Health Care Reform - the morning after

[82_28]

Am I actually going to have to explain why any universal coverage must necessarily be mandatory for all?

I don't like the means to the end with an end in cursory glance, I do happen to agree with. That said, I have health insurance that I pay for at my own expense and as justdrew noted, it also is a non-profit outfit. Or so I've been led to believe. I want single-payer. But with this atrocious bill, this country will never, ever see single-payer ever. All this does is form a new, huge bureaucracy to oversee new methods in which to extract obedience to the corporate overlords, always seeking profit and dominion over "markets" it believes it has bought and now owns -- namely human lives. It is no different than the brand new Department of "Homeland" Security and its underling, privatized, contracted out underlings we call the TSA. None of which making us any more safe than we already were and any more healthy than we were before that. This is adding confounding complexity to an issue that needed to be simplified. Such as, axing out the insurance companies all together and in a word, disbanding them.

You're sick? You go to the doctor and don't worry about it. Yet as it is now, as I happen to work in a place that sees and has many customers that happen to be medical equipment salesmen, prices on shit are priced to sell to a captive audience. This is not going to change FM9. But this is what needed to change in any bill calling itself "health reform". A piece of cutting edge medical equipment that can be sold for (just pulling random absurd numbers out of my ass here) $100 in Canada, sells for $1,000 here. I know this, because they've told me so. You can wring more profit out of the system as it is here in the USA now. And again, this bill does nothing to change that. In fact, you could say it magnifies the captivity of the audience even more, by making it mandatory, punishable by fine -- for now. Remember the old canard $1000 toilet seats. Same mechanism at work here, IMO.

[nathan28]

Maybe "forced" was the wrong choice of wording. Penalized by the government for not supporting a private industry is more like it.

I just find that notion highly absurd.

I don't really know how much these new clients are going to be 'supporting' these insurance companies, if they choose to use the plans and liekly have a well of pent-up needs, these new clients are likely to be rather costly for the insurers for many years to come. national single payer still seems like the best choice to me, but it's a democracy and that plan didn't have the votes at this time, it could still come to pass in time.

Like I said before--previous private mandates have generally favored high-premium high-deductible plans. IOW: you pay $10k annually in premiums and then have $10k in deductibles. IOW: its value is low barring a disaster. Without knowing about the projections for subsidies for low-income enrollees, this can't be sorted out. "Likely have a well of pent-up needs" is, respectfully, nonsense. For every "pent-up need" there's two actuary's equations.

nathan28, sorry, I'm not up to answering your detailed questions atm. but about the bankruptcy thing: what's so bad about declaring bankruptcy? The "homestead" protections prevent people from losing their homes and a large amount of tangible assets, it's just a way to get out of unpayable bills. Maybe it screws one's credit, but I'm not so sure of that, it can only be done once per seven years, so after having done it, you're a safer risk than before and are carrying less debt. I did it a few years ago and got a lot of credit offers in the mail afterward specifically to help rebuild. (didn't use any of the offers and remain semi-=debt free today) S

The issue I intend to draw attention to with bankruptcies is that treatment remains exorbitantly priced and the burden lies solely with individuals, as just as many insured people as uninsured face bankruptcy over costs. Without further information or projections on the ramifications of lifetime limits being lifted--i.e., whether those are marginal or substantive contributions to bankruptcies among the insured--this cannot be sorted out.


I cannot find any information about these coming non-profit firms. Non-profit health insurance cos. already exist. Something tells me that by "non-profit" ins. cos. we aren't going back to widows' & orphans' trusts. So if anyone can explain how these regulatory reforms lead to the promotion of non-profit ins., or explain what model the non-profit firms operate under, that'd help.

[justdrew]

Am I actually going to have to explain why any universal coverage must necessarily be mandatory for all?

Okay, I get it. You have what we might call a faith-based understanding of this bill.

oh wait, is that a semi-humorous tautology ? To be universal, it must be required, otherwise it wouldn't be universal. Anyway, even if the system were "free" care for all citizens, taxes would just go up, things have to be paid for somehow. The main problem with private insurance companies is it's inherently less efficient than single payer, they seek profits by denying care, they cancel policies, they pay to much to their executives. The last three objections are all addressed in this bill (to some extent even the outrageous ceo pay is addressed as companies with outrageously high ceo pay are going to be at a marketing disadvantage.) It would be nice if the efficiency of a single payer system could be had, but we'll just have to get there later on.

It may not even be essential. With a monolithic system like that, what is setup by the bureaucracy is just the way it is, this way, insurers can compete to find the most efficient ways to run their organizations. over time any innovation one finds, will leak out to the others... if they keep their overhead down, pay claims, stop canceling people, etc and find themselves without the spare money to dump into legislators campaigns, things can be fine with this.

the old saying holds: we mustn't let the perfect be the enemy of the good

be pragmatic... declare victory and dance on the chances-of-republican-electoral-victory's graves. They've fucked up big time on this and now is the time to press the advantage.
Drive them into the sea America!

[Simulist]

It's a pain in the arse to have to get insurance, but it's the right thing to do, it's part of fulfilling our obligations to each other.

I don't see how pumping money into a private for-profit system has anything to do with "fulfilling our obligations to each other."

I don't either, SanDiegoBuffGuy.

The kind of language JustDrew used there is the kind of guilt-laden rhetoric used by both political parties whenever they want to cram something the people don't want down their collective throats.

Complying with someone's demand to buy a defective product is neither "the right thing to do" nor is it "part of fulfilling our obligations to each other."

It's bullshit — that's what it is.

[IanEye]

hey freemason9!
it seems like a lot of people here want to give you a hard time about your views on the state of healthcare and congress.
i'd love to help you out, but:



i'm kind of busy these days dealing with the reality of getting my kid home from the hospital (who was born a full trimester premature) and helping my Wife recuperate because she got so stressed out after giving birth that she suffered two massive myocardial infarctions about a month and a half later.

so, very quickly, my advice to you is:

tell all the personas here at RI to go fuck themselves

turn off the computer

spend time with your family

.

[nathan28]

Am I actually going to have to explain why any universal coverage must necessarily be mandatory for all?

Okay, I get it. You have what we might call a faith-based understanding of this bill.

oh wait, is that a semi-humorous tautology ?... The main problem with private insurance companies is it's inherently less efficient than single payer, they seek profits by denying care, they cancel policies, they pay to much to their executives...

Yes, but in reference to this. There's other, far more preferable plans of action.

be pragmatic... declare victory and dance on the chances-of-republican-electoral-victory's graves. They've fucked up big time on this and now is the time to press the advantage.
Drive them into the sea America!

Don't worry about that, I've been laughing at them all day.

[justdrew]

Yes, I did know that I would have been able to save all that money. The proof is in the outcome. I didn't waste my money on a crappy system that makes its money by denying people care.
"Things could have been different." Oh, yes, I was scared once, too, about this sort of thing, but I liberated myself from the fear and took control. "What if something happens" is how they get you. People stay in awful jobs under stupid bosses for the same reason.

well, I agree with your feelings about taking personal responsibility, avoiding the 'fear' etc - but I also know plenty of healthy people who work on it hard who nonetheless develop (or have inflicted) some kind of health problems at some point. You might like a kind of plan called a medical savings account, it comes with tax benefits and the plan just backstops large low-probability costs (it's also sometimes called a very-high-deductible plan) and so isn't as expensive as plans with a very low deductible.

I don't see how pumping money into a private for-profit system has anything to do with "fulfilling our obligations to each other." If you want to talk responsibility, talk to all of the people who drain the healthcare system by making poor lifestyle choices and making the decision to be unhealthy.

paying into our "system" is fulfilling mutual obligations because that system (flawed though it is) is the only way we have for creating and sustaining the entire health-care infrastructure, which will now be accessible to nearly everyone.

Build this into my cost structure? Yes, that's so easy. Do you own a business? I guess I just do that magically?

I do not own a business as such, but I do think that if you're saying you have no power to adjust your prices to reflect costs, you may already have been in some difficulty.

This health insurance bill benefits the insurance companies with a few scraps (ie "no denial based on pre-existing conditions") to the lowly masses. So goes life in America. No surprises here, really.

time will tell, but I don't really think there's going to be a huge benefit to these companies. I'm expecting a wave of consolidation (a good thing) and commodification of the service, this should ultimately mean that health insurance companies will no longer be a "sexy" high income profession for a certain class of executives and things may just have to come down to earth generally at these enterprises. good.

[justdrew]

It's a pain in the arse to have to get insurance, but it's the right thing to do, it's part of fulfilling our obligations to each other.

I don't see how pumping money into a private for-profit system has anything to do with "fulfilling our obligations to each other."

I don't either, SanDiegoBuffGuy.

The kind of language JustDrew used there is the kind of guilt-laden rhetoric used by both political parties whenever they want to cram something the people don't want down their collective throats.

Complying with someone's demand to buy a defective product is neither "the right thing to do" nor is it "part of fulfilling our obligations to each other."

It's bullshit — that's what it is.

let me ask you this:
would you shove peace and justice down their throats?
would you shove repeal of the patriot act down their throats?

and what's wrong with guilt? If the shoe fits wear it. I only object to guilt when it is undeservedly thrust on people. The infrastructure has to be paid for somehow, this is, among other things, a first step in reducing the portion of paid money being wasted on overhead. If you're absolutely adamant that you don't want to pay for health insurance or receive the subsidy to do so, there are ways to opt-out, I think the "fine" (which is the only form the mandatory-ness takes I think) is only $345 a year added to your taxes. I believe there is religious exemptions to avoid even paying that fine.

[SanDiegoBuffGuy]

So, drew, you are calling paying fine is a way to "opt out"?

I thought that's what we call "coercion."

[justdrew]

So, drew, you are calling paying fine is a way to "opt out"?

I thought that's what we call "coercion."

no, there are provisions for avoiding the fine, at least on "religious" grounds, iirc.

society coerces all sorts of behaviors already, it's not necessarily a bad thing.

and...

Public option momentum invigorates after bill passes
President Obama and Democratic leaders partly convinced disillusioned progressives to get behind this health care bill by explaining that its passage would make a public option more likely in the future, not less, while its failure would guarantee that no president or Congress revisits the whole issue for another generation.
... < more at link >

[nathan28]

So, drew, you are calling paying fine is a way to "opt out"?

I thought that's what we call "coercion."

That's silly. $345 is about three months of insurance premiums, and well below that four-digit figure that was floating around a week or two ago. There's no problem with taxes, and a fine isn't much different than a tax in this instance.

[nathan28]

The infrastructure has to be paid for somehow, this is, among other things, a first step in reducing the portion of paid money being wasted on overhead. If you're absolutely adamant that you don't want to pay for health insurance or receive the subsidy to do so, there are ways to opt-out, I think the "fine" (which is the only form the mandatory-ness takes I think) is only $345 a year added to your taxes. I believe there is religious exemptions to avoid even paying that fine.

The infrastructure is paid for, though, every day. It's called Medicaid. I don't see where the "overhead" disappears, though, or how this necessarily does anything about it.

[SanDiegoBuffGuy]

Nathan, it isn't silly.

I choose not to participate (I make my own decisions about my own health) and I get fined. I don't see how anyone can defend this "opt out" at whatever price. It's coercion. It's bullshit.

And if $345 per year isn't a big deal, I can send you my address and you can mail me an annual check.

[nathan28]

Nathan, it isn't silly.

I choose not to participate (I make my own decisions about my own health) and I get fined. I don't see how anyone can defend this "opt out" at whatever price. It's coercion. It's bullshit.

And if $345 per year isn't a big deal, I can send you my address and you can mail me an annual check.

I have cheap insurance, which I've got to carry on account of some stupid administrative policies. It's $100/month. But if I didn't face that, it'd be cheaper to shell out $345 once a year than $700 every six months. That's all. On edit, even with low-low-prices insurance that you can't get everywhere, around $60/month, it's still cheaper. That's not a serious fine, because it's still 50% the cost of the other nonsense.

I'll point out that the $2000/employee fine on insurance gaps for small employers is a fairly transparent barrier-to-entry regulation, while I'm at it, though the petty bourgie types aren't exactly all that common these days.

[justdrew]

The infrastructure has to be paid for somehow, this is, among other things, a first step in reducing the portion of paid money being wasted on overhead. If you're absolutely adamant that you don't want to pay for health insurance or receive the subsidy to do so, there are ways to opt-out, I think the "fine" (which is the only form the mandatory-ness takes I think) is only $345 a year added to your taxes. I believe there is religious exemptions to avoid even paying that fine.

The infrastructure is paid for, though, every day. It's called Medicaid. I don't see where the "overhead" disappears, though, or how this necessarily does anything about it.

medicaid patients don't bring in remotely enough on their own to keep all the hospitals and clinics open and equipped.

the overhead I'm talking about reducing is the difference between an insurance companies in-takes and it's health-care payouts, medicare is like 95% efficient in this sense, private companies are now going to have to reveal their list of "expenses" publicly. If I were shopping around, I'd be sure to find one with the lowest overhead. So much of the 'what-they-pay-for' details are going toward standardization, and they'll be carrying a lot more expensive customers they can deny care to or cancel, the primary point for insurers to compete on now will be overhead efficiency. It could really work out well. Now if they ignore that and fail to get more efficient, they'll find a public option will surely be introduced.