That Healthcare Bill Thing

[Matti]

Yep, companies showed us, what "efficiency" means for two centuries now: Bribes, massive layoffs, complete disregard to hygiene, recycling or anything that could help reducing the destruction of the environment, outsourcing to countries where governments give a shit about civil rights etc. Take a look at all the examples all over the globe where electricity, transit or other key industries got privatized: It all got worse and why shouldn't it? You said it yourself: It's all about profit, but that can't possibly mean anything good. What's the point in having an efficient health insurance for the rich, while the poor become obese eating efficiently made fastfood?

Nah, we all know how bad the American Health care system is and there's no denying it. But it seems that throwing around catchwords like "socialism" keeps the people on the conservative's side in that matter. And many other matters.

[Questionable]

the most religious western nation

This can't be true... can it?? Wait- are we competing with Ireland or are they in a different division?

treats their poor the cruelest.

The American concept is that with hard-work anyone can prosper, even the poor. For better or worse we are a country founded on the principal of "Surival of the FIttest." Unfortunately, at the sacrifice of self-humanity. The American dream is to have made "something" from nothing but your own applied effort.

It's funny how the most religious western nation also treats their poor the cruelest.

Agreed.

ADDITIONAL THOUGHTS:
The fact of the matter is that US Healthcare providers do cut corners and they do screw people over. I agree with you that businesses are in business to make money (mostly) and that typically the best way to be a sucessful business is to offer a core product that is superior than your competition. If that we're the case, however, we'd all be flying JetBlue, using Mac's, browsing with Opera and eating at McRamsays. It could be said that these are all successful companies, however they're all considered "niche." Being the best doesn't mean being the most successful and that is the bottom line! EA certain isn't making the best games. Michael Bay certainly isn't making the best films. David Letterman certainly isn't the funniest comedian.

I don't believe that the government needs the added layer of running a healthcare system (I believe that a hybrid of government and private as a public option would probably be most effective) but I think it's the most logical option. Our military is one of the most effective in the world and we certainly fund it with the trillions of dollars that would require! Couldn't we, in a modern world, create an effective healthcare system that keeps EVERYONE healthy instead of most of us healthy and if need be pump it full of cash to make it the best in the world? Priorities in a "post-war era" shouldn't be mainly on military operations. The resource grab is over an we came out pretty good! The Global Political posturing of the last 150 years is mostly settled and we're Top Ten, by all accounts! I think it is time that we focused on the welfare of citizens because when we set our minds to it we tend to do a pretty decent job of thing... the problem is setting ourselves on the task. The battle to focus on healthcare is won, but now the war for the outcome of healthcare reform has really only started.

I agree (with RickJ) that sometimes government agencies can be ineffective but the postal service is an antiquated system. It is largely the same system that it was 100-200 years ago. There is probably room for MASSIVE improvement. The situation you're describing does have a resolution; according to the US Postal Service if you officially notify them that you are receiving mail for a deceased person you can have their mail forwarded to next of kin or an official proxy for the deceased. Additionally you can place their name on the DNC list. You can also have the postal service assign you another P.O. Box with an official complaint in an attempt to have any associated fees with switching be eliminated.

Whether or not the people at the lowest echelon know it or not, there are always ways to get around the red tap and idiocy of the people working at these jobs.

I have a passport, a drivers license, stamps and financial aid. All the government agencies that I need to work for me have worked for me.

Something else to note is that if there was a public option, you wouldn't be dealing with a government agent you would be dealing with a doctor, at a hospital. One you have your drivers license you can drive wherever you want (for four years) without stepping foot in a DMV/BMV.

@Matti
There are three types of conservatives: Conservatives that understand the (original) core value or the movement was that the Federal Government should be a small entity that exists on a basis to keep order and ensure basic human rights... and little else. There is wiggle room here as many conservatives recognize that certain privileges (not rights) are also beneficial to American society: the FDA, Roadways, etc...
These people are known as "sensible conservatives."

People who hate/dislike the government/various government agencies/various government policies/"the other guys." Like the Tea Party, for instance, who in their grand retardation think that it's a good idea to abolish taxes... and then we'll all just continue to exist happily in our modern world! As streets crumble, law enforcement becomes puppets of criminals, the rest of the civilized world abandons us, and ultimately we rape ourselves until a new order is developed which installs taxes! "Right-Wing Conservatives."

People that believe that other people believing in a particular idea must believe in all idea's which they arbitrarily link to that particular idea and also that the people immediately associated with that person must also believe in all of the idea that that person has. Meanwhile, they either have no ideals themselves or are misinformed on the reality of particular schools of thought. These people dissent and oppose these other ideals for mostly no reason, without basis or the ability to offer constructive thought to aid in the process of developing a compromise or a solution. We call these people "Republicans."

It is possible to be more than one, as counter-intuitive as that may seem. John McCain for instance is a "Sensible Republican..." figure that one out. Mitch McConnell is a "Right-Wing Republican." Ron Paul is a "Sensible Conservative." Yay for analogies!

[Snarky]

I should interject that I'm a big believer in competition and the private marketplace to hone efficiency and reward innovation. But the "invisible hand" doesn't magically make everything right, individual companies respond to the incentives of their industry. And the US healthcare sector is set up in such a way (involving complex relationships between healthcare providers, insurance companies, employers and, lastly and probably leastly, the people who actually need the healthcare) that many of the most important priorities don't come through as clear signals to those businesses.

Since most people don't choose their own health insurance, but get a package offered them through work, insurance companies have little incentive not to screw their customers. On the flip side, since patients don't pay most of the cost of treatment (and hence have little incentive to limit it), and doctors get paid per procedure (and hence have a strong incentive to maximize it), there's massive over-treatment and over-prescription with little regard for cost-effectiveness.

I think most people agree that if you have health insurance in America, and you're not in danger of losing it (by losing your job or similar), you'll probably get decent treatment. The biggest pain is dealing with the billing and the insurance company. Because of the negotiations between hospitals and insurance companies, this is insanely complex. When I went to the hospital for surgery last year, I ended up getting dozens of statements and bills for months following my stay, each one full of medical and financial gobbledygook. The hospital billings departments and administration eat up something like (IIRC) 30% of each dollar spent on healthcare, and that's not counting the insurance company's costs, or the cost to the economy of the patient's time. That's insanely wasteful! (Also, it is obviously hell for people who are seriously ill to deal with.)

Government intervention and regulation can make the marketplace more efficient as a whole, by reducing externalities and forcing each party to bear the costs of its own actions (similar to forcing polluters to pay for the cost of their destruction).

[Questionable]

...the "invisible hand" doesn't magically make everything right...

Agreed.


I should also point out my end of the spectrum. I was just laid off about a week and a half ago. I had fully covered healthcare. Now I can't afford new glasses ($300 WTF?!) nor can I afford even the cheapest quote that I've received for healthcare ($490/mo.) With 3 years experience in management, a year of marketing/business administration and a years worth of Media Arts/Animation/Graphic Design (should've stuck with one major until I got my Associates...) you would think that find a decent job would be easy...

Nope.

For the foreseeable future, I better not run out of contacts, need dental work, get seriously injured, need surgery, get sick, need prescription medication (for new OR previous diagnosis) or require a therapist for any physical/mental/emotional reasons.

If I paid a tax for healthcare (like I did for buying a crateful of grenades/pay a cops salary/inspect some dead cows for disease/fix some potholes in a highway/deliver someones mail) I could get new glasses! I could see a dentist (appointment is in 2 months!) I could let a therapist know that i'm feeling a bit depressed at my whole situation. I could get medicine for my flu (hope there's no pigs in it!) I wouldn't be worried about getting into a car wreck every time I leave my house, and I would feel better knowing that everyone else could do the same stuff.

Is the government telling me to buy healthcare a good thing? No. Is the government telling me to pay for milk and eggs for some single mother with kids from 3 different men a good thing? No. But also, yes and yes. I don't care if the government runs it or if Starbucks runs it, I just care that someone is running something that is keeping all of us healthy. At least I would... if there was.

[RickJ]

Then how come Medicare, Medicaid and Veterans' care are the most efficient healthcare providers in the US, much more so than the private insurance companies?

First of all these [programs are nothing like obamacare.  They function the same as private insurance in that they are not involved in the delivery of services and only make payments on behalf of their beneficiaries.  I have never heard that before but this Washington Post Article sheds some light on the topic.  It discusses the difficulty in determining what counts as administrative costs and says: 

"...But most seem to think that Medicare's administrative costs are significantly undersold in the public debate. An apples-to-apples comparison would not leave you with the 2 percent of total Medicare spending often bandied about in debate. That doesn't count, for instance, Medicare's premium collection, which is done through the tax code, and thus through the IRS. Nor does it count most of Medicare's billing, which is outsourced -- and this might surprise people -- to private insurers like Blue Cross Blue Shield and listed under vendor services rather than program administration. A more straightforward estimate, according to experts I've spoken to, would be in the range of 5 to 6 percent."

The article asks whether profits should be included in administrative costs or not but doesn't attempt to answer the questions I will opine.  Corporation sell stock certificates to raise money to fund their operation.  Profits are returned to share holders in the form of dividends and/or increased valuation of the stock shares.  Profit is the cost of using other peoples' money.   IMHO if this cost is used in evaluating private insurance than it should also be factored in to government insurance plans as well.  Just because gov agencies get their money from tax payers doesn't mean that there is not cost attached to it's use especially if you are trying to measure who is doing the best job..

If you read further in the article you find that there is a 2:1 variation in private insurers administrative costs depending on group size and other factors.  It would seem that planns with group size of 1000 or more are comparable to what the article guesses are Medicare's actual administrative costs.

This is widely reported and documented. You can start with the Wikipedia articles ...

I followed the link and read through  a couple of the articles.  First of all according to the linked article the US does not spend 3 times as much as other countries as asserted earlier in this thread but rather only 40% more than France by GDP and 20% more than Norway by per capita expenditures.

The table showing life expectancy and infant mortality is published by the Commonwealth Fund "a United States private foundation whose stated purpose is to promote a high performing health care system that achieves better access, improved quality, and greater efficiency".   It is currently run by, according to wiki, Karen Davis who worked for Jimmy Carter in the Department of Health and Human Services.   I suspect that "high performing health care system that achieves better access, improved quality, and greater efficiency" is code for single payer government run health care system. I can't say how true  my suspicions are but it is certain that the organisation is promoting a particular point of view. 

In particular there seemed to belittle or  no accounting for other factors affecting life expectancy and infant mortality. The US probably has the most diverse population in the world.  People come from all  parts of the world and bring with them cultural beliefs/habits and genetic pre-disposition for different diseases.  The US also seems to have a disproportionate amount of violent crime as compared to many other countries and it's citizens are infamous for over consuming everything from cigarettes to carbohydrates.   Clearly there are other factors and is confirmed by data in the table under discussion. The Japanese live longer than anybody and spend less per person on medical care; how inconsiderate of them to live so long with out even trying .

Hope she's OK. Incidentally, was your aunt's tests and treatments paid for by private insurance, or did she receive government-funded healthcare through Medicare? If she's 77, I'm betting the latter.

She has private insurance for which she pays premiums.   The insurance company receives some payment from the government for assuming Medicare's obligations.   It is my understanding that her insurance current plan is illegal under obamacare.   

All nations ration healthcare in some way or another. In the US, this is mainly by price and access: if you can't afford insurance, or you exceed your lifetime maximum, or you have a pre-existing condition that means you can't get insurance, you'll receive a low standard of care.

This not the case.  My wife does language interpretation for medical professionals.  She deals with people in this circumstance  on a daily basis and often complains that they receive better care than our family and friends.

The UK takes another approach, which is statistically more efficient (fewer people die from        insufficient care), but certainly has its own drawbacks.

Such decisions are inevitably based on political expediency.   Can you not see the immorality of a system where a group group of human beings decide who shall live and who shall die so as to derive the maximum benefit for their benefactors?   In the US system (up til now) the people at least retain their freedom to choose.

When I heard for the first time that in the U.S. of all countries, poor people can't afford basic treatment because there's no "universal health care", a term I also hadn't heard before, I was sure I was the victim of a very bad joke. Seriously. I couldn't believe it.

Khris, you are mis-informed.  Poor people who can't afford health care are covered by a government program called Medicad.  They receive the same services as anybody else, sometimes even better. My wife deals with such people on a daily basis.    Further it is against the law for hospitals and doctors to deny medical treatment regardless of their ability to pay.

I don't know any details about the current bill, but to me, opposing it seems absurd in the highest degree.

I think this it's the normal case that people who don't know what's in the bill support it and the people who do know what's in it don't support it.   Maybe if you knew and understood what it says you wouldn't support it either?

McDonalds would like a word with you.
So would Microsoft.

McDonalds: I often eat at McDonalds.  If I am ever displeased with the product or price I can easily take my patronage elsewhere.   The same cannot be said for universal health care.

MicroSoft:  I have taken my patronage else where.  I now use Linux for everything except AGS which I run from Linux in a virtual XP window (details here)

The American concept is that with hard-work anyone can prosper, even the poor. For better or worse we are a country founded on the principal of "Surival of the FIttest." Unfortunately, at the sacrifice of self-humanity. The American dream is to have made "something" from nothing but your own applied effort.

you are mis-informed.  The US was founded on the principle of personal liberty and freedom from oppressive government and that such freedoms are acquired by virtue of being a human being and not bestowed on anyone by a king or politburo as is the case in all or almost all other countries.

I agree with you that businesses are in business to make money (mostly) and that typically the best way to be a sucessful business is to offer a core product that is superior than your competition. If that we're the case, however, we'd all be flying JetBlue, using Mac's, browsing with Opera and eating at McRamsays.

JetBlue is a discount no-frills airline that fly a limited number of routes, Apple products look nice but have always been under-powered and over-priced, Opera is a fat black woman with a TV show, and I have no idea what a McRamsays is.  Why do you think everyone would make the same lousy choices? 

I don't believe that the government needs the added layer of running a healthcare system (I believe that a hybrid of government and private as a public option would probably be most effective) but I think it's the most logical option. ...

I agree to some extent. I wouldn't use the term hybird though.  I think a Medicaid type of system could be extended so that is not an all or nothing deal.  Currently if you earn over a certain amount you don't qualify period.  It could just as easily been setup so that people who have income below a certain amount would have a 100% goverment subsidized health insurance.  Then as an individual's income increases above a certain amount the subsidy decreases and the individual pays the remaining part of the premium.  Of course the problem with this is that it doesn't give any political advantage to the democrat party.

Something else to note is that if there was a public option, you wouldn't be dealing with a government agent you would be dealing with a doctor, at a hospital. One you have your drivers license you can drive wherever you want (for four years) without stepping foot in a DMV/BMV.

You would be dealing with a doctor, at a hospital who are under the thumb of a government bureaucrat.   

People who hate/dislike the government/various government agencies/various government policies/"the other guys." Like the Tea Party, for instance, who in their grand retardation think that it's a good idea to abolish taxes... and then we'll all just continue to exist happily in our modern world!

Hmmm, I never heard of any Tea Party folks advocate the abolition of all taxes.   They seem to be in favor of a limited federal government,  a fiscally responsible federal government,  and one that interferes as little as possible in the free market.  More like the first kind of conservative you talk about.

People that believe that other people believing in a particular idea must believe in all idea's which they arbitrarily link to that particular idea and also that the people immediately associated with that person must also believe in all of the idea that that person has. Meanwhile, they either have no ideals themselves or are misinformed on the reality of particular schools of thought. These people dissent and oppose these other ideals for mostly no reason, without basis or the ability to offer constructive thought to aid in the process of developing a compromise or a solution.

I thought you were describing the far left liberals in the US,  hehe - go figure

I should interject that I'm a big believer in competition and the private marketplace to hone efficiency and reward innovation. But the "invisible hand" doesn't magically make everything right, individual companies respond to the incentives of their industry. And the US healthcare sector is set up in such a way (involving complex relationships between healthcare providers, insurance companies, employers and, lastly and probably leastly, the people who actually need the healthcare) that many of the most important priorities don't come through as clear signals to those businesses. ...

I agree, Snarky makes some very good points.   It was once said that a free market economy is essential for freedom but not sufficient to guarantee it.   I think it would be fair to say that with regard to health insurance the free market is essential but not sufficient to produce the desired result.    As Snarky suggests government's role ought to be responsible regulation of the industry so that private insurers and their customers (i.e. the people) are incentivized to produce the desired result.

Since most people don't choose their own health insurance, but get a package offered them through work, insurance companies have little incentive not to screw their customers. On the flip side, since patients don't pay most of the cost of treatment (and hence have little incentive to limit it), and doctors get paid per procedure (and hence have a strong incentive to maximize it), there's massive over-treatment and over-prescription with little regard for cost-effectiveness.

Absolutely agree.   There are a number of things that can be done.   First of all health insurance premiums should be made tax deductible by individuals and not corporations.   If a company provides a health care benefit they should pay the money to their employees and their employees should pay the insurance premiums.  They could still negotiate a group rate for their employees however their employees would be able to spend the money as they see fit.  They would be free to shop for a better or cheaper plan.  They could choose a plan with a high deductible and lower premium.   There would surely be many many options and innovations.

A health savings plan type of thing gives incentive to patients to self-limit their access to the system.  The way it typically works is that a portion of the premiums the insurance company receives  is placed in a savings account setup for the individual and the other portion is used to purchase a high deductible insurance plan.  The individual uses the money in the savings account to pay for doctor visits and prescriptions.   If money is left in the account at the end of the year the individual keeps it tax free.  If all the money is spent then the individual has met his deductible and the insurance benefits kick in.   This was passed into law by the republicans under Bush but has now been eliminated obama and the democrats.

Government intervention and regulation can make the marketplace more efficient as a whole, by reducing externalities and forcing each party to bear the costs of its own actions (similar to forcing polluters to pay for the cost of their destruction).

Again agreed.  I would characterize it sa little differently as eliminating the possible of gaining  completive advantage in the market place through undesired practices.  If all insurance companies were required to insure a proportionate number of individuals with pre-existing conditions then one company would not be disadvantaged over another by accepting such individuals.  The result would be a slightly higher cost to everyone.

Now I can't afford new glasses ($300 WTF?!)

Try Eyeglass world or Wallmart.   

nor can I afford even the cheapest quote that I've received for healthcare ($490/mo.)

Obama and the democrats passed their health car reform bill so now you have coverage right?

On a serious note you should consider getting catastrophic coverage (i.e. high deductible).

[Ali]

McDonalds would like a word with you.
So would Microsoft.

MicroSoft:  I have taken my patronage else where.  I now use Linux for everything except AGS which I run from Linux in a virtual XP window (details here)

Good for you Rick, but surely the laws of market forces dictate that as the most popular OS, Windows must also be the best?

We probably all agree that freedom to choose is invaluable, but the quasi-monopolies of corporations like Microsoft mean that consumer choice is often an illusion. If you want to test this, try choosing to buy affordable clothing made by people who were paid decently using environmentally sustainable materials. Clothing companies could offer that choice, but it's far more profitable not to.

So, given the freedom to choose, I would choose a state healthcare system supported by taxpayers.

[Radiant]

McDonalds would like a word with you.
So would Microsoft.

McDonalds: I often eat at McDonalds.  If I am ever displeased with the product or price I can easily take my patronage elsewhere.   The same cannot be said for universal health care.

MicroSoft:  I have taken my patronage else where.  I now use Linux for everything except AGS which I run from Linux in a virtual XP window (details here)

You're missing the point. It's not about whether you personally buy McDonalds or Microsoft products, or whether you have the choice to do so.

The point is that the biggest, most well-known, and most successful companies are precisely the ones with the biggest profit margins, and the ones known to act highly unethically whenever they can get away with it, and precisely not the ones that offer the best products. This directly disproves your points about the free marketplace.

[Snarky]

First of all these [programs are nothing like obamacare.  They function the same as private insurance in that they are not involved in the delivery of services and only make payments on behalf of their beneficiaries.

That would make them exactly the same as the now-abandoned "public option (aka "socialism", "government takeover of healthcare" etc.).

Without the public option, Obamacare now amounts mainly to:

-a mandate covering most of the uninsured, obliging them to buy private insurance
-financial support for those who are too poor to afford it, essentially paying for their private insurance for them
-regulations on insurance companies that restrict their ability to deny coverage
-a new system known as an "exchange" where private insurance companies work together to offer insurance plans

In other words, Obamacare, instead of being an alternative to private insurance the way Medicare/Medicaid is, relies on private insurance.

Something else to note is that if there was a public option, you wouldn't be dealing with a government agent you would be dealing with a doctor, at a hospital. One you have your drivers license you can drive wherever you want (for four years) without stepping foot in a DMV/BMV.

You would be dealing with a doctor, at a hospital who are under the thumb of a government bureaucrat.

Errr... you do realize that the public option would not institute government-run hospitals, just a government-run insurance option, don't you?

If you read further in the article you find that there is a 2:1 variation in private insurers administrative costs depending on group size and other factors.  It would seem that planns with group size of 1000 or more are comparable to what the article guesses are Medicare's actual administrative costs.

That would still leave Medicare as efficient as the most efficient private insurance companies, and more efficient than the rest of them.

I followed the link and read through  a couple of the articles.  First of all according to the linked article the US does not spend 3 times as much as other countries as asserted earlier in this thread but rather only 40% more than France by GDP and 20% more than Norway by per capita expenditures.

A number of different studies were linked from the articles, and they use slightly different numbers, but the most often cited figure is that the US spends twice as much on healthcare (as a proportion of GDP) than the average for developed nations.

In particular there seemed to belittle or  no accounting for other factors affecting life expectancy and infant mortality. The US probably has the most diverse population in the world.  People come from all  parts of the world and bring with them cultural beliefs/habits and genetic pre-disposition for different diseases.  The US also seems to have a disproportionate amount of violent crime as compared to many other countries and it's citizens are infamous for over consuming everything from cigarettes to carbohydrates.   Clearly there are other factors and is confirmed by data in the table under discussion. The Japanese live longer than anybody and spend less per person on medical care; how inconsiderate of them to live so long with out even trying .

I agree that cultural factors play a big part (I'd add being overworked to the typical American health factors, but the major factor is obviously America's large underclass of poor people), and that it's unlikely that even if the US adopted a French-style or German-style health system its statistics would match those countries', just like adopting European gun-control laws would not by itself reduce crime or gun violence to European levels.

But it also means that preventative care has a greater potential to raise people's wellness and improve the health of the nation; and moving people from critical care through the ER to preventative care that keeps them from getting sick in the first place is one of the main goals of health reform.

She has private insurance for which she pays premiums.   The insurance company receives some payment from the government for assuming Medicare's obligations.   It is my understanding that her insurance current plan is illegal under obamacare.

I believe you're completely wrong about that. What makes you think so?

All nations ration healthcare in some way or another. In the US, this is mainly by price and access: if you can't afford insurance, or you exceed your lifetime maximum, or you have a pre-existing condition that means you can't get insurance, you'll receive a low standard of care.

This not the case.  My wife does language interpretation for medical professionals.  She deals with people in this circumstance  on a daily basis and often complains that they receive better care than our family and friends.

So she complains that government-paid healthcare is better than that offered by private insurance, and therefore you think we shouldn't have government-paid healthcare?

It's also the case that the Medicaid system and the quality of care varies enormously from state to state. It's also my understanding that it's focused on critical care, not prevention (for example, it doesn't cover oral screenings, only dental work once a problem has become acute, and it only covers HIV patients once their disease has progressed to full-blown AIDS). That doesn't sound like very good care to me.

Anyway, even it true, it doesn't contradict what I was saying. I was talking about the millions of uninsured, those 60% of poor Americans not covered by Medicaid.

The UK takes another approach, which is statistically more efficient (fewer people die from        insufficient care), but certainly has its own drawbacks.

Such decisions are inevitably based on political expediency.   Can you not see the immorality of a system where a group group of human beings decide who shall live and who shall die so as to derive the maximum benefit for their benefactors?   In the US system (up til now) the people at least retain their freedom to choose.

Of course, doctors make those decisions every day, in the US like anywhere else. And in the US, insurance companies routinely decide not to cover certain procedures or drugs that are too expensive for too little gain. I don't know why dealing with an insurance company rep is that much preferable to dealing with a government bureaucrat...

Anyway, in countries with a nationalized health system like the UK, rationing mostly doesn't take the form of "we've decided not to treat you, please go home and die", but of waiting lists. You'll get help, but unless it's acute, it might take a few weeks. Are people happy about the wait? Of course not, but they'd rather have guaranteed healthcare with a wait than maybe/maybe-not healthcare that's prompt.

Americans might never be willing to make that tradeoff, which is why none of the proposed reforms looked anything like that.

Khris, you are mis-informed.  Poor people who can't afford health care are covered by a government program called Medicad.  They receive the same services as anybody else, sometimes even better. My wife deals with such people on a daily basis.    Further it is against the law for hospitals and doctors to deny medical treatment regardless of their ability to pay.

Again, some 60% of poor Americans are not covered by Medicaid. And ERs offer only critical care, causing people to not seek treatment until their illness or injury has become debilitating. (And if you, as an uninsured person, go to the ER with anything less than a life-threatening condition, you'll learn what waiting is!) Treating the uninsured is currently the most expensive part of the healthcare system: it would be cheaper to just give them regular healthcare, except that would create negative incentives and so on. That's what Obamacare tries to get around with the mandates and the financial support and so on.

you are mis-informed.  The US was founded on the principle of personal liberty and freedom from oppressive government and that such freedoms are acquired by virtue of being a human being and not bestowed on anyone by a king or politburo as is the case in all or almost all other countries.

You seemed to have missed the last two hundred years of history, buddy. "Almost all other countries"! LOL! 

Of course the problem with this is that it doesn't give any political advantage to the democrat party.

"Democrat" party instead of "Democratic party"? Have we really descended to that level of discourse?

[Questionable]

First of all these programs are nothing like obamacare.  They function the same as private insurance in that they are not involved in the delivery of services and only make payments on behalf of their beneficiaries.

It's unfair to make this assessment as the entirety how how the new healthcare reform bill will function has not been solidified.

This is widely reported and documented. You can start with the Wikipedia articles ...

http://www.photius.com/rankings/healthranks.html World Health Organization Rankings
http://www.photius.com/rankings/who_world_health_ranks.html Support for the rankings

http://www.nytimes.com/2008/04/27/weekinreview/27sack.html?_r=1
http://www.washingtonpost.com/wp-dyn/content/article/2008/05/13/AR2008051302599.html
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0002181
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=52138
Links referring to the disparity or healthcare in America

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html
Infant Mortality Rate by the CIA

She has private insurance for which she pays premiums.   The insurance company receives some payment from the government for assuming Medicare's obligations.   It is my understanding that her insurance current plan is illegal under obamacare.

My understanding is that she's set! As long as she is covered by a healthcare provider either privately, through federal means, or a combination of the two she is okay. One of the biggest things that changed in the early iterations of the bill was that existing healthcare coverage will not be invalidated.

This not the case.  My wife does language interpretation for medical professionals.  She deals with people in this circumstance  on a daily basis and often complains that they receive better care than our family and friends.

Medicare/medicaid are limited service. They're TOO limited. I think that they could play a greater role in providing healthcare for the uninsured but they're not a be-all end all.  Besides, if they're getting better healthcare and paying less: wouldn't you want to be on it?

Such decisions are inevitably based on political expediency.   Can you not see the immorality of a system where a group group of human beings decide who shall live and who shall die so as to derive the maximum benefit for their benefactors?   In the US system (up til now) the people at least retain their freedom to choose.

Who is deciding who lives or dies? If there's evidence that they've revived Das Herrenvolk, I think we should tell somebody.

People have the right to choose? Like the hundreds that have died A YEAR after Hurricane Katrina, due to related causes because they didn't have healthcare? Or the thousands of people under the age of 25 living on their own (sometimes with kids) who can't break into an industry that pays good enough for them to buy healthcare or offer healthcare? Those people don't really have a choice, do they?

Khris, you are mis-informed.  Poor people who can't afford health care are covered by a government program called Medicad.  They receive the same services as anybody else, sometimes even better. My wife deals with such people on a daily basis.    Further it is against the law for hospitals and doctors to deny medical treatment regardless of their ability to pay.

Don't be naive. If this were the case do you really think we would be having this debate? People that can't afford healthcare ARE NOT covered by medicaid or medicare. Those that ARE do receive good levels of care. It is NOT against the law for hospitals and doctors to turn you away if you can't pay and even if they DO NOT turn you away you then become personally responsible for the hundreds to thousands of dollars that a typical examination costs.

I think this it's the normal case that people who don't know what's in the bill support it and the people who do know what's in it don't support it.   Maybe if you knew and understood what it says you wouldn't support it either?

I've said it before and i'll say it again, the litigation is still in effect. How the bill will ultimately respond is still unknowable until that time.

You are mis-informed.  The US was founded on the principle of personal liberty and freedom from oppressive government and that such freedoms are acquired by virtue of being a human being and not bestowed on anyone by a king or politburo as is the case in all or almost all other countries.

The Declaration of Independence? I am talking about the establishment of the United States as a Capitalist society, not the United States of a Fledgling America.  The REASON we were founded was because we wanted to establish a government that afforded and protected our human liberties and freedoms that were previously repressed. The story of the founding isn't the establishment of modern America. Overtime we have become a different beast entirely and there is no deny that capitalism is our greatest core value, as a nation. That's not misinformed, that's reality.

I agree with you that businesses are in business to make money (mostly) and that typically the best way to be a sucessful business is to offer a core product that is superior than your competition. If that we're the case, however, we'd all be flying JetBlue, using Mac's, browsing with Opera and eating at McRamsays.

JetBlue is a discount no-frills airline that fly a limited number of routes, Apple products look nice but have always been under-powered and over-priced, Opera is a fat black woman with a TV show, and I have no idea what a McRamsays is.  Why do you think everyone would make the same lousy choices?  

JetBlue is the best airline for the money. You pay less and get more. It runs a limited number of routes because financial it is limiting to exist in all major hubs. It is currently expanding... This is the concept that I was trying get across. JetBlue is more superior than +70% of the commercial domestics flights that I've been on (and I fly alot.) If your concept was true then they would be the largest airline in America as opposed to the CLUSTERFLUCK that is Delta.

Apple products may be over-powered and under priced but are they a superior product (for the average consumer) than a Windows based PC or Linux based PC? Linux is getting close to being ready for primetime but its still not there. I had to jump through hoops to get my scanner to work! And GIMP just isn't photoshop... InkScape just isn't illustrator... and my old windows PC crashed!! OH NO! But My Parents macs are 6 years old and still zippy as hell!

Opera is statistically proven to be the fastest, most secure web browser currently available and it's also available on the broadest array of platforms. IE (the most used web browser in internet land) is a buggy, bloated, hacktastic, crapfest.

Gordon Ramsay is arguably on of the best Chefs in the world and has a reputation for being able to make EXTREMELY delicious food from very cheap ingredients. McDonalds instead contributes to the industrialization of the American agriculture industry which having grown up on a farm in Wisconsin, I can tell you is NOT the way you want your food being raised/grown.

At the end of the day it's all about profits and share holders. Somebody needs to keep companies accountable.

I agree to some extent. I wouldn't use the term hybird though.  I think a Medicaid type of system could be extended so that is not an all or nothing deal.  Currently if you earn over a certain amount you don't qualify period.  It could just as easily been setup so that people who have income below a certain amount would have a 100% goverment subsidized health insurance.  Then as an individual's income increases above a certain amount the subsidy decreases and the individual pays the remaining part of the premium.  Of course the problem with this is that it doesn't give any political advantage to the democrat party.

I agree, the political posturing is retarded. Medicare/Medicaid could EASILY be expanding to exist on a sliding income scale. Everyone already pays for it, a small hike wouldn't be that big of a deal.  People making under a certain amount get 100% compensation and all the way up to a certain income level means you will get 10% compensation. Then pistol whip the HELL out of the insurance companies, make them get their shit together and then we can all go out to dinner. Problem solved.

With Tea Parties, Coffee Parties, Libertarians... I think we're getting closer and closer everyday to a post-bipartisan Political system and I STRONGLY believe that once (if) that scale tips, we'll be better for it.

You would be dealing with a doctor, at a hospital who are under the thumb of a government bureaucrat.

We're not talking about the CIA here. Do you really think it would be cost effective for the US government to micromanage doctors like that? Not only would it make zero political sense, it would make zero financial sense and would cause a failure in the healthcare system as the doctors resentment pushed them into rebellion, which would ultimately force the system to be REreformed.

Hmmm, I never heard of any Tea Party folks advocate the abolition of all taxes.   They seem to be in favor of a limited federal government,  a fiscally responsible federal government,  and one that interferes as little as possible in the free market.  More like the first kind of conservative you talk about.

That would be correct, however the Tea Party isn't a party, doesn't have an official platform and doesn't have any Unity. I've been to three different Rallys here in Ohio and they all talk about almost completely different things. I truly believe that the Tea Party movement at its ROOTS are fundamentally sound, but the message has gotten so convoluted and muddied by people with only the greyest semblance of what the original message was... and that's then you get the shambling muttering masses that take things to extremely that are border line insane. Those are the people that represent the message.

I thought you were describing the far left liberals in the US,  hehe - go figure

I don't live in New England or California, so I haven't met any...  
I suppose that could be said for all "Fundamentalists" "Extremists" or "Wings."

A health savings plan type of thing gives incentive to patients to self-limit their access to the system.  The way it typically works is that a portion of the premiums the insurance company receives  is placed in a savings account setup for the individual and the other portion is used to purchase a high deductible insurance plan.  The individual uses the money in the savings account to pay for doctor visits and prescriptions.   If money is left in the account at the end of the year the individual keeps it tax free.  If all the money is spent then the individual has met his deductible and the insurance benefits kick in.   This was passed into law by the republicans under Bush but has now been eliminated obama and the democrats.

The bill does not effect previous bills and no laws have been repealed, so I'm not sure how this would STOP being true. Playing along party lines isn't something that you want to instigate, either. Under Bush, our Education system saw it's lowest numbers in relation to the world, our defecit ballooned year after year, we collapsed foreign relationships to almost NIL and we saw increases in illegal immigration. The last 5 years of his presidency were a joke. Regan? I'll give the republics him... HELL, even Bush Sr., was good. Kennedy, Carter and Clinton we also good leaders for the Democrats. However, virtually all of them (maybe with the exception of Carter) we're crooks and liars. There's no question that Bush was the least effective president for the past 30 years. Both parties have their good and bad and I don't think it's fair to ascribe ANY achievements in recent American Political History to either party. I find it amazing that both parties have people with political beliefs that are all over the place... I really think there should be more than two parties, because there aren't only two solutions, or two correct choices.

Try Eyeglass world or Wallmart.

Exam+Frames+Lenses
My girlfriend accidently broke my last pair and they're a prescription from when I was 17, they hardly worked and I am unable to track down where I got the prescripton from, anyways. Wallymart told me $150 for the exam, frames starting at $20 (really lame frames, but whatever) and lenses typially cost around $70+ It's extra for astigmatism (DAMNIT,) scratch protection (let's be real that is essential,) and a warranty (how is this not included? I didn't ask if it was an extended warranty or not...)

I've got two more pairs of contact lenses so I'm biding my time because money is tight...

Obama and the democrats passed their health care reform bill so now you have coverage right?

A.) The bill isn't finalized and is going through a process of revisions that are going to take forever
B.) It is most likely that the full rollout of changes won't be completed until 2016
C.) My situation won't get any better until I get a new job but somebody else's might, in the future

My Political Opinions are thusly:
1.) I believe in a strong federal government who's primary interest is the welfare of all citizens and individual present in the country. (This would include making sure they all have healthcare by some measure rather than no measure.)
2.) I believe that the representation system is flawed. State governments rarely listen to their public. The Californian proposition system is an interesting format for guaranteeing that the populace has power, but it is flawed. I think that state governments should seek ways of more actively engaging their public to shape legislature.
3.) Democrat = Wrong
4.) Republicans = Wrong
5.) The welfare of all is more important than the success of some.
6.) Stay off my lawn, out of my house, away from my family or I will kill you... unless you're invited over for a barbecue.
7.) Feed a man a fish, he east for a day. Teach a man to fish and he eats for a life time. Correctional institutions need to focus more on rehabilitation for non violent/sexual offenders and need to have a standardized recommendation for various crimes across all states. No more getting life for weed possession while RapistMcGee is out in 12 Years. Additionally, there should be a rehabilitation center for homeless individuals.
8.) Mitt Romney should NEVER be president... His head is FAR too long.
9.) What is and what isn't taxed is completely fucked up. We need to eliminate the capital gains tax. More heavily tax major corporations. Give tax breaks to smaller comnpanies and more tax breaks to individuals operating businesses. Additionally taxes should be placed on financial entities (default swaps, credit papers, debt obligations, etc...)
10.) Credit companies and Debt collection should be more heavily regulated and observed.
11.) Our education system needs a complete overhaul... actually virtually ALL federal institutions need an overhaul, to be more effective AND save money.
12.) Lobbyists should be outlawed and politicians taking assets from private entities or from those representing private entities should be considered as having revived bribes. Corporations deserve protection under American laws but they do not take precedence over people. American people don't have lobbyists, or thousands of dollars to donate, or ad campaigns we just have tax dollars and if that's not good enough for politicians to eat off of, they're not good enough to be fed by us.
13.) Buying a home for the first time (or the first time in 7 years) should always grant a tax break, which would decline for every house you purchase every 7+ years. This will help get people into homes as opposed to renting which will provide the government with tax money, the banks will mortgage money which the will use to pay back their loans from the federal bank. Additionally, the interest rates for federal loans should be between 60-100% of the interest rate that a bank/credit/corporation charges its loanees.
14.) Small government is good but is flawed. Larger government is small but flawed. We need a medium sized government willing to accept its flaws and correct them where it can and we simply CANNOT get that done with people on the extremes and no-one bringing them together.
15.) Puppies>Kittens

EDIT:

We probably all agree that freedom to choose is invaluable, but the quasi-monopolies of corporations like Microsoft mean that consumer choice is often an illusion. If you want to test this, try choosing to buy affordable clothing made by people who were paid decently using environmentally sustainable materials. Clothing companies could offer that choice, but it's far more profitable not to.

Good point Ali!

Or try buying a diamond:
You can go to Kay Jewlers, or Jared Jewlers or J.B. RObinson, or LeRoys, or Ostermann, or Belden, or Shaws, or Goodmans, or Westhall, or Rogers, or Friedlanders, or Mark & Morgan, or Adison, or Orange Blossom... except they're all the same company.

Or an Album:
You can buy from Interscope, or Geffen, or A&M, or Octone, or DGC, or Island, or Def Jam, or Mercury, or Motown, or Republic, or MCA, or Mercury, or Nashville, or Lost Highway, or Universal Latino, or Fonovisa, or Disa, or Machete, or Verve, or GRP, or Impulse, or Forecast, or Decca, or V2, or Fontana, or Show-Dog, or Polydor... except they're all the same company.

[Calin Leafshade]

This idea of 'rationing' in the UK is no where near as widespread as people seem to think.

The figures cited by the conservative media in the US are often ridiculously misleading.

I know that it's considered crass to cite Fox News but it's the most popular news channel in the US so alot of people subscribe to that way of thinking. Fox News ran a section (Hannity i think it was) who described a case in which a baby had been "left to die" despite the mother pleading for doctors to revive the baby.

Hannity put this down to rationing of care without mentioning that the baby was several weeks more premature than the most premature baby ever to have survived but now ofcourse many Americans believe that story to be 100% accurate which fuels the distaste for universal healthcare.

I've had relatively limited experience with the NHS but my girlfriend usually manages to get a doctors appointment within a week, often within 2 days. My mother had surgery under the NHS and had the operation within a few weeks, even though it was non essential.

Yes we do have waiting lists but theres no evidence to suggest that affects the effectiveness of the care.

Also on the subject of the US life expectancy and infant mortality an awful lot of institutions (independent and otherwise) report that America performs terribly when compared to nations with universal healthcare.

[Andail]

you are mis-informed.  The US was founded on the principle of personal liberty and freedom from oppressive government and that such freedoms are acquired by virtue of being a human being and not bestowed on anyone by a king or politburo as is the case in all or almost all other countries.

I'm....speechless.

[Calin Leafshade]

NO Freeman shall be taken or imprisoned, or be disseised of his Freehold, or Liberties, or free Customs, or be outlawed, or exiled, or any other wise destroyed; nor will We not pass upon him, nor condemn him, but by lawful judgment of his Peers, or by the Law of the land. We will sell to no man, we will not deny or defer to any man either Justice or Right.

The Magna Carta - 1215

[Matti]

nor can I afford even the cheapest quote that I've received for healthcare ($490/mo.)

I pay 240 â,¬* a year. As a student that is, but I wasn't, it wouldn't be intolerably more. I'm glad not to live in the US.

* 1â,¬ = 1.3$ or something.

[Vince Twelve]

The Japanese live longer than anybody and spend less per person on medical care; how inconsiderate of them to live so long with out even trying .

If that was trying to say that the Japanese live really long DESPITE their health care system, I've got to take exception.  Obviously life-style will make a great contribution to life expectancy, but the Japanese health care system's low expenditure per person is not a reflection on the quality or amount of care.

The Japanese government strictly controls costs that providers can charge for every procedure or exam.  This allows them to keep the costs of their universal government-provided health insurance program way down.  The total costs to the government, and by extension, tax payers is so low DESPITE Japanese people having one of the highest average number of doctor visits per person per year in the world.

I was just in japan, and my daughter started having some kind of alergic reaction to something with her eyes getting all puffy and coughing all night, so we took her to the doctor WITHOUT INSURANCE and the total cost of the visit PLUS MEDICINE was $40, which is the same as my copay would have been if I had taken her to a walk-in clinic in the states WITH INSURANCE and NOT INCLUDING MEDICINE. 

If I had taken her with insurance in Japan on the same visit, the cost would have been $4. Plus, I would have been able to get that money refunded in cash to me at the end of the month because all children's medical bills are refundable up to a certain age.  So, it would have cost a net of zero.  (Of course, they could have saved all kinds of administrative money by skipping the parts where I pay and a few days later apply for reimbursement, but that's Japanese bureaucracy for you!)

I'm not saying their health care system is perfect.  It causes some strain on their economy to pay for everyone.  It causes strain on healthcare providers by not allowing them to set their own costs.  But fuck, if there isn't some kind of beneficial middle ground between Japan and America.  No one ever goes bankrupt in Japan due to medical bills.  And I think it would be worth it to try to find a system where we can achieve that too.  I'm tired of balancing the severity of my (or my wife's or kids') illness against my ability to pay for a doctor visit that month.  And that's WITH insurance.


Also, regarding the disapproval numbers reflected in polls, what most people ignore is the fact that a sizeable portion of the people who were disapproving of the bill held that position because they didn't think it was liberal enough.  If you subtract them from the disapproval numbers, every poll is showing significantly less than 50% opposed.

[Calin Leafshade]

Also, regarding the disapproval numbers reflected in polls, what most people ignore is the fact that a sizeable portion of the people who were disapproving of the bill held that position because they didn't think it was liberal enough.  If you subtract them from the disapproval numbers, every poll is showing significantly less than 50% opposed.

I hadnt thought of that, good point.

[Questionable]

The Japanese live longer than anybody and spend less per person on medical care; how inconsiderate of them to live so long with out even trying .

See:

People from the islands of Okinawa are reported to have the longest life expectancy in the world. This has in part been attributed to the local diet, but also to other variables such as genetic factors, lifestyle, and environmental factors.

Generally, the traditional diet.. is 20% lower in calories than the Japanese average and contains 300% of the green/yellow vegetables (particularly heavy on sweet potatoes). The Okinawan diet is low in fat and has only 25% of the sugar and 75% of the grains of the average Japanese dietary intake.[1]  The traditional diet also includes a relatively small amount of fish (less than half a serving per day) and somewhat more in the way of soy and other legumes (6% of total caloric intake). With exception of pork, almost no meat is consumed; virtually no eggs or dairy products are consumed either.[3]  Okinawans include pork in their diets. However, the fat content of the pork is eliminated; prior to the preparation of the pork, the fat is boiled off.

Healthcare is not the be-all end-all when it comes to life expectancy, this is why life expectancy by itself is not considered an accurate barometer of a countries "healthiness." If we all ate like that, and danced and laughed daily (as is apparently Okinawan culture) I'm sure we would be a healthier country, but we don't and so we need to revitalize a functioning but sub-prime system of healthcare.

[Calin Leafshade]

but can you use the same argument with infant mortality? surely healthcare is practically the only thing that counts there. and you still lose.

[Questionable]

Agreed.

[SSH]

The UK takes another approach, which is statistically more efficient (fewer people die from        insufficient care), but certainly has its own drawbacks.

Such decisions are inevitably based on political expediency.   Can you not see the immorality of a system where a group group of human beings decide who shall live and who shall die so as to derive the maximum benefit for their benefactors?   In the US system (up til now) the people at least retain their freedom to choose.

In the UK, anyone can always go for the US option and pay out of their own pocket for private treatment if they feel the NHS is failing them.  In the US, paying for treatment yourself one way or another is the ONLY  option, rather than the worst-case scenario.

Besides, doctors decide all the time on priority of treatment,a s there is always SOME resource that is limited, e.g. organs, blood, etc. Are you saying that they are beign immoral? Is it immoral to prioritise non-smokers over smokers for lung transplants?

In the USA, a guy who was really lazy and worthless but whose grandfather was very rich and gave him a good inheritance can get better care than someone who has moderate income but is self-employed, e.g. Dave Gilbert. How is that moral?

[Shane 'ProgZmax' Stevens]

Government intervention and regulation can make the marketplace more efficient as a whole, by reducing externalities and forcing each party to bear the costs of its own actions (similar to forcing polluters to pay for the cost of their destruction).

I just wanted to point out that this is hogwash and has never been true.  Historically, any interests taken over by government result in lower efficiency by virtue of greater bureaucracy (more red tape, more pointless interim government oversight,etc).  Better quality and higher efficiency only ever come from free market practice where the people decide what works best and cheapest by voting with their money.  What America should have is less bureaucracy in medicine, not more.

This is a good article to cut your teeth on actual government policy.  I also recommend The Cure by Dr. David Gratzer and any of Milton Friedman or Murray Rothbard's books on government provided services.  They're all good and both men are rightly considered pillars of sound economics theory and practice -- but don't take my word for it, I'd rather you actually read articles from these gentlemen and formed a better opinion of government's role.  http://mises.org/daily/3793