Why so much fuss over Obamacare?

[fuzzybabybunny]

What other taxes does the U.S. government require to be paid just for being in the country?

The majority of citizens pay income tax.

 

[OGOC]

The majority of citizens pay income tax.

I'll try again...

What other taxes does the U.S. government require to be paid just for being in the country?

 

[fuzzybabybunny]

I'll try again...

What other taxes does the U.S. government require to be paid just for being in the country?

Oh, I see. You're arguing semantics. When I said "being in this country" I meant "a citizen of this country." I was not referring to some foreign tourist or some illegal immigrant.

Let me remind you that this topic is about mandated healthcare for people of this country that the IRS can track.

 

[OGOC]

Oh, I see. You're arguing semantics. When I said "being in this country" I meant "a citizen of this country." I was not referring to some foreign tourist or some illegal immigrant.

Let me remind you that this topic is about mandated healthcare for people of this country that the IRS can track.

It's not semantics.
It's not a trick question.
You said the government requires you to pay taxes just for being in this country. I couldn't think of any, so I assumed you knew of some since you said it.

And you don't have to pay income tax just for existing.
You say you meant "a citizen of this country," so I will change my question.

What other taxes does the U.S. government require to be paid just for being a citizen in the country?

 

[fuzzybabybunny]

It's not semantics.
It's not a trick question.
You said the government requires you to pay taxes just for being in this country. I couldn't think of any, so I assumed you knew of some since you said it.

And you don't have to pay income tax just for existing.
You say you meant "a citizen of this country," so I will change my question.

What other taxes does the U.S. government require to be paid just for being a citizen in the country?

Are we talking about citizens who are 1 year old as well? Or are we going to make the bold assumption that we are referring to the average adult citizens who earn enough as to be required to pay income tax?

No, not all citizens are required to pay tax. Citizens who are just out of a woman's womb have no tax burden to my knowledge. Those who make no income or very little income do not have to pay income tax.

Just trying to be on the same page here.

 

[fuzzybabybunny]

Whether the courts have said it's ok doesn't mean the government has the right to do it. It's wrong.

What other taxes does the U.S. government require to be paid just for being in the country?

So if the Supreme Court says that it is OK, why does that ruling *still* not give the government the right to do it? What entity/process/group *does* give the government the final right to do something then?

 

[OGOC]

So if the Supreme Court says that it is OK, why does that ruling *still* not give the government the right to do it? What entity/process/group *does* give the government the final right to do something then?

If the Supreme Court says it's ok to kill your neighbor for no reason, that doesn't mean it's right or that you should. If the Supreme Court says you do not have the right to be secure in your person against unreasonable searches and seizures, that doesn't mean you're not, because U.S. citizens have certain inalienable rights.

What's interesting is that Obamacare would be fought against much less if they simply passed universal coverage and then paid for it out of regular taxes. But that's not what they are doing.

 

[OGOC]

Are we talking about citizens who are 1 year old as well? Or are we going to make the bold assumption that we are referring to the average adult citizens who earn enough as to be required to pay income tax?

No, not all citizens are required to pay tax. Citizens who are just out of a woman's womb have no tax burden to my knowledge. Those who make no income or very little income do not have to pay income tax.

Just trying to be on the same page here.

There could be various examples. Someone who lives on a beach and eats sand. A homeless person living on the sidewalk surviving on handouts. Your cousin who sleeps on your couch all day and doesn't do anything. Someone with a stack of cash in their bunker fortress that they don't even pay unearned tax on because it's not in a bank collecting interest.

What other tax does someone have to pay just for being a citizen in the U.S.? I can't think of any. If so, this is a first. Obamacare requires you to pay a tax just for being a living citizen in the United States. Yes, poor people may get a subsidy on that tax so they pay zero, but it's still a required tax, and the government could raise it if they choose.

So is this a first? Is Obamacare the first U.S. tax for simply existing?

I am taxed, therefore I am.

 

[AViking]

What other taxes does the U.S. government require to be paid just for being in the country?

Who cares? Seriously who gives a shit? If you work you pay taxes. Nobody is paying taxes who isn't working.

It's a basic need. The country needs healthcare. For everyone. They need to fix the problem of millions without healthcare, hundreds of thousands going bankrupt, and people being denied healthcare and although I don't think ACA is perfect it's a step in the right direction.

 

[fuzzybabybunny]

If the Supreme Court says it's ok to kill your neighbor for no reason, that doesn't mean it's right or that you should. If the Supreme Court says you do not have the right to be secure in your person against unreasonable searches and seizures, that doesn't mean you're not, because U.S. citizens have certain inalienable rights.

What's interesting is that Obamacare would be fought against much less if they simply passed universal coverage and then paid for it out of regular taxes. But that's not what they are doing.

I think there's a fundamental disconnect here that you're not getting.

You have a written set of standards (the Constitution, in our case).

By itself, the Constitution is a piece of paper that holds no power.

It is up to *people* (Supreme Court in our case) to interpret the standards and to agree to its meaning.

It is up to *people* to then enforce that interpreted standard.

In the case of the ACA, the people in charge have interpreted the meaning and have set the standard. They are the ones who set the "right" and the "wrong" standards.

When you say that it is "wrong," you're simply expressing a personal opinion. It's just that. An opinion. Disconnected from the established, interpreted standard.

If you have a valid technical argument over why you think the SC *interpreted* the Constitution incorrectly, then say it. Simply saying it's "wrong" goes nowhere.

 

[fuzzybabybunny]

There could be various examples. Someone who lives on a beach and eats sand. A homeless person living on the sidewalk surviving on handouts. Your cousin who sleeps on your couch all day and doesn't do anything. Someone with a stack of cash in their bunker fortress that they don't even pay unearned tax on because it's not in a bank collecting interest.

What other tax does someone have to pay just for being a citizen in the U.S.? I can't think of any. If so, this is a first. Obamacare requires you to pay a tax just for being a living citizen in the United States. Yes, poor people may get a subsidy on that tax so they pay zero, but it's still a required tax, and the government could raise it if they choose.

So is this a first? Is Obamacare the first U.S. tax for simply existing?

I am taxed, therefore I am.

No, no tax is universal for everyone, including the ACA. They're all at least situational.

http://ccf.georgetown.edu/all/individual-mandate-exceptions/

I would suggest doing more research on the ACA before commenting.

It's hard to have a good debate when the people debating are lacking very critical pieces of information.

Unfortunately, I have a feeling this is what the entirely of our Congress (and the vast majority of our society) is like... people not being on the same page even on the fundamentals.

 

[Ksyder]

One of the things that I have a problem with is that the current medical system is basically sick care. There seems to be very little effort to teach the masses how to prevent diabetes, heart disease, and other things that are diseases of affluence.

Even if there was some widespread attempt to improve the lifestyle of the average unhealthy person, it may be too late for most people. The damage has been done. The greed of the agribusiness/industrial complex in the 20th century has done the citizens irreparable harm by promoting refined food, hydrogenated oils, and sugars, and the government has subsidized these things for the benefit of the farmers. The artificially low cost of these poor quality foods like chips, donuts, bread, etc has caused a widespread obesity crisis, as well as the other associated diseases like type 2 diabetes which is preventable and treatable through lifestyle, at least at some level.

But, there is no agreement as to what the right lifestyle is, and no one size fits all solution. Which brings me back to the sick care idea. Other types of healthcare like naturopathic doctors actually do treat the causes of diseases in many cases but I don't think people are being mandated to become their patients. I don't know that any insurance would even cover that. For example, sleep is very important for metabolic health. But most people won't prioritize that because in our culture sleep is optional.

This is somewhat off topic to this discussion but I feel it is rarely discussed in the context of the health care crisis in this country.

 

[AViking]

Well you would need to legislate fast food and processed food and I don't think most people are for that.

There has to be some level of personal responsibility. It is up to each of us to eat healthy and exercise.

At some point though I wouldn't be surprised if a fat tax is instituted. It will probably be in the form of much higher taxes on these types of foods and then people will stop eating them since the cost difference is not significant enough to warrant eating them over healthy foods. That is still not going to stop many people but it might cover the cost of their healthcare.

Honestly though people who eat that type food are not doing the math. You can buy a bag of rice, some beans, eggs, etc and come out way ahead of eating processed and fast food. Why go and buy 8 pcs of fried chicken when you can buy a whole chicken, put it in a clay pot, and cook it in the oven for much less money and for a much more healthy meal?

 

[Ksyder]

I'm sure everyone here remembers the food pyramid guide. That says to eat 6-11 servings of bread, rice, and pasta. Even vegetables are less servings on the pyramid than that. Its laughable when you think about the fact that it was created by the USDA. And what do they know about health? Apparently they know more about money.

 

[AViking]

I'm sure everyone here remembers the food pyramid guide. That says to eat 6-11 servings of bread, rice, and pasta. Even vegetables are less servings on the pyramid than that. Its laughable when you think about the fact that it was created by the USDA. And what do they know about health? Apparently they know more about money.

You might want to double check that

http://www.choosemyplate.gov/

 

[Gunslinger08]

I know I've already posted here, but I want to talk about the mandate.

I think it's pretty crappy to require people to purchase a private product. Many people will equate this to car insurance, but:
1. You don't have to own a car. The ACA penalty is incurred just for being alive. Yes, it is waived if you have a low income, but it still exists.
2. You have a natural and Constitutional right to life. Driving a car is a privilege. This is the same argument used against requiring licenses for firearms.
3. Now that the precedent has been set, why wouldn't/couldn't Congress pass a bill requiring you to buy other private products or face a penalty? Require everyone to buy an electric car. Require everyone to buy a gun. Require everyone to buy a home alarm system. Require everyone to buy life insurance. I don't like the precedent at all.

I think just about everyone can see that our current system isn't sustainable. I think we need to do one or more of these things:
1. Change health insurance to only cover catastrophic illness. Day to day fees are paid out of pocket. There are already plans like this and I think they make a lot of sense. This should lead to lower costs for a lot of things, as insurance billing costs are reduced and people actively choose to shop around for a doctor that provides better value.
2. Remove the link between employment and health insurance. Individuals should purchase their own insurance. Open the markets up nationwide. This lets you have hundreds/thousands of options for insurance instead of the 2 or 3 plans offered by your employer which they chose for reasons that may not entirely benefit you. Now you get the exact insurance you want and can afford.
3. Single payer. I think this is probably where we're headed, but I don't love it. I'm afraid of the consequences down the line in regards to cost controls. It's a fact that healthcare costs go up. With the government footing the entire bill, it's going to become political. We're either going to raise taxes to pay for an aging and unhealthy population's healthcare or we're going to implement cost controls. Cost controls could include:
- Limit salaries in healthcare. This could lead to an exodus of talent and/or an extremely overworked employee base.
- Ration most care. With a decreased employee base and an increased demand (of people who now have free insurance), it's going to be harder to get an appointment and things like tests and medication will be rationed to save money. Some of this is good - I'm sure we waste a good amount of money on pointless tests and prescriptions. Will it always be good? Do you want politicians or unelected government workers deciding if you can have a test or procedure done? I know that the insurance companies do this now, but you also have the option to switch insurance plans. In single payer, you don't.
- Reduce end of life care. This is the death panel a lot of people were up in arms about. Basically, someone will have to decide if Grandma can get her mastectomy at 85 when she's diagnosed with breast cancer.
- Tort reform. I know this isn't a big cost, but it's going to happen eventually. Having a single payer system that may involve the government covering malpractice insurance will make this happen much faster.
- Cut research spending. Now that prescriptions are more limited and prices are controlled, drug companies are going to have smaller profits. The government will eventually step in and start funding it. This is an easy place to cut spending when results are 5-10 years out vs. spending now that will save some lives today and win an election tomorrow.

 

[Ksyder]

You might want to double check that

http://www.choosemyplate.gov/

No, thats a plate, not a pyramid. I'm talking about the old food guide pyramid which is what people like me were told to follow in the 80's and 90's. Maybe the plate is a bit better now.

 

[fskimospy]

It's not semantics.
It's not a trick question.
You said the government requires you to pay taxes just for being in this country. I couldn't think of any, so I assumed you knew of some since you said it.

And you don't have to pay income tax just for existing.
You say you meant "a citizen of this country," so I will change my question.

What other taxes does the U.S. government require to be paid just for being a citizen in the country?

In order to survive as an adult in this country you will need to pay sales tax at a minimum, (sans Delaware!), income/payroll taxes are also extraordinarily likely.

The only way to truly avoid all these taxes would be to simply not buy anything. The only way I see someone doing that would be by not having any money, but in that case you would be covered by the Medicaid provisions of the ACA anyway so you wouldn't have to pay anything then either.

 

[fskimospy]

3. Now that the precedent has been set, why wouldn't/couldn't Congress pass a bill requiring you to buy other private products or face a penalty? Require everyone to buy an electric car. Require everyone to buy a gun. Require everyone to buy a home alarm system. Require everyone to buy life insurance. I don't like the precedent at all.

Quick thing, the precedent for the federal government forcing you to buy things was set by George Washington and a number of the founding fathers with the Militia Act of 1792.

 

[Mr. Pedantic]

I know I've already posted here, but I want to talk about the mandate.

I think it's pretty crappy to require people to purchase a private product. Many people will equate this to car insurance, but:
1. You don't have to own a car. The ACA penalty is incurred just for being alive. Yes, it is waived if you have a low income, but it still exists.
2. You have a natural and Constitutional right to life. Driving a car is a privilege. This is the same argument used against requiring licenses for firearms.
3. Now that the precedent has been set, why wouldn't/couldn't Congress pass a bill requiring you to buy other private products or face a penalty? Require everyone to buy an electric car. Require everyone to buy a gun. Require everyone to buy a home alarm system. Require everyone to buy life insurance. I don't like the precedent at all.

I think just about everyone can see that our current system isn't sustainable. I think we need to do one or more of these things:
1. Change health insurance to only cover catastrophic illness. Day to day fees are paid out of pocket. There are already plans like this and I think they make a lot of sense. This should lead to lower costs for a lot of things, as insurance billing costs are reduced and people actively choose to shop around for a doctor that provides better value.
2. Remove the link between employment and health insurance. Individuals should purchase their own insurance. Open the markets up nationwide. This lets you have hundreds/thousands of options for insurance instead of the 2 or 3 plans offered by your employer which they chose for reasons that may not entirely benefit you. Now you get the exact insurance you want and can afford.
3. Single payer. I think this is probably where we're headed, but I don't love it. I'm afraid of the consequences down the line in regards to cost controls. It's a fact that healthcare costs go up. With the government footing the entire bill, it's going to become political. We're either going to raise taxes to pay for an aging and unhealthy population's healthcare or we're going to implement cost controls. Cost controls could include:
- Limit salaries in healthcare. This could lead to an exodus of talent and/or an extremely overworked employee base.
- Ration most care. With a decreased employee base and an increased demand (of people who now have free insurance), it's going to be harder to get an appointment and things like tests and medication will be rationed to save money. Some of this is good - I'm sure we waste a good amount of money on pointless tests and prescriptions. Will it always be good? Do you want politicians or unelected government workers deciding if you can have a test or procedure done? I know that the insurance companies do this now, but you also have the option to switch insurance plans. In single payer, you don't.
- Reduce end of life care. This is the death panel a lot of people were up in arms about. Basically, someone will have to decide if Grandma can get her mastectomy at 85 when she's diagnosed with breast cancer.
- Tort reform. I know this isn't a big cost, but it's going to happen eventually. Having a single payer system that may involve the government covering malpractice insurance will make this happen much faster.
- Cut research spending. Now that prescriptions are more limited and prices are controlled, drug companies are going to have smaller profits. The government will eventually step in and start funding it. This is an easy place to cut spending when results are 5-10 years out vs. spending now that will save some lives today and win an election tomorrow.

This won't really work in healthcare, because demand will always be greater than supply. If your wife is sick and every single doctor in the States charges, say, $500 an hour, what are you going to do? Let her stay sick and die? Of course not. You're going to suck it up and pay the money. And that's what has basically been happening in the US. Hospitals can charge the prices they charge because they know that even with those exorbitant prices they will always have business.

 

[Juddog]

No, thats a plate, not a pyramid. I'm talking about the old food guide pyramid which is what people like me were told to follow in the 80's and 90's. Maybe the plate is a bit better now.

The understanding of macro nutrition, back in the 80's and 90's, isn't what it is today.

Back then they didn't know better, and didn't understand about how excess glucose gets dumped into building up glycogen in your liver and triglycerides in your adipose, as well as stressing your pancreas from producing so much insulin (not to mention the necessity of activating glucagon and the value of ketones / growth hormones from periods when glucose gets low and the body starts tapping into glycogen reserves).

The old food pyramid is obsolete, which is why there was the big push to change it to something that made sense, which is why they changed it to a plate.

 

[Gunslinger08]

Quick thing, the precedent for the federal government forcing you to buy things was set by George Washington and a number of the founding fathers with the Militia Act of 1792.

I knew about this, but forgot while I was writing that post. I wonder how it would have played out in the Supreme Court, had it been challenged after Marbury v. Madison?

I haven't read the actual text of the acts. What was the penalty for not buying a rifle?

 

[Gunslinger08]

This won't really work in healthcare, because demand will always be greater than supply. If your wife is sick and every single doctor in the States charges, say, $500 an hour, what are you going to do? Let her stay sick and die? Of course not. You're going to suck it up and pay the money. And that's what has basically been happening in the US. Hospitals can charge the prices they charge because they know that even with those exorbitant prices they will always have business.

I don't know that this is necessarily true. Yeah, there is (and always will be) high demand for healthcare, but demand would probably drop if health insurance was only for catastrophic illness/emergency. People (like many I know) wouldn't go to the doctor multiple times for a cold to get antibiotics that aren't actually going to help. I think demand would go down if people had to pay out of pocket for lesser illness. If you look at healthcare segments that aren't typically covered by insurance (ex. plastic surgery, LASIK), prices in the market have dropped quite a bit as time goes on.

 

[Mr. Pedantic]

I don't know that this is necessarily true. Yeah, there is (and always will be) high demand for healthcare, but demand would probably drop if health insurance was only for catastrophic illness/emergency. People (like many I know) wouldn't go to the doctor multiple times for a cold to get antibiotics that aren't actually going to help. I think demand would go down if people had to pay out of pocket for lesser illness.

Actually, in that situation demand would probably go up because fewer people would engage in the care necessary for early diagnosis/prevention of those diseases. Chronic conditions make up far more of doctors' workload than I think most healthy people realise.

If you look at healthcare segments that aren't typically covered by insurance (ex. plastic surgery, LASIK), prices in the market have dropped quite a bit as time goes on.

Yes, because those are non-essential. Saying that the price of that boob job is too high, therefore you'll go to South Korea for it is a bit different to saying the price of that chemotherapy is too high, therefore you'll go to Burma for it.

 

[fuzzybabybunny]

I know I've already posted here, but I want to talk about the mandate.

I think it's pretty crappy to require people to purchase a private product. Many people will equate this to car insurance, but:
1. You don't have to own a car. The ACA penalty is incurred just for being alive. Yes, it is waived if you have a low income, but it still exists.

The purpose of mandatory insurance is to hedge risk for *everyone* in society because healthcare is one of those things that is very expensive for ordinary single people to pay. Health, along with life, is also a mandatory thing. Some would argue it is also a right.

Imagine if car insurance was not mandatory. People would get in wrecks and many people wouldn't be able to pay the other party for damages because car repair is extremely expensive. This can have an effect of putting a lot of citizens at risk and even dragging down society.

Healthcare costs are the same thing. They can get VERY expensive and if *someone* didn't have the ability to pay the providers the entire system and even society would weaken tremendously.

2. You have a natural and Constitutional right to life. Driving a car is a privilege. This is the same argument used against requiring licenses for firearms.

See my point above. It's not about rights vs. something that's not a right. It's about decreasing the cost and risk to society as a whole for something that is necessary to life and a functional society. It's a public good. Education is not a right. Infrastructure like roads and bridges are not a right. Yet we still pay taxes to fund local public schools (whether or not you have a kid in the local school) and roads and bridges are also paid for by your mandatory taxes despite the fact that you may not necessarily use them and it's not a right to have them.

3. Now that the precedent has been set, why wouldn't/couldn't Congress pass a bill requiring you to buy other private products or face a penalty? Require everyone to buy an electric car. Require everyone to buy a gun. Require everyone to buy a home alarm system. Require everyone to buy life insurance. I don't like the precedent at all.

Still flows into my previous two points. But it also has to do with the fact that, for example, mandating that everyone buy a home alarm system won't bring enough benefits to society as a whole as to justify a mandate, a decrease in freedom, and the added financial burden to individuals.

I think just about everyone can see that our current system isn't sustainable. I think we need to do one or more of these things:
1. Change health insurance to only cover catastrophic illness. Day to day fees are paid out of pocket. There are already plans like this and I think they make a lot of sense. This should lead to lower costs for a lot of things, as insurance billing costs are reduced and people actively choose to shop around for a doctor that provides better value.

We can't do this. We have to work with the system that we have and pick the low-hanging fruit and take baby steps. Our system is severely misconfigured and the ACA is the best that we can do *at this time* with the current structures in place. That is, we utilize and reconfigured the existing imperfect systems to at least make things a *little* better. The sad fact is that the entire medical industry (and their prices) are NOT subject to free-market forces.

People would have a very difficult time choosing and shopping between providers because the market infrastructure just isn't there and the prices are hidden and not advertised. Day-to-day fees are already extremely high without insurance, and you only find out about those fees *after* you get treatment.

Add to the fact that there is a fundamental difference between healthcare services, which are very custom by nature, and buying a burrito, which does not need to be very customized. It is ALWAYS harder or impossible to accurately price custom services, especially ones in which the details of the problem are unknown, which is why a traditional marketplace sometimes *can't* work for such things.

In fact, this is the same with car repair work, depending on the work. The best that you can do is maybe create an online bidding website in which a customer submits a request for service ("I have a pain in my ear. I'm not sure why. That's all the detail I have of the problem. Ok, bid away!")

Even with all these challenges, is there an active, Yelp-like review service for healthcare providers? Is there a "Pricegrabber" where you can find the prices and services and reviews of all the doctors in your area? And even if there were, would it even work for the extremely custom nature of healthcare?

Insurance does more than hedge and limit risk exposure for society. It simplifies pricing for extremely custom services.

With that said, people often complain about how we are using insurance to pay for ALL medical services. Even if we go in for a simple thing like diarrhea, we use insurance to pay for it. If one of our tires blows out on our car, we pay out of pocket for it - we most definitely don't using insurance for it.

What these people are missing is that we DON'T use insurance to pay for all medical expenses. There's a deductible! If your deductible is $4,000, you'll be paying out of pocket for everything under that $4,000 and your insurance won't be helping you with any of it (with the exception of yearly free checkups and whatnot).

Insurance is acting as an expense *limiter.* It saves your ass in catastrophes, but it can also limit your expenses if you're just having a bad year, like repeat required visits to the doctor for your back that you blew out lifting a rock while gardening.

Lastly, insurance acts as a bargaining agent between YOU and the provider. You, as a single consumer, have zero bargaining power over a provider, ESPECIALLY since the providers do not operate under free market principles, due to both the custom nature of the work and the lack of marketplace infrastructure. Insurance gets you the good bulk pricing that you would never be able to get as an individual.


2. Remove the link between employment and health insurance. Individuals should purchase their own insurance. Open the markets up nationwide. This lets you have hundreds/thousands of options for insurance instead of the 2 or 3 plans offered by your employer which they chose for reasons that may not entirely benefit you. Now you get the exact insurance you want and can afford.

Yes. Employment and getting insurance has never made any sense to me. I guess it started out as a weak government attempt to get more people insured by mandating that employers insure their employees if the business is above a certain size. It was a half-measure, but better than nothing. Right now we are finally employing something more full with the ACA.

3. Single payer. I think this is probably where we're headed, but I don't love it.

Why do you think this is where we're heading? This would mean a drastic and profound overhaul of our entire healthcare industry. It is the exact opposite of the low-hanging fruit and working to incrementally change things. It would mean dissolving the entire industry of private health insurance companies.

See bolded.