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PUmatty
Joined: 10 Nov 2004
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 Posted: 09/22/17 3:27 pm ::: |
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| ArtBest23 wrote: |
| justintyme wrote: |
| ArtBest23 wrote: |
So it looked like good news that McCain says he "cannot in good conscience" vote for the latest GOP bill.
Then I see about CNN'S Monday night healthcare debate. Graham and Cassidy vs Sanders and Klobuchar. One last chance for Bernie and the Dems to fuck this up and drive the "no" votes into the yes column.
Maybe they should just STFU while they're ahead. |
I actually agree with you here. Like just wait until next month when this crap is dead and then go gung ho on the single payer. This makes the narrative much more confusing to the lay person and it makes it sound like the ACA is so untenable that we need to get rid of it. And if that's the case, no harm going with the GOP shitpile.
After the clock ticks October and 60 votes become required on this, then we can start getting into the ACA=decent but are there better options that go further debates. |
Plus, does anyone think that Sanders and Klobuchar make a great front pair? Well, I suppose they could have paired Warren with Sanders and REALLY looked foolish. |
I have to think Klobuchar is trying to raise her profile. She is very impressive, IMO, but it has been hard for her to cut through and get noticed.
It's all about 2020.
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cthskzfn
Joined: 21 Nov 2004
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cthskzfn
Joined: 21 Nov 2004
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| Posted: 09/22/17 5:15 pm ::: |
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| jammerbirdi wrote: |
| pilight wrote: |
| cthskzfn wrote: |
| Why do Republiscums continually lie about this bill? |
That's what politicians do. If you like your health care plan, you can keep it... |
Yeah, boo-hoo, cry me a river.  |
yeah, wtf was i thinking. OF COURSE they will lie about people being exempt from pre-existing condition disqualification, thus ensuring their insolvency and/or death. Just like the Democrats lie about it, right?
Cuz see there, pilight did that bs equivalency thing he likes to do. Obama said you could keep your plan, but some couldn't. And that "lie" is the same as Trump, Cassidy, et al, saying yes your pre-existing condition WILL be covered.
Same exact thing.
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GlennMacGrady
Joined: 03 Jan 2005
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| Posted: 09/22/17 5:26 pm ::: |
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| justintyme wrote: |
| do you choose to pay $600 per year in tax penalties (provided you also don't just lie), or do you pay $200 per month for affordable health insurance? |
Where do you get your numbers? I've been providing actual ones in this and the other thread.
I just got quoted an Obamacare policy in my state for a 25 year old male with a $45,000 per year income. The lowest premium bronze policy is $237 per month with a $6,000 deductible, $200 copays at the ER and $40 copays at a primary.
If I fit that profile and were healthy, I'd definitely pay the tax unless it approached that huge deductible. Even Democrats wouldn't have voted for that big a tax.
PUmatty, it's an irrelevant tangent, but federal power to make people pay money for not buying a product (the "individual mandate") can only come from three places in the Constitution: the Commerce Clause, the Necessary and Proper Clause or the Taxing Clause. The Obamacare case began by explicitly holding that there is no federal power to impose the individual mandate under the CC or N&P clauses, but that it was constitutional if interpreted as a tax. The tax argument was considered by just about everyone to be the weakest argument for the government because, for several technical reasons, the individual mandate does not have the characteristics of a tax.
McCain's rationale for voting against G-C is partly irrational. He says he only wants legislation that goes through regular committee order with bipartisan support. That's ridiculous. Democrats will never vote to do anything that will change Obamacare coverage or funding. They would be in favor only of the same kind of fix that JIT is: increasing the mandate/tax dramatically to force more insurance purchases or to get more mandate/tax revenue to give to the insurance companies to support their premiums. This would be a tax hardship entirely on the middle class. The poor get subsidies and the rich don't care. |
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jammerbirdi
Joined: 23 Sep 2004
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| Posted: 09/22/17 7:05 pm ::: |
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| ArtBest23 wrote: |
So it looked like good news that McCain says he "cannot in good conscience" vote for the latest GOP bill.
Then I see about CNN'S Monday night healthcare debate. Graham and Cassidy vs Sanders and Klobuchar. One last chance for Bernie and the Dems to fuck this up and drive the "no" votes into the yes column.
Maybe they should just STFU while they're ahead. |
This I agree with. Timing, context, etc. dictates strategy and actions. This is a treacherous moment until this latest Republican effort goes down in flames.
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justintyme
Joined: 08 Jul 2012
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Location: Northfield, MN
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| Posted: 09/22/17 7:06 pm ::: |
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| GlennMacGrady wrote: |
| justintyme wrote: |
| do you choose to pay $600 per year in tax penalties (provided you also don't just lie), or do you pay $200 per month for affordable health insurance? |
Where do you get your numbers? I've been providing actual ones in this and the other thread.
I just got quoted an Obamacare policy in my state for a 25 year old male with a $45,000 per year income. The lowest premium bronze policy is $237 per month with a $6,000 deductible, $200 copays at the ER and $40 copays at a primary. |
That's the point. My example was in a hypothetical world in which the ACA performed as expected. Even in those idealized circumstances, young and healthy people would have opted to not buy the insurance. In the real world ot was doubly so. The penalty needed to be more than they would pay for the bare minimum policy. Basically, the mandate needed to be mandatory.
The first year the prices weren't terrible in most places (and that was without the risk corridors, which had they been funded would have dropped premiums even more. But even then there were not enough young and healthy signing up, which meant that the next year there was a massive premium hike, which priced even more people out of the pool and made it even more likely people would opt for the penalty.
You want to see premiums drop? Auto-enroll everyone unless they return a hardship waiver showing that the premiums they would have to pay were greater than a certain % of income. And if you really wanted to do it, fully fund the risk corridors so that the initial premiums are even lower, making less people qualify for the waiver.
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GlennMacGrady
Joined: 03 Jan 2005
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| Posted: 09/22/17 10:13 pm ::: |
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Mandatory mandate?
In the real world millions would lie on their tax returns or tell the truth but refuse to pay the tax. Neither Obama nor Clinton nor Sanders nor Trump would authorize the IRS to prosecute millions of young people for tax avoidance, even if the IRS had the manpower, which it doesn't. There would be an executive DATA order -- Deferred Action for Tax Avoiders.
Result: same as today. Death spiral. |
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GlennMacGrady
Joined: 03 Jan 2005
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| Posted: 09/22/17 10:49 pm ::: |
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justintyme
Joined: 08 Jul 2012
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| Posted: 09/23/17 2:47 am ::: |
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| GlennMacGrady wrote: |
Mandatory mandate?
In the real world millions would lie on their tax returns or tell the truth but refuse to pay the tax. Neither Obama nor Clinton nor Sanders nor Trump would authorize the IRS to prosecute millions of young people for tax avoidance, even if the IRS had the manpower, which it doesn't. There would be an executive DATA order -- Deferred Action for Tax Avoiders.
Result: same as today. Death spiral. |
That is why you auto-enroll everyone. Only way to not get enrolled is to submit a waiver proving the premium would be over a certain % of your income.
In other words, for a free market system to work (hell, any system) it needs to be mandatory. Really, that is the magic bullet that makes single payer so cost effective everywhere it has been implemented: it forces 100% enrollment.
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pilight
Joined: 23 Sep 2004
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| Posted: 09/23/17 4:18 pm ::: |
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| Damn the freedom of choice, full speed ahead. You must buy what Big Brother tells you to, whether you need it or not.
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justintyme
Joined: 08 Jul 2012
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| Posted: 09/23/17 5:59 pm ::: |
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| pilight wrote: |
| Damn the freedom of choice, full speed ahead. You must buy what Big Brother tells you to, whether you need it or not. |
No, you just need to buy insurance. It is only if you fail to buy it at all that you would be auto-enrolled. But what plan people buy is up to them, it would only be the people who fail to excercise their choice that one would be made for them. It is basically what Germany does with their plan.
But, no, people should not have the "freedom" to go without health coverage just like people should not have the "freedom" to drive without auto insurance. In order for insurance to work, there needs to be people to balance out the older and sicker people. Or else premiums are ridiculous.
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pilight
Joined: 23 Sep 2004
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| Posted: 09/23/17 6:26 pm ::: |
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Auto insurance is not the same as health insurance. Auto insurance is required because of the relatively high probability of the insured person doing damage to someone else. That's why the only required insurance in the majority of states is liability insurance. Equating that to health insurance would mean you think people need to buy health coverage in case they make someone else sick. Also, auto insurance isn't required. Many millions of people who don't drive on public streets don't have it. Unless you're claiming people's bodies are public thoroughfares, auto insurance requirements and this health insurance mandate are not analogous. And, for people who do drive, it's not a federal requirement, not all states require auto insurance, and in the states that do require it the minimum varies widely.
And, of course, no states auto-enroll people in car insurance if they decline to purchase their own.
STOP trying to equate auto insurance and health insurance. They are not equivalent.
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justintyme
Joined: 08 Jul 2012
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| Posted: 09/23/17 6:47 pm ::: |
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| pilight wrote: |
| STOP trying to equate auto insurance and health insurance. They are not equivalent. |
Of course they aren't equivalent.
But whether or not people get health insurance absolutely affects everyone else, and in cases like that governmental regulations are not uncommon. If the only people who got insurance were the people who were likely to use/need it, the markets would be even worse. We all rely upon people who don't need it paying in so that those who do need it can have it. The reality is, with the exception of some very rich people, health insurance will be necessary for all of us at some point in our life. So in a way it is worse than car insurance where we could easily go our entire lives without utilizing it. Not to mention, when the people who don't have insurance get sick, they end up costing us all even more money in increased medical costs.
So, yes, it is not like auto insurance since not everyone drives a car. And people who don't drive don't need to be insured. But everyone has health needs, everyone "drives" their own bodies and will eventually need health care. So the basic philosophy for why people can't have the "freedom" to not have these things remains.
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GlennMacGrady
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| Posted: 09/23/17 10:02 pm ::: |
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JIT, remember that the NFIB (Obamacare) case held that there is no power in the Constitution for the federal government to force citizens to buy anything. The mandates/penalties were only upheld as federal taxes on that segment of U.S. taxpayers who have no health insurance. Hence, it would be unconstitutional for the federal goverment to auto-enroll or otherwise force citizens into a payment scheme to buy insurance or any other product or service, unless they can construct the entire auto-enrollment forcing scheme to be nothing more than a constitutional tax, which seems very unlikely.
State governments have much more legal power to compel behavior under the federal Constitution and their state constitutions. This power, called the "police power", has been recognized since ancient times and extends to state legislation in the areas of health, safety and the general welfare. States can require auto insurance under their inherent police power.
The federal goverment, under the 10th Amendment, has no police power and cannot require auto insurance. What the federal goverment apparently can do, at most, under the contorted NFIB decision is to make people pay a "tax" if they don't have auto insurance. Not many constitutional lawyers would have thought the federal government even had that power prior to NFIB.
Most people today have no understanding of the constitutional structure of our country. We do not have a unitary government like Germany. The United STATES of America is a voluntary federation of independently sovereign states who joined together and gave the centralized national government only very limited powers in a contract called the Constitution. Originally, those federal powers were the power to command a national army and run a national post office, and a few other things. You can see how the federal power has H-bomb mushroom-clouded since then, mostly by "big government" federal legislators and judges, who continually ignore and try to rip away the fundamental and original fabric of state sovereignty. |
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pilight
Joined: 23 Sep 2004
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| Posted: 09/23/17 10:59 pm ::: |
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| justintyme wrote: |
| But whether or not people get health insurance absolutely affects everyone else, and in cases like that governmental regulations are not uncommon |
It always did. Long before ObamaCare ever existed that was the case. ObamaCare made it worse by forcing companies to give away their product to people who couldn't afford it, meaning the people who could had to pay more. Since rich people were already paying top dollar for insurance, it was the working class and middle class that got killed.
None of this is news. It's exactly what critics of ObamaCare said would happen when it was adopted.
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ArtBest23
Joined: 02 Jul 2013
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| Posted: 09/24/17 12:16 am ::: |
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| GlennMacGrady wrote: |
| JIT, remember that the NFIB (Obamacare) case held that there is no power in the Constitution for the federal government to force citizens to buy anything. . |
You'd better quote the portions that you imagine say that.
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ArtBest23
Joined: 02 Jul 2013
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| Posted: 09/24/17 12:18 am ::: |
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| Duplicate
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justintyme
Joined: 08 Jul 2012
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| Posted: 09/24/17 3:27 am ::: |
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| pilight wrote: |
| justintyme wrote: |
| But whether or not people get health insurance absolutely affects everyone else, and in cases like that governmental regulations are not uncommon |
It always did. Long before ObamaCare ever existed that was the case. ObamaCare made it worse by forcing companies to give away their product to people who couldn't afford it, meaning the people who could had to pay more. Since rich people were already paying top dollar for insurance, it was the working class and middle class that got killed.
None of this is news. It's exactly what critics of ObamaCare said would happen when it was adopted. |
That is an overly simplistic view on what happened. The insurance companies weren't "forced" to give away their product, they had free reign to set their prices at what their actuarial tables dictated. There was some limiting on the amount of profit an insurer could make, but that was basically it.
Before the ACA, insurance companies used a couple big tricks to manage their premiums:
1) Pricing out high risk people. If you had a preexisting condition you would either be denied, or forced to pay so much that it priced you out of the pool. This left a risk pool of relatively healthy people who were not as likely to be a net taker.
2) Bare bones policies, or policies with caps. This was a common technique used by companies. The policies were basically worthless if you actually got sick. They were cheap because the risk was tiny.
3) Refusal to cover certain services. It was basically impossible to get mental health, maternity, or rehabilitation coverage unless you were in a group plan that specifically requested it. And even those were few and far between. But individual plans? Forget it. This was by design, as the only people who would want these on an a la carte basis are the people who expected to need to use them. But it wasn't just about those services, because the little actuarial tables pointed out that people who need those services also tend to be much higher risk of needing other health services. In other words, insurers didn't want these people at all.
But the ACA changed all that. Insurance companies had to insure sick people. This meant that some other mechanism was required to make sure the risk pool wasn't out of whack. That is where the individual mandate came into play. The mandate is what made it workable. For the ACA to be tenable, it required universal participation. The mandate was the cornerstone of the legislation. So, yes, insurance companies were forced to sell a more comprehensive package and couldn't exclude high risk people, but the flip side of that was that the people were also required to now buy their product. It was the failure of that second part that led to the working and middle classes getting hosed on premiums.
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pilight
Joined: 23 Sep 2004
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| Posted: 09/24/17 10:07 am ::: |
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| We're basically in agreement that the ACA never had a chance of working
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GlennMacGrady
Joined: 03 Jan 2005
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| Posted: 09/24/17 12:44 pm ::: |
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| ArtBest23 wrote: |
| GlennMacGrady wrote: |
| JIT, remember that the NFIB (Obamacare) case held that there is no power in the Constitution for the federal government to force citizens to buy anything. . |
You'd better quote the portions that you imagine say that. |
I don't have to imagine anything. I can read. So can you. Do it, and make your argument against my one sentence summary of a complex opinion.
For those who don't read Supreme Court opinions, as you should, here are quotes from the majority opinion holding that the federal Congress cannot compel unwanted purchases of any product in any market in which an individual is not participating:
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| . . . Congress has employed the commerce power in a wide variety of ways to address the pressing needs of the time. But Congress has never attempted to rely on that power to compel individuals not engaged in commerce to purchase an unwanted product. |
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| The individual mandate . . . . compels individuals to become active in commerce by purchasing a product, on the ground that their failure to do so affects interstate commerce. Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority. Every day individuals do not do an infinite number of things. |
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Indeed, the Government's logic would justify a mandatory purchase to solve almost any problem. . . . To consider a different example in the health care market, many Americans do not eat a balanced diet. That group makes up a larger percentage of the total population than those without health insurance. . . . The failure of that group to have a healthy diet increases health care costs, to a greater extent than the failure of the uninsured to purchase insurance. . . . Those increased costs are borne in part by other Americans who must pay more, just as the uninsured shift costs to the insured. . . . Congress addressed the insurance problem by ordering everyone to buy insurance . Under the Government's theory, Congress could address the diet problem by ordering everyone to buy vegetables.
People, for reasons of their own, often fail to do things that would be good for them or good for society. . . . Under the Government's logic, that authorizes Congress to use its commerce power to compel citizens to act as the Government would have them act.
That is not the country the Framers of our Constitution envisioned. |
| Quote: |
| Everyone will likely participate in the markets for food, clothing, transportation, shelter, or energy; that does not authorize Congress to direct them to purchase particular products in those or other markets today. . . . Any police power to regulate individuals as such, as opposed to their activities, remains vested in the States. |
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| The individual mandate forces individuals into commerce precisely because they elected to refrain from commercial activity. Such a law cannot be sustained under a clause authorizing Congress to "regulate Commerce." |
The Supreme Court's majority decision, having forcefully held that Congress cannot compel unwanted purchases in the insurance or "any other market" under the Commerce Clause, then went on to hold that Congress cannot compel purchases under the Necessary & Proper Clause either.
JIT, you should be in favor of a state-centric plan like Graham-Cassidy because the states, unlike the federal government, may have the compulsive legal power to do what you want. If the federal goverment allocates sufficient money back to the states to do this, you should drop your concerns that different states may enact different flavors of compelled healthcare. Direct your lobbying efforts at your state's legislature where you may have much greater impact than on the national legislature, which is hopelessly gridlocked on every issue of substance. Meanwhile, Obamacare will inexorably continue its death spiral. |
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justintyme
Joined: 08 Jul 2012
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| Posted: 09/24/17 2:41 pm ::: |
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| GlennMacGrady wrote: |
JIT, you should be in favor of a state-centric plan like Graham-Cassidy because the states, unlike the federal government, may have the compulsive legal power to do what you want. If the federal goverment allocates sufficient money back to the states to do this, you should drop your concerns that different states may enact different flavors of compelled healthcare. Direct your lobbying efforts at your state's legislature where you may have much greater impact than on the national legislature, which is hopelessly gridlocked on every issue of substance. Meanwhile, Obamacare will inexorably continue its death spiral. |
A state centric plan could work. And there are ones I would support were the funding on point. However, Graham-Cassidy is a garbage plan. Getting rid of the essential health benefits and the locked in community rating is a non-starter for me.
But ultimately I support single payer as I feel that the buying power of a single entity would help to manage health care prices and would streamline administration costs. None of these other plans, Obamacare included, do much to target the runaway costs of health care in our country. And, single payer would be constitutional since it comes in the form of a tax.
BTW, the ACA is severely flawed, but it is not in a "death spiral", and will not enter one provided Trump doesn't undermine the law and allows it to work as intended.
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ArtBest23
Joined: 02 Jul 2013
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| Posted: 09/24/17 2:49 pm ::: |
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| GlennMacGrady wrote: |
For those who don't read Supreme Court opinions, as you should, here are quotes from the majority opinion holding that the federal Congress cannot compel unwanted purchases of any product in any market in which an individual is not participating:
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You'd better re-read it. First, there was no "majority opinion" on the issue you're addressing. You're quoting from part III-A which was the opinion of Roberts and ONLY Roberts. No other justice joined in that part of the opinion. Second, since the constitutionality was upheld on other grounds, the various discussions of the commerce clause are classic examples of dicta, irrelevant to the outcome. Third, you have recast what was actually said in a manner you find favorable to your position.
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ArtBest23
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| Posted: 09/24/17 3:17 pm ::: |
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| justintyme wrote: |
But ultimately I support single payer as I feel that the buying power of a single entity would help to manage health care prices and would streamline administration costs. None of these other plans, Obamacare included, do much to target the runaway costs of health care in our country. And, single payer would be constitutional since it comes in the form of a tax.
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I don't believe there is any economy of scale over a choice of multiple large private plans, and when was the last time Government ran anything more efficiently than private enterprise?
Besides, the administrative costs may look like a big number in isolation, but they are actually an insignificant drop in the bucket next to the actual health care expenditures.
The only way a single payer plan reduces costs in any meaningful amount is by imposition of price controls on providers and suppliers and utilization controls on beneficiaries. That can certainly reduce costs if you're willing to accept the loss of capacity, loss of providers and loss of quality that follows, and the political blowback from utilization controls. ("Death Squads" here we come.)
In the end, it's all about money. We can have as much, as cutting edge, and as comprehensive health care as we're willing to pay for regardless of the payment system we adopt. But nothing more. There's no magic bullet. Glenn says you should love state flexibility " If the federal goverment allocates sufficient money back to the states." But of course the entire purpose of these block grants is to slash how much the federal government spends, so the bill takes a TRILLION dollars out of the federal payments over twenty years. This bill has nothing to do with improving health care or insurance coverage. It's about slashing the budget. By design there will never be "sufficient money" distributed to the states.
A client explained it starkly for me one time. We were discussing the tension between the unpopularity of utilization management approaches vs the crying over skyrocketing costs. He said he didn't care which way people chose to go. He could have his actuaries price it either way. Just tell him what you want. You can have lower costs, or you can have fewer controls. You just can't have both. Doesn't work.
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mercfan3
Joined: 23 Nov 2004
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| Posted: 09/24/17 5:02 pm ::: |
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Honestly, I think the best solutions a lot of times are hybrids between government and private.
Typically, people in government don't understand business (that isn't there job), and people in business don't understand government (that isn't there job). It's two different thought processes.
The ACA is fixable. One of the most important fixes needed is that element of a hybrid solution..a public option. Have an option that has reasonable healthcare with a reasonable price, and now private companies have to compete with it. I would be willing to bet they suddenly could afford to provide better quality health insurance for cheaper rates.
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cthskzfn
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| Posted: 09/24/17 8:27 pm ::: |
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https://www.forbes.com/sites/johntharvey/2012/10/05/government-vs-business/#75ef35612a54
The idea that government should be run like a business is a popular one with both Republicans and, albeit to a lesser extent, Democrats. But this betrays a basic misunderstanding of the roles of the private and public sector. We should no more want the government to be run like a business than a business to be run like the government.
Those popularizing this notion feel this way because they see business as more efficient. This must be the case, so the logic goes, or the entity in question would lose market share and go bankrupt. Only the fit survive. Meanwhile, government agencies face no backlash. This is why we have long lines to get driver’s licenses, poorly maintained VA hospitals, inferior returns on investment from Social Security, etc., etc. Were there a choice on where to be licensed to drive, then such offices would forced to make the customer’s experience a positive one or they would go elsewhere.
There are, of course, many businesses that also make the customer’s life very unpleasant because simply being in the private sector does not guarantee effective competition. The American Medical Association has, for example, argued for years that very few people actually have much choice when it comes to health care. It is a very concentrated industry, meaning that they can demand payment while giving only a vague idea of coverage (which may well change over time and with little to no notice) and they can delay reimbursement. And there are government agencies, like police and fire departments, where their dedication to duty has nothing to do with profit. They put their lives on the line every day because they think it’s the right thing to do.
The problem in a nutshell, is that not everything that is profitable is of social value and not everything of social value is profitable.
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