Excellent Op-Ed piece on Obamacare and SCOTUS in Washington Post

[OrByte]

The premise of the original article is completely wrong because, as I've said multiple times, health insurance != health care.

But healthcare cost != broccoli cost.

I am honestly curious if that matters at all.

 

[LunarRay]

Shira,

I don't think there is any question about why we need mandated insurance but there is about under what authority can Congress make that law... (I know it is not the thrust of your OP)

Forcing business to sell insurance 'universally' or forcing all to buy it seems not Constitutional to me.

I've sat here for ten minutes trying to find some other product or service that is the same as health insurance with all its tentacles and I can't. Not federally, that is and not already seen as a tax like SSI/Medicare. Justice Kennedy thinks Congress could develop a medicare type universal thingi for uninsured and avoid the entire issue... everyone would pay the tax... just like SSI... While Ginsberg thinks totally opposite...

I don't think you can create commerce in order to regulate it as Kennedy said at some point.


[I am in favor of the law in its entirety btw.]

 

[Craig234]

Shira,

I don't think there is any question about why we need mandated insurance but there is about under what authority can Congress make that law... (I know it is not the thrust of your OP)

Forcing business to sell insurance 'universally' or forcing all to buy it seems not Constitutional to me.

I've sat here for ten minutes trying to find some other product or service that is the same as health insurance with all its tentacles and I can't. Not federally, that is and not already seen as a tax like SSI/Medicare. Justice Kennedy thinks Congress could develop a medicare type universal thingi for uninsured and avoid the entire issue... everyone would pay the tax... just like SSI... While Ginsberg thinks totally opposite...

I don't think you can create commerce in order to regulate it as Kennedy said at some point.


[I am in favor of the law in its entirety btw.]

Of course that can be regulated.

Are carmakers required to sell seat belts in cars? Are they required to meet pollution or efficiency standards? Yes. Those are the only products they're allowed to sell.

Can the goverment require businesses to sell to people regardless of race? Yes.

This is basic government - public interest constrains private freedom on things like this.

The government isn't forcing anyone to sell such insurance -just to limit what can be sold.

 

[PokerGuy]

Yawn. I'm sure every op-ed piece that supports your point of view is 'excellent', while every article with a different perspective is lousy.

Health insurance is not the same as health care. People just seem to have a hard time with that distinction. Everyone will need care at some point, but not everyone will need health insurance.

 

[Ausm]

How about removing the role of government and actually allowing costs to be played out and dealt with by the system rather then masking it to push out idealist views that do not adhere to basic principles of economics and thus create unintended consequences, i.e. higher prices for goods and services or worse reduce quality and quantity of good and services.

Yeah we can see how wonderful that is working in the private markets... I take you never tried to deal with a private insurance company?

 

[Ausm]

yawn. I'm sure every op-ed piece that supports your point of view is 'excellent', while every article with a different perspective is lousy.

Health insurance is not the same as health care. People just seem to have a hard time with that distinction. everyone will need care at some point, but not everyone will need health insurance.

lmfao......

 

[PokerGuy]

lmfao......

Does Bill Gates need insurance, or does he need health care? As I said, everyone needs health care, but not everyone needs insurance.

The real issue is how to control the costs of health care such that people can afford to pay for their regular health care while having insurance to cover catastrophic scenarios.

 

[Anarchist420]

The reason why health insurance is so expensive is because it covers already everything due to regulations. The regulations should be abolished and people should use insurance in case of catastrophic events, then pay out of pocket for everything else (cash only practices are pretty damn inexpensive). There should be personal deductions (but no deductions for employer-provided plans) for all personal, dependent, and charitable health care expenses and no patents so drugs can be cheaper.

Health insurance is not the same as health care. People just seem to have a hard time with that distinction. Everyone will need care at some point, but not everyone will need health insurance.

I couldn't agree more. Obama's a retard for thinking health insurance is the same exact thing as health care.

 

[cybrsage]

There have to be the seven year patents on drugs, else no company would ever take the massive expense AND risk in creating new ones. Why would Company A spend $50 million dollars inventing a new drug and getting it approved if they new Company B could immediately copy it and sell it? That is one of the few things which actually makes sense. Yes, it makes the drug more expensive for a few years, but the companies which invent these things need to be able to make a profit on their development.

 

[Carmen813]

The premise of the original article is completely wrong because, as I've said multiple times, health insurance != health care.

If only the world was so simple.

 

[cybrsage]

Of course that can be regulated.

Are carmakers required to sell seat belts in cars? Are they required to meet pollution or efficiency standards? Yes. Those are the only products they're allowed to sell.

They car makers are already selling cars, so the selling of them can be regulated. If you are not buying a car, can you be forced to buy one with a seat belt in it?

The government isn't forcing anyone to sell such insurance -just to limit what can be sold.

If everyone is forced to buy it, companies have to be forced to sell it. It cannot work if you are forced to buy it but no one will sell it to you.

 

[cybrsage]

If only the world was so simple.

It is that simple. Health Insurance != Health Care. If it did, then Auto Insurance = Auto. You can have a car and not have auto insurance. You can have health care and not have health insurance.

 

[Bitek]

Shira,

I don't think there is any question about why we need mandated insurance but there is about under what authority can Congress make that law... (I know it is not the thrust of your OP)

Forcing business to sell insurance 'universally' or forcing all to buy it seems not Constitutional to me.

I've sat here for ten minutes trying to find some other product or service that is the same as health insurance with all its tentacles and I can't. Not federally, that is and not already seen as a tax like SSI/Medicare. Justice Kennedy thinks Congress could develop a medicare type universal thingi for uninsured and avoid the entire issue... everyone would pay the tax... just like SSI... While Ginsberg thinks totally opposite...

I don't think you can create commerce in order to regulate it as Kennedy said at some point.


[I am in favor of the law in its entirety btw.]

The fact is at the health care system is so large does make it falls under congress is ability to regulate under the commerce clause. Is there a burden when a person lives in one state and lives on another and is not insured? The worker gets in an accident, has no ability to pay the medical bills (my wife broke her leg once, bill was $50,000+ for.reference.)
So then the unpaid bills fall on the neighboring state. -> Congress can regulate.

The whole idea that the govt can't force.you to buy something is a phony complaint. Even the plaintiffs' lawyer admitted the govt could mandate purchase of ins upon arriving at the hospital. The whole debate is about the timing of that requirement. Can it make you buy ins well in advance?

 

[Bird222]

Mandating health insurance will only have the effect of increasing the cost of medical goods and services across the board or worse degrading the quality and quantity of these services.

You keep saying this but from the info I have heard countries with 'single payer' systems spend less of their GDP on healthcare and have better outcomes than we do.

For all the healthcare != health insurance folks, while that is true they are still very linked together. As stated in the oral arguments (which I listened to a lot of), health insurance is the primary way people pay for health care.

Here is the problem in my view as to why you can't treat this as a 'normal market'. Capitalism works when you have a viable alternative to choose from. There aren't enough hospitals/providers to have true competition on costs. Also, having your kids die is just not a viable choice for most people, so the healthcare providers really have you over a barrel and can theoretically charge what they want. Two, hospitals have to provide care even if you can't pay which of course drives up the cost for other paying customers. I can't go to Verizon, and say "I can't pay you but you still have to give me a phone." or go to the store and still get broccoli when I can't pay for it (I don't know why the justices were making these comparisons and why no one really seemed to respond with that simple fact). As I have said before, the 'pure capitalist' folks that don't like ACA need to be intellectually honest and say they are fine with people not getting care and dying. Maybe we can go back to the middle ages and have people come around to pick up our dead. Look we have a big problem here, I don't know what the right answer is but I think most 'normal' people would agree that it is too big for the individual to solve.

 

[nonlnear]

Here is the problem in my view as to why you can't treat this as a 'normal market'. Capitalism works when you have a viable alternative to choose from. There aren't enough hospitals/providers to have true competition on costs.

This isn't really the problem behind the lack of cost compettition at all. We dont' have competition on price because there is rampant price discrimination, and there is no price information. Both of these problems are fairly simple fixes (Well, correcting most of the price information problem ould be fairly easy.) that PPACA totally ignores.

As I have said before, the 'pure capitalist' folks that don't like ACA need to be intellectually honest and say they are fine with people not getting care and dying.

This is possibly true of a few anti-ACA folks, but this is such a stretch that it seems a deliberately malicious fallacy. Pretending that ACA's mandated expansion of our no-choice employer lock-in system is the only (or even a good) way to "save" the private system is utterly idiotic.

 

[Bird222]

This is possibly true of a few anti-ACA folks, but this is such a stretch that it seems a deliberately malicious fallacy. Pretending that ACA's mandated expansion of our no-choice employer lock-in system is the only (or even a good) way to "save" the private system is utterly idiotic.

I am all ears. Besides requiring insurance purchase, public option, or just going 'single payer' and raising taxes to cover it, what do you propose? Can we slap price controls on doctors/hospitals? Somehow, I think the 'free capitalism' crowd wouldn't be for that either. Less profit may also cause fewer doctors and innovation. Like I said it's a big mess and I am truly all ears.

 

[Ausm]

Does Bill Gates need insurance, or does he need health care? As I said, everyone needs health care, but not everyone needs insurance.

The real issue is how to control the costs of health care such that people can afford to pay for their regular health care while having insurance to cover catastrophic scenarios.

How many people have Bill gates money?

 

[Ausm]

The reason why health insurance is so expensive is because it covers already everything due to regulations. The regulations should be abolished and people should use insurance in case of catastrophic events, then pay out of pocket for everything else (cash only practices are pretty damn inexpensive). There should be personal deductions (but no deductions for employer-provided plans) for all personal, dependent, and charitable health care expenses and no patents so drugs can be cheaper.

I couldn't agree more. Obama's a retard for thinking health insurance is the same exact thing as health care.

My bullshit meter just blew up.

 

[nonlnear]

I am all ears. Besides requiring insurance purchase, public option, or just going 'single payer' and raising taxes to cover it, what do you propose? Can we slap price controls on doctors/hospitals? Somehow, I think the 'free capitalism' crowd wouldn't be for that either. Less profit may also cause fewer doctors and innovation. Like I said it's a big mess and I am truly all ears.

I made a brief post in the other PPACA love-fest thread (Europe is baffled...) that touches on a couple points. It was hardly comprehensive, but then again nothign I post will make a difference anyways... I'll just give some of the more fundamental reasoning here.

The thing about "Free market" lobbyists is that they are all lying. No capitalist actually wants a "free market". The term itself is generally a massive slegith of hand when used by anyone in a position to write a press release. To economists, "free market" usually refers to a market which satisfies some basic criteria from which it can be shown that a market equilibrium is optimal in some sense. When these criteria can be approximated reasonably well, the resulting outcome is generally very efficient. The problem is that in order to keep a market close to competitive (in the economic sense, not the marketing sense), you actually need pretty robust regulation. At the very least you need it to prevent price discrimination, and in markets for complicated products you need it to keep appropriate information flowing. These two issues pretty much define the American health insurance market, and the situation has been made worse by PPACA.

The economic term "free market" has nothing to do with what anti-regulation lobbyists want people to think it means. This is because no capitalist actually wants to operate in an economically competitive environment. In media print, "free market" means take out the regulations we don't like, but keep the ones that allow us to behave anti-competitively. This explains why the Republican party is generally bereft of good ideas. It's not because making a private system operate efficiently (yes, even one with a decent safety-net beneath it for the poor) is so hard, but because there is no deep pocketed lobbyist with an incentive to push for sanity within a private system.

 

[PokerGuy]

How many people have Bill gates money?

So you agree that you are wrong and that not everyone needs insurance, but that everyone needs health care. Good, we're making progress.

Then it comes back to my point, we have to address the cost of health care such that people can pay for their health care.

 

[Ausm]

So you agree that you are wrong and that not everyone needs insurance, but that everyone needs health care. Good, we're making progress.

Then it comes back to my point, we have to address the cost of health care such that people can pay for their health care.

So you want people to roll the dice and not carry insurance and when something catastrophic happens to them, then everyone who was responsible and carries health insurance would have to foot the bill...Gotcha!

 

[piasabird]

They have socialized medicine in the UK and cant even find a dentist.

Up to this point how we subsidise health costs for people with no insurance is the cost is high enough to pay for the indigent that show up at the emergency room with no insurance. However, not all the people with no insurance are poor. Many people choose not to pay for health insurance so they can purchase a larger house and drive a larger car. So why should we pay for people like this? I had to take my 70 year old mother to the emergency room and the people in the emergency room did not look poor. Most of them also did not have an emergency.

It is time to come up with a better system. However, I dont trust the Federal Government to run health Care. They will just make whatever we have, even more expensive, and add tons of red tape to do what we are doing now.

 

[PokerGuy]

So you want people to roll the dice and not carry insurance and when something catastrophic happens to them, then everyone who was responsible and carries health insurance would have to foot the bill...Gotcha!

Where exactly did I say any of that? Oh yeah, I didn't. I pointed out that health care is NOT the same as health insurance, and that you can have one without the other. Pretending they are the same muddies the water and makes it harder to have conversations about possible solutions. Do health insurance and health care both affect people? Yes, for those of us who are not Bill Gates, they do. Are they the same thing? No, they are not.

Health insurance has created a massive distortion of the marketplace for health care by insulating the consumer from the costs of the product they consume. Lack of pricing information prevents smart 'shopping' by the consumer.

ER services are by definition emergency situations, so the consumers can't shop around for the best deal. Hospitals can't deny ER treatment, so ER care is a completely different situation than most other health care and should be treated as such.

 

[sactoking]

For all the healthcare != health insurance folks, while that is true they are still very linked together. As stated in the oral arguments (which I listened to a lot of), health insurance is the primary way people pay for health care.

Except it's not when measured on a per-occurrence basis and it's becoming less so. Health insurance is the primary payor on a per-dollar basis because one $100,000 treatment will nullify 100,000 $1 treatments, but the vast majority or treatment occurrences are paid for out-of-pocket by people who haven't met their deductible. That will only get larger as the country shifts to more high-deductible plans.

This ignores most "cadillac" plans because they're actually HMOs which, while regulated like insurance, are not insurance they are managed-care plans.

 

[Ldir]

Where exactly did I say any of that? Oh yeah, I didn't. I pointed out that health care is NOT the same as health insurance, and that you can have one without the other.

Maybe for the 1%. Not for everyone else. For the 99% health insurance = health care.