Affordable Care Act: Thoughts on the Law with 2014 Almost Here

Started by RubySlippers, February 26, 2013, 02:51:51 PM

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RubySlippers

I was thinking with the ACA aka Obamacare almost here and a repeal or major changes unlikely to happen for years what are peoples thoughts about it? From your perspective or as an outsider if not an American.

I am in Florida and the governor made a deal with HHS and it still needs to go into law by the Legislature acting on the Medicaid Expansion among the measures are everyone goes into an HMO, these must spend 85% of health care and there are oversight provisions in the law plus primary care providers will get more money.

One thing I noticed as a professed idler, lounger or slacker (pick your version) is that there is one clear point its an expansion only based one ones income there are now no other factors.  In simpler terms one can decide not to work, work to earn a lower income than you could or reduce hourse to get Medicaid if your earning over 133% of the poverty line. I can go into the social worker that handles that, tell them here is my income and proof and I choose not to work more that is my income its enough or if you don't work and your parents support you bring in a letter of support and say I don't want to work. In either case they cannot refuse to give it to you and there is no law demanding one work or work as much as you can to make more money. And since in my state its an HMO there are no out of pocket costs for me its for me 100% free. Seems to me kind of ripe for abuse.

On the employer front the IRS won't seem to make it easy to just cut hours to avoid the penalty they have rules in place to curb abuses but what if they say to an employee who is working 40 hours. We will be offering part-time workers only more money say they earn $10 an hour the part-timers get $12 an hour if they work under 30 hours say 29 hours or less. Also we are dropping insurance and paying the penalty if you stay on but part-timers who choose to work less we will offer to help pay for the exchange say the half the premiums. So you can decide to reduce your hours signing this form or not. I will note the law and provisions will make it hard to have the compnay drop them down but not if they willingly choose to work less hours this would be legal its just incentives to encourage employees to work less hours. If everyone does that there would be no tax penalties if I read the law right.

Overall seems to need work not that I mind for me its a sweet deal.

Hades

I agree that the law as it's written is far from perfect.  I think it's a good first (and tiny) step in the right direction, as the law is essentially a huge subsidy to the health insurance companies in the country.  I would have prefered an idea that Vermont Senator Bernie Sanders put forward that was ignored by the mainstream media, which is have essentially Medicare part E, with the E standing for everyone.   Despite the rhetoric, medicare is fairly efficient, though there is always room for improvement just like in any government program.   Of course, expanding to a nationalized health care (like those evil socialist countries in Europe do that enjoy better health, longer average life spans and much happier quality of life, those heathens) would require expanding the tax base on the upper class so that there's no cap on the amount of income taxed for Medicare.  Currently that cap is at I believe $150,000.   Meaning any amount of money you earn above that, the IRS does not withhold FICA taxes (which also includes Social Security but that's an entirely different can of worms).

That being said, you asked about what we have rather than what I would like to see the country provide.   I live in Kentucky, which currently has a Democratic governor and House of Representatives with a tiny Republician-majority Senate.  The governor has said that he would decide this year whether to accept or deny the expansion of Medicare, but almost everyone believes that he will go along with it.  And if he does, then that means I will fall under the cut-off limit to qualify which I am happy to hear.   

I have no insurance, because I am considered part-time despite working 36 hours a week.  And since I entered the work force fifteen years ago, I have never had insurance provided for me through my job.   I looked into buying private insurance, but because I have high blood pressure as a pre-existing condition, my monthly premiums were all well over $130.  To an 18-year old kid flipping burgers at McDonald's making minimum wage (at that time it was $5.15/hour), that was entirely out of reach.   Now granted the new law does prohibit insurance companies from denying coverage based on pre-existing conditions, but it doesn't do anything about keeping the cost down.

I was disappointed with the end result, and how it's being trumpted in the media as this impressive overhaul of our health system.  It's as impressive an overhaul in my opinion as the law requiring everyone to have auto insurance before they drive was an impressive overhaul to our transporation system.

Darius

The Time article on medical costs is very good. One of the strengths that Medicare has that I wish was in the ACA was the ability to control the costs of medical providers.  Its long but worth a read



Bitter Pill

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Trieste

Quote from: Darius on February 27, 2013, 07:00:48 PM
The Time article on medical costs is very good. One of the strengths that Medicare has that I wish was in the ACA was the ability to control the costs of medical providers.  Its long but worth a read



Bitter Pill

I just read that when it came out. It was a hefty read but it was enlightening.

Scribbles

Quote from: Darius on February 27, 2013, 07:00:48 PM
The Time article on medical costs is very good. One of the strengths that Medicare has that I wish was in the ACA was the ability to control the costs of medical providers.  Its long but worth a read



Bitter Pill

Haven't finished reading it myself but so far it's proving interesting, if incredibly depressing... You'd think people working to make it in the health sector would be more benevolent.
AA and OO
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Pumpkin Seeds

I think people underestimate the amount of work those of us in the health sector do.

As for my problem with the bill, my main concern revolves around patient satisfaction surveys and press gainey being used to dictate payment.

Scribbles

Quote from: Pumpkin Seeds on February 28, 2013, 02:38:38 AM
I think people underestimate the amount of work those of us in the health sector do.

To clarify, I meant the people charging such ridiculous markups (something I find difficult to justify), not the entire health industry and everyone in it. I've seen the conditions some work in so I definitely don't underestimate the work they do.
AA and OO
Current Games: Stretched Thin, Very Little Time

Pumpkin Seeds

Sorry if I was clip there.  I often see people making an assumption that as someone in the healthcare field I make a massive amount of money, but simply put we do not.  The money does not go to the actual people at the bedside. 

Scribbles

No worries, I should have been more specific from the start. I was just kind of blown away by the article. It makes it seem so helpless to effect any change. I've heard of some who argue for regulating prices but I've yet to see such a course work, the bloat normally stays while the actual workforce is cut down. I've also heard the idea of handing the hospitals over to government control but that normally causes a rapid decay in service, either through corruption or mismanagement.
AA and OO
Current Games: Stretched Thin, Very Little Time

RubySlippers

Quote from: Scribbles on February 28, 2013, 04:21:17 AM
No worries, I should have been more specific from the start. I was just kind of blown away by the article. It makes it seem so helpless to effect any change. I've heard of some who argue for regulating prices but I've yet to see such a course work, the bloat normally stays while the actual workforce is cut down. I've also heard the idea of handing the hospitals over to government control but that normally causes a rapid decay in service, either through corruption or mismanagement.

And there is no corruption and mismanagement now lets see $7.00 for a basic alcohol swab on a bill seems to me why can't they be honest make the hospital charge for services what it actually costs and these other items what they are on paper supposed to be. Its also odd medical care is the only industry where prices and costs of operation are not generally out in the open you get a haircut you know the price up front, you by a gallon of gasoline you can get a good idea the costs to produce it and such but not going to the hospital for a procedure - is that fair. And it rarely makes sense one hospital might charge $50,000 and another $30,000 for the same procedure and its worse if you have a procedure here that costs $100,000 you can fly to India to a tourist hospital and get the same procedure for perhaps $15,000. And in India the hospital will give you a flat rate you pay complications happen they must under contract fix it and you get a base time in say ten days for a coronary bypass graft with tons of extras. Here not as good a time in the hospital and I get its a higher standard of living and all but still seems odd to me overall the cost differences.

Like I said for ME the Medicaid Expansion in Florida as planned is a sweet deal and its good for other voluntary or not poor people under 133% of the Federal poverty line but it seems to me not well designed.



Scribbles

RubySlippers, I didn't mean to imply that there's no corruption in the private sector; my comment (as well as those before it) actually implies the total opposite... I was just saying that the entire situation feels hopeless. It's almost as if everyone is trying to pick between two rotten apples as opposed to one rotten and one fresh. Sorry for the confusion, I'm clearly not portraying my points properly.
AA and OO
Current Games: Stretched Thin, Very Little Time

RubySlippers

Well this is more about the impact of the law on each of you seems two of us benefit sadly on the backs of a lot of other people, see again for me its if the HMO plan goes through 100% free to use Medicaid under state rules as they are now. Likely these demanded by HHS also under the basic Medicaid rules for the state. And since its only based on income no other factors they cannot refuse me in fact anyone who would choose to not work could get it as much as a working low income worker.

I was wondering what the impact is on other US people on the site.

Trieste

It's not 100% free to use. It comes from taxpayer income (which I'm not convinced you pay, Ruby) and taking some of the funding from other places like higher education (about which you give exactly no fucks). So...

I'm sorry, I guess I missed the point where you explain that you're honestly seeking an answer rather than just gloating about your 'sweet deal' kind of like you've done in the past. Over and over. A lot. The bottom line is that the ACA is a compromise that, while I suppose it's better than nothing, is a shitty deal for the US people. It is not a sweet deal by any stretch of the imagination.

Ephiral

Quote from: Scribbles on February 28, 2013, 04:21:17 AM
No worries, I should have been more specific from the start. I was just kind of blown away by the article. It makes it seem so helpless to effect any change. I've heard of some who argue for regulating prices but I've yet to see such a course work, the bloat normally stays while the actual workforce is cut down. I've also heard the idea of handing the hospitals over to government control but that normally causes a rapid decay in service, either through corruption or mismanagement.


I've seen this meme a lot. Maybe it's just my outsider status on this one, but it always brings two questions to mind:


1. Why are "let them run amok" and "the government runs everything" the only two options? I come from a system where hospitals are private entities, but are regulated to the hilt, and it's pretty damn solid.


2. What is with the (apparently American, IME) belief that government involvement inevitably leads to incompetence, malice, and waste? As it stands right now, US hospitals are being run by people who aren't doctors, have no idea what patients actually need, and give zero fucks as long as the money continues to roll in. The administrative overhead alone in this system is ten times that of a typical single-payer publicly-funded system. (This is before we get into the pure-waste item known as "profit" in accounting circles.) You've already got guaranteed incompetence, malice, and waste; isn't an alternative where these things are possible but by no means guaranteed worth a shot?

Scribbles

Ephiral,

1) It is really all dependent on the government which is doing the regulating... Let's be honest, out of all the countries in the world, it’s hardly the majority which can lay claim to a trustworthy government. I'm glad that it works where you come from but I can confidently say that your locale is likely one of the few exceptions. It’d be nice to hear some of the regulations put in place by your government as it could lend something to ponder on for the current debate. Maybe even a solution.

2) There are a number of Americans (I think) on this very forum which are pro-government. There are plenty of non-Americans around the world which hate their own governments. I'm surprised that your country has absolutely no anti-government groups... It would be the first country I've heard of.

My own opinions come from a trend which I’ve noticed when it comes to government-controlled versus privately-owned entities. I’ve found that unless specific attempts are made to avoid it they're normally both controlled by common administrators rather than the field's professionals, so there’s generally a bit of confusion no matter who is in charge (nothing a consultant can’t fix… with a heavy cost). I’ve also noticed that while a privately-owned company might be a touch far too driven, a government-controlled one is usually hardly driven at all… Neither option provides for an ideal situation.

And then there’s the middle-ground… If government strictly regulates cost prices, there’s the fairly good chance that the company will make cuts to balance the loss. This has a tendency to hurt the actual workforce more than the overpaid admin.

QuoteYou've already got guaranteed incompetence, malice, and waste; isn't an alternative where these things are possible but by no means guaranteed worth a shot?

Is it worth a shot? Maybe… It could either show some success or it could cause a decline in service and equipment as well as a loss of experts, leaving quite a bit of restoration work to do. Not to mention the population has to consider if they can even afford to take the risk.

In the end it can be exceptionally difficult at times to tell the likely success of an act until it has passed. Even the experts and analysts tend to be shocked by the results, on more than a few occasions. This is why it’s nice to see such healthy debate before or even after a government/population takes the plunge, no matter how “meme”-like some might consider another side’s argument.
AA and OO
Current Games: Stretched Thin, Very Little Time

Ephiral

Quote from: Scribbles on February 28, 2013, 03:33:16 PM
Ephiral,

1) It is really all dependent on the government which is doing the regulating... Let's be honest, out of all the countries in the world, it’s hardly the majority which can lay claim to a trustworthy government. I'm glad that it works where you come from but I can confidently say that your locale is likely one of the few exceptions. It’d be nice to hear some of the regulations put in place by your government as it could lend something to ponder on for the current debate. Maybe even a solution.

I trust my government to take care of the interests of large businesses and its own members, and screw everybody else. But they know that screwing with universal heath care is political suicide, so making sure it's healthy and functional becomes their interest. I flatly reject your claim that my health-care experience is exceptional; cross-referencing countries with universal health care with life expectancy by country (Registration but no paywall) reveals an interesting trend - the overwhelming majority of countries with UHC have at least as much life expectancy as the US, and a cursory look reveals absolutely no countries that beat the US but do not have UHC. Meanwhile, US health expenditures are the second-highest in the world. The US seems to be the exception here; its citizens are paying more than most countries with UHC, and in many cases getting worse care.

As for my own country's regulations on hospitals: That falls under provincial law, and is more difficult to find than I have time for at the moment, I'm afraid.

Quote from: Scribbles on February 28, 2013, 03:33:16 PM2) There are a number of Americans (I think) on this very forum which are pro-government. There are plenty of non-Americans around the world which hate their own governments. I'm surprised that your country has absolutely no anti-government groups... It would be the first country I've heard of.

"A number of", yes, but - and this might simply be my experience; the plural of anecdote is not data - it seems like the knee-jerk reaction among Americans is to assume that their government will massively screw up anything it touches. I have absolutely zero love for my government - I regard it as poisonous to my country. But I expect it to execute its agenda competently, even if I don't agree with that agenda.

Quote from: Scribbles on February 28, 2013, 03:33:16 PMMy own opinions come from a trend which I’ve noticed when it comes to government-controlled versus privately-owned entities. I’ve found that unless specific attempts are made to avoid it they're normally both controlled by common administrators rather than the field's professionals, so there’s generally a bit of confusion no matter who is in charge (nothing a consultant can’t fix… with a heavy cost). I’ve also noticed that while a privately-owned company might be a touch far too driven, a government-controlled one is usually hardly driven at all… Neither option provides for an ideal situation.

What criteria do you judge effectiveness or "drive" by? Going by simple efficiency (quality of care and dollars spent per patient treated)... well, in the field of health care, the data is in, and public systems are vastly superior.

Quote from: Scribbles on February 28, 2013, 03:33:16 PMAnd then there’s the middle-ground… If government strictly regulates cost prices, there’s the fairly good chance that the company will make cuts to balance the loss. This has a tendency to hurt the actual workforce more than the overpaid admin.

Why is this the only middle ground? Why not start by regulating salaries - or administrative overhead as a whole? Or mandate that "non-profit" actually means "we do not make a profit"?

Quote from: Scribbles on February 28, 2013, 03:33:16 PMIs it worth a shot? Maybe… It could either show some success or it could cause a decline in service and equipment as well as a loss of experts, leaving quite a bit of restoration work to do. Not to mention the population has to consider if they can even afford to take the risk.

Treating these possibilities as even remotely close to equal is disingenuous. There's plenty of data that clearly shows it will improve things; I'd like to see even two substantial and credible pieces that say it will cause harm.

Quote from: Scribbles on February 28, 2013, 03:33:16 PMIn the end it can be exceptionally difficult at times to tell the likely success of an act until it has passed. Even the experts and analysts tend to be shocked by the results, on more than a few occasions. This is why it’s nice to see such healthy debate before or even after a government/population takes the plunge, no matter how “meme”-like some might consider another side’s argument.

That's because, to be frank, experts in a field that is not statistics tend to make extremely poor statisticians and probability analysts - just like most people. If we look at the actual data on what happened when this was tried, over and over and over and over again the numbers say the same thing. At this point, it would take overwhelming evidence to balance out everything sitting on the pro side.

For the record, the "meme" comment was not intended to be derisive; I use the term in its original sense.

Scribbles

Quote from: Ephiral on February 28, 2013, 04:49:19 PM
I trust my government to take care of the interests of large businesses and its own members, and screw everybody else. But they know that screwing with universal heath care is political suicide, so making sure it's healthy and functional becomes their interest. I flatly reject your claim that my health-care experience is exceptional; cross-referencing countries with universal health care with life expectancy by country (Registration but no paywall) reveals an interesting trend - the overwhelming majority of countries with UHC have at least as much life expectancy as the US, and a cursory look reveals absolutely no countries that beat the US but do not have UHC. Meanwhile, US health expenditures are the second-highest in the world. The US seems to be the exception here; its citizens are paying more than most countries with UHC, and in many cases getting worse care.

It might sound silly but I’m very paranoid about where I register… I’ll just take your word for it. The fact that it took me some time to find any failures of UHC to counter your points speaks volumes.

Unless, of course, you’re willing to take FOX as a totally unbiased and completely legitimate source of news. Then I suddenly have a surplus of reasons why a UHC is bad news.

QuoteAs for my own country's regulations on hospitals: That falls under provincial law, and is more difficult to find than I have time for at the moment, I'm afraid.

I understand.

Quote"A number of", yes, but - and this might simply be my experience; the plural of anecdote is not data - it seems like the knee-jerk reaction among Americans is to assume that their government will massively screw up anything it touches.

I doubt this will go anywhere considering that we’re both debating from experience…

QuoteWhat criteria do you judge effectiveness or "drive" by? Going by simple efficiency (quality of care and dollars spent per patient treated)... well, in the field of health care, the data is in, and public systems are vastly superior.

By drive, I was simply referring to the motivation required to push an administrator to succeed. For example, you believe that administrators will be motivated by their own political interests. Drive/Motivation is essential for at least some success.

QuoteWhy is this the only middle ground? Why not start by regulating salaries - or administrative overhead as a whole? Or mandate that "non-profit" actually means "we do not make a profit"?

There’s never only one middle-ground. Sorry if I implied as much. Naturally there’ll be an assortment which lean either toward greater government or private control. Regulated costs is simply the one I’ve heard of the most.

QuoteTreating these possibilities as even remotely close to equal is disingenuous.

Not from my perspective but this was because I was trying to lump developing and developed countries into the same basket. I figured the situations would be similar but I was obviously wrong.

QuoteI disagree, There's plenty of data that clearly shows it will improve things; I'd like to see even two substantial and credible pieces that say it will cause harm.

I’m shocked to say that I can’t provide any, at least not in the developed world. The two main culprits that I’ve been made aware of over the years were Russia and Cuba and yet a little in-depth research shows that most of what I’ve been told was either an over-exaggeration or outright lie. Cuba’s health-care is apparently praised the world over, with the only problem being that it benefits foreigners more than its own people: www.global-politics.co.uk – link to article

Russia’s own UHC failed horrifically but from what I’ve read this was due more to the effect communism had as a whole as well as other external factors (radiation, industry, fall of the Soviet Union, etc) rather than the UHC itself. Unfortunately, the best article I could find doesn’t go beyond the year two thousand but from what I’ve read, Russia is moving away from its current system. It’s considered a developing country however so it really doesn’t add much to the discussion. www.countrystudies.us - link to article

There is an interesting titbit I found while digging through articles. This is just a hunch for now, one which I’ll look up more thoroughly when I have time, but it seems that the US’s private system might provide better care than other countries. So the difference might lie in the fact that a UHS provides more, if less specialized, care while the US’s current system provides less but highly specialized care. Of course, providing for a bigger group trumps providing for individuals at exorbitant prices.

QuoteFor the record, the "meme" comment was not intended to be derisive; I use the term in its original sense.

I'll take your word for it. I looked it up and was instantly put-off by the definition I found...
AA and OO
Current Games: Stretched Thin, Very Little Time

Ephiral

Quote from: Scribbles on February 28, 2013, 07:12:33 PM
It might sound silly but I’m very paranoid about where I register… I’ll just take your word for it. The fact that it took me some time to find any failures of UHC to counter your points speaks volumes.

It's the Lancet - one of, if not the medical journal of record. You're probably safe. As for failures: When checking my lists, Mongolia jumped out at me. I suspect that has something to do with a lack of resources or infrastructure, though.

Quote from: Scribbles on February 28, 2013, 07:12:33 PMUnless, of course, you’re willing to take FOX as a totally unbiased and completely legitimate source of news. Then I suddenly have a surplus of reasons why a UHC is bad news.

Hahahahahahano. I'm sorry, but no news source that fought a court battle for its right to outright lie has the slightest shred of credibility with me.

Quote from: Scribbles on February 28, 2013, 07:12:33 PMI understand.

Did some more digging. Regulations aren't subject to the same sort of compulsory publication as law, but I do have an example of provincial health care law, and it does provide some insight: Items specifically noted as requiring legal regulation include not just costs of uninsured services, but staffing requirements, quality of care, and related factors. I won't lie - funding cuts do hit nurses hardest (often in the form of excessive hours), but nobody's pulling down seven figures in a hospital.

Quote from: Scribbles on February 28, 2013, 07:12:33 PMI doubt this will go anywhere considering that we’re both debating from experience…
I'll concede the point; it's far more likely that I'm suffering from confirmation bias than that a huge number of people have the same odd fault in thinking.

Quote from: Scribbles on February 28, 2013, 07:12:33 PMBy drive, I was simply referring to the motivation required to push an administrator to succeed. For example, you believe that administrators will be motivated by their own political interests. Drive/Motivation is essential for at least some success.

Mmm. I honestly don't care why the job gets done - be it from personal drive, or a desire for promotion out of a crappy job, or what have you. What I care about is the effects where the rubber meets the road: How does a change affect actual patients?

Quote from: Scribbles on February 28, 2013, 07:12:33 PMThere’s never only one middle-ground. Sorry if I implied as much. Naturally there’ll be an assortment which lean either toward greater government or private control. Regulated costs is simply the one I’ve heard of the most.

There's a very clever collection of well-paid organizations and people whose job it is to suggest the worst possible implementation as loudly as possible, and then say that since that won't work the whole thing is a wash. (See also: Fox news.)


Quote from: Scribbles on February 28, 2013, 07:12:33 PMNot from my perspective but this was because I was trying to lump developing and developed countries into the same basket. I figured the situations would be similar but I was obviously wrong.
Developing countries are different, yes. It's difficult to implement universal anything without the money and infrastructure to do it.

Quote from: Scribbles on February 28, 2013, 07:12:33 PMI’m shocked to say that I can’t provide any, at least not in the developed world. The two main culprits that I’ve been made aware of over the years were Russia and Cuba and yet a little in-depth research shows that most of what I’ve been told was either an over-exaggeration or outright lie. Cuba’s health-care is apparently praised the world over, with the only problem being that it benefits foreigners more than its own people: www.global-politics.co.uk – link to article

Russia’s own UHC failed horrifically but from what I’ve read this was due more to the effect communism had as a whole as well as other external factors (radiation, industry, fall of the Soviet Union, etc) rather than the UHC itself. Unfortunately, the best article I could find doesn’t go beyond the year two thousand but from what I’ve read, Russia is moving away from its current system. It’s considered a developing country however so it really doesn’t add much to the discussion. www.countrystudies.us - link to article

I must say, it's very rare to see someone actually check the facts, conclude that they were mistaken, and change their mind. You have my deep and abiding respect. As for Russia... I haven't looked into it in depth, but there's endemic corruption issues and serious infrastructure problems, so this doesn't surprise me overmuch. The fact that they're considered developing does, though.

Quote from: Scribbles on February 28, 2013, 07:12:33 PMThere is an interesting titbit I found while digging through articles. This is just a hunch for now, one which I’ll look up more thoroughly when I have time, but it seems that the US’s private system might provide better care than other countries. So the difference might lie in the fact that a UHS provides more, if less specialized, care while the US’s current system provides less but highly specialized care. Of course, providing for a bigger group trumps providing for individuals at exorbitant prices.

Speaking for my country, we've got roughly the same level of specialization. Where the US pulls way, way ahead is in specialized-treatment capacity. You have, for example, a huge number of CT machines. The problem is, while this looks good on paper, it's actually masking another hefty form of inefficiency - there is far more specialist capacity in the US than is needed or ever used, including people coming to the US from other countries for care. Machines are sitting empty and silent, and the half-million dollars or so that each one cost is basically money that was set on fire instead of helping patients.

Quote from: Scribbles on February 28, 2013, 07:12:33 PMI'll take your word for it. I looked it up and was instantly put-off by the definition I found...

The actual, original meaning of the term was, basically, an idea that seems to self-propagate in a manner not dissimilar to a biological virus.

Vekseid

Quote from: Trieste on February 28, 2013, 01:07:05 PM
It's not 100% free to use. It comes from taxpayer income (which I'm not convinced you pay, Ruby) and taking some of the funding from other places like higher education (about which you give exactly no fucks). So...

I'm sorry, I guess I missed the point where you explain that you're honestly seeking an answer rather than just gloating about your 'sweet deal' kind of like you've done in the past. Over and over. A lot. The bottom line is that the ACA is a compromise that, while I suppose it's better than nothing, is a shitty deal for the US people. It is not a sweet deal by any stretch of the imagination.

I just wrote a $720 check for a 2-mile ambulance ride. I went to pay a $950 hospital bill which I found to be more than reasonable, and noticed there was another one for over $10k for the ER trip and stay.

And this isn't the price insurers pay. It isn't the price Medicare pays. It's simply the price that hospitals try to charge to cover nonpayment, underpayment, overtesting, etc. On top of all this 'for profit non-profit' bullshit.

And like Pumpkin said... little of it goes to doctors and less to nurses.

It's not like traditional insurance is an option for me. For $12k, I can get two months of insurance. The war on the self-employed is going strong in this country.

Do you think this situation is even remotely defensible, or would you rather I have not had care?

Scribbles

Quote from: Ephiral on February 28, 2013, 11:04:38 PM
Did some more digging. Regulations aren't substitute to the same sort of compulsory publication as law, but I do have an example of provincial health care law, and it does provide some insight: Items specifically noted as requiring legal regulation include not just costs of uninsured services, but staffing requirements, quality of care, and related factors. I won't lie - funding cuts do hit nurses hardest (often in the form of excessive hours), but nobody's pulling down seven figures in a hospital.

Thanks for digging that up, I can see what you mean by strict regulation. It looks as if they go so far as to require hospital improvements or additions to be pre-approved and that the board is appointed by the government - I take it that the hospitals are fully state-owned.

QuoteMmm. I honestly don't care why the job gets done - be it from personal drive, or a desire for promotion out of a crappy job, or what have you. What I care about is the effects where the rubber meets the road: How does a change affect actual patients?

----

Developing countries are different, yes. It's difficult to implement universal anything without the money and infrastructure to do it.

These two are actually related, if you take my previous thoughts on the matter. One of the major hurdles in some developing countries isn’t actually resources or infrastructure, oddly enough, but rather an apparent indifference held by leaders for their citizens. There just isn’t any motivation (positive or negative) to compel them to do their jobs, properly.

QuoteI must say, it's very rare to see someone actually check the facts, conclude that they were mistaken, and change their mind. You have my deep and abiding respect.

Aww, thanks, the feeling is mutual!

QuoteAs for Russia... I haven't looked into it in depth, but there's endemic corruption issues and serious infrastructure problems, so this doesn't surprise me overmuch. The fact that they're considered developing does, though.

I was caught off guard by that as well…

I thought this might be an interesting read, if a bit dated (2000). I haven’t had the time to wade through the actual documentation yet but I found the statistics at the bottom interesting enough.

http://www.who.int/whr/2000/en/whr00_en.pdf

I hope it’s alright that I cut a few chunks out of the conversation. I just didn’t see anything more I could add to those other points beside maybe a nod. Thanks for the discussion Ephiral, it was an eye-opener.
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Oniya

Quote from: Vekseid on March 01, 2013, 06:24:19 AM
I just wrote a $720 check for a 2-mile ambulance ride. I went to pay a $950 hospital bill which I found to be more than reasonable, and noticed there was another one for over $10k for the ER trip and stay.

And this isn't the price insurers pay. It isn't the price Medicare pays. It's simply the price that hospitals try to charge to cover nonpayment, underpayment, overtesting, etc. On top of all this 'for profit non-profit' bullshit.

And like Pumpkin said... little of it goes to doctors and less to nurses.

It's not like traditional insurance is an option for me. For $12k, I can get two months of insurance. The war on the self-employed is going strong in this country.

Do you think this situation is even remotely defensible, or would you rather I have not had care?

The system as it is - even as it's going to be - still needs a lot of work before we get a true UHC.  There's still a big difference between the attitude of 'I'm working as much as I can, or I am unable to work.  I need help and I still can't afford it.' and 'I don't want to work.'

Regulating prices (like Reich and Sanders have both suggested over the past year) in the vein of expanding Medicare/Medicaid coverage would go a long way in helping the self-employed or those whose employers are offering the bare minimum.  Right now, the 'health care plan' that Mr. Oniya's company is offering - assuming we only chose to enroll him and the little Oni - would take out about $150 per month.  During that one month, if either of them had a doctor's visit, we would have to pay the doctor up-front, and then apply for a $50 reimbursement.

It would do us more good to take the money and stuff it in a bank account.
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Trieste

Quote from: Vekseid on March 01, 2013, 06:24:19 AM
I just wrote a $720 check for a 2-mile ambulance ride. I went to pay a $950 hospital bill which I found to be more than reasonable, and noticed there was another one for over $10k for the ER trip and stay.

And this isn't the price insurers pay. It isn't the price Medicare pays. It's simply the price that hospitals try to charge to cover nonpayment, underpayment, overtesting, etc. On top of all this 'for profit non-profit' bullshit.

And like Pumpkin said... little of it goes to doctors and less to nurses.

It's not like traditional insurance is an option for me. For $12k, I can get two months of insurance. The war on the self-employed is going strong in this country.

Do you think this situation is even remotely defensible, or would you rather I have not had care?

I'm not sure how "ACA is better than nothing but nowhere near what we need" translates to defending current health care costs?

Ephiral

Quote from: Scribbles on March 01, 2013, 08:56:20 AM
Thanks for digging that up, I can see what you mean by strict regulation. It looks as if they go so far as to require hospital improvements or additions to be pre-approved and that the board is appointed by the government - I take it that the hospitals are fully state-owned.

I learned something here. I had always thought they were Crown corporations - entities owned by the government but privately run - but it turns out that they're actually owned and operated by private non-profit entities. The relationship strikes me as akin to a contractor - the government is pretty much their sole customer, so that customer gets to dictate a lot of the contractor's practices in order to insure that their money is well-spent. I've seen similar relationships in my time in the call-center industry.

Quote from: Scribbles on March 01, 2013, 08:56:20 AMThese two are actually related, if you take my previous thoughts on the matter. One of the major hurdles in some developing countries isn’t actually resources or infrastructure, oddly enough, but rather an apparent indifference held by leaders for their citizens. There just isn’t any motivation (positive or negative) to compel them to do their jobs, properly

I know this isn't the way the vernacular works, so not faulting you here, but I think it would be useful to draw a distinction between "developing" and "undeveloped" here. What you're describing, I'd file under "undeveloped".

Quote from: Scribbles on March 01, 2013, 08:56:20 AMI thought this might be an interesting read, if a bit dated (2000). I haven’t had the time to wade through the actual documentation yet but I found the statistics at the bottom interesting enough.

http://www.who.int/whr/2000/en/whr00_en.pdf

I hope it’s alright that I cut a few chunks out of the conversation. I just didn’t see anything more I could add to those other points beside maybe a nod. Thanks for the discussion Ephiral, it was an eye-opener.

Damn it, this is exactly the report I could've used in my second post. And yeah, it's got some pretty revealing bits. I don't mind you trimming the fat at all - I'm pretty horrible at it, myself. And you're quite welcome. I really enjoyed this.

Valthazar

I realize I am a bit of a late entrant to this conversation, but I figured I would add my two cents.  Like many others here have stated, while ACA is a step in the right direction, the wording of the law may actually end up hurting more Americans, than helping.

For example, the ACA defines a "full-time" employee entitled to health benefits as anyone working over 30 hours a week.  "For purposes of section 4980H, a “full-time employee” is an employee who is employed on average at least 30 hours per week." [[ Source ]]

As a business owner, this would either prompt me to keep more of my employees in part-time positions, or it would cause me to reduce the number of employees.  Just some food for thought.

Ephiral


RubySlippers

Quote from: ValthazarElite on March 23, 2013, 11:31:59 AM
I realize I am a bit of a late entrant to this conversation, but I figured I would add my two cents.  Like many others here have stated, while ACA is a step in the right direction, the wording of the law may actually end up hurting more Americans, than helping.

For example, the ACA defines a "full-time" employee entitled to health benefits as anyone working over 30 hours a week.  "For purposes of section 4980H, a “full-time employee” is an employee who is employed on average at least 30 hours per week." [[ Source ]]

As a business owner, this would either prompt me to keep more of my employees in part-time positions, or it would cause me to reduce the number of employees.  Just some food for thought.

Employers were trending this way in many major lower wage industries in my area retail, hospitality and food service as well as some skilled areas like nursing are generally under 30 hours or temporary workers in the case of nurses as one of several areas of more skilled workers. I suspect this trend will continue. But put it this way employers will need to hire more people to do the work the hours still need to be filled so it will lower the unemployment rate.

Its not a big issue people and industry just needs to adapt to the new law the odds of a repeal are remote.

Valthazar

Quote from: RubySlippers on March 23, 2013, 01:07:56 PMBut put it this way employers will need to hire more people to do the work the hours still need to be filled so it will lower the unemployment rate.

This is a good point, I think ACA will increase the number of jobs (even if that means an increase in the number of part time jobs, and a decrease in the number of full time jobs).  But overall, I think it will mean a decrease in the number of "good" jobs that provide benefits, which is needed to support a family.

Pumpkin Seeds

People will probably have to work two sets of jobs in order to make their money while also relying on government insurance for their benefits.  This will have the added bonus of less expensive benefits as the person is not paying the increasing insurance rates that are now coming out due to the AFA.  Also I don't think nursing is seeing a decline in the amount of hours offered.  If anything I see nurses working more hours.  Traveling has grown in size but that is because of the national shortage which is predicted to grow drastically over the next decade.

RubySlippers

Its not that big a deal in my area Target has for ten years set hours no more than 29 hours and when they want to get rid of an older employee they just gut the hours right now one worker is getting four hours a week so part-time hours are oddly warped in the employers favor in many ways. But I tend to see this as value to the employer a highly skilled worker say a nurse with a masters degree is worth more than a nursing assistant and the former is far more likely to work full-time over the less skilled worker.

In simple terms a cashier is worth less to an employer than a pharmacist in a Target and benefits and hours will be considered based on that.

Pumpkin Seeds

See, I’m not so certain the cutting back on hours will have as much of an impact as people are thinking.  As Ruby has pointed out many such employers have already cut back hours anyway to avoid paying for insurance coverage and benefits.  Those that have not tend to be smaller stores that were not obligated to provide insurance anyway and I believe under the AFA are still not required to do so.  Harder to come by employees such as nurses (which are harder to come by due to the massive shortage not from educational background since they only need an associate’s degree) and as listed pharmacists will not have their hours cut back since to attract such employees a decent benefits package is necessary.  So even with a few additional employers cutting back hours, the ones who had benefits before will likely keep them at the higher end and those that were teetering or had none will receive government insurance.

RubySlippers

Actual in the case of Target they just don't want to go over 40 hours a week now so set hours at 30 hours a week so shaving off a few hours is not a big leap and they will have to hire more people. In fact I'm seeing the shift to under 30 hours now at most places with low skill workers. Burger King, Taco Bell, McDonald's and Target I know for sure.

On the other hand a friend who is a commercial truck driver who is hazard cargo qualified is working over 40 hours a week for a company, its hard to replace drivers right now at that level. He likely will be fine.

But what matters is whether your state or mine is expanding Medicaid in some way since most of the workers will not likely earn at 138% of the poverty line or fairly low income and will get into an exchange. Its just the important part.

AndromedaDevonshire

I have a high skilled job myself, and work at a good company that is trying their best to keep our coverage.  Though, ::laughs::  Where I live, I applied for Medicaid.  Hell I even applied for food stamps too.  Want to know what's funny, I got approved for Medicaid and food stamps to my surprise.  I believe in working hard for a living, though hey... if the Govn't is gonna give me hand outs, why the hell not!?  So I dropped UCH health insurance, and transferred to Hosier Health, the state's Medicaid program. 

Here are the numbers....

Through work I was paying a month $215.00 with an 90/10 split, and three tier Prescription Drug at $10 / $30 / $70 .. oh and there was a $250 deductible, as well as $25 co-pay and $50 Specialist Co Pay visits. 

Through Indiana Medicaid I pay now...

$90 a month with 100% coverage, no 90/10 split, Prescription Drugs, (All) for only $3.00... no more three tier pay system, no Deductible, no Co Pay's ever again for me.... I can go to any major hospital and all cost covered. 

$300 in food stamps a month which don't ask me how, somehow I have Obama to thank for that too.  :\ 

So in a nut shell, I'm in my mid 30's great health.  Do I need Medicaid?  Nope.  Do I need food stamps?  Nope.  I got on them because hell, I see it as a hand out that I will thankfully take while it is around.  What's the lesson here? 

Learn the Law inside and out.  Hell, how do you think companies get out of paying taxes and skirting around the ACA, or Obama Care?  Easy, they study and learn the law page by page, then find loop holes in which to exploit.  High Health Cost got everyone down?  Did your premiums go way up because of Obama?  If so, then invest in hiring a lawyer who can sift through the dense papers, and trust me, you can find ways to Cheat the System.  Hell big companies do it all the time, why not the little guy too? 

This is not bragging as some might think that is what I'm doing here, though I'm giving you a real world reality check, and that if you think you're somehow getting screwed by all of this, chances are... you probably are.  Do research, and if you have money, seriously hire a lawyer to help you sift through the legal loop holes. 

Now, How do you honestly, lower health care cost?  Not by passing the ACA, nope..... you do something a bit different.  How about limiting the amount a person can sue a hospital or doctor for.  I have my doctor, and I know he is human, and can he make a mistake?  Yes.  He knows his art form as I call it, has been practicing for over two decades, yet I know, even he can still mess up.  Nurses, they have also been taught an art themselves, and can they also make mistakes?  Yes.  Now seeming that we have established everyone is human... and can be flawed, left open the gate for lawsuits to pour in.  You take into account that medical lawsuits have no cap value placed on them, and one wrong needle prick can cost not only the Doctor's Insurance, though the Hosiptal he works for Millions upon Millions of dollars.  High cost for an ambulance ride?  Wanna know why that is?  Again, their driving a Commercial Vehicle, and as such you know the insurance on Ambulances is extremely high.  This is why a single ambulance ride can cost between $500 - $1500 respectively depending on where you live. 

Just food for thought I guess. 

A.D.           

Trieste

That kind of skips over the fact that litigation and settlements are most often not actually about punishing the medical personnel. Um.

AndromedaDevonshire

Quote from: Trieste on March 29, 2013, 09:17:53 AM
That kind of skips over the fact that litigation and settlements are most often not actually about punishing the medical personnel. Um.

In most cases, it all adds up to money one can get.  I'm speaking about, someone who makes an -honest- mistake, because you know there are times, honest mistakes happen, and yes there are those quacks out there who shouldn't be practicing anyways. 

Trieste

That's because medical mistakes are expensive. It's not about punishing the provider and I'm having a hard time believing you're trying to make some sort of point about greed considering your previous post (you are aware that the money you don't need but you're accepting from the government anyway comes out of your nice doctor's taxes, too, right?) So the only objection I can figure is that you find the amounts staggering.  I assure you, if Jane Doe goes into the hospital and they make an honest, human mistake that makes her unable to work, she is not being outrageous suing them for millions. Most especially if she is a young woman who can expect to have to survive for 50+ years of living expenses and medical bills.

Ephiral

Quote from: AndromedaDevonshire on March 29, 2013, 08:56:05 AM
Now, How do you honestly, lower health care cost?  Not by passing the ACA, nope..... you do something a bit different.

Are you sure about that? The analyses are not on your side.

Trieste has the malpractice-caps bit covered, which brings me to...

Quote from: AndromedaDevonshire on March 29, 2013, 08:56:05 AMHigh cost for an ambulance ride?  Wanna know why that is?  Again, their driving a Commercial Vehicle, and as such you know the insurance on Ambulances is extremely high.  This is why a single ambulance ride can cost between $500 - $1500 respectively depending on where you live. 

Just food for thought I guess. 

This is not an argument for lawsuit caps, it is an argument that health care should not be a commercial venture. I've had to pay for an ambulance ride before. Want to know the cost that I found outrageous and unjustifiable at the time? $60. Because health care is considered an essential public good here, not a business.

Now, you want an idea that will really make a difference in health care costs, other than the ACA? Try cutting down the amount of administrative overhead in your health system. The US is basically setting one dollar in three on fire under the current system.

Valthazar

Quote from: Ephiral on March 29, 2013, 10:11:22 AM
Are you sure about that? The analyses are not on your side.

Just to point out, this analysis is a Congressional release written by the same Congress that passed ACA.

Quote from: Ephiral on March 29, 2013, 10:11:22 AMThis is not an argument for lawsuit caps, it is an argument that health care should not be a commercial venture. I've had to pay for an ambulance ride before. Want to know the cost that I found outrageous and unjustifiable at the time? $60. Because health care is considered an essential public good here, not a business.

What you say here is good in theory, but there will be unintended consequences.  People say the same thing about higher education in the US - and how it should be a "public good" for society.  The reason why American colleges have cutting edge research, and offer some of the best programs in the world is because they are all private business (apart from state/community colleges, who they themselves often function autonomously with their own internal budgets).  In order for each business, or college, to excel, they need to funnel grants and funding for research, and hiring the best professors, etc.  It is the same for healthcare in the US.  We have the best hospitals, the best medical equipment, and the best doctors - and that is the result of healthcare being a business.  For better or for worse, people are motivated by money, and money creates opportunities for services to flourish.

However, I do agree with you that the administrative overhead is the primary cause for the high cost of healthcare in the United States.  The problem is not the privatization of healthcare.

Avis habilis

Quote from: ValthazarElite on March 29, 2013, 03:40:05 PM
Just to point out, this analysis is a Congressional release written by the same Congress that passed ACA.

Nope. CBO is a nonpartisan body that in fact has nothing to do with any politician from either party.

Valthazar

Quote from: Avis habilis on March 29, 2013, 03:44:41 PM
Nope. CBO is a nonpartisan body that in fact has nothing to do with any politician from either party.

Thank you for the clarification - my mistake.

Ephiral

Quote from: ValthazarElite on March 29, 2013, 03:40:05 PMWhat you say here is good in theory, but there will be unintended consequences.  People say the same thing about higher education in the US - and how it should be a "public good" for society.  The reason why American colleges have cutting edge research, and offer some of the best programs in the world is because they are all private business (apart from state/community colleges, who they themselves often function autonomously with their own internal budgets).  In order for each business, or college, to excel, they need to funnel grants and funding for research, and hiring the best professors, etc.  It is the same for healthcare in the US.  We have the best hospitals, the best medical equipment, and the best doctors - and that is the result of healthcare being a business.  For better or for worse, people are motivated by money, and money creates opportunities for services to flourish.
You keep saying "the best", and yet it keeps looking like you haven't actually bothered comparing. Quite a few other countries have amazing research programs - many of them coming out of universities. As for health care, the central point at issue here... well, if the US's is the best in every category, why are you paying more for lower standards of care and reduced life expectancy? That's... an odd definition of "best".

Quote from: ValthazarElite on March 29, 2013, 03:40:05 PMHowever, I do agree with you that the administrative overhead is the primary cause for the high cost of healthcare in the United States.  The problem is not the privatization of healthcare.
These statements contradict each other. High administrative overhead is a direct result of privatization.

Trieste

I know this isn't statistical data or any such thing, but incidentally I found it interesting that Christopher Reeve, who by all rights should have had the money and the celebrity to gain access to pretty much the best that the US medical system had to offer, repeatedly praised places that have 'socialized healthcare' - Australia and Isreal are the ones he specifically names in this transcript.

While he was an activist, the man had a clear and burning desire to walk again. If the most effective medicine was going to be found in the US, he would have pursued it in the US. So... there's that.

(I could probably look up the statistics or something but I'll let someone else do that. I'm going to sit here and sigh over pictures of Superman.)

Valthazar

#41
Quote from: Ephiral on March 29, 2013, 07:20:12 PM
You keep saying "the best", and yet it keeps looking like you haven't actually bothered comparing. Quite a few other countries have amazing research programs - many of them coming out of universities. As for health care, the central point at issue here... well, if the US's is the best in every category, why are you paying more for lower standards of care and reduced life expectancy? That's... an odd definition of "best".

The reason we are in disagreement is because we have different perspectives of "best."  From what I understand, your concept of the best healthcare system is the one which offers average medical care to all its citizens at a low cost.  If you are using that as the standard of measure, then the US ranks 37th [[ Source ]]  On the other hand, my definition of "best" is a healthcare system that provides high quality services with easy access to those willing to pay.  [[ Source ]] 

The quote I liked was, "When Italian Prime Minister Silvio Berlusconi needed heart surgery, he didn't go to an Italian hospital. He didn't go to Austria or the Netherlands. He had his surgery at the Cleveland Clinic in Ohio." [[ Source ]] 

In addition, "They come here because they know that despite its flaws, the U.S. health care system still provides the highest quality care in the world. Whether the disease is cancer, pneumonia, heart disease or AIDS, the chances of a patient surviving are far higher in the U.S. than in other countries." [[ Source ]] 

In the United States, the traditional philosophy has always been that no one is inherently entitled to any commodity or service.  I personally believe that healthcare is a privilege, and not a right.  If people feel that their healthcare is a priority, then by buying heath insurance, they are guaranteed access to the best medical resources and cutting edge technology.  With my medical insurance right now, I know that if I ever wanted an elective procedure or to see a doctor, I will have no problems booking an appointment.

The ACA is a subtle move towards a single payer healthcare system, similar to England.  While it is certainly true that private insurances exist even in countries like England, it would be much more difficult for a person like myself to purchase it.  Because the tax rate is so high in England compared to the US, I simply wouldn't be unable to afford private insurance - and would be bundled along with everyone else.  In other words, regardless of one's priorities in saving, everyone gets the same medical care.

Ephiral

Yes, I believe that the best course of action is the one that maximizes pleasure and minimizes pain across the entire group of affected people. This is... kinda morality 101 for me. So you'll have a pretty hard time convincing me that a health care system founded on "Screw the majority, and overcharge even the minority" is anything but a bad idea. That's not the only issue I see with what you're saying, though:

Quote from: ValthazarElite on March 29, 2013, 07:48:25 PM
In the United States, the traditional philosophy has always been that no one is inherently entitled to any commodity or service.  I personally believe that healthcare is a privilege, and not a right.  If people feel that their healthcare is a priority, then by buying heath insurance, they are guaranteed access to the best medical resources and cutting edge technology.  With my medical insurance right now, I know that if I ever wanted an elective procedure or to see a doctor, I will have no problems booking an appointment.
There are a lot of assumptions being made here that have already been debunked in this very thread:
-That health insurance, particularly without ACA, is remotely affordable for the average person.
-That all, or even most, health insurance provides anywhere near the resources required.
-That "the best" services will be in-network for all insurance.
-That purchasing health insurance is a guarantee of access to the services the insurance does provide.
-That those of us who live under government-funded single-payer systems have any problem with going to the doctor just for shits and giggles, if we so choose.

If your insurance is covering all of your needs adequately, is not an unreasonable burden on your income, and provides a high quality of care, you are not the average US citizen. If you are arguing that this is a perfectly acceptable situation... well, that looks basically like "I got mine, screw everyone else". Which is a decidedly poor position to argue legislation from.

Kythia

Quote from: ValthazarElite on March 29, 2013, 07:48:25 PM
The reason we are in disagreement is because we have different perspectives of "best."  From what I understand, your concept of the best healthcare system is the one which offers average medical care to all its citizens at a low cost.  If you are using that as the standard of measure, then the US ranks 37th [[ Source ]]  On the other hand, my definition of "best" is a healthcare system that provides high quality services with easy access to those willing to pay.  [[ Source ]] 

The quote I liked was, "When Italian Prime Minister Silvio Berlusconi needed heart surgery, he didn't go to an Italian hospital. He didn't go to Austria or the Netherlands. He had his surgery at the Cleveland Clinic in Ohio." [[ Source ]] 

In addition, "They come here because they know that despite its flaws, the U.S. health care system still provides the highest quality care in the world. Whether the disease is cancer, pneumonia, heart disease or AIDS, the chances of a patient surviving are far higher in the U.S. than in other countries." [[ Source ]] 

In the United States, the traditional philosophy has always been that no one is inherently entitled to any commodity or service.  I personally believe that healthcare is a privilege, and not a right.  If people feel that their healthcare is a priority, then by buying heath insurance, they are guaranteed access to the best medical resources and cutting edge technology.  With my medical insurance right now, I know that if I ever wanted an elective procedure or to see a doctor, I will have no problems booking an appointment.

The ACA is a subtle move towards a single payer healthcare system, similar to England.  While it is certainly true that private insurances exist even in countries like England, it would be much more difficult for a person like myself to purchase it.  Because the tax rate is so high in England compared to the US, I simply wouldn't be unable to afford private insurance - and would be bundled along with everyone else.  In other words, regardless of one's priorities in saving, everyone gets the same medical care.

OK, pedantry of the highest order, but England isn't a country in the strictest sense.  UK is what you're aiming for.

/pedantry

Quote from: Declaration of Independannce
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.
(Emphasis mine - obviously)

Quote from: ValthazarElite
I personally believe that healthcare is a privilege, and not a right.

I get teh the DoI has no legal weight.  But I can't imagine a single purpose of government MORE important than maintaining the health of its population.  If you don't think thats what a government is for, to help give a healthy, well and happy populace, then honestly I can't see how you can think the government has any point at all.
242037

Valthazar

#44
Quote from: Ephiral on March 29, 2013, 08:09:32 PM
Yes, I believe that the best course of action is the one that maximizes pleasure and minimizes pain across the entire group of affected people. This is... kinda morality 101 for me. So you'll have a pretty hard time convincing me that a health care system founded on "Screw the majority, and overcharge even the minority" is anything but a bad idea.

I agree with you.  I think any sane person would say that universal coverage is an absolutely priority.  Don't confuse my position on this.  Where we differ is in HOW that is achieved.  You believe that it is the role of government to provide health insurance, whereas I believe that it is the role of the government to create an atmosphere where people can voluntarily choose to buy affordable private insurance on their own.  In other words, eliminate corruption in healthcare, and eliminate the overhead costs, as we discussed earlier.

ACA unfortunately puts sanctions on private businesses that coerces them to purchase private insurance plans for their employees.  As a small business owner, this is taking a terrible toll on my business - and it is not at all solving the high cost of healthcare.  You're basically giving more people coverage, but taxing our economy to death.  I am struggling to stay afloat in preparation for 2014.

For example, the idea of eliminating pre-existing conditions clauses is one that I support.  In no way am I saying that it is desirable for people to be uninsured.

Quote from: Kythia on March 29, 2013, 08:12:56 PMI get teh the DoI has no legal weight.  But I can't imagine a single purpose of government MORE important than maintaining the health of its population.  If you don't think thats what a government is for, to help give a healthy, well and happy populace, then honestly I can't see how you can think the government has any point at all.

Again, I also fully support the idea of providing healthcare to all Americans - we just differ in how it is achieved.  I think all of us can agree that corruption, greed, and flawed capitalism have created the high costs of health insurance in the US.  I support greater sanctions on health insurance companies to create affordable plans that people can voluntarily opt into or out of.  In other words, I'm sure both of you would agree that charging $150-250/month for health insurance is a fair premium for an average single person, right?  Right now, it's well over $1000 dollars, and it's ridiculous.  We should aspire for a climate where everyone has the opportunity to afford healthcare as a choice - since that maintains individual liberty and responsibility.  Should someone who squanders all of his money on fast food and beer really be utilizing our tax dollars for health care?

Oniya

Hate to break it to you, but those are exactly the people that our tax dollars have been providing health care for.  When Joe Schmoe smokes so much his circulation starts to be affected, he doesn't go to 'a doctor' right away - no insurance, after all, and he can put up with tingly fingers.  He waits until his fingers are turning black and gangrenous and gets a ride to the ER - that he can't pay for, but 911 doesn't check your wallet along with your vitals.  After he's gotten the dead stuff cut off, and he's recovering, he starts getting bills - that he also can't pay.  Then it goes to collections and so forth and so on.  Joe Schmoe ends up dying of a heart attack walking 6 feet from his car to the McDonald's door, and there might be enough in his combined assets to pay for that initial ER trip, but probably not.  Where does the cost get paid from? Higher costs, higher insurance rates.
"Language was invented for one reason, boys - to woo women.~*~*~Don't think it's all been done before
And in that endeavor, laziness will not do." ~*~*~*~*~*~*~*~*~*~*~Don't think we're never gonna win this war
Robin Williams-Dead Poets Society ~*~*~*~*~*~*~*~*~*~*~*~*~*~Don't think your world's gonna fall apart
I do have a cause, though.  It's obscenity.  I'm for it.  - Tom Lehrer~*~All you need is your beautiful heart
O/O's Updated 5/11/21 - A/A's - Current Status! - Writing a novel - all draws for Fool of Fire up!
Requests updated March 17

Valthazar

Quote from: Oniya on March 29, 2013, 08:45:57 PM
Hate to break it to you, but those are exactly the people that our tax dollars have been providing health care for.

Yes, very true point.  I agree with all of you that there are some real problems with our current healthcare system - it's just that I don't feel ACA is the right solution.  I'm seeing the effects first hand - as I am unfortunately having to turn a lot of my full-time employees into part-time employees because I simply cannot afford the insurance mandates.


Ephiral

Quote from: ValthazarElite on March 29, 2013, 08:31:53 PMACA unfortunately puts sanctions on private businesses that coerces them to purchase private insurance plans for their employees.  As a small business owner, this is taking a terrible toll on my business - and it is not at all solving the high cost of healthcare.  You're basically giving more people coverage, but taxing our economy to death.  I am struggling to stay afloat in preparation for 2014.
I assume you have an actual rebuttal to the studies I linked earlier? Or at least some grounds to assert that it's not reducing the cost of care?

Quote from: ValthazarElite on March 29, 2013, 08:31:53 PMAgain, I also fully support the idea of providing healthcare to all Americans - we just differ in how it is achieved.  I think all of us can agree that corruption, greed, and flawed capitalism have created the high costs of health insurance in the US.  I support greater sanctions on health insurance companies to create affordable plans that people can voluntarily opt into or out of.  In other words, I'm sure both of you would agree that charging $150-250/month for health insurance is a fair premium for an average single person, right?  Right now, it's well over $1000 dollars, and it's ridiculous.  We should aspire for a climate where everyone has the opportunity to afford healthcare as a choice - since that maintains individual liberty and responsibility.  Should someone who squanders all of his money on fast food and beer really be utilizing our tax dollars for health care?

No, I would not say that. Health care is an essential public service, and I don't think that a business model is a good one at all. Flat rates are wildly unfair toward the poor - that rate would be crippling to my family. By comparison, let's look at the progressive model I'm under. My province, as always, keeps shitty books, but if we assume the province's numbers are the same as the federal ones, my wife is currently paying approximately two percent of her income for health care. If we look at the top marginal tax rate in the country, only applying to income over $150k, then that works out to a whopping 4.25%. Yes, that's a lot more than your $150-$250/mo, but it's still a completely negligible burden.

Should someone who blows all their money on fast food and beer have access to government-supported health care? Absolutely - they're paying into the system too. This is how it works.

Valthazar

#48
Quote from: Ephiral on March 29, 2013, 09:21:20 PM
I assume you have an actual rebuttal to the studies I linked earlier? Or at least some grounds to assert that it's not reducing the cost of care?

First and foremost, the healthcare that is provided by an employer who provides benefits for full-time employees is at a subsidized cost, usually at a very affordable rate for most employees.  This is because the employer fronts most of the premium for full-time workers.  For example, as part of the full-time benefits package I offer my employees, I pay a portion of the premium, and the employee pays a small portion of it as well.  This is the case with most businesses that currently provide health insurance for their employees.  This issue about the high premiums for health insurance applies for people who want to autonomously purchase private insurance (outside or independently of an employer) - or if their employer does not offer a benefits package. 

With ACA, myself, and many other business owners will be forced to convert many of our full-time positions into part-time positions.  Any employee working over 30 hours qualifies for the affordable benefits package under ACA.  Because this is simply unaffordable for me, I will need to get rid of many of these positions - so these individuals will have to now autonomously purchase heath insurance (which even though the price of private insurance may fall slightly with ACA - does not gain help from their employer in paying for for the premium).  In other words, my point is that ACA will reduce the # of full time employees, and thus remove employer support for health care premium payments.  If anything, it will cause more people to turn to Medicaid.

Like I have said repeatedly, I completely support the goals of ACA - but I feel it will end up hurting the economy to a far greater degree than it will reduce the cost of healthcare (which is something I am less familiar with).

Edit: typo correction

RubySlippers

We need more people employed if you need to hire more people more people have jobs, lowering unemployment. Does it matter if they get insurance from you, on an exchange or going onto Medicaid?


Valthazar

Well, I am planning to open up more part-time positions, to get the same amount of work done, now that I have to cut full-time peoples' hours.  I guess in one way it is good, because it creates more part-time jobs.  The result though, will be an increase in the number of people going into Medicaid (as opposed to employer subsidized private insurance).  I am not very familiar with the details, but the end result will be an expansion of government provided healthcare, I believe.

Ephiral

Quote from: ValthazarElite on March 31, 2013, 09:32:37 PM
Well, I am planning to open up more part-time positions, to get the same amount of work done, now that I have to cut full-time peoples' hours.  I guess in one way it is good, because it creates more part-time jobs.  The result though, will be an increase in the number of people going into Medicaid (as opposed to employer subsidized private insurance).  I am not very familiar with the details, but the end result will be an expansion of government provided healthcare, I believe.
And if this expansion is happening at a net decrease in costs, as the studies indicate... I'm failing to see the downside here. More people get work, more people get health care, less money is set on fire in the process. Seems like a win-win-win.