Obamacare passes muster

[Engineer61]

"The nations 100 largest employers will pay $111 billion in fines if they drop health insurance when Obamacare...er...ACA provisions are fully implemented in 2014, but it will cost them over $450 billion to provide ACA-compliant coverage."

 

The Walmart's and McDonald's ... yeah, try the Intel's and Apple's. I've been working in the top end of the semiconductor and telecomm businesses for 27 years. In all that time, the only constant has been the reduction in the quality of my medical insurance.

 

I have no doubt that it will happen...if a Company has a way to save 60% on their largest employee cost...you can bet they will do it.

 

As for doctor's going cash only...I can see it. They don't expect to be paid more than Medicare/Medicaid, and they also expect the time to payment to increase. It's already 90 days or more according to one Dr.

[AZMike]

Sorry, my last post was in reference to an earlier post: from johnponz: ""Romney says if elected he will repeal "Obamacare." Can one person do that? Doesn't he need to get the 60 votes in the senate to avoid filibuster of the repeal?"

 

 

[acco40]

Before we all debate with a bunch of rhetoric, let's get down to brass tacks on some current political issues.

 

Q1) Should pregnancy be treated as an illness?

Q2) Is access to health care a "right" or a privilege?

 

For the first question, if an illness, then prenatal care, delivery, etc. should be covered by medical insurance. So should contraceptive devices - they prevent this illness. If not an illness, don't cover prenatal care nor contraceptive devices - for both are choices folks freely make.

 

For the second question, if government laws can dictate treatment, they should be able dictate coverage. I can't walk into a store and get free food just because I'm hungry and stores are not forced to supply food to hungry folks. Why is health care so different? If, as a society, we feel health care is a right, tax folks and provide it. What is a fallacy, either way you feel about the second question, is that we have unlimited resources for health care - we don't and therefore they need to be rationed. The system now rewards health care providers for providing massive amounts, in terms of dollars, of care for a persons last six months or so of life. A huge savings would ensue if we allowed for folks to die respectfully, without extending their lives a few weeks with intrusive machines. Yes, these are tough ethical decisions but when 50% or so of our health care budget is spent on peoples last six months of life, something is amiss.

[moosetracker]

Huh??..

 

Is driving down a road a right or a priviledge?.. If a priviledge then why tax us for the upkeep of the roads??

 

Is being able to smoke a right or a priviledge?.. Well why tax smokers?

 

Is going to war a right or a priviledge??... Ummm.. Is it either???.. Well why the hell tax us for it???

 

How much are you being taxed for the right of free speech?

How much are you being taxed for the right to vote?

How much are you being taxed for equal rights in various things?

How much are you being taxed for the

[FScouter]

"Q2) Is access to health care a "right" or a privilege?"

 

Both (neither?). If you want health care, you have both the "right" and the "privilege" to buy it from the doctor. Or work out an arrangement with an insurance company whereby you pay monthly fee and they pay the doctor.

 

If you don't want to pay and want/expect someone else to pay your bill, that's what we have today - go to the emergency room for "free".

 

The reform legislation attempts to make those folks PAY something in terms of an insurance premium to get what they currently get through everyone else paying the bill.

[Callooh! Callay!1428010939]

"is access to health care a "right" or a privilege?"

 

Neither. It's a transaction. That transaction can be more voluntary or it can be more coerced.

 

Politicians' and opportunists' shell games surrounding these transactions grow ever more complex but still only serve to conceal different mixes of voluntary vs. coerced intercourse.

 

[Woapalanne]

Moosetracker asked: "Is driving down a road a right or a priviledge?.. If a priviledge then why tax us for the upkeep of the roads?? "

 

It's a privilege. And you are taxed for the upkeep of the roads only if you use those roads. (Remember the gas tax? Of course, some is skimmed off the top to pay for mass transit, but that's another matter.)

[packsaddle]

"Comprehensive health insurance is an idea whose time has come in America.

There has long been a need to assure every American financial access to high quality health care. As medical costs go up, that need grows more pressing. Now, for the first time, we have not just the need but the will to get this job done."

 

Dirty little secret: Richard Nixon (1974) was a communist.

[FScouter]

"If a priviledge then why tax us for the upkeep of the roads??"

 

You also have the privilige of fixing the potholes in front of your house any time you want.

[CalicoPenn]

A few things:

 

"Bills relating to taxes can't be filibustered and require a simple majority to pass. As the Supreme Court has labeled ObamaCare a tax, the bill to repeal it would be one too." Yeah, funny thing about that - each house of Congress makes its own rules - just because the Supreme Court said it was a tax for constitutional purposes, doesn't mean the Senate has to treat it as a tax for voting purposes. They can call it a fee and allow a fillibuster if they so choose.

 

 

"Q1) Should pregnancy be treated as an illness?" No, because it is not an illness. It is, however, a medical condition. Illness is a very narrow view of healthcare. Not all medical conditions are illnesses. A broken bone, for instance, doesn't fit into the classic view of illness, rather it's an injury. A congenital defect of the heart is not an illness. Medical care also includes wellness as well - preventive medicine.

 

"And you are taxed for the upkeep of the roads only if you use those roads. (Remember the gas tax? Of course, some is skimmed off the top to pay for mass transit, but that's another matter.)" We have a very narrow view of taxes in this country - for some reason, we've allowed folks with agendas to convince us that statements about taxes are "true" as long as we accept their definition of taxes narrowly. For instance, when the popular meme that "50% of workers don't pay taxes" is bandied about, most people accept that figure without question because they consider only one tax - the federal income tax. They fail to understand that the 50% that don't pay federal income taxes are still patying SS, Medicare, sales, gas, property, etc. tax. Until we start demanding that our politicians and pundits be more specific in their statements, we'll continue to have folks stating that only people who use the roads pay for the roads. That's just not correct - most local roads are maintained by a combination of local gas taxes (if your state allows you municipalities to collect one - Illinois allows it) and local property taxes, with some federal and state dollars tossed into the mix. If you own or rent property (if you rent, your property taxes are built into your rent) and you don't drive, you are still paying taxes that help build and maintain you local roads, and chances are that the States are using money from the "general fund" to pay for some transportation costs as well.

 

We've now had the spectre of the House of Representatives voting to repeal the act for the 31st time - that means there are now 31 repeal bills pending in the Senate that are not going to be passed. Those bills don't go away until the Senate either votes on them (and they're all being held with no floor vote) or until this session of Congress ends (next January). The GOP in the House is wasting our time - the people's time. Is that what the GOP-leaning public really wants? A circus act?

 

[Beavah]

Yah, hmmmm...

 

I confess I'm just confused by da last page or three. Most of yeh probably think that's not unusual.

 

Da issues to me don't have much to do with "right" or "privilege". The fundamental question I think is "what is common infrastructure to which we all agree to contribute?"

 

If yeh live in an urban area, then there is a lot of common infrastructure. Water and sewer service, for example. Without common water and sewer service, urban areas would collapse in disease and epidemics. Paying into the common water and sewer system is expected. Yeh may want to avoid "being required to purchase water and sewer service by the guvmint", but when yeh start dumpin' your chamberpot in the street below your apartment, your personal "freedom" to avoid purchasing sewer service is goin' to get trampled by your neighbors' desire to not step in feces on the street or be exposed to disease risk. Your neighbors can do that civilly by regulation and legal mandates and law enforcement, or they can do it just by beatin' the crap out of you or setting fire to your apartment so yeh move away. We mostly prefer da former.

 

That's where da ultra-libertarian notions fall apart, eh?

 

Now, if yeh live in a rural area, yeh might be off-grid as far as water and sewer service. Yeh have your own well, and yeh are responsible for your own septic system. Still, yeh are likely required to install and maintain an appropriate septic field (yet another "forced to buy broccoli" moment), because your neighbors expect that yeh won't contaminate the common aquifer that their well water comes from with your feces. Again, your neighbors through the government do that civilly by regulation and law enforcement, because that's preferred to showin' up with pitchforks at 2am and makin' yeh eat the feces you've been dumpin'.

 

And again, da ultra-libertarian notions fall apart. "Freedom" curtailed by da guvmint.

 

Yeh can of course live in remote areas where perhaps da population density is so low that yeh can use an outhouse or flush your toilet into da stream. That's still sort of a choice, at least until other folks want to live there too. In that case, though, yeh either have a subsistence economy or yeh are dependent for economic aid from all those manufacturing cities with their forced-to-pay-for sewage systems.

 

We see that in rural electrification, eh? There is no good business reason to send electricity, internet, or phone service to rural areas. Da capital and maintenance cost of doin' so vastly exceeds the profits which are possible. Same with roads in rural areas. So if yeh want to live in low-tax, low-service areas, yeh depend on a subsidy from the folks payin' electrical and telecommunications taxes in the cities. That's one of da reasons why rural "red" states are net recipients of federal money, eh?

 

Da question for the nation is therefore not really one of "liberty" or all that nonsense. It's just a question of what constitutes common infrastructure. Common infrastructure, whether it's sewage service or telecommunication, is somethin' that we feel is important enough that we all pay into it because we feel it's our patriotic duty as Americans. People who don't pay or try to avoid payin' we feel are cheats, or worse, and we're perfectly happy to have 'em arrested because if da police didn't handle it we'd smack 'em up side the head ourselves. Some of that common infrastructure like roads and sewer service we do as "single payer", government-run programs. Some of that common infrastructure, like electricity and telecommunications we do as regulated and tax-supported private services with perhaps government options.

 

So in health care, da question is first whether health care is common infrastructure. Is it somethin' that all or mostly all folks need? Is it somethin' where folks who exercise "liberty" to opt out put their neighbors at risk?

 

I think da answer is clearly yes, that at least some baseline health care is common infrastructure. Like not havin' sewers, lots of people not havin' health care is a genuine epidemic and disease risk for the rest of us. We've seen that in da resurgence of tuberculosis in urban areas. If my kids get resistant TB because yeh decided your kids didn't need health care, that's just like you dumpin' your feces in the street. If it isn't handled by da law and regulation, then folks are goin' to handle it more aggressively in person.

 

Similarly, just like rural electrification and roads, health care is somethin' that we also feel a patriotic duty toward. We agreed to taxes to provide electricity and telecommunications to rural Americans because we just felt those were things that all Americans should have, even if they couldn't afford the real cost themselves. In the same way, we believe it's unAmerican to turn injured people away from Emergency Rooms, and we don't like da notion that our neighbor can't take a higher-paying job because his son's accident in Boy Scouting is a "pre-existing condition" that would be excluded from his new employer's coverage.

 

So then da only real question is whether baseline health care coverage is better as a single-payer system like sewer service, or better as a highly regulated and tax-supported multi-provider system like electric or telecommunications service. That's just a policy debate, eh? It shouldn't get as heated as it is. And da proper answer to it is probably whichever mechanism is more economically efficient rather than which is ideologically preferred.

 

I'm not really sure what da answer is. I expect that the ideal is that basic, baseline coverage should be single-payer. That gets yeh all preventive medicine, acute care, pediatric care, injury treatment while yeh are a workin' (or at least job-seekin') member of society, and palliative care when yeh are retired. Beyond that, if yeh want coverage for aggressive end-of-life care, drug support for da conditions of old age and lifestyle choices, expensive treatments like joint replacements and cancer therapies and the like, then yeh need to purchase and maintain your own insurance. That insurance should be a regulated market, so that it's portable between employers without undue penalties for pre-existing conditions, and so that there's some consolidation of paperwork. Honestly, though, I'm not sure of all that, eh? I'd love there to be a lively investigation and debate between responsible adults who really know a lot more than I do in the design of such a system.

 

That, to date, has been missing.

 

Beavah

 

 

 

[moosetracker]

I agree with what you say Beavah.. That what was what I was getting at with what I was saying, but just couldn't come up with the verbal word of infrastructure.. I also don't know if this is the right way or the wrong way.. But, something has to be done.

 

If hospitals could just deny helping people at deaths door who had no way to pay.. Let them die on the streets.. And it caused no health issues, to just let them die then it wouldn't be any problem..

 

It's like the small towns who have no fire service.. Don't want to pay for the upkeep.. Expected the neighboring town to give them service for free.. Neighboring town said.. "Nope, not unless you pay us $xxx amount per year.." Person does not pay. House burns down, fire trucks come to watch the weenie roast.. People are all upset, "Save the house..!" Nope.. The will rescue a person trapped in the fire.. If your burning home is in danger of setting your neighbors home on fire who did pay his per year amount.. They will hose down the neighbors house and keep it from burning.. Your house.. Bye.. Bye..

 

How said but the town with the fire Department paid for their infrastructure in taxes the neighboring town, just wanted free service..

 

Now.. If we could just let the poor and "have the money but don't want to pay" people die off, no problem.. Unfortunately we choose to care about them, and want them not to die on the doorstep of our hospitals.. Looks bad for the hospital, looks bad for the country..

 

So we have made it mandatory that hospitals give medical care to those who require it and have no way to pay.. That has now become part of our infrastructure.. But we have not set up a way to pay for that infrastructure.. That has to be dealt with. Few states were doing it, and they had no intention of ever addressing the problem.. So due to their inactivity.. You got the Federal Government doing what they did not do..

 

Is ObamaCare good? I don't know.. I tend to see holes in it, needs some more work I think.. But, it is a start, and a start is needed, because we cannot continue to live with a mandated infrastructure which is unfairly being paid for by only those willing to buy insurance, or lucky enough to be employed in a company giving them a benefit of health insurance..

 

[johnponz]

Saying that you can repeal "Obamacare" with a simple majority in the Senate is too simplistic. The Supreme Court ruled that the mandate was a tax (if you read the opinion, it really is not clear that it is a tax-Roberts says something to the effect that it is like a tax), but the mandate is only a part of the Affordable Healthcare Act, maybe that part could be repealed with a simple majority, but to repeal the whole Act would require a filibuster proof majority.

 

Sounds like another complicated constitutional question, not one easily answered on an internet discussion board.

(This message has been edited by johnponz)

[SSScout]

There was once a bank robber (in Florida, I think)who was quoted as saying he robbed banks because "that's where the money is". May be appochryphal, but it sounds good.

 

Same thing here. In ACA, Follow the money. Despite any public moans from the insurance companies, guess what? They are now guaranteed income from the required need to sign on to health insurance. Competition lowering costs? Maybe. Big maybe.

The alternatives are/were: Stay the same, single payer, some hybrid combination.

 

Single payer? Somebody has to administer it and wow, what a gigantic government agency that would create. But then, we already have lots of them, and very successful and well overseen (?term?) too. IRS, Social Security, all open to public scrutiny when necessary. Private companies? Not so much.

 

Our duelly elected representatives (we are a republic, right?) have settled the matter for the present.

 

As has been said, the new ACA is not perfect, but it is a start in the right direction. It will be adjusted in future as the public gets used to it, I am sure.

[packsaddle]

We had three brushes with socialized medicine this summer: an advisor nearly cut his thumb off the first day of their visit (doing something stupid with a pocketknife), a student developed a serious dental problem, and another advisor slipped and broke both legs on a hike (these were really serious breaks, too, in a very remote location). They all went to the hospital or the dental clinic.

Anyone curious about how long we had to wait?

Anyone curious about the forms we had to fill out?

Anyone curious about the insurance entanglements, residency questions, etc.?

Anyone curious about how much the surgeries and multiple days in the hospital cost?

Curious?