Because I think Obama has health care right, the economy right, Iraq and Afghanistan right, and for a number of other reasons, I do support him for President.
http://dangerousidea.blogspot.com/2008/10/on-improving-tone-of-political-debate.html
On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17% of his pre-tax income. A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20% of its pre-tax income.
In addition to reducing future Medicare funding by an estimated $500 billion, the bill fundamentally changes how Medicare pays doctors and hospitals, permitting the government to dictate treatment decisions.
The medical home is this decade's version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis."
A December 2008 Congressional Budget Office report noted that "medical homes" were likely to resemble the unpopular gatekeepers of 20 years ago if cost control was a priority.
Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.
Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20% of seniors). Advantage plans have warned this will result in reductions in optional benefits such as vision and dental care.
http://online.wsj.com/article/SB10001424052748704795604574519671055918380.html
I'm not certain what the issue is here about people paying for their health care. Is 17% on $44k steep? Or 20% on $100k? Sure it is, but maybe they'll have to go without cable TV or a new car or take a cheaper vacation or not eat out so much. Which is more important - health insurance or eating out multiple meals per week? But if health care is so important, maybe people need to prioritize their expenses and pay for what they really need. Is health care expensive? Sure it is but if you want the best health care in the world, it's not going to be cheap.
ReplyDeleteI certainly think people should pay for their care rather than me being stuck with it because they don't carry insurance. Don't ask me to subsidize your lifestyle of eating out all the time or your cable TV habit. Aren't we as Americans supposed to be self reliant and take care of ourselves?
17% off the top, before taxes, is pretty steep.
ReplyDeleteA lot of twenty-somethings and thirty-somethings don't have health insurance because it isn't cost effective for someone in the prime of life. So they pay out of pocket–if and when they need medical care.
What makes you think you'd pick of the tab for someone who makes $44K, but prefers a fee for service arrangement? Consumers are actually billed for medical services, you know.
What does "self-reliance" have to do with gov't mandates? Can you even think straight?
Because I pick up their bill if they have a major medical expense and can't afford to pay "fee for service". Can't you even think straight? :)
ReplyDeleteWhat does me paying for their medical bills through increased insurance premiums have to do with self reliance either? There are two sides to every coin. I'm looking at one side, you're looking at the other. I'd prefer that we look at both sides, but since you were just looking at one, I'd thought I'd point out the other side.
I mean I guess it would be great if people who took the bet and went without insurance were willing to live with the consequences of their actions if they ran into major medical trouble - either pony up the cash or just suffer without health care. But we as a society aren't comfortable with that, and people who make that bet still scream for help when they lose the bet.
So we either continue to let them make that bet and then bail them out of trouble when they lose or we require them to cover themselves with insurance.
False dilemma.
ReplyDeleteWe can always let them learn that actions have consequences and that if they're stupid, they pay the price.
There's a reason that every economy collapses when it's based on the "I can't afford it, but want it, therefore you should be required to get it for me" method. If it doesn't work with anything else you buy, why would it work in health care?
As they say, if you think health care is expensive now, wait until it's free.
By the way, did you see how the Calgary Flames (hockey team) took their players to a "special" clinic for H1N1 shots? It proves two points: 1) the Canadians suck at socialized medicine (not because they're Canadian, but because it's socialized medicine), and 2) socialized medicine created a black market in health care that did not exist before, wherein people with money/influence/power can get the care they need while those without money still suffer--the exact problem bleeding heart liberals were seeking to avoid is instead exacerbated. (This also shows the primacy of thought over feelings, but that's another issue.)
Story about the Flames here.
GRIFMAN SAID:
ReplyDelete“What does me paying for their medical bills through increased insurance premiums have to do with self reliance either?”
To say that gov’t should mandate self-reliance is oxymoronic.
“So we either continue to let them make that bet and then bail them out of trouble when they lose or we require them to cover themselves with insurance.”
This will come as a revelation to you, but insurance operates on the principle that policyholders who use it less often pick up the tab for those who use it more often.
If everybody’s house burned down, insurance companies couldn’t afford to sell fire insurance. They can only turn a profit on fire insurance if just a fraction of the insured actually put in a major claim.
If the gov’t mandated universal health insurance, then, by definition, some policyholders would be picking up the tab for others.
Moreover, you’re penalizing everyone by making everyone pay for it, whether they need it or not, to cover some who need it, but don’t have it. So you’re making everyone pick up the tab for goods and services which many of them never even received.
Do you also think the gov’t should mandate that all Americans buy liquor store gift certificates so that we don’t have to pick up the tab for robbers who hold up liquor stores?
Or would it be better to catch the robbers and put them on a work far to reimburse the liquor store?
Man, a little reading reveals some misinformation in the WSJ editorial which I guess is why it's on the editorial page and not the news page :)
ReplyDelete"Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients."
Actually, this is not true. Currently physicians and/or nurse practitioners are officially recognized as "attending physicians" for hospice care providers under Federal law. This merely adds PA's to the list of providers. It does not require that doctors be replaced with PA's. (pg 391/392)
"The medical home is this decade's version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis.
A December 2008 Congressional Budget Office report noted that "medical homes" were likely to resemble the unpopular gatekeepers of 20 years ago if cost control was a priority."
The first medical home demonstration project was passed by a Republican congress under President Bush in 2006 (Tax Relief and Health Care Act of 2006). Hmmm, interesting wouldn't you say? Why did the Republicans pass this unless they thought there might be something to it? The whole purpose of a pilot is to test something.
This looks to expand the project. Per the bill, the pilot program would run for no more than 5 years. The bill would direct the govt to assess the whether health care quality had improved, whether hospitalizations had decreased, if there had been improvements in outcomes and patient satisfaction, and if costs had been reduced. According to the bill the program would be rolled out only if it met quality and cost control goals (pg 688). This sounds like a logical conclusion to what was started under the Republicans.
The statement about what the CBO said is also not true. Here's the link if you want read what the CBO really said:
http://www.cbo.gov/ftpdocs/99xx/doc9925/12-18-HealthOptions.pdf#page=92
Reading starting at page 92 I can't see that it says anything about medical homes being the equivalent of HMO's. One might draw that conclusion themselves but the CBO doesn't say that. The report lists possible pros and cons but says we can't know without further study.
"To say that gov’t should mandate self-reliance is oxymoronic."
ReplyDeleteI agree. But people wanting to be self reliant until an emergency comes along and then they need/want help is just a bad, though it may not be oxymoronic :)
"This will come as a revelation to you, but insurance operates on the principle that policyholders who use it less often pick up the tab for those who use it more often."
Sure. But this may also come as a revelation to you that we have people who can afford insurance but don't buy it, and when they have medical issues they can't afford to pay for, I currently subsidize their care. So right now they get all the benefits of insurance without bearing any of the cost. How is that fair?
"If the gov’t mandated universal health insurance, then, by definition, some policyholders would be picking up the tab for others."
Sure, that's the nature of insurance. We insure against risks that we cannot afford to pay for ourselves. Risk is spread. Do you have some objection to the concept of insurance? Or just the mandate?
"Moreover, you’re penalizing everyone by making everyone pay for it, whether they need it or not, to cover some who need it, but don’t have it. So you’re making everyone pick up the tab for goods and services which many of them never even received."
Sure, that's the nature of insurance. I may never need it, but I don't know that I won't. None of us can predict the future.
I guess the question I have for you is this? Are you ok if people who don't take out insurance not getting care if they lose that bet? Are you willing to let Billy Bob Twentysomething die of an ruptured appendix if he shows up at the hospital without insurance and without enough cash in his bank account to pay for it? If so, then you are at least being logically consistent. If not, then what is the solution to "free riders" who take the bet and lose and yet want me/you to pay for their care?
"We can always let them learn that actions have consequences and that if they're stupid, they pay the price."
ReplyDeleteSo just to be clear, I'll put the same question to you:
Are you willing to let Billy Bob Twentysomething die of an ruptured appendix if he shows up at the hospital without insurance and without enough cash in his bank account to pay for it?
GRIFMAN SAID:
ReplyDelete“Sure. But this may also come as a revelation to you that we have people who can afford insurance but don't buy it, and when they have medical issues they can't afford to pay for, I currently subsidize their care. So right now they get all the benefits of insurance without bearing any of the cost. How is that fair?”
i) Let’s see. You object to the status quo because, according to you, you have to pick up the tab for somebody else. So you favor Obamacare in its place.
When I point out that Obamacare universalizes the very thing you found objectionable in the status quo, you respond by restating your objection to the status quo–as a reason to universalize that objectionable consequence. Fascinating logic.
ii) Moreover, the status quo is obviously fairer if you voluntarily buy health insurance. In that case you’re prepared to accept the potentially “unfair” consequences of health insurance as long as that is outweighed by the potential benefits.
iii) Furthermore, your objection poses a false dilemma. If we want to “reform” the status quo, one way of doing that is to pass laws in which the consumer is free to pay for only as much coverage as he wants, rather than having to buy into a complete package of benefits, which may include coverage for many things he’s unlikely to need, and would rather pay out of pocket, if and when the need arises. If you’re truly concerned about fairness, then that would be fairer.
“I guess the question I have for you is this? Are you ok if people who don't take out insurance not getting care if they lose that bet?”
There’s no general answer to that question. Are we talking about folks who engage in high-risk behavior, then expect the rest of us to pay off their bookie? If they gamble and lose in that sense, then they play at their own risk.
“Are you willing to let Billy Bob Twentysomething die of an ruptured appendix if he shows up at the hospital without insurance and without enough cash in his bank account to pay for it?”
i) If Billy Bob makes $44K a year (which was the original reference point), then why could he not afford to pay for an appendectomy out of pocket?
ii) You are also taking the cost of health care for granted, then demanding that everyone buy into an overpriced system.
In that case, universal healthcare does nothing to lower the cost of healthcare. To the contrary, it drives up the costs.
Why not begin with some cost-saving measures, like tort reform and interstate competition?
“If so, then you are at least being logically consistent. If not, then what is the solution to ‘free riders’ who take the bet and lose and yet want me/you to pay for their care?”
What makes you think free riders can’t pay for an appendectomy? Even if they can’t pay on the spot, that doesn’t mean they can’t pay on some installment plan.
"i) Let’s see. You object to the status quo because, according to you, you have to pick up the tab for somebody else. So you favor Obamacare in its place."
ReplyDeleteI've said nothing about supporting Obama care anywhere. I can support certain aspects of a plan without supporting the entire plan. I can also point out false assertions made about the plan (as I have) without supporting it. As far as I know, we've just been discussing requiring people to have health insurance. I don't remember anywhere that I've said I support or don't support the President's plan. That's an incorrect assumption on your part.
"When I point out that Obamacare universalizes the very thing you found objectionable in the status quo, you respond by restating your objection to the status quo–as a reason to universalize that objectionable consequence. Fascinating logic."
Sorry, I don't see where you have shown that. I think you misunderstand what my objection is to. I don't object to the insurance concept that those that end up not using it subsidize others as we are all in the same boat - we have it if we need it and we all pay for it. I object to subsidizing "free riders". If free riders are required to get insurance I no longer will subsidize them and my objection goes away. There will be no more free riders. So I guess you won't be fascinated any longer by my logic.
"ii) Moreover, the status quo is obviously fairer if you voluntarily buy health insurance. In that case you’re prepared to accept the potentially “unfair” consequences of health insurance as long as that is outweighed by the potential benefits."
I'm not sure why the status quo is "obviously fairer". That's an assertion in search of an argument. It's not fair to me. Yes, I buy insurance knowing there are free riders, but I would rather that they be required to buy insurance as that would reduce my cost. That would be the "fairer" solution to me.
"iii) Furthermore, your objection poses a false dilemma. If we want to “reform” the status quo, one way of doing that is to pass laws in which the consumer is free to pay for only as much coverage as he wants, rather than having to buy into a complete package of benefits, which may include coverage for many things he’s unlikely to need, and would rather pay out of pocket, if and when the need arises. If you’re truly concerned about fairness, then that would be fairer."
There's no false dilemma for me as I agree. I've said nothing about what coverage they should be required to buy. It would make a great deal of sense for the young to buy some sort of high deductible, catastrophic coverage which would answer my complaint. Again, you seem to think because I support one aspect of the President's program that I've bought the entire program. That's an erroneous assumption on your part - again.
"There’s no general answer to that question. Are we talking about folks who engage in high-risk behavior, then expect the rest of us to pay off their bookie? If they gamble and lose in that sense, then they play at their own risk."
I'm not talking about people who engage in high risk behavior. I'm just talking about the average young 20 something who chooses to "roll the dice" because they are apparently young and healthy. So can you answer the question?
Continued . . .
ReplyDelete"i) If Billy Bob makes $44K a year (which was the original reference point), then why could he not afford to pay for an appendectomy out of pocket?"
From my reading an appendectomy can cost between $12k and $22k. What if Billy Bob for whatever reason doesn't have that kind of cash? And in an emergency situation absence insurance how does the hospital verify his ability/willingness to pay?
Or I could just have well selected some other even more expensive procedure. Maybe Billy Bob is in an auto accident (not one he caused just so we ge the risky behavior thing out of the way) and has to have critical care, multiple surgeries, etc. and has to be in the hospital a month, where he can easily run up a bill of $100k. Do we let Billy Bob die because he doesn't have that kind of money?
"ii) You are also taking the cost of health care for granted, then demanding that everyone buy into an overpriced system."
How do you know this? We've not discussed anything about the issue of reducing the cost of health care or steps that could be taken. Our discussion has been around the idea of requiring people to buy insurance, nothing more. There you go again (where have we heard that before? :)), assuming my position on something we have not even discussed.
"In that case, universal healthcare does nothing to lower the cost of healthcare. To the contrary, it drives up the costs."
I agree, merely requiring people to buy insurance will do nothing to reduce costs. But we haven't' been discussing cost reduction either. Just requiring insurance coverage.
"Why not begin with some cost-saving measures, like tort reform and interstate competition?"
I support those measures. The problem with the Obama plan as I see it is that it addresses the need for access to health care but really does little that I can tell to address the cost issue.
Grifman said:
ReplyDelete---
Are you willing to let Billy Bob Twentysomething die of an ruptured appendix if he shows up at the hospital without insurance and without enough cash in his bank account to pay for it?
---
Are you willing to force Billy Bob Twentysomething to pay off his credit card bills right now or risk jail?
Hmmm, wait a minute. How does that work out? A person isn't required to pay back credit card debt instantly, but *IS* required to pay his medical bills instantly?
Too bad they messed up and let me pay it off over three years when I had surgery.
Frankly, this should be no different from any other debt that people have. And if it turns out that you cannot pay for it in the end, that's why we've got bankruptcy laws. There's no reason to pretend that the medical profession is in an alternate universe functioning by different rules than those which already govern the marketplace everywhere else.
BTW, it should be emphasized that bankruptcy laws are already "grace" for the debtor. We have no debtor's prisons in America, and we never have had them. The Constitution provides bankruptcy protections for us (Article I, Section 8, Clause 4).
ReplyDeleteOn the other hand, the Constitution says nothing about health care.