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Old 03-28-2012, 09:01 AM   #41
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Oh well, it had to happen eventually. only 6 posts later than projected.

Yea... I was thinking the same thing when I was reading that post.... a killjoy



Still padding the count!!!
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Old 03-28-2012, 09:28 AM   #42
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What's the population of Hungary? Not apples to apples..........
Whatever the rest of the debate, I don't understand this question. I've not yet seen any suggestion from either side of the argument that a reason to choose this or that healthcare system is a question of scalability to a certain number of people, or, conversely, population density per square mile/km. For example, the population of the US as a whole is only 4 times bigger than that of Germany; on the other hand, Hungary has a population larger than all but 7 US states.

Also, I don't think that the proposal was specifically to adopt Hungary's system. It's one of the lowest rated in Europe. France, Italy, Spain, and even the crappy old UK are all ranked above the US, and all have different models; nobody's proposing adopting any of those brick-by-brick either, as far as I know. But the general point, that even many countries with a substantially lower GDP than the US are not having their citizens dying in droves from curable conditions, or wearing "don't euthanize me" bracelets , is reasonably valid.
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Old 03-28-2012, 11:43 AM   #43
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It's interesting to compare/contrast the questions posed by the Justices. Some of the Justices concentrate on the need and impact of the law, on the severability of the mandate, etc (paraphrase: "what will this do to insurers if the mandate is struck down but the law stands", "if Medicaid eligibility is expanded, what will this do to the state budgets", etc). Other justices seem much more focused on the whether the law is a proper use of federal power under the Constitution. I guess these different perspectives stem from fundamentally different views of the role of the Supreme Court. Very interesting stuff.
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Old 03-28-2012, 11:55 AM   #44
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It's interesting to compare/contrast the questions posed by the Justices. Some of the Justices concentrate on the need and impact of the law, on the severability of the mandate, etc (paraphrase: "what will this do to insurers if the mandate is struck down but the law stands", "if Medicaid eligibility is expanded, what will this do to the state budgets", etc). Other justices seem much more focused on the whether the law is a proper use of federal power under the Constitution. I these different perspectives stem from fundamentally different views of the role of the Supreme Court. Very interesting stuff.

I have not heard the arguments (I still do something for a paycheck).... but I think from the clips on the news etc. that it is true...

I wish they all would first consider the proper use of federal powers since that has a lot more impact going forward.... even though a lot of people are against the law, I think if it is upheld it give the gvmt a lot more power than was anticipated in the Constitution... I think they could have written the law differently to basically acheive the sames ends without (IMO) crossing the line of constitutionality....
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Old 03-28-2012, 01:56 PM   #45
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I think they could have written the law differently to basically acheive the sames ends without (IMO) crossing the line of constitutionality....
Certainly. They easily could have written the law to bump every tax bracket up 1%-2.5% (the size of the penalty), included a per-person tax deduction for everyone who buys health insurance equal to 1%-2.5% of AGI, dropped the word "mandate," and the word "penalty" and the whole thing would be constitutional. The ease with which we can achieve the same exact thing by slightly different means exposes the silliness of this whole debate.
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Old 03-28-2012, 02:18 PM   #46
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Certainly. They easily could have written the law to bump every tax bracket up 1%-2.5% (the size of the penalty), included a per-person tax deduction for everyone who buys health insurance equal to 1%-2.5% of AGI, dropped the word "mandate," and the word "penalty" and the whole thing would be constitutional. The ease with which we can achieve the same exact thing by slightly different means exposes the silliness of this whole debate.

But IMO if it were presented to the average American as a tax with a deduction, they would be against it... that is why it is packaged as is... and why it might be in trouble....

Also, even if packaged as you say, I doubt that some of the other arguments that are being made would go away.... there are a lot of people who do not like it no matter how you package it... that is the real debate...

PS... I think we are both being civil here... let's hope others are and do not bring on piggy....
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Old 03-28-2012, 02:28 PM   #47
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Just today, a big move in the information markets (now at 56% likely to strike down):

Intrade - The US Supreme Court to rule individual mandate unconstitutional before midnight ET 31 Dec 2012 is 56.8% probable
Now the information markets are saying there's a 62% likelihood the individual mandate will be struck down. Of course, that's just folks like us reacting to what they hear (and want to hear?). We'll hear from the market that matters in late June--and in November.
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Old 03-28-2012, 02:43 PM   #48
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I think the individual mandate could be replaced by a system of open enrollment every year or two. The whole point of requiring insurance is to keep people from gaming the system by not buying it when healthy and then buying it only when they are sick. In other words, they want to be leach off the other people. However, if there was an open enrollment every two years, many of these people would have to think twice since they could easily be betting their life. Most people I know with serious illnesses usually can't wait a year or two for medical care. Sure, some will be able to wati and come out ahead, but not nearly as many as f there were an 'enroll anytime' policy.

Another idea would be to allow enrollment outside the open enrollment period but apply pre-existing conditions for the first few years. Again, they would be betting their life.

The one problem I see is that Mr. Leach decides not to buy insurance for his family and himself. A few months later, his 6 year old daughter, Linda Leach, gets ill. Do we really want to deny her care because her father is a leach?

The simplest thing would be to say "here is the package of medical care we are going to provide citizens and legal aliens, this is the tax that is going to pay for it'. You, good citizens, tell us if you want this or not, in a series of statewide plebiscites during an election year.

Dream on......
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Old 03-28-2012, 02:52 PM   #49
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The one problem I see is that Mr. Leach decides not to buy insurance for his family and himself. A few months later, his 6 year old daughter, Linda Leach, gets ill. Do we really want to deny her care because her father is a leach?
As I understand the argument, the free riding ways of Mr. Leach is a constitutionally protected right.
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Old 03-28-2012, 02:54 PM   #50
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Intrade has shown some accuracy at forecasting outcomes of popular votes, but only a day or two ahead of elections. This is not a public vote and the outcome is not limited to "keep or revoke". The US Supreme Court is expert at ruling in a way that satisfies no one but itself.

I thought this was well-said.

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The debate is good to see. Shame on any HS civics teacher who isn't using the present hearing, the legislative battle that preceded it, and the involvement of the executive branch as a case study in the fundamental purposes of the three branches of government and the wisdom of the drafters of the Constitution.
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Old 03-28-2012, 02:57 PM   #51
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I think that if there was a hard stance, to those who can afford insurance, "No insurance, no treatment" then folks would get the message and be more than willing to get coverage.

Think about car insurance. If Mr. Risk-taker had no insurance but got in a wreck, could he go say, "Well, I really meant to be insured, but couldn't because of <excuse>" and get away with that? I don't think so.

Of course, than the question becomes are we willing to take that extreme and stick to the hard line?
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Old 03-28-2012, 03:00 PM   #52
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Intrade has shown some accuracy at forecasting outcomes of popular votes, but only a day or two ahead of elections.
In this case, there won't really be any new news coming out, so I think what we have here is about as accurate an estimate as we're going to get.

I like the comment about the Supremes deciding things in a way that satisfies nobody but themselves. It doesn't seem like striking down the whole law is necessary. Nor does it seem like even striking down the guaranteed issue provisions are necessary. If the states don't like what is happening to their insurance companies without a mandate, they can certainly institute one.

Seems like just deserts for the states bringing the suit in the first place.
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Old 03-28-2012, 03:06 PM   #53
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You mean the insurance that most states require you to purchase?
I meant to say, if you have no car insurance, but is found liable, or need want to file a claim, good luck saying "well, I have no insurance but cover me anyhow."

If folks who forgo any health insurance see that to have insurance or don't expect any coverage, I'd think folks would sign up. I guess it'll be a game of who blinks first. The ones who think no insurance whatsover is needed vs 'do we treat them anyhow?"

But as I think about it, the hard stance wouldn't fly anyhow. For example, if someone needed emergency treatment. Will the first question be "Insured or not?" or treatment. I'm sure treatment comes first.
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Old 03-28-2012, 03:08 PM   #54
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You can't tell how the justices will vote based on what they say, and you certainly can't tell based on the sound bites on the news.
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Old 03-28-2012, 03:12 PM   #55
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You can't tell how the justices will vote based on what they say, and you certainly can't tell based on the sound bites on the news.
Agreed. And I think today's arguments are biased toward giving the impression that the judges will vote to strike down the mandate. The whole "severability" discussion presuposes that outcome. Intrade is probably a good sell today. Maybe we can get this discussion moved to the Stock Picking board.
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Old 03-28-2012, 03:12 PM   #56
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The one problem I see is that Mr. Leach decides not to buy insurance for his family and himself. A few months later, his 6 year old daughter, Linda Leach, gets ill. Do we really want to deny her care because her father is a leach?
The Emergency Medical Treatment and Active Labor Act of 1986 guarantees care in an emergency.
http://en.wikipedia.org/wiki/Emergen...tive_Labor_Act

One could self insure for minor care, and rely on the Act for emergency treatment for accidents, injuries, and illness, including chronic life threatening diseases. Millions of Americans currently rely on this mechanism. Funding for the extremely expensive ER care is derived from a combination of Medicaid when available, state and county taxes for public facilities, and very high un-negotiated or retail rate hospital charges and padding on negotiated rates charged for those who have insurance.

I've talked with folks who have philosophical issues with insurance. There is some sentiment that if they are in good health, their insurance payments are going to cover the expenses of some sick people or malingerers because of insurance risk pooling, and they object to this. It's an interesting concern, even if it does miss the whole way insurance works, as a mechanism for risk pooling.

Given this concern, and the whole per-existing conditions problem with people gaming insurance, I have a modest proposal. Reduce the size of the risk pool to an individual, or a family as a single covered entity. Now the insured doesn't have to fear paying for some stranger. Further, to prevent gaming the system, limit the lifetime payment from the insurance to 80% of the total payments made by the insured. (The 20% reserve is to cover administrative costs, expenses, and bonuses for the insurance company.). Now they can't possibly game the system.
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Old 03-28-2012, 03:20 PM   #57
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I think that if there was a hard stance, to those who can afford insurance, "No insurance, no treatment" then folks would get the message and be more than willing to get coverage.

Think about car insurance. If Mr. Risk-taker had no insurance but got in a wreck, could he go say, "Well, I really meant to be insured, but couldn't because of <excuse>" and get away with that? I don't think so.

Of course, than the question becomes are we willing to take that extreme and stick to the hard line?
This sounds like a nice formula to return to the good old days of emergency medical care, where the first procedure done was the traditional walletectomy.

http://www.ncbi.nlm.nih.gov/pubmed/21421951

Folks didn't seem willing to stick with that extreme a century ago. Perhaps with modern medical costs they'd be more open to this today.
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Old 03-28-2012, 03:24 PM   #58
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The Emergency Medical Treatment and Active Labor Act of 1986 guarantees care in an emergency.
http://en.wikipedia.org/wiki/Emergen...tive_Labor_Act

One could self insure for minor care, and rely on the Act for emergency treatment for accidents, injuries, and illness, including chronic life threatening diseases. Millions of Americans currently rely on this mechanism. Funding for the extremely expensive ER care is derived from a combination of Medicaid when available, state and county taxes for public facilities, and very high un-negotiated or retail rate hospital charges and padding on negotiated rates charged for those who have insurance.

I've talked with folks who have philosophical issues with insurance. There is some sentiment that if they are in good health, their insurance payments are going to cover the expenses of some sick people or malingerers because of insurance risk pooling, and they object to this. It's an interesting concern, even if it does miss the whole way insurance works, as a mechanism for risk pooling.

Given this concern, and the whole per-existing conditions problem with people gaming insurance, I have a modest proposal. Reduce the size of the risk pool to an individual, or a family as a single covered entity. Now the insured doesn't have to fear paying for some stranger. Further, to prevent gaming the system, limit the lifetime payment from the insurance to 80% of the total payments made by the insured. (The 20% reserve is to cover administrative costs, expenses, and bonuses for the insurance company.). Now they can't possibly game the system.
(note that this look a lot like a medical savings account, with a fee to gain access to the insurers negotiated rates. It will be a bit harsh on the insured for the first decade or two on their plan, but over the entire population it will probably work out. On average. Except for the sickies...)
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Old 03-28-2012, 03:29 PM   #59
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Given this concern, and the whole per-existing conditions problem with people gaming insurance, I have a modest proposal. Reduce the size of the risk pool to an individual, or a family as a single covered entity. Now the insured doesn't have to fear paying for some stranger. Further, to prevent gaming the system, limit the lifetime payment from the insurance to 80% of the total payments made by the insured. (The 20% reserve is to cover administrative costs, expenses, and bonuses for the insurance company.). Now they can't possibly game the system.
Nice!
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Old 03-28-2012, 03:40 PM   #60
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This sounds like a nice formula to return to the good old days of emergency medical care, where the first procedure done was the traditional walletectomy.

Patient dumping in New York City, 1877-1917. [Am J Public Health. 2011] - PubMed - NCBI

Folks didn't seem willing to stick with that extreme a century ago. Perhaps with modern medical costs they'd be more open to this today.
Thanks for the link.

Yeah..on second thought...I guess dumping won't work.
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