It's about protecting you from the financial consequences of catastrophe.
Do you realize that this kind of policy is being outlawed in the reform?
So you're saying that in the reform, health insurance will no longer insulate you from the financial consequences of health catastrophes? That doesn't explain the cap on annual and lifetime expenditures that they've put into the legislation.
And it does serve to get you treated better once you're already sick.
That is a byproduct of the system, and nothing designed into it. In fact, the insurer actively works to prohibit you the more expensive treatments in favor of cheaper ones. This is irrespective of which care is actually 'best'.
You're making my argument for me--a system with no profit motive will go with the 'best' rather than the cheapest. Once you eliminate the profit motive, the only motivation left is to provide the most effective care for the money.
I'm sure you are aware of the fact that if you're uninsured and you go to the ER, you're twice as likely to die [msn.com]?
Do you suppose there are any other forces at work? Or are you implying that those with insurance have magical antibodies that keep them well?
Of course there are demographic trends. However, unless you can explain away 100%, it's still a problem that needs solving.
Drop a name on that if you'd like, but there's just no logical way to deny how a system without any independent oversight and without competition will not gorge itself to death.
...[S]avings from changes to the Medicare program (along with other changes to direct spending that are not associated directly with expanded insurance coverage) would increase at a rate that is between 10 percent and 15 percent per year during the 2020–2029 period [...] All told, CBO expects that the legislation, if enacted, would reduce federal budget deficits over the decade after 2019
relative to those projected under current law—with a total effect during that decade that is in a broad range between one-quarter percent and one-half percent of GDP.
If you disagree with me then you must be crazy/uneducated/misinformed.
Or it could be that such a league of crazies is, in fact, crazy. The league of crazies I speak of are the birthers, etc., who despite being shown all valid evidence to the contrary continue to propagate myths about death panels and "pulling the plug on grandma" and so forth; the "keep your government hands off my Medicare" sort. And anyone who says that is, by any measure, crazy, what with government being the sole proprietor of Medicare.
The question of an individual mandate breaks down into an individual mandate and the no-denials-based-on-PECs wording. I'll grant you that the tie to interstate commerce as it relates to the individual mandate is tenuous, but it's in line with the mandate to insurance companies that they have to cover you. You fail to address the preamble, however, which it seems to me in line with a mandate designed to limit a)under/nonpayment to doctors and b)situations in which inadequate/no care is received.
And in any case, there are huge subsidies.
Irrelevant.
Not if you keep using the word "unfunded". I realize that the technical definition of an unfunded mandate may be in line with what you're saying, but it's scarcely unfunded if you look at the $900 billion in subsidies for the poor. And on top of that, if we tried to, say, fund the hospitals using the government, the same people would get up in arms about that, so it's clearly not about the funding so much as "omg government is teh ebil" which, when made as a moral argument, is specious at best, especially when you look at the success (by any measure--cost per-capita, life expectancy, infant mortality, etc) of UHC systems.
Then end the unfunded mandate that hospitals treat people regardless of their ability to pay.
And if you are trying to tell me that any hospital ought to be able to say "nope" if somebody walks in the door gushing blood, and would be absolved of all guilt should they simply die on the floor, then we've nothing more to talk about, since we've now hit a moral argument instead of a practical one, and my opinion of you, as someone who would advocate for such a policy, is that you've no conscience and/or soul.
The problem with the "car insurance paying for oil changes" analogy is that if your car breaks, you can buy a new one. Fundamentally, car insurance is about protecting *other people* from *you*. Health insurance is about protecting yourself.
This is fundamentally false.
False assumption is false.
I did not suggest that it would protect you from getting sick, though in the long run preventative care enabled by insurance might. It's about protecting you from the financial consequences of catastrophe. And it does serve to get you treated better once you're already sick. I'm sure you are aware of the fact that if you're uninsured and you go to the ER, you're twice as likely to die?
Certainly participating in the care might do so, but it would do so whether you had insurance or paid out of pocket.
Conveniently you neglect the third scenario, which is "none of the above; I have no insurance and money with which to pay". See my link above.
Deficit spending is not the monster you make it out to be, especially in an economic slump at the zero lower bound on the Fed funds rate. It's called a liquidity trap, and Paul Krugman has written about it many a time. And as for the actual proposal, it's better than deficit-neutral over ten years. Of course, we could solve all of it by expanding Medicare to everyone, but people are inexplicably terrified of that--does anyone know a senior who wishes they didn't have it?
Why must I spend my money to cover someone else? Why should I be forced to pay for something I don't want?
This may seem pedantic, but I believe that the GP is not building strawmen but applying your intentionally vague assumptions about our responsibilities to one another, as laid out in the questions above, to other situations. You mentioned nothing about governmental or not.
I personally advocate a single-payer system, but you're right that this isn't what's on the table. And if you think that this violates the constitution, you'd be in league with a lot of crazies. As I recall, there's something about interstate commerce, or even better, "promot[ing] the general Welfare" of the people.
And in any case, there are huge subsidies. They cover more than 50% of the cost for most families, then again I would guess the average/.er brings home twice what the average family makes.
Oh--and if you get sick or get hit by an uninsured motorist and go to the ER and you can't pay, well, it's the taxpayers subsidizing that bill for you, so the taxpayers are now saying that you ought to have insurance.
What if I want a doctor who cares more about curing me than how big his paycheck is? Look at what doctors make in countries with universal healthcare, and consider the hours they work. Here, they make twice as much but work twice as much.
Offhand, I'd say a UHC system in this country could probably pay doctors around $200,000. That's certainly more than I make. There's room for personal incentive in a nonprofit *hospital*.
In sum, your assertion-phrased-as-a-question is refuted by the actual experiences of universal (nonprofit) healthcare systems.
I won't argue that it takes away from freedom of choice, as does an income tax and any other kind of tax or anything else that benefits the public collectively at taxpayer expense. It's unpopular, but so are denials based on preexisting conditions, and voters overwhelmingly want that practice stopped. But we can't have one without the other.
The problem with the "car insurance paying for oil changes" analogy is that if your car breaks, you can buy a new one. Fundamentally, car insurance is about protecting *other people* from *you*. Health insurance is about protecting yourself.
I agree that the best cost reduction mechanism is certainly not addressed in the legislation. More information on that is in this incredible (and like yours, nonpartisan) New Yorker article. I've skimmed yours, and will do a more thorough read after work.
What the article I've linked says is that it's unnecessary procedures that are the biggest cost. Bureaucracy, depending on your sources and whether you talk about Medicare (whose admin costs are less) or private insurers will run anywhere between 3% to 15%, which is significant but static--it's not a growing percentage, and it's not nearly enough to account for such growth in premiums (119% since 2000).
Driving costs down from where they are expected to be (not down absolutely, but bending the curve a little) can be done in part by ensuring that we cover preventative care, which is a good part of the base package proposed in this health reform.
And for the record, sometimes routine expenses can be catastrophic. I work for the pharmaceutical industry. One of our drugs (which my stepfather happens to be on) costs upwards of $400 a bottle. With insurance it's a manageable $30 or $40. Just because it's recurring (like, say, insulin) doesn't mean it shouldn't be insured, since I'd wager that recurring expenses of that size can add up to bankruptcy for the majority of people. And bankruptcy doesn't fix your health issues, so even after that, how do you keep paying?
On another level, insurance that pays for routine expenses is, in some sense, paying to protect the both the insurer and the insured against catastrophe in the future. That's the idea of preventative medicine.
But with everyone covered and everyone in the risk pool, everyone's costs go down. And they'd be just as heavily subsidized by the government as individuals are going to be--somewhere to the tune of $900B, geared toward smaller businesses (of which, as it turns out, many would be exempt).
And people with practical foresight knew that no system can make insurance companies cover you, in spite of preexisting conditions, unless they had a mandate of some kind. The logical way that he could have done so would've been an employer mandate, but in a way you're forcing business owners to buy it, and they're people too. So no matter what you'll have some people upset.
I happen to prefer the employer mandate, but *some* form of mandate is absolutely necessary to avoid a death spiral in the industry (ie, I have no insurance, I get sick, buy insurance 'til I'm better, drop it again; if everyone does this the risk pool gets so poor that premiums are even more absurd, leading more to drop coverage, and eventually insurance premiums end up as a proxy for hospital bills).
As far as the healthcare bill being a bailout to Wall Street and the insurance companies, take a look at their profit margins. They're around 3%. What we're talking about is $900B in subsidies to people who can't afford insurance on their own:
Insurance stocks [rose 3.40%] on news of healthcare deal [...] The 3.40 percent net gain translates into about $3.34 billion in market capitalization added. [...] This would mean that the total value added from passage of the bill is $16.04 billion. [...] That's a lot of money: $16 billion. But relative to the total outlay from the bill, it is fairly small. Over the course of the next ten years, the Senate's bill directs about $447 billion in public subsidies to people for the purchase of private health insurance. (This is in addition to another $400 billion or so in subsidies for the expansion of Medicaid). The $16 billion in value-added, therefore, represents about 3.6 percent of the subsidy. Coincidentally -- and it is mostly a coincidence, since the numbers are not directly comparable for a variety of reasons -- this compares rather neatly to the 3.3 percent profit margin in the health insurance industry overall.
This is not to mention the fact that after passage, the stocks were down in the net, but the math about the percentage of the subsidy that actually profits insurers is the important bit.
I would just like to point out that the people *raising* these children have themselves grown up in the "Just let them be kids!" era. Maybe they didn't like it, or saw flaws in what their parents did, and want to rectify that. We'll know how well this "sheltered" generation does once *their* children themselves become parents.
Also, you're right about the 3k price point on a good laptop a few years ago. But now you can get an enterprise-grade machine (Dell Precision series, HP EliteBook, etc.) for 1.5k or so, and it's the *line* moreso than the specs of the individual machine that makes all the difference.
When I used to work in PC repair, my boss would give that info to people in a cute analogy: "You have the big numbers on the front of the case for your processor, your of ram, hard drive... but there's no specification for what's connecting them. It's like you have New York, LA, and Chicago connected with dirt roads. What you pay for when you buy a higher line is the superhighways."
They've made some high-end motherboards that I've been pretty satisfied with, back when nForce2 was the thing to beat. Aside from the chipset fan issues (to be expected with a half-dollar-sized fan spinning at 12k rpm) I loved my A7N8X-E and its sequel, the A8N-SLI.
Parent is not offtopic. Bioshock addresses religion in exactly the manner that the quote indicates--people, for instance, create a smuggling ring around religious artifacts from the surface. It's stated that Rapture was created to get away from its influence. This is clearly not the light that the evangelists are looking to see it in, but it's there and there's no denying that.
Assassin's Creed also involves religious elements, to the point where the devs felt a disclaimer was necessary at the beginning. The first deals with assassinations during the crusades, and the second has *SPOILER*
you assassinating the fucking pope.
*/SPOILER*
So, I'd argue that religion as a plot element is reasonably common in modern games, and that the production quality of those two games/series alone is enough to offset the summary's assertion. And for that matter, I've not heard of many boycotts of the above titles. They're titles that sold quite well, so if there had been such boycotts, they can't have had much effect.
Now, if they want to talk about games that portray religion in a positive light, that's a different story.
My father was without power for fourteen days in this storm--in urban Massachusetts.
"Useful" really depends on the context. If you live in an area prone to black/brownouts (thunderstorms in IN killed my home server about once a week this summer before I got my UPS) or where the infrastructure is older/more fragile, it's no longer an issue of *if* our power becomes so erratic that they make sense so much as how big of a battery one ought to invest in.
Slashdot Mirror
Hyundai. You mean it's a Hyundai. Or maybe a Kia.
Or a Samsung. This is South Korea after all.
It's about protecting you from the financial consequences of catastrophe.
Do you realize that this kind of policy is being outlawed in the reform?
So you're saying that in the reform, health insurance will no longer insulate you from the financial consequences of health catastrophes? That doesn't explain the cap on annual and lifetime expenditures that they've put into the legislation.
And it does serve to get you treated better once you're already sick.
That is a byproduct of the system, and nothing designed into it. In fact, the insurer actively works to prohibit you the more expensive treatments in favor of cheaper ones. This is irrespective of which care is actually 'best'.
You're making my argument for me--a system with no profit motive will go with the 'best' rather than the cheapest. Once you eliminate the profit motive, the only motivation left is to provide the most effective care for the money.
I'm sure you are aware of the fact that if you're uninsured and you go to the ER, you're twice as likely to die [msn.com]?
Do you suppose there are any other forces at work? Or are you implying that those with insurance have magical antibodies that keep them well?
Of course there are demographic trends. However, unless you can explain away 100%, it's still a problem that needs solving.
Drop a name on that if you'd like, but there's just no logical way to deny how a system without any independent oversight and without competition will not gorge itself to death.
Evidence belies your assertion. We already pay multiples of what countries that have universal healthcare pay.
...[S]avings from changes to the Medicare program (along with other changes to direct spending that are not associated directly with expanded insurance coverage) would increase at a rate that is between 10 percent and 15 percent per year during the 2020–2029 period [...] All told, CBO expects that the legislation, if enacted, would reduce federal budget deficits over the decade after 2019 relative to those projected under current law—with a total effect during that decade that is in a broad range between one-quarter percent and one-half percent of GDP.
If you disagree with me then you must be crazy/uneducated/misinformed.
Or it could be that such a league of crazies is, in fact, crazy. The league of crazies I speak of are the birthers, etc., who despite being shown all valid evidence to the contrary continue to propagate myths about death panels and "pulling the plug on grandma" and so forth; the "keep your government hands off my Medicare" sort. And anyone who says that is, by any measure, crazy, what with government being the sole proprietor of Medicare.
The question of an individual mandate breaks down into an individual mandate and the no-denials-based-on-PECs wording. I'll grant you that the tie to interstate commerce as it relates to the individual mandate is tenuous, but it's in line with the mandate to insurance companies that they have to cover you. You fail to address the preamble, however, which it seems to me in line with a mandate designed to limit a)under/nonpayment to doctors and b)situations in which inadequate/no care is received.
And in any case, there are huge subsidies.
Irrelevant.
Not if you keep using the word "unfunded". I realize that the technical definition of an unfunded mandate may be in line with what you're saying, but it's scarcely unfunded if you look at the $900 billion in subsidies for the poor. And on top of that, if we tried to, say, fund the hospitals using the government, the same people would get up in arms about that, so it's clearly not about the funding so much as "omg government is teh ebil" which, when made as a moral argument, is specious at best, especially when you look at the success (by any measure--cost per-capita, life expectancy, infant mortality, etc) of UHC systems.
Then end the unfunded mandate that hospitals treat people regardless of their ability to pay.
And if you are trying to tell me that any hospital ought to be able to say "nope" if somebody walks in the door gushing blood, and would be absolved of all guilt should they simply die on the floor, then we've nothing more to talk about, since we've now hit a moral argument instead of a practical one, and my opinion of you, as someone who would advocate for such a policy, is that you've no conscience and/or soul.
The problem with the "car insurance paying for oil changes" analogy is that if your car breaks, you can buy a new one. Fundamentally, car insurance is about protecting *other people* from *you*. Health insurance is about protecting yourself.
This is fundamentally false.
False assumption is false.
I did not suggest that it would protect you from getting sick, though in the long run preventative care enabled by insurance might. It's about protecting you from the financial consequences of catastrophe. And it does serve to get you treated better once you're already sick. I'm sure you are aware of the fact that if you're uninsured and you go to the ER, you're twice as likely to die?
Certainly participating in the care might do so, but it would do so whether you had insurance or paid out of pocket.
Conveniently you neglect the third scenario, which is "none of the above; I have no insurance and money with which to pay". See my link above.
Deficit spending is not the monster you make it out to be, especially in an economic slump at the zero lower bound on the Fed funds rate. It's called a liquidity trap, and Paul Krugman has written about it many a time. And as for the actual proposal, it's better than deficit-neutral over ten years. Of course, we could solve all of it by expanding Medicare to everyone, but people are inexplicably terrified of that--does anyone know a senior who wishes they didn't have it?
Why must I spend my money to cover someone else? Why should I be forced to pay for something I don't want?
This may seem pedantic, but I believe that the GP is not building strawmen but applying your intentionally vague assumptions about our responsibilities to one another, as laid out in the questions above, to other situations. You mentioned nothing about governmental or not.
/.er brings home twice what the average family makes.
I personally advocate a single-payer system, but you're right that this isn't what's on the table. And if you think that this violates the constitution, you'd be in league with a lot of crazies. As I recall, there's something about interstate commerce, or even better, "promot[ing] the general Welfare" of the people.
And in any case, there are huge subsidies. They cover more than 50% of the cost for most families, then again I would guess the average
Oh--and if you get sick or get hit by an uninsured motorist and go to the ER and you can't pay, well, it's the taxpayers subsidizing that bill for you, so the taxpayers are now saying that you ought to have insurance.
What if I want a doctor who cares more about curing me than how big his paycheck is? Look at what doctors make in countries with universal healthcare, and consider the hours they work. Here, they make twice as much but work twice as much.
Offhand, I'd say a UHC system in this country could probably pay doctors around $200,000. That's certainly more than I make. There's room for personal incentive in a nonprofit *hospital*.
In sum, your assertion-phrased-as-a-question is refuted by the actual experiences of universal (nonprofit) healthcare systems.
I won't argue that it takes away from freedom of choice, as does an income tax and any other kind of tax or anything else that benefits the public collectively at taxpayer expense. It's unpopular, but so are denials based on preexisting conditions, and voters overwhelmingly want that practice stopped. But we can't have one without the other.
The problem with the "car insurance paying for oil changes" analogy is that if your car breaks, you can buy a new one. Fundamentally, car insurance is about protecting *other people* from *you*. Health insurance is about protecting yourself.
I agree that the best cost reduction mechanism is certainly not addressed in the legislation. More information on that is in this incredible (and like yours, nonpartisan) New Yorker article. I've skimmed yours, and will do a more thorough read after work.
What the article I've linked says is that it's unnecessary procedures that are the biggest cost. Bureaucracy, depending on your sources and whether you talk about Medicare (whose admin costs are less) or private insurers will run anywhere between 3% to 15%, which is significant but static--it's not a growing percentage, and it's not nearly enough to account for such growth in premiums (119% since 2000).
Driving costs down from where they are expected to be (not down absolutely, but bending the curve a little) can be done in part by ensuring that we cover preventative care, which is a good part of the base package proposed in this health reform.
And for the record, sometimes routine expenses can be catastrophic. I work for the pharmaceutical industry. One of our drugs (which my stepfather happens to be on) costs upwards of $400 a bottle. With insurance it's a manageable $30 or $40. Just because it's recurring (like, say, insulin) doesn't mean it shouldn't be insured, since I'd wager that recurring expenses of that size can add up to bankruptcy for the majority of people. And bankruptcy doesn't fix your health issues, so even after that, how do you keep paying?
On another level, insurance that pays for routine expenses is, in some sense, paying to protect the both the insurer and the insured against catastrophe in the future. That's the idea of preventative medicine.
But with everyone covered and everyone in the risk pool, everyone's costs go down. And they'd be just as heavily subsidized by the government as individuals are going to be--somewhere to the tune of $900B, geared toward smaller businesses (of which, as it turns out, many would be exempt).
I happen to prefer the employer mandate, but *some* form of mandate is absolutely necessary to avoid a death spiral in the industry (ie, I have no insurance, I get sick, buy insurance 'til I'm better, drop it again; if everyone does this the risk pool gets so poor that premiums are even more absurd, leading more to drop coverage, and eventually insurance premiums end up as a proxy for hospital bills).
As far as the healthcare bill being a bailout to Wall Street and the insurance companies, take a look at their profit margins. They're around 3%. What we're talking about is $900B in subsidies to people who can't afford insurance on their own:
Insurance stocks [rose 3.40%] on news of healthcare deal [...] The 3.40 percent net gain translates into about $3.34 billion in market capitalization added. [...] This would mean that the total value added from passage of the bill is $16.04 billion. [...] That's a lot of money: $16 billion. But relative to the total outlay from the bill, it is fairly small. Over the course of the next ten years, the Senate's bill directs about $447 billion in public subsidies to people for the purchase of private health insurance. (This is in addition to another $400 billion or so in subsidies for the expansion of Medicaid). The $16 billion in value-added, therefore, represents about 3.6 percent of the subsidy. Coincidentally -- and it is mostly a coincidence, since the numbers are not directly comparable for a variety of reasons -- this compares rather neatly to the 3.3 percent profit margin in the health insurance industry overall.
This is not to mention the fact that after passage, the stocks were down in the net, but the math about the percentage of the subsidy that actually profits insurers is the important bit.
Wow, epic whoosh on my part. /ducks
Am I the only one that read this in Agent Smith's voice?
So it would seem. Here's what I meant to link.
And although this is linked in the post I sent you, here's a little more on it.
Except that if they sold them, they'd be doing us a favor.
Yeah, but do you really want to volunteer your nipples to be on one end of a set of jumper cables?
I would just like to point out that the people *raising* these children have themselves grown up in the "Just let them be kids!" era. Maybe they didn't like it, or saw flaws in what their parents did, and want to rectify that. We'll know how well this "sheltered" generation does once *their* children themselves become parents.
Also, you're right about the 3k price point on a good laptop a few years ago. But now you can get an enterprise-grade machine (Dell Precision series, HP EliteBook, etc.) for 1.5k or so, and it's the *line* moreso than the specs of the individual machine that makes all the difference.
When I used to work in PC repair, my boss would give that info to people in a cute analogy: "You have the big numbers on the front of the case for your processor, your of ram, hard drive... but there's no specification for what's connecting them. It's like you have New York, LA, and Chicago connected with dirt roads. What you pay for when you buy a higher line is the superhighways."
They've made some high-end motherboards that I've been pretty satisfied with, back when nForce2 was the thing to beat. Aside from the chipset fan issues (to be expected with a half-dollar-sized fan spinning at 12k rpm) I loved my A7N8X-E and its sequel, the A8N-SLI.
Somehow I think a GPS-enabled desktop misses the point of both GPS (mobility) and a desktop (stationary power).
...how intrepid of it.
/ducks
Parent is not offtopic. Bioshock addresses religion in exactly the manner that the quote indicates--people, for instance, create a smuggling ring around religious artifacts from the surface. It's stated that Rapture was created to get away from its influence. This is clearly not the light that the evangelists are looking to see it in, but it's there and there's no denying that.
Assassin's Creed also involves religious elements, to the point where the devs felt a disclaimer was necessary at the beginning. The first deals with assassinations during the crusades, and the second has *SPOILER*
you assassinating the fucking pope.
*/SPOILER* So, I'd argue that religion as a plot element is reasonably common in modern games, and that the production quality of those two games/series alone is enough to offset the summary's assertion. And for that matter, I've not heard of many boycotts of the above titles. They're titles that sold quite well, so if there had been such boycotts, they can't have had much effect.
Now, if they want to talk about games that portray religion in a positive light, that's a different story.
My father was without power for fourteen days in this storm--in urban Massachusetts.
"Useful" really depends on the context. If you live in an area prone to black/brownouts (thunderstorms in IN killed my home server about once a week this summer before I got my UPS) or where the infrastructure is older/more fragile, it's no longer an issue of *if* our power becomes so erratic that they make sense so much as how big of a battery one ought to invest in.
Mod parent up. Informative.
Nobody is going to be dumb enough to do that again.
I bet somebody once said that about people rebuilding cities on top of active faults.