Well, I was wrong. The Supreme Court has voted 5-4 to uphold the PPACA:
June 28, 2012 (WASHINGTON) — The Supreme Court has upheld the individual insurance requirement at the heart of President Barack Obama’s health care overhaul.
The court on Thursday handed Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty.
The entire ACA is upheld, with the exception that the federal government’s power to terminate states’ Medicaid funds is narrowly read.
The White House must be very pleased. Relieved.
What I expect going forward is that, barring its repeal by a future Congress, the workings of the ACA will be allowed to play out. The law will not be expanded for the foreseeable future. A few more people but not everybody will have healthcare coverage. Due to the Medicaid portion of the decision the additional number covered will not be as many as projected. Healthcare costs will continue to rise at a rate sufficient for healthcare to remain the primary driver in the increasing cost of living.
@Sam
“Both parties used and withdrew the “tax†term as needed. When drafting the bill the Republicans called it a tax. They stopped calling it a tax when it wouldn’t have helped their case before the court. Now that it’s no longer before the court they are back to calling it a tax.”
In the months leading up to the December vote, the republicans were saying the mandate was a tax, as one of their reasons they were so against the ACA. Such an interpretation, though, was soundly refuted by Obama and the democrats. It was then parlayed into a Congressional vote as ‘not’ a tax, and, consequently passed on that label, under the commerce clause.
However, when it finally made it up to the supremes, the vehicle it was carried in on (a regulation of the commerce clause) didn’t fit within the constructs of the constitution. In order for Roberts to exercise his judicial restraint, he used the liberty of shifting the argument out of the commerce clause, over into a taxing mechanism, which was then construed to properly uphold the mandate part of the ACA. But, was this judicial enabling? And, how fair is a law, going into a congressional vote under the guise of regulation, coming out, on the other end of the supremes, as a tax, when suppositions say it never would have even passed mustard in the Congress had it not been mislabeled in the first place?
TastyBits,
I appreciate your open-mindedness in assessing the failures of both parties. Politics always seems to have it’s way in overriding common sense and honesty during the legislative activities of deciding what is the best outcome for the country. It usually seems to pan out as to what is best for the politicians first, and secondarily what is best for their own special interest groups. Everything and everyone else falls to the back of the line, after those two items on their ‘to-do list’ are satisfied.
I was also struck by the clarity of this paragraph:
“The problem is that you have isolated yourself from the consequences of the solutions you support. Your concern for the “poor and working class people†is only for your benefit. The devastation your solutions have caused is not your problem.”
That is the crux of liberal guilt, IMO. Hence we have a proliferation of limousine liberals, who are able to assuage any uneasiness towards their wealth or status, by being vocal supporters of who they see as the underclass. Never mind, that much of their ‘help’ may only weaken these same human beings into a permanently dependent class. It is all about the show of empathy, the rage and sarcasm towards those who they deem as callous offenders to their own superior philosophical ideas and ideals. It all seems such a sham to me. But, boy does it play well out there in the public arena!
I also agree that the ‘pulling yourself up by the boot straps’ is oftentimes just as nearsighted and disingenuous on the other side of the political spectrum. My dad always stressed moderation and balance in one’s life. And, IMO, neither the far right nor the far left seems to practice the wisdom of meeting in the middle, as the theatrical gain, or possibility of power, that embodies strident behavior, is just too tempting to pass up. .
@Jan
… permanently dependent class …
I would not limit this to the lower end of the socio-economic hierarchy. Most of us are sucking off the government teat – me, you, Dave, Icepick, Drew, Michael Reynolds, and we are all whores to one degree or another.
A panda in the zoo has nutritious food and health care. According to liberal philosophy, the panda is being given his/her panda rights. According to conservative philosophy, the panda should be striving to improve his/her situation. Does this mean the panda should learn a few tricks.
I suspect most pandas would rather be with other pandas in their natural habitat, but a few would rather the zoo. What the pandas would benefit from most, is for humans to stop destroying their home. When I see the panda lovers lowering their living standard, I will take notice. Sell all your possessions, and give it to the pandas.
“It is all nonsense anyway.”
– Me
@ TastyBits
…” we are all whores to one degree or another.”
It’s human nature to cuddle up and get used to what we are either given, or can get away with. Consequently, it takes a great deal of self awareness, ethical behavior, coupled with self-discipline to do “the right thing” in this life…
@jan:
I don’t deny that the Democrats were opportunistic and dishonest with the “tax” term. I just question your position that Republicans were not. I have a healthy distrust of ALL politicians, not just the ones that pretend to agree with me.
Sam
I am not trying to cover the republicans in all sweetness.
However, by my recollection, the battle between the republicans and the democrats on the mandate was that it was called a tax by the former. Taxation is a dirty word, and when a protocol falls into that category, there is a far greater likelihood it will fail. Hence, the dems were adamant in their conclusions that the mandate was a penalty, not a tax. And, it was through this assertion (and now mislabeling of the policy) that they got it past a very controversial congressional vote.
It was because of this vote that the ACA made it all the way up to the supremes, where it was then magically transformed, by Justice Roberts, into being a ‘tax,’ thereby creating, by his single vote alone, a majority decision validating the ACA as meeting the perimeters of being constitutional . When you follow the strategy here, I’m handing the obfuscation and deception award to the dems.
In other issues and discussions the criticism might be apportioned differently.
TastyBits:
Dude, if you’ve decided your mission is to take me on, you should try paying some attention. I’m pretty sure my “poverty cred” beats anyone here. Everyone here who has less than a high school diploma, raise your hand. Everyone here who spent more than ten years as a waiter, raise your hand. Everyone here who started full time work at age 16, raise your hand. Everyone who’s ever been in jail. Everyone who’s lived in a trailer. Everyone who’s ever slept under a freeway overpass or behind a bush? Kept your stuff in a Trailways locker? “Bathed” in a public library bathroom? Been held up at gunpoint? Has his wife pistol-whipped in a rape attempt? Cleaned toilets and used tampon bins for a living? Walked from one end of town to another in bare feet looking for work because he couldn’t afford the 60 cents for the bus and his one pair of shoes was falling apart?
Oh, look: I’m the only one with his hand up the whole time. I have a very nice life now. Emphasis on now. As I admitted to Ice the other day, all that past is finally starting to fade a little for me, but only a little.
I wouldn’t even try to go head-to-head with you but, if I’ve never been quite as low as you, it’s only because I’m more middle class, cagier.
So, for example, I worked full time from age 17 on—while going to college full time. For the next half dozen years I made more money singing than doing anything else. The most I’ve ever done is spent a single night in jail. Crashed on various friends’ sofas for a year. Spent a summer with nothing to eat but rice I’d bought at the beginning of the summer, vegetables I grew in my garden, and fish I caught in the lake.
I’ve never been held up at gunpoint. Jumped a couple of times and beat the snot out of my attackers.
I suspect that some of these similar experiences are why we’re pretty simpatico.
Sometimes the lights all shinin’ on me
Other times I can barely see
Lately it occurs to me
What a long, strange trip it’s been.
–Grateful Dead
Michael
You wear your life like it’s a badge of courage, combined with an Oscar for best human travails documentary. And, maybe, because of what you’ve experienced, living through it all to be on the opposite side of impoverishment — wealthy and successful — it’s well deserved.
However, hard dirty times are part and parcel of many peoples’ lives, who don’t become wealthy and successful. So, I would call you lucky, resourceful, resilient, and smart. However, I still think with all that rich fodder, distilled in your background, there would be less snark and defensiveness, and more confidence in what the human spirit can accomplish, under less than desirable circumstances.
Essentially, the philosophies, and somewhat destructive empathetic moods resonating from you reminds me of the butterfly coming out of it’s chrysalis story. By feeling sorry for the butterfly, in a struggle to free themselves from the chrysalis, a sympathetic observer helpfully cuts and loosens the chrysalis. However, the butterfly becomes weakened from this kind gesture, emerging with undeveloped wings — wings that would have been stronger had the struggle been allowed to continue and be completed. That’s the analogy of the society you so oftentimes champion; one that, in your estimation, is never good enough to become something on their own, without government assistance jumping in and giving them a push, whether they really need it or not.
You can stop at “lucky.” The rest comes from luck. I drew some good cards in the DNA deal. Then I had even more luck. Which is why this. . .
. . . doesn’t work.
I’ll give you a quick anecdote that still makes me feel guilty. I was working at a restaurant in Ocean City. We had a somewhat disabled dishwasher named Bob. He used to wear a trash bag cut like a poncho to avoid getting wet at work. So clever me, I coined the phrase Bob-In-A-Bag for him and got some laughs.
Now, I want you to try and understand the gap between me and Bob-In-A-Bag. Bob was fucked by life. I probably have 85 IQ points on Bob. I’m big, strong, healthy and smart. While I was being dealt three aces in the form of undeserved talents, Bob was retarded and friendless and ridiculed and working a dead-end job that was the highest he was ever going to get.
I’d like to live in a country where Bob could get to a doctor when he’s sick and have enough to eat and a place to live. That’s what we’re talking about. That’s the essence of being a Democrat, believing that people who are screwed by life — whether permanently like Bob, or temporarily like someone with an illness — still deserve a decent existence.
When I was a Christian we were told that we had an obligation to our fellow man. And no, Jan, your husband handing out two dollar bills to hobos does not discharge that obligation. These are our fellow Americans, our fellow humans, and it makes me frankly sick when some middle-class mommy like you, or some upper-income businessman like Drew, bitches about having to surrender a portion of the incredible bounty you have to care for someone who has little or nothing. It is nauseating.
You wear your life like it’s a badge of courage, combined with an Oscar for best human travails documentary.
No, that would be Drew.
@Michael Reynolds
I asked specific questions, and they have nothing to do with poverty. As to your “poverty cred”, I specifically did not question it. You have given examples, and I have no reason to distrust you.
I can answer yes to all of my questions, and it is not pretty. These are the results of liberal solutions. (To be fair, conservatives have profited.) It was my choice not poverty that caused me to be there. I prefer to be closer to the streets, but I understand Alfred P. Doolittle’s complaint. I have moved on, but I have not forgotten.
I was a dish pig for a while, but my hands got too raw. I have had my share of manual labor – shoveling, hauling, loading, unloading.
Sleeping and bathing in non-conventional places – yes, but not long term.
I have never been held-up. I suspect that they way I look and carry myself prevents a lot of problems. It is not intimidation. It is easier to mess with somebody else.
I am sorry your wife had to experience something that ugly. My wife thinks she is a bad ass. The fact that it may be me that is the intimidating factor does not enter her calculations.
Jail? Prison really, but yeah – in the drunk tank and otherwise.
I do not care where you live now or much money you have. I am happy for you.
“And no, Jan, your husband handing out two dollar bills to hobos does not discharge that obligation. These are our fellow Americans, our fellow humans, and it makes me frankly sick when some middle-class mommy like you, or some upper-income businessman like Drew, bitches about having to surrender a portion of the incredible bounty you have to care for someone who has little or nothing. It is nauseating.”
My husband gives two dollar gestures to people, all kinds of people, in order to wish upon them luck, not as a monetary hand-out.
As far as my classification, it’s human being. I don’t layer myself with any status associated by material means. For one thing, we leave this plain totally alone and without our valuables. The only asset we take with us are our actions, contributions to others, and the lessons learned and perhaps humbly given to others. This is our wealth.
However, I also don’t pity people as you seem to do. Bob may have seemed like a guy given the short end of the stick…. to you However, that is your assessment. It may not have been his. In fact I look at it as being rather condescending to evaluate him as you appear to have done. For, ‘Bob’ may have been a contented fellow, not down in the mouth by the handicaps that you obviously didn’t want to be burdened with yourself.
I’ve been involved with street people, homeless people, addicts, people without a pot to pee in, and you know what, they somehow survive, make it, are very entertaining to be with, some even bloom where they are planted, and certainly would grimace if I gave them the one-two sob story of how down and out they were like you attach to such human beings.
IMO, one’s pity only takes away another’s dignity.
@Michael Reynolds
… We had a somewhat disabled dishwasher named Bob. He used to wear a trash bag cut like a poncho to avoid getting wet at work. …
For future reference, ditch the bag. You still get wet from sweating. Use a folded busboy apron instead. Also, it’s dish pig.
… I probably have 85 IQ points on Bob. …
Again, I am tired of hearing about how much smarter you are based on a test designed for smart people by smart people.
… friendless and ridiculed …
How is this societies fault. Do we outlaw assholes, or do we have an asshole tax? I am not willing to accept your guilt. You need to work it out yourself. While you cannot help Bob, you could help somebody else. Drop by an old folks home, tutor one of the children of the cleaning lady (your neighbor’s?), find another Bob to help.
If you were able to locate Bob, would you bring him into your home and share your good fortune (luck)?
I’d like to live in a country where Bob could get to a doctor when he’s sick and have enough to eat and a place to live. … [see above]
Bob gets all that, but it is substandard (really, really shitty). In order to ensure that Bob gets the worst of everything, we have tossed a few generations into the shitcan as well. While Bob and the others live in a shithole, somebody is making a lot of money with the money we are spending to help them. Of course, the only way to know this is to take of a tour of these areas.
If Bob lives in a large city, he probably goes to a public hospital. It is probably a teaching hospital, and he may have to pass through a metal detector to enter. Bob will get free healthcare, and the soon to be doctors will get experience (practice). Bob gets free nutritious food and healthcare, but so does a cow waiting to be slaughtered. Bob would probably be better off in the barn, but he is not as valuable as a cow.
… These are our fellow Americans, our fellow humans …
Yes, and they deserve respect. They are not pets that need to be cared for, and they damn sure do not exist to make you feel better about yourself.
@jan
Well said.
Do we outlaw assholes, or do we have an asshole tax?
Technically I think they would tax people for failing to be not an asshole. It would be called a “penalty”.
But will they subsidize poor assholes so that they can be just as big an asshole as someone who is rich? I mean, it would only be fair…
Because only the assholes get ahead in this world. So we would need to have a Headstart-type program to help childre in poor areas learn to be true assholes. Call it Anusstate, and look for federal subsidies to states that run the programs. You’ve got to do it – think of the children!
[And thus, on the evening of June 29th, 2012, a great new program in social welfare was formed. In order to ensure equal outcomes in life’s grand Asshole Sweepstakes, programs were put into place to help everyone become the cornhole they had always dreamed of being. Funding was obtained by taxing current assholes for their success in bungholery. By this method, all the non-assholes automatically became assholes by use of state force to ensure that assholes be both punished for their sphincter-like natures and that they pay to teach others how to pucker up. A great Golden Age followed as now EVERYONE got ahead, tax revenues soared (allowing the national debt to be retired within three years) and a true Lake Woebegone Society flourished over a large part of North America.]
@Icepick
I bow down before you.
Maybe you should think about writing. I think you could work this up into an essay at least, but you could easily increase it. “Animal Farm” is about 120 pages.
Tasty:
I have no idea what any of that meant. Kind of seems like drivel to me. And again, it would be so helpful if you actually read what people write before ranting. Ocean City ≠major city with teaching hospital. So there goes that fantasy answer.
Jan:
Luke 6:36 Be full of pity, even as your Father is full of pity.
Matthew 15:22 Here a Canaanite woman of the district came out and persistently cried out, “Sir, Son of David, pity me; my daughter is cruelly harassed by a demon.” And Jesus got his disciples together and said, I have pity for the people, because they have now been with me three days and have no food: and I will not send them away without food, or they will have no strength for the journey.
Matthew 20:34:
And Jesus in pity touched their eyes, and immediately they recovered their sight and followed him.
Matthew 9:36
And when He saw the crowds He was touched with pity for them, because they were distressed and were fainting on the ground like sheep which have no shepherd.
Luke 10:33 But a certain Samaritan, being on a journey, came where he lay, and seeing him was moved with pity. “The one who showed him pity,” he replied. “Go,” said Jesus, “and act in the same way.”
I could go on. And on and on. But you’re that special kind of Christian, aren’t you? The one who prefers Rush Limbaugh to the actual, biblical Jesus. Much easier to be sanctimonious and selfish.
I could go on. And on and on. But you’re that special kind of Christian, aren’t you? The one who prefers Rush Limbaugh to the actual, biblical Jesus. Much easier to be sanctimonious and selfish.
I don’t listen to Limbaugh, for one thing… disliking the man. But, that is only the crusty Michael trying to get a dig in here and there. I also infrequently attend a church service, but I do pray every night asking for guidance for all the problems I have no control over. I did have a Greek Orthordox Father of the church call me last week to see how I was doing, as well. But, I don’t rely on scriptures to take another down on their knees to show superiority over them. I’ll leave that to you, Michael…poor soul that you are.
@Michael Reynolds
… Ocean City ≠major city with teaching hospital. So there goes that fantasy answer.
Perhaps you missed the “If” and “probably” portion of the sentence. Substitute Frank in Oakland if you prefer. There are a lot of folks in Oakland that would trade places with Bob. Now that I know about Ocean City, I would switch places with Bob.
Are we are supposed to use the case of one guy in a resort town as a basis for US social policy? You are kidding right? If not, it explains a lot.
Maybe you should think about writing.
Or maybe not! That’s one hard-ass profession. It would be like banking on becoming a professional athlete – few have the inate ability, and fewer still ever make it.
Comparatively, Reynolds is like one of those guys that is always a starter in the NBA, maybe an occassional All-Star, like a Horace Grant. I’m not saying that to run him down, really I’m not. There’s a big difference in achievement between him and the Stephen King’s of the world. That would be like comparing Horace to one-time teammates Michael Jordan or Shaquille O’Neal. But the difference between Horace Grant and someone that barely hangs on for two or three seasons as a scrub, like a Michael Ansley, is even bigger, and more heart-breaking. And the difference between Horace and the guys that don’t make it is bigger still.
Reynolds is WAY high up there on the success ladder* of writers. Personally, I’ve never read any of his stuff and doubt I ever will. I wouldn’t be shocked if no one on this board has ever read any of his books. So what? He and his wife have been bankable for twenty years or so now. That’s remarkable.
What you’re suggesting is something like telling a tall guy that can dunk on a playground he should give the NBA a shot. That just ain’t gonna happen.
* I once saw a show on one-hit wonders in music. One of the people commenting on it was a musician of some note himself, better than a one-hit wonder type. He made the point that one-hit wonders are incredible successes compared to just about every other musician out there. In these kinds of professions inches are like miles. You can be SO CLOSE and never even get noticed.
Discussions like the above make me not mind the lack of religiousity in my life. Sanctimoniousness oozing out all over.
My objections are practical. I don’t give a damn about who cares or claims they care about whomever, save that condescension pisses me off reflexively. There are winners and losers in life, and the winners pretty much don’t give a shit about the losers unless they’re blood relatives, and frequently enough not even then. Social policy to allow people to shake off some guilt about mistreating some fellow human being is unhelpful. Depending on the size of the proposed “solution” it is downright dangerous.
No policy that proposes impractical or unworkable solutions can succeed. It is as simple as that. The PPACA is unworkable – it amplifies much of the bad in the current system and cures few problems, and at best it does nothing about the single biggest problem in the American health care system, that of exploding costs.
IT IS A BAD POLICY PRESCRIPTION.
Worse, it is a big overreach by Congress and vests ever more power in unelected officials via their regulatory capacity. On top of that, it is clearly, to my mind, beyond the scope of the power vested in Congress. The Supreme Court disagrees with me, but I don’t really care much about that – the legal profession has made it clear in the last 100 years that they view the Constitution as a hurdle to be cleared at best, and as a burden at worst.
So, we have a bad policy which cannot accomplish anything positive in the health care system overall, and it is just hastening the overall destruction of the US governmental system by the people elected to uphold it. How long before the Supreme Court’s approval ratings are in the same range as Congress’s? How long can the government survive if no one respects it?
Against this we have inchoate feelings of guilt by some, and naked profit motive by others.
Can someone explain to me how this is supposed to work out in the end?
The guy I kind of worship. Not just talented as hell but an amazingly hardworking person. Guy runs him down with a truck and up pops Steve and cranks out a thousand pages. And he was very nice to me. One of the handful of biggest rushes in my writing life was getting blurbed by Mr. King.
I have no argument to make that the ACA will work. You and Dave have made compelling arguments. But I don’t see it as a constitutional violation or the end of the world. What I have wanted from the start, and have said from the start I wanted, is that we establish as a principal: 1) Everyone is in the pool, and 2) We don’t let health care emergencies push people into homeless shelters.
I’m a half a loaf guy. The above is my half a loaf, I’ll take it and hope someone figures out the other half.
We’ll find out.
@Michael Reynolds
1) Single-payer
Modeled after an HMO with some Medicaid or Medicare
(a) issue a Universal Healthcare card and # (SS)
(b) everyone gets minimum healthcare (checkups, etc.)
(c) add a new Universal Healthcare tax (SS or Medicare)
2) Health Insurance (catastrophic)
(a) Flood insurance model or
(b) auto insurance high risk model
The third issue everybody is trying to fix is costs, and this is the problem. Neither of the two will fix the cost issue.
Health “Insurance” will not solve the cost problem. A Health “Insurance” Market may lower policy costs through competition, but it does not address healthcare costs. The system we have now is analogous to using FedEx instead of the Post Office.We pay exorbitant prices for a simple service.
A fourth issue few people are trying to address is supply. Presently we have less supply than demand, and in a free market, prices go up. Until we have more supply than demand, prices will not naturally go down, and this requires an increased supply and/or a decreased demand.
This is just a thumbnail sketch. It would take to long to flesh out.
Democrats should have gone for 1 & 2. The Republicans would have howled, but it would probably have been popular. Insurance remains unchanged, but everybody gets minimum coverage.
Tasty:
Yes, I’m familiar with the issue. And unlike some, I remember the politics which were not so long ago. The Republicans had vowed absolute opposition – to anything and everything. Which put any effort in the hands of a couple of conservative Democrats from red states who were determined to avoid backing anything “socialist.”
So the “should have . . .” is nonsense. What was done is what could be done under the circumstances. Anything more fundamental was rendered impossible by GOP nihilism.
The truth is that what should have been done is that Republicans should have been willing to work with Democrats to actually solve the problem. But the GOP had sworn to oppose any program of any sort on any issue, no matter how pressing.
What we salvaged from this mess was a principle that at that point was under attack from the GOP: the principal that American citizens should have a right to health care, and that everyone should contribute. It was politically necessary to take this half step because Republicans are retarded. It’s the same reason we had to have DADT before we could move to the obviously inevitable full legal acceptance of gays: because Republicans are retarded. The same reason we can’t get immigration reform, even when it’s backed by John McCain: because Republicans are retarded. Same reason we launched wars we were not prepared to win, and tax cuts we couldn’t afford, and wandered off into ludicrous impeachments and contempt citations and birth certificate obsessions: because Republicans are retarded. We end up doing a lot of stupid, half measures because Republicans are retarded.
Here’s how American politics is supposed to work: Democrats are the enthusiastic, idealistic kid full of ideas, and Republicans are the sober, experienced old hands who say, “Hey, let’s think about this first.” Well, that died with the Southern Strategy. Republicans lost their fucking minds and descended into a sort of political Alzheimers – senile ranting, wild paranoias, confusion, emotional breakdowns and intransigence. And at the same time Democrats discovered that Goldman Sachs could make political contributions. (Hey!)
So we have two corrupt parties, with one at least attempting – however incompetently – to do something right, and the other nothing but a collection of stupid, crazy old farts who refuse to take their meds.
You want us to come up with the exact right solution? Under these circumstances? We got what we could get, everything else is fantasy.
At the same time the Democrats suffered their own collapse, not something induced by Republicans. I think that Viet Nam killed the “enthusiastic, idealistic kid full of ideas”. Now the Democratic coalition is rocked between the Scylla of interest group politics and the Charybdis of technocracy.
@Tasty- I think being in the same kind of system is more important than single payer. There arent really many single payers in the world and it is not clear that they are superior.
I generally like the idea of a universal but limited plan. People who want could buy additional coverage. It should be portable and not attached to the workplace.
Supply is interesting. You should read up on supplier induced demand. I think that an increase in the number of providers would likely eventually decrease the costs of individual procedures, but initially and for some unknown amount of time, it is likely to just increase overall spending. Health care really is different than buying commodities. OTOH, having been through a divorce, I believe that divorce lawyers are also pretty good at supplier induced demand, so medicine is not unique in this aspect.
Costs are the tough part.
Steve
I think that was true for a long time, but I think Mr. Clinton put that partly to bed.
Sort of the fossils of their ideas – civil rights morphs into a series of bureaucracies and voting blocs. Public works become payola machines. Education becomes sinecures for mediocrities and their unions. Etc… I understand the horror genuine conservatives have at the creation of any new government thing. Once “It’s alive!” it’s impossible to kill it. Even when it’s no longer doing anything useful. It’s why we need actual, real conservatives. I wish we had some.
It’s a symbiosis. Real liberals and real conservatives can maybe get things done. Corrupted, directionless liberals and angry mental patients can’t.
Steve:
I think a lot of costs could be reduced in areas that aren’t all that big a part of the problem – doctor visits, etc.. But as everyone has pointed out the real cost is in the 85 year-old desperate to become an 85 1/2 year old. As a society we are just in denial about death in old age. We act as though it’s an unfortunate and avoidable thing to be fought with every last weapon at hand, not as if it is natural and inevitable. Let me put it this way: Vikings would have much lower health care costs.
There’s a significant chance I’ll be dead in 10 years, a strong likelihood I’ll be dead in 20, and a near-certainty I’ll be dead in 30. And so it goes.
@sam
I am not endorsing a single payer system, but I tend to agree with the left in their reasoning.
My observation is that the same dynamic in housing and tuition is working on healthcare. More money pours into the system, and prices increase. Price increases cause more money to be poured into the system. Rinse and repeat.
I am with the VA, but we do not have insurance for my wife and stepson. Neither of our employers offer it. My employer tried to get policies for us, but because we are small, the price was high. I believe it was about 20K, and there was no way the company could support. We could either take a pay cut or do without. Since our bills were not going to be cut, we kept our pay. My healthcare plan is the pay as you go, and try to keep expenses down. A lot of things become optional when you pay for it. Our healthcare costs are determined by how much we are willing to pay.
If we had health “insurance”, our choices would be limited by what we could get the insurance to pay. Things that were optional suddenly become must haves. When we are forced to get a policy, we are not going to utilize the system less. Our usage will increase substantially, and I suspect this will be true for most of the newly insured.
When the demand is limited by what a third-party will pay, the feedback loop is short circuited. The patient’s decision to go to the doctor is based upon what the third-party will pay, and the doctor’s decision for treatment is based upon what third-party will pay. The outcome seems obvious to me, but I suspect the reason is because I utilize the system as a paying customer.
The dynamic is almost exactly the same as housing, and that did not end too well.
@Michael Reynolds
Most of the US problems are caused by “retarded” Republicans? Once the “retarded” Republicans are gone, will be left with the “smart” Republicans? Who gets to decide what is a “retarded” Republican?
If I ask a Republican what is the cause of the problem, I will be informed it is the “retarded” Democrats, and I will be subject to the same nonsense.
What I want is to keep my money and the power over my life. I want everybody subjected to the same rules. I get tired of hearing about the need for tax increases by folks who will not be subjected to those increases.
I cannot afford an accountant to figure out how many loopholes I can use to lower my taxes, and I damn sure cannot afford to have the tax code rigged to help me. If you want to pay your “fair share”, take the standard deductions. What are tax incentives to the rich are tax loopholes to me. I have no problem with anybody being rich. Your wealth does not affect me, but your desire to raise taxes does.
Most the solutions of rich white liberals/progressives affect me. Your tax increase is paid by me. Your housing solutions affect my property value. I could go on and on, but it does not matter. You have built a fantasy world, but I have paid for it.
I do respect President Obama in regards to his desire to improve people’s lives. He was at least getting his hands dirty. He may have lived among the privileged, but at least, he has an idea of what it is like in the hell holes where the underclass is housed.
I have a few items you could add to your retard Republican actions, but I do not want to hijack the thread.
Michael, I think I see the dynamics of the two parties a bit differently than you. I think that each of the parties has two aspects: its aspect when in power and its aspect when out of power. That’s been described as smug and arrogant when in power and insane when out of power. I could go into detail on how and why it works that way but that’s a good enough summary.
I’m with you on one thing: I can’t forgive today’s Republican Party’s accepting of the Dixiecrats. However, the entire Republican Party isn’t made up of radical nutjobs any more than the entire Democratic Party can be epitomized by Maxine Waters.
For every Mitch McConnell there’s a Mitch Daniels.
The progressives’ explanation for why this happens is the sums that insurance companies are jumping through their rear ends to reduce their exposure to expenses, adverse selection. That doesn’t explain why the declining productivity with scale that occurs in hospitals, HMOs, and so on.
I think it’s an inevitable factor in bureaucracies. Gammon’s Law.
@Tasty- Two things. First, if you look at a graph of health care spending back to 1930, we have fairly good data back to then, health care spending increases at a fairly steady rate up to the present. There are dips and surges here and there, but it seems to smooth out.
Second, I dont really see how you do health care w/o something like insurance. Sure, I think market approaches could save a bit of money around the edges, like the doctor visits Michael mentions, but the big ticket items that drive our costs would be difficult to manage via markets. It is procedures and major testing, especially outpatient ones, that have really been driving our costs up. Think chemo, major surgery, MRIs and CT scans. Chronic disease is the other big driver.
If you want the consumer to pick up more of that bill to incentivize lower spending, there are at least a couple of problems. First, if you want to do it with deductibles, any of these are going to run over any kind of workable deductible. I dont see $40,000 deductibles as very workable for many people. Next, it would take a huge cultural change. In over 40 years in medicine and 27 as a doc, I think I can count on one or two hands the times people have asked me what things cost. When you tell a Mom you are taking a kid back for surgery, they are worried about a lot of things. They cry, or try their best not to do so. They dont ask about cost. When you tell that couple who have been married for 30 years that one now has cancer, they worry about each other, not the cost. Which is actually not just an emotional response but a rational one, at least for now. Spending is going to exceed the deductible.
Even with Medicare, where there will likely be 20% co-pays for a lot of the care, assuming no Medigap, people just dont ask about costs. Interestingly, insurance companies dont seem to care either. When we charged 2/3 of what other area hospitals did for a CABG or valve, we did not get more referrals. So, we jacked up our charges. Our volume stayed the same, but we made more money.
Steve
@steve
For my family, an MRI or a CT scan is a $1,500 or $950 cost. When you want my wife to get an MRI, we cannot just run out and get one. We have to consider the situation:
(1) Is this an absolute necessity?
(2) Can it wait?
(3) If so, how long?
(4) What are the possible negative outcomes?
(5) How likely that one of the risks will occur?
(6) If one of these do occur, what is the worst and best case scenarios?
(7) Do we have or can I get the money?
(8) Where will we not be able to have?
(9) Does grandma really need the hip replacement, or do we want to go to Disney World?
I am not whining, and I am a lot better off than most people without health insurance. People without health insurance have been means tested out of any gov’t assistance (including tax deductions). Of this group, some cannot afford it; it is not offered at work; there is pre-existing condition; they choose not to purchase it; or it is some combination of these. I am considered a “free rider”, but there is nothing about my ride. I also know the people that cannot afford it. For them, and MRI is substantially more costly.
For most people in the system – doctors, patients, et al., it cannot be possible for the system to work any other way, but for those of us outside the system (for whatever reason), we know that it is possible. We may not like it, but we live with it.
Tasty:
You get t-boned coming through an intersection. Broken bones, ruptured organs, you’re unconscious, you have no capacity to make decisions and your treatment costs $250,000.
That’s where the free ride starts. Chances are this never happens to you, but it happens to some guy just like you. That’s why we need everyone into the pool. You, me, your employer, everyone. That’s the idea behind the mandate.
I think in the Obama era the GOP has gone further off the deep end than I have ever seen a party go. Even crazier than they went with Clinton, although that was some Grade A crazy.
By contrast the Democrats offered significant support for Afghanistan and Iraq and some of Mr. Bush’s domestic policies as well, including his disastrous tax cuts. Where have we seen similar give by Obama-era Republicans?
As for there being a Mitch Daniels here or there, no, there aren’t, not anymore, not as powers within the GOP. Show me the Republican Lieberman. Dick Lugar just got tossed out on his ear and the entire GOP is terrified of casting even a small vote in support of any Democratic bill. They rejected a 10-to-1 cuts for taxes deal. They fought a pro-forma debt ceiling increase. Democrats are incapable of that kind of unity-in-madness. (Or unity, period.)
@Tasty- I kind of wish everyone would ask those questions. We do too many procedures and tests, IMO. Many people do not realize, or dont want to realize, that there is risk even when we do seemingly benign tests.
I suspect you know, but if you dont you should, that many groups will give a discount or do stuff for free if you can document financial difficulties. One of the quirks of our system is that people w/o insurance are charged more than insurance will pay.
Steve
The guy I kind of worship. Not just talented as hell but an amazingly hardworking person. Guy runs him down with a truck and up pops Steve and cranks out a thousand pages.
Hadn’t he already decided to retire before getting run-down? I’m probably getting the dates turned around. Seriously, he’s not retiring until he has to, either due to death or other infirmity. He should stop kidding himself, he’s hooked!
(Another reason to not be a writer, it tends to be addicting.)
The same reason we can’t get immigration reform, even when it’s backed by John McCain: because Republicans are retarded.
No, Republicans have largely been in favor of immigration reform, by which I mean graniting US citizenship to every third world peasant on the planet. The US citizens, especially those on the right, rise up periodically and put the fear of electoral defeat into them and stop that noise. The elites of both parties want to replace the current citizenry with one that is less intelligent, poorer and more easily led. They are willing to take their chances on that population being more prone to revolution. This decision was taken in 1965, and it is really hard to back away from that.
Incidentally, I don’t see any of those rich assholes in favor of amnesty for illegals living here in Pine Hills with the Haitian boat people or with the Mexican gangsters that have taken over parts of the Orlando area. Once again, physical segregation leading to stupid-assed policies guaranteed to punish America’s own middle class and poor. (Saw a graph recently that high-lighted the correlation between stagnant wage growth and increased illegal immigration in recent decades. Not that there could possibly be any causation to go with the correlation….)
That’s where the free ride starts. Chances are this never happens to you, but it happens to some guy just like you. That’s why we need everyone into the pool. You, me, your employer, everyone. That’s the idea behind the mandate.
Except that if TB can’t afford it before, he still can’t afford it now. And my neighbors aren’t going to be able to afford it either. So they’re STILL free riders. But now the government, through the magic of T-Bills will fund them directly, so that they can get more services, they will utilize them more, but we’re not going to have any more doctors or nurses, etc.
The only way to interpret this bill is that it is meant to break the system. That means the Democrats behind it are so corrupt that they are trying to destroy the nation for their own gain, or that they are too stupid to realize that is what they are doing, or both. Explain to me this concept of retarded Republicans again?
By contrast the Democrats offered significant support for Afghanistan and Iraq and some of Mr. Bush’s domestic policies as well, including his disastrous tax cuts.
That’s because the voters significantly supported those policies, rightly or wrongly. I also remember Democratic commentators calling for Bush’s assasination, and crackpots claiming that Bush was going to overthrow the government and declare himself President for Life. Not to mention the 9/11 Truthers and such. Not to mentiont those democrats frothing at the mouth about Bush’s abuses of civil liberties that are quite happy with Obama doing the same AND WORSE. (One of the reasons I give Glen Greenwald credit is that he has been consistent in all of this.)
Of course, all of those position and flip-flops aren’t crazy or retarded, they are examples of Democrats standing on pure prinicple! Especially the part about wanting to assassinate Republican officials…. The only good opposition is dead, right?
@Michael Reynolds
That’s where the free ride starts. …
No it does not. First, the other guy’s auto insurance pays, next my auto insurance (under/uninsured) pays, next I pay. The amount outstanding will determine the next course of action. Either I will be on a payment plan, or I will go bankrupt. If I do neither, my debt will be sold to a collection agency, and they will try to collect. Their methods are just short of breaking legs, but if they cannot collect, they will bring me to court. They will get a judgement against me, and they will have a lien placed against my house.
The insurance companies are another hassle. The are all going to offer me a settlement, and it will look good especially since I am footing the bill until their check arrives. (Hopefully, I am not thrown to a collection agency.) The insurance company knows that the bills I have submitted are only part of the costs. Some of the hospital bills will take a while to be sent, and they have not included enough for any long term aftercare that may be needed. I do not accountants or lawyers for advice, and I do not realize that the are seriously low balling me. I take the check, sign the papers, and go celebrate. I can pay off the bills, and I fucked the insurance company. Unfortunately, I quickly learn who got fucked.
This is my world, but if you know where it is different, please let me know. I live in fuckover country, but I would love to move.
I don’t think those are the only possible interpretations. I think the most likely explanation is what both Michael and steve have said: that the plan is to keep tinkering, adjusting, fine-tuning, and amending the system as the flaws appear or, in other words, forever.
@steve
We are not destitute. We are in the middle or a little higher income bracket. We do not live paycheck to paycheck, but I do have some family and friends who do. We made a choice to put the money into my stepson’s education instead of health insurance, but a lot of people do not have that choice.
I am not complaining. I have it good compared to others that I know. Most of the resources that I could use are non-governmental, and they are limited. Most people are not aware of the price difference with non- insurance, but some labs and imaging places do offer discounts if you can pay cash. This is great if you have cash, but if not, … The doctors we go to are usually understanding, and they try to work with you.
Show me the Democratic Lieberman. I seem to recall that he lost a primary challenge to a more radical opponent, ran as an independent, and won the election as an independent. I think your narrative needs a little fine-tuning.
Both parties becoming dominated by cynical apparatchiks and radical nutjobs—supportable. Only Republican Party becoming dominated by cynical apparatchiks and radical nutjobs—not supportable.
I think the most likely explanation is what both Michael and steve have said: that the plan is to keep tinkering, adjusting, fine-tuning, and amending the system as the flaws appear or, in other words, forever.
yeah, because it is clear that after the PPACA was passed that doing a new healthcare bill every year is not just possible but enjoyable. @@
In the Senate John Tester, Ben Nelson, Baucus, Jim Webb, Bob Casey, Tim Johnson. What’s his name in WV who sounds like Munchkin? Arguably Landrieu. Nelson’s quitting, but not because he was beaten from the left. And Lieberman still caucuses with Democrats. There are what, three arguably moderate GOP Senators? Scott Brown and the women from Maine, one of whom is quitting for the stated reason that her party no longer has a place for her.
“The only way to interpret this bill is that it is meant to break the system. That means the Democrats behind it are so corrupt that they are trying to destroy the nation for their own gain, or that they are too stupid to realize that is what they are doing, or both.”
That’s blunt but honestly stated, in a bleak sort of way. The democrats seem corrupt and manipulative, while the republicans appear impotent and politically hysterical. In the meantime, we already have entitlement programs that are woefully under funded…and, what have we done, but add yet another fiscal albatross around this country’s neck! The progressives’ responses, though, are to send vulgar twitters and gleefully clap, while the band plays on as we sink further into bigger government insolvency.
You miss my point, Michael, which was that the Democratic Party didn’t run Lieberman.
In the Republican Party there are Kirk, Lugar, Coats, Grassley, Murkowski, Snowe, Collins, and Brown who are arguably moderate based on lifetime ACU ratings, at least as moderate as Lieberman based on ADA ratings. I don’t want to defend Republicans or attack Democrats and I don’t dispute that the Republicans are radicalizing. I think that both parties are radicalizing.
For me the key problem is that neither party is really representing the people. They’re representing themselves, government, key interests, and the most strident factions of their own parties. The American people as a whole are more pragmatic than that.
Another problem is the committee system that tends to give higher podiums to the most strident members of both parties.