There not going to be a real anarchy in a world in which civilization has not collapsed.
Even the end of Nazism in Germany did not lead to anarchy. I recall reading one time that at the beginning of the occupation of Germany in 1945 the occupying powers agreed to govern Germany based on the laws that had been in effect there on January 29, 1933--the day before Hitler came into power. That way no Nazi laws could get grandfathered into postwar German civil/political life.
Of course all of the occupying powers, especially the Soviets, quickly modified that law code in their zone of occupation to fit their own ends but the point remains, even the end of a horrid system like Nazism did not lead to anarchy.

Here's where I learned that the IRS is limited in what they can do to collect ACA penalties.

Originally Posted by herbal tee

There not going to be a real anarchy in a world in which civilization has not collapsed.

That's precisely the point of contention between myself and anarchists. It's not that anarchy is literally impossible. Our ancestors lived in stateless societies for the vast majority of time that humans have been in existence. Anarchy is definitely possible -- but it's incompatible with civilization, that is, with life in cities. All anarchic societies of the past were pre-civilized.

Anarchists who claim we can do without a state today face the burden of either:

1) Showing a civilized anarchy in history, which is impossible as no civilized anarchy has ever existed; or
2) Presenting a theoretical basis for believing that civilized anarchy is possible.

So far, I've never found an anarchist who has met this burden.

Originally Posted by Brian Rush

It is an interesting question what the government could and would do if, like myself, a person has no tax refund to garnish. Would a prison sentence for tax evasion ensue if one refused to pay the tax, as you are implying? Bear in mind that most tax evaders are not charged with a criminal offense:

http://taxattorneydaily.com/topics/c...tax-crimes.php

"It is a crime to cheat on your taxes. In a recent year, however, fewer than 2,000 people were convicted of tax crimes —0.0022% of all taxpayers. This number is astonishingly small, taking into account that the IRS estimates that 15.5% of us are not complying with the tax laws in some way or another. . . .

"Tax crimes are most likely to be first spotted during an audit. If you are caught in a tax lie by an auditor, she can either slap you with a penalty or refer your case to the IRS’s criminal investigation division (CID). In the vast majority of cases, the auditor won’t call in the CID."

No criminal penalties are imposed in the ACA legislation for failure to pay the tax. If refusal to pay the tax comes under the rubric of tax evasion and so is covered by existing criminal penalties, you are still highly unlikely to go to prison for failure to pay the tax, unless the IRS makes a special policy just for this tax. A lawsuit and attachment of assets is much more probable.

One of the better explanations here, from NPR interview -

http://www.npr.org/2012/06/29/156005...ll-be-enforced

BLOCK: The penalties are going to be administered through the IRS. How is that going to work?

JOST: Well, you'll just file your return at the end of the year and there'll be a box saying, did you have qualifying health insurance? And, if you did, then you'll just breeze on from there. If you didn't, then you'll be asked to add the penalty onto your taxes.

BLOCK: And, if you were to say, I'm not going to pay the penalty, what happens? What's the enforcement mechanism?

JOST: Well, if you were expecting a refund, they will deduct it from your refund. If you were not expecting a refund, then there's not much they can do to you. The statute prohibits them from imposing criminal penalties. It prohibits them from levying against your property. It prohibits them from putting a lien on your property. It would just remain an outstanding obligation to the IRS.

I guess if one wants to avoid the insurance and the penalty, just work hard to avoid having a tax refund. At some point, people will grow tired of the game, part of the growing up process. Also, the IRS might add their interest on the unpaid taxes, but contrary to the inflationisites, like Justin, that's not going to be much of a big deal for some time to come. As I laid out earlier, I think "the catch" will come to those uninsured visiting the emergency room and expecting a "special lower rate" for services provided.

Originally Posted by Justin '77

Oh wow. So it's not just in the dank dungeons of the Soviet "medical" system where one encounters prices far less than the American one would have you believe are necessary. How do those poor wop doctors survive on such starvation-wages??

Hold on a minute. You started with a diatribe about NICUs. Now, you want to talk about basic GP care. Let's agree that NICUs are expensive in the US, unless you think that staff should work for miniimum wage or something. GP care, on the other hand, is totally different. It coudl be a serivce, much like public safety, since it is a service accessed by many, and the services are more or less straight forward. We aren't doing heart-bypass surgery in an Internist's office, after all. That entire concept may need to be rejiggered - into a clinic model, perhaps.

Originally Posted by The Rani

Heart surgeries are a lot more straightforward than what most GPs have to deal with in the course of an average day.
\

And GPs deal with the patients a whole lot longer.

Originally Posted by The Rani

I've been thinking about it, and I've decided that the best way to spend my own personal healthcare dollars is by buying organic/local fruits and vegetables.
That's worth a lot more to me than a cardiac bypass, and the outcome is a lot better too.

Good idea, but we still need insurance to cover genetic chronic illness, accidents or being the innocent victim of gun violence, rape, muggings and other sorts of maladies that are beyond our control.

Originally Posted by The Rani

Here we go again with the royal "we need."
Guess what you don't speak for me.

Not attempting to speak for you, just throwing in a bit of reality. There really are *needs* in this world.

Originally Posted by Marx & Lennon

Hold on a minute. You started with a diatribe about NICUs. Now, you want to talk about basic GP care. Let's agree that NICUs are expensive in the US, unless you think that staff should work for miniimum wage or something. GP care, on the other hand, is totally different. It coudl be a serivce, much like public safety, since it is a service accessed by many, and the services are more or less straight forward. We aren't doing heart-bypass surgery in an Internist's office, after all. That entire concept may need to be rejiggered - into a clinic model, perhaps.

The two are parts of the same system.

We can talk GP, too, if you want. Sixty bucks total cost for a housecall on the weekend. A hundred if the pediatrician brought a neurologist with her to do their voodoo together. Plus cost of injections, needles, and other one-use stuff (another fifteen-twenty dollars). And any lab fees (I honestly can't remember or find right off those, but they were on the same order).

NICU I use as just an example where the out-of-handedness of pricing in the US is most blatantly obvious. But it indeed permeates the whole structure, top to bottom. As you would expect, when the function of the system is not to provide medical services to people but to ensure the cushy lifestyles of some small group at the expense of everyone else.

Originally Posted by Deb C

Good idea, but we still need insurance to cover genetic chronic illness, accidents or being the innocent victim of gun violence, rape, muggings and other sorts of maladies that are beyond our control.

No, *we* don't. A stay in intensive care is pretty much a definition of 'beyond our control'. But insurance isn't what provides it, nor is it inaccessible to the run-of-the-mill unfortunate without insurance. What makes it inaccessible is the system (one system in particular, it seems perhaps) itself. Insurance doesn't change that.

Originally Posted by Justin '77

No, *we* don't. A stay in intensive care is pretty much a definition of 'beyond our control'. But insurance isn't what provides it, nor is it inaccessible to the run-of-the-mill unfortunate without insurance. What makes it inaccessible is the system (one system in particular, it seems perhaps) itself. Insurance doesn't change that.

In today's dysfunctional system, we do need insurance unless we want to go bankrupt if we meet with an unfortunate accident or illness. I am all for single payer. But our country doesn't see that as a need. Some would rather feed the insurance beast.

Originally Posted by The Rani

Here we go again with the royal "we need."
Guess what you don't speak for me.

Okay. You don't need insurance to cover those events. Neither do Warren Buffett (too rich) nor Superman (invulnerable to them.) But, since my brain isn't working very well this afternoon, could you please suggest "what do the simple folks do?" Though one quick and easy answer came immediately to mind, courtesy of Charles Dickens.

Originally Posted by Deb C

Not attempting to speak for you, just throwing in a bit of reality. There really are *needs* in this world.

Debs, there really is not much use with this crowd. They're not really interested in discussing reality. We're getting everything from: the US will become Russia or India; eat organic and you will never get sick, have an accident or die; holding out on insurance coverage even if it means the rape cages; and of course the revolution is just around the corner - Annie get your gun.

Compare that intellectual rigor to let's say the current discussions taking place regarding just the issue of whether a state should set up it's own exchange or let the feds do it. Consider just this alone -

The value of establishing a state-based Exchange includes:

• Maintaining regulatory authority over a large share of the commercial health insurance market;
• Mitigating risk selection that may result from different rating and underwriting rules for insurance policies sold inside and outside the Exchange;
• Enabling greater coordination of benefits and eligibility rules across health coverage programs (e.g., Medicaid, CHIP and policies sold through the Exchange); and
• Promoting state health reform strategies and priorities through the Exchange.

On the other hand, there are risks for states that choose to establish their own Exchange, including:
• The challenge of creating a new program, particularly at a time when many states are struggling to balance their budgets;
• The requirement that the Exchange be self-sustaining by 2015; and
• The tension that will be created between keeping administrative fees low while satisfying the demands for high quality customer service.

I'm pretty sure they wouldn't know a CHIP if it hit them on the head. One might see the advantage for the intellectually lazy to wallow in magic pony land



Although it might be interesting to assign the various players to their particular steed.

Originally Posted by playwrite

Ah, I don't think I said any of those things.

Yeah, I've been trying to keep up with the thread despite lacking time to respond, but this is basically what you've been saying here for the last few pages.

Other that moving to lovely Mother Russia, just exactly how do you propose changing the situation we have now to anything close to what you see as better?

Please, amuse me.

Constitutional convention? Too soon.

Actually, the plan of leaving America sounds like the most practical solution on the individual level.

Originally Posted by JohnMc82

Actually, the plan of leaving America sounds like the most practical solution on the individual level.

That is my niece's plan -- she's interviewing for jobs Down Under. Her Dad is from Oz and so she has dual citizenship.

Until today, I thought she was disgusted with American politics (she's progressive), but I've since found out that she has a romantic interest over there...

Originally Posted by The Rani

Heart surgeries are a lot more straightforward than what most GPs have to deal with in the course of an average day.
It really is interesting to see what people find "valuable," and what they don't. The propaganda seems to be working.

There is some truth to this, but it's still not the level of difficulty so much as the level of knowledge. We, as a society, are unwilling to receive less than what is necessary, but fully willing to receive too much ... even if it's too much of the wrong thing. That we often have no idea what works and what doesn't says volumes about the US medical system.

Originally Posted by The Rani

You replied to my post about my own choices by saying "we need."
Now it's about "reality."
Sorry, but I don't buy your version of reality.

I'll use "we" as a substitute for society in general. Your attitude is similar to that of parents who have decided that it's OK not to immunize their children. Herd imunity only works until the number of susceptable members of the herd rises above a certain level, then the whole thing crashes.

We don't need to experience a pandemic to know that "we" need to act in our universal interest. I find your attitude baffling for a layperson, and stunning for a medical professional.

Originally Posted by Justin '77

The two are parts of the same system.

We can talk GP, too, if you want. Sixty bucks total cost for a housecall on the weekend. A hundred if the pediatrician brought a neurologist with her to do their voodoo together. Plus cost of injections, needles, and other one-use stuff (another fifteen-twenty dollars). And any lab fees (I honestly can't remember or find right off those, but they were on the same order).

NICU I use as just an example where the out-of-handedness of pricing in the US is most blatantly obvious. But it indeed permeates the whole structure, top to bottom. As you would expect, when the function of the system is not to provide medical services to people but to ensure the cushy lifestyles of some small group at the expense of everyone else.

Hey, the whole thing can cost nothing directly, if it is modeled on the public safety system. Does the dispatcher ask for your insurance info when you call to report a fire or a burglery? Of course not. They just respond, and the police or firefighters do their job. This is a socialist solution to the problem, and one I prefer. The UK operates on that model. Everything flows to the tax system, where you are then free to whine about how high your taxes have become.

There is another alterntive: compensate healthcare providers on a scale just above minimum wage. I'm sure the standard of care will be high. That, by the way, is how you achieve your directly financed $60 housecall. Do a little math. A housecall requires travel to and from and the necessary time on site. This also requires a vehicle and at least one practitioner, as well as medical equipement and materials (we'll ignore those for now). Of course, there is the queueing problem, where a highly employed staff of providers is either heavily loaded during busiy periods and often idle otherwise, or heavily loaded at all times, and backed-up in busy periods. This is a combination of policy setting and an Erlang C problem. Feel free to set policy appropriately.

Now, play around with the numbers, and determine what a provider can be paid for supporting $60 housecalls. For simplicity, assume 40% of the fee ($24) translates into provider pay. All you need to determine is, on average, how many provider hours equal one housecall. I can't see it being as little as one, and it can't be much more than two, or you won't have a staff. Now having made your operational choices, who provides those services: MD/DO, NP/PA, RN, LPN, or someone with litlle training at all?

I hope you can see that the qualifications have to be limited if the service is even marginal ... or vice versa. In no case would I expect to receive care from a US-trained MDs or DOs, unless they are serving in a public health role. Even then, they can't do it unless their college (especially med school) loans are forgiven.

In short, your model doesn't translate.

Originally Posted by The Rani

Now why on Earth do you assume that some folks are so simple that they Need others to tell them what to do?
I speak for myself and only myself. It's obvious that some prefer to believe that Healthcare Insurance protects them from all ills, and that's their choice too.

You assume that your right to say no has no impact on anyone elses's right to say yes. This is how we (the universal "we") got into the mess we're in today.

There is a free-choice option that would work, though. If affordable insurance is available to all, but not required by anyone, then removing the mandatory care requirment would mean that you only get care - including emergency care - if you have insurance. BTW, that includes auto accidents .. in fact all accidents regadless of cause or liablity.

Is that to your liking?

$60 for an hour and a half's time (including travel).
minus call it $20 for the travel itself
give over 25% for overhead (better to overestimate)
Leaves 20 bucks an hour to the pediatrician herself.
Bearing in mind that cost of living in that city is such that a decent life can be lived and family raised on 2k-3k a month, 20 bucks an hour is a pretty decent take for a trained professional ('pediatrician' means several years post-grad studies). Even if you need for some reason twice as much pay to cover a different CoL, it still works out to a hundred dollars for the visit.

Originally Posted by Justin '77

$60 for an hour and a half's time (including travel).
minus call it $20 for the travel itself
give over 25% for overhead (better to overestimate)
Leaves 20 bucks an hour to the pediatrician herself.
Bearing in mind that cost of living in that city is such that a decent life can be lived and family raised on 2k-3k a month, 20 bucks an hour is a pretty decent take for a trained professional ('pediatrician' means several years post-grad studies). Even if you need for some reason twice as much pay to cover a different CoL, it still works out to a hundred dollars for the visit.

Two comments:

1. You haven't fully assessed the underlying costs of the system, if you insist on the numbers you used. Nonetheless, we can run with those for now.
2. $20 per hour is not viable for anyone with a medical degree in this country, unless they have all school debt absorbed by some entity other than thenselves. Even then, it's $40,000 per annum, putting then squarely below the median income and well below the average.

Originally Posted by Marx & Lennon

1. You haven't fully assessed the underlying costs of the system, if you insist on the numbers you used. Nonetheless, we can run with those for now.

The 'underlying costs' of the American system are not fundamental to the provision of quality health care -- that's the whole point of the comparison. So of course they're left out of the assessment!

$20 per hour is not viable for anyone with a medical degree in this country, unless they have all school debt absorbed by some entity other than thenselves. Even then, it's $40,000 per annum, putting then squarely below the median income and well below the average.

The ridiculous cost of schooling under the American system is yet another facet of the gouging that the cartels maintaining the medical industry in the USA use to maintain their power and lucre. Those costs (at least the vast majority of them)? They're not fundamental aspects of the provision of quality medical care! Chuck 'em out!!

Originally Posted by Justin '77

The 'underlying costs' of the American system are not fundamental to the provision of quality health care -- that's the whole point of the comparison. So of course they're left out of the assessment!

I gave you a bye on this, but since you brough it up ... I'm not talking about system costs, but rather simple things like electricity, food, maintenance, and a myriad of other basic costs that have to be covered to keep the doors open and the place operating ... including interest on the improvement bonds 99% of such facilities use to finance capital programs.

Originally Posted by Justin '77 ...

The ridiculous cost of schooling under the American system is yet another facet of the gouging that the cartels maintaining the medical industry in the USA use to maintain their power and lucre. Those costs (at least the vast majority of them)? They're not fundamental aspects of the provision of quality medical care! Chuck 'em out!!

It costs a small fortune to get a BA or BS, to say nothing of a medical degree. Whether that's sensible or not is beside the point. Today, it is what it is. If it offends you, then a quick return to the Russian Republic should solve that dilemma. I assume that will not be the chosen option for most.

If we fix the high cost of schooling problem, then we can expect physicians to take lower compensation packages ... but not before.

Originally Posted by Marx & Lennon

If we fix the high cost of schooling problem, then we can expect physicians to take lower compensation packages ... but not before.

Yep, their debt is outlandish. Our son's first year is just under $75,000.00. That amount also includes housing and living expenses.

Originally Posted by Marx & Lennon

I gave you a bye on this, but since you brough it up ... I'm not talking about system costs, but rather simple things like electricity, food, maintenance, and a myriad of other basic costs that have to be covered to keep the doors open and the place operating ... including interest on the improvement bonds 99% of such facilities use to finance capital programs.

That's all bundled into what gets called 'overhead'. I gave you a 33% markup for it.

It costs a small fortune to get a BA or BS, to say nothing of a medical degree. Whether that's sensible or not is beside the point. Today, it is what it is. If it offends you, then a quick return to the Russian Republic should solve that dilemma. I assume that will not be the chosen option for most.

If we fix the high cost of schooling problem, then we can expect physicians to take lower compensation packages ... but not before.

True. So as I've been saying for a fair chunk here, the 'fix' being offered not only doesn't fix a thing (since it doesn't even begin to address the actual problem or provision of actual solutions), but it accepts the broken status quo as a foundation and makes it that much less assailable. I've never tried to claim that it was a short or easy road from here to a better place.