Government Shutdown

[He's Dead, Jim]

@Jim, there are people with PhD's in political and economic sciences that fundamentally don't agree with each other since you can't really prove political philosophies are scientifically right or wrong. Likewise as someone who also has a degree (in something different but I have taken economics classes) we can all be wrong at times a degree doesn't make us immune to error.

That's a fair point, but the anti-intellectualism that can crop up in some of these discussions is absurd. I'm not calling out anyone in particular.

I explained earlier why in the sense of a mandate why health insurance is not the same as car insurance. You can choose not have a car, you can opt out if you want to. That isn't so possible when it comes to healthcare as its your health and regardless and you can't opt out of that regardless if you have health insurance or not.

Right, which is precisely what the Obama administration would say, and what they did say to SCOTUS: the mere fact that you exist means, like it or not, you are a part of the healthcare market. Therefore, your participation in that market means it can be regulated through the interstate commerce clause, which is the legal and economic rationale for the ACA.

And I agree with you on the discussion part, but then it actually needs to be a discussion. Not "This is the most ungodly, unconstitutional law ever created in world history," which is what a Republican congressman from Indiana said yesterday. Yes, it was on the Daily Show, but that is the rhetoric I hear constantly from a lot of people. It's ridiculously overblown. Is Massachusetts a godless communist hellscape? No. The Republicans should at least let the law- which is constitutional, and was passed through this country's national legislature, regardless- go into effect. If it doesn't depress costs enough, then get rid of it or modify it. I'm pretty sure Republicans will have the presidency at some point. The "ZOMG IT'S SO UNJUST" backstop was the Supreme Court, and John Roberts of all people voted to uphold the law.

I think this says it all. You can't and SHOULDN'T believe everything you're told.

This is a nice paternalistic sentiment and I appreciate the concern, but I don't, dude. I think for myself, which is why I'm able to say, "You know what? I don't think the ACA brings down long-term costs enough, but I'm willing to wait and see if it does." Or, more controversially, "You know what? I think most of what the NSA is doing is actually okay, but I think it needs more oversight and the scope should probably be reduced." I also think Guantanamo Bay is an affront to human dignity! I have opinions that are different about different things because I'm a person and I read stuff!

 

[JeffTD]

I'm more than happy to hand things off to HD,J at this point (as he's handling you guys with much more civility than I'd be able to today); I'm sure he'll also be able to give some personal examples of how the shutdown is affecting his everyday life as he lives in DC where infrastructure runs almost entirely off of federal funding.

 

[egan.]

In the big article that I read they laid out a plan that insurance companies could do to get healthcare down and make more money for themselves in the process. Basically it would involve the companies getting together and finding the cheapest hospital for a given procedure and all say that for that procedure we will only pay as much as hospital x is charging, if you want to go to another hospital not covered under the insurance plan, you have to pay whatever the differences are out of pocket. The example they gave was a hip replacement surgery. While the mean price is around $30k some hospitals have been known to charge well over $100k for. If your covered up to $30K at your hospital, but you wanted to go to a hospital that charged $40k, then you will have to pay the difference. If all insurance companies and their partnered medical practices followed, the more expensive hospitals would be forced to drop their prices, therefor if the prices drop and the insurance companies don't lower their premiums, they make more money. So the patient can go to any doctor or hospital they prefer and the insurance company makes more money, sounds like a win. On top of that it would force the hospitals to start looking for cheaper contracts or stop using contracts entirely so that they save. That would ultimately force down the over inflation medical supply companies are charging.

That's the exact opposite of a free market. That's a single payer system by way of an illegal trust. Essentially what you're talking about is letting
for-profit insurance companies get together and negotiate as a single entity. One for-profit negotiating body and an insane risk of abuse.
BTW, I'm not saying we can't have new ideas. I'm saying we don't have to as there is a wealth of real world examples of systems that are cheaper, with more people covered and with demonstrably better results than our own.

 

[He's Dead, Jim]

^ egan is completely correct.

Country after country after country has shown that the most effective way to bring down costs is to use the government as a single buyer in a monopsonistic system and force companies to provide services for as cheap as the government can bargain for. That isn't a 100% perfect model, but that's literally the only reason Americans pay three and four times as much for medical care as people in other countries: the health care providers are pocketing the profits. They're businesses, so they're entitled to do that I guess, but I think it's outrageously inhumane, and I don't particularly see us benefiting from it in any way. There is the possible exception of medical device and medicine development, but that's more an intellectual property issue.

Read this: http://www.bloomberg.com/news/2013-06-03/the-real-reason-we-pay-so-much-for-health-care.html

Or this NYT article, which received a lot of coverage when it originally came out: http://www.nytimes.com/2013/06/02/h...the-world-in-health-expenditures.html?hp&_r=0

As an anecdote, I have a medical condition for which I needed to get a colonoscopy. I'm 23. Because my mother is a public school administrator, her health care only covers me in the northeast, where I grew up. I had to drive back to my home state from DC to get a colonoscopy, because if I had done it in DC it would have cost my parents $3,000. This is the sort of stuff that makes me feel like we're living in a third-world country when it comes to health care, and in a lot of ways, we are. That term actually does a disservice to developing countries, because they at least try to provide universal health care.

 

[Genius Gone Insane]

Solution to most people's problems = spend more and shop at mom and pops instead of chains whenever possible. If we all do it, life will be tough for a few years but it will weed out a lot of the systematic problems we ALL face.

Pffft!!!

 

[TheWinterSnow]

That's the exact opposite of a free market. That's a single payer system by way of an illegal trust. Essentially what you're talking about is letting
for-profit insurance companies get together and negotiate as a single entity. One for-profit negotiating body and an insane risk of abuse.
BTW, I'm not saying we can't have new ideas. I'm saying we don't have to as there is a wealth of real world examples of systems that are cheaper, with more people covered and with demonstrably better results than our own.

In my haste to write my post I miss-worded some things, my bad. What I meant to say was that an Insurance company looks into the prices of the procedures for the medical practices that insurance covers. In other words, the doctors and hospitals that are in that insurance's coverage. Set forth government regulations where a person can go to any doctor/hospital they want but if it is beyond what that person's coverage covers then they have to pay out of pocket the difference. As of now if you go out of coverage most insurances won't pay a dime.

In this system, insurance companies aren't bargaining together, you are right that is illegal under the Sherman Anti-trust Act. What the system I mentioned would do is force expensive doctors, practices, hospitals and insurances to bring their prices down to stay competitive because no one would go to them if they had to choice to go with the same exact thing for cheaper. Again it is very important that people have the options to choose.

Again, I do apologize for my incorrect wording.

With that in mind I do support a single payer system and do hope that California makes the right decisions that allow us to make other decisions outside the ACA.

 

[StayTrue]

Question: Do you think we would be having a healthcare discussion had the exchanges opened prior to Oct 1? Notice how this thread is all about healthcare and not about passing a budget.....

Our government has passed budgets in the past, and will continue to do so in the future, in which every American "philosophically" doesn't believe is 100% correct.

This shutdown is being used as political leverage in a time where problems need to be fixed, rather than finger pointing and ideologue misdirection.

 

[JoeMeek12397]

Have none of you known someone that has or personally been affected by the ACA? My family has. Lots of places are already cutting people's hours down to part time, thus removing lots important necessitates from people's lives. Nice loophole.

Shit is already stretched way too thin for me to buy health insurance, so I can't see a doctor and I've been sick for the past 8 years. Forcing me to buy insurance helps me gain it, when I can't afford in the first place? That's a mafia type sell if I've ever heard one, an offer I CAN'T refuse.

Don't get me wrong, I hate republican views/actions even more, but people are being such sheep about this shit.

 

[XxSicRokerxX]

 

[Jind]

Shit is already stretched way too thin for me to buy health insurance, so I can't see a doctor and I've been sick for the past 8 years. Forcing me to buy insurance helps me gain it, when I can't afford in the first place? That's a mafia type sell if I've ever heard one, an offer I CAN'T refuse.

If this response is too personal, feel free to not answer, but your post raises a few questions. You note that things are stretched too thin for you to buy health insurance which begs the question have you looked into how much, if any of the cost would be subsidized via tax credits under the ACA?

Second you also note that you've been sick for 8 years. Trust me I know long term illness - have had two bone marrow transplants for Acute Myelogenous Leukemia in the past 8 years, and while I'm fortunate that I had a well paying job with good insurance benefits including LTD coverage, I know that without them I'd be shit out of luck prior to the ACA since I've had a pre-existing condition since age 21 when I was diagnosed with a blood disorder that eventually morphed into the Leukemia (by the way I turned 46 this year). Had I tried to get insurance in the market prior to the ACA I'd either be outright denied coverage (most likely outcome) or have premiums so high it would be impossible to maintain.

So - the ACA has possibly provided insurance that you would have been denied prior to it's implementation and with the ACA insurance companies can no longer charge you more for any pre-existing illness - add to that the possibility tax credits could offset much of the cost depending upon your income, it still sounds better than the prior alternative.

As I said this is more an observation than a question so feel free to ignore it.

 

[StayTrue]

Have none of you known someone that has or personally been affected by the ACA? My family has. Lots of places are already cutting people's hours down to part time, thus removing lots important necessitates from people's lives. Nice loophole.

Shit is already stretched way too thin for me to buy health insurance, so I can't see a doctor and I've been sick for the past 8 years. Forcing me to buy insurance helps me gain it, when I can't afford in the first place? That's a mafia type sell if I've ever heard one, an offer I CAN'T refuse.

Don't get me wrong, I hate republican views/actions even more, but people are being such sheep about this shit.

Check this to see if you qualify for the tax credit: https://www.healthcare.gov/will-i-qualify-to-save-on-monthly-premiums/

As mentioned this is all your personal business, but hopefully this will help

 

[He's Dead, Jim]

You also don't have to buy health insurance. You can pay the tax/penalty if you really want to, and it is technically less than most health plans. And if businesses in your area are really cutting down workers to save on health care costs, the entire point of the state exchanges is to make individual plans actually affordable for people who need/want them.

 

[TheWinterSnow]

You also don't have to buy health insurance. You can pay the tax/penalty if you really want to, and it is technically less than most health plans. And if businesses in your area are really cutting down workers to save on health care costs, the entire point of the state exchanges is to make individual plans actually affordable for people who need/want them.

One the website they claim that the penalty is 1% of your income or $97(or something close) which ever comes first and you have to pay 100% of your medical expenses. So you don't get healthcare with the fee, you just have to pay the fee because you don't have healthcare. I like the wording on the site, they basically fear monger you with saying something along the lines of, most people that pay out of pocket go bankrupt. They give you an ultimatum, buy Obamacare or be financially ruined.

 

[JeffTD]

You do realize that your taxes already go towards paying for the health care of uninsured people, right? Penalizing you for not having health insurance (AKA not being a part of the insurance pool but being able to reap the benefits of it by defaulting on bills related to health care or having to rely on gov't subsidies when you become too unhealthy to work, when a breadwinner in a family dies because his illness goes untreated, etc) is the same as penalizing someone for not having car insurance (eg you screw over other people if you hit them and don't have insurance). It's totally fair.

If you're going to try and argue that auto insurance ≠ health insurance again, you're just dead wrong.

Yes, you can opt out of needing auto insurance by not driving. You can also opt out of needing health insurance by not living.

I get that it sucks to not be able to opt out of health insurance when you feel totally healthy, but every single healthy person ever is going to require healthy care at some point in their life.

 

[MarcusGHedwig]

Can someone please explain why the ACA is motivating employers cut hours (and downgrade employees from full- to part-time) when health insurance is getting cheaper?

 

[He's Dead, Jim]

Can someone please explain why the ACA is motivating employers cut hours (and downgrade employees from full- to part-time) when health insurance is getting cheaper?

Because the law has an employer mandate that forces employers to provide health insurance if they employ 50 or more workers, so allegedly some businesses are cutting back employees to part-time or firing people to avoid having to pay up.

I say allegedly for 2 reasons. First, even if they do, I think I said before a major part of the law is an attempt to make individual coverage affordable through the state exchanges. So if you're in that situation, you should ideally be able to get insurance anyway through the cheaper individual plans and the tax credits.

Second, I've seen quite a few economic studies that claim it's nonsense, and that if any employers are actually doing this, they're isolated cases and not reflective of broad economic trends. Also, like you said, the hope is that over time, the reduction in costs relative to inflation will incentivize them not to. Costs have already been declining quite a bit, but it's hard to separate that phenomenon from the lingering effects of the recession without more data. They also just delayed the employer mandate for a year, so it's a bunch o' malarkey IMO. That said, I might be wrong. But I don't think there's conclusive proof yet.

 

[XxSicRokerxX]

/thread

 

[Genius Gone Insane]

Republicans: "Meh."

 

[egan.]

Because the law has an employer mandate that forces employers to provide health insurance if they employ 50 or more workers, so allegedly some businesses are cutting back employees to part-time or firing people to avoid having to pay up.

I say allegedly for 2 reasons. First, even if they do, I think I said before a major part of the law is an attempt to make individual coverage affordable through the state exchanges. So if you're in that situation, you should ideally be able to get insurance anyway through the cheaper individual plans and the tax credits.

Second, I've seen quite a few economic studies that claim it's nonsense, and that if any employers are actually doing this, they're isolated cases and not reflective of broad economic trends. Also, like you said, the hope is that over time, the reduction in costs relative to inflation will incentivize them not to. Costs have already been declining quite a bit, but it's hard to separate that phenomenon from the lingering effects of the recession without more data. They also just delayed the employer mandate for a year, so it's a bunch o' malarkey IMO. That said, I might be wrong. But I don't think there's conclusive proof yet.

Keep in mind you have guys like Papa John Schnatter promising to cut hours/pay and raise prices at conservative fundraiser at his private golf course.

 

[Jind]

Like many politically/ideologically biased subjects, knee jerk reactions and first impressions based upon uninformed half truths spread to other uninformed like minded individuals tends to be the basis for automatically disliking something you have obviously not fully investigated.

Have I covered most of the objections to the ACA put forth in this thread?