Clearly the answer is that they spend too much time with animals, so their moral compasses get confused. Refer to the principle called "animal magnetism".
Tort reform is not a solution in itself. It's a small piece of a bigger problem. It can help, but results of (e.g.) Texas's reform are mixed.
Restricting competition across state lines is done because we want to avoid a race to the bottom on consumer protections and other 'mandatory coverage' rules that benefit us collectively--and those are mostly there at the state level. They're there so that, for example, some right-wing nutjob can't claim religion as a reason to avoid letting his daughter see an ob/gyn (say, to get birth control)--or perhaps a better example, he can't claim it as a reason to avoid covering his *employees'* daughters. Since most people get their health coverage through employers, they serve as a way to insulate individual employees from moralistic assertions by their employers.
And as to what constitutes a race to the bottom, well, see what happened with credit card deregulation: now all of the CC companies are in South Dakota because SD happens to have the fewest consumer protection regulations re: spontaneous rate increases, etc. Or at least they did until the CC Holder's Bill of Rights went into effect last month. I certainly don't want all the health insurance co's moving to the place where they're the least regulated and applying those standards to all of us. If individual states have legislated what their citizens feel ought to be included at a minimum, who are these corporations to circumvent that?
American is a nationality. Socialism is an ideology. The two are not mutually exclusive. I am an American socialist.
Besides, do you object to our socialist police force, our socialist fire department, our socialist postal service, our socialist military, our socialist public education system, our socialist health regulatory agencies (which make decisions for us about what food is safe to eat and water is safe to drink and which drugs are safe to take)? How about our socialist public roads? Or our socialist health insurance program for seniors? What about our socialist unemployment insurance?
Last I heard, those were all American. And last I heard, most Americans liked them.
And from this it is clear that you stopped reading my post at that point. Keep reading.
But to counter your point nonetheless, if, say, you're born diabetic, that's a preexisting condition. You can have a preexisting condition before you're old enough to know what insurance is. And the insurance companies can fuck you over for life. And then you die.
As for the cost of insurance getting higher for everyone else, that's not true either in the current context. You're equally forcing those who are healthy to have insurance and widening the risk pool. The bill, as it stands, will likely have a negligible impact on (unsubsidized) premiums.
You're not seeing that removing pre-existing condition clauses and restricting rescission actually helps to align private insurers' interests with preventive care and medical cost reduction.
Actually, I am. See my other posts in this same thread, wherein I used that point in different words.:)
I'm in agreement with you for the most part--I do think we could do better, however, by implementing some controls on payment mechanisms--namely, restricting pay-for-procedure medicine and paying doctors for outcomes, like Mayo does.
Except for the part where they're now forced to cover the sick and spend that money on healthcare rather than profits. We're telling them they can't drop people and they have to cover everyone, even when they get sick. This will cut into their profit margins, not help them (see the article I linked about Assurant making $150 million based on dropping everyone with HIV). While it may increase their absolute profits, as a percentage of revenues it will go down.
As I posted below, this forces a change in their business model, to actually *competing* for their customers, and actually working to deliver services more efficiently and with higher quality, instead of just making their risk pool better by weeding out the stragglers.
I agree that there could/should be more oversight in the cost structure, but as it is that authority is granted to the Secretary of HHS, in conjunction with the states, in the reconciliation bill.
While I don't have the free processor cycles at the moment to go through every point you've raised, the one thing that sticks out at me as off-track is this:
It wasn't that people were just being denied care, they weren't carrying coverage in the first place so they were denied care then they went to buy it. This bill simply reinforces that bad action of that pool of people, and uses it as an excuse to force *everyone* to buy insurance. It took a combination of bad industry tactics combined with the irresponsible, and rewards both--the insurance groups get the reward of the more customers, the irresponsible get paid for being irresponsible and sick.
If you read my reply to a post below this one on the same thread, I linked an article about an insurance company (Assurant, formerly Fortis) revoking policies on anyone who had HIV. They made $150 million off of this arrangement. By disallowing this practice in the future, we are certainly not rewarding them--we're forcing them to change their business model from "let's cover the fewest sick people we can and leave them for our competitors" to "let's provide the best coverage at the least cost so people want to buy from us instead of our competitors". This also explains why they're funneling money to the Chamber of Commerce to undermine reform at the same time they're publicly declaring that they're open to it.
Basically, the assertion you're hiding in here is that people who are uninsured are uninsured by choice. And at the same time, you're asking why half of them still don't get coverage, even after subsidy. My answer is that the remainder are people who still fall through the cracks--as people who can afford it will be required to be covered under this legislation, those remaining uninsured likely fall under the "financial hardship" exemption.
In short, I don't buy said assertion: I don't believe that most uninsured are uninsured by irresponsibility. Given the pre-existing condition clauses and rescission policies, anyone who gets sick and is dropped (either because of rescission or because they've lost their job) can no longer be covered anywhere. While there are the young twentysomethings who think they're bulletproof, those aren't the ones likely to get sick. And now they'll be in the risk pool and drive down costs for everyone else.
Because it's a law, written in legalese, that incorporates simple regulatory changes, as I mentioned, and then makes a whole bunch more tangentially-related changes in order to pay for itself. The rest is trimming around the edges.
If you condense it from the large font, huge-margin, triple-spaced nature into something we're more used to (like, say, a book) it ends up being about 500 pages. And much of that is references to other clauses in other laws that it supersedes.
That's a valid point to make, but the priority that I'm putting forth is not cost--it's life. And this legislation will save lives, if for nothing other than the removal of pre-existing condition clauses.
That said, on its current path, the cost is unsustainable. And I agree that this legislation doesn't do enough to curb the costs. For a way to fix the cost problem, I would not suggest throwing the consumer into the middle of it, but putting a regulation in place that says doctors can't be paid by procedure, and that they must be disallowed ownership stakes in the places in which they practice (which would just be a way of ensuring point number one can't be circumvented by proxy). You'll understand what I'm getting at if you read the article I'm linking.
The best discussion I've seen on our runaway healthcare costs is here. In short, it's an investigation into why, of two cities in the same state with the same demographics, one pays triple.
Another thing which I'm not sure wound up included or not was the thing that spawned "death panels": we spend something like $30,000 per person in the last month of life. End of life counseling, hospice care, etc. can dramatically lower that cost since family members would know, ideally by living will, what the desires of their loved one were. It would give people the ability to say (e.g.) "if I don't know who I am anymore, just pull the plug." That alone would save a lot.
No--I'm choosing to have payment for my coverage provided by somebody who we can hold electorally accountable, versus a conscience-less corporation.
And moreover, I would choose the option where the paycheck of person deciding which of my medical bills gets covered does not depend upon their denying my care.
Tony Benn said it best:
Choice depends on the freedom to choose, and when you're shackled with debt, you don't have the freedom to choose.
Chances are, if your family is making under $88k a year, you're not going to see a tax increase due to the structure of the tax plan. It's financed primarily by increased taxation on unearned income (rent paid to you, capital gains) and that's not the income bracket that needs to be subsidized. This is far from a neutral source, but the point-by-point breakdown seems to address funding.
Re:A false choice, of course...
on
Health Care Reform
·
· Score: 2, Insightful
I agree we should untie it from employers.
What part of my post is a fallacy, exactly? If you can point out the flaw in my logic given that I never really addressed cost control but simply the revocation of pre-existing condition clauses as a desirable outcome, I'd be glad to address it.
I'd also make the point that as consumers, we are at the mercy of the procedures that our doctors prescribe for us. We pay them for their knowledge and rely on their diagnoses, and if everyone seeks a second opinion on everything, don't we end up with more doctor appointments and more bills?
The ability to comparison-shop implies a level informational playing field, and unless consumers go to med school, that doesn't happen.
People don't want to haggle over their health; not with their physicians and not with their insurance companies. When you're sick, and especially critically so, it's not worth it.
Re:A false choice, of course...
on
Health Care Reform
·
· Score: 5, Informative
This bill is the minimum that can be done to remove recission and pre-existing condition clauses without destroying the system.
The economic logic is as follows:
We want to regulate the insurers such that they don't exclude people based on pre-existing conditions. This makes sense.
However, once you try to apply that in practice, it gets hairier: if you cease to enable insurers to do that, then you get what's called an "adverse selection death spiral", wherein some healthy people drop coverage (since they know they can get it back as soon as they get sick) which worsens the risk pool. Because it's worse, those remaining members left in this new risk pool get charged higher premiums. These higher premiums cause more healthy people to drop coverage (since they're getting less for their money) which causes a repeat of the same cycle. As this goes on, the price of insurance gets so astronomical that only the sickest have it and nobody can afford it because the cost approaches the cost of the procedure you're supposed to be insured for.
The way we work around this is the unpopular part. We put a mandate on everybody that says "alright, since they can't kick you out anymore, you can't game the system: everyone has to be insured". Whether it's better to do this by putting the mandate on individuals or on employers is debatable, but what's on the table is an individual one.
Now that we're mandating everyone have insurance, we need to address its affordability, since mandates to buy things that people can't afford don't really work. This is where the subsidies (ie, costs) come in. This package is basically $900bn in subsidies for people who have trouble affording comprehensive insurance--including everyone from the average joe to a reasonable percentage of the slashdot crowd. The latest bill has caps on premiums set as follows: "[f]or people who buy insurance on the exchanges, a family of four making $88,000 would have a cap of 9.5 percent of their income." The penalty for not buying insurance is $695/person/year with exemptions for financial hardship, etc.
The $900bn comes by way of medicaid as well as direct subsidies.
The rest, once those things are in place, are to cut costs/cut the deficit and regulate insurers. But the above is by far the bulk of the bill.
While I personally wouldn't mind killing the insurance companies so we can institute a single-payer system, if you want pre-existing conditions gone, this is what you get.
I read another article on this that says most of Google's $300m Chinese revenue comes from companies that by their AdWords in order to drive exports--that is, the ads are targeted at us and not at China. They expect most of those customers to stick around, buying from google.com instead of google.cn.
If Google pulls out, it's expected to be more problematic for Chinese businesses who depend on their services (gmail, google docs, maps, etc.) than it is for Google. Plus there's the added effect of reducing Chinese internet competition as a driver for innovation/development, which will hinder businesses that ever hope to compete abroad.
Slashdot Mirror
No, that's just "tent recognition".
This is what you get for hiring space prostitutes without putting a condom on your telescope.
From here:
"THEY CAME FIRST for the Communists,
and I didn't speak up because I wasn't a Communist.
THEN THEY CAME for the Jews,
and I didn't speak up because I wasn't a Jew.
THEN THEY CAME for the trade unionists,
and I didn't speak up because I wasn't a trade unionist.
THEN THEY CAME for the Catholics,
and I didn’t speak up because I was a Protestant.
THEN THEY CAME for me
and by that time no one was left to speak up."
Clearly the answer is that they spend too much time with animals, so their moral compasses get confused. Refer to the principle called "animal magnetism".
There's no need. REAL men's underwear don't ever get GUI!
/ducks
You meant "recursive"; apparently it's recursive.
And at least with a stranger, you know that you don't know.
Shenanigans.
:)
Come and get it, motherfucker.
Here in the states, you gotta spend roughly 20k per year in order to send your kids to college.
And if they want a job when they graduate, you have to spend $40k a year.
/currently living this
On top of that, the health insurance companies also fund the Chamber of Commerce, which tried like hell to kill reform.
Tort reform is not a solution in itself. It's a small piece of a bigger problem. It can help, but results of (e.g.) Texas's reform are mixed.
Restricting competition across state lines is done because we want to avoid a race to the bottom on consumer protections and other 'mandatory coverage' rules that benefit us collectively--and those are mostly there at the state level. They're there so that, for example, some right-wing nutjob can't claim religion as a reason to avoid letting his daughter see an ob/gyn (say, to get birth control)--or perhaps a better example, he can't claim it as a reason to avoid covering his *employees'* daughters. Since most people get their health coverage through employers, they serve as a way to insulate individual employees from moralistic assertions by their employers.
And as to what constitutes a race to the bottom, well, see what happened with credit card deregulation: now all of the CC companies are in South Dakota because SD happens to have the fewest consumer protection regulations re: spontaneous rate increases, etc. Or at least they did until the CC Holder's Bill of Rights went into effect last month. I certainly don't want all the health insurance co's moving to the place where they're the least regulated and applying those standards to all of us. If individual states have legislated what their citizens feel ought to be included at a minimum, who are these corporations to circumvent that?
American is a nationality. Socialism is an ideology. The two are not mutually exclusive. I am an American socialist.
Besides, do you object to our socialist police force, our socialist fire department, our socialist postal service, our socialist military, our socialist public education system, our socialist health regulatory agencies (which make decisions for us about what food is safe to eat and water is safe to drink and which drugs are safe to take)? How about our socialist public roads? Or our socialist health insurance program for seniors? What about our socialist unemployment insurance?
Last I heard, those were all American. And last I heard, most Americans liked them.
Damnant quod non intellegunt.
Because the regulation necessitates a mandate which necessitates subsidies, which you'd know if you finished reading my first post.
And from this it is clear that you stopped reading my post at that point. Keep reading.
But to counter your point nonetheless, if, say, you're born diabetic, that's a preexisting condition. You can have a preexisting condition before you're old enough to know what insurance is. And the insurance companies can fuck you over for life. And then you die.
As for the cost of insurance getting higher for everyone else, that's not true either in the current context. You're equally forcing those who are healthy to have insurance and widening the risk pool. The bill, as it stands, will likely have a negligible impact on (unsubsidized) premiums.
You're not seeing that removing pre-existing condition clauses and restricting rescission actually helps to align private insurers' interests with preventive care and medical cost reduction.
Actually, I am. See my other posts in this same thread, wherein I used that point in different words. :)
I'm in agreement with you for the most part--I do think we could do better, however, by implementing some controls on payment mechanisms--namely, restricting pay-for-procedure medicine and paying doctors for outcomes, like Mayo does.
...which completely ignores the value of having insurance.
Except for the part where they're now forced to cover the sick and spend that money on healthcare rather than profits. We're telling them they can't drop people and they have to cover everyone, even when they get sick. This will cut into their profit margins, not help them (see the article I linked about Assurant making $150 million based on dropping everyone with HIV). While it may increase their absolute profits, as a percentage of revenues it will go down.
As I posted below, this forces a change in their business model, to actually *competing* for their customers, and actually working to deliver services more efficiently and with higher quality, instead of just making their risk pool better by weeding out the stragglers.
I agree that there could/should be more oversight in the cost structure, but as it is that authority is granted to the Secretary of HHS, in conjunction with the states, in the reconciliation bill.
It wasn't that people were just being denied care, they weren't carrying coverage in the first place so they were denied care then they went to buy it. This bill simply reinforces that bad action of that pool of people, and uses it as an excuse to force *everyone* to buy insurance. It took a combination of bad industry tactics combined with the irresponsible, and rewards both--the insurance groups get the reward of the more customers, the irresponsible get paid for being irresponsible and sick.
If you read my reply to a post below this one on the same thread, I linked an article about an insurance company (Assurant, formerly Fortis) revoking policies on anyone who had HIV. They made $150 million off of this arrangement. By disallowing this practice in the future, we are certainly not rewarding them--we're forcing them to change their business model from "let's cover the fewest sick people we can and leave them for our competitors" to "let's provide the best coverage at the least cost so people want to buy from us instead of our competitors". This also explains why they're funneling money to the Chamber of Commerce to undermine reform at the same time they're publicly declaring that they're open to it.
Basically, the assertion you're hiding in here is that people who are uninsured are uninsured by choice. And at the same time, you're asking why half of them still don't get coverage, even after subsidy. My answer is that the remainder are people who still fall through the cracks--as people who can afford it will be required to be covered under this legislation, those remaining uninsured likely fall under the "financial hardship" exemption.
In short, I don't buy said assertion: I don't believe that most uninsured are uninsured by irresponsibility. Given the pre-existing condition clauses and rescission policies, anyone who gets sick and is dropped (either because of rescission or because they've lost their job) can no longer be covered anywhere. While there are the young twentysomethings who think they're bulletproof, those aren't the ones likely to get sick. And now they'll be in the risk pool and drive down costs for everyone else.
Because it's a law, written in legalese, that incorporates simple regulatory changes, as I mentioned, and then makes a whole bunch more tangentially-related changes in order to pay for itself. The rest is trimming around the edges.
If you condense it from the large font, huge-margin, triple-spaced nature into something we're more used to (like, say, a book) it ends up being about 500 pages. And much of that is references to other clauses in other laws that it supersedes.
That's a valid point to make, but the priority that I'm putting forth is not cost--it's life. And this legislation will save lives, if for nothing other than the removal of pre-existing condition clauses.
That said, on its current path, the cost is unsustainable. And I agree that this legislation doesn't do enough to curb the costs. For a way to fix the cost problem, I would not suggest throwing the consumer into the middle of it, but putting a regulation in place that says doctors can't be paid by procedure, and that they must be disallowed ownership stakes in the places in which they practice (which would just be a way of ensuring point number one can't be circumvented by proxy). You'll understand what I'm getting at if you read the article I'm linking.
The best discussion I've seen on our runaway healthcare costs is here. In short, it's an investigation into why, of two cities in the same state with the same demographics, one pays triple.
Another thing which I'm not sure wound up included or not was the thing that spawned "death panels": we spend something like $30,000 per person in the last month of life. End of life counseling, hospice care, etc. can dramatically lower that cost since family members would know, ideally by living will, what the desires of their loved one were. It would give people the ability to say (e.g.) "if I don't know who I am anymore, just pull the plug." That alone would save a lot.
And moreover, I would choose the option where the paycheck of person deciding which of my medical bills gets covered does not depend upon their denying my care.
Tony Benn said it best:
Choice depends on the freedom to choose, and when you're shackled with debt, you don't have the freedom to choose.
Chances are, if your family is making under $88k a year, you're not going to see a tax increase due to the structure of the tax plan. It's financed primarily by increased taxation on unearned income (rent paid to you, capital gains) and that's not the income bracket that needs to be subsidized. This is far from a neutral source, but the point-by-point breakdown seems to address funding.
I agree we should untie it from employers.
What part of my post is a fallacy, exactly? If you can point out the flaw in my logic given that I never really addressed cost control but simply the revocation of pre-existing condition clauses as a desirable outcome, I'd be glad to address it.
I'd also make the point that as consumers, we are at the mercy of the procedures that our doctors prescribe for us. We pay them for their knowledge and rely on their diagnoses, and if everyone seeks a second opinion on everything, don't we end up with more doctor appointments and more bills?
The ability to comparison-shop implies a level informational playing field, and unless consumers go to med school, that doesn't happen.
People don't want to haggle over their health; not with their physicians and not with their insurance companies. When you're sick, and especially critically so, it's not worth it.
This bill is the minimum that can be done to remove recission and pre-existing condition clauses without destroying the system.
The economic logic is as follows: We want to regulate the insurers such that they don't exclude people based on pre-existing conditions. This makes sense.
However, once you try to apply that in practice, it gets hairier: if you cease to enable insurers to do that, then you get what's called an "adverse selection death spiral", wherein some healthy people drop coverage (since they know they can get it back as soon as they get sick) which worsens the risk pool. Because it's worse, those remaining members left in this new risk pool get charged higher premiums. These higher premiums cause more healthy people to drop coverage (since they're getting less for their money) which causes a repeat of the same cycle. As this goes on, the price of insurance gets so astronomical that only the sickest have it and nobody can afford it because the cost approaches the cost of the procedure you're supposed to be insured for.
The way we work around this is the unpopular part. We put a mandate on everybody that says "alright, since they can't kick you out anymore, you can't game the system: everyone has to be insured". Whether it's better to do this by putting the mandate on individuals or on employers is debatable, but what's on the table is an individual one.
Now that we're mandating everyone have insurance, we need to address its affordability, since mandates to buy things that people can't afford don't really work. This is where the subsidies (ie, costs) come in. This package is basically $900bn in subsidies for people who have trouble affording comprehensive insurance--including everyone from the average joe to a reasonable percentage of the slashdot crowd. The latest bill has caps on premiums set as follows: "[f]or people who buy insurance on the exchanges, a family of four making $88,000 would have a cap of 9.5 percent of their income." The penalty for not buying insurance is $695/person/year with exemptions for financial hardship, etc.
The $900bn comes by way of medicaid as well as direct subsidies.
The rest, once those things are in place, are to cut costs/cut the deficit and regulate insurers. But the above is by far the bulk of the bill. While I personally wouldn't mind killing the insurance companies so we can institute a single-payer system, if you want pre-existing conditions gone, this is what you get.
I read another article on this that says most of Google's $300m Chinese revenue comes from companies that by their AdWords in order to drive exports--that is, the ads are targeted at us and not at China. They expect most of those customers to stick around, buying from google.com instead of google.cn.
If Google pulls out, it's expected to be more problematic for Chinese businesses who depend on their services (gmail, google docs, maps, etc.) than it is for Google. Plus there's the added effect of reducing Chinese internet competition as a driver for innovation/development, which will hinder businesses that ever hope to compete abroad.