Healthcare Mandate Stands

[Pure Method]

discuss...

[Hype]

Good job America, on finally making it to the 20th Century!

[Pandemonium]

Our health care system needs serious reform from top to bottom but Obamacare wasn't the right way to do it. It's riddled with problems, and could possibly lead to a single government-run healthcare insurer in the next 15 or so years that would simply be unsustainable for future generations (see Social Security). Obviously, every US citizen should have access to affordable healthcare but Obama care, especially as being enforced as a "tax" with all the Federally enforced power and penalties is not the correct path. Add to that, it still can be repealed or modified once we get a new administration/new Justices in the Supreme Court in place - is this what we're going to deal with every major election cycle?

I thought some of Obama's comments in this clip were pretty astonishing, not to mention fundamentally ignorant:

[Hype]

could possibly lead to a single government-run healthcare insurer in the next 15 or so years that would simply be unsustainable for future generations (see Social Security).

I think you may be confused, or feeding into the neocon narrative. Single-payer is the most efficient way to deal with a collective action problem like health insurance. It doesn't follow from something being government-run that it would "simply" be unsustainable, just because some other plan is unsustainable. It's true that the demographic problem in North America is causing a sustainability headache, as the boomers age. And as you gen-Xers age, the millenials'll have a problem paying for you too... but that's just how it works. The money you put in isn't for you... it's for the existing bills, and things have to be managed so that the future bills can be paid too. So there is a genuine worry here, but it has nothing to do with whether something is government-run or private.

[farrellgirl99]

This article laid out some key provisions in the law that I found interesting/helpful for understanding it a little better.

http://www.commonwealthfund.org/Blog/20 ... ccess.aspx

[Hype]

http://www.buzzfeed.com/daves4/people-m ... -obamacare

[tvrec]

http://www.buzzfeed.com/daves4/people-m ... -obamacare

That's pretty funny. Up there with "Get Government Out of My Medicare!"

[Pandemonium]

could possibly lead to a single government-run healthcare insurer in the next 15 or so years that would simply be unsustainable for future generations (see Social Security).

I think you may be confused, or feeding into the neocon narrative. Single-payer is the most efficient way to deal with a collective action problem like health insurance. It doesn't follow from something being government-run that it would "simply" be unsustainable, just because some other plan is unsustainable. It's true that the demographic problem in North America is causing a sustainability headache, as the boomers age. And as you gen-Xers age, the millenials'll have a problem paying for you too... but that's just how it works. The money you put in isn't for you... it's for the existing bills, and things have to be managed so that the future bills can be paid too. So there is a genuine worry here, but it has nothing to do with whether something is government-run or private.

Yes, it is an issue whether it's government run or private. US history proves especially in the last 50 years just how fucked up and wastefully bloated US government run programs can be. And do I really need to point out how unsustainable various European government run universal health care has become, not to mention Canada? As I said, there's numerous issues with the mandate as written. Just one example:

"A separate provision of the health reform law creates a new tax on so-called "Cadillac" insurance plans provided by employers. Beginning in 2018, plans valued at $10,200 for individual coverage or $27,500 for family policies will be subject to an excise tax of 40% on the value of the plan that exceeds these thresholds. The tax will be levied on insurers and self-insured employers, not directly on employees."

Sub $30k coverage is nothing. It doesn't even begin to cover catastrophic illness for an individual. How many employers will now be dropping their insurance programs, or lowering their quality to match that of the government mandated programs to avoid such taxes? Clearly, there will be a move from (more) employers towards altogether dropping any sort of insurance coverage for employees while individual consumers will opt for low tier coverage to meet basic Federal (tax - which is what it is) requirements.

My problem isn't with the basic tenant that every citizen in a country like the US should have affordable healthcare even w/pre-existing conditions. It's how the law was written and especially how it's going to be implemented and what kind of precedent it sets which is the problem.

[Hokahey]

could possibly lead to a single government-run healthcare insurer in the next 15 or so years that would simply be unsustainable for future generations (see Social Security).

I think you may be confused, or feeding into the neocon narrative. Single-payer is the most efficient way to deal with a collective action problem like health insurance. It doesn't follow from something being government-run that it would "simply" be unsustainable, just because some other plan is unsustainable. It's true that the demographic problem in North America is causing a sustainability headache, as the boomers age. And as you gen-Xers age, the millenials'll have a problem paying for you too... but that's just how it works. The money you put in isn't for you... it's for the existing bills, and things have to be managed so that the future bills can be paid too. So there is a genuine worry here, but it has nothing to do with whether something is government-run or private.

Yes, it is an issue whether it's government run or private. US history proves especially in the last 50 years just how fucked up and wastefully bloated US government run programs can be. And do I really need to point out how unsustainable various European government run universal health care has become, not to mention Canada? As I said, there's numerous issues with the mandate as written. Just one example:

"A separate provision of the health reform law creates a new tax on so-called "Cadillac" insurance plans provided by employers. Beginning in 2018, plans valued at $10,200 for individual coverage or $27,500 for family policies will be subject to an excise tax of 40% on the value of the plan that exceeds these thresholds. The tax will be levied on insurers and self-insured employers, not directly on employees."

Sub $30k coverage is nothing. It doesn't even begin to cover catastrophic illness for an individual. How many employers will now be dropping their insurance programs, or lowering their quality to match that of the government mandated programs to avoid such taxes? Clearly, there will be a move from (more) employers towards altogether dropping any sort of insurance coverage for employees while individual consumers will opt for low tier coverage to meet basic Federal (tax - which is what it is) requirements.

My problem isn't with the basic tenant that every citizen in a country like the US should have affordable healthcare even w/pre-existing conditions. It's how the law was written and especially how it's going to be implemented and what kind of precedent it sets which is the problem.

And therein lies the problem with a lumbering government attempting to provide something like this. Not to mention the assault on freedom in forcing me to pay in to something with no option to opt out.

There is another provision that excludes people that use injectables. Really?

Let the states decide, and may the best program win. Romney had it right in that regard. Although the guy is a giant war mongering neocon and makes my skin crawl.

[Hype]

And do I really need to point out how unsustainable various European government run universal health care has become, not to mention Canada?

Yes. You do. Because as far as I can tell, universal health insurance (not health care... private care providers can exist in a single-payer insurance system) is totally sustainable... where are these mysterious "unsustainable" cases? Find me a country in which public health insurance literally wasn't sustainable, and led to the country going back to private.

Not to mention the assault on freedom in forcing me to pay in to something with no option to opt out.

Not this again... you mean like... every tax? Jesus Christ... when did people start thinking like this? Was it Ayn Rand, or was it the Reagan era? What the hell?

[Hokahey]

you mean like... every tax?

Is that how we justify taking as much as much income from someone as possible? Does the program matter? Or do we say "taxes iz taxes bro deal with it?"

[chaos]

This article laid out some key provisions in the law that I found interesting/helpful for understanding it a little better.

http://www.commonwealthfund.org/Blog/20 ... ccess.aspx

Some more info:


http://online.wsj.com/article/SB1000142 ... 39300.html

Health-Care Industry Moves Ahead With Plans

By ANNA WILDE MATHEWS

One-sixth of the U.S. economy just started breathing again.

After months of questions as the federal health-care overhaul faced legal challenges, the industry—which at $2.7 trillion represents 17.9% of the nation's gross domestic product—has a clearer picture of what's in store.

The coming election and expected budget negotiations could throw off more changes, and the fate of the law's Medicaid expansion creates some new uncertainty. But the Supreme Court's decision to largely uphold the law means that two years of preparation by insurers, hospitals, drug makers and the rest of the health-care industry will continue apace, and possibly gain momentum.

"We'll just continue to do what we've been doing," said Michael B. McCallister, chief executive of insurer Humana Inc.

The major provisions of the health-care law now stand, though they aren't slated to go into effect until 2014. That is when insurers have to start selling coverage to adults regardless of pre-existing health conditions and to stop pegging premiums to health status. A mandate will require most people to obtain health-care coverage—with federal subsidies to help lower-income people buy plans through new health-insurance marketplaces—or pay a tax.

The aspect of the ruling that raises new questions is the weakening of the Medicaid expansion, which will now depend in part on individual states' decisions. The high court said that the federal government can offer money to pay for the growth of Medicaid, the health-care program for the poor, but can't threaten states with the removal of their current Medicaid funding. That takes away a stick that was going to enforce the expansion.

Health-care companies had predicted an influx of more than 30 million newly covered people with the means to pay for care. About 17 million of those were expected to come through Medicaid, and some of that growth is now in question. That could scale back the benefit the industry was relying on to balance out the federal overhaul's costs, which include cutbacks to government reimbursement and new fees and taxes, and pressure to move to new payment models that boost efficiency and quality.

Still, even states that sued to block the Medicaid expansion will come under enormous pressure to accept it, since the federal government will pick up 100% of the cost for the first two years, moving down gradually to 90% in 2020, said Alan Weil, executive director of the National Academy for State Health Policy.

"When push comes to shove, to turn your back on a big infusion of federal money would be very difficult," said Larry Levitt, senior vice president at the nonpartisan Kaiser Family Foundation.

To prepare for the overhaul, health-care providers and insurers have already embarked on a wave of structural changes, consolidating to cut costs and position themselves for the overhaul's main provisions. These shifts would have been difficult to unwind had the law been shut down, and could pick up even more speed now.

Hospital systems are snapping up doctor practices, as well as buying other hospitals, hoping for economies of scale and greater leverage in negotiations with insurers. Some are tiptoeing into the insurance business themselves and talking to employers about direct deals to care for their workers. The 86 hospital-merger deals announced last year represented the biggest total in at least a decade, according to Irving Levin Associates, a research firm that tracks health-care transactions.

Insurers are buying health-care providers, or working with them on new ways to share the risks of offering health-care coverage. They are beginning to move away from the traditional style of paying fees for each service, and instead starting to tie reimbursement to quality targets, as well as rewarding health-care providers that rein in costs.

"We're full steam ahead" on efforts to create new partnerships with providers, said David M. Cordani, Cigna Corp.'s chief executive. The decision "may provide some acceleration within the industry."

In a report issued this month, Leavitt Partners, a health-care information firm, counted 221 "accountable-care organizations" around the U.S. The concept was embedded in the health-care law and typically involves health-care providers trying to coordinate and manage the care of a patient population and being rewarded if they trim costs. That was up from 164 in September.

[chaos]

Slideshow on healthcare in America since 1934:

The health-care overhaul passed by Congress and signed into law in 2010 is the latest in a series of attempts by the U.S. government to change how Americans receive and pay for their health care. Sources: Kaiser Family Foundation, Social Security Administration, Wall Street Journal research

http://online.wsj.com/article/SB1000142 ... in+america

[Hype]

you mean like... every tax?

Is that how we justify taking as much as much income from someone as possible? Does the program matter? Or do we say "taxes iz taxes bro deal with it?"

No, but that's not what you said... what you said was (roughly paraphrased) "And we don't even get to opt out."... But you don't get to opt out of any tax... the important issue isn't whether you can "opt out", but whether the program is better or worse than what the government already had, and in what way. Shifting the focus onto it being "unfair" because you "can't opt out" is just weird. It sounds like Fox News talking points nonsense...

Especially since they DON'T take "as much income from someone as possible". That has never been LESS true.

[Essence_Smith]

I admit to being ignorant on exactly how this mandate will work...but I have been in the position of being unemployed, uninsured and in pain (also in need of surgery) and being turned away at several public hospitals because I didn't have health insurance...I was not eligible for medicade because I was collecting unemployment and my "income" was too high to qualify...I was pretty much told unless I was going to die, I'd have to live in pain...not a good position to be in...so for those that need it I can definitely relate...

[Hype]

Here's the whole thing: http://en.wikisource.org/wiki/Patient_P ... e_Care_Act

`SEC. 2712. PROHIBITION ON RESCISSIONS.
`A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not rescind such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved, except that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage. Such plan or coverage may not be cancelled except with prior notice to the enrollee, and only as permitted under section 2702(c) or 2742(b).

Seems good.

SEC. 1101. IMMEDIATE ACCESS TO INSURANCE FOR UNINSURED INDIVIDUALS WITH A PREEXISTING CONDITION.

(a) In General- Not later than 90 days after the date of enactment of this Act, the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014.

Even better.

(a) No Changes to Existing Coverage-

(1) IN GENERAL- Nothing in this Act (or an amendment made by this Act) shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on the date of enactment of this Act.
(2) CONTINUATION OF COVERAGE- With respect to a group health plan or health insurance coverage in which an individual was enrolled on the date of enactment of this Act, this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply to such plan or coverage, regardless of whether the individual renews such coverage after such date of enactment.

Heh.

I'd like to see people who disagree with this act actually read the thing and find the stuff they actually think is so bad as to make it bad to pass it.

[sinep]

healthcare is for pussies.

i haven't seen a doctor since my testicles dropped.

[Hype]

http://fdlaction.firedoglake.com/2010/0 ... care-bill/

Not clear whether these "Myth/Fact" things are trustworthy, but at least it's an attempt to make systematic criticisms.

[Hype]

http://m.theatlantic.com/business/print ... ph/259056/

Also notice that none of this applies to the United States. We never have to worry about self-fulfilling prophesies of bankruptcy because we can never run out of dollars. As the Boomers retire, we'll spend more on entitlements. That's not the end of the world. Unless you think Sweden is the end of the world. Yes, we need to rein in healthcare inflation, and, yes, we need to raise some more revenue. The former might already be happening. The latter is a political choice. Neither makes us Greece.

[LJF]

My question to all of these programs is, how is it paid for? Don't say tax the rich because they can afford it, that's just a bullshit answer.

[Hype]

Why is that a bullshit answer? You realize the United States federal budget is $3.8 trillion for next year, right?

http://www.whitehouse.gov/omb/overview

KEY BUDGET FACTS

• In the Budget Control Act, both parties in Congress and the President agreed to tight spending caps that reduce discretionary spending by $1 trillion over 10 years. This budget reflects that decision. Thus, for all the priority areas we are investing in, difficult trade-offs had to be made to meet these very tight caps.
  Discretionary spending is reduced from 8.7 percent of GDP in 2011 to 5.0 percent in 2022.
• Including the $1 trillion in discretionary cuts, the Budget includes more than:
  $4 trillion in balanced, deficit reduction so that, by 2018, we cut the deficit to less than 3 percent of GDP, stabilize the debt-to-GDP ratio, and achieve primary balance.
• For every $1 in new revenue from those making more than $250,000 per year and from closing corporate loopholes, the Budget has $2.50 in spending cuts including the deficit reduction enacted over the last year.
• 2012 Projected Deficit: $1.33 trillion, 8.5 percent of GDP; 2013 Projected Deficit: $901 billion, 5.5 percent of GDP; 2018 Projected Deficit: $575 billion, 2.7 percent of GDP; 2022 Projected Deficit: $704 billion, 2.8 percent of GDP.

http://www.whitehouse.gov/sites/default ... ts/ccs.pdf

And, recognizing the role that
rising health care costs play in our long-term fiscal future,
the President advocated for and signed into law fiscally
responsible health care reform that will reduce our deficit
by more than $1 trillion over the next two decades, as well
as fully pay for all new coverage.

The spending caps enacted by the BCA, on top of
significant reductions to discretionary spending for 2011,
will dramatically reduce this category of spending. Indeed,
further cuts would lead to an erosion of Government
effectiveness and services that the American people
neither want nor deserve. Nevertheless, we can meet
these tight caps by making tough choices about where
to invest taxpayer dollars. That begins with identifying
programs that are outdated, ineffective, or duplicative and
designating them to be reformed, consolidated, or cut. In
each of his three previous budgets, the President identified,
on average, more than 150 terminations, reductions, and
savings, totaling nearly $25 billion each year. These
proposed cuts ranged from a radio circumnavigation
system for ships that was made obsolete by GPS to new
F-22 aircraft that the military said it does not need and
did not want.

The Obama administration's February 2012 budget request contained $2.902 trillion in receipts and $3.803 trillion in outlays, for a deficit of $901 billion. The budget projects a reduction in the deficit to $575 billion by 2018 before rising to $704 billion by 2022.

Code: Select all

Total receipts (in billions of dollars)::
Item                                                          Requested
Individual income tax                                             1,359
Corporate income tax                                                348
Social Security and other payroll tax                               959
Excise tax                                                           88
Customs duties 	                                                   33
Estate and gift taxes 	                                            13
Deposits of earnings and Federal Reserve System                      80
Other miscellaneous receipts                                         21
Total                                                                      $2,902 billions

http://money.cnn.com/2012/02/13/news/ec ... /index.htm

President Obama unveiled a $3.8 trillion budget request Monday that hikes taxes on the rich, spends new money on infrastructure and education, but does little to reform the entitlement programs that pose the biggest long-term threat to the federal budget.

[LJF]

Well what if they can't afford to? What if they spend all of their money?

You and I will never agree on this. I think it is stupid to have programs that can't be paid for. If people can't understand that then please look no further then Europe. We are watching what happens when you have programs that aren't paid for and what that debt does. Short term debt might work, but when you get to the levels of a lot of European countries and where the US is headed it just doesn't work.

When this country gets to over 50 percent not paying taxes there will be no turning back. Good luck ever having the party that promises more hand outs ever being voted out.

[tvrec]

When this country gets to over 50 percent not paying taxes there will be no turning back. Good luck ever having the party that promises more hand outs ever being voted out.

The matter gets a bit more complicated, of course, when you stack this idea (above) against income distribution in the country and the different categories and kinds of taxes. (Unless someone lives completely off-grid, it's pretty difficult not to pay several kinds of taxes, even if s/he doesn't pay federal income tax.)

[LJF]

When this country gets to over 50 percent not paying taxes there will be no turning back. Good luck ever having the party that promises more hand outs ever being voted out.

The matter gets a bit more complicated, of course, when you stack this idea (above) against income distribution in the country and the different categories and kinds of taxes. (Unless someone lives completely off-grid, it's pretty difficult not to pay several kinds of taxes, even if s/he doesn't pay federal income tax.)

Yes I was talking fed tax.

[Hype]

Yeah, we won't agree about this, because that's just dumb. The United States has a fucked up level of income inequality. The number of people not paying taxes has nothing to do with anything.