D.C. Circuit guts ObamaCare

[sophie]

At no point did the bill have popular support. Still doesn't.

J

Nobody here was claiming it did.

 

[bhsup]

When a bill is so horrible that it actually gets me to publicly endorse CommieCare as an alternative, you know it is bad. From about nine months ago...

That said, you are under the mistaken impression that I support a single-payer system. I do not. You need to re-read what I've repeatedly posted.

Anyway, I'll try to expand a bit. I do not like the government being directly involved in things it doesn't need to be involved him. Regulating things, sure, but that's about it. Right now our healthcare is a wreck, there is no denying that, but this abomination of a bill takes the worst of private health and the worst of government mandated health and mashes it all together. it's the worst possible thing possible. My God, it's actually worse than HMOs, and I wouldn't have thought that possible.

What I would have personally loved to see happen is rolling everything back to pre-73/pre-HMO existence, where traditional style health insurance was king. Start from there and work on ways to get more people insured. That isn't going to happen, though. The government is going to be involved heavily and that's a given, so the only viable solution as far as I am concerned is the government completely taking everything over. Not a single payer system, but a no payer system (well, beyond paying of general income taxes that is.)

The government telling you "You have to go out and spend your money on health insurance" is unacceptable. I am seriously considering dropping my private health insurance I get just out of spite and daring them to prosecute me for it.

I still say we should roll back to pre-HMO days and then go from there since that was the last time when our health care wasn't totally screwed.

 

[KMRblue1027]

The US heathcare system has always been broken as hell and will continue to be until a public option is put in place. Doctors and nurses have known this for decades, unfortunately without education reform as well, the slash in pay due to universal healthcare would bury already debt ridden interns and residents.

 

[onejayhawk]

Nobody here was claiming it did.

Perhaps, but the support for "a public option" has been raised several times, when it would have been more appropriate to be specific. An example would be your post.

Yeah, scrapped it and replaced it with the public option, which is what a plurality of voters actually wanted.

Since the context was already the ACA debate, that is--at best--misdirection.

More to the point, the Bill's proponents were doing the same sort of slight of hand. They still do concerning the law. It's politics as usual, but it's annoying. The correct action is to admit the mistake and try to fix things. Instead, they want the courts to read things into the law that were not written there.

The public is not the only ones that want free lunch.

J

 

[onejayhawk]

The US heathcare system has always been broken as hell and will continue to be until a public option is put in place. Doctors and nurses have known this for decades, unfortunately without education reform as well, the slash in pay due to universal healthcare would bury already debt ridden interns and residents.

Why pick the worst possible option?

The USA has the best quality of healthcare in the world. That is undisputed. The concerns are over cost and access.

J

 

[Arakhor]

The USA has the best quality of healthcare in the world. That is undisputed. The concerns are over cost and access.

Quality is utterly irrelevant if hardly anyone can afford it or access it - and if you can't access it, you have no healthcare, good or otherwise.

 

[El_Machinae]

Healthcare is a really tough service to generate good economics around. It's a lot like housing, very easy to create bubbles. At some levels of delivery, healthcare is an essential service. At other levels of income, it's treated (by the customer) as a luxury good.

So, as wealth increases, the cost of essentials decreases (essentially). This means that the amount and proportion spent on luxury goods will rise. We see the same thing in housing. People used to be satisfied with four walls and a roof, but excess wealth has flooded into housing, bidding up both the expected standards and the costs for those trying to buy minimal housing. The contractors, etc. will flood to try to provide luxury housing, because that's where all the profits are.

A LOT of medicine is very easy to ratchet up in price. A doubling in the quality of some service is easily worth ten times the price to some customers - so that's what they get. Expiring patents means that the affordable baseline slowly rises, but the demand rises faster than the baseline does due to the exponential nature of our deterioration.

BUT, it's very important to remember, that each individual demand can be satisfied. A person without polio will not need an Iron Lung or its 21st century equivalent. A person who is not blind will NOT need a walking cane, a seeing eye dog, or fancy radar bionic implant. Etc. A person without dementia will not need years of attentive hospice care, making sure they don't wander into traffic and making sure they feed themselves. etc. etc.

My signature says The only acceptable longterm outcome is an affordable cure. This is so, so true. Any condition that has an affordable cure bottoms out the medical demand for help with that condition. We live in a world where the cost of treating that condition is happy to keep ratcheting upwards, the treatments will improve and the baseline treatments will improve too. This marching upwards will continue until it doesn't. And then, whabam! it bottoms out to essentially nothing..

Where's the raging public debate today about the public option paying for Universal Iron Lung coverage? Where's the hue and cry about Death Panels denying some people access to years of misery contained within an expensive machine? It's been completely headed off at the pass. It doesn't exist.

 

[Farm Boy]

I still say we should roll back to pre-HMO days and then go from there since that was the last time when our health care wasn't totally screwed.

The sharing of public risk through things such as HMO plans is the reason I have a wife. And it's the reason I'll continue to have one, for as long as such can last. And El Mac's theory holds. They don't do classic fontans anymore, now they do better. I'm not looking forward to the day we land on the transplant lists, which let's be honest, will take a degree of luck in itself. Not all of us are fortunate enough from birth to slowly ruin our own given health. God gave us a screwed up and fickle world to work with. To the degree which we have managed to do good work in his stead and for the blessings it has wrought, I am thankful.

 

[warpus]

The government telling you "You have to go out and spend your money on health insurance" is unacceptable.

In the rest of the world we've accepted that we all belong to one society and that we need to help each other to lower healthcare costs. If we all pay into a (well designed) system, everyone's costs go down. If people to start to opt out, this system falls apart, so I'm 100% against you here brotha.

Having said that, I understand that your system is crap and can see why you'd want to opt out of that one.

Just sayin' that what you said doesn't apply to all governments. A government can say what you quoted just fine. It's perfectly acceptable unless the system sucks.

I realize you're probably talking about this with the U.S. in mind, but I think my point needs to be made.

 

[onejayhawk]

Quality is utterly irrelevant if hardly anyone can afford it or access it - and if you can't access it, you have no healthcare, good or otherwise.

Don't throw the gold ring out with the wash water.

This the sort of overstatement that gets in the way of a decent dialog. How can you --reasonably--ignore the "good" in good healthcare. One objective should be to preserve the quality, while enlarging the access and controlling the costs. Extremist rhetoric of this nature is a main reason why the ACA is such a mess.

If access is a problem, work on that. If cost is a problem, work on that. Don't fix what is not broken.

J

 

[Arakhor]

Really? Pointing out that unaffordable healthcare is no healthcare at all is considered extremist?? Forgive me for being British and all, but not being able to access affordable healthcare is very definitely 'broken' by any reasonable measure of the word.

"When I give food to the poor, they call me a saint. When I ask why they are poor, they call me a communist." ~ Hélder Câmara, Archbishop-Emeritus of Olinda e Recife

 

[El_Machinae]

In the rest of the world we've accepted that we all belong to one society and that we need to help each other to lower healthcare costs. If we all pay into a (well designed) system, everyone's costs go down. If people to start to opt out, this system falls apart, so I'm 100% against you here brotha.

Having said that, I understand that your system is crap and can see why you'd want to opt out of that one.

Just sayin' that what you said doesn't apply to all governments. A government can say what you quoted just fine. It's perfectly acceptable unless the system sucks.

I realize you're probably talking about this with the U.S. in mind, but I think my point needs to be made.

To be honest, I agree with Agentman. I think that forcing people to buy insurance (or a variant on that heuristic) is fundamentally anti-freedom and fundamentally paternalistic. The problem is, of course, is that it's so damned effective. So, in principle, I object. In practice, I like the outcome.

As a Canadian, I am 'forced' to fund our UHC system out of my taxes. But, truth be told, if I were reimbursed that money and offered the opportunity to 'buy into' our system at that price, I'd be nuts to not accept. Similar with modern Americans and Medicare, it's great value for the money. And, while I accept that it sucks that the system would degrade if there was the option to opt out, I acknowledge that it's fundamentally anti-freedom to prevent people from opting out.

 

[bhsup]

The sharing of public risk through things such as HMO plans is the reason I have a wife. And it's the reason I'll continue to have one, for as long as such can last. And El Mac's theory holds. They don't do classic fontans anymore, now they do better. I'm not looking forward to the day we land on the transplant lists, which let's be honest, will take a degree of luck in itself. Not all of us are fortunate enough from birth to slowly ruin our own given health. God gave us a screwed up and fickle world to work with. To the degree which we have managed to do good work in his stead and for the blessings it has wrought, I am thankful.

I said we should revert back to that as a starting point and build from there. I didn't mean just warp back to pre-1973 and remain static, but it would be a far better starting poing than now. That said, I realize it isn't realistic... that's why I put that quote of mine up there from some months ago. CommieCare, let's do it! *whimpers*

In the rest of the world we've accepted that we all belong to one society and that we need to help each other to lower healthcare costs. If we all pay into a (well designed) system, everyone's costs go down. If people to start to opt out, this system falls apart, so I'm 100% against you here brotha.

Once again, quoting what I said before. I think you all are just not seeing it for some reason?

When a bill is so horrible that it actually gets me to publicly endorse CommieCare as an alternative, you know it is bad. From about nine months ago...

What I would have personally loved to see happen is rolling everything back to pre-73/pre-HMO existence, where traditional style health insurance was king. Start from there and work on ways to get more people insured. That isn't going to happen, though. The government is going to be involved heavily and that's a given, so the only viable solution as far as I am concerned is the government completely taking everything over. Not a single payer system, but a no payer system (well, beyond paying of general income taxes that is.)

 

[Timsup2nothin]

Every person in any civilized country is forced to buy healthcare insurance. Taxes are collected, some would suggest by force. If you are in need of care and show up at a hospital you do get cared for. Maybe it's because doctors are altruists. Maybe it's because hospitals recognize that pushing you out the door to die on the sidewalk is bad advertising. Maybe it's because the government tells the doctors and hospitals thy have to. But for whatever reason, it happens...and it does get paid for. So whether it is through taxation/government spending or through premiums/claims healthcare insurance is in fact universal to start with.

By 'forcing' people to buy insurance it puts more people in the more efficient premium/claims model and reduces the number in the taxation/gov spending model, but it isn't like anybody is being made to do something they weren't already doing.

 

[bhsup]

My point is that if the government is going to be involved, they might as well go whole hog and completely do it. No more health insurance at all, period. You sick and need to see a doctor? Fine, call and make an appointment and go. No billing paperwork, hell no bill. You just show up, you do your thing, you leave. You don't have to fill out a form every time you want to drive down an interstate... The government just pays for the roads for everyone to use. Might as well do the same with healthcare if the federalies insist on being involved.

 

[warpus]

To be honest, I agree with Agentman. I think that forcing people to buy insurance (or a variant on that heuristic) is fundamentally anti-freedom and fundamentally paternalistic. The problem is, of course, is that it's so damned effective. So, in principle, I object. In practice, I like the outcome.

As a Canadian, I am 'forced' to fund our UHC system out of my taxes. But, truth be told, if I were reimbursed that money and offered the opportunity to 'buy into' our system at that price, I'd be nuts to not accept. Similar with modern Americans and Medicare, it's great value for the money. And, while I accept that it sucks that the system would degrade if there was the option to opt out, I acknowledge that it's fundamentally anti-freedom to prevent people from opting out.

What's more important to you, good solid universal healthcare, or an insistence that a vague notion of freedom should trump the ability of a country to set such a thing up?

I value freedom, but in this case healthcare wins out.

I think it's dangerous to ideologically state that freedom trumps all, no matter what. You've got to look at the details and decide what's more important to you then. The government mandates a whole bunch of things, that's the nature of the beast. Surely you're not against all of them? They all infringe on your freedom in one way or another.

Once again, quoting what I said before. I think you all are just not seeing it for some reason?

I did, I was just focusing on the "The government can't..." aspect of your post.

 

[Timsup2nothin]

My point is that if the government is going to be involved, they might as well go whole hog and completely do it. No more health insurance at all, period. You sick and need to see a doctor? Fine, call and make an appointment and go. No billing paperwork, hell no bill. You just show up, you do your thing, you leave. You don't have to fill out a form every time you want to drive down an interstate... The government just pays for the roads for everyone to use. Might as well do the same with healthcare if the federalies insist on being involved.

I can see that. I do want to point out that 'the federalies' don't really insist on being involved in anything...the people demand it, as a general rule.

Why in the world is the government hip deep in schools? Because people don't really want to be responsible for educating their own children...or even providing day care for them...so they demand public schools.

Why is the government hip deep in my retirement plan? Because people refused to be responsible for planning for the reality that someday they wouldn't be able to earn a living, and people who couldn't stand the thought that anyone who didn't plan could have just been alowed to starve so they insisted the government get involved.

Why is my bank run by the government even though it is supposedly a private enterprise? Because people want to be able to hand their money over a counter and know they can come and get it later without taking any responsibility for examining who they are handing it to in even the most cursory fashion.

Etc, etc, etc, etc, etc...there is absolutely nothing the 'nanny state' is involved in for any reason other than the fact that we the children demand it. When we complain about it it is almost always along the lines of 'I want my bank deregulated, but still don't want to be responsible for examining them myself' or 'I want my medical care paid for but I don't want to be taxed to pay for it' or some other impossible combination.

 

[Farm Boy]

Why in the world is the government hip deep in schools? Because people don't really want to be responsible for educating their own children...or even providing day care for them...so they demand public schools.

Now that's an interesting take on that. I think the general consensus is that specialized teachers can generally outperform multitasking and unspecialized parents, that the resources dedicated to learning tools will be greater than for the typical household, and that double-earner households have become the norm eliminating the ability of many houses to provide personal daycare much less education of any quality on top of it. Have you seen what daycare costs? Are you really intending to come off as this snide regarding social investments in the children of the middle class on down for the economic ladder? This isn't simple bread and circuses. It's a lot more important than that.

 

[El_Machinae]

What's more important to you, good solid universal healthcare, or an insistence that a vague notion of freedom should trump the ability of a country to set such a thing up?

Oh, I choose healthcare. Mainly because it's such a good deal, but I acknowledge the welfare benefit, too. I still recognises the moral dilemma. Again, cheap cures are the solution, because it solves both horns of the dilemma.

 

[Timsup2nothin]

Now that's an interesting take on that. I think the general consensus is that specialized teachers can generally outperform multitasking and unspecialized parents, that the resources dedicated to learning tools will be greater than for the typical household, and that double-earner households have become the norm eliminating the ability of many houses to provide personal daycare much less education of any quality on top of it. Have you seen what daycare costs? Are you really intending to come off as this snide regarding social investments in the children of the middle class on down for the economic ladder? This isn't simple bread and circuses. It's a lot more important than that.

No, I was actually intending to come off as 'they provide public schools because we need public schools, not because they are trying to indoctrinate our kids as part of some evil plan'...apparently that was a complete swing and miss. Sorry.