Originally Posted by Deb C

Unaffordable co-pays and deductibles, death by a million cuts for insured Americans

There are clearly major problems with our so-called health care 'system'. Although we do not agree on the solution, the USA needs to seek a national consensus on a real national health care system . The current warfare seems to promote stalemate. I know a few small businesses that are considering the elimination of health care for employees( this will only make the problem worse).

Health Care Costs: Issue Modules, Background Brief - KaiserEDU.org
http://www.kaiseredu.org/Issue-Modul...und-Brief.aspx

..."Health expenditures in the United States neared $2.6 trillion in 2010, over ten times the $256 billion spent in 1980.[1] The rate of growth in recent years has slowed relative to the late 1990s and early 2000s, but is still expected to grow faster than national income over the foreseeable future.[2] Addressing this growing burden continues to be a major policy priority. Furthermore, the United States has been in a recession for much of the past decade, resulting in higher unemployment and lower incomes for many Americans. These conditions have put even more attention on health spending and affordability. [1]
Since 2001, employer-sponsored health coverage for family premiums have increased by 113%, placing increasing cost burdens on employers and workers. [3] In the public sector, Medicare covers the elderly and people with disabilities, and Medicaid provides coverage to low-income families. Enrollment has grown in Medicare with the aging of the baby boomers and in Medicaid due to the recession.[1], [4] This means that total government spending has increased considerably, straining federal and state budgets. In total, health spending accounted for 17.9% of the nation’s Gross Domestic Product (GDP) in 2010. [5]"...

Originally Posted by radind

There are clearly major problems with our so-called health care 'system'. Although we do not agree on the solution, the USA needs to seek a national consensus on a real national health care system . The current warfare seems to promote stalemate. I know a few small businesses that are considering the elimination of health care for employees( this will only make the problem worse).

Yes, my son-in-law has a job with a small company that is insisting they can no longer afford insurance for the employees.

Health Insurers: We'll Deny Coverage for Pre-Existing Conditions if Health Mandate Is Repealed

Health insurers and supporters of the Obama administration’s health-care reform law are currently in the midst of drawing up possible contingency plans in case the Supreme Court overturns the Affordable Care Act’s individual mandate.

The insurance industry argues that premiums are likely to skyrocket without the individual mandate in place to aid in pushing millions of new enrollees into the marketplace, as healthy people will be less likely to buy insurance, while insurers will still be required to sell policies to all applicants. In fact, a repeal of the individual mandate would increase insurance premiums by 25 percent, according to a study released by the Robert Wood Johnson Foundation.

http://www.truth-out.org/health-insu...led/1332259202

I'm not sure where to put this, so ...

Yesterday we did a 911 call to a nice house in a nice neighborhood here in ABQ. When we arrived we found a policeman, three women with ID cards around their necks on lanyards, and an 80-something, little old lady (maybe 90 pounds, soaking wet, with a rock in each hand).

The little old lady was pissed. One of the lanyard ladies claimed to be the lady's Power of Attorney for healthcare decisions. The POA lanyard lady said she worked for a company called "Decisions, Inc." or something like that. This company takes on the task of being POA for family members who do not want to have to deal with the details of being someone's POA.

The little old lady, after questioning by us, was obviously alert and oriented, at least according to our relatively superficial assessments. She knew exactly who she was, where she was, what she was doing, what day it was, etc. etc. She wanted to go to a doctor's appt, but said she didn't trust the POA lady. She further said that her son had arranged the whole POA thingy through the court somehow.

Ultimately, we did not transport her because our guidelines do not allow us to take someone who is fully alert and oriented anyplace they don't want to go. Then of course the lanyard ladies got pissed at us. Because they wanted her to go.

The cop finally came through and worked a compromise - he transported her to a mental facility for a better assessment after which he promised the little old lady that he would take her to her doctor's appt.

I was shocked. I guess everything is for sale. Even the taking care of private affairs of parents. Surely there must have been something that the courts found that made this lady unable to care for herself and make her own decisions. But we get used to the usual evasiveness and the usual mental state of even the early Alzheimer's patient, and this lady really seemed very together to us.

I dunno. It sure seemed like the "system" was ganging up on her to me.

Originally Posted by TnT

I'm not sure where to put this, so ...

Yesterday we did a 911 call to a nice house in a nice neighborhood here in ABQ. When we arrived we found a policeman, three women with ID cards around their necks on lanyards, and an 80-something, little old lady (maybe 90 pounds, soaking wet, with a rock in each hand).

The little old lady was pissed. One of the lanyard ladies claimed to be the lady's Power of Attorney for healthcare decisions. The POA lanyard lady said she worked for a company called "Decisions, Inc." or something like that. This company takes on the task of being POA for family members who do not want to have to deal with the details of being someone's POA.

The little old lady, after questioning by us, was obviously alert and oriented, at least according to our relatively superficial assessments. She knew exactly who she was, where she was, what she was doing, what day it was, etc. etc. She wanted to go to a doctor's appt, but said she didn't trust the POA lady. She further said that her son had arranged the whole POA thingy through the court somehow.

Ultimately, we did not transport her because our guidelines do not allow us to take someone who is fully alert and oriented anyplace they don't want to go. Then of course the lanyard ladies got pissed at us. Because they wanted her to go.

The cop finally came through and worked a compromise - he transported her to a mental facility for a better assessment after which he promised the little old lady that he would take her to her doctor's appt.

I was shocked. I guess everything is for sale. Even the taking care of private affairs of parents. Surely there must have been something that the courts found that made this lady unable to care for herself and make her own decisions. But we get used to the usual evasiveness and the usual mental state of even the early Alzheimer's patient, and this lady really seemed very together to us.

I dunno. It sure seemed like the "system" was ganging up on her to me.

My daughters had better no get any ideas like that. But I have given my younger brother power of attorney and have asked a local friend - the one who took care of another friend's business after her stroke - to be my local advocate if anything happened to me, just in case my case was mishandled. You see, I am a firm believer that anything can happen, people make all sorts of mistakes or decisions the person on the other end would not want, and I've had proof they often do not act logically. People - be warned!

Originally Posted by playwrite

Putting aside the Senator laying out a set of bizarre numbers never confirmed by Sebelius...

-Numbers everyone else is aware of. Including Sebelius.

Originally Posted by playwrite

The [mis-named] Affordable Care Act was past two years ago; in that time, no one's tax rates have gone up. They have actually gone down with the payroll tax cuts...

-How disingenuous. Even PW knows that the costs were backloaded so it wouldn't show up in the "10 years out" graphs.

Imagine an America with no health insurance companies.

What do health insurance companies do?

They take as much money as possible from people who want health insurance coverage. They pay out as little money as possible — so-called medical loss — to settle claims from creditors for health services and products that have been delivered.

They keep as much money as possible for the incomes of their executives and other employees, and to enhance share value for their owners.

They do try to attract enough premium money from customers — so-called covered lives — so that they can spread the risk of a few high-cost customers across the premiums of many low-cost customers.

They try as much as they legally can to cover as many low-cost customers as possible, and to keep as many high-cost customers out of their plans in order to maximize revenues and minimize expense.

They do employ a lot of people, all “following the money” — sort of a jobs program.
Why do we need them? There must be a better way.

It is true that health insurance companies use market clout to attempt to “keep costs low.”

And they are motivated to try to keep their own costs low by limiting use of expensive procedures.

But, by any fair, rational, national, international, and outcome measure, health insurance companies have failed to keep utilization low and failed to keep costs low.

But they have succeeded splendidly at growing their workforces, paying their execs highly, and rewarding their shareholders handsomely.

The for-profit American health insurance industry — and many of those not-for-profit lookalikes — is a poster child for the triumph of poorly-regulated and misplaced capitalism in a historically fundamental service profession.

Why does the United States need health insurance companies at all?

The answer is we don’t, at least not in their current forms. They cause more harm than they do good.
There must be better way to use our national and personal resources more effectively and efficiently to keep our people healthy and manage their illnesses when they get sick.

Let’s create it.

Having abolished health insurance companies in this fantasy, how would you start over?

I would grandfather in Medicare, but insist that it be greatly improved before implementation.
I would expect most ambulatory care to be paid out of pocket up to a means-based annual deductible.

And I would insist on means-based “catastrophic coverage” for ALL Americans.

I would expect the government to pay for preventive services for all that had been proven to be safe and effective, considering them to be public health.

I would take the profit motive out of the health insurance market.

What do you think about these ideas? What would you do?

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally Posted by JDG 66

-Numbers everyone else is aware of. Including Sebelius.

yea, sure, keep telling yourself that.

Originally Posted by JDG 66

--How disingenuous. Even PW knows that the costs were backloaded so it wouldn't show up in the "10 years out" graphs.

Now tell me then where will those future costs show up exactly?

Krugman lays out a rather calm way of looking at the ACA -

http://krugman.blogs.nytimes.com/201...reme-thoughts/

...We know, or I think we know, that a single-payer system — in which the government collects taxes, and uses the revenue to provide health insurance — would be constitutional. I mean, I don’t think the court is about to strike down Medicare.

Well, ObamaRomneycare is basically a somewhat klutzy way of simulating single-payer. Instead of collecting enough revenue to pay for universal health insurance, it requires that those who can afford it buy the insurance directly, then provides aid — financed with taxes — to those who can’t. The end result is much the same as if the government collected taxes from those under the mandate and bought insurance for them.

Yes, the system is surely less efficient than single-payer, both because it’s more complex and because it introduces another layer of middlemen. That’s what happens when you have to make political compromises. But it is in no sense more interventionist, more tyrannical, than Medicare; it’s just a different way of achieving the same thing.

Take that simple way of looking at it and think about the attacks on it.

From the Left is the notion of undeserved enrichment of the insurers. That comes from Krugman's "klutzy way of simulating single payer." It is an inefficiency argument ("more complex... and introduces another layer of middlemen") - an argument that usually comes from the Right.

However, what the Right's attack focus on is that the ACA is essentially, as Krugman notes, a subsidized single payer for those who cannot otherwise afford insurance - that raises the Right's concern of "no free lunch" for anyone from the government.

There are two aspects not covered here -

One is the individual mandate riling up the Libertarian bent of the Right. It does no good with them to point out when you slice-and-dice the various groups out (employer-insured, group insured, kids up to 26 on their parents plans, those desperately wanting the subsidized insurance), you are left with a relatively small segment of folks where the mandate/penalty could actually come about. No, this is America, and we only eat Freedom Fries here! Make just a realtively few pay a penalty for not getting insurance and the next thing you know the Black Hawk helicopters will be landing to pry our guns from our cold dead hands!

The second thing missing here is the misdirection of blaming any rise in health care costs on the ACA. It is counterfactual to assert that costs would be much higher without ACA and therefore much more difficult to provide a convincing argument - particularly one that would fit on a bumper sticker and be understandable by the pea-brains that make up most of the Right's base.

This basically covers all the arguments against, what Krugman calmly states, a klutzy way of doing single payer. The arguments are all pretty silly from a logical standpoint, but in reality are literally deadly to millions of people if played out.

What a country!

This may seem unbelievable but it's very true.

Wealthy Families Skip Waiting Rooms With Concierge Medical Plans

Doctors on-call day or night.

Medical care while traveling outside the U.S. Emergency-room grade equipment, modeled on gear used in the White House, installed in the client’s home.

Well-heeled executives and their families increasingly are paying tens of thousands of dollars a year for high-end medical services that aren’t covered by insurance.Such white-glove attention, known as concierge care, doesn’t come cheap. It may cost as much as $30,000 a year out- of-pocket for unfettered access to physicians who limit the number of patients they take on. An emergency room in one’s home designed to handle a family’s ailments can cost as much as $1 million.

“Wealthy people want to have a little exclusivity and want better service than they can get at their normal health-care facility, and they’re willing to pay for it,” said Rick Flynn, principal and head of the Family Office Group with Rothstein Kass, a Roseland, New Jersey-based accounting and consulting firm.

More: http://www.bloomberg.com/news/2012-0...cal-plans.html

Ezra Klein breaks it down -

http://www.washingtonpost.com/blogs/...rss_ezra-klein

....What it is: The individual mandate is a requirement that all individuals who can afford health-care insurance purchase some minimally comprehensive policy. For the purposes of the law, “individuals who can afford health-care insurance” is defined as people for whom the minimum policy will not cost more than 8 percent of their monthly income, and who make more than the poverty line. So if coverage would cost more than 8 percent of your monthly income, or you’re making very little, you’re not on the hook to buy insurance (and, because of other provisions in the law, you’re getting subsidies that make insurance virtually costless anyway).

How it works: In 2016, the first year the penalty is fully in place, those who don’t carry insurance will be assessed a $695 fine, per year, or 2.5 percent of their income, whichever is higher.

In terms of logistics, the Treasury Department handles the mandate. The penalty gets assessed as a federal tax liability, on the income tax returns that Americans already file yearly. Starting in 2014, federal tax returns will include a new form where Americans will detail their source of health insurance. If they don’t carry coverage—and fall within the mandate— then they’ll get hit with the penalty.

Oh, it sounds so evil; it sends a shiver up my spine!

But let's see who may actually be impacted -

Who it impacts: The Urban Institute estimates that if the mandate were enacted today, it would affect about 26 million Americans who are currently uninsured. About a third of those affected, however, would qualify for Medicaid coverage at little to no cost. Another third would qualify for public subsidies to purchase insurance. That leaves “about 7.3 million people—2 percent of the total population (3 percent of the population under age 65)— who are not offered any financial assistance under the ACA and will be subject to penalties if they do not obtain coverage.”

Well, it looks like the big brewhaha is over 2% of the population. How many Faux News viewer do you think are aware of that? 0.2%? 0.002% 0.0000000000000000000002%?

But what about that 2%; do you think any of them fall into these categories -

Who is exempt: About 24 million Americans would be exempt from the requirement to carry insurance, according to a Kaiser Family Foundation analysis. That includes those who can’t afford insurance, as well as members of certain religious groups, Native American tribes, undocumented immigrants (who aren’t eligible for subsidies under the law), those in jail and people whose incomes are so low that they don’t have to file taxes (currently $9,500 for individuals and $19,000 for married couples).

Turns out, several of these groups identified by Kaiser were not in the UI estimates so the number actually impacted is less than their 2%.

One can also make different assumptions of how many of these people are not so stupid as to avoid having insurance (and before you get up in my face about affordability and other mitigating factors, just look at those exemptions and subsidies again).

But here's the real kicker -

What happens if you don’t buy insurance and you don’t pay the penalty? Well, not much. The law specifically says that no criminal action or liens can be imposed on people who don’t pay the fine. If this actually leads to a world in which large numbers of people don’t buy insurance and tell the IRS to stuff it, you could see that change. But for now, the penalties are low and the enforcement is non-existent.

Yes people, we are holding up getting over 95% of our population covered by health insurance, lowering average premiums 10-20%, doing away with pre-existing denial, etc. etc because probable less than 1% of our population is too stupid to get insurance and don't want to pay a penalty that no one is going to make them pay.

Idiot America at its finest.

And what would be wickedly funny, except for the sickness and deaths of millions at stake, is where the mandate came from -

Where the policy came from: The individual insurance mandate was the brainchild of conservative economists, as a way to address “free-riding” in healthcare without going all the way to a single-payer system. Our colleague N.C. Aizenman picks up the story:

The tale begins in the late 1980s, when conservative economists such as Mark Pauly, a professor at the University of Pennsylvania’s Wharton School of business, were searching for ways to counter liberal calls for government-sponsored universal health coverage. Pauly then proposed a mandate requiring everyone to obtain this minimum coverage, thus guarding against free-riders...Heath policy analysts at the conservative Heritage Foundation, led by Stuart Butler, picked up the idea and began developing it for lawmakers in Congress.

The Heritage Foundation worked with then-Gov. Mitt Romney (R) to pass Massachusetts’ 2006 health reform law, which required all Bay State citizens to purchase coverage. You can read Wonkblog’s interview with Pauly here.

Imagine, it came from Idiot America!

You can't make this shrt up.

Well, obviously, the members of the SCOTUS are very very smart people (although several are very very evil, of course )

Didn't take long for them to go for the Mandate's jugular - "the limiting principal" (look it up).

Doesn't look good.

I'm thinking the mandate goes down, but the SCOTUS determines it is separable.

That, of course, would leave the biggest mess possible for an unworkable govt to sort out.

We be still early 4T.

Here's a perspective from a doctors group. I'm sure there is a middle ground here in regards to PW's post and this one.

The third from the last paragraph sums it up for those of us who have been working for single payer for what seems like forever.

Health law, constitutional or no, fails to remedy ailment: doctors group

Leaders of Physicians for a National Health Program, an organization of
18,000 doctors who advocate for single-payer national health insurance,
released the following statement today:

Regardless of whether the Supreme Court upholds or overturns the Affordable
Care Act in whole or in part, the unfortunate reality is that federal
health law of 2010 will not work: (1) it will not achieve universal
coverage, as it leaves at least 26 million uninsured, (2) it will not make
health care affordable to Americans with insurance, because gaps in their
policies will leave them vulnerable to bankruptcy in the event of major
illness, and (3) it will not control costs.

Why? Because the ACA perpetuates a dominant role for the private insurance
industry. That industry siphons off hundreds of billions of health care
dollars annually for overhead, profit and the paperwork it demands from
doctors and hospitals; it denies care in order to increase insurers? bottom
line; and it obstructs any serious effort to control costs.

In contrast, a single-payer, improved-Medicare-for-all system would achieve
all three goals ? truly universal, comprehensive coverage; health security
for our patients and their families; and cost control. It would do so by
replacing private insurers with a single, nonprofit agency like Medicare
that pays all medical bills, streamlines administration, and reins in costs
for medications and other supplies through its bargaining clout.

The major provisions of the ACA do not go into effect until 2014. Although
we will be counseled to ?wait and see? how this reform plays out, we?ve
seen how comparable reforms in Massachusetts and other states have worked
over the past few decades. They have invariably failed our patients,
foundering on the shoals of skyrocketing costs ? even as they have profited
the big private insurers and Big Pharma.

The Supreme Court?s ruling is not expected until June. Regardless of how it
rules, we cannot wait for an effective remedy to our health care woes any
longer, nor can our patients. The stakes are too high.

We pledge to continue our work for the only equitable, financially
responsible and humane cure for our health care mess: single-payer national
health insurance, an expanded and improved Medicare for all.

http://www.pnhp.org/news/2012/march/...-doctors-group

Originally Posted by playwrite

Well, obviously, the members of the SCOTUS are very very smart people (although several are very very evil, of course )

Didn't take long for them to go for the Mandate's jugular - "the limiting principal" (look it up).

Doesn't look good.

I'm thinking the mandate goes down, but the SCOTUS determines it is separable.

That, of course, would leave the biggest mess possible for an unworkable govt to sort out.

We be still early 4T.

Medicare for all is obviously the answer, but won't be enacted until at least the 2020s. That will at least be a time when people are willing to take action. It remains to be seen of course whether the right actions will be taken.

I think there is some kind of limiting principle, though I'm not sure it will fly. The idea is that health insurance is something everyone will need, and not buying it now is letting others pick up the tab. I'm not sure what other products come in that category. They could for example mandate that every home owner buy a solar panel, because it's needed for the health of the planet. But that doesn't say that it's something that I will buy, or will need to buy. If I don't buy it, will that mean others have to buy it and install it on my home for me? That would be a lot more intrusive than having to buy health insurance, and just paying a fine for not installing a panel does nothing to save energy or CO2 emissions.

Of course, the mandate is really a tax. We already have a mandate to buy health insurance for our old age, for example; though the government acts as a single-payer intermediary to pay the doctors for their service. We pay social security taxes too. The ACA penalty is also a tax of this kind. If the conservatives justices ignore that, then they really are mere captives of the conservative movement.

I imagine if the mandate falls, there will be more pressure for budget cuts to the other provisions, on the grounds that the debt will skyrocket. The consequences will be less coverage and regulation, or more debt.

Originally Posted by Eric the Green

Medicare for all is obviously the answer, but won't be enacted until at least the 2020s. That will at least be a time when people are willing to take action. It remains to be seen of course whether the right actions will be taken.

This is obviously a well duh thing, for sure.

1. Change the eligibility age from 65 to 0.
2. Enact a VAT to pay for it. (No free lunches, sorry).
3. Delete the current payroll tax. Would this not lessen the burden of hiring a bit?
4. We can then also delete Medicare and every other current government health care programs. - Simplicity has a beauty all its own.
5. If folks still want some sort of "Medigap" plan to cover boob jobs, face lifts, penis enhancements, etc. OK by me. However for most of normal folks, private insurance would go away.
6. Health care (not health insurance) is more of public good, IMHO, say like roads. If you need a particular road, you need it. If you need , say cancer treatment, you need it. IOW, it's not a "want", like candy. I think "health insurance" is a useless meme that serves the healthcare industry more than anything else. I think that is the crux of your second paragraph about assorted ideas surrounding "health insurance".
7. I don't think the Medicare bill had 2000+ pages of cruft. I think my ideas would actually reduce existing cruft (laws on the books) we already have.

I think there is some kind of limiting principle, though I'm not sure it will fly. The idea is that health insurance is something everyone will need, and not buying it now is letting others pick up the tab. I'm not sure what other products come in that category. They could for example mandate that every home owner buy a solar panel, because it's needed for the health of the planet. But that doesn't say that it's something that I will buy, or will need to buy. If I don't buy it, will that mean others have to buy it and install it on my home for me? That would be a lot more intrusive than having to buy health insurance, and just paying a fine for not installing a panel does nothing to save energy or CO2 emissions.

The above is the paragraph I was referring to. To me it highlights 2 points.
a. The utter lack of discourse about private/public goods.
b. The idiotic "mandate" issue. Of course if the healthcare plan were paid for by some sort of tax, like Medicare, we'd all be spared all of this drama involving the SCOTUS.

Of course, the mandate is really a tax. We already have a mandate to buy health insurance for our old age, for example; though the government acts as a single-payer intermediary to pay the doctors for their service. We pay social security taxes too. The ACA penalty is also a tax of this kind. If the conservatives justices ignore that, then they really are mere captives of the conservative movement.

... item b on my reply above.

I imagine if the mandate falls, there will be more pressure for budget cuts to the other provisions, on the grounds that the debt will skyrocket. The consequences will be less coverage and regulation, or more debt.

Or to be more blunt. Healthcare clusterfuck. Sorry, Kunstler made me do it.

Originally Posted by playwrite

Well, obviously, the members of the SCOTUS are very very smart people (although several are very very evil, of course )

Didn't take long for them to go for the Mandate's jugular - "the limiting principal" (look it up).

Doesn't look good.

I'm thinking the mandate goes down, but the SCOTUS determines it is separable.

That, of course, would leave the biggest mess possible for an unworkable govt to sort out.

We be still early 4T.

Like you, I got this news today, and it has really set me thinking.

Barack Obama still has serious credibility problems with the American people. If his signature achievement is struck down, as it seems now to be at least 50% likely, I am afraid that he will not be able to recover. The Republicans, in addition, will cry, see? The Supreme Court proved we were right! He was an evil dictator trying to take away our freedom! I suspect it would cost him the election.

Some facts that might give us pause.

• The annual inflation rate of health insurance premiums outpaced US household earnings, which stagnated from 2008 to 2011 and included an absolute reduction in average household income from $50,300 in 2008 to $49,800 in 2009.
• From 2000 to 2009, the average annual increase in insurance premiums was 8.0%; household incomes rose an average of 2.1%.
• If health insurance premiums and national wages continue to grow at recent rates and the US health system makes no major structural changes, the average cost of a family health insurance premium will equal 50% of the household income by the year 2021…
• and surpass the average household income by the year 2033 (pictured).
• If out-of-pocket costs are added to the premium costs, the 50% threshold is crossed by 2018 and exceeds household income by 2030.

http://www.smartplanet.com/blog/reth...e-by-2033/8319

Originally Posted by Deb C

Some facts that might give us pause.

• The annual inflation rate of health insurance premiums outpaced US household earnings, which stagnated from 2008 to 2011 and included an absolute reduction in average household income from $50,300 in 2008 to $49,800 in 2009.
• From 2000 to 2009, the average annual increase in insurance premiums was 8.0%; household incomes rose an average of 2.1%.
• If health insurance premiums and national wages continue to grow at recent rates and the US health system makes no major structural changes, the average cost of a family health insurance premium will equal 50% of the household income by the year 2021…
• and surpass the average household income by the year 2033 (pictured).
• If out-of-pocket costs are added to the premium costs, the 50% threshold is crossed by 2018 and exceeds household income by 2030.

http://www.smartplanet.com/blog/reth...e-by-2033/8319

Listening to NPR this evening on the subject -- amazing how totally health care was referred to as a "product" and sick people referred to as "consuming" health care. As if they were gobbling down the chocolate layer cake meant for the entire family?

If nobody sees what's wrong in referring to people "consuming" health care, I will back off, put on my "last leaf" last century garb, and totter down the street with an unfashionably tall, teased, and ratted wig on crooked.

Originally Posted by The Grey Badger

Listening to NPR this evening on the subject -- amazing how totally health care was referred to as a "product" and sick people referred to as "consuming" health care. As if they were gobbling down the chocolate layer cake meant for the entire family?

If nobody sees what's wrong in referring to people "consuming" health care, I will back off, put on my "last leaf" last century garb, and totter down the street with an unfashionably tall, teased, and ratted wig on crooked.

You are right on the mark. The NPR broadcast gave you a clear view of the insurance industry.

Years ago the citizens had to *buy* fire protection. Those who couldn't afford it just had to watch their homes burn down. Now we have to *buy* health insurance coverage. And we all know what happens to those who can't afford that product or the ever inflating co-pays.

Originally Posted by The Grey Badger

Listening to NPR this evening on the subject -- amazing how totally health care was referred to as a "product" and sick people referred to as "consuming" health care. As if they were gobbling down the chocolate layer cake meant for the entire family?

If nobody sees what's wrong in referring to people "consuming" health care, I will back off, put on my "last leaf" last century garb, and totter down the street with an unfashionably tall, teased, and ratted wig on crooked.

I made this point some time ago. Until we start regarding health care like fire protection, police protection, or national defense, we will not get out of this mess. It's something we all need and thus, like those other things, something we all should pay for. And it should not generate profits.

I will be amazed if I live to see this come to pass in the USA though. Very sad.

Originally Posted by Ragnarök_62

This is obviously a well duh thing, for sure.

1. Change the eligibility age from 65 to 0.
2. Enact a VAT to pay for it. (No free lunches, sorry).
3. Delete the current payroll tax. Would this not lessen the burden of hiring a bit?
4. We can then also delete Medicare and every other current government health care programs. - Simplicity has a beauty all its own.
5. If folks still want some sort of "Medigap" plan to cover boob jobs, face lifts, penis enhancements, etc. OK by me. However for most of normal folks, private insurance would go away.
6. Health care (not health insurance) is more of public good, IMHO, say like roads. If you need a particular road, you need it. If you need , say cancer treatment, you need it. IOW, it's not a "want", like candy. I think "health insurance" is a useless meme that serves the healthcare industry more than anything else. I think that is the crux of your second paragraph about assorted ideas surrounding "health insurance".
7. I don't think the Medicare bill had 2000+ pages of cruft. I think my ideas would actually reduce existing cruft (laws on the books) we already have.



The above is the paragraph I was referring to. To me it highlights 2 points.
a. The utter lack of discourse about private/public goods.
b. The idiotic "mandate" issue. Of course if the healthcare plan were paid for by some sort of tax, like Medicare, we'd all be spared all of this drama involving the SCOTUS.


... item b on my reply above.



Or to be more blunt. Healthcare clusterfuck. Sorry, Kunstler made me do it.

Discourse on public/private goods? Health care as a public good??
Rags, have you been hitting on the Galbraith bottle?

The massive stream is toward "profitizing" the public goods. Swimming against that with already established public goods not only like SS, Medicare but running prisons or even the military is hard enough, what are the chances of taking something like health care that, outside of Medicare, is already fully profitized? In today's world, it's a pipe dream.

Yea, there was some counter-trend to the profitizing with student loans and mortgages, but it took a financial meltdown and even those are already eroding against the relentless profitizing current.

One can either view the ACA as all that is possible in our profitizing world (and even then likely to fail against the current, i.e. the current SCOTUS process) or, one can see the ACA as something that needs to fail so that we can get to abject poverty quicker and that, in turn, will lead to a revolt.

I can swing both ways on it, but how I swing on it has no bearing to how it will unfold. We're powerless.

There really is no question that the Federal govt, as the money issuer, can afford Medicare-for-all. It would only be a question of such deficit spending causing inflation, and if it did, then raising taxes and/or interest rates to deal with it. MMT would say that taxes destroy spending on private sector goods in order to make room for public sector goods while maintaining price stability. If prices are stable, there is no reason to tax anybody for federal keystrokes on a computer to add funds to bank accounts that pay for health care.

It is our collective emotional, not intellectual, ability to grasp that simplicity that keeps us at the mercy of vampire squids and their sock puppet political clowns.

Try this experiment. Just to humor me: assume that the federal deficit was something that was not only far from a problem but actually a necessary means to maintain a growing economy. Imagine that on occassions where the economy is booming and aggregate demand was reaching economic capacity to the point that price increases might become a concern. Imagine that basically technocrats would near-automatically raise taxes and/or interest rates (remember everyone is now rolling in money) to sufficiently manage inflation.

Now take that assumption and listen to any GOP position (other than the culture wars, although you'll find aspects there as well, e.g."why should I pay for someone's birth control pills?"). That assumption devastates EVERY position the GOP espouses. Soon the question would be why do we need the Right as it is currently constituted?

Given how that assumption would change the world into a much better place, wouldn't it be worth exploring?

Originally Posted by The Grey Badger

Listening to NPR this evening on the subject -- amazing how totally health care was referred to as a "product" and sick people referred to as "consuming" health care. As if they were gobbling down the chocolate layer cake meant for the entire family?

If nobody sees what's wrong in referring to people "consuming" health care, I will back off, put on my "last leaf" last century garb, and totter down the street with an unfashionably tall, teased, and ratted wig on crooked.

Very well said, and very appreciated.

Originally Posted by KaiserD2

Like you, I got this news today, and it has really set me thinking.

Barack Obama still has serious credibility problems with the American people. If his signature achievement is struck down, as it seems now to be at least 50% likely, I am afraid that he will not be able to recover. The Republicans, in addition, will cry, see? The Supreme Court proved we were right! He was an evil dictator trying to take away our freedom! I suspect it would cost him the election.

Maybe in the long run (and yes, I know what Keynes said about that), it would best if they both go down in flames.

A clean sweep by the GOP in November might be enough to keep the Bush tax cuts from expiring, but they will carry through on the debt ceiling agreement spending reductions and more. That alone would be enough to tip us back into a severe economic contraction exacerbated by Europe being in recession and the BRICs slowing considerably. A remaining recalcitrant Dem in the Senate could kill the Bush tax cuts - that would likely throw us into an economic depression. Add to that the impossible health care costs to an increasingly large share of the population that Debs points out, and it is lights out again.

There is absolutely nothing in the GOP traditional, let alone current wingnut, bag of tricks that can pull us out of what is coming; I really don't think they understand how what the consider success since Reagan was absolutely dependent on unsustainable household debt and that can never again for decades be a route out of what they have created. And Romney attempting to pull a "only Nixon could go to China" turnaround would require him to not only outdo Obama but FDR on the Keynesian front - even if he does eventually, it will be far far too late.

I will still be going all out for Obama and hope that he wins. There's a slight chance he will "be more flexible" not only with the Russians but with real fiscal support in his second term. However, if he should go down with the ACA that would help relieve that nagging concern of mine of having the Dems in power when the shit hits the fan next year - it will taint the Party in power for at least as long as Hoover was tainted - i.e. forever.

Originally Posted by KaiserD2

Like you, I got this news today, and it has really set me thinking.

Barack Obama still has serious credibility problems with the American people. If his signature achievement is struck down, as it seems now to be at least 50% likely, I am afraid that he will not be able to recover. The Republicans, in addition, will cry, see? The Supreme Court proved we were right! He was an evil dictator trying to take away our freedom! I suspect it would cost him the election.

David, I know I am hounding you in some ways. But in your world Barack Obama has serious credibility problems. In mine. those problems are not serious in the next voting cycle.

Perhaps because I live in cynical Chicago world of hard-ball politics. But among most people I know, this election is a no brainer. Your level of disappointment makes me wonder if you haven't spent too much time in history as it is written and interpreted rather than history as it is lived.

With deep respect, a liberal Boomer who was 24 when Reagan was elected, who has long thought you early Boomers have had the luxery of idealism.

Originally Posted by playwrite

if he should go down with the ACA that would help relieve that nagging concern of mine of having the Dems in power when the shit hits the fan next year - it will taint the Party in power for at least as long as Hoover was tainted - i.e. forever.

I have been looking at my "crystal ball" a bit, and I really think things will be fine next year. I have yet to see any convincing indication of another severe crash, even though we have done next to nothing to avoid one. So, maybe the gods are looking out for us.

Things around the year 2020 could be dicey though. There is nothing worse in our future than what I foresaw and experienced in 2008-2010, but 2020 does look like a rough transition point. Zero years and years surrounding them are usually at least a bit unstable. This one looks more unstable than usual. If Republicans win in 2016, we can expect both economic and foreign problems to mount through the term, sort-of like a Republican Carter.