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Old 03-29-2012, 05:00 PM   #121
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How about open enrollment of medicare for all without exclusion of pre-existing conditions?
We'd have the same problem as always due to adverse selection. Every person with a chronic medical condition would get on Medicare. And Medicare is already going broke even with all those people paying into it who aren't expected to start getting Medicare benefits for 30-40 years.
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Old 03-29-2012, 05:22 PM   #122
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The irony is that the way we're being asked to read the Constitution the government can buy insurance for you and force you to pay for it under threat of imprisonment but can't tell you to choose a policy for yourself or face a fine.

That is one strange configuration of liberty.
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Don't have to read it. The first part is how Medicare works. The second part is how the ACA works.

You do not have to sign up for Medicare... besides that your stmt looks to be true...
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Old 03-29-2012, 05:22 PM   #123
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Don't have to read it. The first part is how Medicare works. The second part is how the ACA works.
So you're saying that under Medicare the government can buy insurance for you and force you to pay for it under threat of imprisonment? I think you are misinformed.

So if someone like Warren Buffett or Mitt Romney refused to enroll in Medicare because they have the resources to pay for better health care the government would threaten to imprison them?
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Old 03-29-2012, 05:26 PM   #124
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How about unsubsidized enrollment in FEHB without conditions or underwriting?
Of course there would be bumps.
1) How would current FEHB recipients feel about the flooding of their network with new patients? The present recipients are almost exclusively federal employees. I will leave the political aspects of that alone, but I think many in Congress and elsewhere would have problems supporting anything that adversely affected government employees.
2) The adverse selection problem driving up the price of policies for everyone. In addition, the FEHB doesn't take all comers now--the requirement to be employed by the government serves to screen out those with the most serious medical/psychiatric problems.
3) Affordability. If we want people of moderate income to buy this insurance, we'd still need the subsidies (or something like 'em)

But, maybe it (or something like it) could work.
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Old 03-29-2012, 05:27 PM   #125
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We'd have the same problem as always due to adverse selection. Every person with a chronic medical condition would get on Medicare. And Medicare is already going broke even with all those people paying into it who aren't expected to start getting Medicare benefits for 30-40 years.

I actually think that adverse selection is not as big a problem as some people make it out to be... when I was young, I bought the very cheap insurance because I did not need that much service... they got very little money out of me...

But if I had a problem that I could not get insurance (a pre-existing condition).... I could get a job at a mega firm and get on their insurance policy... none of the companies I worked with every had a pre-exisiting exclusion...

Now, if you needed emergency room care for whatever reason, you would not be able to sign up for a policy anyhow...
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Old 03-29-2012, 05:28 PM   #126
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You do not have to sign up for Medicare... besides that your stmt looks to be true...
I took G4G to be saying that you have to pay the Medicare tax while working. I believe you have to pay the tax even though you don't have to sign up for Medicare when you are 65.
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Old 03-29-2012, 05:37 PM   #127
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I took G4G to be saying that you have to pay the Medicare tax while working. I believe you have to pay the tax even though you don't have to sign up for Medicare when you are 65.
If that is the case then I understand and just didn't understand what G4G meant since it was so poorly worded.

I still don't get under what circumstances would one be imprisoned?
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Old 03-29-2012, 05:47 PM   #128
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If that is the case then I understand and just didn't understand what G4G meant since it was so poorly worded.

I still don't get under what circumstances would one be imprisoned?
Tax evasion?
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Old 03-29-2012, 05:51 PM   #129
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You do not have to sign up for Medicare... besides that your stmt looks to be true...
True, but one must still pay the medicare tax if one works. If the government funds medical care through a tax system (payroll tax or something new), then one has to pay or else. Tax evasion is frowned on by the Feds.
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Old 03-29-2012, 05:53 PM   #130
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The irony is that the way we're being asked to read the Constitution the government can buy insurance for you and force you to pay for it under threat of imprisonment but can't tell you to choose a policy for yourself or face a fine.

That is one strange configuration of liberty.
I agree that there is no material difference between:

A) Taxing a person and providing a service (like garbage pick up in some places I've lived), and

B) Requiring someone to buy a service (like garbage pick up).

But our Constitution is written such that it is questionable if 'B' is OK. Congress was aware of this, and could have acted accordingly. They didn't, so here we are.

We run into all sorts of cases where an alternative might seem equal to, or even superior to the original . Yet, we are often bound by the wording in a contract, which called for the original. Sometimes it seems to make no sense to either party to the contract, but we have systems in place that say we agreed to follow the rules. In general, that's a good thing. If the rules need to be changed, there is a process for that (agree to a new contract, or amend the Constitution).


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The very best indicator of Congress's intent is what they put in the actual bill. Severability clauses are a normal part of most large legislation, and it's for a reason. It tells the courts what Congress intends. Congress didn't include one in this law. ...
After reading up some more on the severability clause, I agree. Like my story of the car sale and car parts sale - it would be clear if I said ahead of time that I would take either/or/both independently. But w/o that, it's fuzzy - maybe I don't want the car w/o those parts, fearing I can't get them and that would make the car useless. Or the parts are useless to me w/o the car. Far better to define that up front, then to ask a judge to decide what I was thinking.

edit/add to close that loop: So if Congress had said this is severable from that, then we can accept that there was no tie between those clauses, and dropping one would not have affected votes on the other. They didn't, so we can't (except the Supremes can do whatever they want! But the written argument could get 'interesting')

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Old 03-29-2012, 05:58 PM   #131
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So, don't say much.
I agree. Best to keep thinking and speaking to a minumum around here. Can't we just concentrate on cats, how wasteful other people are, and on detailed fantasies about simple living? Soon it will be spring; then we can also share photos of flowers in our gardens. Anything else is just a want, not a need.

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Old 03-29-2012, 06:01 PM   #132
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I agree. Best to keep thinking and speaking to a minumum around here. Can't we just concentrate on cats, how wasteful other people are, and on detailed fantasies about simple living?
I want to hear about how to avoid growing cynical and snarky as we age...
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Old 03-29-2012, 06:02 PM   #133
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I agree that there is no material difference between:

A) Taxing a person and providing a service (like garbage pick up in some places I've lived), and

B) Requiring someone to buy a service (like garbage pick up).

-ERD50
Quite well said! I agree. We have to follow the law as it is written.

What I find interesting is that the people who so energetically protest plan B, may end up with plan A, which gives them even less choice. I suspect this is the opposite of what they want. Just my 2 cents.
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Old 03-29-2012, 06:09 PM   #134
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I want to hear about how to avoid growing cynical and snarky as we age...
What's age got to do with it?

I'm pretty sure I was cynical and snarky in the womb!

I think cynical has served me well. Snarky, you gotta size up the situation. Mistakes can be painful!

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Old 03-29-2012, 06:32 PM   #135
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Many insurance companies increase premiums for those who smoke under group plans. I wonder if they are required to accept those with pre-existing conditions will they be able to increase premiums for those individuals or is it one premium for all.
Or how about disease covered by the ADA?
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Old 03-29-2012, 06:43 PM   #136
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So it's this law or we'll never have anything?
Never is a very long time. But so too is the history of trying to get comprehensive health reform: Roosevelt tried in 1935 and failed. It took another 30 years before we got a partial solution in Medicare. A decade after Medicare Nixon tried to pass a universal health care bill and failed. It took another two decades before Clinton tried again and failed, and almost another two decades for ACA to finally pass only to possibly fail at the hands of the Supreme Court. Considering the average American life span, the eighty years we've been trying to pass comprehensive health reform legislation is pretty close to "never."

The difficulty in tackling this problem is legendary. And while this difficulty is not a Constitutional issue, it certainly is something the Court should consider before kicking the entire thing to the curb under the assumption that Congress can just whip up an alternative.
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Old 03-29-2012, 06:45 PM   #137
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We'd have the same problem as always due to adverse selection. Every person with a chronic medical condition would get on Medicare. And Medicare is already going broke even with all those people paying into it who aren't expected to start getting Medicare benefits for 30-40 years.
That goes back again to a mandate to get the young, healthy folks in the system to avoid the adverse selection.

If SCOTUS does agree to uphold the mandate, it may be because of the uniqueness of the situation. That's seems to be what justice Kennedy was hinting at a bit. Of course, one can't draw a conclusion from a hint as he also said, the lawyer for the gov't has a tall hill to climb.
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Old 03-29-2012, 07:12 PM   #138
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Never is a very long time. But so too is the history of trying to get comprehensive health reform: Roosevelt tried in 1935 and failed.
Harry Truman also proposed a national health care plan but Congress would not have it.
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Old 03-29-2012, 07:16 PM   #139
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Harry Trueman also proposed a national health care plan but Congress would not have it.
Who is Harry Trueman?
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Old 03-29-2012, 07:20 PM   #140
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I want to hear about how to avoid growing cynical and snarky as we age...
I am sorry, I am unable to be of service with that one.
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