Good news or bad? You decide.

[Chris Brady]

A blog on the Obama health reforms, he brings up some interesting details.  Mainly about how the insurance companies should spend most of the money they get from customers, like minimum 80%.

http://www.forbes.com/sites/rickungar/2011/12/02/the-bomb-buried-in-obamacare-explodes-today-halleluja/

Bearing in mind, this is one side of the equation.

[RubySlippers]

Ohhhhhh, lets see they make 15-20% profit on sick people and they will still make money so the issue is?

There is a simple solution to this innovate and come up with new ways to deliver care cheaper.

[meikle]

Ohhhhhh, lets see they make 15-20% profit

That's certainly not what the article says.

It says they have to spend 80-85% of their income from customers on the health care that those customers are paying for.  The other 15-20% is not 'profit', it's 'what we have left to pay our employees with'.

[Iniquitous]

What this is saying is that when an insurance company sells a policy to someone they have to use 80% of the premium that the customer pays towards the customer’s health care costs (which is how it should be) instead of using that money for marketing, overhead (costs they have to spend in order to stay in business - pay for employees, utilities, rent, insurance for their own employees, etc) or profit for their own pockets. This means they have to learn how to keep their businesses solvent without shortchanging those they sold policies to.

If I am understanding correctly, this is the first step towards ending the practice of selling someone an insurance policy and then denying them coverage right at the moment the customer needs it most on some bullshit reason.

I can see both sides here - insurance companies are taking money from people on the promise that they will pay when the customer needs to see a doctor/needs a procedure and they should be held to that promise without having to be forced into doing so. At the same time, they have to be able to stay in business in order to fulfill that promise. Sticky situation.

[RubySlippers]

That's certainly not what the article says.

It says they have to spend 80-85% of their income from customers on the health care that those customers are paying for.  The other 15-20% is not 'profit', it's 'what we have left to pay our employees with'.

Lets see they have a CEO, Board of Directors and the like they are employees so get a salary usually quite good so the issue is again?

And there is nothing that says they cannot offer other options and make money on those I would think alternative medicine, foreign medical care insurance and the like could be used for extra profit as long as not tied to the official insurance package. Just get creative.

For me the 15-20% is to run the program, pay the people running it and other costs seems to me adequete.

[Iniquitous]

You are not understanding Ruby.

Trying to run a business (salaries, insurance, rents, utilities, office supplies, equipment, marketing, IT, etc) would no doubt come up to be a lot more than the 15-20% that is left after they pay what they owe for their customers. And that isn’t even getting into what is left to be considered “profit” for the company. Just because you see the 15-20% being “left over” it is not profit. It is what they have left to pay their bills.

An easier way of looking at this is:

Say I make 1,600 a month. Now, the total of all my bills that I HAVE to pay each month is 1,675. I am now in the red - I am not bringing in enough money to cover what I have to pay out each month. I either have to demand more from my employer for my services or I start losing things I need and I am most certainly not making a profit. The only way I make a profit is if I bring in more than 1,675 a month.

It is the same way for businesses. They have to bring in more money each month than they have to pay out. And if they want to actually make a profit? Then they need to make a LOT more than what they have to pay out.

[RubySlippers]

They just need to innovate its a free market, they can do that. In Switzerland companies cannot make a profit on the basic package of care just enough to cover the costs of care and to operate. But they can extend profit to things added to this basic plan say Mr. Shultze and his family want a plan offering private rooms and alternative medicine they can. In fact the company could offer this and keep half the profits if they can do so and offer the care added in.

And I get it they have to pay the lights and salaries and for other things well good they have that 15-20% left over to administer these costs they might have to cut out bonuses, some perks, find ways to cut costs to administer the plan or something but that is the new law.

The companies will not go broke and have to stop working at health care will they, just won't have profits that is over the operational costs unless they find it some other way. I'm not stupid I get it, I don't see the issue are you and the article saying that this will force these companies out of business?

[consortium11]

I'd need to study everything in more depth but it seems to me a couple of points immediately leap out:

1) Premiums and excesses aren't the only method an insurance company gains a profit. Even with this change in their methodology I see nothing that indicates that any profit they make from a premium (i.e. I take the premium in, spend 80% on medical care and then invest the rest) would also have to be spent the same way. It may lead to a tightening of belts but the companies will probably still exist.

2) Is this change individual or collective i.e. do 80% of all premiums have to be spent on medical care or do 80% of my premiums have to be spent on my medical care or I get a rebate?

3) Likewise, is it year on year or over a wider period? Do my premiums "stack"?

I do see it probably leading to a tightening of underwriting criteria... but that's been a trend in the entire insurance industry across the globe for the last few years.

Also to point out the Swiss example is pretty different. No, the companies can't make profits on the basic packages that are mandated by the government but they can make huge profits on the "top up" packages without any lines in the sand relating to what has to be spent on medical care.

[Iniquitous]

There is every chance it could force the companies out of business.

While some things can be cut to save money on operating costs there are things that cannot be cut. Like base pay - they have to pay the federal minimum wage. They have to have insurance to run their business. And then they are dependent on the costs set by other companies (electric, water, office supplies, IT, janitorial, etc).

Yes, they can charge more for certain additions to the policies. They can also charge more for their services (which in the end hurts the consumer).

As for them being in business without making profit? Who starts a business with the intention of NOT making a profit? Making a profit is the very base reason for opening a business! Sorry, I would not open a business to bust my butt and deal with the stress that comes with running a business if I wasn’t going to make a profit on said business. Not too mention, if I am not making a profit, how the hell am I living?? The profit is the owner’s pay check. So you are saying the owner of the company shouldn’t get paid?

And for clarification, I am not saying I am against this nor am I saying I am for it. I am pointing out that I can see the insurance companies’ side in all this.

[Jude]

In order to start a business in the first place you have to take out loans.  If you expand, you have to take out loans.  A quick list of the things businesses pay for:

- Permits
- Membership in organizations (Chambers of Commerce, for example)
- Interest on loans and/or returns for investors
- Employee benefits, compensation, insurance, and pay
- Taxes
- Website expenses
- Maintaining customer records
- Actually providing their core service (paying for the procedures, facilitating that, talking to the medical profession) *
- R&D (they have to learn about new treatments and decide what to cover and what not to)
- Physical upkeep of property/HQ
- Legal staff
- HR for their employees

I mean, none of that event takes profit into account.  Only the *'d item would count towards the 85%.  Assuming they keep 5% as profits (which is pretty lean for a business), a 10% overhead is extremely rare and hard to come by for any business.

[RubySlippers]

There is not much that can be done the law is the law, they will have to adapt and find a way to make a go of it. But one idea is to set premiums to cover the costs of doing business so in this case if they were charging for a plan $300 a month they could raise it to $400 and that would generate $15-20 more dollars a month as an example. It is a strict percentage so the math is simple and this would be legal.

I would think in the long run this could stabilize costs but premiums would go up, that was expected if I am right about the core debate on this.

[Iniquitous]

People are already having a hard time having enough money to pay for insurance and you suggest raising the cost? Do you pay for your own insurance by chance?

I can tell you this. For me to get insurance from my job - just covering ME - it is $150 a month. This is something I NEED because I am diabetic and NEED to be under the care of a doctor plus take medications every single day of my life. And guess what. I can’t afford it. I am one of the uninsured in this country. I bust my butt anywhere from 40 to 70 hours a week and I cannot afford health insurance.

So the idea that they can ‘just’ raise the cost of their policies is not a valid one.

[Chris Brady]

For the record, I cannot comment on this.  I am Canadian, so our medical care system is quite different.  However, I was and still am curious to see what you guys (Of those of you who are American) have to say on this.

Please continue, and know that I am very much interested in what's going on.

[Serephino]

I don't think they can raise premiums, which I believe is what this was supposed to do.  If they do, then they probably wouldn't be spending the 80% on actual health care.  They can only charge what it's going to cost them to pay your medical expenses, plus 20% extra. 

I would guess that the 80% applies to the average the company pays out a year for everyone.  After all, an average healthy young person doesn't go to the doctor very often, so they wouldn't be able to charge hardly anything.  Although, you'd be surprised at how expensive a tiny little kidney stone can be...

[RubySlippers]

People are already having a hard time having enough money to pay for insurance and you suggest raising the cost? Do you pay for your own insurance by chance?

I can tell you this. For me to get insurance from my job - just covering ME - it is $150 a month. This is something I NEED because I am diabetic and NEED to be under the care of a doctor plus take medications every single day of my life. And guess what. I can’t afford it. I am one of the uninsured in this country. I bust my butt anywhere from 40 to 70 hours a week and I cannot afford health insurance.

So the idea that they can ‘just’ raise the cost of their policies is not a valid one.

I'm uninsured due to cost and a pre-existing condition like you so the idea is not pleasant. But since the whys and wherefores are regulatory the first area to look at is including "necessary administrative costs" to the patiant side of the care in the 80-85% that might help somewhat. I'm not sure what the 80-85% covers under the current rules.

I just pointed out raising premiums is likely one option they have but in most states they would have to allow it under the insurance oversight each state has, there I'm not to optimistic of containment.

[Iniquitous]

As of right now, that part of the bill says that the 80% to 85% is to pay for medical costs only. The article stated that insurance companies were trying to get it allowed for them to say that employees selling the policies to people was part of the 80% to 85% - and the Department of Health and Human Services shot it down (and I agree with the author of the article, they should have). The only thing the 80% to 85% needs to cover IS the medical costs covering what the customer needs. The companies should not be using that money to put commercials on tv, run websites, pay their employees, pay their loans, or anything that is overhead to keep the company running.

[Caela]

This is the trap in the Bill. Like someone else said, most companies cannot run on a simple 10% overhead (allowing for a very lean 5% profit margin) which means you'll likely see a couple of things happening. 1) Major layoffs from insurance companies trying to cut costs, always fun in an already down economy. 2) Insurance companies just saying "F*** it all", declaring bankruptcy and going out of business while they are still ahead and ALL of their employess thus being fired.

In the end this is why a lot of people with private insurance can kiss it goodbye. The politicians said they wouldn't take it away from you and force you onto a single payer plan, if you like your insurance you can keep it...if they can manage to stay in business to provide it.

[Callie Del Noire]

This is the trap in the Bill. Like someone else said, most companies cannot run on a simple 10% overhead (allowing for a very lean 5% profit margin) which means you'll likely see a couple of things happening. 1) Major layoffs from insurance companies trying to cut costs, always fun in an already down economy. 2) Insurance companies just saying "F*** it all", declaring bankruptcy and going out of business while they are still ahead and ALL of their employess thus being fired.

In the end this is why a lot of people with private insurance can kiss it goodbye. The politicians said they wouldn't take it away from you and force you onto a single payer plan, if you like your insurance you can keep it...if they can manage to stay in business to provide it.

I foresee more processing facilities being outsourced. Along with claim processing, accounting, payroll and anything else that can be done more cheaply overseas. But hey, thats the cost of business.. and the execs who authorize it will most likely get bonuses for complying.

[Vekseid]

It isn't 10% overhead. When you're taking money in trust for some purpose, the entirety of that amount is not typically intended to be 'revenue'. Medicare doesn't operate on a 3% overhead because it is the model of efficiency - Taiwan operates on 1% - but because Medicare's purpose is to collect money and expense the vast majority of it directly. It doesn't, itself, buy a whole lot to operate. It needs a few people, and a few materials, but this isn't a hot dog stand where it has to actually have an inventory of things to sell, to buy materials to manufacture things with, etc. It's taking money in trust for some purpose. In Europe, there are companies that do play by these rules, and they do just fine. The author is rather skeptical of their ability to move down from their current 30+% overhead ratings, which in one industry I worked in, would have gotten the owners arrested for fraud.

Of course, they wouldn't have been able to survive with these obscene margins if they didn't have the monopolies they do. And this is far from the only thing wrong with the US health care system, but I don't think many people are going to weep for them.

[Crazy]

I will.  Destroying our insurance industry is the single most damaging blow the socialists could inflict upon this country.  In America we enjoy the best healthcare in the world, by lightyears, and people from all other countries (yes, even Europe) are pouring into the United States for the most up-to-date treatment.  A century ago,  the wealthy might travel by steam power to see a specialist in Paris or Vienna, but today it is Johns Hopkins or Vanderbilt.

This is because our powerful free market has attracted the brightest doctors in the world,  and there is great incentive to research and invent the very best techniques money can buy.  Whatever their overhead,  insurance companies compete for your business - naturally regulating the cost and the services offered.  Once they've gone out of business,  it will be nigh impossible to restart the industry,  and the costs and benefits of medicine will be in the hands of incompetent bureaucrats.

I cannot believe this article in Forbes has the writer cackling with glee as the unlikelyhood of their survival looms near.  Already, he states,  they are seeking other investments.  This is bad news for the healthcare sector,  as Medicare's wasteful spending,  easy fraud,  and outright denial of service demonstrates.

The bomb in Obamacare is the stipulation that anyone who does not purchase $2100 in annual health insurance goes to jail.  Over my dead body.

[Iniquitous]

The bomb in Obamacare is the stipulation that anyone who does not purchase $2100 in annual health insurance goes to jail.  Over my dead body.

I do believe that part was shot down and there will be no jail time - though don't quote me. It's too early for me to remember for sure and I do not have enough time before work to actually research to see if my hazy memory is correct.

[Pumpkin Seeds]

We do enjoy amazing advances in medicine within the borders of the United States.  Marvelous are the technological measures we can take and the skill of our surgeons.  The research in this country is top notch along with the procedures that can be done.  This does not equate, necessarily, to better healthcare overall though.  A heart transplant is a marvelous affair that brings together some of the brightest minds of medicine and involves amazing skill.  Cheaper and better for the patient though to never need the transplant.  Rare trauma aside, most people suffer not from a problem with their very genetics but from their lifestyle.  People flood into this country from other areas in order to receive this stellar treatment, not for the grandness of our healthcare system.  Our system is poor our capabilities great, there is a big difference.

[Zakharra]

I do believe that part was shot down and there will be no jail time - though don't quote me. It's too early for me to remember for sure and I do not have enough time before work to actually research to see if my hazy memory is correct.

No. That has been both shot down and upheld by several courts. It's going to the Supreme Court now and will be examined in this coming year to see if it is constitutional for the US government to make it's citizens  pay, one way or another, for health care. Either you  buy it yourself, or you will be fined for not having it.  That, I believe, is the issue the SC is going to look at.

[RubySlippers]

I will.  Destroying our insurance industry is the single most damaging blow the socialists could inflict upon this country.  In America we enjoy the best healthcare in the world, by lightyears, and people from all other countries (yes, even Europe) are pouring into the United States for the most up-to-date treatment.  A century ago,  the wealthy might travel by steam power to see a specialist in Paris or Vienna, but today it is Johns Hopkins or Vanderbilt.

This is because our powerful free market has attracted the brightest doctors in the world,  and there is great incentive to research and invent the very best techniques money can buy.  Whatever their overhead,  insurance companies compete for your business - naturally regulating the cost and the services offered.  Once they've gone out of business,  it will be nigh impossible to restart the industry,  and the costs and benefits of medicine will be in the hands of incompetent bureaucrats.

I cannot believe this article in Forbes has the writer cackling with glee as the unlikelyhood of their survival looms near.  Already, he states,  they are seeking other investments.  This is bad news for the healthcare sector,  as Medicare's wasteful spending,  easy fraud,  and outright denial of service demonstrates.

The bomb in Obamacare is the stipulation that anyone who does not purchase $2100 in annual health insurance goes to jail.  Over my dead body.

Unless your poor or middle class and still might go bankrupt over the health care bills, do you deny this is a concern for many people? May I ask people from EU nations and Canada do people there go bankrupt over medical debts or if your a low income person you can't get care for say diabetes or other conditions?

And oddly the ID issue rears its ugly head to access health care and government program care you need an ID that is acceptable, what if you can't get one and therefore don't get into Medicaid when it goes off as an income only benefit. Its assured to be at least the poverty line as a cut-off regardless of other factors.

Back to this issue do you want this law repealed or not or just fixed, say the companies could add basic costs to the health care delivery say filing paperwork, deciding what treatements work best at the least cost, cost saving innovations into that end. I feel that if they end up saving 8% of the routine costs of a patiants care and the result is they are not healthy or the condition managed they should get that money as profit in that case. That is how you get companies to do more, innovate the system and alow them fair added profits IMHO but they are not doing that sadly.

[Chris Brady]

I will.  Destroying our insurance industry is the single most damaging blow the socialists could inflict upon this country.  In America we enjoy the best healthcare in the world, by lightyears, and people from all other countries (yes, even Europe) are pouring into the United States for the most up-to-date treatment.  A century ago,  the wealthy might travel by steam power to see a specialist in Paris or Vienna, but today it is Johns Hopkins or Vanderbilt.

I'm going to have to take exception to this.

Actually, no.  You don't.  You have the highest paid healthcare professionals, but most other 1st and 2nd world countries actually have better service and/or equivalently trained doctors and nurses.  Anyone who tells you that America has the best, is trying to sell you insurance so you won't see the truth.

[Callie Del Noire]

This is because our powerful free market has attracted the brightest doctors in the world,  and there is great incentive to research and invent the very best techniques money can buy.  Whatever their overhead,  insurance companies compete for your business - naturally regulating the cost and the services offered.  Once they've gone out of business,  it will be nigh impossible to restart the industry,  and the costs and benefits of medicine will be in the hands of incompetent bureaucrats.

I cannot believe this article in Forbes has the writer cackling with glee as the unlikelyhood of their survival looms near.  Already, he states,  they are seeking other investments.  This is bad news for the healthcare sector,  as Medicare's wasteful spending,  easy fraud,  and outright denial of service demonstrates.

The bomb in Obamacare is the stipulation that anyone who does not purchase $2100 in annual health insurance goes to jail.  Over my dead body.

funny.. so you're saying that my 400/year Tricare Prime policy is going to get me sent to Jail? And my old coworkers still in the service who pay NOTHING for their healthcare are going to join me?

No offense but don't drink the kool-aid dude. Not everything the rivals of Obamacare say is true. I got leery of 'factual reporting' when the 'death panels' were being trotted out.

Take news from EITHER side of the line with more than a dash of salt.

[TheGlyphstone]

funny.. so you're saying that my 400/year Tricare Prime policy is going to get me sent to Jail? And my old coworkers still in the service who pay NOTHING for their healthcare are going to join me?

No offense but don't drink the kool-aid dude. Not everything the rivals of Obamacare say is true. I got leery of 'factual reporting' when the 'death panels' were being trotted out.

Take news from EITHER side of the line with more than a dash of salt.

This is why I tend to stay out of debates like this, because I don't like to commit myself to an issue without knowing the facts, and I simply can't find any source I consider reliable for the 'facts'. Social medicine advocates champion places like Australia, Britain, and Canada as evidence that socialized health care works and is great. Social medicine detractors hold up the exact same countries as examples of why it's a horrible idea. Who do I trust? I don't know, and can't be certain.

[Callie Del Noire]

This is why I tend to stay out of debates like this, because I don't like to commit myself to an issue without knowing the facts, and I simply can't find any source I consider reliable for the 'facts'. Social medicine advocates champion places like Australia, Britain, and Canada as evidence that socialized health care works and is great. Social medicine detractors hold up the exact same countries as examples of why it's a horrible idea. Who do I trust? I don't know, and can't be certain.

I get that.. I remember what problems the introduction of HMOs into the mix in the 90s was like. My buddy's mom suddenly got excluded from his new policy for 'pre-existing' conditions.  I confess I find it easier to trouble shoot a high gain high output aircraft radar system than follow the rules and regs of getting my own 'pre-existing' condition taken care of.

[Crazy]

I'm going to have to take exception to this.

Actually, no.  You don't.  You have the highest paid healthcare professionals, but most other 1st and 2nd world countries actually have better service and/or equivalently trained doctors and nurses.  Anyone who tells you that America has the best, is trying to sell you insurance so you won't see the truth.

You'll forgive my American bias, but when I talk to people who have travelled to the U.S. to receive healthcare they invariably complain about waiting periods in their home country, usually six to eight months.  They are happy to have the opportunity to spend whatever it costs for lifesaving procedures, particularly when they were unlikely to survive the waiting period.  I fear that socialized medicine in America will leave them and us with nowhere left to run.

No. That has been both shot down and upheld by several courts. It's going to the Supreme Court now and will be examined in this coming year to see if it is constitutional for the US government to make it's citizens  pay, one way or another, for health care. Either you  buy it yourself, or you will be fined for not having it.  That, I believe, is the issue the SC is going to look at.

This is the crux of the issue at hand.  When you buy insurance,  you gamble that you will need expensive procedures that outway the costs of your premiums.  When companies sell you insurance,  they gamble that they will be able to recuperate the expenses through the power of investment.  Allowing people to purchase insurance with preexisting conditions is like opening a casino where everyone wins,  thus the need for an individual mandate.

funny.. so you're saying that my 400/year Tricare Prime policy is going to get me sent to Jail? And my old coworkers still in the service who pay NOTHING for their healthcare are going to join me?

No offense but don't drink the kool-aid dude. Not everything the rivals of Obamacare say is true. I got leery of 'factual reporting' when the 'death panels' were being trotted out.

Take news from EITHER side of the line with more than a dash of salt.

No, you and your armed forces colleagues will continue to enjoy your benefits, as will public sector employees and elected officials.  The private sector will continue to shoulder the burden of your government benefits.  This will dramatically reduce the costs associated with hiring a public sector employee,  increasing the size and scope of government.

No offense taken,  but how am I being likened to an adherent of a suicide pact?  The idea of death panels being 'trotted out' is a very rational fear that a government bureaucrat will decide which procedures will be covered and which will not.  The fact that this healthcare package only applies to people aged 20-60 and is being paid for through cuts to medicare is in essence 'trying to kill my grandmother'.  The rhetoric is used to stress the importance of this issue,  which I don't feel that proponents of Obamacare fully grasp.

Unless your poor or middle class and still might go bankrupt over the health care bills, do you deny this is a concern for many people? May I ask people from EU nations and Canada do people there go bankrupt over medical debts or if your a low income person you can't get care for say diabetes or other conditions?

And oddly the ID issue rears its ugly head to access health care and government program care you need an ID that is acceptable, what if you can't get one and therefore don't get into Medicaid when it goes off as an income only benefit. Its assured to be at least the poverty line as a cut-off regardless of other factors.

Back to this issue do you want this law repealed or not or just fixed, say the companies could add basic costs to the health care delivery say filing paperwork, deciding what treatments work best at the least cost, cost saving innovations into that end. I feel that if they end up saving 8% of the routine costs of a patients care and the result is they are not healthy or the condition managed they should get that money as profit in that case. That is how you get companies to do more, innovate the system and allow them fair added profits IMHO but they are not doing that sadly.

As it stands,  a person with a life-threatening illness and no insurance or assets will receive the care they need.  They also receive special protections as hospital bills cannot produce asset seizure or wage garnishment the same way other liabilities can.  It can wreck your credit,  but losing the ability to borrow money does not put you on the street or force you into poverty.  For people in need,  there are many philanthropic organizations that help people get expensive operations or basic healthcare.  Neighborhood churches make that a large part of their missionary outreach,  and is a favorite charity among anonymous donors.

As for requiring legitimate identification,  it will be even easier for unscrupulous people to defraud the system,  as illegal immigrants often have valid identification from sanctuary states.  Already they come from all over the world to benefit from our topnotch healthcare services,  imagine how much more when it is 'free'.  This is to say nothing of hypochondriacs who overutilise the system as it stands.

I would like to see this law repealed.  No good will come of it,  and the damage done has been a terrible price, already.  I don't see how a pencil pusher from Washington could help a profit driven industry to cut costs without denying us the best possible treatment, or allowing more people access to it will help drive down the costs for paying customers.  What I do see is an internal threat to my American way of life.

There is something to be said for the value of preventive medicine over curative measures,  but what are they going to do, force me to go to the doctor for regular checkups? Doctors who graduated top of their class,  and are on call 24/7, you want to hold them to an acceptable profit ratio?  How do you expect to keep research and development dedicated to medicine?  What is going to happen to lesser countries when America needs more doctors?  Is my smoking and drinking and having unprotected sex a waste of taxpayer dollars?  Are they going to have more say in my dietary choices?   

That is never going to happen.  Only, instead of simply not doing business with an insurance company,  and trusting the free market to regulate itself,  I'm going to have to go to guns or butter with the government, who would love nothing more than to suck more blood from free enterprise, put the unemployed in labor camps,  and then just write us off at retirement.

[Callie Del Noire]

No, you and your armed forces colleagues will continue to enjoy your benefits, as will public sector employees and elected officials.  The private sector will continue to shoulder the burden of your government benefits.  This will dramatically reduce the costs associated with hiring a public sector employee,  increasing the size and scope of government.

No offense taken,  but how am I being likened to an adherent of a suicide pact?  The idea of death panels being 'trotted out' is a very rational fear that a government bureaucrat will decide which procedures will be covered and which will not.  The fact that this healthcare package only applies to people aged 20-60 and is being paid for through cuts to medicare is in essence 'trying to kill my grandmother'.  The rhetoric is used to stress the importance of this issue,  which I don't feel that proponents of Obamacare fully grasp.

Wow! That was pretty pointed.

Okay, how is the fear of a public offical deciding treatment different from a for profit HMO exec doing the same thing with an eye towards the bottom line? I watched friends lose out on medical programs because they worked in the Naval Nuke program. No history of any problems but because they worked around nuclear reactors.

I think that we need less partisan and DEFINITELY less industry angling for their bottom line.  The problem is people in BOTH parties are now party members and not leaders and statesmen.

[Zakharra]

This is the crux of the issue at hand.  When you buy insurance,  you gamble that you will need expensive procedures that outway the costs of your premiums.  When companies sell you insurance,  they gamble that they will be able to recuperate the expenses through the power of investment.  Allowing people to purchase insurance with preexisting conditions is like opening a casino where everyone wins,  thus the need for an individual mandate.

The problem though is that you HAVE to pay one way or another. Either by buying health insurance or by paying a fine. You cannot just say  'screw it' and do without. You're being forced to buy it, just by being an American citizen.

There are people who can buy any care they need. They don;t need health insurance, yet this bill will force them to buy it or pay a fine for not doing so. WHY should we be forced to buy health care if we do not want it?

[Serephino]

Either way you get a pencil pusher.  You either get one from Washington, or one from a fancy office building deciding whether or not the treatment you need is worth the cost.  There have been unfortunate people who paid that premium their whole lives without needing much, but then they get really sick and need it, and the insurance company decides the treatment is too expensive.

Then there were the lifetime limits.  There is no limit to how much you pay them however.  You could sign up for a $125/month policy fresh out of college, and get cancer in your 60's.  Do you have any idea how expensive cancer is to treat?  My mom still owes several hundred thousand dollars for my dad's treatment, and he died 11 years ago...

Okay, so say your lifetime limit is 1 million.  Guess how long it takes to go through that?  Probably not very long.  Once you hit that limit, they don't care how sick you are, they drop you, and you won't be able to get coverage from anyone else. 

I have a permanent minor disability because of this country's 'wonderful' health care system.  I broke my arm in gym class when I was 14.  The HMO we had at the time required permission from my PCP to go to the ER if it wasn't a life threatening situation.  Well, a broken arm won't kill you, it just hurts like hell. 

The problem came when we found out my PCP was still listed as the doctor that had moved somewhere else weeks before that.  The paperwork to change it hadn't gone through yet.  We had to track him down after office hours.  I broke my arm at around 3:30pm.  I got to the ER about 8:00 pm.  That's a long time to sit in your living room with a broken arm, let me tell you.  During that time my bones tried to fix themselves.  I have what's called a bone spur that connects the two bones in my forearm.  You know how you can stick your arms out and rotate them so that your palms face upward?  My left arm doesn't do that anymore because of that spur, and I can't lift more than 15lbs.  It's fixable, but not medically necessary, so I'll have this the rest of my life. 

Then there was my gallstone.  Also not life threatening, so the surgeon wouldn't operate unless I coughed up $1300.  For about 5 months I lived in almost constant pain on a diet of grilled chicken and vegetables because that was all I could keep down.  I looked for charities, talked to several surgeons, anything I could think of.  I had that stone until someone was dumb enough to give me enough credit.  Then I ended up declaring bankruptcy, which kills your credit, and your credit is everything in this country.  You can't even rent an apartment or get a cell phone without good credit.     

[RubySlippers]

The problem though is that you HAVE to pay one way or another. Either by buying health insurance or by paying a fine. You cannot just say  'screw it' and do without. You're being forced to buy it, just by being an American citizen.

There are people who can buy any care they need. They don;t need health insurance, yet this bill will force them to buy it or pay a fine for not doing so. WHY should we be forced to buy health care if we do not want it?

Because for a universal coverage system to keep costs down for insurers for adverse risk they must enroll everyone healthy and young and the sickly into the system. As for the law the Supreme Court is going to hear the case and will decide on the standing of the law. If they nix the mandate there are other options such as penalizing people when they opt to get insurance or penailizing their employers that amount for covering you. Say for every year not insured you meed to pay a 10% higher premium with grace periods and the like and that would not require a law. So if you opted out and later ACME hired you after two years THEY would have to pay 20% more to cover you and that by law would be only payable by them. That might encourage people that could afford insurance to get covered if it means employers having to pay more or not hire this person over the other parties applying. [My example likely the penalties would be lower but the idea would be the same.]

[Vekseid]

I will.  Destroying our insurance industry is the single most damaging blow the socialists could inflict upon this country.  In America we enjoy the best healthcare in the world, by lightyears,

This is such a blatant lie as to be laughable. The default measure of health care quality is to measure life expectancy. We're tied with Cuba. Go USA.

Longtime members of this forum and friends of members of this forum are dead due to raw medical incompetence in this country, including the woman in my signature, who would be alive today had she only had a slightly more attentive doctor mere weeks earlier. Another woman died from a punctured lung...during a knee surgery.

Forcing the poor into ER is flat-out ridiculous. One member had to wait until an infection became an emergency, so she spent five days in ICU because she could not afford antibiotics. Another could not go to the doctor for her headaches. Rather than spend several hundred dollars on preventative care, we're happy to spend a quarter of a million for her to suffer through chemo for years.

Norway solved its MSRA problem. Here it's still a terror.

and people from all other countries (yes, even Europe) are pouring into the United States for the most up-to-date treatment.  A century ago,  the wealthy might travel by steam power to see a specialist in Paris or Vienna, but today it is Johns Hopkins or Vanderbilt.

And yet for the not so wealthy, 'medical tourism' is about going the other direction. When I lacked insurance, the Mayo was one of the few institutions that would treat me, yes. They wanted $3,000 just for the evaluation. For one of the most routine surgeries in the world. For that, I could fly to Prague, meet some Elliquiy members, get treated, and fly back.

The excellence of the Mayo and Hopkins has less to do with the magic of the talent they hire and more to do with the fact that they have developed better incentives for doctors to actually treat patients.

This is because our powerful free market has attracted the brightest doctors in the world,  and there is great incentive to research and invent the very best techniques money can buy.  Whatever their overhead,  insurance companies compete for your business - naturally regulating the cost and the services offered.  Once they've gone out of business,  it will be nigh impossible to restart the industry,  and the costs and benefits of medicine will be in the hands of incompetent bureaucrats.

Insurance companies don't compete for business in many states. Exempt from antitrust laws, they are happy to establish monopolies and engage in blatant price fixing without recourse, while providing said same incompetent bureaucrats in the form of rescission workers.

I cannot believe this article in Forbes has the writer cackling with glee as the unlikelyhood of their survival looms near.  Already, he states,  they are seeking other investments.  This is bad news for the healthcare sector,  as Medicare's wasteful spending,  easy fraud,  and outright denial of service demonstrates.

Let me guess, you were shouting 'Death Panels!' right alongside the rest when it was proposed to take care of the main offender of said wasteful spending.

The bomb in Obamacare is the stipulation that anyone who does not purchase $2100 in annual health insurance goes to jail.  Over my dead body.

That's a bridge that will be burned when it happens.

You'll forgive my American bias, but when I talk to people who have travelled to the U.S. to receive healthcare they invariably complain about waiting periods in their home country, usually six to eight months.  They are happy to have the opportunity to spend whatever it costs for lifesaving procedures, particularly when they were unlikely to survive the waiting period.  I fear that socialized medicine in America will leave them and us with nowhere left to run.

This is usually for very specific problems in said health care system. This isn't true of Japan, for example. "We need to schedule a surgery... how does next Tuesday look?"

Japan has other problems (getting a second opinion can be seen as insulting to the original doctor and is generally Not Done), but that's cultural.

This is the crux of the issue at hand.  When you buy insurance,  you gamble that you will need expensive procedures that outway the costs of your premiums.  When companies sell you insurance,  they gamble that they will be able to recuperate the expenses through the power of investment.  Allowing people to purchase insurance with preexisting conditions is like opening a casino where everyone wins,  thus the need for an individual mandate.

No, when you buy health insurance, you are taking advantage of said provider's ability to dictate prices. The larger the insurer, the more powerful their ability to dictate.

To say nothing of the fact that, as a self employed person with conditions on my record, it would cost me six thousand dollars a month to buy insurance. And I'd still have to pay for my surgery out of pocket. That isn't free market competition.

No, you and your armed forces colleagues will continue to enjoy your benefits, as will public sector employees and elected officials.  The private sector will continue to shoulder the burden of your government benefits.  This will dramatically reduce the costs associated with hiring a public sector employee,  increasing the size and scope of government.

This is a non sequitur. Two, actually. It neither follows that public employee costs will reduce because of a collapse of private insurers, nor does it follow that reduced employee costs would cause a larger government.

No offense taken,  but how am I being likened to an adherent of a suicide pact?  The idea of death panels being 'trotted out' is a very rational fear that a government bureaucrat will decide which procedures will be covered and which will not.  The fact that this healthcare package only applies to people aged 20-60 and is being paid for through cuts to medicare is in essence 'trying to kill my grandmother'.  The rhetoric is used to stress the importance of this issue,  which I don't feel that proponents of Obamacare fully grasp.

"Death panels" was trotted out to giving older people actual end of life care, rather than wasting 60% of our health care spending in making them suffer for six more months. Their lifespan would be increased by a far greater amount if they had better care before 65. It was originally a Republican proposal, but because Obama tried it, that makes it worthy of attack.

Of course, people such as yourself blatantly overlook the fact that private health insurers essentially are barriers to care in our current system, often denying critically needed treatments.

As it stands,  a person with a life-threatening illness and no insurance or assets will receive the care they need.  They also receive special protections as hospital bills cannot produce asset seizure or wage garnishment the same way other liabilities can.  It can wreck your credit,  but losing the ability to borrow money does not put you on the street or force you into poverty.  For people in need,  there are many philanthropic organizations that help people get expensive operations or basic healthcare.  Neighborhood churches make that a large part of their missionary outreach,  and is a favorite charity among anonymous donors.

And yet, the prime cause of bankruptcies in the United States is what?

And how many of them had insurance?

Half a percent of the voting population loses their insurance each year. That sort of bullshit is only going to go on for so long before the fraud gets tossed on its head.

As for requiring legitimate identification,  it will be even easier for unscrupulous people to defraud the system,  as illegal immigrants often have valid identification from sanctuary states.  Already they come from all over the world to benefit from our topnotch healthcare services,  imagine how much more when it is 'free'.  This is to say nothing of hypochondriacs who overutilise the system as it stands.

Nonpayers already do place that burden on our system. Go to a medical forum and you will see doctors bitch about how good people who are down on their luck struggle to afford basic care while they have to give effectively free ER care to bums and druggies.

And, of course, the threat of a hypochondria declaration did nearly kill the friend of another member here, who had a life threatening condition, but the hospital could not find it after five visits. If another friend had not stood up for them, your 'finest healthcare in the world' would have left them to die in agony.

Because the hospital would not do a fucking X Ray.

I would like to see this law repealed.  No good will come of it,  and the damage done has been a terrible price, already.  I don't see how a pencil pusher from Washington could help a profit driven industry to cut costs without denying us the best possible treatment, or allowing more people access to it will help drive down the costs for paying customers.  What I do see is an internal threat to my American way of life.

Of course you don't see it. In common parlance, this is because you are 'drinking the kool-aid'. You have bought bullshit right-wing talking points hook, line, and sinker, and happily regurgitate the bald-faced lies you've been told.

Eventually, however, reality will assert itself.

There is something to be said for the value of preventive medicine over curative measures,  but what are they going to do, force me to go to the doctor for regular checkups? Doctors who graduated top of their class,  and are on call 24/7, you want to hold them to an acceptable profit ratio?

Doctors in general are overworked and underpaid, very little health care money actually goes to them. Most of it goes to overpriced goods (I paid $40 for a piece of gauze and tape, for fuck's sake) and frivolous testing.

How do you expect to keep research and development dedicated to medicine?

Probably the same way America got to that lead in the first place, and why other nations are catching up to the US while American prestige is falling.

What is going to happen to lesser countries when America needs more doctors?

Nothing. We'll just hire the Indian doctors currently working as New York taxi drivers.

Is my smoking and drinking and having unprotected sex a waste of taxpayer dollars?  Are they going to have more say in my dietary choices?   

Well, I know some medical professionals -as is- who would give you less time of day -right now- simply because you do those two things. They'd much rather be treating people who just had something horrible happen to them through little to no fault of their own, rather than some ignorant jackass who waltzes into trouble.

That is never going to happen.  Only, instead of simply not doing business with an insurance company,  and trusting the free market to regulate itself,  I'm going to have to go to guns or butter with the government, who would love nothing more than to suck more blood from free enterprise, put the unemployed in labor camps,  and then just write us off at retirement.

You don't even know what the market hypothesis is, where it works, or why, and believe our current system of lobbyist infested corporatism is 'free enterprise'. Hint: It isn't free enterprise if lobbyists can insert legal barriers to entry.

If you refuse to learn basic terminology, there is no reason to take your arguments seriously.

[RubySlippers]

For the Free Market to be free I will note this for this debate - you need three things no insurance at all so there is not outside force affecting prices, no government regulation save for the safety issue they cannot and shouldn't decide if a treatment works or is better than current options and the last clear and open pricing it needs to be like going to a contractor if they give you an estimate it cannot go over that amount by so much without your consent.

Those are not going to happen.

Would the system survive if the medical providers had to take cash and what people can pay as it now stands?

[Vekseid]

For the market hypothesis to function, it requires that there be a large number of suppliers, a large number of consumers, and that all participants are fully informed.

The former two imply antitrust regulation. The latter implies truth and disclosure regulations.

[Chris Brady]

http://www.latimes.com/news/opinion/commentary/la-oe-ward-in-praise-of-obamacare-20111206,0,6794828.story

An opinion piece from a woman with breast cancer, detailing her experiences.

For me, for being a Canadian, just the implications of what she's saying is blowing my mind...

[Zakharra]

Because for a universal coverage system to keep costs down for insurers for adverse risk they must enroll everyone healthy and young and the sickly into the system. As for the law the Supreme Court is going to hear the case and will decide on the standing of the law. If they nix the mandate there are other options such as penalizing people when they opt to get insurance or penailizing their employers that amount for covering you. Say for every year not insured you meed to pay a 10% higher premium with grace periods and the like and that would not require a law. So if you opted out and later ACME hired you after two years THEY would have to pay 20% more to cover you and that by law would be only payable by them. That might encourage people that could afford insurance to get covered if it means employers having to pay more or not hire this person over the other parties applying. [My example likely the penalties would be lower but the idea would be the same.]

So you have no problem with the mandate that forces people to pay one way or another, no matter what?  If someone doesn't want or need insurance, why should they pay a fine for not having it?

If this passes, I can easily see this being used as a precedent to force people to comply with federal programs, to either join it, or pay a fine until you do join it.  Personally, I think it's a very bad precedent to set.

What happens if/when (I think it will be more of a 'when' than 'if') insurance companies close shop? Where will the formerly covered people go? To governmental insurance programs?

[Serephino]

Ah, yes, I remember the financial office.  Before I gave in and took Medicare, I used to have to go there after every ER visit to discuss how I was going to pay them.  It was degrading.  Before that the financial office would call the next day.  They didn't even at least ask how I was feeling before asking how I intended to pay them.  That was insulting.

It's not my fault I had to go to the ER to get anything done.  I sucked it up and went to my doctor when I had gallstone symptoms.  He ordered an ultrasound, but because I was uninsured I had to pay $100 up front before they would do it.

Two years later, I have more pain.  I go straight to the ER, and what do you know, they did x-rays and ultrasounds right then and there!  I found out it was a huge kidney stone. The Urologist said it had probably been there several years, which makes me wonder why no one said anything about it when they found the gallstone.   

[MercyfulFate]

Because for a universal coverage system to keep costs down for insurers for adverse risk they must enroll everyone healthy and young and the sickly into the system. As for the law the Supreme Court is going to hear the case and will decide on the standing of the law. If they nix the mandate there are other options such as penalizing people when they opt to get insurance or penailizing their employers that amount for covering you. Say for every year not insured you meed to pay a 10% higher premium with grace periods and the like and that would not require a law. So if you opted out and later ACME hired you after two years THEY would have to pay 20% more to cover you and that by law would be only payable by them. That might encourage people that could afford insurance to get covered if it means employers having to pay more or not hire this person over the other parties applying. [My example likely the penalties would be lower but the idea would be the same.]

Cost have still skyrocketed in Massachusetts with Romney's mandate, it doesn't work.

[Trieste]

I have to say that I'm not all that sorry for the insurance companies, and I'll tell you why: the insurance company already doesn't cover all my costs. I have a 30% coinsurance requirement on my policy. If I go to the hospital for whatever reason and the bill is $1000, they pay $700 and that's all of it. So they're essentially being ordered to spend 85% of what I pay them on 70% of my costs. Considering the fact that the whole concept behind insurance is that you pay in and they get money regardless of whether you're sick or not - and the fact that my yearly cost of insurance is in itself over $2000 whether I go to the doctor or not, I feel not a single twinge of remorse for them. The whole point of insurance is numbers: out of ten people who each pay $2k each year, one of those people might actually end up in the hospital with a $50k bill, and it won't be every year. The point of insurance is banking on the fact that the premium paid by the other nine people will help share out the cost of your bill and it will be spread over several years. That's what their business is. That's what they got into. It's not exactly rocket science to call it money held in trust. Yes, they have overhead, but making profit off of peoples' misfortune is just perverse. Protecting that profit by ditching their customers when those customers actually needed to make use of the benefits they'd been paying for is reprehensible.

And getting only a 15% cut of thousands of dollars per year per person is nothing to cry over. People keep saying that premiums will go up - so what? A crapton of people can't pay anyway. It's a net loss for them if they hike premiums, and they'll go out of business anyway.

Cost have still skyrocketed in Massachusetts with Romney's mandate, it doesn't work.

That's because Romney is an idiot.

[RubySlippers]

So you have no problem with the mandate that forces people to pay one way or another, no matter what?  If someone doesn't want or need insurance, why should they pay a fine for not having it?

If this passes, I can easily see this being used as a precedent to force people to comply with federal programs, to either join it, or pay a fine until you do join it.  Personally, I think it's a very bad precedent to set.

What happens if/when (I think it will be more of a 'when' than 'if') insurance companies close shop? Where will the formerly covered people go? To governmental insurance programs?

Yes but its not my decision its in the hands of the Supreme Court, they will decide this matter. Like I said the law overall is constitutional its the mandate in question they could remove that and leave the rest of it intact. Then they would need another mechanism in use to compel people into the system such as they used for the drug plan under Medicare.

But to get the cost benefit the requirement of everyone get coverage that can is usually needed to broaden the risk pools thats all I mentioned pretty much.

And states have to do their part, in the case of states they regulate health insurance and enact laws so they could control costs also but that means saying no to someone not something politicians like to do.

[Zakharra]

Yes but its not my decision its in the hands of the Supreme Court, they will decide this matter. Like I said the law overall is constitutional its the mandate in question they could remove that and leave the rest of it intact. Then they would need another mechanism in use to compel people into the system such as they used for the drug plan under Medicare.

But to get the cost benefit the requirement of everyone get coverage that can is usually needed to broaden the risk pools thats all I mentioned pretty much.

And states have to do their part, in the case of states they regulate health insurance and enact laws so they could control costs also but that means saying no to someone not something politicians like to do.

I cannot believe what you just said there. If the USSC finds the mandate unconstitutional, you say they should find a way to compel people to get health insurance? How the hell would that constitutional if the mandate (and I hope to all of the gods that IS found unconstitutional) is found not to be? That they should go around and basically ignore the law?

On a side note, aren't over half of the states in the US filling actions to be able to opt out of the plan anyways? If they can opt out, why can't US citizens?

[RubySlippers]

Compel not force lets say you opt out and in five years want insurance you could get it but say for 6% higher premiums and deductibles. You would not have to get it but might want to sooner.

Again I would have kept it simple the same taxes on businesses and the like but pool all the monies into one fund and give each state based on the census figures a block grant of it then tell the states you cover everyone save those on Medicare and Tricare as you see fit under these guidelines for basic services. If you don't agree to do this say in 90 days we will remove any and all Federal funding and program access to your state and its businesses and citizens. Decide. This means no extra education money, road funds, pell grants, federal backed loans, grants, research money, medical funds for the indigent and the like unless there is a commitment to do so Medicaid or an established contract or deal.

Then its a choice of each state do it or no Federal funds for anything save maybe vital national things like natural disasters and I would even cut off FEMA funds just crank on the screws.

This would have been constitutional and gotten the same results in the end likely very fast.  >:)

[Serephino]

Penalties do not help anything.  If you can't afford coverage now, how in the hell are you supposed to be able to afford it when the premium is higher? 

That is how Medicare is run, and I'm screwed because of it.  When I first became eligible, my premium would have been $96.  I couldn't afford that.  We were barely making ends meet as it was, so I needed that money to survive.

But then I had the gallstone, and complications with that.  Kidney stones after that.  I was getting sick and going bankrupt anyway.  I was able to find slightly better policies for about the same, but I couldn't get them.  Why?  Because Medicare Part A is mandatory.  It doesn't cost anything, and only covers in-patient hospital stuff. 

So when the insurance companies put me through their system they saw had I had Medicare Part A and said oh hell no.  I had one honest salesman tell me it was mostly because they figure if I'm disabled at my age, then there's probably something horribly wrong with me, and I would be expensive to cover.  That's not true in my case, but whatever.

So, after a few years, I said screw it and enrolled in Medicare Part B.  Because of the stupid yearly 10% penalty, my premium is now $150!  Yeah, they tacked on the stupid penalty for this year even though I was taking it.  Now I can't pay my rent. 

What needs to be done is the cost needs to be lower.  Like I said, the threat of the penalty never changed the fact that I couldn't afford it to begin with.  If someone can't afford it than they can't afford it.  All you're doing by tacking on a penalty is making the problem worse.  I seriously hate ex-President Bush for this....

[Iniquitous]

Compel not force lets say you opt out and in five years want insurance you could get it but say for 6% higher premiums and deductibles. You would not have to get it but might want to sooner.

Again I would have kept it simple the same taxes on businesses and the like but pool all the monies into one fund and give each state based on the census figures a block grant of it then tell the states you cover everyone save those on Medicare and Tricare as you see fit under these guidelines for basic services. If you don't agree to do this say in 90 days we will remove any and all Federal funding and program access to your state and its businesses and citizens. Decide. This means no extra education money, road funds, pell grants, federal backed loans, grants, research money, medical funds for the indigent and the like unless there is a commitment to do so Medicaid or an established contract or deal.

Then its a choice of each state do it or no Federal funds for anything save maybe vital national things like natural disasters and I would even cut off FEMA funds just crank on the screws.

This would have been constitutional and gotten the same results in the end likely very fast.  >:)

Wow, talk about cramming the Federal government into our lives in a very large way. You protest a national ID but then want the Federal Government to have the right to tell states what to do. Methinks you should step back and look at what you are saying here because you are contradicting yourself with these two issues.

Oh, and have a read here. It describes what the federal governments limits are suppose to be and what powers the states have ... per the Framers of the Constitution.

[Zakharra]

Compel not force

Wrong!
com·pel
 
verb (used with object)
1.
to force or drive, especially to a course of action: His disregard of the rules compels us to dismiss him.
2.
to secure or bring about by force.
3.
to force to submit; subdue.
4.
to overpower.
5.
Archaic . to drive together; unite by force; herd.
verb (used without object)
6.
to use force.

That is force.

lets say you opt out and in five years want insurance you could get it but say for 6% higher premiums and deductibles. You would not have to get it but might want to sooner.

And as Serephino pointed out, someone that cannot afford it is screwed because if they can't pay the premium, they are doubly screwed because they can't pay the fine either way.

lAgain I would have kept it simple the same taxes on businesses and the like but pool all the monies into one fund and give each state based on the census figures a block grant of it then tell the states you cover everyone save those on Medicare and Tricare as you see fit under these guidelines for basic services. If you don't agree to do this say in 90 days we will remove any and all Federal funding and program access to your state and its businesses and citizens. Decide. This means no extra education money, road funds, pell grants, federal backed loans, grants, research money, medical funds for the indigent and the like unless there is a commitment to do so Medicaid or an established contract or deal.

Then its a choice of each state do it or no Federal funds for anything save maybe vital national things like natural disasters and I would even cut off FEMA funds just crank on the screws.

This would have been constitutional and gotten the same results in the end likely very fast.  >:)

So it's the Federal way or no way. So much for States rights...  Rights the Constitution is supposed to protect. Rights which would be stripped away under the plan you propose.

[RubySlippers]

Wow, talk about cramming the Federal government into our lives in a very large way. You protest a national ID but then want the Federal Government to have the right to tell states what to do. Methinks you should step back and look at what you are saying here because you are contradicting yourself with these two issues.

Oh, and have a read here. It describes what the federal governments limits are suppose to be and what powers the states have ... per the Framers of the Constitution.

The Federal ID makes it impossible for some people to get ID, the states had the right to have two tiers one for state use and then a Federal REAL ID version so it was not an infringement at the DHS level but at my state level. I never said they cannot demand a Federally approved ID for Federal uses at all.

And this would uphold states rights they can opt out under my idea and just lose Federal funding and benefits, you seem to want that to since most of these are not in the orginal constitution. You can't have it both ways either you can't have the Federal government out of states and your lives then on the other hand have Federal interests in non-constitutional areas - for example there is no provision for a standing army or air force the states are to have militias they fund and officers appointed by the Federal government who are paid for by the states. There should be no CIA, FBI, NSA, CDC, FDA, Department of Education, EPA and well most agencies now in play. After all the only constitutional Federal crimes is treason, countefieting and piracy which demanded little prison space. Unless you amended the constitution to add more crimes most of the crimes now crimes are state matters - murder in Florida of a Federal agent should then be tried as murder in Florida not a Federal crime as an example.

I find my views consistant I admit they need these agencies to deal with real threats and a standing army, maybe even for some people a Federal ID as long as my state can offer a non-Federal version and do so which is why I consider the fact they didn't a violation under state constititutional provisions.

But the government can do what it wants with its money so if they offer it to cover everyone and have a big club their money if the state refuses its fine, they don't have to do anything they are not obligated to by constitutional mandate or in place obligations. States can say no. Even Medicaid they could opt out of at any time its elective.

As for a matter of the law in the high court what if they strike down the mandate only everything else will kick in including the medicaid expansion based on income limits, corporate taxes, exchanges and the like just there will be less funding to do the programs. That could happen to you know and they could opt to require the mandate but nix the tax penalties so you might have to get insured just there is no penalty for not doing so. Or they could expand Federal powers invoking the unique case of health care as a market to only appy to health care and let it stand. Who knows for sure.

As for FEMA I would point out they are funded for national emergencies I would think my example very unlikely in that regard but the cutting off ofstates, businesses and citizens of Federal funding, programs and benefits not obligatory is sound to use. Is there an obligation that you pay taxes and get money back in each state - no. The money is really up to the Federal government to allocate and they can just say no. They did it before for the age limit for drinking comes to mind. 

[Iniquitous]

Personally, I am one of those that wants LESS government. I think we have too much government in our lives as is. I do not believe in paying federal taxes (as the whole tax system is illegal to begin with and was started to fund a war and the government promised it would end as soon as the war did.) though I pay with every paycheck.

And let me point out the inconsistency Ruby. You want the government to be able to say “Do what we say or else!” where healthcare is concerned. What ever in the world makes you think that if they are given that power that they wouldn’t turn around and go “Do what I say or else!” where the national ID is concerned. You can’t have it both ways Ruby. You’d scream bloody murder if the government slammed the hammer down about the national ID but you are encouraging the federal government to do just that where health care is concerned. And if the government is given the right to dictate healthcare, how long before they dictate what we eat, what we drink, whether we exercise or not, who we have sex with, how many children we can have, what we can watch on tv, where we live, etc etc etc. Damn slippery slope there.

Originally the federal government was an overseeing body while each state had it’s own power. That is becoming less and less as we go on.

[OldSchoolGamer]

Time for America to go to a single-payer system like the rest of the industrialized world has and be done with it.  Those who want gold-plated private hospital beds can still see a doctor outside the national system.  If the rich and the Ayn Rand fanboys/girls are in such mortal terror of the notion of having to sit next to a poor person in the waiting room of their doctor's office, they can just STFU and pop a Valium and chill out and deal with it.

Having said that, I think Obamacare is a bad idea--especially the part about HAVING to buy health insurance.  I don't think I should be made to subsidize some CEO's private jet or multimillion-dollar golden parachute.  I don't mind paying a few more percent in taxes for it though.

[Vekseid]

Cost have still skyrocketed in Massachusetts with Romney's mandate, it doesn't work.

There can be multiple things wrong about a system. Just because one solution does not solve the core driving problems (excessive focus on specialists over general and preventative care, frivolous testing, overpriced medical gear) does not mean that solving other problems (rising insurer overhead, patient nonpayment) is useless.

[RubySlippers]

Personally, I am one of those that wants LESS government. I think we have too much government in our lives as is. I do not believe in paying federal taxes (as the whole tax system is illegal to begin with and was started to fund a war and the government promised it would end as soon as the war did.) though I pay with every paycheck.

And let me point out the inconsistency Ruby. You want the government to be able to say “Do what we say or else!” where healthcare is concerned. What ever in the world makes you think that if they are given that power that they wouldn’t turn around and go “Do what I say or else!” where the national ID is concerned. You can’t have it both ways Ruby. You’d scream bloody murder if the government slammed the hammer down about the national ID but you are encouraging the federal government to do just that where health care is concerned. And if the government is given the right to dictate healthcare, how long before they dictate what we eat, what we drink, whether we exercise or not, who we have sex with, how many children we can have, what we can watch on tv, where we live, etc etc etc. Damn slippery slope there.

Originally the federal government was an overseeing body while each state had it’s own power. That is becoming less and less as we go on.

The difference is the states keep their rights in the case if ID they left a window and did not slam it down, every state can and should offer a state-use only ID and DL in addition to the Federal one under different rules so everyone can get an ID even if homeless.

With health care the states could opt out, they would still get Medicaid funding and other monies as agreed to for health care just they would lose alot of Federal monies and the citizens with them if they did not cover everyone in their state in some form of health care system. Its simply the Federal government using its right to use its money as they want and they would say fine your not covering people we will do exchanges and things on our end with our funds and you lose the use and access to those funds. Within reason like I said disaster relief is likely not going to be affected but loans to start a business backed by the SBA would for example. Its constitutional unless you can show me where the Federal government MUST spend some of their money in a state outside of again obligations it has in place. Its not dictating no state is being forced under my idea to participate in health care for all.

[Chris Brady]

Personally, I am one of those that wants LESS government. I think we have too much government in our lives as is. I do not believe in paying federal taxes (as the whole tax system is illegal to begin with and was started to fund a war and the government promised it would end as soon as the war did.) though I pay with every paycheck.

The problem with taxes is that every government in the world uses them as income.  And every single budget they do counts that in, rather than as a 'bonus' as they imply to do.  So now, they can't operate without it.  It's not just an American thing, it's worldwide.

[Zakharra]

The difference is the states keep their rights in the case if ID they left a window and did not slam it down, every state can and should offer a state-use only ID and DL in addition to the Federal one under different rules so everyone can get an ID even if homeless.

With health care the states could opt out, they would still get Medicaid funding and other monies as agreed to for health care just they would lose alot of Federal monies and the citizens with them if they did not cover everyone in their state in some form of health care system. Its simply the Federal government using its right to use its money as they want and they would say fine your not covering people we will do exchanges and things on our end with our funds and you lose the use and access to those funds. Within reason like I said disaster relief is likely not going to be affected but loans to start a business backed by the SBA would for example. Its constitutional unless you can show me where the Federal government MUST spend some of their money in a state outside of again obligations it has in place. Its not dictating no state is being forced under my idea to participate in health care for all.

The problem is Ruby, the Federal government could and sooner rather than later WOULD use 'it's' money (mind you, the money the feds get is from it's citizens, it's not the Fed's money, but the citizen's money...) as a club to force states to toe it's line. Even if it's against the interests of the state. If all Federal aid is cut off, what option does the state have? To withhold the money it gives the state for it's own use? I dare say the government would take that action very badly and work to get 'it's' money no matter what.

By tying all Federal funds to this damned healthcare thing, it would harm the state in question a lot and give the Federal government far too much power. Why? Because the Feds or more likely the bureaucracies would use it as a club to violate state rights because they can do it to get what THEY (Feds/politicians and bureaucrats) want. Even if it's not in the states best interests. What if the population of the state supports that state's government? Or other states? Should the Feds cut those states off too? How far would it be to push this? Why should the Federal government be given another club to use in it's arsenal?

The one example you used of the drinking age and withholding of funds was limited to only highway funds. The Feds didn't cut off all funds as you seem to want.

[Pumpkin Seeds]

The humor of this debate to me is that everyone views medical care as their own right.  Each one of us would be appalled to arrive at a hospital after a car accident and be refused due to an inability to pay for the care provided.  The hospital and people in the hospital have a responsibility to care for those in need to the best of their ability.  Oddly enough the government has gone further than that to make the statement that the care provided cannot be adjusted based on the ability of the person to pay, the conditions under which the treatment is administered (disasters) and the forces affecting the hospital (strikes).  Care is to reach a certain level and be maintained there no matter the cost.  So in effect people feel a right to medical care and not just basic emergency care but a higher standard of care.  People only begin to dispute the right of medical coverage when it extends to another person and who is paying for that person. 

Hospitals are consistently running in the red of their profit margins across the country.  Many are on the verge of shutting down and many more would shut down without access to government funding.  Insurance companies actually make up a small portion of revenue for a hospital.  I believe the figure for most hospitals is that government funding, at least with Medicare and Medicad, makes up around 60% of their income.  This does not include government funding for certain types of procedures, research and state funding for similar things.  Factor in that there are also charity groups that donate to hospitals and the amount of money insurance companies actually contribute is reduced even further.  If the government simply decided to pull those funds, the healthcare system would collapse.  They do not need to play all these games to force states to accept something covered medically.

The system that exists now cannot continue.  No, I do not like the idea of the government coming in to become the only figure in power over medicine.  They have already made some very bad decisions such as the “Never” events that can seriously deprive a hospital of money.  Still I have to recognize that hospitals and clinics cannot continue to operate as they are now.  People without insurance and people without money flood the Emergency Rooms with an inability to pay.  For every person that does not pay, the hospital eats that cost.  My paycheck as a nurse does not go down because four of my seven patients did not pay.  The surgeon does not ask for less because he is working on an uninsured patient.  The janitor does not take a paycut because he is sweeping a floor filled with non-paying patients.  I have read across multiple threads about how people “get out” of paying medical expenses not realizing that this is part of the problem.  I also understand that them being sick does not magically give them money and that they are not paying because there is no money.

Still this inability to pay then puts pressure on the insured.  The reason people are seeing their insurance rates go up so much, seeing the costs rise so quickly is because the hospitals have to raise rates on people with insurance.  They cannot raise the Medicare and Medicad rates because the government simply says no.  So hospitals raise the cost on people with private insurance depending on the rates negotiated.  For instance my payment may be hundreds if not thousands more than someone else based on our insurance.  A person with Medicare pays drastically reduced costs compared to the either of us with private insurance.  Certainly we could all complain and refuse to go see a doctor, but eventually we’d have to and the cycle starts again.  The system does not work. 

[Crazy]

This is such a blatant lie as to be laughable. The default measure of health care quality is to measure life expectancy. We're tied with Cuba. Go USA.

By that line of thinking, Monacco has the best healthcare in the world.  Who knew?  There are many factors that contribute to life expectancy.  Genetics being chief among them,  other considerations like diet, vice,  violence,  automotive accidents, and poor record keeping make that number meaningless.  If you really want to get into a measuring contest on the best healthcare in the world, I'd prefer to talk in terms of successful operations,  childbirth survival rates,  or other more relevent aspects of comparison.

Longtime members of this forum and friends of members of this forum are dead due to raw medical incompetence in this country, including the woman in my signature, who would be alive today had she only had a slightly more attentive doctor mere weeks earlier. Another woman died from a punctured lung...during a knee surgery.

Forcing the poor into ER is flat-out ridiculous. One member had to wait until an infection became an emergency, so she spent five days in ICU because she could not afford antibiotics. Another could not go to the doctor for her headaches. Rather than spend several hundred dollars on preventative care, we're happy to spend a quarter of a million for her to suffer through chemo for years.

Norway solved its MSRA problem. Here it's still a terror.

I'm sorry for your loss,  but so far much of the horror stories on this forum are the result of HMOs and other regulations from the body politic, Medicare and Medicaid.  None of these tragedies would be averted by the new healthcare law,  and there is every reason to believe that more government interference will result in more travesty.

Norway is a wealthy nation with an enviable oil supply.  We would be too were it not for the evironmentalists.

And yet for the not so wealthy, 'medical tourism' is about going the other direction. When I lacked insurance, the Mayo was one of the few institutions that would treat me, yes. They wanted $3,000 just for the evaluation. For one of the most routine surgeries in the world. For that, I could fly to Prague, meet some Elliquiy members, get treated, and fly back.

The excellence of the Mayo and Hopkins has less to do with the magic of the talent they hire and more to do with the fact that they have developed better incentives for doctors to actually treat patients.

I don't know what this means.

Insurance companies don't compete for business in many states. Exempt from antitrust laws, they are happy to establish monopolies and engage in blatant price fixing without recourse, while providing said same incompetent bureaucrats in the form of rescission workers.

This is true,  and I'm sorry that the healthcare debate isn't centered around this key issue.  Nothing would lower the cost of healthcare more than removing the imaginary political boundries between states.  More evidence that the government is the root of the problem.

Let me guess, you were shouting 'Death Panels!' right alongside the rest when it was proposed to take care of the main offender of said wasteful spending.

You're damn right I was,  and an embarassed president removed end of life counseling from the bill before it was passed.

That's a bridge that will be burned when it happens.

That's never going to happen.

No, when you buy health insurance, you are taking advantage of said provider's ability to dictate prices. The larger the insurer, the more powerful their ability to dictate.

Another sound reason such an important aspect of our life should not be relegated to a single entity.

To say nothing of the fact that, as a self employed person with conditions on my record, it would cost me six thousand dollars a month to buy insurance. And I'd still have to pay for my surgery out of pocket. That isn't free market competition.

Yes it is.  Forcing me and two other people to pay for insurance we don't want or need to compensate for your exceptional condition is exactly the opposite of free enterprise.

This is a non sequitur. Two, actually. It neither follows that public employee costs will reduce because of a collapse of private insurers, nor does it follow that reduced employee costs would cause a larger government.

I felt that that was a logical conclusion.  With a single payer system,  the government need only pay itself to insure its employees.  They have a bad track record for that sort of paper shuffling,  and ultimately the private sector will support the burden for all recipients of benefits.

The obvious intention of this legislation is to further increase the influence the government has over our lives.  As it stands,  we just shrug our shoulders about a government shutdown.   That won't be the case in our dark future. 

"Death panels" was trotted out to giving older people actual end of life care, rather than wasting 60% of our health care spending in making them suffer for six more months. Their lifespan would be increased by a far greater amount if they had better care before 65. It was originally a Republican proposal, but because Obama tried it, that makes it worthy of attack.

This statement is not worthy of a response.

Of course, people such as yourself blatantly overlook the fact that private health insurers essentially are barriers to care in our current system, often denying critically needed treatments.

And yet, the prime cause of bankruptcies in the United States is what?

And how many of them had insurance?

Half a percent of the voting population loses their insurance each year. That sort of bullshit is only going to go on for so long before the fraud gets tossed on its head.

As I've said,  standing up to private health insurers is as easy as doing business with someone else.  There are many plans to choose from,  a good situation that the current adminstration finds intolerable.

Poor health does cause bankruptcies,  but not so much from medical bills as loss of income.  Many of these bankruptcies are the result of living beyond their means,  having no emergency funds for even minor financial setbacks.

Even with insurance, there is some out of pocket expense.  Proponents of the bill blatently ignore that that aspect of medical care isn't going to go away.  Opponents of the bill strongly believe that situation will become far worse.

There is a fraud that will be tossed on its head,  but it is the communist nationalization of one of our nation's largests industries,  not the ideals of free markets and personal liberty.

Nonpayers already do place that burden on our system. Go to a medical forum and you will see doctors bitch about how good people who are down on their luck struggle to afford basic care while they have to give effectively free ER care to bums and druggies.

And, of course, the threat of a hypochondria declaration did nearly kill the friend of another member here, who had a life threatening condition, but the hospital could not find it after five visits. If another friend had not stood up for them, your 'finest healthcare in the world' would have left them to die in agony.

Because the hospital would not do a fucking X Ray.

This only supports my arguement.

Of course you don't see it. In common parlance, this is because you are 'drinking the kool-aid'. You have bought bullshit right-wing talking points hook, line, and sinker, and happily regurgitate the bald-faced lies you've been told.

There's that kool-aid thing again,  has AMC been rerunning Jonestown late at night?

Negative, bro.  Conservatives don't need newswires, support groups, or thinktanks.  We automatically know right from wrong.

Eventually, however, reality will assert itself.

Just like it did in Massachusetts under Romneycare,  or in Tennessee under Hilarycare.  Bankruptcy at the state level.  Not enough people in the pool?  We're looking at bankruptcy on a national level.

Doctors in general are overworked and underpaid, very little health care money actually goes to them. Most of it goes to overpriced goods (I paid $40 for a piece of gauze and tape, for fuck's sake) and frivolous testing.

You'd be amazed what the army pays for a hammer.

Probably the same way America got to that lead in the first place, and why other nations are catching up to the US while American prestige is falling.

Jim Crow laws?

Nothing. We'll just hire the Indian doctors currently working as New York taxi drivers.

Touche`

Well, I know some medical professionals -as is- who would give you less time of day -right now- simply because you do those two things. They'd much rather be treating people who just had something horrible happen to them through little to no fault of their own, rather than some ignorant jackass who waltzes into trouble.

On the contrary,  they send Christmas cards and provide services as personal favors.   I'm not real sure what Hippocrates would have to say on the subject,  but it is difficult to date nurses or paramedics, much less go bareback on one.
 

You don't even know what the market hypothesis is, where it works, or why, and believe our current system of lobbyist infested corporatism is 'free enterprise'. Hint: It isn't free enterprise if lobbyists can insert legal barriers to entry.

Precisely the point I am trying to make.  There is already too much regulation.  More of the same is going to be disasterous.

Here's a hypothesis for you:  The government is one big fuck-up machine.

If you refuse to learn basic terminology, there is no reason to take your arguments seriously.

I can't hear you unless you speak into the conch.

[Iniquitous]

Poor health does cause bankruptcies,  but not so much from medical bills as loss of income.  Many of these bankruptcies are the result of living beyond their means,  having no emergency funds for even minor financial setbacks.

This is almost like asking which came first, chicken or egg. But I can tell you this much - I am looking at bankruptcy because of medical bills. I work, usually 50-60 hours a week when overtime is available, but there is no way for me to pay off nearly 100k in medical bills from having cancer twice and two major surgeries from 2005 to 2007. And to top it all off - I HAD insurance during that time and I am now getting calls from debt collectors wanting ME to pay for shit the insurance company was suppose to pay for in 2007.

Fact of the matter is what I make now goes to keep a roof over my head, my utilities on, take care of my kids and food in the house. I do not have extra money, I most certainly do not live beyond my means. I live in the ghetto, I do not own a car right now, I don't go on vacations or have the newest gadgets. Don't own game systems, dont even own a dvd player. My tv was a prize from work for nearly killing myself working 12 hour days 7 days a week for just about a month straight. To put it bluntly - what money I make is what I need to live on. There is nothing to spare.

Insurance companies are a major problem with healthcare and it isn't as simple as "oh, I don't like your prices. I'm going over here." Open up competition across state lines and it might be that simple. But right now it isn't.

Do I think the government can do better with healthcare? Not the way our government is right now. I think they need to take lessons from countries where socialized healthcare works (Norway comes to mind). But something has got to give. As it stands right now I don't have health insurance. Can't afford plain and simple - and I desperately need it because I am diabetic and need to be under the care of a doctor.

[RubySlippers]

I'm sadly in some ways better off than you are Iniqui I am firmly in the Underground Economy and make ONLY cash, have no financial institution accounts, no job as in one that anyone can garnish, my income is fully untraceable and my credit rating horrid. In other words I look like an indigent homeless person to any credit search means. This means generally I never got pressured to pay a debt the hospitals never tried to bill me or go to collections, my medical doctor I'm tossing something to being nice but figure they had not choice I pointed out I had nothing to take if they pushed.

When you look like a pauper on paper and live very modestly its a fine defense from such people. You likely having a job, bank account and the like were an easy target to move on they could hurt you and go after assets.

Its a pity sadly I work as little as I can to make money and am in many ways better off medically I can go to the ER and laugh off the bill, figuring logically they will look at my credit report and do an asset search and go - arghhhhhhhhhh. And I don't even keep financial records it goes into my safe deposit box and I spend what I need to and use a few envelopes to set aside sums for things I need to alot money for. Its oddly not hard I learned much of it from undeground illegal immigrant workers I know and with things like Amscott for electronic bill paying and money orders plus Debit Gift Cards with a Major Card Imprint (useable for online purchases) its not oddly hard. Housing is not even hard you post on Craigs List offering cash for rent every day a certain amount and you get lots of offers, usually can even pick and choose. Underground landlords are also pretty common.

You did everything right and are getting hit so hard doesn't seem fair does it.

(One advantage you pay taxes including social security and medicare and well I can't without risking exposure. So in that your lucky.)

In the end I just don't care in the end I live day by day and enjoy my life and won't let bills get me down.

[AndyZ]

I'm sadly in some ways better off than you are Iniqui I am firmly in the Underground Economy and make ONLY cash, have no financial institution accounts, no job as in one that anyone can garnish, my income is fully untraceable and my credit rating horrid. In other words I look like an indigent homeless person to any credit search means. This means generally I never got pressured to pay a debt the hospitals never tried to bill me or go to collections, my medical doctor I'm tossing something to being nice but figure they had not choice I pointed out I had nothing to take if they pushed.

When you look like a pauper on paper and live very modestly its a fine defense from such people. You likely having a job, bank account and the like were an easy target to move on they could hurt you and go after assets.

Its a pity sadly I work as little as I can to make money and am in many ways better off medically I can go to the ER and laugh off the bill, figuring logically they will look at my credit report and do an asset search and go - arghhhhhhhhhh. And I don't even keep financial records it goes into my safe deposit box and I spend what I need to and use a few envelopes to set aside sums for things I need to alot money for. Its oddly not hard I learned much of it from undeground illegal immigrant workers I know and with things like Amscott for electronic bill paying and money orders plus Debit Gift Cards with a Major Card Imprint (useable for online purchases) its not oddly hard. Housing is not even hard you post on Craigs List offering cash for rent every day a certain amount and you get lots of offers, usually can even pick and choose. Underground landlords are also pretty common.

You did everything right and are getting hit so hard doesn't seem fair does it.

(One advantage you pay taxes including social security and medicare and well I can't without risking exposure. So in that your lucky.)

In the end I just don't care in the end I live day by day and enjoy my life and won't let bills get me down.

This is probably a personal question, so don't feel that you have to answer it. 

If they don't repeal Obamacare, though, and you end up in the hospital so that your lack of health insurance suddenly appears and forces them to trace down your existence, wouldn't that risk exposure for you also?  Or am I not understanding this correctly?

I mean, when you Zero, everything depends on your having absolutely no paper trail.  If you're forced to buy insurance, then not having it means that you'll show up on radar.  The government will want to make sure you're paying the fine and will go after you.

I honestly can't understand why you'd want more governmental regulation and crackdown.