D.C. Circuit guts ObamaCare

[El_Machinae]

Oh, no question. But the demented 92 year old who would have died of heart, kidney, lung, liver, or other failure years before if they hadn't been gotten past it would never have been demented at all. So effectively the increased frequency of dementia is a function of making the other body parts last longer than the brain, which one could theorize was originally designed to be the longest lasting part.

Your theory is broadly true. Except with dementia. It's an actual disease, it's not just 'old person syndrome ramped up', like what I think you're theorizing. Yes, dementia will increase in frequency because of fewer strokes, but as a disease it will ramp up costs.

Think of it like a subset of elders who have their left hand whither away. There's no doubt that 'muscle weakness' happens when you're older. But the whithering away of one hand is an actual disease, one that drastically increases costs.

Now, we could bring down dementia cost by giving strokes to people in their sixties, but that's not going to happen. The onset of the disease 'dementia' will happen in a subset of elders.

 

[Timsup2nothin]

Your theory is broadly true. Except with dementia. It's an actual disease, it's not just 'old person syndrome ramped up', like what I think you're theorizing. Yes, dementia will increase in frequency because of fewer strokes, but as a disease it will ramp up costs.

Think of it like a subset of elders who have their left hand whither away. There's no doubt that 'muscle weakness' happens when you're older. But the whithering away of one hand is an actual disease, one that drastically increases costs.

Now, we could bring down dementia cost by giving strokes to people in their sixties, but that's not going to happen. The onset of the disease 'dementia' will happen in a subset of elders.

We are in basic agreement. That 'subset of elders' is getting larger, because the percentage of people surviving to be elders is growing. That rapidly growing number of people suffering from dementia, which before a diagnostic label was hung on it was simply called 'getting old and senile' produces a huge economic load.

While just allowing people to die before they reach typical onset age of dementia may be practical, it is certainly not practicable. So we need to marshal the resources necessary to deal with the predictable growth in numbers and costs in the short term. Ideally we should also marshal the resources to find a preventive solution so that we do not have to bear the costs over the long term.

I see the ACA as a good effort towards the marshaling of resources that might get us through the short term. Despite obvious disagreement from Republicans I think you generally agree there as well.

Where we disagree is in the approach to the long term issues. Where I see a miserable person who has gone well past any opportunity to be productive, the medical community sees a cash cow whose life needs to be extended as much as possible at any cost that anyone can be made to bear. Our current generation of elderly and those approaching elderliness have seen so many 'medical miracles' that they are willing to hunker down in their misery and hope for a miracle, going along with any misery extender that can be suggested as long as some way to pay for it can be found.

In my opinion the only solution is to alter the mindset of the medical community and the citizenry at large, to something close to what Illram suggested; that the objective is to extend the healthy, productive lifespan as much as possible. Stop diverting 90% of our efforts and resources into extending misery and costs.

 

[JollyRoger]

The extrapolation of that to the general case is:

1) We have a problem

2) Congress passes law to fix problem

3) Since by design conditions are improved by the law, refusal to acceptance the law is a penalty, thus people are effectively 'coerced' to accept it.

4) Supreme court strikes down 'coercive' law and reinstates problem.

And we thought we had governmental gridlock before.

Kennedy's point was that if to read the statute in the way the Virginian "victims" want it to be read means that the Feds would be unconstitutionally coercing the states, then the Court could read the statue in a way that would not make it unconstitutional (the government's way).

 

[Timsup2nothin]

Kennedy's point was that if to read the statute in the way the Virginian "victims" want it to be read means that the Feds would be unconstitutionally coercing the states, then the Court could read the statue in a way that would not make it unconstitutional (the government's way).

I was extrapolating from Sotomayer's comment, and probably misreading that, but it sounded good.

 

[Crackerbox]

Dementia is not a disease. It is an outcome of multiple causes, some of which are diseases, but can be related to severe diet issues, the consequences of alcoholism, or aging, or a complete mystery, or a combination of factors.

There's a tendency to demonize the elderly and the aging Baby Boomers to be the root cause of the exponential rise of healthcare. Well since they own so much wealth due to savings and investment, that results in keeping the economy afloat. The reason they can pay for their healthcare more than a younger person is that thrift and hard work earlier. The reason that there was any money at all for healthcare was that they put tax money into it, plus money into private insurance. The reason there are physicians and medical staff are that they did this too.

To think of only something like Alzheimer's as causing dementia and therefore the reason for an explosion of healthcare (like assisted living) discounts the fact that some younger people get it. Some people with Down's Syndrome will end up with it. That Alzheimer's isn't the only reason people get dementia. Etc.

Boy there's a lot of hostile generalities in this topic. It's why I took a breather on it, not due to irritation, but to save me from irritation.

Obamacare is here to stay unless somehow the Supreme Court tosses it out for one reason or the other like federal subsidies. Instead of the pointless task of eliminating it, we should be finding ways to work within the system to improve healthcare for all. Certainly from a Christian perspective or a non-Christian perspective of altruism, if we mean what we say, then healthcare is in keeping with that principle. Just as we have Habitat for Humanity to help provide homes to the indigent who will work alongside of those assisting them, likewise we should expect that the indigent should do preventative maintenance such that their health improves daily versus a decline of health as a consequence of Western living.

Despite the accusation to the contrary, I doubt many folks who dislike it, want to unravel it. Don't assume that it's going to be better without staff though to practically service those new to healthcare.

If I write you a check, but I have no money to draw from in my checking account, then what use is that paper check? Obamacare is just like that as we really don't have the money to pay for it, and only by some screwy federal subsidies can it work. How is that sustainable?

 

[JollyRoger]

Screwy Federal subsidies have been keeping farmers, bankers, and oilmen afloat for decades.

 

[Crackerbox]

Screwy Federal subsidies have been keeping farmers, bankers, and oilmen afloat for decades.

Hmmm, do you actually know any family farmers at all? With that attitude, no wonder family farmers are a dying breed in America.

How very lame to associate the two. Nowhere did I say that federal subsidies were a bad thing in of themselves. In a very real sense, the home mortgage deduction is a form of subsidy. These generalized leaps you're making...why not be more specific and discuss the federal subsidies of Obamacare instead of vague accusations to all of these which have nothing to do with the topic?

As federal subsidies are currently written for Obamacare, it's a debacle and could result in disruptions. Do you think Republicans or Conservatives or whatever demonized group you're thinking of, that they clap their hands with evil glee to see the house burn down?

How supremely weird.

 

[Timsup2nothin]

Trying to reawaken the topic with another spew of dated talking points? Followed up with some good old fashioned name calling. That always works. But why?

 

[Crackerbox]

Trying to reawaken the topic with another spew of dated talking points? Followed up with some good old fashioned name calling. That always works. But why?

I noticed that you provided nothing substantial to the discussion. You failed to quote where I used dated talking points or made any name calling. You failed to address any of the points I did discuss and refute them.

In short your post was entirely a waste of time. Why bother? It's not fruitful. It's not enlightening.

 

[Timsup2nothin]

I noticed that you provided nothing substantial to the discussion. You failed to quote where I used dated talking points or made any name calling. You failed to address any of the points I did discuss and refute them.

In short your post was entirely a waste of time. Why bother? It's not fruitful. It's not enlightening.

But at least it was short.

Spoiler :

The points you 'discussed' have been beaten to death for years, or are just so out of touch with the discussion that they would allow no refuting until they were reined in somewhere closer to reality.

For example, trying to debate with you about this mythical "tendency to demonize the elderly and aging baby boomers" would require that there actually be such a tendency somewhere other than in your disjointed posts. Accounting for the rising numbers of elderly people isn't 'demonizing', it's dealing with the realities of demographics.

Your take on dementia is only notable in that you mention that some younger people get it. Frankly, does that have anything at all to do with the discussion at hand? Some whales beach themselves. There, I have matched your point with one of similar relevance.

Then we follow you back into the conservative talking point screed "Obamacare just can't work!!!!!" Apparently yes it can. There. Refuted with similar diligence to that which you applied to crafting your argument.

Your turn...I assume you will now post some links. Or start throwing 'lame' and 'weird' and disapproval of my attitude...unless that's reserved for JR.

 

[El_Machinae]

Dementia is not a disease. It is an outcome of multiple causes, some of which are diseases, but can be related to severe diet issues, the consequences of alcoholism, or aging, or a complete mystery, or a combination of factors.

Granted. It's tough creating a short-form for this. Dementia is not a specific disease. But, there are many diseases that cause dementia. The main point of using 'dementia' as a specific label is that it distinguishes from the general decline of cognition that can occur with aging.

There's no hostility here towards the elderly. You'll find me the exact opposite. The point I bring is the dementia will cause a level of difficulty in affording health care provision. The Business as Usual system will have the cost that provision rise faster-than-inflation, and then discovered efficiencies can lower that rate-of-increase.

People will then argue about whose parents get appropriate levels of care.

It's discovered cures that will drop those costs though. Discovered cures can cause the 'cost' of each cured dementia to drop well-below inflation (akin to the current cost of polio, and our raging debate about whether Iron Lung insurance should be nationalized). It's the actual solution (not just 'make do fix') for this component of the economic burden.

 

[JollyRoger]

I said farms in general, which includes family farms along with corporate farms. Subsidies are a common way to hold the ship together. I do not see why health insurance should be any different than a host of other categories.

 

[Timsup2nothin]

I said farms in general, which includes family farms along with corporate farms. Subsidies are a common way to hold the ship together. I do not see why health insurance should be any different than a host of other categories.

Because OBAMA!!!!!

Figured I would beat the crowd.

 

[Crackerbox]

But at least it was short.

Spoiler :

The points you 'discussed' have been beaten to death for years, or are just so out of touch with the discussion that they would allow no refuting until they were reined in somewhere closer to reality.

For example, trying to debate with you about this mythical "tendency to demonize the elderly and aging baby boomers" would require that there actually be such a tendency somewhere other than in your disjointed posts. Accounting for the rising numbers of elderly people isn't 'demonizing', it's dealing with the realities of demographics.

Your take on dementia is only notable in that you mention that some younger people get it. Frankly, does that have anything at all to do with the discussion at hand? Some whales beach themselves. There, I have matched your point with one of similar relevance.

Then we follow you back into the conservative talking point screed "Obamacare just can't work!!!!!" Apparently yes it can. There. Refuted with similar diligence to that which you applied to crafting your argument.

Your turn...I assume you will now post some links. Or start throwing 'lame' and 'weird' and disapproval of my attitude...unless that's reserved for JR.

How extremely lame. I am not speaking from compiling conservative talking points and vomiting them in the forum. I haven't read any talking points, and frankly am only conservative about some things! You make shocking assumptions about someone you know nothing about! I doubt any conservative Republican would claim me.

In a discussion of healthcare, tossing around words like dementia as a disease is a huge disservice to the readers. Many people have no idea that someone can be very young but a severe alcoholic and get Weirnecke-Korsakoff syndrone which leads to alcoholic encephalopathy and dementia as a condition.

We have loads of Down Syndrome kids who mature into adults (due to improvements in healthcare) and so many of them end up with one form of dementia or another. That might happen at 40.

People here are tossing around ideas that the Baby Boomers are a drag on healthcare resources and so they can't wait until they croak.

There's so many nutty posts containing an utter lack of discipline that is then masking as a discussion while demonizing the perceived Other. How the heck are you ever going to get better healthcare if you just bad mouth groups that are not young college age liberals?

What's the point of trying to have a discussion when people post that way?

 

[Timsup2nothin]

People here are tossing around ideas that the Baby Boomers are a drag on healthcare resources and so they can't wait until they croak.

Provide a quote demonstrating this is actually happening, lest your continued whining about it permanently brands you as someone who doesn't even read the thread they are pretending to participate in.

It also may behoove you to read this.

 

[El_Machinae]

Subsidies are a great way of easing economic disruption or of preventing an outcome that the Market would choose. They risk preventing a perfectly efficiently optimal outcome, but there are many instances where you don't want the perfectly efficient outcome.

 

[Crackerbox]

As a millennial in the North America labour market I'm incensed at anything (such as having medical care or being non-bankrupt) that increases the labour supply of my peers as the baby boomers retire and/or die off.

The elderly are mind bogglingly expensive because they forget how to say no to a doctor, especially when the doctor says "it's covered by insurance" as if that was the same as "it's FREEEEEEEE!!!!"

My point about bracing for the storm is that there really isn't time to expect vast medical breakthroughs to reduce per capita costs as rapidly as demographics are going to drive them up, especially given that the 'never say no since it is FREEEEE culture is so thoroughly engrained. What we are doing is setting up the healthcare system in such a way that it (hopefully) won't break everything over the next twenty years. Hopefully over that interval the culture will change, because people who pass through the storm as adult earners will be far less likely to fall into the same mindset, compared to the current elderly who never experienced it as a problem, just as a benefit.

Dementia is a ten dollar word for outliving your mental capacity, in my opinion. It's growing frequency is an inevitable consequence of extending lifespan. But that's just me.

I think prolonging the healthy productive human lifespan as long as possible is a worthy public policy goal.

Me too. When are we going to start working on that?

For decades we have been primarily focused on extending the misery span of the no longer healthy and the expense span of the no longer productive...and we show no signs that we intend to change.

Provide a quote demonstrating this is actually happening, lest your continued whining about it permanently brands you as someone who doesn't even read the thread they are pretending to participate in.

It also may behoove you to read this.

These statements all show a clear bias against aging Americans who unlike young people paid into the system and yet you all want to limit their ability to take back out the money they invested into the system.

What's next, firing squads?

Guess what Sherlock? Dementia is not about overliving your mental capacity, but it's about any number of diverse pathology states that happen to everyone. Is Cancer about overliving our usefulness too? What a novel concept! We can cut costs to the bone by a cheap bullet for anyone who has a major illness who's outlived their mental capacity as Americans. You have schizophrenia. Bang! You have major depression. Bang! You have autism. Bang!

Nuts!

 

[illram]

I'm saying I want people to live longer. How in the world is that one step below firing squads?

 

[JollyRoger]

You probably want them to serve out their lives in FEMA Camps.

 

[Crackerbox]

I'm saying I want people to live longer. How in the world is that one step below firing squads?

Well I certainly thought you were piling on with the other drivel about the baby boomers and the elderly outliving their usefulness and making the costs high.

Well you folks are going to pay money into healthcare over forty years and maybe longer. As such, put yourself in their shoes for crying out loud. Someday you'll be the ones that will be using up a larger percentage of dollars for healthcare, but dang it, you paid into it.

It's as nutty as saying these folks don't deserve the Social Security that they invested with the Federal government.