FreedomWorks is right about Obamacare *sigh*

Great Debates
121

That’s absolutely amazing.

Nowhere did I use the term “regret.” Yet you confidently assert that this is precisely synonymous with “acceptable.” It’s not, except in your mind, a mind dedicated to twisting this narrative.

And while I appreciate your attempts to define my thinking, I mean I appreciate the reasons that you would do so in such a completely self-serving and dishonest way is very telling.

Protip, Dear Readers: when someone responds to the claim that there is context to define a quote by offering up the quote with carefully snipped-out words… that person is not a Friend of Truth.

And when a commentator announces dismissively that you have all the context you need, that might be a good clue that the commentator doesn’t want you to see the rest of the quote. Here it is:

Tell me. Do we spend ten million public health care dollars to keep a sick ninety-year-old alive for a month? No? You heartless, unfeeling monster!

Yes? You … You administrator of a broke-ass health care system!

122

Wow! Death panels!

123

What’s funny is that Canada does just that. There is nothing in place to stop money being spent on end of life care, so that’s where it at all goes. My 86 year old grandmother was scheduled to have triple by-pass surgery, which we all knew was a stupid thing to do. At our request her case was reviewed by several doctors and it was decided that after surgery there was no way her quality of life would improve. That type of operation requires extensive physio and we all knew she’d never do it, and end up worse off.

I forget the numbers now, but Canada’s entire health system spends about $4000 per person per year (covering 32 million people). In the US, Medicare spends about $11,000 per person to 48 million. But if you looked at what Canada spends on seniors the average jumps up towards $14,000 if not higher. So what does that tell you about average spending for younger Canadians?

The real lesson though is that it’s paid for by the middle class with income tax rates approaching 45%. Here is a link to what people in Ontario pay in addition to their provincial and federal income tax.

124

Yes.

Of course, to call them death panels was always unfair, because it suggests that the panels’ only function is to decide who lives and who dies. But there has to be some method in any system for the rationing of health care use under some sort of criteria. Does an alcoholic who has ruined three livers by drinking qualify for a fourth liver transplant? Who decides? A panel? And what do we call that panel? Not a death panel, of course. But it shouldn’t just be The Panel, and spoken of in whispers, right?

This truth seems to be beyond some people to comprehend. Alternatively, it’s possible that everyone gets it, but few people are willing to admit the necessity because they fear getting smeared with the same tactic that was used on me above.

125

You are correct it is a necessity. However, please remember that the original death panel comment, by Palin, wasn’t even about this, but was about funding end of life discussions with doctors.
And the vast majority of end of life decisions will be made involving seniors, who are already covered by our UHC. We seem to handle it without a lot of million dollar per patient bills.

126

A few general points to help clarify people’s thinking:

  1. When you buy insurance, the product you are purchasing is not health care/auto repairs/home repairs/etc. The product you are buying is risk avoidance. When you call something ‘insurance’ and demand that it pay for fixed, known costs, you are no longer talking about insurance. In fact, the whole concept of ‘utility’ is needed to explain why anyone buys insurance, since insurance on average is a ‘bad bet’ (i.e. the average person gets less out than they put in).

  2. People respond to incentives, not to wishes or appeals to their ‘better nature’ or their ‘civic duty’. If that weren’t the case, we wouldn’t need punishment for crimes - we’d just tell people to be really, really good and they’d all comply because ‘we’re all in this together’.

Those two principles get to the heart of the problem with Obamacare. If the fine for not buying insurance is less than the cost of insurance, and there are no other drawbacks, then of course the vast majority of people will choose to pay the fine. If you don’t believe me, go see how much the fines are for driving without auto insurance - in most jurisdictions, fines for not having auto insurance are much higher than are the fines for behaviors that actually endanger others. Why? Because they have to be, because auto insurance costs money and people would otherwise choose to risk the fines.

If you honestly believe that a young person trying to get started in life is going to sit down and write a check for $1500 to an insurance company instead of writing a check for $500 to the government, just out a sense of ‘shared responsibility’, you’re smoking something. You have to align the incentives with the behaviour you want. If you want the law to work, make the fine for no insurance equal to the cost of the cheapest health plan available to that person… PLUS $500. Now they’ll choose the insurance.

Allowing people to get insurance for pre-existing conditions with no financial penalty makes the problem of adverse selection MUCH worse. Today, the only reason for young healthy people to buy insurance is to lock in lower rates so that they are protected if they develop expensive medical conditions. Take that risk away, and you guarantee that healthy people will stay out of the market and sick people will enter it.

Allowing you to buy health insurance after you develop a condition requiring care makes about as much sense as allowing you to buy collision insurance even if you have ‘pre-existing’ damage and forcing the insurance company to pay for that damage. It’s no longer insurance - it’s just a third party you’re going through to get a subsidy for your costs.

  1. Extending ‘insurance’ to known costs like annual checkups, birth control pills, and the like is just stupid. That’s like forcing car insurers to pay for regular oil changes. I understand the logic - pre-emptive care should theoretically lower costs in the long run. But you’d be better off to do it another way - with direct tax subsidies, vouchers, whatever. Running routine health care through an insurance system just increases costs by injecting a middleman into the process.

If you ran car insurance like you’re trying to run health insurance, car insurance would cost a fortune. The paperwork requirements to the insurance companies would be insane, and in the end everyone would pay more for their car repairs and maintenance because a new class of middlemen would be adding costs and skimming off some of the revenue for themselves.

A single payer system would be better than Obamacare. But you don’t have that, so instead you’re going with a highly flawed, poorly designed system on the theory that you have to have ‘something’. A better alternative would be something like what Singapore has - private health care backstopped by a government catastrophic care system. No one should be bankrupted by sudden accidents or chronic health problems, but that doesn’t mean you need to have a crazy convoluted patchwork system that tightly controls trivial and mundane aspects of health care.

127

Another thing - a lot of people seem to be assuming that the number of people classified as the working uninsured will remain about the same. In the current system, Medicaid covers the poorest, Medicare covers the oldest, and the professional class gets health care through their employers. Only the ‘working poor’ are uncovered, and that’s roughly 30 million people. Estimates of Obamacare’s costs and impact are usually based on numbers like that.

However, it seems to me that people in the ‘uninsured worker’ class is about to go up dramatically. Without an employer mandate, and with subsidies available to people in the middle class for going to the exchanges, the current implementation plan of Obamacare is bound to drive people out of worker-provided health care and onto the public exchanges. How can it not? And you’re already seeing a rise in part-time employment as employers seek to avoid the mandates in the future.

The incentives in Obamacare are totally screwed up. If an employer is fined $2,000 for not providing health care, but health care coverage costs $6,000, he’s got a pretty strong incentive to dump his employees on the exchanges and pay the penalty (and of course he’s got an even stronger incentive if there is no mandate). Furthermore, if the employee gets a subsidy if he goes to the exchanges, but the employer doesn’t get an equal subsidy for providing that health care, then both the employee and the employer can use arbitrage to improve their situation by going to the exchanges.

For example, let’s say the employee gets an additional $3000 subsidy at the exchange, and the employer pays a $2000 penalty if the employee goes to the exchange. Either way, the actual insurance costs $6,000. In that case, if the employee gets insurance from the employer, the cost is $6,000. If the employee goes to the exchange, the total cost of insurance is now $5,000 because the subsidy is greater than the penalty. So now the employer can say to the employee, “Tell you what: You go to the exchange, and I’ll give you a $3500 raise.” The employer now pays $5500 instead of $6,000, and the employee takes the $3000 of the $3500 raise, adds in the $3000 subsidy, and pays his premium and also comes out $500 ahead.

Now, whether the subsidies and penalties result in this situation is still unknown because we don’t know exactly how much exchanges will cost, and the amount of subsidy available varies by income. But if the original calculus in the bill was set up to avoid this WITH the employer mandate, then taking out the mandate almost ensures that this kind of arbitrage will take place, and many more people are going to move to the exchanges than were planned for.

Couple that with the adverse selection problem which has been made worse by the pre-existing condition clause, and the likely result is going to be an increase in health care costs in the exchanges until a new equilibrium is reached (i.e. the arbitrage potential goes away). And in fact, that’s what seems to be happening.

You can be in favor of universal health care and still be against Obamacare on the grounds that it is a bizarre, convoluted, very poorly designed scheme.

128

Just pointing out that calling the cuts “insurance company overhead” is not correct. If you want to compare these cuts to what companies do, and capitalism, feel free but don’t try to drag me into it.

129

Point well taken. Regardless of its genesis, “death panel,” was never a fair description of anything in the law.

130

Your analysis has merit if the fine is less than the subsidy, but reverses otherwise. Based on prior experience it seems best to assume you picked these numbers arbitrarily to make a point.

True. It’s a sad indictment of our political system that the UHC system we ended up with was, in effect, designed by politicians opposed to any UHC at all. Now we have right-wingers complaining and pointing out the flaws. Where were you when the system was being designed? (Spoiler: you were implicitly taking the side of Republicans actively sabotaging Obamacare.)

131

As I pointed out up thread, the adverse selection problem is being dealt with just as it is in employer and Medicare health plans - Open Enrollment periods each year from 15 October - 7 December starting in 2014 and in following years (the initial period is 1 October 2013 - 28 February 2014.

I don’t know why adverse selection is constantly treated as a deficiency in the ACA. This article from 2011 explains the open enrollment process, so it is not really new info.

132

Civic duty is an incentive in many cases because there are direct and indirect benefits to being (or being seen as) a good citizen. This is how private charity works, among other things. By your logic, nobody would ever support charities, little league teams, churches, etc.

There are clearly other drawbacks- namely you don’t have insurance, and will have to pay your costs out of pocket. More importantly, those costs will be MUCH higher than the negotiated insurance rates in many cases. Your calculus leaves all that out. As much as you think you are clarifying what insurance really is, you left the value of that insurance out of your later calculations. Even if you wanted to simplify the equation to something like your formula, it would be that the fine + the value added by having insurance vs. being uninsured < buying insurance. It seems like even relatively healthy people will make out better in the medium term using that formula.

First time offenders are rarely punished far and above the cost of insurance. In Texas, it’s a fine up to $350 fine plus court costs. Most states I have looked at are roughly in line with that. More importantly, whereas there is a 100% chance you will have to pay in Obamacare fine, most uninsured drivers will not pay a fine for being uninsured. You only get cracked over the head if you get pulled over, which means the average “fines” are a lot less than the statutory ones.

Nonsense. A more apt way to propose this would be whether you want to pay $500 for NOTHING, and have to pay your own exorbitant medical costs, or pay a monthly fee totaling $1500 with a service that will protect you from catastrophic medical costs, and subsidize others. The choice becomes a lot less clear cut. That’s not saying some people won’t opt out, but the rationale probably won’t be that it’s a bad deal financially speaking.

Already answered several times in this thread. You can’t just sign up once you get sick in the majority of cases.

People aren’t cars which makes this a really poor analogy in terms of mitigating costs.

133

I think there is an erroneous leap of logic there. The reason Canada has higher taxes is unlikly to be that thay have a much cheaper healthcare system.

The US spends 18 % of its GDP on healthcare, Canada 11 %. US total military spending is less than 5 % of GDP. Having that kind of saving is unlikly to be the reason for higher taxes.

134

What if the decision was really “we pay $60/month for internet but we can really only afford $50/month, do we then add the $8 for netflix on top of what we can’t afford?”

This is the primary reason you start adding the numbers up. What States pay out is currently a really heavy burden without adding to it.

135

Consider yourself corrected. Where did I say or even suggest that? I pointed out an extreme case where the statement would be true for you and everybody else. You took Bricker’s statement out of context. The context of his statement was very similar to the point I made upthread.

136

It needs context because without the context, the statement sounds like a wholesale abandonment of ALL people to their fate regardless of the financial issue – if a person can’t pay, period, then too bad for them. But the actual statement merely seeks to recognize the practical reality that SOME people, for whom the cost of treatment is high and/or the prognosis very poor to begin with, will suffer because of a lack of ability to pay – a constraint imposed by any system of rationing.

You deliberately failed to include that context by snipping off a portion of the quote:

The total content of the post was:

That’s a dramatic change in meaning, isn’t it?

137

There are two points that I often think of, in regards to how we mange the funding of Health Care.

The first, is that I have never understood why it is considered the employer’s responsibility to provide a Health Care package to employees. I’ve never actually heard anyone give any reason for this, good or bad, so I genuinely don’t understand.

The second, is that just about every Health Care plan presented seems to be focused on the pound of cure, not the ounce of prevention. They try to find ways to help the average taxpayer find affordable health care, usually by subsidizing, or by spreading the cost, but they never seem to address the often artificially-inflated cost of health care. The current system allows Pharmaceutical companies to maintain patents on medicines by creating those medicines with a certain number of inactive ingredients, which they can change for other inactive ingredients, as the patent approaches expiration. It seems to me, that a medicine patent should apply to the medicine, that is to say the active ingredients, and not to fillers.

Then there’s Tort reform: There have been a number of cases, in which the manufacturers of medicines and medical devices have been the target of Attorney-initiated class-action lawsuits, in which the plaintiffs often don’t have to have experienced any negative sides effects, they merely have had to POTENTIAL to experience them. What makes this worse, is that these side effects are often common effects of aging, or of normal, minor illnesses, and the document used to file these suits are boilerplate motions with blanks for the names of the plaintiffs, the defendants, and the drug or device in question, but the symptoms, ( fatige, sore joints, muscle pain, mild dizziness, etc.) already filled in. Suing large medical companies, hospitals, labs, physicians, etc. is a multi-billion-dollar industry.

Following Tort reform is Insurance Reform. I knew a doctor who was sued for malpractice when a patient suffered permanent effects because hi mother IGNORED the Doctor’s very specific recommendation, as to which hospital she should take her son to. The hospital she drove her son to put him on an ambulance and sent him to the hospital the Doctor recommended, because they had the resources to properly treat the child. The plaintiff LOST her case, but the Doctor’s malpractice insurance premiums were increased so much, he could no longer afford to practice medicine.

There are many people, and many businesses, trying to pick our pockets: most government programs do nothing more that try to shift the larceny to other pockets.

138

It’s the government’s fault. During World War II, the US government decided fringe benefits like health insurance didn’t count as income, meaning they were not subject to the government’s price fixing of wages nor subject to income tax. As a result, employer sponsored health insurance is tax free but individually purchased health insurance is not.

139

Opposition to expanding Medicaid by Republican governors and state legislatures is partly due to knee jerk opposition to anything connected with Obamacare. But it’s also partly due to political reality.

Fact is that once major programs are enacted, they have a way of becoming permanent. This is in part due to the public coming to rely on them, but also in part due to their tendency to displace alternative options that previously existed or that might otherwise come to exist.

In theory, it’s possible for any state to opt out of Medicaid expansion, if the matching rates get too low. And in in theory it would also be possible to opt out if the feds - who are facing their own budget problems, and who have already modified numerous other elements of the ACA - revise the matching amount to lower than 90%. But as a practical matter, it can’t be done.

140

THey’re not forcing greater efficiencies. They’re just cutting out the higher priced suppliers in favor of lower priced suppliers.

Which is one reason that it has been widely assumed that for the most part the $700B in cuts would not come about and was just included so that Obama and the Democrats could claim the program was deficit-neutral. Because there is already a formula in place that reduces Medicare reimbursements, but the political and practical costs of actually implementing it - in terms of outraged doctors and shrinking networks of doctors who accept Medicare - are such that it gets avoided annually by congress. It’s expected that the same will happen to the Obamacare cuts.