No, it means exactly what I think it means. That the law applies to everyone in theory, and some in practice. If you were to become destitute, it would apply to you. A safety net is useless if it ensnares everyone all the time.
Why do some people receive assistance? Because a long time ago, we decided it was (a) cheaper (b) logical and (b) more humane to make sure that when people get too low on the totem pole to even have money to invest in themselves to start to dig themselves out of the hole, we should lend a hand. That humans, while they are also animals, do not have to behave like animals. Natural rights don't protect your belongings, only violence does. If you get a large population of poor people with no hope, you can either cheaply try to keep them happy and give them hope or you can hire a whole lot of mercenaries. When you have lots of poor people out of work, you can let them go without healthcare and becoming breeding grounds for diseases, you can let them starve; or you can keep them alive, nurse them back to health, help them get an education, and they will pay you back tenfold when they get a job again and can contribute to the economy and move everyone forward. And when we have poor out-of-work people, we can ignore them at our own peril, only to find ourselves outcasts in the next economic downturn, when a bubble bursts or our wife divorces us or jobs move to another country or we have a terrible crop failure, and we can reap what we sow.
But to correct you: not all 30 million are getting free health insurance. The subsidies are on a sliding-scale, so that as people work their way out of poverty, we support them less.
Nature by default is a dog-eat-dog world, yes. And I respect the self-consistent philosophy that claims we should leave it as is. I don't think we can measurably claim that it is "good" or "better" in any sense, though, because by asserting we should not intervene, not design, not move beyond, we remove from ourselves the agency to set goals and develop solutions to achieve those goals. If we're not trying to achieve anything, there's no way to measure success. Is the natural world succeeding? Unanswerable. Do I accept that we should trust that it works in magical unmeasurable unknowable ways? No, I think we should apply science to the social realm just as we do with everything else. I think we should strive to find a real solution, not throw up our hands and trust to the winds, simply because they already exist. But again, I respect the self-consistency of your worldview.
I can't say I like "Big Government", but whatever. I do like good practical solutions to real problems.
You seem to think we could have solved the uninsured problem without affecting anyone else -- would you care to expand on that? Maybe we could all poke holes in your proposal, until you understand the complexity of the problem, the inter-relatedness of the issues, the side-effects you would cause. Maybe, given enough time, and enough revisions, we would arrive at a workable plan. But you probably wouldn't like it. Real-world problems often require complex solutions.
I do find it unfortunate that we don't require every law passed to come with the equivalent of source-code comments, explaining the necessity of each provision in the law, or how pieces work together. As simple as it looks to armchair legislators, it's not. Even the legislators paid to do the job, often don't realize how their changes will affect a system. They don't have a good test environment, and the simulators can only do so much. (The CBO, for one, tries to setup such simulations.) But they still have to try their best, I'm sorry you don't like the result.
It makes me just another citizen, but you can label me as you wish.
A shill would have close ties, possibly financial motives, that are not disclosed. I can only promise that I have none such; I have employer-provided healthcare at the moment, with which I'm quite satisfied, and this law changes nothing for me at the moment. Do I, like everyone else in this country, have something to gain or lose from it? Sure, but that doesn't make me a shill. I'm sorry if you don't see the difference.
The law was no secret. Hundreds of legislators had a chance to hack on it. It was published for all to see. What matters in the end is the law itself, not what any politicians (even Obama) have said about it -- they all have their own, usually self-serving, take on it. What about Palin and her dreaded Death Panels? That was a misrepresentation too (which some 30% of us apparently still believe). Find me a politician who never lies, never represents, never withholds, never steers or manipulates, never... yeah. We can't make ever law depend on every politician being a model citizen, we'll never get anywhere at that rate.
RE: (c) Single-payer is not single-provider, there's still a market at play. The economies of scale, the group purchasing power, are what allows the insurance provider to apply pressure the individuals couldn't, and to monitor for systemic irregularities in ways individuals couldn't. This is already true with individual (large) insurance companies. It's already true of Medicare. But they're not insane; they don't mandate that all providers cost the minimum that any provider could possibly charge. They know they're gliding over choppy waters, so they apply statistical rules, to find the likely price-point based on the variation seen, and apply a small tolerance on top of that. They communicate out-of-band (not just bills and checks) with providers, to make sure the quality of care isn't impacted. Medicare already gets input from the industry on what procedures should cost, yet still pays less than other insurance companies -- while there's the potential for abuse, it's not the norm.
RE: (e) My point is that where the free market can work, we should use it. It's a good system for solving certain types of problems. But there's nothing inherent in the algorithm that makes it applicable to any and all markets, for all time. We as humans have our own physical needs and desires, and it behooves us to examine each situation individually, to determine which approach will work best. We should not blindly strap ourselves to free market ideals, only to be at their mercy. The Invisible Hand has no compassion, it cares not whither we wish to go.
Is this form of insurance less efficient than a totally-free-market at providing care to those who can afford to pay for it? Yes! But the two approaches don't solve the same problem. The ACA (etc.) is trying to make sure everyone gets practical access to care. Once you introduce such a requirement into the specification, it changes everything, including how you measure success.
There are issues with centralizing power, yes. But inherent unavoidable intractable corruption to the point of uselessness and counter-productivity? I wouldn't go that far. Civilization has yet to throw Government to the curb as a tried-and-failed idea.
That's really more an argument against any form of wealth redistribution, ever. It would imply not only that progressive tax rates are immoral, but that it's immoral for anyone to ever receive a benefit they didn't pay for equally -- such as being a pauper citizen of a nation with a standing military to defend it. In fact, you would need to either get a job and pay taxes, or be thrown out. I suppose such a regime is plausible, and +1 on logical consistency, but maybe outside the scope of the current discussion on the potential drawbacks of the ACA vs. single-payer healthcare?
The income redistribution was already happening, except it happened in spurts (when people went to the ER, couldn't pay, and the hospital passed along the loss) or through the courts (when people went bankrupt, and we all paid for it when their creditors passed along the loss.)
Insurance, by its very nature, is always re-distributive. Those who don't need (today) pay for those who do (today). It evens out, eventually (there's no reason to expect those who are currently rich to be naturally healthier over their entire lifetime), but in the short term it's redistribution. We redistribute for basic needs -- food, shelter, and healthcare. We've had a mandate to that effect since 1986, under Reagan. It's not a particularly partisan issue to say that our fellow man doesn't deserve to die of some curable disease just because he can't currently pay for care. And it's not unreasonable to say we'd rather he go see a doctor while the problem is easy to fix, rather than wait until the last minute -- by doing so, he's doing us a favor (if we're footing the bill.) We may subsidize his care today, but if he recovers and thrives, he'll be paying back into that same insurance pool too.
We generally regulate what products people can buy. We do that with securities. With drugs. With food. Weaponry. Animals....
We have certification requirements for plumbers, lawyers, electricians, and yes, doctors. Does that increase the cost of the services? I'm pretty sure it does -- but the regulation wasn't done without reason. When you look at the history of deregulation of these industries, you see all sorts of calamities. A cheap self-described electrician can set fire to a whole neighborhood. A quack doctor could easily cause a pandemic. We're all affected.
Self-reliant today, but what about tomorrow? Will you willingly accept to be left in the gutter by the rest of society in your hour of need, because you deserve no better? Money is secondary to me. People come first.
The ACA does not prevent you from paying more, if you want to. So I'm not sure what that's about.
The cost information is available. But the original statement was about costs and outcomes -- and there, it gets harrier, because the billing system we use isn't really setup to help the insurance company (private or not) track how conditions are related to each other over time. They can, and do, guess. But it's tenuous at best, and as you switch insurance companies, your history doesn't cleanly move with you. So determining exactly what the original commenter wanted -- whether you were overpaying for the outcomes experienced -- is a problem not yet entirely solved.
I haven't seen a source for the 3x value. AFAICT, it's in the 20%-100% more range, depending on the study and the metric (per capita, adjusted for GDP, equivalent care, etc.)
You really didn't get my point about "if/then/else" clauses, did you. Nor what I mean by a "jab". I'm sorry I've so thoroughly failed to communicate.
But to take your point seriously: could they have legislated ONLY that people without insurance, must get some? And not touched anything else, such as the definition of minimum insurance coverage, which cascades to people being unable to keep their current plan? No, I don't think they could have, because of how it would have been gamed. Any change to a system is going to have knock-on effects throughout the system, and they had to tackle this holistically. Not to do so would be reprehensibly reckless. So yes, they had to write the law for 300 million, not 30 million.
Similarly, food stamps are for everybody, in the sense that anyone/can/ become eligible for them. (Well, barring exceptions. I recall something about Florida and drug-testing?) The laws are the same for everyone. How they get applied depends on the circumstances. The laws governing food stamps apply to more than just the people receiving them; there are also laws regarding those who are not eligible (and what happens if they get their hands on some), on retailers (accepting, reporting). So... yes. The law is for everybody, even those not actively receiving benefits.
Yes, that was a simplistic promise that could not be kept.
A baseline definition of health insurance had to be created, for a mandate to have such insurance to have any weight at all. To say "you must have something that someone somewhere titled "ur totally ahsome helth ensurince" or else pay a fine" would be asking for people to sign up for bogus $1/year "insurance", yet still be a burden on their fellow man when they actually fell ill and needed more than the cursory care covered by their "insurance".
So if a line in the sand had to be drawn for the law to work at all, then of course some people would fall on that side of the line. It was inevitable, and they shouldn't have stated the situation so simplistically. I can't apologize on their behalf, but I can agree it was misleading.
In better news, many of the people being forced to shop for insurance are, in turn, finding they can get cheaper and better insurance through the exchanges. If you feel an emotional attachment to your healthplan, though, I can't help you there.
The impetus to increase supply comes when people notice that they could be making a profit by increasing supply. If costs are kept down but supply is not keeping up with demand, there's still a profit to be made in filling the gap and sucking up whatever demand there is, even at the set price. Rising prices are just one potential signal that such a gap exists. Everyone complaining about shortages despite the availability of funds would be another.
We should note that we have already experienced healthcare supply shortages over the years, even without the ACA. The free market never guarantees that anything will be smooth, fast, or automatic. Just because people live longer and need more care, doesn't automatically cause more college students to go into nursing in preparation. There's a causal (well, almost causal) chain, sure, but it's long and convoluted. Signals get lost along the way. Let's not paint too rosy a picture of life under a laissez-faire regime.
I'd prefer to be concerned for the people who have been waiting to finally get insurance at a reasonable rate, and don't get it as soon as it's available. The penalty the first year is extremely low anyway.
But you should note that people can still sign up over the phone or in-person. The website isn't the only method. So... it's not really a good excuse for not signing up.
Also note that the individual States were given the option to take federal money and do this better than the federal government, and many refused to do so. As a resident of such a state, I can blame it, on top of the federal government, for any such failure.
If doctors have the choice between getting paid by (a) Medicare, which is trying to lower costs by actually paying less for services, or (b) private insurance, which can (and does) raise rates every year to pass costs along to the insured, OF COURSE doctors would prefer to see patients with private insurance.
But you'll note that if we took that choice away, things could be different. France, for example, uses a single-payer system (mostly -- you can get supplementary insurance) and most (not all) doctors agree to the equivalent of Medicare rates, to get the vast majority of patients referred to them. There have been complaints, rarely, from the providers. Not that they weren't paid enough to stay open, but maybe that they needed more money in order to invest in new/upgraded equipment (e.g. x-ray). What you DID NOT see was a whole country going without doctors, because the doctors just didn't like the lifestyle they were being provided with. It is doable to apply sufficient pressure to keep costs under control -- but in a multi-payer system, it's a lot harder.
Medicare's insolvency is mostly the result of baby-boomers, and would work itself out over a long enough period. But it's a system where we accept surplus, but not deficit. So while we don't complain about the highs, the lows become fatal. It's hard to average something out under those circumstances. Same with the US Postal Service -- not letting them rake in large profits, yet complaining when they haven't been able to save up money in the good years to pay for the bad ones.
The jab was very specific: legislators can't just write a law "only for 30 million uninsured". The law is the law, for everyone. How it affects people, obviously, varies. We can't write laws without "if/then/else" clauses. Here, the ACA did not drastically change the landscape for the 85% of people who already had insurance; it did make changes, but it's not the same as saying the government tried to solve a problem 10x larger than it needed to.
Ethnic background? As far as I can tell, when that's requested, it's always voluntary, and gathered for statistical purposes to detect bias in employment or other decision-making by different agencies of locations... Unless there are examples of abuse, that seems like a generally good idea. It's a little different, of course, if you're a member of a Native American tribe, where some entitlements are provided as a result of your membership.
And during the Iraq War, it was fashionable to suggest that us liberals go to France. It's all fun and games.
As you well know, what providers charge insurance, and what insurance pays, are very different things. I myself have seen plenty of providers who charge the uninsured exactly the same amount they charge for the insured -- except the insurance company never pays that amount. The uninsured get screwed in those situations.
The last stats I saw indicated that vision and dental insurance were a wash -- you didn't really save or lose money by using insurance. That's probably due to the fact that regular "checkup" visits of this type are non-emergency, or even optional. You could go another year without a cleaning. Your current glasses might be good enough for a while. You have the time to shop around, the services are fairly straightforward, there are lots of providers in a given area, and if you don't like any of their prices, you won't die from neglecting your own health for a while longer.
That, however, is not the case for all "medical" services. In fact, you'll note that the ACA specifically does not mandate dental and vision coverage for adults. It's not the problem-area they were going after, because the market for those services works differently from, say, cancer treatment.
Your examples are great. They just don't cover the same gamut as the ACA. Different markets, different behaviors.
That aside, the analogy's terrible. Obama won the majority in the popular election, the ACA (originally a Republican plan from the 90's) passed both the House and Senate, the United States Supreme Court mostly upheld it... that's not "the captain" embarking on a reckless plan by himself.
Hey look, more "damned if you do, damned if you don't" logic -- AlphaWolf argues he (?) doesn't know any insiders who think it's good law (argument from authority, terrible, but whatever), so I provide such an example (not that it matters one whit), and now being in-the-know is a bad thing. I love you guys, really I do.
in what way is the ACA designed to do so? by what method, and what's the loop?
yes, you're correct that we have a pricing problem. i don't think any of us disagree on that point. the problem is what to do about it. we didn't get to this point because of the ACA.
(a) efficiency is not morality, you haven't answered the question (b) how is this about adding rich people to a queue? (c) all group coverage (single or not) attempts to drive down prices over time (d) rationing, if it occurs, is a short-term problem, which the free market (training medical personnel) should fix (e) healthcare isn't a luxury to be consumed willy-nilly; if we have to implement a system to prevent rich people from using up available healthcare man-hours on themselves, when we already have a long-standing mandate to help everyone... I won't feel bad about it. Just because some rich dude could in theory foot the bill for draining a city of its entire water supply, doesn't mean we should allow it to happen. The free market works for the betterment of humans, not the other way around.
Let me fix that for you: I've worked for years in healthcare IT (insurance AND healthcare provision, government AND private), and this is NOT a train-wreck in the making.
But hey, if you want to complain that laws ever change and might affect you... fine. I think the Somali government is currently on hiatus, so you should be safe from any potential changes there.
That information is already available, to some degree, to Medicare and private insurers. They use it to determine how much procedures should cost, and apply pressure (by paying only that amount) to hospitals and providers to drive down the price; they use the incentives of "preferred" status to route patients to cheaper (but still effective) care. A big buyer like Medicare can do that. Large private insurers can do that. Individuals who need emergency heart surgery, and have the choice between two somewhat-nearby hospitals? Not so much. They don't have the time, they don't have the data, they don't have the choice.
A product (healthcare) which they may not want to plan to pay the eventual cost of at the moment, no, but which by law we are required to provide if ever asked for, even if they can't pay? And it's been that way (legally) since 1986, under Reagan. Single-payer would have removed the "buy a product" argument, but hey, we didn't get what we wanted. You already buy a product you don't want, all the time, with taxes. I buy more military than I really want. You probably buy more road projects than you really want. That's life in society.
But as to your original point: states' rights? Sigh. By making employment and healthcare laws a federal thing, we make the market for housing and employment far more fluid. You can move from one state to another looking for a job, with fewer impediments. Employers can attract talent from out of state, without having quite so many per-state issues to overcome. Increased market fluidity reduces localized market irregularities, and makes the overall system more efficient. Living in Oklahoma, I can tell you, I do *not* want more issues to be handled at the State level. But maybe, rather than all working together to come up with a good solution, we should balkanize further: I think all employment and healthcare laws should be handled at the county level, you know, for greater flexibility (people in my county clearly have different healthcare needs and expectations than elsewhere). Maybe even at the city-block level?
I'm a US citizen. I really don't give a crap what State I live in. It's all about being near family, near a job, near good entertainment, with good services. I don't have time to further filter my choices based on some local politician's "bright idea".
The 50 states are not cauldrons of experimentation, centers of innovation. They're just a good excuse for conservatives to shield themselves from changes they don't like. But those same conservatives will be quick to attempt federal legislation (DOMA) to prevent the rest of the country from changing without them. States' rights only come in to play when you lose at the federal level -- but everyone plays that game.
Would you care to explain how single-payer (if we implemented it beyond the current scope of seniors and disabled and poor and children) would be immoral?
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No, it means exactly what I think it means. That the law applies to everyone in theory, and some in practice. If you were to become destitute, it would apply to you. A safety net is useless if it ensnares everyone all the time.
Why do some people receive assistance? Because a long time ago, we decided it was (a) cheaper (b) logical and (b) more humane to make sure that when people get too low on the totem pole to even have money to invest in themselves to start to dig themselves out of the hole, we should lend a hand. That humans, while they are also animals, do not have to behave like animals. Natural rights don't protect your belongings, only violence does. If you get a large population of poor people with no hope, you can either cheaply try to keep them happy and give them hope or you can hire a whole lot of mercenaries. When you have lots of poor people out of work, you can let them go without healthcare and becoming breeding grounds for diseases, you can let them starve; or you can keep them alive, nurse them back to health, help them get an education, and they will pay you back tenfold when they get a job again and can contribute to the economy and move everyone forward. And when we have poor out-of-work people, we can ignore them at our own peril, only to find ourselves outcasts in the next economic downturn, when a bubble bursts or our wife divorces us or jobs move to another country or we have a terrible crop failure, and we can reap what we sow.
But to correct you: not all 30 million are getting free health insurance. The subsidies are on a sliding-scale, so that as people work their way out of poverty, we support them less.
Nature by default is a dog-eat-dog world, yes. And I respect the self-consistent philosophy that claims we should leave it as is. I don't think we can measurably claim that it is "good" or "better" in any sense, though, because by asserting we should not intervene, not design, not move beyond, we remove from ourselves the agency to set goals and develop solutions to achieve those goals. If we're not trying to achieve anything, there's no way to measure success. Is the natural world succeeding? Unanswerable. Do I accept that we should trust that it works in magical unmeasurable unknowable ways? No, I think we should apply science to the social realm just as we do with everything else. I think we should strive to find a real solution, not throw up our hands and trust to the winds, simply because they already exist. But again, I respect the self-consistency of your worldview.
I can't say I like "Big Government", but whatever. I do like good practical solutions to real problems.
You seem to think we could have solved the uninsured problem without affecting anyone else -- would you care to expand on that? Maybe we could all poke holes in your proposal, until you understand the complexity of the problem, the inter-relatedness of the issues, the side-effects you would cause. Maybe, given enough time, and enough revisions, we would arrive at a workable plan. But you probably wouldn't like it. Real-world problems often require complex solutions.
I do find it unfortunate that we don't require every law passed to come with the equivalent of source-code comments, explaining the necessity of each provision in the law, or how pieces work together. As simple as it looks to armchair legislators, it's not. Even the legislators paid to do the job, often don't realize how their changes will affect a system. They don't have a good test environment, and the simulators can only do so much. (The CBO, for one, tries to setup such simulations.) But they still have to try their best, I'm sorry you don't like the result.
It makes me just another citizen, but you can label me as you wish.
A shill would have close ties, possibly financial motives, that are not disclosed. I can only promise that I have none such; I have employer-provided healthcare at the moment, with which I'm quite satisfied, and this law changes nothing for me at the moment. Do I, like everyone else in this country, have something to gain or lose from it? Sure, but that doesn't make me a shill. I'm sorry if you don't see the difference.
The law was no secret. Hundreds of legislators had a chance to hack on it. It was published for all to see. What matters in the end is the law itself, not what any politicians (even Obama) have said about it -- they all have their own, usually self-serving, take on it. What about Palin and her dreaded Death Panels? That was a misrepresentation too (which some 30% of us apparently still believe). Find me a politician who never lies, never represents, never withholds, never steers or manipulates, never ... yeah. We can't make ever law depend on every politician being a model citizen, we'll never get anywhere at that rate.
RE: (c) Single-payer is not single-provider, there's still a market at play. The economies of scale, the group purchasing power, are what allows the insurance provider to apply pressure the individuals couldn't, and to monitor for systemic irregularities in ways individuals couldn't. This is already true with individual (large) insurance companies. It's already true of Medicare. But they're not insane; they don't mandate that all providers cost the minimum that any provider could possibly charge. They know they're gliding over choppy waters, so they apply statistical rules, to find the likely price-point based on the variation seen, and apply a small tolerance on top of that. They communicate out-of-band (not just bills and checks) with providers, to make sure the quality of care isn't impacted. Medicare already gets input from the industry on what procedures should cost, yet still pays less than other insurance companies -- while there's the potential for abuse, it's not the norm.
RE: (e) My point is that where the free market can work, we should use it. It's a good system for solving certain types of problems. But there's nothing inherent in the algorithm that makes it applicable to any and all markets, for all time. We as humans have our own physical needs and desires, and it behooves us to examine each situation individually, to determine which approach will work best. We should not blindly strap ourselves to free market ideals, only to be at their mercy. The Invisible Hand has no compassion, it cares not whither we wish to go.
Is this form of insurance less efficient than a totally-free-market at providing care to those who can afford to pay for it? Yes! But the two approaches don't solve the same problem. The ACA (etc.) is trying to make sure everyone gets practical access to care. Once you introduce such a requirement into the specification, it changes everything, including how you measure success.
There are issues with centralizing power, yes. But inherent unavoidable intractable corruption to the point of uselessness and counter-productivity? I wouldn't go that far. Civilization has yet to throw Government to the curb as a tried-and-failed idea.
That's really more an argument against any form of wealth redistribution, ever. It would imply not only that progressive tax rates are immoral, but that it's immoral for anyone to ever receive a benefit they didn't pay for equally -- such as being a pauper citizen of a nation with a standing military to defend it. In fact, you would need to either get a job and pay taxes, or be thrown out. I suppose such a regime is plausible, and +1 on logical consistency, but maybe outside the scope of the current discussion on the potential drawbacks of the ACA vs. single-payer healthcare?
The income redistribution was already happening, except it happened in spurts (when people went to the ER, couldn't pay, and the hospital passed along the loss) or through the courts (when people went bankrupt, and we all paid for it when their creditors passed along the loss.)
Insurance, by its very nature, is always re-distributive. Those who don't need (today) pay for those who do (today). It evens out, eventually (there's no reason to expect those who are currently rich to be naturally healthier over their entire lifetime), but in the short term it's redistribution. We redistribute for basic needs -- food, shelter, and healthcare. We've had a mandate to that effect since 1986, under Reagan. It's not a particularly partisan issue to say that our fellow man doesn't deserve to die of some curable disease just because he can't currently pay for care. And it's not unreasonable to say we'd rather he go see a doctor while the problem is easy to fix, rather than wait until the last minute -- by doing so, he's doing us a favor (if we're footing the bill.) We may subsidize his care today, but if he recovers and thrives, he'll be paying back into that same insurance pool too.
We generally regulate what products people can buy. We do that with securities. With drugs. With food. Weaponry. Animals. ...
We have certification requirements for plumbers, lawyers, electricians, and yes, doctors. Does that increase the cost of the services? I'm pretty sure it does -- but the regulation wasn't done without reason. When you look at the history of deregulation of these industries, you see all sorts of calamities. A cheap self-described electrician can set fire to a whole neighborhood. A quack doctor could easily cause a pandemic. We're all affected.
Self-reliant today, but what about tomorrow? Will you willingly accept to be left in the gutter by the rest of society in your hour of need, because you deserve no better? Money is secondary to me. People come first.
The ACA does not prevent you from paying more, if you want to. So I'm not sure what that's about.
The cost information is available. But the original statement was about costs and outcomes -- and there, it gets harrier, because the billing system we use isn't really setup to help the insurance company (private or not) track how conditions are related to each other over time. They can, and do, guess. But it's tenuous at best, and as you switch insurance companies, your history doesn't cleanly move with you. So determining exactly what the original commenter wanted -- whether you were overpaying for the outcomes experienced -- is a problem not yet entirely solved.
I haven't seen a source for the 3x value. AFAICT, it's in the 20%-100% more range, depending on the study and the metric (per capita, adjusted for GDP, equivalent care, etc.)
Random example, citing data from various research: https://www.medmutual.com/~/media/Files/Healthcare%20Reform%20PDFs/Report%20Healthcare%20costs%20in%20the%20US.ashx
You really didn't get my point about "if/then/else" clauses, did you. Nor what I mean by a "jab". I'm sorry I've so thoroughly failed to communicate.
But to take your point seriously: could they have legislated ONLY that people without insurance, must get some? And not touched anything else, such as the definition of minimum insurance coverage, which cascades to people being unable to keep their current plan? No, I don't think they could have, because of how it would have been gamed. Any change to a system is going to have knock-on effects throughout the system, and they had to tackle this holistically. Not to do so would be reprehensibly reckless. So yes, they had to write the law for 300 million, not 30 million.
Similarly, food stamps are for everybody, in the sense that anyone /can/ become eligible for them. (Well, barring exceptions. I recall something about Florida and drug-testing?) The laws are the same for everyone. How they get applied depends on the circumstances. The laws governing food stamps apply to more than just the people receiving them; there are also laws regarding those who are not eligible (and what happens if they get their hands on some), on retailers (accepting, reporting). So ... yes. The law is for everybody, even those not actively receiving benefits.
Yes, that was a simplistic promise that could not be kept.
A baseline definition of health insurance had to be created, for a mandate to have such insurance to have any weight at all. To say "you must have something that someone somewhere titled "ur totally ahsome helth ensurince" or else pay a fine" would be asking for people to sign up for bogus $1/year "insurance", yet still be a burden on their fellow man when they actually fell ill and needed more than the cursory care covered by their "insurance".
So if a line in the sand had to be drawn for the law to work at all, then of course some people would fall on that side of the line. It was inevitable, and they shouldn't have stated the situation so simplistically. I can't apologize on their behalf, but I can agree it was misleading.
In better news, many of the people being forced to shop for insurance are, in turn, finding they can get cheaper and better insurance through the exchanges. If you feel an emotional attachment to your healthplan, though, I can't help you there.
The impetus to increase supply comes when people notice that they could be making a profit by increasing supply. If costs are kept down but supply is not keeping up with demand, there's still a profit to be made in filling the gap and sucking up whatever demand there is, even at the set price. Rising prices are just one potential signal that such a gap exists. Everyone complaining about shortages despite the availability of funds would be another.
We should note that we have already experienced healthcare supply shortages over the years, even without the ACA. The free market never guarantees that anything will be smooth, fast, or automatic. Just because people live longer and need more care, doesn't automatically cause more college students to go into nursing in preparation. There's a causal (well, almost causal) chain, sure, but it's long and convoluted. Signals get lost along the way. Let's not paint too rosy a picture of life under a laissez-faire regime.
I'd prefer to be concerned for the people who have been waiting to finally get insurance at a reasonable rate, and don't get it as soon as it's available. The penalty the first year is extremely low anyway.
But you should note that people can still sign up over the phone or in-person. The website isn't the only method. So ... it's not really a good excuse for not signing up.
Also note that the individual States were given the option to take federal money and do this better than the federal government, and many refused to do so. As a resident of such a state, I can blame it, on top of the federal government, for any such failure.
Is that a bad thing? Do you enjoy over-paying for services?
If doctors have the choice between getting paid by (a) Medicare, which is trying to lower costs by actually paying less for services, or (b) private insurance, which can (and does) raise rates every year to pass costs along to the insured, OF COURSE doctors would prefer to see patients with private insurance.
But you'll note that if we took that choice away, things could be different. France, for example, uses a single-payer system (mostly -- you can get supplementary insurance) and most (not all) doctors agree to the equivalent of Medicare rates, to get the vast majority of patients referred to them. There have been complaints, rarely, from the providers. Not that they weren't paid enough to stay open, but maybe that they needed more money in order to invest in new/upgraded equipment (e.g. x-ray). What you DID NOT see was a whole country going without doctors, because the doctors just didn't like the lifestyle they were being provided with. It is doable to apply sufficient pressure to keep costs under control -- but in a multi-payer system, it's a lot harder.
Medicare's insolvency is mostly the result of baby-boomers, and would work itself out over a long enough period. But it's a system where we accept surplus, but not deficit. So while we don't complain about the highs, the lows become fatal. It's hard to average something out under those circumstances. Same with the US Postal Service -- not letting them rake in large profits, yet complaining when they haven't been able to save up money in the good years to pay for the bad ones.
The jab was very specific: legislators can't just write a law "only for 30 million uninsured". The law is the law, for everyone. How it affects people, obviously, varies. We can't write laws without "if/then/else" clauses.
Here, the ACA did not drastically change the landscape for the 85% of people who already had insurance; it did make changes, but it's not the same as saying the government tried to solve a problem 10x larger than it needed to.
Ethnic background? As far as I can tell, when that's requested, it's always voluntary, and gathered for statistical purposes to detect bias in employment or other decision-making by different agencies of locations... Unless there are examples of abuse, that seems like a generally good idea.
It's a little different, of course, if you're a member of a Native American tribe, where some entitlements are provided as a result of your membership.
And during the Iraq War, it was fashionable to suggest that us liberals go to France. It's all fun and games.
As you well know, what providers charge insurance, and what insurance pays, are very different things. I myself have seen plenty of providers who charge the uninsured exactly the same amount they charge for the insured -- except the insurance company never pays that amount. The uninsured get screwed in those situations.
The last stats I saw indicated that vision and dental insurance were a wash -- you didn't really save or lose money by using insurance. That's probably due to the fact that regular "checkup" visits of this type are non-emergency, or even optional. You could go another year without a cleaning. Your current glasses might be good enough for a while. You have the time to shop around, the services are fairly straightforward, there are lots of providers in a given area, and if you don't like any of their prices, you won't die from neglecting your own health for a while longer.
That, however, is not the case for all "medical" services. In fact, you'll note that the ACA specifically does not mandate dental and vision coverage for adults. It's not the problem-area they were going after, because the market for those services works differently from, say, cancer treatment.
Your examples are great. They just don't cover the same gamut as the ACA. Different markets, different behaviors.
And your evidence or argument is ... ?
That aside, the analogy's terrible. Obama won the majority in the popular election, the ACA (originally a Republican plan from the 90's) passed both the House and Senate, the United States Supreme Court mostly upheld it ... that's not "the captain" embarking on a reckless plan by himself.
Hey look, more "damned if you do, damned if you don't" logic -- AlphaWolf argues he (?) doesn't know any insiders who think it's good law (argument from authority, terrible, but whatever), so I provide such an example (not that it matters one whit), and now being in-the-know is a bad thing. I love you guys, really I do.
in what way is the ACA designed to do so? by what method, and what's the loop?
yes, you're correct that we have a pricing problem. i don't think any of us disagree on that point. the problem is what to do about it. we didn't get to this point because of the ACA.
(a) efficiency is not morality, you haven't answered the question ... I won't feel bad about it. Just because some rich dude could in theory foot the bill for draining a city of its entire water supply, doesn't mean we should allow it to happen. The free market works for the betterment of humans, not the other way around.
(b) how is this about adding rich people to a queue?
(c) all group coverage (single or not) attempts to drive down prices over time
(d) rationing, if it occurs, is a short-term problem, which the free market (training medical personnel) should fix
(e) healthcare isn't a luxury to be consumed willy-nilly; if we have to implement a system to prevent rich people from using up available healthcare man-hours on themselves, when we already have a long-standing mandate to help everyone
Let me fix that for you: I've worked for years in healthcare IT (insurance AND healthcare provision, government AND private), and this is NOT a train-wreck in the making.
But hey, if you want to complain that laws ever change and might affect you ... fine. I think the Somali government is currently on hiatus, so you should be safe from any potential changes there.
That information is already available, to some degree, to Medicare and private insurers. They use it to determine how much procedures should cost, and apply pressure (by paying only that amount) to hospitals and providers to drive down the price; they use the incentives of "preferred" status to route patients to cheaper (but still effective) care. A big buyer like Medicare can do that. Large private insurers can do that. Individuals who need emergency heart surgery, and have the choice between two somewhat-nearby hospitals? Not so much. They don't have the time, they don't have the data, they don't have the choice.
Hold on one partisan moment: now lowest-bid is a bad thing? Suddenly, the Obama administration isn't spending enough money?
A product (healthcare) which they may not want to plan to pay the eventual cost of at the moment, no, but which by law we are required to provide if ever asked for, even if they can't pay? And it's been that way (legally) since 1986, under Reagan. Single-payer would have removed the "buy a product" argument, but hey, we didn't get what we wanted. You already buy a product you don't want, all the time, with taxes. I buy more military than I really want. You probably buy more road projects than you really want. That's life in society.
But as to your original point: states' rights? Sigh. By making employment and healthcare laws a federal thing, we make the market for housing and employment far more fluid. You can move from one state to another looking for a job, with fewer impediments. Employers can attract talent from out of state, without having quite so many per-state issues to overcome. Increased market fluidity reduces localized market irregularities, and makes the overall system more efficient. Living in Oklahoma, I can tell you, I do *not* want more issues to be handled at the State level. But maybe, rather than all working together to come up with a good solution, we should balkanize further: I think all employment and healthcare laws should be handled at the county level, you know, for greater flexibility (people in my county clearly have different healthcare needs and expectations than elsewhere). Maybe even at the city-block level?
I'm a US citizen. I really don't give a crap what State I live in. It's all about being near family, near a job, near good entertainment, with good services. I don't have time to further filter my choices based on some local politician's "bright idea".
The 50 states are not cauldrons of experimentation, centers of innovation. They're just a good excuse for conservatives to shield themselves from changes they don't like. But those same conservatives will be quick to attempt federal legislation (DOMA) to prevent the rest of the country from changing without them. States' rights only come in to play when you lose at the federal level -- but everyone plays that game.
Would you care to explain how single-payer (if we implemented it beyond the current scope of seniors and disabled and poor and children) would be immoral?