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Old 12-14-2010, 03:11 PM   #61
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Here is where your argument falls apart - substitute "public education" for "public health care" and where are we? The US spends more on public education than other countries and gets worse results. I think that tells us that switching private health care to public is not a slam dunk positive.
Maybe, maybe not. With education we're comparing public education here with public education elsewhere. The fact that we get worse results, then, has to derive from some other source. I think a lot of it is cultural (we laugh at the "nerds" and admire the jocks. We scorn the "educated elite" as "not real Americans" while admiring the hard working manual laborer. It's tough to expect kids to work to educate themselves in a country that often times looks down on the educated, or, at the very least sees, "street smarts" and "common sense" as an equivalent).

With health care at least a case can be made that having a quasi private system instead of a public one is a driver of our worse results. Many studies show a large divergence between the health outcomes of the rich and the poor, the insured and uninsured in the U.S. That latter group tends to pull the average results down, suggesting our uneven system of providing care is a large contributing factor to our worse results.
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Old 12-14-2010, 03:38 PM   #62
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More contributions to our uneven system of providing care: Medicaid services slashed to save $

Some states have cut or are in the process of severely cutting medicaid benefits, leaving people without necessary care or with care that makes no sense. For example, not paying for drugs, such as antipsychotic drugs, blood thinners, insulin, antibiotics, etc resulting in more hospitalizations at a far greater cost than the drugs. Not paying for hospice services. Not paying for dental care, except to relieve pain.
Medicaid services slashed to save $

Medicaid prescription drug cuts not smart - Columnists | Tri-City Herald : Mid-Columbia news
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Old 12-14-2010, 04:47 PM   #63
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There's nothing in it for corporate campaign contributors (to either party OR to both parties), which is the problem. The bottom line, IMO, is that as the nation is more and more run by corporations using Congress as a proxy, the health care law that passed gave almost all of these big corporate lobbies something on their wish list.
"Congressman? There's a gentleman here from the Soylent Corporation who has an interesting proposal to rein in Medicare costs."
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Old 12-14-2010, 05:15 PM   #64
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They should have passed a public insurance option instead of this mess. The whole thing was a setup by the insurance companies in the beginning. Having a non-profit public option to compete with the private insurance companies will definitely force the current system to be more efficient.

Just a question... isn't Blue Cross/Blue Shield a non-profit... it still does not prevent premiums from going up sky high...
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Old 12-14-2010, 05:18 PM   #65
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I don't see too much to cheer about.

Our health care system has major problems in multiple areas. Anyone that thinks that doing nothing is a victory must be lulled into some false sense of security... thinking that their situation (or their family members situations) cannot change for the worse.

I was not pleased with certain parts of that bill or the way the whole thing played out with no compromise or collaboration on either side.

But at least there was some sort of progress.

For some reason there is a group of politicians that are content leaving us with the problems we face.

Something about that seems wrong to me.
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Old 12-14-2010, 05:25 PM   #66
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I'd love to hear the specific details of the alternative (I've asked several times and gotten responses that either look very much like the existing health care law or simply assume that sick folks will go into high risk pools without providing any specifics about how those pools would work).

It really isn't helpful to simply throw stones at an admittedly unperfect solution without offering any realistic alternatives that would work better.

One problem is that we have a fundamental difference... (and I might be reading your posts wrong, so forgive me if I do).... I will try and make it no personal...


There is one big camp who thinks everybody should have insurance and get medical care... this can be in the form of single payor or everybody has to have insurance and we can help out with tax money... think of this as universal coverage...

The other big camp is that health care is not a right... but there should be rules and regulations covering what an insurance company can and can not do... think of this as universal access...

Now, since I am in the camp of universal access and not universal coverage... why should I make up rules that make everybody have insurance That means I am in the universal coverage camp and I do not want to be there... I also do not want the gvmt paying insurance premiums (or any part of it) for people who make $70K... heck, even $50K...

If we can get over the theory that everybody should have the same level of health care then we can design a plan that covers the poor, a plan that covers the lower income people... and one that covers the higher income people...

I make more than average... I live in a house that is more than average... I can have a car that is more than average.... etc. etc.. so why should I have average insurance....

(BTW, I do not have a great plan... and I can not get one because I am tied to the company since I get a tax deduction... so even if I could go out on my own.. it does not pay to do so)...
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Old 12-14-2010, 05:33 PM   #67
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But at least there was some sort of progress.

For some reason there is a group of politicians that are content leaving us with the problems we face.
I agree that some sort of progress is better than the status quo, and I rarely see the government as a solution but they could be in the case of health care IMO. I say that because the fact remains we pay way more per capita than any other country on earth, including all developed countries - and don't get superior results overall by any measure I've seen. Yes we could make it worse, but clearly that's not a given (as evidenced by every other country).

But I don't think we can hang this on politicians alone. The uninsured is a problem, but they are still the minority. The insured majority squawks about the increasing cost of employee contributions, but most have no idea how much corporations and others are paying on their behalf. In the end, they don't want their "benefit" touched by their politician. Even though they complain, subconsciously or consciously they realize it's a bargain in what they pay out of pocket. And it's easy to convince them universal care would be "expensive" because they're unaware of what the US system actually costs them - most of it hidden in the products & services and taxes they pay.


The problems for the US include:
  • lifestyle (obesity, smoking, drugs)
  • high cost and profit for intermediaries (insurance)
  • excessive profit for some product and service providers
  • administrative burden (millions of microplans)
  • high charges for specialized services
  • forced use of expensive specialized facilities for routine medical needs (emergency room)
  • multiple regulations around the country
  • punitive legal awards
  • diagnostic overuse (expensive tests even for routine matters)
  • treatment overuse (especially end of life)
  • excessive unproductive labor vs technology
  • plus significantly/ironically, excessive usage
It's no easy issue...
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Old 12-14-2010, 08:24 PM   #68
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Originally Posted by Midpack View Post

The problems for the US include:
  • lifestyle (obesity, smoking, drugs)
  • high cost and profit for intermediaries (insurance)
  • excessive profit for some product and service providers
  • administrative burden (millions of microplans)
  • high charges for specialized services
  • forced use of expensive specialized facilities for routine medical needs (emergency room)
  • multiple regulations around the country
  • punitive legal awards
  • diagnostic overuse (expensive tests even for routine matters)
  • treatment overuse (especially end of life)
  • excessive unproductive labor vs technology
  • plus significantly/ironically, excessive usage
It's no easy issue...
You forgot:

The US Govt gave tax breaks to companies to provide health coverage. This led to higher costs for those outside of companies that supplied coverage. It meant people lost coverage if they lost their jobs. It meant that during good times, companies competed for talent by offering "good" benefits. For the employee, "good" meant low deductibles and low co-pays, which led to no one knowing or caring what their health care really costs. And that became a downward spiral.

So the history of Govt involvement is not good. They don't consider the consequences. They need to tread carefully, and they haven't demonstrated that quality.


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... Anyone that thinks that doing nothing is a victory must be lulled into some false sense of security... thinking that their situation (or their family members situations) cannot change for the worse.
I don't want this to come across as confrontational, I'm just playing off your own phrasing, but anyone who thinks that doing anything is a victory must be lulled into some false sense of security. Or that action is justified just because it is doing 'something'. We need good, thoughtful actions. Not just 'actions'.

-ERD50
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Old 12-14-2010, 08:50 PM   #69
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The current insurance we have allows you to look online to see what a medical provider charges, and what the insurance pays. It is an eye-opener. Nearly always 1/3, and sometimes less.

I'm a retiree in a mega-corp group. Can't imagine how smaller groups and individuals get by.
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Old 12-14-2010, 09:16 PM   #70
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?? There's no privilege involved. The Supreme Court has found that the government can direct citizens to do all kinds of business with the government--file tax returns, go to jury duty, obey a subpoena, register for selective service, etc. The present question (among a couple that will come up about the new law) is whether it is constitutional for the government to direct citizens to engage in a certain type of private commerce, and punish them if they don't.

Selective service can be attacked on several other grounds.

The government forcing citizens to do all kinds of things, private or not is a little George Orwell. (I was being sarcastic about the privlege of being drafted).

But what if the government had, cough.."a public option"? That way they won't be forcing citizens in private commerce.

At the other extreme, I bet if the governement said we have to right to say "no insurance" no treatment" that might change the whole dynamic
of things.
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Old 12-14-2010, 09:39 PM   #71
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But what if the government had, cough.."a public option"? That way they won't be forcing citizens in private commerce.
I don't think a "public option" would face any significant constitutional hurdle of the type this law faces. Depending on how things are structured, there might be some problems with implementation (e.g. in some foreign plans, the intrusiveness of the government medical system into people's lives goes well beyond what Americans have been comfortable with. But, we're gradually becoming desensitized to this, so maybe it won't be a problem. Once we strap on the government diaper and suckle from the government bottle, I think we understand that Uncle Sam will need to peek in our nappies occasionally to assure himself that all is well. )

Regarding the taxation level needed to support it: As far as I can tell, according to the present "sense of the public" there seems to be no inherent constitutional limit to how much the government is allowed to seize from one citizen to give to another. There is a practical limit, however. Unfortunately, there's no elegant feedback mechanism that keeps that "taking" in check, things just decay when people can't keep the product of their labor.

From an abstract "which is a bigger affront to freedom" POV, we should realize that taking our private property is very much like taking a part of our lives from us. We traded our time to get that property, it is time we can't get back, and when the property (earnings, savings, etc) is taken it's like losing a portion of our life. So, I'm not as concerned with the government directing me to buy a product from a private company as I am with minimizing the amount of this "taking", and also having some control over it (how much, what for, who gets my money, etc). If the government directs me to buy insurance from a private company (on the exchanges), at least I have the choice of who gets the money and maybe how much I spend. If history is a guide, and if the field is level, this privately-provided service may cost less, overall, and be of higher quality than the same service run by the government. On the other hand, with single payer, I'll be taxed without any say in how much is taken, and I'll live with whatever Uncle Sam chooses to provide. Neither is what the framers of the Constitution would have envisioned, but I know which I'll pick if given the choice.
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Old 12-14-2010, 11:21 PM   #72
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"Congressman? There's a gentleman here from the Soylent Corporation who has an interesting proposal to rein in Medicare costs."
"Make room! Make room!"

I guess those lines are too old & niche for this crowd...
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Old 12-15-2010, 05:13 AM   #73
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I enjoyed this piece from David Leonhart in today's NY Times. He describes a national debate very much reflected in this thread.

http://www.nytimes.com/2010/12/15/bu...t.html?_r=1&hp
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Old 12-15-2010, 09:10 AM   #74
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I don't see too much to cheer about.
I see a lot to cheer about. This judge said that government can not force a person to buy something simply because they are alive. That is huge. I do think a single payer system would be found to be constitutional, but I also think a single payer system would be highly inefficient and more expensive than what we currently have.
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Old 12-15-2010, 09:37 AM   #75
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but I also think a single payer system would be highly inefficient and more expensive than what we currently have.
It may well be, but that's a really scary thought -- that something could actually be worse than the "system" currently in place. Hard to imagine anything less efficient, more costly and more of a headache to deal with in terms of bureaucracy.
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Old 12-15-2010, 09:59 AM   #76
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It may well be, but that's a really scary thought -- that something could actually be worse than the "system" currently in place. Hard to imagine anything less efficient, more costly and more of a headache to deal with in terms of bureaucracy.
Apparently you underestimate the power of the government. They can make the most simple task complex and confusing. They rival a computer's ability to really screw things up.
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Old 12-15-2010, 10:39 AM   #77
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It may well be, but that's a really scary thought -- that something could actually be worse than the "system" currently in place. Hard to imagine anything less efficient, more costly and more of a headache to deal with in terms of bureaucracy.
All you have to do is imagine the same people who brought you the IRS & TSA in charge of health care.
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Old 12-15-2010, 11:40 AM   #78
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According to some politicians, we have the best health care in the world.

The judge probably isn't hostile to that line of thinking, as he's a Bush appointee.
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Old 12-15-2010, 11:45 AM   #79
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The judge probably isn't hostile to that line of thinking, as he's a Bush appointee.
I didn't know Bush appointees got a better health insurance plan than other federal judges. You learn something new every day.
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Old 12-15-2010, 12:34 PM   #80
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You get the sense that this law will ultimately be ruled along partisan lines if and when it reaches the SCOTUS.

They probably have great health care coverage there.
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