universal healthcare

[kandrathe]

Oh, if it were only this blindingly simple. Unfortunately when an individual or family faces these consequences their effects are not isolated and it has repercussions across everyone, even people who are diligently paying for insurance and taking wonderful care of their health.

It is that blindingly simple. The people who go to emergency rooms anonymously are people who should be covered already by State and Federal programs. The barriers to their embracing the existing bureaucracy are probably also the ones that affect their earning ability as well (be it legal issues, illegal status, mental health, etc.) The costs for them will continue to be on county or state governments.

I'm only speaking as the head of a family who actually lost our health care for about a year, with nary a safety net to be found. This is not a problem that is solved by Obamacare. Yes, we had medical problems during this time period, not to mention a huge amount of fear of having two fairly wild boys who no matter how hard we tried were not covered by any of the four health plans run by my State government. We paid out of pocket. Under Obamacare, we would also be fined $695 for not having insurance (or spend ~ $6000 to buy it out of pocket on the open market). The boys actually eventually became covered by Medicaid about a month before I found my current job. I'm pretty familiar with government run solutions, and their problems as well. I still don't believe our problems should be a burden on tax payers, but I'm 100% against health care being tied to employment.

No, that is unequivocally not a better question. And it's so laden with ideology and hyperbole that the idea of it being more accurate borders on laughable. The real question underlying this is; Does the government have the power, through taxation, mandates, and regulation to promote behavior which it finds to be individually and socially beneficial. I'm sure you will find that the resounding answer to this question is yes.

I think we are bordering on developing an Anarchy of law, where no matter how hard we might try, we cannot help but be in violation of some law. This is a danger then if our government became more of a police state where arbitrary justice is practiced against the enemies of the state. I can't wait to see what the repercussions will be for those who refuse to buy themselves health insurance.

A corollary question would be; Should the government have this power? I'm sure you would answer no. I disagree.

Actually, I would answer a qualified yes. We should be able to discern when power is used to our mutual benefit, or when this power is abused.

To quote Howard Zinn: "The Constitution set up big government, big enough to protect slaveholders against slave rebellion, to pay off bondholders, to pass tariffs on behalf of manufacturers, to tax poor farmers to pay for armies that would then attack the farmers if they resisted. ...Big enough to use the armed forces to clear Indians off their land, to put down labor uprisings, to invade countries in the Caribbean for the benefit of American growers, bankers, investors. This was very big government. "Big government" in itself is hardly the issue. That is here to stay. The only question is: Whom will it serve?"

I would ask if this is the vision we SHOULD have of our government. It was an abuse as much then, as it is now.

[kandrathe]

Nobody is forcing you to buy health insurance, either. If you don't want to buy it, then don't earn enough income to cross the threshold beyond which you would be fined for not buying it. (You don't have to pay taxes either - just don't own anything, earn anything, or spend anything.)

And, you will starve to death, or get killed while you sleep in your card board box. No problem.

Not realistic, you say? Not a real option? So is not driving, at least in most states, for most people.

I know I've had it drummed into my head that driving is a privilege, not a right. If you are saying that the State might be infringing on peoples rights by making driving requirements overly onerous, then you might have a point.

Getting back to your other question, about Obama care funding... The Lie of Fiscal Responsibility.

[eppie]

Don't want to purchase health insurance? No problem. Just help us defray the costs associated with that risky choice.

So why not just tell them they have to buy? You know that not every person is smart enough to make all the right choices, what is next? Throw people that are stupid enough not to buy insurance directly in a volcano?
I understand your point, and the point that many people make, I just find it a bit subjective.
Your government also decides for you if you have an abortion (which is no you are not), your government decides for you you are not allowed to use the drugs of your liking and your government decides you are not allowed to take a suicide pill if you are tired of life.
No I know kandrathe would agree with me here that those things are also wrong, but I think most republicans that voted against this bill would find it perfectly normal that guns are allowed, drugs are not, euthanasia is not etc. etc.
Point is that everybody makes up his own mind on things he likes to see illegal and things he likes to see legal.
Taking this point of 'health care for everybody' as trampling on human rights seems strange to me.

We have the same rule in Holland (you have to buy health insurance), and in Sweden it is all ran by the state.
These countries are not less free than the US.
And as has been mentioned before our health care system is not much more expensive than the one in the US.

[eppie]

These are two very unhappy consequences for those people who risk not having any form of health insurance.

And for their family and for their village, and for the whole country, financially. That is why it is so much more simple just to oblige them to take insurance, or arrange it through the government (as part of taxes).

[Jester]

And, you will starve to death, or get killed while you sleep in your card board box. No problem.

Life sucks when you try to spend your every waking moment avoiding taxes, rather than trying to maximize your happiness. So it is with income, so it is with the individual mandate.

I know I've had it drummed into my head that driving is a privilege, not a right.

And if you listen to the right blogosphere, health care is the same. But, as Pete rightly points out, that ship sailed long ago. Medicare and Medicaid are already huge. Getting rid of them is politically impossible, and would have catastrophic consequences for those who depend on them. The real question is how these services can be provided at lower cost, or for more people at around the same cost. That's what this bill is about.

Getting back to your other question, about Obama care funding... The Lie of Fiscal Responsibility.

If we grant that extra $208 billion in expenses, that amounts to a total of 5.9 billion dollars per year in extra deficits. You could fund that for the next century on the DoD's budget for a single year. It would amount to less than a 1% increase in current annual health care costs. It would no longer save money, but it's hardly a beacon for fiscal irresponsibility - that would be the Iraq war, and the Bush tax cuts, each of which go through that amount of money in about a week.

-Jester

Afterthought: Neato graphic, via DeLong:

[Delc]

The consequence of not having insurance is that you may get sick, and either be given inadequate medical care and die, or end up owing a huge amount of money, and perhaps needing to declare bankruptcy. These are two very unhappy consequences for those people who risk not having any form of health insurance.

Declaring bankruptcy is hardly a consequence for the person doing it. Most people have no assets that can actually be touched by bankruptcy. It just screws the hospitals out of the money, who then pass those costs onto someone else. Its not a terribly efficient system, but I bet lawyers love it.

[DeeBye]

America had a real chance to join the rest of the civilized world with respect to health care, and you blew it.

[--Pete]

Hi,

Your government also decides for you if you have an abortion (which is no you are not), . . .

Abortion is completely legal in the USA.

. . . your government decides for you you are not allowed to use the drugs of your liking . . .

I can get all the Godiva, Glenlivet, Marlboro's, and green Earl Grey I can afford. Although I did cut myself off from the third some years ago. :whistling:

. . . and your government decides you are not allowed to take a suicide pill if you are tired of life.

Actually, there's no law against suicide -- they'd be pretty well pointless. There are laws against attempted suicide.

. . . I think most republicans that voted against this bill would find it perfectly normal that guns are allowed, . . .

Although it varies from place to place, gun ownership isn't all that free and easy in the USA.

. . . drugs are not, . . .

See above. Also, medical marijuana is the wedge back to normalcy.:w00t:

. . . euthanasia is not etc. etc.

The laws against euthanasia vary, with at least two states permitting it under certain circumstances.

And as has been mentioned before our health care system is not much more expensive than the one in the US.

Actually, it is cheaper. Which is the whole point.

In another thread, King Jim asks where we get our facts. I'd love to see your answer. :P

--Pete

[--Pete]

Hi,

America had a real chance to join the rest of the civilized world with respect to health care, and you blew it.

Kinda, but not totally. The Ship of State (or is it Fools) has a lot of inertia. You can seldom turn it all at once, but this is at least the first small correction to its course.

--Pete

[DeeBye]

Hi,
Kinda, but not totally. The Ship of State (or is it Fools) has a lot of inertia. You can seldom turn it all at once, but this is at least the first small correction to its course.

--Pete

Where you were was New York, where you are now is Chicago, and where you need to be is somewhere on Jupiter. And look at what it took to get to Chicago.

[--Pete]

Hi,

Where you were was New York, where you are now is Chicago, and where you need to be is somewhere on Jupiter. And look at what it took to get to Chicago.

A journey of a thousand miles starts with a single step . . .
























. . . after which, you still have a thousand miles left to go. :lol:

--Pete

Or, as Magi likes to say, "Well begun is half started." :whistling:

[kandrathe]

The real question is how these services can be provided at lower cost, or for more people at around the same cost. That's what this bill is about.
If we grant that extra $208 billion in expenses, that amounts to a total of 5.9 billion dollars per year in extra deficits.

How do you rack up 65.3 trillion in unfunded liability? I suspect it is $208 billion at a time.

[Jester]

How do you rack up 65.3 trillion in unfunded liability? I suspect it is $208 billion at a time.

Actually, you rack it up a year at a time. Or a decade. Or any length of time you like. That's the thing about scary "unfunded liability" numbers - they appear to be large lump sums, but they're calculated by just adding the flows up, unto some arbitrarily long future horizon. That 65.3 trillion is accumulated over what, the next 50 years? 100 years? The US has octillions of dollars in unfunded liabilities... if you measure from now until the sun explodes.

The relevant question is what it will take to cover the costs, as a flow.

From the CBO:

The term "unfunded liabilities" has been the source of considerable confusion, leading some people to misconstrue the economic significance of trust funds and trust fund balances. The term may also suggest that certain liabilities are funded when, in fact, the real source of all funding is the government's ability to levy taxes.

-Jester

[kandrathe]

The relevant question is what it will take to cover the costs, as a flow.

I like the term “infinite horizon discounted value”. Now if only I remembered how to solve partial Markov equations. According to Mr. Fisher, "Add together the unfunded liabilities from Medicare and Social Security, and it comes to $99.2 trillion over the infinite horizon."

Storms on the Horizon -- Remarks before the Commonwealth Club of California by Richard Fisher spoken before the crash in the summer of 2008.<blockquote>Let’s say you and I and Bruce Ericson and every U.S. citizen who is alive today decided to fully address this unfunded liability through lump-sum payments from our own pocketbooks, so that all of us and all future generations could be secure in the knowledge that we and they would receive promised benefits in perpetuity. How much would we have to pay if we split the tab? Again, the math is painful. With a total population of 304 million, from infants to the elderly, the per-person payment to the federal treasury would come to $330,000. This comes to $1.3 million per family of four—over 25 times the average household’s income.

Clearly, once-and-for-all contributions would be an unbearable burden. Alternatively, we could address the entitlement shortfall through policy changes that would affect ourselves and future generations. For example, a permanent 68 percent increase in federal income tax revenue—from individual and corporate taxpayers—would suffice to fully fund our entitlement programs. Or we could instead divert 68 percent of current income-tax revenues from their intended uses to the entitlement system, which would accomplish the same thing.

Suppose we decided to tackle the issue solely on the spending side. It turns out that total discretionary spending in the federal budget, if maintained at its current share of GDP in perpetuity, is 3 percent larger than the entitlement shortfall. So all we would have to do to fully fund our nation’s entitlement programs would be to cut discretionary spending by 97 percent. But hold on. That discretionary spending includes defense and national security, education, the environment and many other areas, not just those controversial earmarks that make the evening news. All of them would have to be cut—almost eliminated, really—to tackle this problem through discretionary spending.</blockquote>

[Jester]

Yes. If programs had to be paid for by literally having a gigantic block of capital that would generate enough returns to pay for the programs in perpetuity, then yes, it would take a rather ridiculous amount. You could fund the entire US government forever, tax free, if you just had a fund of about 100 trillion dollars that could somehow be invested at 5%, safely compounding away in perpetuity.

But, as Mr. Fisher rightly notes, that's ludicrous. So, the question is how to cover the anticipated expenditures. Tax increases are certainly a necessary component of this process.

However, far and away the largest component is stopping costs from running away forever. Liabilities will not explode into enormous numbers unless health care costs continue to rise and rise. While the hypothetical system of 2050 (or whatever) would take almost the entire budget to fund, hot damn would people be getting good health care, after half a century of constant-rate growth in per capita costs.

Other factors are important on their own terms (boomers retiring, tax increases/cuts, inefficiency) but they all pale in comparison to the issue of rising costs per person. Keep that down, and the problem will cease to exist.

So, the basic long-run method of solving this fiscal problem is as follows:

1) Reform to reduce costs in the near term.
2) Keeping a lid on perpetual cost increases.
3) Tax increases to offset costs.

How much each part contributes to the solution is an open question, but it seems to me that there is much progress to be made on all three fronts. Add those up, and making up 70-odd percent of government revenues isn't impossible, although it is certainly an enormous problem that will take attention for decades to solve.

One key, however, is that these are social costs, not just government programs. If those health care liabilities were disowned by the government somehow, the costs wouldn't vanish. They'd simply transferred onto the public in one of two ways: either people stop getting health care, or the public simply buys privately at the same (or higher) prices as the public version. Either way, society is as badly off as if the government were trying to pay for it all, or worse.

-Jester

[kandrathe]

One key, however, is that these are social costs, not just government programs. If those health care liabilities were disowned by the government somehow, the costs wouldn't vanish. They'd simply transferred onto the public in one of two ways: either people stop getting health care, or the public simply buys privately at the same (or higher) prices as the public version. Either way, society is as badly off as if the government were trying to pay for it all, or worse.

Once health care is a freely given away commodity (by the government), perhaps with some rationing even, I believe the populous will consume all that the government has to offer. The wages of care givers will be more or less fixed in that area, and so, as in other countries with socialized medicine, the number of care givers will never satisfy the demand. This is a recipe for price inflation for those that pay, and limited care and waiting lists for those who do not pay.

The bottom line as I see it on this health care bill...

We talked already about the anarchy of law, where it will cost $695 to break the law, or many thousands to follow the law. We talked about the budget gimmicks, double counting of savings, and other accounting shenanigans to create an entirely fictitious unbelievable CBO number.

Of the 30 odd million uninsured, 9.6 million of them are in the US illegally. 12+ million will be added to the medicaid roles by raising the lower threshold of the % of the poverty level that qualify and the States are expected to pick up these additional costs. A $500 billion cut to medicare, which will result in fewer services, rationing and waiting lists for seniors. So the two huge deficit running government programs will get worse, both in driving up costs and offering poorer services.

Some 8 or so million of the uninsured will be now covered by raising the age of what constitutes a child (for insurance purposes) to age 26, so ostensibly, children will remain on their parents insurance (while their plans remain solvent). Drug companies get richer by adding a bunch of new customers, and will be the beneficiary of the closure of the "donut hole". The government will implement one of the largest tax increases ever by by applying income tax rates to rent, interest, dividends. For rental income, this will be directly passed onto low income renters, and businesses that lease property. And, the mandate on employers to provide 100% coverage of face a minuscule fine ($2000 for the first 30 employees) will encourage rather than discourage employers (especially those that hire low income people) to skip providing health benefits and just pay the fines. Estimates are the up to 10 million people will lose their insurance due to employers ending their plans altogether. The non-partisan Lewin Group estimates that Obamacare will drive a total of 56 million people off their current health care insurance. New federal regulations and punitive taxes on high-ticket medical expenditures such as medical devices, prescription drugs, and high-cost insurance plans will drive up the health insurance premiums, particularly in the individual market.

The whole risk aspect of health insurance disappears due to removing the lifetime cap on benefits, and the denial of people with pre-existing conditions. Group health plans will need to jack up their prices to cover chronically ill people now. And, yes, this does sound great when you are envisioning people with diabetes. I too thought it was pretty lame to offer insurance to those who didn't actually need it. But then, what about the epidemic of restless leg syndrome diagnosed in California which qualifies one to get prescriptions for pot? I really do want people who need health care to be able to get it, but the bulk of the cost will be consumed by this kind of general abuse by the not so sick. Yes, so we will stick it to those greedy insurance groups who make the measly 3.5% profit now, and drive them out of business. What's making us sick is an epidemic of diagnoses

I don't believe it will fix what is wrong with the US health insurance market, and it is not a baby step in the right direction unless you believe that perhaps destruction of the market is the correct first step.

P.S. Another interesting read from Cato -- Bipartisan indifference to controlling health care costs.

<blockquote>"Today, of every dollar spent on health care in this country, just 13 cents is paid for by the person actually consuming the goods or services. Roughly half is paid for by government, and the remainder is covered by private insurance. And, as long as someone else is paying, consumers have every reason to consume as much health care as is available.
...
This all but guarantees that health care costs and spending will continue their unsustainable path. And that is a path leading to more debt, higher taxes, fewer jobs and a reduced standard of living for all Americans."</blockquote>

[kandrathe]

I'd love to know where you get your numbers on this. From what I've seen 3 state AGs are talking about this. South Carolina, Virginia, and Florida. Quite different than 38.

More accurately, from this source, I counted 13 states (as of yesterday) who haven't yet attempted to block the impact of this Federal law on health care in their states (Hawaii, Oregon, Montana, Nevada, Texas, Illinois, North Carolina, New York, Vermont, Rhode Island, Maine, Connecticut, Massachusetts). With the update from today that Texas was added to the Federal lawsuit (with 13 other states). (source)

[kandrathe]

Declaring bankruptcy is hardly a consequence for the person doing it. Most people have no assets that can actually be touched by bankruptcy. It just screws the hospitals out of the money, who then pass those costs onto someone else. Its not a terribly efficient system, but I bet lawyers love it.

Bankruptcy rates for lawyers are minimal and set by law. But, you are correct that other than ruining a persons credit rating we have little recourse. Not like in the olden days when you could throw them in debtors prison, or sell them into indentured servitude. While I feel bad for hospitals, I feel worse for the people with no money, job or health care. Around here the government run hospitals charge off bad debts to the tax payers which show up in our state, and county taxes.

But, then again, this is exactly the kind of person who automatically should qualify for Medicare. Right? So why isn't the government paying for them already?

[Chesspiece_face]

More accurately, from this source, I counted 13 states (as of yesterday) who haven't yet attempted to block the impact of this Federal law on health care in their states (Hawaii, Oregon, Montana, Nevada, Texas, Illinois, North Carolina, New York, Vermont, Rhode Island, Maine, Connecticut, Massachusetts). With the update from today that Texas was added to the Federal lawsuit (with 13 other states). (source)

Yeah, I've seen this come up since then as well. Still not quite 38. And from my perspective a waste of tax payer's money. The way the "mandate" will be argued in a court is that this law creates a tax on individuals and that those who purchase insurance essentially get a credit for that tax. That may not be the politically expediant way to describe it but that's what it will boil down to as far as the law is concerned and there is no legal argument against it.

[kandrathe]

Yeah, I've seen this come up since then as well. Still not quite 38.

Ok, 50 minus 12. :) That's 37 + Texas.

And from my perspective a waste of tax payer's money. The way the "mandate" will be argued in a court is that this law creates a tax on individuals and that those who purchase insurance essentially get a credit for that tax. That may not be the politically expedient way to describe it but that's what it will boil down to as far as the law is concerned and there is no legal argument against it.

State's AG's are typically lawyers and Governor wannabes. It is politically expedient for them to make a big name for themselves, usually at taxpayer expense.

As for the merits of the case... It's the SCOTUS... Who knows how this will turn out... I predict a 5-4 decision.