by Douglas Holtz-Eakin
President, DHE Consulting, LLC; Fellow, Manhattan Institute
Provided by Kaiser Health News
JAN 18, 2011
With the House of Representatives poised to vote on the repeal of the Patient Protection and Affordable Care Act, there has been a flurry of commentary regarding what is at stake. First and foremost, the law itself is not at risk this week. Regardless of the action in the lower chamber, no sane observer believes that a repeal vote will pass the Senate or ever be signed by President Barack Obama.
Despite this, defenders of the law have launched a massive disinformation initiative regarding the vote. So, in the interest of dispassionate evaluation, let us step back for one moment and review the situation.
First, this is not about denying coverage to those with pre-existing conditions. Yes, repeal would roll back the specific provision of the health law in this regard. But there is nobody on either side of the debate who favors the inability of those with costly, pre-existing medical ailments to obtain insurance. There are deep disagreements over the best way to reach this goal, but the basic objective is, and always has been, shared on both sides of the aisle.
Similarly, a repeal vote is not about defending insurance companies. Conservatives have no love of insurers and many of their proposed reforms would have forced insurers to compete much more vigorously for the business of Americans. For this reason, many (if not all) insurers are nervous about the notion of repeal as it puts at risk the easy access to customers engendered by the measure’s individual mandate.
More generally, repeal is not about being happy with the status quo. It is easily forgotten that at the start of the health care reform debate in January 2009 there was a bipartisan agreement that health care reform was needed. And there was consensus that real reform would provide insurance for more Americans. So assertions like that of New York Times columnist Paul Krugman – who said of the Republican leadership: “They’re against reform because it would cover the uninsured — and that’s something they just don’t want to do” – are just nonsense and shameful.
This brings us to what a repeal vote is about: real health care reform. In January 2009, all sides agreed that the central tenet of health care reform was to control the growth of health care spending. And it is now well understood that the health law fails this test, as witnessed by the findings of dispassionate experts ranging from the Congressional Budget Office to the Obama administration’s actuary. So, with the overhaul’s framework, the health care cost spiral will continue. Repeal is about moving to reforms that will control costs.
Worse, the law sets up two new open-ended entitlement programs that will feed at the trough of excess cost growth and fuel the already-explosive growth in federal spending, deficits and debt. Repeal is about caring enough for the next generations to not destroy the foundation of their prosperity and saddle them with our debts.
Finally, repeal is hopefully about a new era in politics. Many candidates ran for office promising to reverse this measure. They ran in an environment in which the top three issues where jobs, controlling federal spending and accountability. To not hold a vote for repeal would be to deny their accountability to the voters who put them in office. It would be to deny the importance of controlling federal spending. And it would be to deny the importance of pro-growth policies, especially in the one-sixth of the economy most riddled with inefficiency: the health care sector.
Real health care reform that delivers quality care at lower cost and controlling explosive federal spending and debt — that is what the repeal vote is about.
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
“Real health care reform that delivers quality care at lower cost and controlling explosive federal spending and debt — that is what the repeal vote is about.”
Can we hear some concrete post-repeal solutions to these issues offered by those in favor of repeal?
I would specifically like to hear proposals on increasing access to primary preventative care to all citizens and incentive’s for graduating docs to enter primary care.
Indeed,
I keep hearing about this explosive cost and what not, yet I’ve never actually seen any numbers. The only numbers I’ve seen from the CBO have said that it will reduce the deficit.
This isn’t an argument for or against it. I just want to know where this actually comes from.
“In January 2009, all sides agreed that the central tenet of health care reform was to control the growth of health care spending. And it is now well understood that the health law fails this test, as witnessed by the findings of dispassionate experts ranging from the Congressional Budget Office”
The CBO estimates indicate that repealing the bill will increase the deficit by hundreds of billions. Citing them in support of the budget benefits of repeal seems a bit dishonest.
And it makes it a bit harder to take the rest of your statements seriously.
http://cboblog.cbo.gov/?p=1750
Link to some of the CBO’s more recent comments on repeal.
Wow, this article is completely ridiculous. Instead of being a rational set of arguments backed up by facts, it is just a collection of conservative talking points that aren’t even true.
“Despite this, defenders of the law have launched a massive disinformation initiative regarding the vote.”
Like what?
I love these next two sentences. They directly contradict each other:
“First, this is not about denying coverage to those with pre-existing conditions.”
Ok, so if that’s true what’s your plan . . .
“Yes, repeal would roll back the specific provision of the health law in this regard.”
I see. You’re saying repealing health care reform isn’t about denying coverage to those with pre-existing conditions even though repealing health care reform will do just that. Ladies and gentlemen, say hello to the conservative misinformation machine that doesn’t like universal health care because that would mean poor people could get health care.
Moving right along . . .
“Similarly, a repeal vote is not about defending insurance companies. Conservatives have no love of insurers”
But they sure like taking money from them!
“and many of their proposed reforms would have forced insurers to compete much more vigorously for the business of Americans.”
One, I have yet to hear any replacements for health care reform from conservatives in Congress. Two, could you be referring to the plan to eliminate the ban on preventing people from buying health insurance across state lines? Because not only do insurance companies like this, but it won’t increase coverage or lower costs. All it would do is send companies to the state with the fewest regulations.
“For this reason, many (if not all) insurers are nervous about the notion of repeal as it puts at risk the easy access to customers engendered by the measure’s individual mandate.”
No, the love in the individual mandate because that means it compels Americans to buy their product. It was what THEY wanted.
“So assertions like that of New York Times columnist Paul Krugman – who said of the Republican leadership: ‘They’re against reform because it would cover the uninsured — and that’s something they just don’t want to do’ – are just nonsense and shameful.”
Every Republican suggestion would result in either higher premiums, less coverage, or both. Krugman wasn’t wrong. You haven’t demonstrated why he was wrong. What have Republicans suggested that would have expanded coverage while lowering the deficit (which the ACA does)? None. You’re a liar.
“This brings us to what a repeal vote is about: real health care reform.”
If that were true, Republicans in Congress would have a plan, regardless of the outcome of repeal, of what they would replace the current health care reform law with. They don’t. The repeal vote is about playing to your base and about obstructing any effort at governing. Republicans have created an atmosphere where they think anyone in office who isn’t a Republican isn’t legitimately there and/or their legislation is not legitimate. Either way, repeal is about trying to make it impossible to pass the President’s agenda so the Republicans can make it seem like he can’t anything done.
One thing it isn’t about: health care reform.
“In January 2009, all sides agreed that the central tenet of health care reform was to control the growth of health care spending.”
Um, no. One side wanted to increase coverage to the 40 million Americans who currently lack coverage. The other side consists of a bunch of whores to the insurance industry.
“And it is now well understood that the health law fails this test, as witnessed by the findings of dispassionate experts ranging from the Congressional Budget Office to the Obama administration’s actuary. So, with the overhaul’s framework, the health care cost spiral will continue.”
This is a LIE, and you are a LIAR. The CBO disagrees with you, and considering you provided no number or studies to back up your claim, which is a pretty big one since the CBO says current health care reform would lower the deficit.
“Worse, the law sets up two new open-ended entitlement programs that will feed at the trough of excess cost growth and fuel the already-explosive growth in federal spending, deficits and debt.”
Again, this is a lie. Health care reform is something that is needed because the insurance companies are doing a less than stellar job providing adequate health care to millions of Americans. Furthermore, when compared to other countries, and minus the stimulus (which most economists say not only was necessary but wasn’t nearly big enough), our spending in relation to GDP is about average. We have a large deficit for two reasons: 30 years of a shrinking tax rate on the rich and, with regard to the financial crisis of 2008, shrinking tax base due to massive unemployment.
Besides, we had a surplus at the end of the Clinton administration which, economists estimate, had it been continued, would have COMPLETELY paid off the federal debt by 2012. As in next year. But, where were you when Bush destroyed that surplus with unnecessary tax cuts for the wealthy and two unnecessary wars? Oh, that’s right: you’re all for spending when Republicans do it. Not so much when a Democrat is in office.
“Repeal is about caring enough for the next generations to not destroy the foundation of their prosperity and saddle them with our debts.”
One, if you really care about future generations, you would create a health care system that would allow all to serviced, regardless of their ability to pay, just as in EVERY OTHER INDUSTRIALIZED COUNTRY. It would make them healthier and lower costs all around, considering that we pay more on health care than all other countries with universal health care and we don’t even serve everyone.
Two, what prosperity? Income inequality is reaching levels not seen since the Gilded Age. The Great Depression is a perfect lesson as to why this is a bad idea. Most of the income gains in the last 30 years have gone to the top 10%. To put it simply, most Americans have seen their wages either go down or stay the same. There has been no “shared prosperity”.
“Finally, repeal is hopefully about a new era in politics. Many candidates ran for office promising to reverse this measure.”
Then, when they get into office, they hypocritically use government health care while demanding that regular Americans shouldn’t have it.
“They ran in an environment in which the top three issues where jobs, controlling federal spending and accountability.”
Right, wrong, right. Jobs was definitely a big issue in 2010, but not federal spending (unless you’re a conservative). And when is accountability not an issue? Oh, I know! When George W. Bush was in office! Silly me!
“To not hold a vote for repeal would be to deny their accountability to the voters who put them in office.”
When polled correctly, most Americans EITHER like the law OR want it to go further. Thus, holding a vote for repeal is a major waste of time.
“It would be to deny the importance of controlling federal spending.”
We don’t have a spending problem. We have a revenue problem.
“And it would be to deny the importance of pro-growth policies,”
Low taxes on the rich.
“especially in the one-sixth of the economy most riddled with inefficiency: the health care sector.”
It is most riddled with inefficiency because insurance companies, not because of the government! Medicare’s overhead is a FRACTION of an insurance company’s because Medicare doesn’t have to pay for administrative costs, marketing, or employing armies of lawyers and insurance handlers to try and rescind insurance policies from people once they get sick.
Oh, wait! Health care reform outlaws that! Will your beloved repeal get rid of that, too?
Douglas Holtz-Eakin, you are a lying whore for the insurance agency, and a right-wing douchebag to boot. Your article isn’t worthy enough for me to print out and use as toilet paper.
The CBO prediction for a net reduction in budget deficits is based on many shoddy assumptions, including educational loan default rates, the impact of health care taxes and penalties on other commercial and income tax receipts, and disregarding future appropriations necessary to fund the legislation.
In addition, the CBO acknowledges that the predicted reduction in the budget deficits will be passed on to the private sector and other non-federal governments, and that many of the key cost savings measures will be “difficult to sustain over a long period of time.”
Refering to reducing federal spending on MediCare the CBO continues: “It is unclear whether such a reduction in the growth rate of spending could be achieved, and if so, whether it would be accomplished through greater efficiencies in the delivery of health care or through reductions in access to care or the quality of care.”
They don’t want health care reform because they want more money in their pockets, and they don’t care about the uninsured. Read Spin Doctor’s comment, it is the truth.
I cannot believe SDN allowed this nonsense to be a featured article. I guess Mr. Douglas thinks the people who come here are some half brained morons who just believe anything. This article is full of falsehoods and hogwash. If I pointed everyone out, I’d have a full article of my own.
“First, this is not about denying coverage to those with pre-existing conditions. Yes, repeal would roll back the specific provision of the health law in this regard.” What a shit-load of a statement.
“Finally, repeal is hopefully about a new era in politics”-Are you kidding me?
” Repeal is about caring enough for the next generations to not destroy the foundation of their prosperity and saddle them with our debts.” Save this nonesense for your faux-news and tea party rallies. I’m going to stop here. As if i’m not paying for the previous generation’s debt right now.
SDN, please if youre going to make something a feature article, please vet this crap.
To be fair guys, he is president of conservative think-tank American Action Forum and was John McCain’s chief economic policy adviser during the 2008 campaign. He wouldn’t be doing a very good job if he wasn’t trying to support repeal.
Therefore, well done on managing to use SDN as a platform for your thinly veiled, fallacious propaganda, Mr. Holtz-Eakin and may it further your illustrious career!
No…what repeal IS about is an empty gesture at satisfying the Tea Party base of the Republican Party. Repeal has no chance of passing the Senate and would be vetoed by the President. So instead of working on meaningful and productive changes to the health care reform law, the Republican Congress just chose to waste a bunch of time. All so they could rile up the base for their votes and raise money from the insurance lobby.
So Mr. Holtz-Eakin, if repeal isn’t about denying people with pre-existing conditions access to health care (which it is) or about feeding the campaign coffers with contributions from insurance companies, then is it about denying 22-26-year-olds access to their parent’s insurance plan? Because repeal would do that too. Is it about taking away subsidies for middle class families to purchase insurance that would be otherwise unaffordable? Because repeal would do that too.
While I think that more efforts could have been made (and should be made) to implement cost-saving measures and slow the increase in health care costs, what is in the bill is a good start.
I am all for open debate and a diverse array of opinions, but I am very disappointed that SDN has chosen to publish pure drivel, lies, and unsubstantiated conservative propaganda as a feature article.
This “article” is a sad transplanted heap of weak minded hot air that contributes nothing to the discussion- much like most of the activity in the house right now. I would like to tear it apart line by ridiculous line, but spin doctor hasn’t left much of a corpse to kick.
Read this as well if interested in a more researched view of the economic impact of repeal:
http://www.nytimes.com/2009/12/16/business/economy/16leonhardt.html?_r=1
Not one comment fully supported Mr. Holtz-Eakin’s analysis yet you permitted several very lengthy meals of very biased dishonest and erroneous information to be set before us. I find them indigestible. As in most debates, there are truths within each side’s positions yet they are often used to secure a footing that can then be used to build a meal of, as I noted, dishonesty and biases, purporting to be the “real” truth. To the contrary, the article is actually stimulating, thought-inspiring and needs to be borne in mind as the repeal plan goes forward. The recent House vote is far from the end of the process; it is just the first shot across the bow. The Socialist Obabmacare law must be repealed — and replaced. And as quickly as possible. So be prepared for a House, Senate and President who will do that starting in January 2013. In the mean time, be well.
Jack, MD calls it the health care reform bill Socialist Obabmacare [sic] care. Jack, do you even know what’s in the bill? Which of the following are you opposed to and/or consider “socialist”? From CBS news
* Six months after enactment, insurance companies could no longer denying children coverage based on a preexisting condition.
* Starting in 2014, insurance companies cannot deny coverage to anyone with preexisting conditions.
* Insurance companies must allow children to stay on their parent’s insurance plans until age 26th.
* Expands Medicaid to include 133 percent of federal poverty level which is $29,327 for a family of four.
* Illegal immigrants are not eligible for Medicaid.
* Closes the Medicare prescription drug “donut hole” by 2020. Seniors who hit the donut hole by 2010 will receive a $250 rebate.
* Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs. The bill also includes $500 billion in Medicare cuts over the next decade.
Are you opposed to Medicare because it’s government run healthcare? Are you opposed to the VA system? Do you want to privatize VA healthcare? Would you like to take away the certainty of Medicare for elderly Americans? Do you honestly think that insurance companies would chose to insure older Americans if Medicare didn’t exist? Would you rather that health insurers (who are motivated by profit and investor returns) to make coverage decisions?
I would hope that more people would get educated as to actual the contents of the bill and engage in an informed debate…rather than regurgitating talking points of “repeal and replace Socialist Obamacare” from Speaker Boehner, Eric Cantor, Sarah Palin, Mr. Holtz-Eakin, and their Tea Party friends.
I’m going to have to heartily agree with those who have posted before me. This guy comes on here with an opinion piece not supported by any sorts of numbers or facts and expects us to swallow it. Maybe the tea-baggers swallow for you sir, but bringing this infantile garbage onto a website populated by those pursuing careers in science (you know…basing things on facts and verifiable data) isn’t going to get you far.
I’m disappointed that SDN featured this spinster.
Boy, it’s fun to see how people react to a little bit of conservative common sense!!! SpinDoc is the perfect example of poorly thought out rambling that comes out of the mouth of most liberals, yes even in medicine where you’d think they’d at least be able to see two different view points. Yes, SpinDoc there are ways of decreasing the number of uninsured people out there without Obamacare- how about lowering actual costs? One of my major problems with Obamacare is that it doesn’t address the real problem with American healthcare, it just shifts the costs to other people (tax payers). We talk about how the free market doesn’t work in medicine but hey, since we haven’t had a bonafide free market healthcare system for decades it’s hard to make that argument. Most economists will tell you that unless there are incentives for lowering costs we are never going to stop the out of control spiral we are in. Mandating costs only goes so far as you will see if you look at most European countries. What we need is to get rid of the middle man for the majority of our routine healthcare, ie. the insurance companies. You see insurance should be about covering unexpected, catastrophic medical expenses, not your everyday stuff. That would give us two very important game changers- #1 people we pay directly for most of their medical costs and this would dramatically increase competition in medicine, something we haven’t had for a long long time (just try asking the hospital how much any kind of procedure will cost, usually the best they can do is “from $1000 to $3000″ or something to that effect). Medicine has been in a magical wonderland where they don’t have to really competitively price their services and changing this would drive down prices faster than anything else we could do. #2 This would dramatically cut administrative costs of health insurance companies which last estimate I saw put it at nearly a third of total healthcare costs. Just think about how much it would cost to fuel up your car if you sent every gas bill to your car insurance company to be processed and then haggled back and forth with the gas station representative. It’s a ridiculously inefficient system but that’s exactly what we have in medicine. And how did it get this way? Did the free market system fail us? Nope, it was government stepping in with their condescending “we know better than you” attitude (also prevalent in many med students and physicians I might add) and mandating the insurance companies cover ABC and XYZ and dramatically transforming the role of insurance and made it this giant inefficient monstrosity and driven premiums through the roof.
So you see Obamacare does nothing to fix the real problem. The best way to get more people insured is to bring medicine back to the real world and apply some basic principles of economics. Until prices drop we won’t have sustainable healthcare because you can only push costs onto other people for so long before things start to break down (like right now). And as for the CBO, don’t make me laugh. They are incredibly inaccurate for a host of reasons (and yes people have done analysis on their estimates and found them to nearly always underestimate costs and often dramatically so). Several of the assumptions the CBO made in their calculations for Obamacare are wishful thinking at best, here’s a prime example- the CBO included the decreased medicare reimbursement in their estimate which was supposed to have already been put into effect. Guess what? The AMA, etc. would only endorse Obamacare if that was nixed and so what did we see last year? They delayed the cuts once again and probably will continue to do so. I’m not saying the medicare cuts were the right thing to do, I’m saying when politics are involved you can’t count on the CBO. Many other organizations have put the costs at about double the CBO estimate. You can find these other estimates if you do a little homework- again, something very few med students (at least at my school) take the time to do. They’d rather latch onto the same old childish talking points and reduce every conversation to a squabble of “you don’t care about the poor and just want to see the insurance companies get rich”. Come on guys, grow up.
“SpinDoc is the perfect example of poorly thought out rambling that comes out of the mouth of most liberals”
When lacking decent arguments, insult previous poster.
“Yes, SpinDoc there are ways of decreasing the number of uninsured people out there without Obamacare- how about lowering actual costs?”
And there are ways of making cold fusion work: just put two atoms together. Gee, that was simple!
“One of my major problems with Obamacare is that it doesn’t address the real problem with American healthcare, it just shifts the costs to other people (tax payers).”
What are the real problems with American healthcare? To anyone who has studied the matter, the problems are cost AND access. The ACA, in its own way, attempted to do both. It introduced an insurance mandate so that more healthy people get health insurance. You see, right now, our health insurance system provides health for people 65 and older (whose costs are already high), some poor people, people lucky enough to have employer-based health insurance, and those lucky souls who can get it on their own. But many don’t have any insurance (approximately 40 millions). Worse yet, millions more have inadequate insurance. The end result is that all of these people put off health care for reasons of financial inability until they have to get emergency care. This care is far more expensive than preventative care. Many of these people who get emergency care this way are unable to pay for it. Hospitals and doctors then shift the costs onto those with insurance. Ergo, the more people getting emergency care they can’t afford, the more expensive our health care is. Furthermore, health insurance companies take a nice slice of our money not to provide care but to award themselves generous salaries and bonuses. There are additional administrative and marketing costs which are NOT seen in Medicare, Medicaid, or the health care system of every other industrialized democracy. When more healthy people have insurance, the healthy will subsidize the sick. Thus, costs will go down as there are less freeloaders in the system. Now, the ACA isn’t perfect; the best way to accomplish this would have been through some type of universal health care system. But, the ACA is a start.
Conservatives, on the other hand, haven’t really suggested anything. I appreciate that you have decided to offer your opinion. Let’s see if it can actually work.
“We talk about how the free market doesn’t work in medicine but hey, since we haven’t had a bonafide free market healthcare system for decades it’s hard to make that argument.”
True. Employer-based health care exists only because of massive tax subsidies. Medicare and Medicaid or also obvious government components. A true free market health care system would involve getting rid of ALL of these systems and only allowing people to purchase plans individually. However, human beings are imperfect organisms; there is something wrong with most of us, and in the insurance industry they call those pre-existing conditions. A true free market health care system would leave even more people without insurance. And, as I have indicated above, people without insurance are going to get health care somehow, and it will likely be when they can least afford it. This makes the overall system much more costly.
“Most economists will tell you that unless there are incentives for lowering costs we are never going to stop the out of control spiral we are in. Mandating costs only goes so far as you will see if you look at most European countries.”
What kinds of incentives would you provide? Lowering costs, by the way, is not the most important thing. Improving access is. While you may think lowering costs may be the key to getting more health care to people, you have to be careful that your “cost-saving” measures don’t stop people from being able to get care in the first place. Then, you yourself aren’t really cutting costs; you’re just shifting them.
“What we need is to get rid of the middle man for the majority of our routine healthcare, ie. the insurance companies.”
What?! And replace with them with . . . gasp . . . the government?
“You see insurance should be about covering unexpected, catastrophic medical expenses, not your everyday stuff.”
I’ve heard this argument before. Treat health insurance like car insurance. 1. Human beings aren’t cars. Having a car is a luxury and a privilege and is conditional on having the money to pay for it. Everyone, regardless of their ability to pay, is born with a body that can have numbers of things that can go wrong with it. 2. The basic everyday stuff is what often times prevents the catastrophic medical expenses. Plus, it’s cheaper too. Only permitting catastrophic medical expenses would drive costs up, not down. 3. Unlike with car maintenance, treatment often costs way more than anyone can individually afford. That’s why we have insurance to being with! 4. Interesting analogy. Don’t state governments require people purchase auto insurance? Isn’t that . . . a mandate? Are you suggesting a similar mandate for health care? Because the ACA already does that!
“That would give us two very important game changers- #1 people we pay directly for most of their medical costs”
No, they wouldn’t. They just wouldn’t seek care until they absolutely needed it.
“and this would dramatically increase competition in medicine, something we haven’t had for a long long time (just try asking the hospital how much any kind of procedure will cost, usually the best they can do is “from $1000 to $3000″ or something to that effect).”
How does THAT increase competition? Doctors and hospitals don’t post prices because in medicine it’s not feasible to do so. Pricing is often very subjective and is subject to change. Besides, the difference in costs between two or more doctors for a kidney transplant is essentially meaningless to someone who can’t pay the thousands upon thousands it will inevitably cost. I do agree with you that the ACA doesn’t lower costs everywhere; part of the reason procedures are so expensive is because our doctors graduate with far more debt than they do in other countries. They have to recoup these costs somewhere, and that place is the OR.
“Medicine has been in a magical wonderland where they don’t have to really competitively price their services and changing this would drive down prices faster than anything else we could do.”
Possibly for low cost things. Not for big surgeries. That’s one of the reasons you can’t treat health care like a “business”. Costs are way too expensive and you don’t know when you’ll need it. If something goes wrong, you don’t shop around. It’s not because they “don’t post prices”. It’s because consumers don’t do that when it comes to health care. It’s another reason why no other industrialized democracy does health care like that.
“#2 This would dramatically cut administrative costs of health insurance companies which last estimate I saw put it at nearly a third of total healthcare costs.”
No, it wouldn’t. Administrative costs come from profits, executive salaries, claims deniers, and marketing. Doing this won’t lower those costs at all. All of the behavior that requires all of these people and activities doesn’t go away just by posting prices or only covering catastrophic injuries. What if a claim handler, not wanting to bill the company $100,000 for that operation to treat that catastrophic injury determines that it wasn’t? Things like this happen all the time.
“Just think about how much it would cost to fuel up your car if you sent every gas bill to your car insurance company to be processed and then haggled back and forth with the gas station representative.”
Again with the car analogy. I’ve already stated why it’s false.
“It’s a ridiculously inefficient system but that’s exactly what we have in medicine. And how did it get this way? Did the free market system fail us?”
Um, yeah, it did.
“Nope, it was government stepping in with their condescending “we know better than you” attitude (also prevalent in many med students and physicians I might add) and mandating the insurance companies cover ABC and XYZ and dramatically transforming the role of insurance and made it this giant inefficient monstrosity and driven premiums through the roof.”
If we didn’t have government intrusion, so-called market based health care would be even MORE of a nightmare.
“So you see Obamacare does nothing to fix the real problem.”
No, it addressed the real problem. It just doesn’t go far enough.
“The best way to get more people insured is to bring medicine back to the real world and apply some basic principles of economics.”
What does this even mean? Economics? Really? I hate to break it to you, but these principles are not as ironclad as your free-market fundamentalist buddies make you believe they are. People don’t act rationally all the time. Besides, most economists recognize some role for the government to play.
“Until prices drop we won’t have sustainable healthcare because you can only push costs onto other people for so long before things start to break down (like right now).”
You can’t get prices to drop while you have millions of people turning to hospitals and emergency rooms as a last resort, looking for care they can’t pay for. It will do more to bring costs down if EVERYONE participates, so that the healthy subsidizes the sick. THAT’S how you get costs to go down.
“And as for the CBO, don’t make me laugh. They are incredibly inaccurate for a host of reasons (and yes people have done analysis on their estimates and found them to nearly always underestimate costs and often dramatically so). Several of the assumptions the CBO made in their calculations for Obamacare are wishful thinking at best, here’s a prime example- the CBO included the decreased medicare reimbursement in their estimate which was supposed to have already been put into effect. Guess what? The AMA, etc. would only endorse Obamacare if that was nixed and so what did we see last year? They delayed the cuts once again and probably will continue to do so.”
It’s funny how conservatives don’t trust the CBO when it says something they don’t like. I’m sorry, but until I hear otherwise, I’m going to believe their latest numbers.
“I’m not saying the medicare cuts were the right thing to do, I’m saying when politics are involved you can’t count on the CBO.”
So when do you trust the CBO? When are politics not involved with a political office? You make no sense.
“Many other organizations have put the costs at about double the CBO estimate.”
Would those be conservative think tanks? You provided no facts so I can’t say for sure.
“You can find these other estimates if you do a little homework- again, something very few med students (at least at my school) take the time to do. “
Burden of proof is on YOU, not others. Do your own research.
“They’d rather latch onto the same old childish talking points and reduce every conversation to a squabble of “you don’t care about the poor and just want to see the insurance companies get rich”. Come on guys, grow up.”
Unlike you, who’d rather latch onto the same old childish talking points and reduce every conversation to a squabble of “free markets are always good, never bad” or “universal health care doesn’t work” (except that it does) or “this is against my freedom”. Perhaps it is you with your 5 year old mentality (“this is mine! I don’t wanna share anything with you”) that needs to grow up.
Spin Doctor (aptly named) I gotta hand it to you for being quite the marathon writer! Looks like we both had a little extra time today. Let’s look at some of the main point of your rebuttal-
“What are the real problems with American healthcare? To anyone who has studied the matter, the problems are cost AND access”.
You’re creating a false dichotomy here. If you can afford healthcare then you have access. If costs are lower more people have access and that is where are efforts should be focused. Are there always going to be people who won’t be able to afford healthcare? Obviously, and we can devise special programs to care for these be it through local government or charities (yes, charity really does happen in America) BUT if you make a healthcare system based on the exceptions you end up with a one size fits none system. The 40 million number you’ve used is very misleading for various reasons. A majority are people either in between jobs or who deliberately choose not to purchase healthcare. For example I was included in that number three years ago when I finished college and it took me two months to find a job. Not a big deal. But even if you use your 40 million that’s around 13% of the population. Again, let’s design a system that works for the majority and then make adjustments for the exceptions. Plus if healthcare premiums weren’t so outrageous (again, if they covered only major stuff like insurance was designed to do) that number would drop precipitously. And again, if costs were more reasonable people wouldn’t mind paying out of pocket for regular medical expenses. I suppose part of this comes down to your personal philosophy but I don’t like the paternalistic approach. I’d rather treat people like adults, do my best educate them and let them decide how they’ll approach their own healthcare.
“Human beings aren’t cars”
Astute observation. Cars also aren’t food, shelter, electricity or many other necessary things. But amazingly free market principles work well with all those (ok ok, electricity/public utilities is a little different). The principle doesn’t change. When people have to pay for something directly they look for ways to make it cheaper. They shop around. I realize you think the average person is a complete dolt but I disagree. I think most people can put two and two together (especially when it’s their own health) and might not just wait till they have to go to the emergency room for everything. It think they might realize that their regular checkups will save them money in the long run.
“How does THAT increase competition? Doctors and hospitals don’t post prices because in medicine it’s not feasible to do so. Pricing is often very subjective and is subject to change.”
Okay, economics 101- when you can compare prices between physicians, hospitals, etc. your patient can go across the street to the other guy if his price is lower. The reason hospitals don’t post their prices is because it’s different for every insurance- that’s half the complication. Sure we can’t know exactly how much everything will cost but we could get a pretty good estimate (esp. with routine stuff) if there was any incentive to do so. Right now patients don’t care because there’s the middle man (the insurance company) who pays the direct cost. So no matter what physician treats them it will cost them nearly the same so they aren’t inclined to shop around.
“If something goes wrong, you don’t shop around. It’s not because they “don’t post prices”. It’s because consumers don’t do that when it comes to health care”
It’s because it doesn’t matter to them when they don’t pay for the cost directly as I just explained. Here’s another example- my wife needed treatment after having an early miscarriage. There were two options, one was to take some pills the other was a procedure. When I asked how much the procedure would cost all I got was blank stares. They honestly couldn’t even give me a ball park estimate. How am I supposed to make an informed decision? We choose the procedure because of convenience and again, because in the end we new we’d only be paying for a small fraction of it. That is what I mean by there being no incentive to lower costs. This applies to the patients as well as the healthcare system.
“Administrative costs come from profits, executive salaries, claims deniers, and marketing”
The insurance companies are what they are today because of government interference and mandates NOT free market forces. It’s thanks to people like you who know whats best for the rest of us.
“It’s funny how conservatives don’t trust the CBO when it says something they don’t like. I’m sorry, but until I hear otherwise, I’m going to believe their latest numbers”
Keep drinking the kool-aid my friend!! Can you dispute the DocFix? Didn’t think so. And yes, those “other” estimates are by conservative and libertarian think tanks. Is that surprising? Oh, you thought a liberal think tank would contradict the CBO on this one? Check out Cato.org. If you can make it through one of their reports they actually explain how they come up with their numbers and why they contradict the CBO and you can decide if you agree with their reasoning yourself. Novel idea.
Okay, I could go on for hours. Let me sum up all the points of your rebuttal in a few words- “Yeah, like that would work!” The free market principles that you so easily dismiss have proven they work in soooo many industries. That’s your proof right there buddy! Universal healthcare on the other hand is failing all around the world. It’s a big factor in all the trouble the EU find itself in right now – Greece and Ireland needing bailouts, Portugal and Spain not too much farther off. Sorry if I’m not that excited about joining the rest of the “Industrialized world”. You seem to think that the ideas I presented here are my own because of course conservatives don’t have any other their own. Step out of your bubble once in a while. The last piece of conservative healthcare legislation out there was Ryan Paul’s bill which while not comprehensive, had some great first steps. What? Never heard of it? Big surprise.
Yes, medicine is unique among industries, and yes we will make exceptions for the small minority who can’t afford healthcare. The best thing we can do for all involved is start moving in the direction of less government interference and more free market. That is the only really sustainable healthcare system. Until we meet again Spin Doctor!
Chris,
You wrote very long responses to Spin Doctors long comments. I admit to not reading them in detail, but I simply do not understand how Republican proposals would solve the big market failures that exist in the health insurance market.
How will free market solutions work for people with pre-existing conditions (call them ill people). How can an insurance company stay in business if it writes insurance to ill people who will need massive amounts of care? It will have to charge high premiums which either will make the insurance unaffordable to ill people (who often suffer health related financial problems) or it will need massive subsidies. As I understand it, Ryan’s bill relies on “high risk” pools, which are basically what most states use now, and which have been an utter failure both economically and politically. Economically, pooling a bunch of ill people does not significantly reduce the actuarial risk or cost of insurance; 10 ill people still need much more care than 10 well people. Politically, pools fail because governments, which are elected by majorities who don’t directly benefit from subsidies given to ill people, will cut subsidies when times get hard. Medicare has avoided massive cuts because it is basically universal; subsidies for high risk pools will suffer because they aren’t. A mandate coupled with broadly-applicable subsidies will create a constituency for continued funding of health care. That’s exactly why conservatives fear it. They’d much prefer subsidies for high risk pool that can be cut in the next downturn when the next generation of Tea Partiers (or whatever) demand cuts. The inability of insurers to viably offer insurance to ill people is market failure; it is going to take government action to fix it. High risk pools, for both economic and political reasons, fail.
Another market failure Ryan fails to address is the free rider problem. Everyone–and I mean everyone–benefits from having a functioning health care system. Would you rather live in a place where the nearest hospital is 5 miles away or 500 miles away? But a lot of uninsured folks who are not ill have decided to free ride on the system. Often, I suspect, the thinking is ‘I probably won’t get badly ill, and if I do, and medical cost gets too high, I can just go bankrupt.’ We, as a society, simply haven’t reached the point where we are willing to let people die on the side of the road because they lack insurance. For better or worse, ER’s have to accept the ill or injured and stabilize their conditions. When people free ride, when they decide they have more important or more fun things to do with their money than buy health insurance, I, as an insured, end up paying for their care. Everyone faces a risk that they’ll need expensive medical care. When they’re lying in pain, any resolve they had to tough it out will vanish and they’ll want the care. When free riders force others to bear the risk of their behavior (i.e., their failure to buy insurance), that is, to me, simply theft. Obamacare’s mandate deals with that problem. Another much less effective approach would be to make it impossible for non-low-income, non-previously-ill people to discharge medical debt in bankruptcy (or, if you really get nostalgic over the 19th century free market capitalism, bring back debtor’s prison). Ryan simply ignores the free rider problem, treating a free rider’s decision not to obtain insurance as a purely private decision that has no effect on others. But it does, it forces me to pay for the free rider’s care. Ryan is wrong.
Other parts of Obamacare take advantage of markets. The community rating made possible through mandates and subsidies, coupled with the standardization of policies, will turn insurance policies into easily comparable commodities. Consumers will be able to shop dozens of policies with a few clicks.
The Republican cost figures on Obamacare generally are flatly wrong or misleading. The doc fix has been undertaken, with bi-partisan support, every year since 1997. It’ll happen even if the Reps repeal Obamacare. The savings from canceling Medicare Advantage are real. Subsidies to hospitals which serve a lot of uninsured will decrease as the number of uninsured decreases. Tax revenues will go up due to the increased Medicare tax on the wealthy, the luxury tax and the fact that employers (in response to the luxury tax) will switch compensation from non-taxable health plans to taxable cash. Savings will be achieved when the government uses its bargaining power to buy drugs more cheaply. Savings in Medicare are not somehow “double counted”, a dollar saved is a dollar saved.
Way back when, when Dems wanted to extend Medicare to everyone, Republican think tanks championed ideas similar to Obamacare. Obamacare deals with market failure effectively, it gives consumers effective power to choose from easy to compare plans. The Republicans have won the debate, yet they refuse to take yes for an answer.
I’m iivntnig you to join where you’ll find the best, expert-curated news on the web. C’mon board!
Let’s get to the point: Why is this Right-Wing Political Bullshit being featured on SDN?
A good majority of Americans still favor the repeal of the health care law (rasmussenreports), and the Republican message of repeal and smaller government was what helped them do so well last November.
I think it’s very legitimate to feature an article that explains the repeal. It basically says, don’t worry, the law won’t actually be repealed, it’s just an important political signal to send due to the current political climate. Admittedly, this story goes from this into decidedly supporting the measure, which makes it more political than most feature articles, but it still covers a reasonable premise.
“’What are the real problems with American healthcare? To anyone who has studied the matter, the problems are cost AND access’.
You’re creating a false dichotomy here. If you can afford healthcare then you have access.”
Totally not true. Very few people can actually pay for health care. If you mean health insurance, then, I would kindly direct you to:
http://www.kff.org/uninsured/7451.cfm
It’s a study of the uninsured. It puts the number of uninsured at more like 50 million (~19% of the population) uninsured. What’s interesting is what who it includes as insured (and who it doesn’t count at all).
Out of approximately 264.7 million non-elderly people, 57% get insurance through their employer. One, such plans exist only as a result of taxpayer subsidies. Two, these are generally huge risk pools, where healthy workers subsidize the health care of sicker ones. How many of these people do you think could get individual health insurance, considering estimates that 129 million Americans have a pre-existing condition that would render them without health insurance if they had to purchase it on a “free market”? Not many. Another 20% are on Medicaid or other public insurance (excluding Medicare, which I will get to in a second). Your beloved free market insures just 5%. That’s abysmal. The study doesn’t count the elderly because – shocker – they’re on Medicare, one of the most successful and most popular social programs created.
In short, at 5% covered by private insurance, the track record for such a system is too appalling to be enacted.
Furthermore, I think we’re having an argument about cause and effect. You believe that high costs affect access. However, the evidence suggests that the opposite is true: lack of access puts a strain on the whole system, causing higher costs for everyone.
“If costs are lower more people have access and that is where are efforts should be focused. Are there always going to be people who won’t be able to afford healthcare? Obviously, and we can devise special programs to care for these be it through local government or charities (yes, charity really does happen in America)”
So you DO believe in a role for government. Any interference by government, no matter how small, makes the market not free. The point is that health care, in an era of global pandemics and public health disasters, is too important to just allow millions to fall through the cracks. That’s why no other industrialized democracy has a system like ours.
Why do you think that is?
Again, the presence of so many people that can’t afford health care ends up putting a higher cost on the rest of us by causing them to seek expensive emergency care they can’t pay for. Your system doesn’t address that. It places the burden for such costs at the hand of hospitals and doctors. They’ll just shift that back to us. Nothing will have changed. Costs will stay high.
What do you propose for people that can’t afford preventative care? How do they get it? And don’t say charity because there are no numbers anywhere to back up the claim that charity helps everyone else.
“BUT if you make a healthcare system based on the exceptions you end up with a one size fits none system. The 40 million number you’ve used is very misleading for various reasons. A majority are people either in between jobs or who deliberately choose not to purchase healthcare.”
You totally just pulled that out of your butt. Please cite the study that proves that. That’s a popular right wing talking point that has no basis in reality.
“For example I was included in that number three years ago when I finished college and it took me two months to find a job. Not a big deal.”
What if you had an accident or developed a chronic and deadly condition? How would you have been treated? Without a job, how would you have paid for it, given you didn’t have insurance? No, you would be treated, received a massive bill, not paid it, and pushed the costs onto the rest of us. That’s a problem. And it is a big deal.
“But even if you use your 40 million that’s around 13% of the population.”
As I stated earlier, it’s closer now to 50 million. It’s not a number I pulled out of my butt. You make it seem like that, but I assure you, there are studies and research that shows this number to be accurate, give or take. Where’s your research backing up your claims? And the ACA tries to bring that number down. Repealing it leaves those millions who could now get insurance out in the cold.
“Again, let’s design a system that works for the majority and then make adjustments for the exceptions.”
I agree. Single payer system. Medicare for all.
“Plus if healthcare premiums weren’t so outrageous (again, if they covered only major stuff like insurance was designed to do) that number would drop precipitously.”
They’re outrageous because they pay for executive salaries, administrative overhead, marketing, hiring people to deny claims, and less care. And paying only for “major stuff” is exactly what’s wrong with your proposal. This is a forum for future doctors. We all know (which you apparently don’t) that the key to good health and keeping costs down is preventative care, which you suggest shouldn’t be covered. Instead, our system leaves millions out until they need care they can’t pay for, in which those that have insurance then will have higher premiums as hospitals shift the costs onto them.
“And again, if costs were more reasonable people wouldn’t mind paying out of pocket for regular medical expenses.”
I think you misunderstand how much things cost in health care. Prices for procedures aren’t set arbitrarily. Most things really are that expensive. You can’t wave a magic wand and get a quadruple bypass for a quarter. As such, most medical procedures are way out of the range for most people to pay for out of pocket. And preventative care is a little better, but the pharmaceutical cartels running things, most drugs are priced out of access for most. None of your “proposals” tackle any of these issues. All you’re doing is waving around vague concepts of “bringing costs down” without hinting at how you would do it.
“I suppose part of this comes down to your personal philosophy but I don’t like the paternalistic approach. I’d rather treat people like adults, do my best educate them and let them decide how they’ll approach their own healthcare.”
I agree. But the insurance companies throw their own greed and profits into the mix, leaving millions unhealthy and unable to get health care.
“‘Human beings aren’t cars’”
Astute observation. Cars also aren’t food, shelter, electricity or many other necessary things. But amazingly free market principles work well with all those (ok ok, electricity/public utilities is a little different). The principle doesn’t change. When people have to pay for something directly they look for ways to make it cheaper. They shop around. I realize you think the average person is a complete dolt but I disagree. I think most people can put two and two together (especially when it’s their own health) and might not just wait till they have to go to the emergency room for everything. It think they might realize that their regular checkups will save them money in the long run.”
Paul Krugman eludes to a concept developed 45 years ago as to why you can’t treat health care like a normal market:
http://krugman.blogs.nytimes.com/2009/06/28/health-care-is-not-a-bowl-of-cherries/
http://www.scielosp.org/scielo.php?pid=S0042-96862004000200012&script=sci_arttext
In short, “free market” principles can work for televisions, bread, cars, but not health care. I also find it funny that of your three examples, the third is a highly regulated utility; when it was deregulated in California, the results were disastrous (see Erin Brokovitch and Enron).
“’How does THAT increase competition? Doctors and hospitals don’t post prices because in medicine it’s not feasible to do so. Pricing is often very subjective and is subject to change.’
Okay, economics 101- when you can compare prices between physicians, hospitals, etc. your patient can go across the street to the other guy if his price is lower. The reason hospitals don’t post their prices is because it’s different for every insurance- that’s half the complication. Sure we can’t know exactly how much everything will cost but we could get a pretty good estimate (esp. with routine stuff) if there was any incentive to do so. Right now patients don’t care because there’s the middle man (the insurance company) who pays the direct cost. So no matter what physician treats them it will cost them nearly the same so they aren’t inclined to shop around.”
No you don’t shop around because there aren’t often doctors and hospitals within close proximity to you. Further, NO ONE does that in an emergency; you go where the ambulance takes you. It’s one of the many reasons you can’t treat health care this way. See the Krugman post above.
“’If something goes wrong, you don’t shop around. It’s not because they “don’t post prices”. It’s because consumers don’t do that when it comes to health care’
It’s because it doesn’t matter to them when they don’t pay for the cost directly as I just explained.”
No, I just explained why.
“Here’s another example-“
Uh oh. Personal anecdote. I’m supposed to extrapolate your example to 300 million people. Oh, boy.
“my wife needed treatment after having an early miscarriage. There were two options, one was to take some pills the other was a procedure. When I asked how much the procedure would cost all I got was blank stares. They honestly couldn’t even give me a ball park estimate. How am I supposed to make an informed decision?”
In health care, most people can’t make informed decisions. They lack the expertise to do so. Again, another reason why you can’t treat health care with a free market model.
“We choose the procedure because of convenience”
Most people do. In free markets, you can’t do that and be considered acting rationally. But, AGAIN, health care is DIFFERENT.
“and again, because in the end we new we’d only be paying for a small fraction of it. That is what I mean by there being no incentive to lower costs. This applies to the patients as well as the healthcare system.”
Our current system incentivizes procedures (pay for service). One way to get costs down ACROSS THE SYSTEM (and not just the individual) is to help people and encourage people to seek preventative medicine. Kinda hard to do that when millions can’t afford to do so.
“’Administrative costs come from profits, executive salaries, claims deniers, and marketing’
The insurance companies are what they are today because of government interference and mandates NOT free market forces. It’s thanks to people like you who know whats best for the rest of us.”
Don’t presume to know what I think. Those who believe everyone is entitled to health care don’t “know what’s best for the rest of us”. We just recognize what’s really wrong with the system instead of sticking our fingers in our ears yelling, “free market, free market, free market!” If it were up to me, I’d get rid of insurance companies altogether and have them start over from scratch, operating in a system where we have a single payer system (contrary to what you might think, health insurance companies can and do operate under such systems, they just don’t control it, like you would have us do. I don’t like entrusting my health care to unelected tyrannies, do you ?
Insurance companies are what they are today because, like you, too many people have clung to the religious belief that markets in health care fix all. But, as the research has shown, such orthodoxies have failed miserably.
“’It’s funny how conservatives don’t trust the CBO when it says something they don’t like. I’m sorry, but until I hear otherwise, I’m going to believe their latest numbers’
Keep drinking the kool-aid my friend!!”
Rather the Kool Aid than the cyanide. Keep drinking the free market poison!
“Can you dispute the DocFix? Didn’t think so.”
Can you?
“And yes, those ‘other’ estimates are by conservative and libertarian think tanks. Is that surprising?”
No, but understand that they’re lying or being deliberately disengenous. I mean what credibility do conservatives and libertarians have when they come up with “death panels” and the “IRS Agents coming to get you if you don’t have insurance” lies?
“Oh, you thought a liberal think tank would contradict the CBO on this one?”
Umm, no. But conservatives never admit that they’re wrong. When was the last time liberals argue against the CBO on anything?
“Check out Cato.org. If you can make it through one of their reports they actually explain how they come up with their numbers and why they contradict the CBO and you can decide if you agree with their reasoning yourself. Novel idea.”
I don’t. The Cato Institute is a libertarian think tank with its obvious bias. Their research on a wide variety of issues (although not all; they’re not conservative so they’re not as wrong all the time as say, The Heritage Foundation) is heavily suspect.
“Okay, I could go on for hours.”
Please don’t. You haven’t proven anything.
“Let me sum up all the points of your rebuttal in a few words- ‘Yeah, like that would work!’ The free market principles that you so easily dismiss have proven they work in soooo many industries.”
But NOT health care. You’re so convinced that free markets work for everything when in fact they don’t work for a lot of things. Police, fire protection, the military, prisons, water safety, etc. Just add health care to that list.
“That’s your proof right there buddy! Universal healthcare on the other hand is failing all around the world.”
Which countries are asking for a system like ours? Name one. All other industrialized countries have it and it’s about time we did too.
“It’s a big factor in all the trouble the EU find itself in right now – Greece and Ireland needing bailouts, Portugal and Spain not too much farther off.”
See? This is what I’m talking about right now. The lies don’t stop. Greece and Ireland are not in trouble because of universal health care. What are you on and where can everyone else get some? Greece is in trouble because of massive borrowing. They are currently in trouble not because they spent too much but because they eliminated revenues for the better part of the decade. As for the Celtic tiger, those same conservative and libertarian think tanks were praising Ireland a few years ago. Turns out those policies drove it into financial ruin, including the austerity measures that were put in place during the financial crisis.
“Sorry if I’m not that excited about joining the rest of the ‘Industrialized world’. You seem to think that the ideas I presented here are my own because of course conservatives don’t have any other their own.”
No, you just don’t have any good ideas.
“Step out of your bubble once in a while. The last piece of conservative healthcare legislation out there was Ryan Paul’s bill which while not comprehensive, had some great first steps. What? Never heard of it? Big surprise.”
Oh yes I have. Ryan’s roadmap would have eliminated Medicare and Medicaid, cut social security, raised taxes on the middle class, lowered taxes on the rich, and decreased overall revenues. Yeah, there’s a real winner there.
“Yes, medicine is unique among industries, and yes we will make exceptions for the small minority who can’t afford healthcare.”
Medicine isn’t a business, and our current health care mess demonstrates that.
“The best thing we can do for all involved is start moving in the direction of less government interference and more free market. That is the only really sustainable healthcare system.”
More free market? Are you insane? Read my original post about why a completely free market in health care would be disastrous. Short version: even MORE people would lose access to health insurance.
“Until we meet again Spin Doctor!”
Spare me. Your ideas are stupid and your rhetoric is tired and repeated. Milton Friedman is dead, buddy. Deal with it. There is no such thing as a free market.
Universal health care for all!
“A good majority of Americans still favor the repeal of the health care law (rasmussenreports),”
Actually, if you look at the polls, you’ll see that most people like the ACA or want it expanded. And, even further, they like some sections of it while disliking the parts that pay for the ones they want.
Consistently, Americans, in one way or another, favor some sort of universal health care. It is very certain they do NOT like what they have right now.
“and the Republican message of repeal and smaller government was what helped them do so well last November.”
No, they won because incumbents don’t fare so well in midterm elections when the economy is bad. This has nothing to do with Obama or health care and everything with how politics works and how it has worked. It may have gone better if Obama had done something for his base, but that’s just my opinion.
“I think it’s very legitimate to feature an article that explains the repeal. It basically says, don’t worry, the law won’t actually be repealed, it’s just an important political signal to send due to the current political climate. Admittedly, this story goes from this into decidedly supporting the measure, which makes it more political than most feature articles, but it still covers a reasonable premise.”
I agree that an article about repeal would be ok. This one just sucked big time. It was full of unsubstantiated and unsupported hyperbole by a guy working for a conservative think tank. When it comes to health care, conservatives and libertarians haven’t had any real ideas in decades.
Tort reform is a joke. Lawsuits don’t contribute nearly as much as anyone thinks that they do to health care costs. Purchasing insurance across state lines will only produce insurance that is less regulated, more expensive (higher premiums) and that doesn’t pay for as much care.
We are future health care providers. It is up to us to ensure that all Americans receive excellent quality health care. Universal health care is the way to go.
Universal health care is definitely the way to go. Those who are against it are the rich and the uninformed/brainwashed.
Spindoctor,
If the majority of people are happy with the job that the democratic president, democratic house, and democratic senate have done in 2 years; then why was such a landslide at the elections in November? Think about it. Majority of the people would like free health insurance and probably wished cotton candy also grew on trees. Economics for dumbasses: spending more money than you make does not save any money; especially when you are in debt. If you want to be a citizen of a purely socialistic sountry go to mother russia where everything is shared and nobody owns anything. Medicare and medicaid are horribly run and are a direct cause for healthcare costs increasing. medicare and medicaid routinely deny hospitals payment for medical treatment that by law should have been covered. I was part of a team for a hospital that sued medicare for this reason. this is a routine practice. the VA hospitals have been described to me by freinds who have been injured in iraq as the worst place on earth. medacaid has covered breast augumentation and plastic surgeries for people that i have known. one girl i know personally has had tatoos removed (that were not gang symbols or anything like that so dont use it as an excuse) and another girl i knew had a nose job done by medicaid too. But then they deny coverage for a person who is really sick!! the politicians and doctors who also run programs like medicare and medicaid have been caught stealing money from the systems. organized crime has made millions off the medicaid and medicare system too. they were recently caught, b/c they were stupid enough to falsify medical records having a Opthamologist order asomething like heart medication for a guy with a heart condition. too much government control is self destructive. just look how well chicago is run. absolute power leads to absolute corruption. how come no one is also looking at the fact that the same drug companies that raise our medications prices; turn around and sell the same medications to europe and canada for cheaper prices than they sell it to their own countries population (our government is well aware of it and doesnt care). what about illegal aliens (or anyone for that matter) in this country going to emergency rooms for colds and being treated. hopital then eats the bill and healthcare costs go up. emergency rooms are for emergencies!! What about pointless lawsuits? if a doctor screws up he should be sued, but if the lawsuit is unfounded and is determined to be complete s than the plaintiff should have to cover the hospitals legal fees. that would in turn also lower healthcare costs. hospitals do not want to spend money on going to court and would rather pay off many lawsuits that are unfounded and do not have any legal ground for a lawsuit to be filed. if the medical care is so good in universal healthcare countries why do the politicians and rich citizens of canada come to the united states to get treated? it is not like you can just make an appointment to see a doctor. on average you should be able to see a doctor probably in about 6 months if is not life threatening. there have been plenty of instances in canada and europe were patients have died waitting to see a doctor. plus once it does become socialized the competition for creating jobs and doing research will also slow down as well. competition = advancement
on a different note i do want to see everybody get healthcare. i am one of the so called 40 million uninsured. like a vast majority of that number i am young and choose not to spend my money on health insurance b?c i dont need it at this time. the insurance companies contributed millions and millions of dollars to the democratic party members before the healthcare bill was signed b?c it would require by law that everyone has to get health insurance. who would benefit from that? could it be the insurance companies? is it unconstitutional? obama fails to realize that he is not exempt from abiding by the constitution. he is not a dictator. in this country there is freedom of press, that means he can not tell the press that they face federal criminal charges and up to a ten thoousand dollar fine for taking pictures of the oil spill (CN even bashed him for that one look it up on youtube). he can not require us to by healthinsurance. i will do what i want. if he doesnt like it he can pay 100% of the cost. this is supposed to be a free country!!! i am not going to be told how to spend the money that i work for. i cant wait until 2012 for the vast majority of the country to send him another message!!!!
Man, you guys have too much free time on your hands.
“If the majority of people are happy with the job that the democratic president, democratic house, and democratic senate have done in 2 years; then why was such a landslide at the elections in November?”
Landslide? Hardly. Republicans won one house. They managed to screw up the Senate by running really crazy right-wingers. But, to answer a question more aligned with reality, “why did the opposing party to the President win more seats in one house of a bicameral legislature?”, I would say that that is what happens to an incumbent party when the economy is bad. There’s plenty of precedent for that and it has little to do with the politics of the incumbent much of the time. It was expected, given the economy. Now, if the economy had been better, that might not have been the case. That’s the real issue. Many economists (Gilbraith, Krugman, Stiglitz) have argued an even larger stimulus would have put many more back to work (just like under the New Deal).
But, that’s a discussion for a different day. In short, the Republicans won because the economy was/is bad.
“Think about it. Majority of the people would like free health insurance and probably wished cotton candy also grew on trees.”
Although I wouldn’t disagree (cotton candy is awesome), I would add that that is generally how the electorate behaves if you look at polls. People love government programs that they don’t want to pay for. Doesn’t take a doctor to see that one.
But no one calls universal health care “free”. Britain doesn’t call NHS that. Everywhere else, they consider it a government program that they pay for.
“Economics for dumbasses: spending more money than you make does not save any money; especially when you are in debt.”
True, if you’re talking about a person. Governments are different, especially if the debt they have incurred is in a currency that they control (i.e. the United States).
“If you want to be a citizen of a purely socialistic sountry go to mother russia where everything is shared and nobody owns anything.”
1. 1989 just called. Apparently it wanted to remind you that the Soviet Union doesn’t exist anymore. Russia has been a capitalist state for approximately 20 years now. And it’s a particularly bad capitalist state at that.
2. That’s a general misunderstanding of communism and socialism. But since I’m not defending either one, I will just leave it at that.
“Medicare and medicaid are horribly run and are a direct cause for healthcare costs increasing.”
Umm, no. They are both more efficient and have lower overhead costs than private insurance. Care to back up your claims with studies and not just unprovable anecdotes (“my dad’s friend’s first cousin’s girlfriend knows this guy who works with this girl who says that Medicare and Medicaid suck”)? Didn’t think so.
“medicare and medicaid routinely deny hospitals payment for medical treatment that by law should have been covered. I was part of a team for a hospital that sued medicare for this reason. this is a routine practice.”
So someone breaks a law and instead of punishing that person we should just repeal the law? And how do you feel about drug legalization?
“the VA hospitals have been described to me by freinds who have been injured in iraq as the worst place on earth.”
First off, invest in a spellchecker. Two, I’m calling B.S. for two reasons: your description of FRIENDS that have been injured in Iraq telling you means nothing (in a court of law, that’s called hearsay). The second reasons I’m calling B.S. is because it just flatly isn’t true. The VA used to be bad, but during the 1990′s they went through intense reforms and now they outperform most non-military hospitals and clinics. And the reforms had nothing to do with being government provided vs. private insurance.
“medacaid has covered breast augumentation and plastic surgeries for people that i have known. one girl i know personally has had tatoos removed (that were not gang symbols or anything like that so dont use it as an excuse) and another girl i knew had a nose job done by medicaid too. But then they deny coverage for a person who is really sick!!”
Once again, you don’t win an argument like this with personal anecdotes. How can I or anyone else know whether or not they’re true?
“the politicians and doctors who also run programs like medicare and medicaid have been caught stealing money from the systems.”
One of them just became the Republican Governor of Florida. And he wasn’t too fond of health care reform either. Go figure.
“organized crime has made millions off the medicaid and medicare system too. they were recently caught, b/c they were stupid enough to falsify medical records having a Opthamologist order asomething like heart medication for a guy with a heart condition.”
And your point is . . . what exactly? That the mob broke the law? Way to go deep into policy analysis, Mary Matalin.
“too much government control is self destructive.”
Ah, there’s that Reaganite propaganda that we all know and loathe! Good thing the government doesn’t control health care and wouldn’t even under a single payer system!
“just look how well chicago is run.”
Still better than Texas.
“absolute power leads to absolute corruption. how come no one is also looking at the fact that the same drug companies that raise our medications prices; turn around and sell the same medications to europe and canada for cheaper prices than they sell it to their own countries population (our government is well aware of it and doesnt care).”
Because the pharmaceutical companies buy influence in our government with their lobbying?
“what about illegal aliens (or anyone for that matter) in this country going to emergency rooms for colds and being treated. hopital then eats the bill and healthcare costs go up. emergency rooms are for emergencies!!”
Since when does someone’s immigration status matter when they’re seeking medical care? And as for what you said about emergency rooms, please see the Emergency Medical Treatment and Active Labor Act of 1986 for details. Also, you’re right about hospitals eating bills and passing the costs down to us. That’s one of the justifications for an insurance mandate or a single payer system in general. Many people who lack insurance, for whatever reason, forgo health care until it is an emergency, and then they can’t pay for it because most procedures are too expensive for those without seven-figure incomes.
Basically, you’re making my point for me! Thanks!
“What about pointless lawsuits? if a doctor screws up he should be sued, but if the lawsuit is unfounded and is determined to be complete s than the plaintiff should have to cover the hospitals legal fees.”
They already do that.
“that would in turn also lower healthcare costs. hospitals do not want to spend money on going to court and would rather pay off many lawsuits that are unfounded and do not have any legal ground for a lawsuit to be filed.”
Tort reform won’t make a dent in controlling costs.
“if the medical care is so good in universal healthcare countries why do the politicians and rich citizens of canada come to the united states to get treated?”
For the same reason why many people leave the United States to seek care elsewhere: because they can. Show me some statistics on medical tourism without forgetting to put in medical tourism FROM (not just TO) the United States and then we’ll talk.
“it is not like you can just make an appointment to see a doctor.”
Um, like, yes, you can.
“on average you should be able to see a doctor probably in about 6 months if is
not life threatening.”
You’re talking about non-elective surgery. They’ve done studies on this and they’ve found that people in such positions are no worse off medically. Even so, you don’t think we have waiting times in the United States? And that’s the biggest horror of universal health care?
Was I supposed to be scared? Because I’m not. Try again, Michael Myers.
“there have been plenty of instances in canada and europe were patients have died waitting to see a doctor.”
Let’s see some numbers. Like this one: 32,000. That’s how many people die in one year in the United States from lack of medical insurance.
“plus once it does become socialized”
Socialized medicine does NOT equal universal health care. It is one form of universal health care. There are several others. No one is seriously suggesting making socialized health care (i.e. Britain’s system) in this country. What we do want and we will get is a single payer system, which is NOT the same.
“the competition for creating jobs and doing research will also slow down as well. competition = advancement”
Which research are you referring to? You mean the 85% in this country which is already funded by the NIH, meaning your tax dollars? That research? Oh, I’m sure it will be fine.
“on a different note i do want to see everybody get healthcare.”
Oh, good. Your soul hasn’t been completely devoured by the ghost of Ayn Rand.
“i am one of the so called 40 million uninsured. like a vast majority of that number i am young and choose not to spend my money on health insurance b?c i dont need it at this time.”
Just out of curiosity, why are you even here? This is a website and forum for future health care providers and I can guarantee you that this stupid. Everyone ALWAYS needs health care. One of the reasons you can’t treat health care like a normal business is because you never know when you’re going to need it.
And by the way, don’t you feel a little like a hypocrite when you rant against people going to the emergency room when they can’t pay for care when you’re putting yourself at risk for doing the exact same thing?
You can’t buy health insurance when you’re sick in this country. What exactly are you waiting for?
“the insurance companies contributed millions and millions of dollars to the democratic party members before the healthcare bill was signed b?c it would require by law that everyone has to get health insurance. who would benefit from that? could it be the insurance companies?”
I agree. But that was your conservative ideology at work, not my progressive one. You have only yourself to blame.
“is it unconstitutional?”
Most likely, yes.
“obama fails to realize that he is not exempt from abiding by the constitution.”
You’re confusing Obama with Cheney.
“he is not a dictator. in this country there is freedom of press, that means he can not tell the press that they face federal criminal charges and up to a ten thoousand dollar fine for taking pictures of the oil spill (CN even bashed him for that one look it up on youtube).”
Wasn’t that BP, not the President?
“he can not require us to by healthinsurance.”
Right! And the government can’t make me buy car insurance! Or pay for police! Or fire protection! Or the military! Or . . . wait. Nevermind.
“i will do what i want.”
WHATEVA! WHATEVA! I DO WHAT I WANT!
“if he doesnt like it he can pay 100% of the cost.”
Good luck with THAT one.
“this is supposed to be a free country!!! i am not going to be told how to spend the money that i work for.”
Sure you can. It happens all the time. Stop watching Fox News. It’s bad for your (and our) health.
“i cant wait until 2012 for the vast majority of the country to send him another message!!!!”
And what happens if you don’t get your way? What will you do?
“‘is it unconstitutional?’
Most likely, yes.”
I meant to say no, it is not unconstitutional.
“What this is” about is an attack on the Democrats for voting this bill into law in the first place. Look at the polls on NYtimes and other sites. The representatives that voted the bill are all Republican and only 3 democrats. This just a hate trip on the republican side nothing more. And they know the chances of repealing the bill on the senate side is low. Even if that miracle happened, they still face Obama’s veto.