Thread: Obama won re election

Originally Posted by DaveW

There is a mandate in PPACA ("obamacare") that private insurance loss ratios need to be 85% (i.e., at least 85% of a premium collected needs to be spent on losses, or actual costs of benefits).

What is true is that we do have more excessive utilization of health care here, and we are willing to pay more per service and per drug than most places in the rest of the world.

Yes, this is pretty good description of where the problem is, which means that solving it is very hard. Everybody thinks they ought to get state of the art medicine, which is extremely expensive, even if they cannot afford it.

The difference between most developed nations and US is that they offer basic 'lower quality' service to everybody, funded through taxes, and then those who want more need to buy it in addition if they can afford it.
In US on the other hand, there is no basic service that covers everybody, so the free market solution is to exclude the unprofitable patients. But then the society isn't comfortable with simply letting people die on the street, so there is a mandate that everybody gets emergency care even if they cannot pay for it.

In this case the values of our society are inconsistent with the free market, therefore we end up with socialism in one form or another. Obama, and Romney before him decided that overall it is cheaper for the society to pay for basic service for everybody instead of paying for the super expensive emergency care when those lacking basic service are about to die.
Of course, that means people are forced to buy a service they may not need or want (and those who can not afford it get it for free), but that's the only way to prevent more and more people from simply passing the risks of not having health insurance on everybody else.

It always seemed to me like a step in the right direction towards making people more responsible.

Originally Posted by gugi

The difference between most developed nations and US is that they offer basic 'lower quality' service to everybody, funded through taxes, and then those who want more need to buy it in addition if they can afford it.

Can you imagine what would happen if they did that? There would have to be a law that you couldn't sue if you thought basic quality caused death or injury when premium care wouldn't have. But you can't get laws like that passed in the US, partially because people view the chance to get a settlement as the possibility of living a dream, and partly because most of the legislators are bar association members or were bar association members.

I just can't imagine the look on most peoples' face in the US if they were told they got basic care. Everyone here likes to believe that they're #1 first in line for medical attention regardless of the money issue.

Originally Posted by gugi

It always seemed to me like a step in the right direction towards making people more responsible.

That is until the gov't decides now to force you buy or do something else that you CAN'T justify as a step in the right direction. It all comes down to precedent. Once its established that they can do this to you, something else will follow. And when that happens, people will start to wonder how this came about. Well, when the concept was originally posed to us, some of found it reasonable. But later the POWER to do it will be used for something unreasonable. That's the danger. That's what I fear about it the most. A few years back some local radicals tried to have foie gras banned from menus in Chicago. People like myself got very upset about that because we could see where that was leading us. The idea was to establish a precedent. By attacking something very few people eat or care about, they could establish a precedent. Later they could use it to justify banning something most people consume. Its a way to establish what is normal and acceptable. Once established, its hard to go back.

I'm not sure if you are talking about me, since we slightly disagreed earlier

Contrary to popular belief, people that voted for Obama have jobs too. I was busy and did not have time to talk about Obama.

Originally Posted by DaveW

This has turned into a nice factual productive discussion (I won't claim any of us have suddenly become unbiased, nobody is unbiased).

Maybe we drove off the folks just looking for a fight with no facts, but that happens sometimes.

Originally Posted by DaveW

Can you imagine what would happen if they did that? There would have to be a law that you couldn't sue if you thought basic quality caused death or injury when premium care wouldn't have. But you can't get laws like that passed in the US, partially because people view the chance to get a settlement as the possibility of living a dream, and partly because most of the legislators are bar association members or were bar association members.

I just can't imagine the look on most peoples' face in the US if they were told they got basic care. Everyone here likes to believe that they're #1 first in line for medical attention regardless of the money issue.

I believe that the current legislation was designed to run private insurance out of the market leaving only the gov't option behind. Barney Frank said it best that this was a first step toward socialized medicine. That's what the 85% rule is all about. That's what the mandate is all about. And its what the coverage laws on employers is all about. Its about moving the masses slowly into the gov't option. If insurance companies can't get themselved under the 85% mark, they go under or cut back on their benefits until the gov't plan looks attractive. If a company can't afford to pay for employee insurance, they cut back hours and send you to Uncle Sam. And once private insurance is gone, then they can establish minimum care for everyone because there won't be another plan to compare it to. What other plan? Obamacare is the first step toward that gov't solution. And if you don't believe me, believe Barney Frank.

Originally Posted by DaveW

Can you imagine what would happen if they did that?

Well, yeah, it's a cultural change. Similar to the culture of spending on credit, which I think may be part of the cost of entrepreneurship.

There is also a difference between good policies and good politics - even if you have good solutions implementing them is at the very least 'tricky'. For example austerity may sound great in theory, but imposing it overnight is asking for a disaster. Case in point are the Greeks - they have been living off somebody's else's labour for decades and a sudden 20%-30% cut in their standard of living would lead to a civil war, even though plenty of their neighbor countries live way way below that level.

The thing though is that if you go past the fearmongering and the ideology and look for common sense practical solutions it's very possible to gradually improve things. From what I've seen it seems Obama understands the problems and he has shown that he is willing to go past the demagoguery. Remember, they already worked out a 'grand bargain'. With the 'fiscal cliff' looming I would be very surprised if politicians don't come around to finish that up. After all the idea of the sequestration was to serve as a stick and so it was designed not to be good policy, but to inflict maximum pain. It's nothing but stupid to let it happen just because the other side is going to suffer as well (hopefully more than your own side). In any case the next few weeks and months are going to be interesting

There's definitely little to gain politically over the next year or two, so if they can do something productive, hopefully they will do it now.

And using Bill Clinton's words, "more rather than less, sooner rather than later".

Originally Posted by OCDshaver

That is until the gov't decides now to force you buy or do something else that you CAN'T justify as a step in the right direction. It all comes down to precedent.

If that's the issue, the precedent has been set long, long ago by the founding fathers - Individual mandate - Wikipedia, the free encyclopedia

Originally Posted by OCDshaver

I believe that the current legislation was designed to run private insurance out of the market leaving only the gov't option behind. Barney Frank said it best that this was a first step toward socialized medicine. That's what the 85% rule is all about. That's what the mandate is all about. And its what the coverage laws on employers is all about. Its about moving the masses slowly into the gov't option. If insurance companies can't get themselved under the 85% mark, they go under or cut back on their benefits until the gov't plan looks attractive. If a company can't afford to pay for employee insurance, they cut back hours and send you to Uncle Sam. And once private insurance is gone, then they can establish minimum care for everyone because there won't be another plan to compare it to. What other plan? Obamacare is the first step toward that gov't solution. And if you don't believe me, believe Barney Frank.

Whether there was an intention to go to single payer or not, the exchange setup is a good way to get there. I do believe it's an intentional first step, because there is little incentive in the bill for an employer to offer health care in the long term. Instead, they will pay an excise tax to the government, and you'll be left on your own. That tax stuff was necessary to make the bill look less expensive (and no doubt, when the rubber hits the road, it is an extremely expensive bill, because it doesn't do much to control costs and the savings in it really aren't realistic politically).

If you're <4x the poverty rate, I believe, you can go to the exchanges to get subsidized coverage. Certainly you can get subsidized coverage if you are truly poor, and the employer will pay an excise tax. The employer can't take the subsidy and use it to pay your benefits, as far as I know, because they already can't do that now, it would've been an additional cost.

Once the coverages all look similar due to meeting specified levels, then the stage is set for the exchanges to have most of the coverages and to super-standardized plans and ultimately to one. Medicare advantage plans will take a hike and only medicare part d participants will get a 50% retail drug discount, advantage plans won't be able to get it, so they'll be at a cost disadvantage. Generally, despite the MAPD plans being less expensive than it was thought they would be, they are a Republican creation, and have to go if you're writing the bill from the other side of the aisle. that's just the way the politicians do business, not party specific. "Why leave your program in place if I can take it out and put in something with my name on it".

The step to universal care will be held up only if there is some sort of court victory or financial ruin before then.

Originally Posted by gugi

If that's the issue, the precedent has been set long, long ago by the founding fathers - Individual mandate - Wikipedia, the free encyclopedia

This is the first time, though, that I can recall any mandate to spend money on something or be taxed with what was deceitfully referred to as "not a tax" because of campaign promises. That was dirty pool at its finest.