U.S. health bill "thingie" passed -- What is it exactly?

[Bob]

Or what does it mean?  I really wasn't paying that much attention.

Health insurance is mandatory in the U.S.?

No political arguments please.  Of whether it's good or bad, yadda, yadda, yadda.  I really don't care about that stuff. 

Is it that basically I *have* to health insurance, although I would buy it anyway.  Possibly another option for buying it?  And possibly some more taxes to pay for everyone on that?

I'm the person who's paying for lots of things anyway.  One more isn't going to change much. 

[gyzzzmo]

I suppose it means that everybody must have health insurance, by law. And the insurance companies now also have to accept you.
Its pretty standard in most civilized countries as part of social security (and thus also economical security). Who knows, eventually USA might also get that predict 'civilized'?
(NAAAAAAAAAAAA)

[birba]

I'm part American and have been living in Europe most of my life.  What I took for granted here, free health care, is now just making headway in the states.  It was about time.  After Social Security and Medicare, it seems like an obvious step.  The insurance companies with the pharmaceutical houses are going to start seeing less income in their multi billionaire accounts.

[horowitzian]

I'm part American and have been living in Europe most of my life.  What I took for granted here, free health care, [...]

TANSTAAFL

[birba]

?  Is that some sort of code message?

[horowitzian]

?  Is that some sort of code message?

Sort of.

It stands for There Ain't No Such Thing As A Free Lunch. Someone's paying for that "free" healthcare.

[birba]

You're so right.  I didn't mean to give the impression that that's what I thought.  But I think it's a priority that has been lacking too many years in america.  I don't want to turn this thread into a political row.  But compared to  what we spend on arms and weapons in the excuse of looking for terrorists (with NO result), it's a small tribute to those who DON'T work for large companies and are not covered in anyway with medical insurance.  I'm not saying this bill hasn't it's problems (and there are LOTS on the way) but it's a step in the right direction.

[birba]

Anyway, to answer Bob's question, by 2014, insurance will be mandatory for everyone.  (Illegal immigrants excluded).  It won't be expensive.  I'm not sure of the percentage rate - it varies according to your income.  And, what's more important, a company can't refuse you as a high risk (previous health problems).  When I lived in Japan, they had a similar program.  You paid according to how much you earned.  And I was VERY well covered.  Even dental.

[horowitzian]

However, I'm afraid I don't see how spending $500 billion we don't have is a step in the right direction. We need to fix the budget deficit, not increase it. 'Cause sooner or later nobody will have any decent healthcare. All this debt is a bubble that will burst; and when it does a lot of people are in for a rude surprise. Keynesian economics is NOT the answer; it never has been, and it never will be.

Not to mention many parts of this bill are unconstitutional.

Anyhow, I don't wish to start a row either, so over and out for me.

[mrba1979]

https://www.washingtonpost.com/wp-dyn/content/article/2010/03/22/AR2010032201817.html?sid=ST2010032201830


To answer with out bias the orginal question posted.

[richard black]

It's always seemed to me that the fair way to fund healthcare is to have it funded out of taxation with no option to buy any kind of 'top-up' healthcare privately. That way the poor get exactly the same healthcare as the rich, and the people making the rules for the poor are also making rules for themselves.

The USSR had basically that system, although since small-scale corruption was pretty much endemic there were certainly abuses (you could get preferential treatment if you knew the surgeon personally, that kind of thing).

[prongated]

Keynesian economics is NOT the answer; it never has been, and it never will be.

WHAT?!? Where did you get that rubbish from?

I read and understand otherwise just about everywhere - from mere history books (what do you attribute the 1930s recovery from the great depression to?) to my understanding of economics (as preached by my piece of paper from university) says otherwise.

The only people that say what you say is deluded, out-of-touch armchair economists (i.e. the neo-classical economists that used to pervade the world bank and IMF) whose works have been to successfully demolish 3rd world countries by entangling them in debt and damage the economy of some Asian countries involved in the 1997 financial crisis (like my very own homeland, Indonesia).

[rachfan]

What the "thingie" means to me is that the federal government has just seized 1/6th of the economy, the healthcare insurers are now mere utilities, $500 billion dollars will be gouged out of Medicare so that those who most need the funding won't have it, we're now headed for healthcare rationing (queue lines waiting for doctor's appointments, tests and procedures as in Canada and the UK), we're insuring another 30 million people with NO commensurate increase in doctors and nurses, according to a recent poll, 33% of physicians and nurses plan to leave their professions rather quickly making rationing far worse if not desperate, and that instead of our physicians, the federal government will be telling us which tests, procedures and surgeries we can have, and which ones are denied to us.  For young people, anyone not on their parents' healthcare policy or covered by one from their employer, will be mandated to purchase healthcare insurance.  (Figure about $5,000 in premium payments for an individual plan per year with very high deductible.)  Or, the individual can opt to pay a fine of $750 which is a smaller ripoff.  

But it gets worse.  This huge entitlement plan was passed at a time when the national debt is now approaching $14 trillion, and when there are very few ways to pay for it.  As I already mentioned, half a trillion dollars will be clawed out of Medicare and put toward health reform, income taxes are going to rise everyone--not just the rich, and the rest, a cost avoidance supposedly achieved by detecting fraud and abuse, which is just plain silly.  The federal government has had since 1937 to root out fraud and abuse, and it's never been done successfully.  (Is the post service efficient? No, and the rest of the federal bureaucracy is just as bad.)

And it gets far worse.  Given the national debt, now that this humongous healthcare program will be coming online, you can expect in a very short time that Moody's rating service will downgrade the U.S.'s credit rating.  Most here will probably say "so what!"  WRONG!  The borrowing rate for the federal government will climb very significantly to the extent that the it will be unable to even pay just the existing interest on the debt and meet other obligations. That will plunge the country into a deep depression.  You say they can simply print more money? Not unless we want hyperinflation where a dollar is worth pennies.  Soon after, the U.S. wound have no choice but to formally declare bankruptcy. What then?  There will be no alternative to "austerity plans" whereby the federal government makes massive spending cuts and passes massive tax measures as well.  Moody's has already noted in its warning about its lowering the U.S.'s credit rating that civil disorder will likely ensue.  If you think that's far-fetched, just turn on TV or the internet to see the rioting and violence in Greece right now following their implementation of their austerity plan.  It's not a pretty picture.  The focus here should have been on jobs during a deep recession.  Healthcare should have waited until the economy improved first.

So yes, this is change you can believe in, but not me.      

[gyzzzmo]

Its funny Rachfan, but youre one of those many people who just keep 'babling' whatever their (republic) media keeps telling them, without any thinking. UK's healthcare system is very different from Obama's plans.
Plus you're using economic arguments, while more social security pays itself back.

[horowitzian]

WHAT?!? Where did you get that rubbish from?

I read and understand otherwise just about everywhere - from mere history books (what do you attribute the 1930s recovery from the great depression to?) to my understanding of economics (as preached by my piece of paper from university) says otherwise.

The only people that say what you say is deluded, out-of-touch armchair economists (i.e. the neo-classical economists that used to pervade the world bank and IMF) whose works have been to successfully demolish 3rd world countries by entangling them in debt and damage the economy of some Asian countries involved in the 1997 financial crisis (like my very own homeland, Indonesia).

   Suggest you cast a wider net than whatever crap you were taught at uni. Keynesian policies provide short term prosperity, but at what cost? Massive deficit spending year after year (and yes, the Republicans are just as guilty of that as the Democrats), and a debt load that we could not possibly hope to pay off in our lifetimes. The road to hell is paved with good intentions...

[horowitzian]

Its funny Rachfan, but youre one of those many people who just keep 'babling' whatever their (republic) media keeps telling them, without any thinking. UK's healthcare system is very different from Obama's plans.
Plus you're using economic arguments, while more social security pays itself back.

Rachfan knows his stuff; you should pay close attention instead.

[rachfan]

Hi gyzzzmo,

Of course some of my arguments are economic.  When you're talking about social programs, you cannot avoid dollars and cents.  And "more social security pays itself back" is not the case at all.  Hard working taxpayers foot the tab for all of that!

By "paying itself back", you seem to be implying that Social Security, for example, is self-sustaining. Nothing can be further from the truth.  The fact is, according to the nonpartisan Congressional Budget Committee, Social Security will go into the red as early as 2017 and unless it's fixed, will be totally insolvent by 2037.  As of yet, neither political party has stepped up to the plate on the issue.  The ratio of SS beneficiaries to workers has been shrinking, and now stands at 1 to 3 due to rising levels of benefits. The coming retirement of the "Baby Boomer" generation (which has already begun) will hit SS like a tidal wave, which has everyone concerned.  So no, there is no such thing as a free lunch that pays for itself. The likely fixes available will be unpleasant--changing the eligibility requirements, holding the line on benefits, and/or a huge increase in SS payroll taxes.

Other examples?  Would you rather talk about Medicare?  The actuaries have calculated that Medicare will be fully depleted in 2017.  So that social program will need intensive therapy even sooner than Social Security.  Oh, Medicaid (for the poor), that's slated to go broke in 2019 unless fixed in the meantime.

If you think this is "babbling" as you put it, don't tell me about it, rather contact the actuaries at the nonpartisan CBO who do all the numbers and timelines.    

[mephisto]

  Suggest you cast a wider net than whatever crap you were taught at uni.

Yeah, go girl! Getting an education at an university is just a terrible waste of time....

[horowitzian]

Yeah, go girl! Getting an education at an university is just a terrible waste of time....

In some ways, it is a bloody waste of time. In other ways, it's good. BTW, I'm a guy.

[smithreeseii]

Its funny Rachfan, but youre one of those many people who just keep 'babling' whatever their (republic) media keeps telling them, without any thinking. UK's healthcare system is very different from Obama's plans.
Plus you're using economic arguments, while more social security pays itself back.

Its funny gyzzzmo, but you're just one of those many liberals who denies facts, passing them off as republican/conservative propaganda..."without any thinking." 

[prongated]

 Suggest you cast a wider net than whatever crap you were taught at uni. Keynesian policies provide short term prosperity, but at what cost? Massive deficit spending year after year (and yes, the Republicans are just as guilty of that as the Democrats), and a debt load that we could not possibly hope to pay off in our lifetimes. The road to hell is paved with good intentions...

...pfft, you don't even know what is taught in "economics" at universities. The fact is, most universities teach you "mainstream economics", which is neo-classical based, which is what you seem to purport (debt is bad, supply = demand etc. etc.). Keynesian economics is actually part of that wider net you are talking about. Granted, each theory has its place and context, and Keynesian economics has its fallacies too...

...but the American economy is not a good example of Keynesian economics. A lot of the budget deficit is due to their excessive military spending. Military spending means income to the troops, weapons builders etc. but nothing else. Contrast this with effective Keynesian spending, such as building new rail lines that reduces transportation time for commodities. This means not only income for the rail line workers, but also more transactions between commodity producers and their related industry partners. This means growth in the industry, and growth in the economy.

How do you pay for the debt incurred you ask? Through increased tax as a result of greater economic activity, not as a result of increased tax rate. So to sum, the idea behind Keynesian economics is that the government spending is generally directed at infrastructure, health, education...in other words, the spending is to generate not only direct income to the population in the economy, but also increase the economy's operational efficiency so as to stimulate growth. Military spending, on the other hand, does not benefit the economy in the long-run. It is about as unproductive as a government can spend in the modern economy.

In some ways, it is a bloody waste of time. In other ways, it's good. BTW, I'm a guy.

Agreed.

[thalbergmad]

It's always seemed to me that the fair way to fund healthcare is to have it funded out of taxation with no option to buy any kind of 'top-up' healthcare privately. That way the poor get exactly the same healthcare as the rich, and the people making the rules for the poor are also making rules for themselves.

I say, can you imagine any of our dear politicians having to slum it on the NHS??

Would serve the buggers right for pouring billions into the NHS and wasting it on overpaid managers.

Thal

[horowitzian]

...pfft, you don't even know what is taught in "economics" at universities. The fact is, most universities teach you "mainstream economics", which is neo-classical based, which is what you seem to purport (debt is bad, supply = demand etc. etc.). Keynesian economics is actually part of that wider net you are talking about. Granted, each theory has its place and context, and Keynesian economics has its fallacies too...

Glad you don't subscribe entirely to it....

...but the American economy is not a good example of Keynesian economics. A lot of the budget deficit is due to their excessive military spending. Military spending means income to the troops, weapons builders etc. but nothing else. Contrast this with effective Keynesian spending, such as building new rail lines that reduces transportation time for commodities. This means not only income for the rail line workers, but also more transactions between commodity producers and their related industry partners. This means growth in the industry, and growth in the economy.

You're forgetting the billions of dollars that we've thrown at programs like Medicare and Medicaid, and look where they are today. Military spending does expand the private sector, no? Businesses such as Boeing, Lockheed, etc. That equals growth. Only a fool would suggest that we don't need to spend money on the military. I do agree (despite being conservative, which surprises a lot of people) that the wars in recent years are a waste; not only of our resources, but of our young men and women. I guess you could put me in the "support the troops, but not the cause" crowd, because this cause really isn't any of our business.

How do you pay for the debt incurred you ask? Through increased tax as a result of greater economic activity, not as a result of increased tax rate. So to sum, the idea behind Keynesian economics is that the government spending is generally directed at infrastructure, health, education...in other words, the spending is to generate not only direct income to the population in the economy, but also increase the economy's operational efficiency so as to stimulate growth. Military spending, on the other hand, does not benefit the economy in the long-run. It is about as unproductive as a government can spend in the modern economy.

The truth is, these ideas are highly Utopian in their conception. You are assuming that government is a knight on a white horse that can do no wrong, when in truth there is so much corruption and pork-barrel spending — on both sides of the aisle — going on that it really makes succeeding in real change virtually impossible. Power corrupts, and that's the basic reason so many people in this country distrust government, and have for hundreds of years.

The abject failure of Medicare and Medicaid leads me to question just how well the government will handle it this time around.

[prongated]

You're forgetting the billions of dollars that we've thrown at programs like Medicare and Medicaid, and look where they are today.

? Sorry I'm actually not familiar with the specific details of Medicare/Medicaid in the States, but I have only heard that, compared to other developed countries like Canada and Australia, health care in the States for the poor is non-existent...this is largely attributed by some to the way medical care operates - i.e. largely operated by the private sector.

Military spending does expand the private sector, no? Businesses such as Boeing, Lockheed, etc. That equals growth. Only a fool would suggest that we don't need to spend money on the military. I do agree (despite being conservative, which surprises a lot of people) that the wars in recent years are a waste; not only of our resources, but of our young men and women. I guess you could put me in the "support the troops, but not the cause" crowd, because this cause really isn't any of our business.

Military spending does help stimulate certain industries, but the economic benefits are really largely limited when you look into it. Firstly, military spending does not (in general) improve efficiency in the economy. The industry it benefits is also essentially limited to weapons and specialised vehicle manufacturers. Just compare the number of people the industry employs to the amount spent by the government and you get the picture. Contrast with (granted, proper) investments in health, education, and infrastructure, which should result in improvements of human resources and infrastructure, leading to improvements in efficiency and thus real growth in the economy.

The truth is, these ideas are highly Utopian in their conception. You are assuming that government is a knight on a white horse that can do no wrong, when in truth there is so much corruption and pork-barrel spending — on both sides of the aisle — going on that it really makes succeeding in real change virtually impossible. Power corrupts, and that's the basic reason so many people in this country distrust government, and have for hundreds of years.

...and so you choose to trust the private sector instead to sort everything out? I agree that power corrupts. Go too far to the left and you get the government controlling your every aspect of life. But go too far to the right and you will find the private sector, consisting of just a handful of mega-companies, controlling your life - in a different way, of course.

So I actually personally like the idea of social democracies like in the Scandinavian countries. And to many extent, Australia, where I think the balance of power between the private sector and the government is constantly, and thus nicely, jostled around the middle ground. Of course, I'm saying this as a budding music student, who will most likely never end up paying the highest rate of taxes in any country .

[gyzzzmo]

Hi gyzzzmo,

Of course some of my arguments are economic.  When you're talking about social programs, you cannot avoid dollars and cents.  And "more social security pays itself back" is not the case at all.  Hard working taxpayers foot the tab for all of that!

By "paying itself back", you seem to be implying that Social Security, for example, is self-sustaining. Nothing can be further from the truth.  The fact is, according to the nonpartisan Congressional Budget Committee, Social Security will go into the red as early as 2017 and unless it's fixed, will be totally insolvent by 2037.  As of yet, neither political party has stepped up to the plate on the issue.  The ratio of SS beneficiaries to workers has been shrinking, and now stands at 1 to 3 due to rising levels of benefits. The coming retirement of the "Baby Boomer" generation (which has already begun) will hit SS like a tidal wave, which has everyone concerned.  So no, there is no such thing as a free lunch that pays for itself. The likely fixes available will be unpleasant--changing the eligibility requirements, holding the line on benefits, and/or a huge increase in SS payroll taxes.

Other examples?  Would you rather talk about Medicare?  The actuaries have calculated that Medicare will be fully depleted in 2017.  So that social program will need intensive therapy even sooner than Social Security.  Oh, Medicaid (for the poor), that's slated to go broke in 2019 unless fixed in the meantime.

If you think this is "babbling" as you put it, don't tell me about it, rather contact the actuaries at the nonpartisan CBO who do all the numbers and timelines.    

Firstly, i noticed you ignored my 'UK is very different from Obama's plan'- comment, so i guess that you agree with me there that its nonsense to use that as an argument.
Secondly, social security pays back (okay, partially) by having lesser expenses as a government on crime, more tax income from more healthy people, and insurance companies.
And yes, like pretty much any western country, the US will get baby-boom issues. But the expenses so that everybody can get a healthinsurance is only marginally. The real problem is that taxes are too low in the USA and nobody can put that in his election program.

[rachfan]

Hi gyzzzmo,

I don't believe my argument is nonsense at all.  (I should also add that just because you happen to disagree with another person's viewpoint in no way makes it "nonsense".)  I agree with you only to the extent that the appearance of U.S. and the UK systems is different, but only momentarily.  Obama calls it the "first step" only.  It's no secret that his aim is fully nationalized healthcare, and he greatly admires the Western European healthcare programs.  (I have seen a couple of British MPs on TV warning us to avoid a national healthcare system at all costs.)  So how will it be nationalized here?  Obama's agenda is not out in the open, but very likely the regulatory apparatus that results from the bill will have control over the pricing of individual policies and well as future price increases.  It will then be quite easy to simply ensure that the insurers (now in reality just utilities under the act), through controlled pricing, cannot possibly be profitable.  Those companies with then withdraw from the individual policy segment of the market, concentrating instead on commercial group plans.  Once they're swept away, there will be a void, and to fill it, Obama will have Congress introduce "the public option".  Then it's only a matter of a short time before corporations cancel their employee healthcare plans, and everyone's only choice is to jump into the public option.  Hello nationalized healthcare!  

Then there is Part 2 to seal the deal.  Currently Medicare is split into two segments, traditional administered by governmental Medicare, and Advantage Plans offered by private insurers with some subsidy from Medicare.  The purpose of stealing Medicare funds--$500 billion worth--to fund healthcare reform (i.e., adding 32 million people to the rolls), is that all of it will come out of the Advantage Plans, thereby eliminating them.  All that will be left are the good 'ol traditional plan which is totally government controlled already.  

Of course, before these two events unfold, the advent of the public option and the death of Medicare Advantage Plans, two other events might make them moot:

1) 14 States' Attorney Generals, immediately after Obama signed the reform today, filed suit in a federal district court courts challenging the Constitutionality under the "commerce clause" of forcibly mandating uninsured individuals to purchase healthcare policies for their own bodies or face a $750 fine. A 15th suit was filed separately by the AG in Virginia.  (Virginia has also passed a state constitutional amendment protecting its citizens from having to comply with any compulsory purchase of health insurance.  37 other states also have state constitutional amendments in the works.)  Never in the history of the U.S., has the federal government ever forced individuals to purchase any good or service.  For example, even during WWII, no citizen was required to buy U.S. War Bonds. Yet it's a necessity for the government because without those folks enrolled, the  system cannot be financially sustainable.  In addition to the 14 State AGs I mention, as of today there are 23 more states in the wings ready to file similar lawsuits. From there the matter will probably be fast-tracked to the U.S. Supreme Court which, if convinced, could conceivably invalidate the act and strike it down in its entirety.

2) The congressional by-elections are just seven months away.  If the Republicans were to gain majorities on both the House and Senate, then they would likely repeal the act and start over to redo healthcare reform incrementally at a pace that would not bankrupt the country. (85% of Americans were satisfied with their existing insurance and were not eager for any overhaul whatsoever, but were ignored by those who voted to pass the bill.)  The GOP is passionate about tort reform to end outrageous malpractice suits and awards and that generates unnecessary defensive testing of patients, to prevent insurers from dropping sick people off their roles, to prevent people with preexisting conditions to be turned away, to prevent unjustified pushback on claims, to allow all insurers to competitively market their products across state lines, etc.

Adding 32 million people to healthcare at taxpayer expense is NOT "a marginal cost" by any stretch of the imagination.  Over 10 years it will cost well over $2.5 trillion dollars.  There is very little doubt that this will bankrupt the country (which cannot afford the existing entitlement programs), which will touch every American in catastrophic and tragic ways once national austerity kicks in.

Historically Americans don't like the notion of being enslaved by a nanny state, do not relish the mediocrity of collectivism, and abhor the confiscatory high taxes to support such a monstrosity. As the 18th century great American patriot Thomas Paine said, "The government that governs least governs best." Most people want to achieve the American Dream not through control and handouts, but instead through their own hard work and merit.  That's what has made this nation great.  

People also want to enjoy the fruits of their labors.  It allows them to improve their lives.  Americans have always admired the great philosopher, Ralph Waldo Emerson, who emphasized self-reliance and individualism.  We don't need socialism or marxism or nannyism here.  And along with that, Americans have given more charity at home and abroad than any other country in history.  Look at the Marshall Plan to help rebuild Europe after WWII.  Look at the recent huge amount of U.S. aid to Haiti after the earthquake there.  Likewise, reasonable taxes allow businesses to invest, expand, spend on R & D, and introduce new product lines, facilities and jobs which boost the economy which benefits everyone.  On the other side of the coin, no, we don't need or want higher taxes here to feed a bloated, overreaching, and terribly inefficient federal bureaucracy.        

 

[mephisto]

www.foxnews.com

[richard black]

Of course, one does tend to hear only the bad things about nationalised healthcare. I have to say that the UK National Health Service has done pretty well by me and my nearest and dearest - I actually can't think offhand of anything they've done worse than making us wait in the Accident and Emergency waiting area for a couple of hours, and to be fair it was obvious no one was going to die or suffer excruciatingly on account of that wait. Of course there are aspects to the service that aren't ideal, but if you have a UK passport or permanent visa, you know you are going to get treated if sh*t happens, and more often than not you get treated well. (E.g. the local NHS maternity department is superb and has looked after women I know very well indeed under ordinary and extraordinary circumstances.)

What actually is wrong with nationalising things that everyone in a country needs, or is highly likely to need? - i.e. healthcare, utilities, travel and personal transport and so on. The only people who benefit from it being non-nationalised are the people at the top of the corporations selling the service privately.

[ronde_des_sylphes]

I agree with you only to the extent that the appearance of U.S. and the UK systems is different, but only momentarily.  Obama calls it the "first step" only.  It's no secret that his aim is fully nationalized healthcare, and he greatly admires the Western European healthcare programs.  (I have seen a couple of British MPs on TV warning us to avoid a national healthcare system at all costs.)

I'm wary of commenting on the politics of a country other than mine, but feel that I should comment on the British MPs section. Their comments will very much depend on their political persuasion. I'm imagining one of the MPs you saw was Daniel Hannan, who is a right-wing Eurosceptic (not that the latter is relevant here).

From personal experience I would say the British National Health Service is not nearly as bad as they are making out. I would agree with Richard's post. The NHS is certainly not perfect, and if you are unlucky enough to live in certain areas of the country and require specialised treatment, you may have problems. However, the principal issue with the NHS is the culture of excessive bureaucracy and obsession with targets which has crept in over the last decade through political meddling.

[rachfan]

Hi Richard,

I am more familiar with Canadian nationalized healthcare, but understand that it's not all that dissimilar from the UK's version.  What we find in the northern border states here in the U.S. is a large, on-going influx of Canadians seeking healthcare services.  I live in the largest city in central Maine about 90 miles from an international border crossing.  We're a magnet for Canadian shoppers, but there is another attraction too.  Our city has two hospitals (one a very large tertiary treatment hospital), three MRI testing sites, lots of labs, etc.  At these facilities you can ALWAYS spot Canadian license plates on cars. The reason they come here is because of the rationing of care that tends to be inherent in national healthcare systems.  Rationing can manifest itself in several ways.  But the one that manifests itself is that Canadians evidently cannot always get sufficiently prompt testing and/or treatments in the Canadian Maritime provinces.  Canadians and Americans have a very close and special relationship (even though they're Tories ), so Canadians are very comfortable using American medical facilities, and they're certainly always welcomed.

I'm sure this constant influx is a financial bonanza for the hospitals, testing facilities, physicians and labs here and in the other border states, but more importantly, these are people who may have serious conditions (possibly even life threatening).  But they face healthcare rationing at home, and for them it takes the form of waiting queues.  And I guess some of those waits for appointments with specialists or for an MRI or a CAT scan are simply way too long. It's easy to imagine how someone could not only become concerned, but even frightened by such delays. It's illegal in Canada to circumvent the national system by paying for services privately on the side. Thus, they feel compelled to cross the border for help.  I have to say, quite frankly, that type of health system would not be for me!

Now the sad part: With ObamaCare, 32 million additional people will now be covered with NO additional medical staff being added to cope with that volume.  And about 30% of doctors and nurses plan to leave their professions thereby exacerbating the shortage of medical staff very substantially.  The border states will now have their hands full, and Canadians will find with dismay that the rationing queues here in the U.S. are as bad or even worse than in Canada. We will not longer be able to be the "spillover" solution that Canadians have been relying on for years. My guess is that people will by dying on both sides of the border as a result.  We're now in the same unseaworthy boat so to speak.  

[gyzzzmo]

So Rachfan, you pretty much dont want those 32 million people to get health insurance because.... you 'might' have to wait a little longer?

Nice

[rachfan]

Hi ronde,

Thanks for adding that information on the NHS.  As it turns out many of us are worried about that same "excessive bureaucracy" and "political meddling" to which you refer.  Until yesterday, we didn't have to worry about that stuff, as healthcare decisions were made within the patient/physician relationship with an occasional notification to the insurer for certain procedures.  Now that might no longer be the case.

[rachfan]

Hi gyzzzmo,

You seem to believe that simultaneously putting 32 million people onto the rolls while also losing 30% of medical staff who will either leave or retire as a result of ObamaCare will result in a "little wait" for service.  To the contrary, I believe it will be catastrophic and that many people will likely die during interminable waits.  I wish I could be as optimistic about it as you.

[alessandro]

Hello everyone,

Interesting discussion is going on here.

I would like to give (not a pro or a con, nor an opinion) just some thoughts...

1.  What could "health" apart from this conceptual subjective feeling and state of my own body mean for an individual ? Couldn't it be that there is actually the tendency to organize "from above" my health whilst health is something private ? (would you please tell me if I don't write clearly ?)

2.  What to think of the fact that here in Europe it is possible that at the same time an African teenager strands underfed, almost dying on a beach after escaping his country with a boat looking forward to good fortune, and that at the same time an 95 year-old man can get a pace-maker or hip-prostheses whilst the only thing that he has done the last ten years of his life is looking out of his window from his wheelchair, smoking two cigarettes a day and play a game of bridge on Sundays ?

3.  What to think of the fact that there is (almost ?) no country or state left, that hasn't removed from Hippocrates' medical oath the notion that "medical knowledge should be shared no matter the 'financial status' of the "other"..."

I wish you all a very good health and a nice day.
Kindly

[horowitzian]

? Sorry I'm actually not familiar with the specific details of Medicare/Medicaid in the States, but I have only heard that, compared to other developed countries like Canada and Australia, health care in the States for the poor is non-existent...this is largely attributed by some to the way medical care operates - i.e. largely operated by the private sector.

I don't agree; the healthcare is here. Rachfan has pretty much echoed my thoughts on this, so I won't rehash.

I will add one thing. One thing that is NOT TO BE SEEN anywhere near this bill. One thing that would solve a lot of problems. Tort reform. Part of the problem (and yes I do agree there are problems), is junk malpractice lawsuits filed against doctors by ambulance chasing lawyers. That means the doctors must buy malpractice insurance. That means costs must go up. Heck, junk lawsuits aren't just a problem in the healthcare industry...but that's whole other can of worms I'm sure.

Military spending does help stimulate certain industries, but the economic benefits are really largely limited when you look into it. Firstly, military spending does not (in general) improve efficiency in the economy. The industry it benefits is also essentially limited to weapons and specialised vehicle manufacturers. Just compare the number of people the industry employs to the amount spent by the government and you get the picture. Contrast with (granted, proper) investments in health, education, and infrastructure, which should result in improvements of human resources and infrastructure, leading to improvements in efficiency and thus real growth in the economy.

Yes, but military spending makes jobs for engineers and scientists. True, there are fewer of them, but they are well paid, and thus pay their taxes and have disposable income to spend in other areas of the economy.

But, as you rightly point out, you can't have your eggs in one basket; diversification is the key. Look what happened to the Soviet Union. They spent so much money on military purposes, that the country's infrastructure crumbled. Today's CIS still has problems with it.

...and so you choose to trust the private sector instead to sort everything out? I agree that power corrupts. Go too far to the left and you get the government controlling your every aspect of life. But go too far to the right and you will find the private sector, consisting of just a handful of mega-companies, controlling your life - in a different way, of course.

So I actually personally like the idea of social democracies like in the Scandinavian countries. And to many extent, Australia, where I think the balance of power between the private sector and the government is constantly, and thus nicely, jostled around the middle ground. Of course, I'm saying this as a budding music student, who will most likely never end up paying the highest rate of taxes in any country .

Hehe, I fully agree that there are unseemly goings-on in large corporations. Microsoft, anyone? I put my trust in small business, which is arguably the cornerstone of our economy.

I also agree that a balance must be struck. We may indeed agree more than you think. In fact, a lot of my progressive friends (non-internet, anyway ) agree with me; we just are looking at it through a different lens.

Funny you mention Australia, BTW, because IIRC they are generally considered to have one of the most laissez-faire economies in the world. Very cool.

[gyzzzmo]

Hi gyzzzmo,

You seem to believe that simultaneously putting 32 million people onto the rolls while also losing 30% of medical staff who will either leave or retire as a result of ObamaCare will result in a "little wait" for service.  To the contrary, I believe it will be catastrophic and that many people will likely die during interminable waits.  I wish I could be as optimistic about it as you.

I bet you got that 30% number from the astrology department of the Republican party. That astrology department also conveniently seems to forget about all those dieing people who couldnt get a health insurance (wich isnt ofcourse something from their department since its actually a fact).

You're coming with all these arguments you hear on the television (Fox news is probably your source), without putting them into perspective. Objectivly seen you just dont want 32 million people to get health insurance because you might, MIGHT have to wait a little longer. The USA's healthcare system is quite bad as it is now, pretty much anybody agrees on that. But you dont want to change it anyway because it might have a few disadvantages (but has proven itself to be much better in general)?

[prongated]

You're coming with all these arguments you hear on the television (Fox news is probably your source), without putting them into perspective. Objectivly seen you just dont want 32 million people to get health insurance because you might, MIGHT have to wait a little longer. The USA's healthcare system is quite bad as it is now, pretty much anybody agrees on that. But you dont want to change it anyway because it might have a few disadvantages (but has proven itself to be much better in general)?

In a country like USA, which seems to be proud of its extremely liberal economic ideology (free market, privatisation...), I imagine that health care is seen as a privilege, which therefore one must pay for (and the more you pay, the more you get), as opposed to a right, which one would then be entitled to entitled to regardless of wealth. To me it's just one of the nice things being rich in the States...of course, if you're poor you're screwed, full stop.

[prongated]

I don't agree; the healthcare is here. Rachfan has pretty much echoed my thoughts on this, so I won't rehash.

I see...thanks! And I do realise what I've been posting has been generally slightly off-topic...

I will add one thing. One thing that is NOT TO BE SEEN anywhere near this bill. One thing that would solve a lot of problems. Tort reform. Part of the problem (and yes I do agree there are problems), is junk malpractice lawsuits filed against doctors by ambulance chasing lawyers. That means the doctors must buy malpractice insurance. That means costs must go up. Heck, junk lawsuits aren't just a problem in the healthcare industry...but that's whole other can of worms I'm sure.

Yeah, it's getting ridiculous hearing case after case of people seeking compensation for some of the most frivolous matters imaginable, paling the cases of those with genuine reasons. For sure it'll fill up a whole stack of thread.

Yes, but military spending makes jobs for engineers and scientists. True, there are fewer of them, but they are well paid, and thus pay their taxes and have disposable income to spend in other areas of the economy.

But, as you rightly point out, you can't have your eggs in one basket; diversification is the key. Look what happened to the Soviet Union. They spent so much money on military purposes, that the country's infrastructure crumbled. Today's CIS still has problems with it.

...I would be picky and argue it's not so much diversification as it is investing the money in the right projects. Note that the first thing that spending in the economy do is stimulate the economy. By injecting income into the economy, demand will (hopefully) be boosted, and thus increasing the number of transactions in the economy. However, this is not necessarily where the buck stops.

Basically, spending money in an economy that is filled to near-capacity is simply going to create inflation. The argument in neo-classical economics is that the only way to get real economic growth is by increasing efficiency in the economy. Of course, the former is a situation not likely to exist in a recession. However, I believe that in the long-term, the debts incurred at present can only be repaid only if real growth can be secured. And as it is, I see that there is a lot of scope to improve the level of infrastructure in the States - the human resource, through education and health, for one.

(Sorry if that's sketchy - am in a rush!)

Hehe, I fully agree that there are unseemly goings-on in large corporations. Microsoft, anyone? I put my trust in small business, which is arguably the cornerstone of our economy.

I also agree that a balance must be struck. We may indeed agree more than you think. In fact, a lot of my progressive friends (non-internet, anyway ) agree with me; we just are looking at it through a different lens.

Funny you mention Australia, BTW, because IIRC they are generally considered to have one of the most laissez-faire economies in the world. Very cool.

Haha indeed! And you're right - I suppose you're coming from the right, whereas I'm coming from the left...(yeah I do like the general idea of a more socialistic government)

Btw IIRC? Progressive friends? What's that?

And Australia is actually not such a laissez-faire economy. The government has set up watch dogs of all sorts to monitor investment and business activity so as to protect consumer's interest - and they actually work, most of the time anyway. And anti-competitive behaviour is generally strongly forbidden and even illegal. I believe that in the States, mobile phone carriers have exclusive distribution rights for just about all handsets (e.g. you can only get the iPhone if you are on AT&T or something)? In Australia that is illegal. If I remember correctly, I think Apple even had to adjust the iPhone's lock accordingly to comply with Australian regulations.

And in any case, I mentioned Australia because that is what my passport says my nationality is

[horowitzian]

I'm in a rush two, so I'll only address your two questions right now. IIRC = If I Recall Correctly. "Progressive" simply is a another term for people who tend towards leaning left in their views. I like it because it is often more descriptive of many of these people's views, as opposed to the true hard leftist types (of which with I have zero association!).

[rachfan]

Of course I want to change healthcare! As examples: We need total tort reform (not the tiny demonstration project the Democrats very begrudgingly included in their bill) to prevent "defensive" excessive and expensive testing by doctors to be used in the event of malpractice suits.  Why did the Democrats shun real tort reform?  VERY SIMPLE: The American Trial Lawyers Association is their single largest campaign contributor!  (Don't take my word for it, look it up yourself.)  So they're not going to bite the hand that feeds them.  Im not saying the GOP does not have special interest money, it does.  But the ATLA was the roadblock to tort reform.

We need any health insurer anywhere in the U.S. to be able to market its polices in the 50 states to sharpen competition.  In Maine, where I live, we have a choice of just two (2): Anthem Blue Cross/Blue Shield and Dirigo, a subsidized public option plan created by the Democratic controlled state legislature, aimed at small businesses and low income people, which preceded ObamaCare but has failed--nearly bankrupt-- and now has a small shrinking residual band of policy holders.  (Obviously Obama, Pelosi and Reid should have visited this state's Dirigo plan to these sad results before going overboard on ObamaCare.  Likewise, they should have visited Massachusetts to look at that state's universal healthcare, now nearly bankrupt too.) Oh, and back in Maine, who administers Dirigo and processes its claims?  Why Anthem of course!  Gee, what wonderful "competition"!  Other rural states also have health insurance near-monopolies like this with only one or two insurers.  No, we didn't need ObamaCare here (25% of the people in this state are already Medicaid recipients--the highest in the nation).  What we needed was real competition among multiple insurers.

I also favor clamping down on insurers rejecting people due to pre-existing conditions, knocking people off the rolls once they get sick, and announcing obscene price hikes on policies.

The vast majority of U.S. citizens would have been far happier had Obama and his crew addressed these and other issues incrementally rather than turning the entire system upside down in an over-reaching power grab.  

      

[rachfan]

Hi gyzzzmo,

Sorry to disappoint you, but no, the 30% (actually 33%) figure on physicians leaving the profession as a result of ObamaCare did not originate with the "Republican astrology department" as you put it.  It was printed in the most prestigious medical journal in America, The New England Journal of Medicine.  The sample size in the survey was 1,195 doctors.  Here is a pertinent extract for that article:

    "The New England Journal of Medicine’s Career Center has a report by the Medicus Firm talking about how the Democrats’ health bills would drive doctors out of the profession.

    Nearly one-third of physicians responding to the survey indicated that they will want to leave medical practice after health reform is implemented.

    “What many people may not realize is that health reform could impact physician supply in such a way that the quality of health care could suffer,” said Steve Marsh, managing partner at The Medicus Firm in Dallas. “The reality is that there may not be enough doctors to provide quality medical care to the millions of newly insured patients.”

    It’s probably not likely that nearly half of the nation’s physicians will suddenly quit practicing at once. However, even if a much smaller percentage such as ten, 15, or 20 percent are pushed out of practice over several years at a time when the field needs to expand by over 20 percent, this would be severely detrimental to the quality of the health care system.

    A combination of millions of new users demanding virtually unlimited medical resources combined with a loss of doctors can only lead to significant rationing of health care. Obamacare will result in a significant decline in the overall quality of medical care nationwide."

As for your assertion that I'm "worried about MIGHT having to wait" for care, I refer you not only to the article quoted here, but also to my post to Richard above.  I live 90 miles from a U.S.-Canadian border crossing.  There is a large influx of Canadians who come to my fair city to get care, because the wait is too long in Canada with its universal healthcare.  Waiting queues is a synonym for rationing of care. This phenomenon stretches across the U.S. northern border states all the way to Washington state.  So no, I'm not imagining it, I see it with my own eyes in my own city.

Repeal efforts are already underway and I support them.

[rachfan]

I for one don't view healthcare as a right, least of all one conferred by the federal government, as what it grants as a right can then be taken away just as easily.  I also don't view heathcare as a privilege, as that implies some kind of class differential.  To me the act of purchasing health insurance is no different from buying a car, a homeowner's insurance policy, or the daily newspaper.  Healthcare insurance is a commodity available through healthcare insurers and contracted by a willing buyer and seller for consideration.  It's no more glorified than that.

[gyzzzmo]

I for one don't view healthcare as a right, least of all one conferred by the federal government, as what it grants as a right can then be taken away just as easily.  I also don't view heathcare as a privilege, as that implies some kind of class differential.  To me the act of purchasing health insurance is no different from buying a car, a homeowner's insurance policy, or the daily newspaper.  Healthcare insurance is a commodity available through healthcare insurers and contracted by a willing buyer and seller for consideration.  It's no more glorified than that.

Buying a car or not is a choice, and a salesman wont deny you a car. This is different though with insurance companies who do that. And you dont see it as a privilege because it implies class differential? Well, the problem is that theres nothing to imply, because it IS a problem of classes.
And since social security reaches so far beond that simple buyer/seller consideration, it is far too important to let it regulate itself by market, since it obviously does not work this way.

[rachfan]

I think healthcare has often been a choice.  There have always been millions of young workers in particular who opt out of corporate group insurance plans which are far cheaper than individual plans.  Often it has been because they believe they're healthy, won't need it, so prefer not to have the company doing payroll deductions for it.  To be fair, there have also been some wage-earners who feel they cannot afford ever the cheaper group rates. There's been no penalty for younger people opting out in any case.  Now they'll have to at least pay a $750 fine.  The government "new speak" though is not a fine, but instead a "tax", as it is to be enforced by the IRS.   

[oxy60]

If this health bill does nothing else, at least it got peoples attention and started them talking. Last election in the US with about 300 mil people got only about 100 mil voters (which split 55 mil / 44 mil) in Nov 2008. So what about the other 200 mil? Don't they have an opinion or do they just grumble and complain? Is this health bill what America wants? Will they vote this November and say YES to Obama, his agenda and his party to continue or will they say STOP?

If enough people come out to vote we won't have these stupid close elections that need to be decided in the courts.

Can I count on all my fellow Americans who have commented here to get registered and vote?

[gyzzzmo]

I think healthcare has often been a choice.  There have always been millions of young workers in particular who opt out of corporate group insurance plans which are far cheaper than individual plans.  Often it has been because they believe they're healthy, won't need it, so prefer not to have the company doing payroll deductions for it.  To be fair, there have also been some wage-earners who feel they cannot afford ever the cheaper group rates. There's been no penalty for younger people opting out in any case.  Now they'll have to at least pay a $750 fine.  The government "new speak" though is not a fine, but instead a "tax", as it is to be enforced by the IRS.   

The main problem that alot of people didnt have a choice: they couldnt get insured.

[ramseytheii]

To those who claim that the health care bill is a government take over of whatever part of the economy they quote (which is frankly a Frankensteinian fraction) I have a hard time taking any of their arguments seriously.

What has the government taken over?  They are requiring people to buy insurance from private companies.  They are providing some much needed, and much welcomed (strong majority of the country agrees) regulation on those companies. 

The government is not training doctors; it does not have a health insurance plan that people can buy that undercuts private industry; they are not telling people where they have to go; they are not telling people what they have to do.  What is the takeover?  What part of your life does the government now control that it didn't before?

This kind of rhetoric unfortunately casts a shadow on all points one can make subsequently.  It sounds paranoid and spiteful, and not at all logical.

Walter Ramsey

[richard black]

Of course, what is arguably the elephant in the room with all this discussion is that we are living longer and we all know that medical science has cures for more and more things that can go wrong with us, so it's natural that we all want MORE healthcare, NOW. Unfortunately, for all sorts of reasons (not all of the palatable or morally defensible), healthcare is expensive, especially the leading-edge stuff. I've never come across a politician of any angle or nationality who could bring him/herself to say that infinite healthcare is simply not an affordable option, however hard we try.

[rachfan]

Hi walter,

Obama has made it abundantly clear that the healthcare bill is "only the first step".  (His words, not mine.)  He's not after incremental change, but transformational change. There is no question that he would much prefer a nationalized healthcare similar to the Western European models.  So how does he get there?  Through the regulatory controls you yourself mentioned. Here's one plausible roadmap:

The regulatory apparatus that results from the bill will have control over the pricing of individual policies sold by private health insurers, as well as future rate increases (which have been hotly contested of late).  It will then be quite easy to simply ensure through regulated pricing that the insurers (now in reality mere utilities under the act), cannot possibly be profitable.  Rather than taking financial losses, those companies will then likely withdraw from the individual policy segment of the market.  There will then exist an obvious void (i.e., where will individuals get health insurance?), and to fill the void, Obama will urge Congress to re-introduce "the public option", which Democrats fought tooth and nail for in the first place.  The public option will be partly subsidized depending on income level.  It's difficult to impossible to compete with anything that's subsidized, as it's inherently not a level playing field.

Once in place, the private health insurers, by then will be concentrating instead on their commercial group insurance plans.  They will find that they cannot possibly compete in group rates with the public option rates for individuals.  Why not?  Because of artificial regulation and subsidies (courtesy of the taxpayers).  Thus, insurers will be unable to compete and produce earnings that enhance value for shareholders.  Private corporations will be watching these machinations closely and will see an ENORMOUS opportunity before them. Whereas employee group insurance plans are one of their largest costs of doing business, they will then cancel and dump those plans while observing plan notice requirements, and will inform their employees accordingly.  The unions will be pleased, as they want a single payer system, so no resistance there.  At that point, millions of uninsured employees will be migrating to the one avenue left--the public option (a single payer system, of course)--and there stands nationalized healthcare.  So the federal overreach might not be apparent to you momentarily.  There are two more steps to go yet for the game plan to unfold.

Much of the general population in the U.S. regards the Obama Administration as "business as usual." Nothing can be further from the truth.  Thinking logically is very important, but in the current environment, one has to be able to think outside of the box.  We're living in very different times now.  Obama was caught on video in 8 separate venues promising that the healthcare deliberations in Congress would be on C-Span.  That transparency never happened.  It's the Washingtonian "New Speak" so artfully practiced by Obama and Gibbs. And with all of the corrupt back room deals we've seen for the purpose of buying votes in Congress that were revealed well after the fact, we've learned that nothing is necessarily as it seems down in Washington, DC.       

[ramseytheii]

Hi walter,

Obama has made it abundantly clear that the healthcare bill is "only the first step".  (His words, not mine.)  He's not after incremental change, but transformational change. There is no question that he would much prefer a nationalized healthcare similar to the Western European models.  So how does he get there?  Through the regulatory controls you yourself mentioned. Here's one plausible roadmap:

He said it was the first step, but you filled in the rest yourself.  He never said it was a first step towards nationalized health care, or European style health care.  And there is a question what he might prefer - it has been reported that he secretly negotiated the public option away in order to gain industry support; the whole time during the debate he claimed to support it, it had already been taken away as a possibility.  So much of the way one perceives this current bill, frankly depends on one's political leanings.

The regulatory apparatus that results from the bill will have control over the pricing of individual policies sold by private health insurers, as well as future rate increases (which have been hotly contested of late).  It will then be quite easy to simply ensure through regulated pricing that the insurers (now in reality mere utilities under the act), cannot possibly be profitable.  Rather than taking financial losses, those companies will then likely withdraw from the individual policy segment of the market.  There will then exist an obvious void (i.e., where will individuals get health insurance?), and to fill the void, Obama will urge Congress to re-introduce "the public option", which Democrats fought tooth and nail for in the first place.  The public option will be partly subsidized depending on income level.  It's difficult to impossible to compete with anything that's subsidized, as it's inherently not a level playing field.

A lot of this really is your own filling in.  Obama abandoned the public option secretly in order to gain industry support; about this there is no question.  For him to bring it back, would cause a full-scale attack from the health industry.

Also, Democrats did not really fight hard for it.  If I recall, they spent the better part of last year saying, "Sorry, we don't have the votes," even though several vote tallies indicated they did.

Right now, insurance companies are wildly profitable because they drop people who become to expensive for them.  Under this bill, it seems that they will have a lot more customers - including a lot more healthy ones - and their profits may not be the sky high level they are now, but will be contained.  I think personally it is abhorrent that health insurance should be associated with profits, because if you think about it, the only way they can profit is by rationing health care to their customers.  I personally believe it should be public, because it should be divorced from profiteering.  That's just my opinion.

Finally, the Post Office is heavily subsidized, and yet there is private competition.  It's obviously not impossible.

Once in place, the private health insurers, by then will be concentrating instead on their commercial group insurance plans.  They will find that they cannot possibly compete in group rates with the public option rates for individuals.  Why not?  Because of artificial regulation and subsidies (courtesy of the taxpayers).  Thus, insurers will be unable to compete and produce earnings that enhance value for shareholders.  Private corporations will be watching these machinations closely and will see an ENORMOUS opportunity before them. Whereas employee group insurance plans are one of their largest costs of doing business, they will then cancel and dump those plans while observing plan notice requirements, and will inform their employees accordingly.  The unions will be pleased, as they want a single payer system, so no resistance there.  At that point, millions of uninsured employees will be migrating to the one avenue left--the public option (a single payer system, of course)--and there stands nationalized healthcare.  So the federal overreach might not be apparent to you momentarily.  There are two more steps to go yet for the game plan to unfold.

All this depends solely on there being a public option, which I can assure you is not happening in the US anytime soon.  You assure me it is, but I assure you the opposite.  It all depends on where you land in the political spectrum.

Also, by your own argument, you can't therefore say that the law passed is a government takeover.  You say there are "two steps" before there is a takeover.

Much of the general population in the U.S. regards the Obama Administration as "business as usual." Nothing can be further from the truth.  Thinking logically is very important, but in the current environment, one has to be able to think outside of the box.  We're living in very different times now.  Obama was caught on video in 8 separate venues promising that the healthcare deliberations in Congress would be on C-Span.  That transparency never happened.  It's the Washingtonian "New Speak" so artfully practiced by Obama and Gibbs. And with all of the corrupt back room deals we've seen for the purpose of buying votes in Congress that were revealed well after the fact, we've learned that nothing is necessarily as it seems down in Washington, DC.       

I won't disagree with you, but only point out once again that your idea is based more on distrust of an administration, than any evidential reality.  I think you have to confront certain facts before you can argue this is remotely any kind of government takeover.

Walter Ramsey