fact, if this WERE the case, there would be some very hungry providers with a real need to assess their price schedules. Other factors include contracts that preclude a provider from accepting a competing policy (and no, McCarron-Ferguson took insurance off the commerce list, so antitrust laws don't apply), the number of patients an insurance provider is likely to supply from a network, and the ease with which medical billers can submit claims and get timely payments. Doctors have bills too.

Finally, while government mandates for insurance providers to provide payment for more services do have an impact on the cost of insurance, the biggest issue is that the number of healthy people enrolled is down. Quite a few people are unemployed or underemployed, which makes it hard for them to come up with a good financial reason to add to their problems by buying something they feel they don't need right now. As the number of healthy subscribers falls off, the cost of premiums has to rise (which is the reason ACA built in the clause that mandated a 100% subscriber rate).

Your final statement is way off base. It isn't about healthy 24 year olds getting something for free that makes ACA (and ACA would not be free) so attractive. It's about the millions of people who made poor lifestyle choices for whatever reasons and are now having to deal with the very real fact that they are going to be very sick for a very long time and it's going to be very expensive to maintain their health regardless of their politics.

 

[dblack]

Finally, while government mandates for insurance providers to provide payment for more services do have an impact on the cost of insurance, the biggest issue is that the number of healthy people enrolled is down. Quite a few people are unemployed or underemployed, which makes it hard for them to come up with a good financial reason to add to their problems by buying something they feel they don't need right now. As the number of healthy subscribers falls off, the cost of premiums has to rise (which is the reason ACA built in the clause that mandated a 100% subscriber rate).

The other interesting angle to this, that I rarely see discussed, is the extent to which the insurance industry has relied on an expanding base of new enrollees to fund payouts. I wish I could find the article, but I recall an interview with a senior insurance exec, who acknowledged that they've known for a long time about the inflationary pressure (on the underlying health care market) inherent in the kind of insurance they were pushing. But it was manageable because group plans were run as, essentially, ponzi schemes. As long as the stream of new paying customers was growing fast enough, they could afford to payout the inflating health care prices and still keep premiums relatively low. They even deemed the resulting health care inflation a 'good thing' from their perspective, because it further promoted the idea that the only way to afford health care was by being "covered".

But like all ponzi schemes, this lasts only until the expanding base begins to dry up. The combination of lower population growth, a saturated insurance market, and diminished economic prospects for new workers finally created a situation where their system could no longer keep up with the health care inflation. They were forced to raise premiums to match and insurance is no longer the 'something-for-nothing' kind of good deal it once was. People are buying less of it, in part because it's not affordable, but in part because it's just not worth it.

Thus the mandate. It's the insurance industry's last-gasp effort to squeeze a few more years, and a few more dollars, out of a non-viable business model. And even that won't be enough. At some point we'll have to come to terms with the damage that's been done in promoting the idea that patients shouldn't have to concern themselves with price-shopping health care.

I realize that this point of view doesn't resonate with most of the pro-reform liberals who see things differently. They're eager to declare the health care market defunct (without really looking at the reasons why) and use it as justification to nationalize it.