D.C. Circuit guts ObamaCare

[Farm Boy]

Oh don't you throw that filthy nasty title at us Tim. We hates it. But yes, gives us more power you should. Raises taxes we would. Stand in the way of progress through mechanization we would. Yesss.

 

[Timsup2nothin]

It's very hard to increase people's health habits at the government level. I'm not so sure that Americans are that much less healthy than other developed nations, though it's not a checkmark in the way people handle the society.

Other than the fact I would have said impossible I have to agree with this. Prohibition doesn't work. "Sin taxes" are just like outright prohibition in that if you raise them high enough to have any effect at all the effect that they have is to create a black market. Government funded marketing campaigns are notorious for being grossly ineffective if not outright counterproductive.

 

[hobbsyoyo]

Cigarette taxes are a favorite sin tax in the US these days, probably even more so than alcohol sales.

Having said that, I do like revenue being provided for education from things like cigarettes. However, at a certain point it crosses into just plain old targeting of certain groups. For cigarettes taxes, this group is mostly poor individuals. Plus there is no guarantee that taxes that are stipulated to be for education will be used to actually fund schools instead of other projects or ad buys that let everyone know how bad cigarettes are. I don't think those types of ads have much purpose any more. Once, they absolutely did have a purpose and helped, but now I think the money would be better spend on cigarette-cessation treatment.

Even then, I don't think taxing a group to pay for a small segment of that to get treatment is all that wise in and of itself.


And since we're talking Obamacare and nicotine, I think it's disgusting that the law allows for one group (smokers) to be singled out for higher premiums (up to 50% higher) when they're forced to buy coverage. Then, as Farm Boy convinced me, it really does become a 'freedom' issue in that the government shouldn't be in the business of telling people how to live through these kinds of penalties. Particularly when they are doing it by singling out only one group that makes bad life decisions (smokers) but not all the others (alcoholics, drug users, obese people, etc).

 

[Timsup2nothin]

Sin taxes raise revenue, which can then be debated about (is it applied correctly? is it a fairly distributed burden?) but they are totally ineffective at actually stopping the behavior they are purported to be intended to stop. Note that the two favorites...cigarettes and alcohol...have been taxed for decades and are still thriving.

 

[hobbsyoyo]

And I guess that part of the problem is that we've normalized sin taxes on alcohol and tobacco and even conservatives by and large don't see this as a 'freedoms' issue. But when someone tries to do the same to sugary sodas, then you have a massive freakout.

 

[Crackerbox]

It's very hard to increase people's health habits at the government level. I'm not so sure that Americans are that much less healthy than other developed nations, though it's not a checkmark in the way people handle the society.

That's apples and oranges. What difference does it make if Americans are no different that the French in terms of health today? What matters is are Americans less healthy than Americans have been in their history?

Of course we are. Let's be honest. We have a whole slew of health problems because we're FAT as a nation. We even have soldiers who can't do a basic fitness test in basic training. We have kids who play computer games and practically live indoors and don't get enough sunshine (for Vitamin D production).

We went from the common aspect of growing our own food to going to grocery stores and from that point on disconnected ourselves from our role as stewards and being personally responsible for what we put in our bodies.

Say tobacco. In history, only the extremely wealthy could smoke whenever they felt like it. Only a bootlegger could drink whenever they wanted to. The results of that specialization meant that we could smoke it up, drink like a fish, consume red meat whenever we chose and not wait until butchering time. Fail to eat adequate amounts of vegetables because we can buy prepared meals loaded with sugar and salt.

Not only that, but it was hard work to raise our own food. We stopped that, sat at a desk, and ended up growing more and more lethargic and wondering why we got depressed.

The end result was postmodern Americans who decline more and more and ends up costing vast amounts of money for high blood pressure issues alone. Type 2 Diabetes is a largely avoidable issue. Irritable Bowel Syndrome is the result of internalizing stress coupled with poor diet until finally health issues result.

You want to fix American healthcare, then personal responsibility is the beginning of that journey, for no doctor can repair or persuade you to alter your actions. They especially can't do that in the 9 minutes they have under managed care. Cutting their income is not the way to pay for being grossly obese.

Link to video.

Why do we have a problem with STDs? Americans are out of control, don't have safe sex...even today, then on top of it, are too ashamed to take a simple STD test to get healthy and prevent the spread of infection. Why is smoking cigarettes bad? Would smoking a pack a year harm you? I doubt it, but instead the perpetual alteration of oxygen levels, combined with inhaling a toxic cloud, occluding oxygen exchange by permanentely damaging the alveoli of the lungs, then results in a whole slew of other issues as it affects the mitochondria all throughout your body.

How in the world will just giving people healthcare fix that? They have to be linked in some way with manageable goals or else drive the costs skyhigh by that lack of discipline. Do Americans realize that a federally mandated program for healthcare MUST by necessity result in the government telling you what you must do to have that healthcare? Wait and see.

The only way to control costs is not merely to cut the income of physicians and to ration healthcare (since we don't have adequate staffing) but to enforce strict guidelines on access to healthcare based upon the patients actually doing something positive themselves....for they are the ones largely self-destructive who are driving up the costs.

The most likely cause for the rise of young people with knee replacement is...you guessed it...they're FAT. All of those pounds grinding away at their joints over time results in ruining their health and driving up the costs of healthcare. This should be very rare due to a genetic condition, or accidents that occur largely in war, not a routine matter.

 

[Timsup2nothin]

And I guess that part of the problem is that we've normalized sin taxes on alcohol and tobacco and even conservatives by and large don't see this as a 'freedoms' issue. But when someone tries to do the same to sugary sodas, then you have a massive freakout.

The alcohol and tobacco industries are built around the sin taxes. Their entire structure accounts for them in every aspect of their business. Instituting a sin tax on sugary sodas puts huge corporations that have never had to deal with it in a very awkward position.

It also involves whole swarms of people and business entities in the collection of the new tax who have no experience with such activities. A liquor store is required to make sure that what they are selling has passed through the proper taxation channels. Every owner/manager/long term employee has at least a general knowledge of the topic. Sin tax the sugary sodas and next thing you know an inspector is buying his morning coffee at 7/11 and casually notes improper labeling on a bottle of Dr Pepper that might be bootlegged...and the clerk is expected to know how to handle the situation.

Institution of a brand new sin tax is basically far more complex than the mayor of New York gave any evidence that he could comprehend.

 

[hobbsyoyo]

@crackerbox - We are not less healthy now than we were in the past.

Obesity is a relatively new phenomenon for the US on this scale. But we don't get TB or polio, chronic alcoholism and heroin abuse aren't terribly enormous problems like they were in the past and so on. On the whole obesity is far preferable to how terribly sickly people used to be. Its a curse of plenty, which I'd take over starvation and polio any day.

@Tim - I certainly hadn't thought of it that way. If only people would make more rational arguments like that instead of the typical refrain of 'but muh freedums!'.

 

[Timsup2nothin]

You want to fix American healthcare, then personal responsibility is the beginning of that journey, for no doctor can repair or persuade you to alter your actions.

In the car business we had a saying; "you can't make a living selling cars to people who need them."

For a professed health care professional to do all this yapping about how Americans make themselves unhealthy too fast for struggling doctors to keep up with, or the pharmaceutical industry drives them to the doctor for a pill, or whatever line of claptrap you are going to spew next, is the height of being disingenuous.

The pretense that "health is an asset that can be purchased from your doctor" is the foundation of the American medical industry, and marketing that premise has been item one on their agenda for generations. "See your doctor so you can eat like a pig," is just one of many promises the medical industry has made, subtly or directly.

You wouldn't make a living if you had to rely on genuinely sick people.

 

[Timsup2nothin]

@Tim - I certainly hadn't thought of it that way. If only people would make more rational arguments like that instead of the typical refrain of 'but muh freedums!'.

Unfortunately, while you appreciate them rational arguments are a pretty narrow sell. "But muh freedums!" is much easier to pitch to a wide market, so ultimately more effective. Try making the same rational argument to ten people chosen at random, operating from a commitment to convincing them to stop the enactment of the tax. You will find that in at least nine of the ten cases your pitch will end with "Screw it. So, what about yer freedums there pal?"

 

[El_Machinae]

That's apples and oranges. What difference does it make if Americans are no different that the French in terms of health today? What matters is are Americans less healthy than Americans have been in their history?

Well, if you look waaaaay up, I was talking about why the American system for healthcare is so much more expensive than the French system. There are a few explanatory variables. I was under the impression that 'decreased fitness levels' was one.

 

[Timsup2nothin]

Well, if you look waaaaay up, I was talking about why the American system for healthcare is so much more expensive than the French system. There are a few explanatory variables. I was under the impression that 'decreased fitness levels' was one.

I've seen little evidence that Crack looks at the current posts with any depth. Asking him to look far up thread is waaaaaay out of reasonable.

 

[Crackerbox]

Whatever.

The only person who can improve my health is me. I have to chose to actively work at improving the ways I make myself strong and fit. I have to reduce all of the undisciplined ways I harm my body and mind.

Yes, I will get sick, not only because I live in community with others, but because of random chance. That means then I can engage with a physician and in 9 minutes get some advice and some medication to get better. It is entirely nonsensical to expect for a body of insurance companies, pharmaceutical companies, medical centers, and government to fix our failings.

That's where healthcare begins by logic and pragmatism. All else is folly.

 

[Timsup2nothin]

That's where healthcare begins by logic and pragmatism. All else is folly.

Or perhaps just good business practices for medical professionals.

You can't make a living selling medicine to just people who need it.

 

[JollyRoger]

I'm sure getting rid of health insurance and government subsidies will allow a cash-based, pay-as-you-go medical services industry to flourish.

 

[Bootstoots]

I've seen little evidence that Crack looks at the current posts with any depth. Asking him to look far up thread is waaaaaay out of reasonable.

Moderator Action: This is going a bit too far. Please don't attack individual posters.

 

[FriendlyFire]

You want to fix American healthcare, then personal responsibility is the beginning of that journey, for no doctor can repair or persuade you to alter your actions.

Or you could end massive farm subsidies which is distorting the food market ?
and legalize meth, cheap affordable, safe Meth.

 

[Crackerbox]

Since there certainly are going to be issues with the federal subsidies (86% of people who signed up are getting them, which is not sustainable) possibly being an issue with the Supreme Court, then I've got a better idea.

Why not pay people subsidies based upon managing goals. A patient has high blood pressure. It's largely due to weight. She's also prone to a higher amount of stress and has poor coping skills. Her anxiety coupled with being obese results in at least some portion of her high BP. Why not offer an initial federal subsidy but couple this with a measurable improvement through an exercise program? The more she meets exercise goals and gets her BMI more in line of "normal", then the more money is given in terms of a federal subsidy.

American corporations flirted with this idea before downsizing. Existing gyms membership were gifted to employees while other corporations actually built them.

It then results in less expensive health insurance as their health improves and lower costs for the public. If enough people do this, it would significantly reduce obesity, health issues associated with it, and give the patient a better self-image. Do that, and the patient's anxiety begins to drop.

The main problem of health insurance is how much to charge to young people who are relatively healthy. They may not have the endurance or the leaness of prior generations, but by comparison to older Americans, barring accidents, then most young people wouldn't be much of a drain on the system. But if the amount is low, then this will NEVER pay enough to take care of those who are older. The birth rate is too low, and the Millenials are not transitioning into middle class jobs such that they can be independent.

This is why other than well baby care and early child health care, the main costs are far later. In fact, the most costs are often in the last months of life. Since we obviously can't condone euthanasia, then physicians and the medical team have tried to explain to patients and their families that sometimes it's not really going to improve their quality of life to hold on against hope with such poor expectations. One of those issues is at what point to disconnect life support. There's a real problem in my area in which those who are really poor, decide to maintain life support, holding out against hope, that Grandma will pull out of the coma. It's extremely cruel for there is almost nil chance of her doing so.

I can see doing this with someone very young though. What we need is better monitoring of brain activity, for we've had a few come back and say they were aware of what was going on, but were akin to the Locked-In syndrome and so helpless during that period. We need more work on that.

 

[onejayhawk]

I'm sure getting rid of health insurance and government subsidies will allow a cash-based, pay-as-you-go medical services industry to flourish.

Sure. Why not?

J

 

[JollyRoger]

Medical school loans won't get paid off in an unsubsidized market.