Obamacare Going Down?

[Lemur]

People die every day. It doesn't harm the society one bit.

So the future of American healthcare would look something like this?

[rvg]

So the future of American healthcare would look something like this?

Cute. As if health service rationing is any different. Either way somebody's gonna get the short end of the stick. Might as well set this up without giving up even more of our freedom to Uncle Sam. Life isn't fair. It never has been and never will be. Obamacare isn't gonna change that, it's just shifting the stink around.

[gaelic cowboy]

Not necessarily. If the individual mandate is ruled unconstitutional, we will have a situation very similar to New Jersey, which tried to implement universal coverage without a mandate, and is in the quick and predictable process of imploding. This is a concept referred to as "adverse selection" and/or "the death spiral."

The New Jersey effort began in the late 1980s, when rising health care costs were getting the attention of business and political leaders across the country. And a big worry then, as now, was what to do about people who couldn't get insurance from a large employer. When those people tried to get coverage in the individual or small-group market, they underwent scrutiny from insurers, who were wary of taking on big medical risks. "Insurance companies make their money not by being efficient, or managing care, but by weeding out the sick and insuring only the healthy," a frustrated Jim Florio, then governor of New Jersey, said in 1992. [...]

The plan went into effect in late 1993, not long before President Bill Clinton's efforts to reform health insurance nationally started foundering. And, for a while, it looked like Florio and his advisers had done what Clinton and his advisors could not. Nobody believed New Jersey's plan would bring universal coverage to the state. But "people thought this would have a significant impact," says Bruce Siegel, who was the state health commissioner and is now president of the National Association of Public Hospitals. "They thought it would … change the situation for the uninsured."

An early assessment of the program, by researchers at Harvard and sponsored by the Robert Wood Johnson Foundation, declared the experiment a success. But, by 1996, enrollment in the regulated plans started to slide after peaking at about 186,000. By 2001, it was down to about 85,000. Not coincidentally, the mix of people left in the program changed dramatically. According to a study published in Health Affairs, the median age for enrollees jumped from 41.9 years to 48.4 years in just five years, and premiums rose by between 48 percent and 155 percent, depending on the plan.

These were the tell-tale signs of adverse-selection death spiral: An exodus of healthy people from the insurance pool, leaving behind a population of ever-sicker people whose high health costs keep driving up prices. [...]

New Jersey's experience hardly seems unusual. Kentucky, New York and Vermont all tried to reform their insurance markets without a mandate. All ended up with higher premiums, lower enrollment in insurance or some combination of the two.

Raise your hand if you think the public really has the stomach and fortitude to watch people die in the streets. Ain't gonna happen.

So the lesson is whatever you do you make sure to prevent insurance companies selecting who they will ensure.

In Ireland our government actually charges newer companies in the health insurance market and gives the money to older companies to prevent same.

[Lemur]

As if health service rationing is any different.

I don't understand this statement. Rationing occurs no matter the system, no matter the plan. The demand for healthcare is infinite, and the supply is finite. Hell, a marketplace can be viewed as a form of rationing. It's not as though any plan put forward by anyone will mean that everyone gets as much doctor time, drugs and end-of-life care as they please.

I really don't understand the use of the word "rationing" in this context.

[gaelic cowboy]

People die every day. It doesn't harm the society one bit.

There is a differ between passing on with some dignity in your own bed or in a hospital ward and government allowing people to die for want of medicine.

Cute. As if health service rationing is any different. Either way somebody's gonna get the short end of the stick. Might as well set this up without giving up even more of our freedom to Uncle Sam. Life isn't fair. It never has been and never will be. Obamacare isn't gonna change that, it's just shifting the stink around.

Life is not fair no nor is it cheap so thats why we decided that we would rather use the idea of a hospital waiting list than just say stuff ye yis are all poor anyway. Just cos it's rationed is not the same as outright denial of access, eventually you will get seen too.

Naturally people die on waiting list but then thats usually a very serious ailment to begin with and hardly treated better in the USA if your poor. In other words people here might get the short end but in the US your not even given a stick.

[rvg]

I don't understand this statement. Rationing occurs no matter the system, no matter the plan. The demand for healthcare is infinite, and the supply is finite. Hell, a marketplace can be viewed as a form of rationing. It's not as though any plan put forward by anyone will mean that everyone gets as much doctor time, drugs and end-of-life care as they please.

I really don't understand the use of the word "rationing" in this context.

What I mean is that we're replacing a giant douche with a turd sandwich and trumpeting it as some sort of achievement and breakthrough. It is not. In fact, all it achieves in the process is taking away one of our few precious liberties.

There is a differ between passing on with some dignity in your own bed or in a hospital ward and government allowing people to die for want of medicine.

So, the people who will die while on the waiting list will somehow die in a more dignified manner?

Life is not fair no nor is it cheap so thats why we decided that we would rather use the idea of a hospital waiting list than just say stuff ye yis are all poor anyway. Just cos it's rationed is not the same as outright denial of access, eventually you will get seen too.

Who is "we"?

Naturally people die on waiting list but then thats usually a very serious ailment to begin with and hardly treated better in the USA if your poor. In other words people here might get the short end but in the US your not even given a stick.

I said it before and I'll say it again. As of this moment, if a hobo stumbles into the ER, he will receive treatment. This is the way things are right now.

[gaelic cowboy]

In fact, all it achieves in the process is taking away one of our few precious liberties.

What one would that be then?? really I am intrigued here do you think healthcare is actually an attack on your liberty.

[rvg]

What one would that be then?? really I am intrigued here do you think healthcare is actually an attack on your liberty.

Forcing me to buy health insurance is an attack on my liberty.

[Lemur]

Well, to be accurate, since you have already stated that you have employer-funded health insurance, the mandate would actually force the freeloaders you and I currently pay for to buy health insurance. Slight difference.

[rvg]

Well, to be accurate, since you have already stated that you have employer-funded health insurance, the mandate would actually force the freeloaders you and I currently pay for to buy health insurance. Slight difference.

And that is what bothers me. I don't want the feds forcing people to buy stuff even if it means more money for me. More than money is at stake here.

[gaelic cowboy]

So, the people who will die while on the waiting list will somehow die in a more dignified manner?

Yes generally its called palliative care

Who is "we"?

The Irish people who elected governments to provide us with what we call the HSE Health Servcie Executive.

I said it before and I'll say it again. As of this moment, if a hobo stumbles into the ER, he will receive treatment. This is the way things are right now.

Because then your rewarding someone with no income and ignoring the far larger coping classes in the middle.

[gaelic cowboy]

Forcing me to buy health insurance is an attack on my liberty.

Do you own a car cos you need insurance to drive, forcing people to buy same is no differ but I dont see mass movements against it.

[Lemur]

As of this moment, if a hobo stumbles into the ER, he will receive treatment. This is the way things are right now.

File that contention under "not necessarily." See a term called hospital dumping. (Shock, surprise, when we force hospitals into servicing people who cannot possibly pay, they try to get rid of them! Sometimes they succeed! In other news, water wet, fire hot.)

[rvg]

Yes

How?

The Irish people who elected governments to provide us with what we call the HSE Health Servcie Executive.

Good for you! This isn't Ireland though.

Because then your rewarding someone with no income and ignoring the far larger coping classes in the middle.

Like I said, life's a bitch.

File that contention under "not necessarily." See a term called hospital dumping. (Shock, surprise, when we force hospitals into servicing people who cannot possibly pay, they try to get rid of them! Sometimes they succeed! In other news, water wet, fire hot.)

What? An organization trying to evade the law??!!!! Have you called CNN yet?

[gaelic cowboy]

Just cos your on a waiting list RVG does not mean you are not seen by medical staff.

[rvg]

Just cos your on a waiting list RVG does not mean you are not seen by medical staff.

Oh? So waiting list means that people actually get treated while on it. Then why is it called a waiting list and not, say, "Treatment List"?

Do you own a car cos you need insurance to drive, forcing people to buy same is no differ but I dont see mass movements against it.

This has been addressed before: I am not required to buy car insurance if I choose not to drive. The only way to get out of health insurance mandate is to choose not to live. A slightly more drastic choice imho.

[Lemur]

What? An organization trying to evade the law??!!!! Have you called CNN yet?

Right, of course, but it points to a perverse set of incentives that we create by not having comprehensive coverage. If hospitals had a reasonable expectation of getting some sort of payment for treating the indigent, they would not have to dump.

[rvg]

Right, of course, but it points to a perverse set of incentives that we create by not having comprehensive coverage. If hospitals had a reasonable expectation of getting some sort of payment for treating the indigent, they would not have to dump.

True, but if forcing hospitals to spend money they otherwise wouldn't is wrong, then how can forcing the individuals to do the same be okay?

[Strike For The South]

People die every day. It doesn't harm the society one bit.

This is patently false.

[Ironside]

Forcing me to buy health insurance is an attack on my liberty.

In your opinion, does paying taxes (reducing your financial freedom) on police, schools etc increase the total freedom in society or not?

[rvg]

In your opinion, does paying taxes (reducing your financial freedom) on police, schools etc increase the total freedom in society or not?

I'm not sure what you mean by total freedom in society. As for paying taxes, you'll either be paying to a government or to a local crime lord. Government is a better option imho.

[Lemur]

you'll either be paying to a government or to a local crime lord.

Lord Humungus 2012!

[rvg]

Lord Humungus 2012!

'xactly.

[Lemur]

A good perspective on the constitutionality question:

I really wish people would stop acting so darn sure about whether the mandate is constitutional or no. You know what? I’m not sure. I think it seems reasonable, but I don’t profess to know it as truth. But you know what’s crazy? The Supreme Court justices can’t agree! That means the people who are actually in charge don’t even “know” if it’s constutitional. We have to wait until we can poll them and get a consensus before we “know”. And you know what will happen right after that? Half the country will start crowing about how they were “right” and treat the other half as if they were crazy.

Am I the only one who thinks that’s insane? If it’s 5-4 then even though 44% of the Supreme Court justices felt the opposite, they are “wrong”. And so is everyone who agreed.

Can we all develop a little humility here?

[drone]

In all fairness, the Lord Humungus would probably repeal the "Stand Your Ground" laws.

[Ironside]

I'm not sure what you mean by total freedom in society. As for paying taxes, you'll either be paying to a government or to a local crime lord. Government is a better option imho.

To use an Indian example. If the goverment is taking half your money for a year to get 4 casteless into a normal life, then the total freedom would increase, even if the goverment is taking money from you. You got a decreased number of options and they got an increased number of options.

And here I was thinking schools as my primary point. Not many crime lords running those, even if there probably is few. Fire department?

And the local crime lord usually weren't the maintainer of public order, even before the police got organised.

[rvg]

To use an Indian example. If the goverment is taking half your money for a year to get 4 casteless into a normal life, then the total freedom would increase...

Ahh, I see what you mean by total freedom. Yeah, about that.... screw the casteless. Not my problem.

As far as paying for public schools, police and fire, I do not oppose them. In fact, when a millage increase vote comes around (for police, schools or fire departments) I usually vote in favor.

[Tuuvi]

Who voted for it? Assuming you are over 18, you did.

Membership in the UN means accepting that the human rights trumps any of your own laws. Any country is of course free to leave the UN, and since the US is a democracy, you are of course free to start a "leave the UN"-party.

IIRC, the constitution of the US was put to the popular vote in order to be ratified. Before the declaration of human rights, or any other document for that matter, can be held in higher authority than the constitution it needs to put to the popular vote as well, in my opinion.

[Papewaio]

OT the UN is a place for countries to air differences, to unite on objectives.

However the UN has no ability to force the US or any other UN permanent security council member to do anything. UN cannot enforce any UN laws on any of these as the ability to veto any security decision trumps any enforcement action. Just look at Syria and the fact that the UN is blocked from action by two such vetoes: Russia and China.

Essentially the only time that a nation will get spanked by the UN is when all five agree or one of the big five abstains from attending in protest. For instance Russia abstained from attending the UN allowing the four security perms to fight North Korea... This was back when the five were US, UK, USSR, France and "Taiwan".

=][=
As for liberty I prefer the postive variant which espouses eglatarian values and strengthening social fabric. To me it is about creating stronger, better societies. Negative liberty is focused too much on tooth and claw gene ideas where it is survival of the rugged individualist. Romantic but it misses the point that with all bar a few exceptions we live in a society, and those societies have worked well on all the cultural memes of repriocity. Money is a tangible form of a social reciprocity. It is an idea that only works in groups.

[Xiahou]

So this is an issue of federal power rather than about the individual freedom vs general government interference? It's fine for Massachuetts to mandate you to buy brocoli but not for the federal government? (That's not a rhetorical question.)

Well, that states all have their constitutions as well- so the brocoli mandate would vary by state.

The demand for healthcare is infinite, and the supply is finite.

You keep saying that- but that doesn't mean its true. Sure, the demand for pretty much anything is infinite if the cost is free. In our current system healthcare costs are far divorced from most consumers of healthcare service, but there's no reason to think that demand wouldn't slacken if people better felt the costs.

Point is, 'the demand for healthcare is infinite' is hardly a known fact.