The Obama Presidency - 2008 & 2012

[JPhillips]

Originally Posted by molson

It's not a very complicated case. The argument length shows they're pretty obsessed with either perception or the policy merits of the plan. If it wasn't for the how important this was policy/political-wise, I'd expect it to be affirmed 8-1 or 9-0. But instead, I'm curious to see if the dissenters will want to go to back to pre-1930 commerce clause interpretation, or if they'll come up with some other wrinkle that nobody's talking about yet. Because even if you're a justice that believes the commerce clause still means something - this doesn't seem like the best place to fight that battle. In this case, unfortunately, I think Congress does have the authority to make healthcare even more expensive and less efficient and accessible.

I think it's a lot more complicated than that because the court isn't simply looking at one question. Today the argument is whether there is standing to even hear the case. If the mandate is a tax the precedent is that someone has to be affected by the tax before the court can hear a case against it. Tomorrow is the question on the mandate and severability. Apparently the standard severability clause was left out of the ACA, so there's a chance the court will say any of the law that gets tossed invalidates the whole law. Wednesday is the argument on Medicaid expansion and an unfair burden on the states. This has the potential to change almost every federal aid to state package if the court decides that restrictions on federal money aren't allowed.

There's a lot going on here and three of the four big decisions have the potential for major changes the way the federal government works. By judicial precedent and the voting records of the justices this should be a solid win for the admin, but given that this court has already shown an inclination to rule against precedent I think anything's possible.

[albionmoonlight]

Originally Posted by molson

Well, relatively, in the sense that if healthcare costs continue to explode, we're all going to have less access to care. I think that the goal of Obamacare is for more Americans to count as "insured," and it will probably be successful in that, but we'll have to see how that designation translates into actual healthcare when everything costs even more than it does now.

Though, I kind of wonder too if the system completely blows up, if we'll be forced to go to something that looks more like a universal healthcare or even a single payer system, and if that's by design as well.

Edit: And maybe I'm wrong, I'm no healthcare expert or anything. But when the federal government wanted more people to have access to home ownership, college education, and healthcare - the cost of all three exploded and have caused a ton of hardship - and here we have another "solution" that the pharmaceutical companies and insurance companies are completely on board with. It's hard to be optimistic, but maybe it's big enough to cause some kind of burst to where we can rebuild it into something efficient.

Thanks for the well-thought out response.

And, because I'm in a good mood, here's another talking point for your side:

There is a real tension between the "create jobs" talk of how health-care jobs are exploding and how they will provide the decent-paying careers for a new generation of Americans and the "health care costs are too high" talk about how we will make the system more efficient. Efficiency means paying less people less money to do more work. Not really job-creation language there.

Looked at more broadly, it is not at all surprising that the three areas that did well jobs-wise pre-recession (government services, education, and health care) are the three areas where people now say we need to drastically cut costs. A sector can provide decent jobs for people--or it can provide rock-bottom price/value for consumers. I have yet to see a sector do both of those things.

However, having not stayed at a Holiday Inn Express since last summer, I really don't know how we are supposed to balance keeping jobs with efficiency. I'll leave that to the people foolish enough to want to be in charge.

[panerd]

Originally Posted by gstelmack

66 vs 53 is consistent? But yes, the rest are just backing their team.

Meaning the independents seem to match the country as a whole. I didn't really understand what I was supposed to get out of the chart actually. There were a couple of different angles...

1) The Democrats sure had a huge partisan swing when their guy got in office. (With the Republicans also having an expected change of heart)

2) The country as a whole has a lot less faith in Obama than Bush. (I am sure the usual racism answer will be thrown out by some as the reason for this)

3) (My personal explanation) The country is at least starting to come to grips that the president can't control everything especially when things happen on a global scale.

I guess I would have to know more about the OP's politics and where he got the chart to see which angle he was shooting for.

[Marc Vaughan]

Originally Posted by cartman

FactCheck.org : President Obama’s Vacation Days

An 11-day stay in Hawaii where the president and his family celebrated Christmas and New Year’s Eve.

How does that count fully as 'vacation' - surely presidents get public holidays off 'free' as with everyone else?

[gstelmack]

Originally Posted by panerd

Meaning the independents seem to match the country as a whole. I didn't really understand what I was supposed to get out of the chart actually. There were a couple of different angles...

1) The Democrats sure had a huge partisan swing when their guy got in office. (With the Republicans also having an expected change of heart)

2) The country as a whole has a lot less faith in Obama than Bush. (I am sure the usual racism answer will be thrown out by some as the reason for this)

3) (My personal explanation) The country is at least starting to come to grips that the president can't control everything especially when things happen on a global scale.

#3 can't be it, because it presumes a certain level of intelligence that all other indicators say are sorely lacking.

My problem with the chart is that all of these can be spun however you want, and we don't know what the actual questions were that were asked, so there's no real information as far as I'm concerned.

[Galaxy]

Originally Posted by flounder

I think the value of our dollar is really hurting us at the pump, considering that is what oil is pegged to.

[sterlingice]

Well, it's a pile of things:

File:Brent Spot monthly.svg - Wikipedia, the free encyclopedia

First, we have increasing demand around the world. We also have producers in the Middle East who are needing higher and higher prices to break even, budget-wise, so they control supply a lot tighter. And we have a significant increase in the premium that speculation adds to the price. I'd rank all of those above a weak dollar.

SI

[Edward64]

Doesn't look good for the good guys.

Health Care Law Endures Tough Questioning From Swing Justice At Supreme Court Showdown | Fox News

The man often known as the Supreme Court's swing justice posed tough questions about the scope of the controversial health care overhaul Tuesday, suggesting he might have doubts about its validity.

Justice Anthony Kennedy did not fully tip his hand as to how he might ultimately vote in the case -- leaving all sides to ruminate for the next few months until an expected summer ruling.

On this most important day of arguments for the landmark case, most of the high court bench was thoroughly engaged for a two-hour debate over the constitutional merits of President Obama's health care law. Based on the tenor of Tuesday's arguments, the justices appeared to be closely divided and this case, as do so many other close ones at the high court, may ultimately come down to Kennedy's vote.

Early in the arguments, the veteran justice cut to the heart of the debate over the so-called individual mandate -- which was the focus of Tuesday's hearing -- asking the federal government's attorney to explain what constitutional power the government had to force all Americans to obtain health insurance.

[DaddyTorgo]

I'll bite - I wouldn't mind seeing the individual mandate ruled unconstitutinal. It's likely the best/fastest road we have to single-payer, through a "medicare for all" solution then.

See http://robertreich.org/post/19972321637

[Marc Vaughan]

Originally Posted by DaddyTorgo

I'll bite - I wouldn't mind seeing the individual mandate ruled unconstitutinal. It's likely the best/fastest road we have to single-payer, through a "medicare for all" solution then.

See Robert Reich (Healthcare Jujitsu)

Out of interest why is that seen as a 'bad thing' (ie. requiring health coverage and/or the state doing a single-payer approach and negotiating cheap rates like nearly all European countries do).

Secondly - with regards to 'enforcing' people have health coverage, why is this different to any number of other requirements placed on people by law .... last I heard you 'required' insurance to be able to drive a car, you're also required it for numerous other activities (flying a plane, I expect theres something similar for boats beyond a certain size etc.).

How is health insurance any different? - if someone gets ill they get to be treated which costs the society funding in a similar way to if an uninsured person hits another car and it has to be repaired etc.

[JPhillips]

Marc: FREEDOM!!!

[molson]

Originally Posted by Marc Vaughan

Secondly - with regards to 'enforcing' people have health coverage, why is this different to any number of other requirements placed on people by law .... last I heard you 'required' insurance to be able to drive a car, you're also required it for numerous other activities (flying a plane, I expect theres something similar for boats beyond a certain size etc.).

The states are allowed to put requirements on their citizens based on their own laws/constitution, but the federal government's powers are limited to what the federal constitution says it can do. There's different clauses authorizing activity in different areas, but the "commerce clause" has been used as kind of the catchall authority - that clause gives federal congress the power "To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes" - so obviously, you can make an argument that almost anything effects interstate commerce in some way, and those arguments have been pretty successful the last 80 years. (there's some other issues in front of the Court with this case but that's the simple answer).

As far as insurance in general - a few states have managed to require every citizen to buy health insurance, but I think in some states that wouldn't fly depending on their own constitution. Car insurance, and plane insurance, of course, regulates only those who chose to drive or fly, and states regulate the shit out of cars....but health insurance regulates being alive, so it's a tougher sell.

As for the argument itself - I think this is one of the reasons the Supreme Court doesn't like their arguments to be on TV, everyone's jumping to conclusions here. I've done and attended a lot of appellate arguments, tough questions mean most of all that the justices are interested in your case. A lot of times a justice wants to vote with you, they just want some help writing the opinions. Every appellate judge is different obviously, and I don't know the specific reputations of the supreme court justices in this regard, but I don't think there's a ton of correlation between the kinds of questions asked and how the case is going to turn out. Appellate justices tend to be law nerds, I've seen them spend most of the argument talking about an angle they find interesting but then the completely go a different way when they write an opinion. Maybe the U.S. Supreme Court wouldn't do that with so many eyes on them, but that's the thing too - they're not used to this many eyes on them for oral argument, so who knows how the hell they're changing their approach for that.

[molson]

Originally Posted by JPhillips

Marc: FREEDOM!!!

"Healthcare good, must be constitutional, stuff I don't like bad, must be unconstitutional". (Or vice-versa off course, that's the more realistic answer depending on one's policy perspective, you can make an argument for almost anything to be either constitutional or unconstitutional)

Edit: I completely fail at it myself 99% of the time, but if it's a case I don't give a shit about at all I can sometimes see the constitution for what I think it really is supposed to be, like a moment of understanding, and it's like, I don't know, the legal equivalent of having a few good strong beers and seeing the world a little differently. Or a brisk walk in the woods. I don't know what I'm talking about.

[PilotMan]

Originally Posted by Galaxy

I think the value of our dollar is really hurting us at the pump, considering that is what oil is pegged to.

This is something that sounds good, is a favorite of the right but isn't very accurate. It sounds good in theory, especially when you can point to QE under the Obama admin, and disagree with it.

However, looking at a historical chart of the dollar v. the pound (picked because the Euro hasn't been around long enough), it shows that the dollar is stronger now that it was from 04-08 and comparable to the strength in the late 90's.

All currencies devalue through inflation over time. Sure the dollar is weaker than it was 30 years ago, but relatively strength fluctuates. So the price of oil will increase over time, like the price of everything else, but blaming the price at the pump on 4 years of presidency or QE is just convenient and too simple.

From British Pound Rate Forecast

Historical British Pound Rate (GBP)
Year GBP/USD	Year GBP/USD	Year GBP/USD	Year GBP/USD
1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 0.40 0.41 0.43 0.45 0.56 0.57 0.52 0.47 0.43 0.50 0.57 0.66	1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 0.75 0.78 0.68 0.61 0.56 0.61 0.56 0.57 0.57 0.67 0.65 0.63	1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 0.64 0.61 0.60 0.62 0.66 0.69 0.67 0.61 0.55 0.55 0.54 0.50	2008 2009 2010 2011 0.55 0.64 0.65 0.62
Average annual currency exchange rate for the British Pound (British Pounds per U.S. Dollar) is shown in this table: 1971 to present.

Today the dollar trades at 0.63.

[PilotMan]

Originally Posted by molson

The states are allowed to put requirements on their citizens based on their own laws/constitution, but the federal government's powers are limited to what the federal constitution says it can do. There's different clauses authorizing activity in different areas, but the "commerce clause" has been used as kind of the catchall authority - that clause gives federal congress the power "To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes" - so obviously, you can make an argument that almost anything effects interstate commerce in some way, and those arguments have been pretty successful the last 80 years. (there's some other issues in front of the Court with this case but that's the simple answer).

As far as insurance in general - a few states have managed to require every citizen to buy health insurance, but I think in some states that wouldn't fly depending on their own constitution. Car insurance, and plane insurance, of course, regulates only those who chose to drive or fly, and states regulate the shit out of cars....but health insurance regulates being alive, so it's a tougher sell.

As for the argument itself - I think this is one of the reasons the Supreme Court doesn't like their arguments to be on TV, everyone's jumping to conclusions here. I've done and attended a lot of appellate arguments, tough questions mean most of all that the justices are interested in your case. A lot of times a justice wants to vote with you, they just want some help writing the opinions. Every appellate judge is different obviously, and I don't know the specific reputations of the supreme court justices in this regard, but I don't think there's a ton of correlation between the kinds of questions asked and how the case is going to turn out.

How soon until we see lawsuits saying that insured patients (and hospitals) shouldn't be forced to pay for those who are uninsured? Especially when people aren't required to carry insurance. Then hospitals simply refuse to treat people who don't carry insurance (or have it). Isn't that the logic that we are heading toward? Is that the end goal for our society? It's what's been sold to us in every other aspect of our society. How long until healthcare ethics are gone?

[molson]

Originally Posted by PilotMan

How soon until we see lawsuits saying that insured patients (and hospitals) shouldn't be forced to pay for those who are uninsured? Especially when people aren't required to carry insurance. Then hospitals simply refuse to treat people who don't carry insurance (or have it). Isn't that the logic that we are heading toward? Is that the end goal for our society? It's what's been sold to us in every other aspect of our society. How long until healthcare ethics are gone?

That's a good question but it's a total mystery to me how that works or where we're going. Hospitals do completely different things when it comes to turning people away or not even now. I've known people that have gone to hospitals with broken limbs, got 'em fixed up, got a bill, wrote a letter saying they can't pay the bill (one guy was a law student at a public university, so he might have had some strategy to hit the right terms to get the right response), and the bill just kind of goes away. I don't know if it was a public/private/religious hospital or what and obviously that's not everyone's experience, but whose paying for that? Is the hospital just taking a loss on something like that (which would indirectly effect everyone else's costs, of course), or is there some mechanism for them to get reimbursed for services some other way?

[JPhillips]

Originally Posted by molson

"Healthcare good, must be constitutional, stuff I don't like bad, must be unconstitutional". (Or vice-versa off course, that's the more realistic answer depending on one's policy perspective, you can make an argument for almost anything to be either constitutional or unconstitutional)

Where I would differ is that I think there are very few things that are obviously unconstitutional. The document is purposely vague on most things and the decision is always going to come down to the nine on the Supreme Court. Those nine have and will always be influenced by their own biases and political pressure. Ten years ago the mandate probably would have based 6-3 or 7-2. Thirty years ago it was a GOP idea and it wouldn't have even been considered unconstitutional.

That's not to say objectively the mandate is constitutional, but if it is declared unconstitutional that won't be an objective answer either.

[sterlingice]

Originally Posted by Marc Vaughan

Out of interest why is that seen as a 'bad thing' (ie. requiring health coverage and/or the state doing a single-payer approach and negotiating cheap rates like nearly all European countries do).

Secondly - with regards to 'enforcing' people have health coverage, why is this different to any number of other requirements placed on people by law .... last I heard you 'required' insurance to be able to drive a car, you're also required it for numerous other activities (flying a plane, I expect theres something similar for boats beyond a certain size etc.).

How is health insurance any different? - if someone gets ill they get to be treated which costs the society funding in a similar way to if an uninsured person hits another car and it has to be repaired etc.

The really short but meaningful distinction is "you don't have to buy a car". So, you can choose to not pay for car insurance. However, one of the cases the government used in arguing the Supreme Court case is that health care is unique in that all people will use it at some point. So that's where the principal argument lies: is it or isn't it necessary.

{now I'll digress into editorializing}


File:Health care cost rise.svg - Wikipedia, the free encyclopedia
One of the views from our side of the pond is that Europe is bankrupting itself with health care costs. And, while there's a grain of truth there, the chart I linked to show it's not true. However, that brings us to our next point.

Ultimately, it's not the way it is now and there are a lot of forces working against the change and it's a lot harder to convince people to change
You have a lot of interests who have money and power from the way things are now and they are resisting change. So we get all sorts of things about how there are lines for health care in Europe (never mind how long it takes here) or how much it costs.

There's also a large growth of American exceptionalism over the last 20 years so a lot of people say "we do it best" no matter the objective metrics which show otherwise. I think that plays into JPhillips's glib answer of "FREEDOM!!!" was glib, which is true in a sense. People think that it's ok to have what we have now and pay what we pay now and get what we get now because of the "that's how it's been and that's how it should be". It's the idea that people look at change and only see the positives of what are happening now and only measure the negatives of change rather than looking at both the benefits and drawbacks of both systems.

Me, I'm all for a single-payer state but that was taken off the table almost immediately. That's what happens when the chair of the committee drawing up the bill (Max Baucus) received something like $3M in the few years prior from the health care industry.

A cynic would say you end up with one entrenched side that denies there is a problem despite huge evidence to the contrary and another side who puts their faith in a corrupt and captured government. And those parties are voted into office by a populace that's stupid enough to utter things like "Get your government hands off of my Medicare"

SI

[JPhillips]

A big part of the problem is that the discussion on healthcare costs related to ACA only takes government spending into account. There isn't any way to cover more people and get economies of scale without it coming from the government, so of course any major health reform will include an increase in government spending. I'm fine paying more to the government if the overall costs of healthcare decrease(or at least rise much slower.)

[RainMaker]

Originally Posted by molson

That's a good question but it's a total mystery to me how that works or where we're going. Hospitals do completely different things when it comes to turning people away or not even now. I've known people that have gone to hospitals with broken limbs, got 'em fixed up, got a bill, wrote a letter saying they can't pay the bill (one guy was a law student at a public university, so he might have had some strategy to hit the right terms to get the right response), and the bill just kind of goes away. I don't know if it was a public/private/religious hospital or what and obviously that's not everyone's experience, but whose paying for that? Is the hospital just taking a loss on something like that (which would indirectly effect everyone else's costs, of course), or is there some mechanism for them to get reimbursed for services some other way?

The hospital isn't taking the loss. It's passed on to those who can pay or to taxpayers that help fund the hospitals.

It's why we do sort of have a national system. It's just not efficient at all. Not sure how to fix it though.

[RainMaker]

Originally Posted by JPhillips

A big part of the problem is that the discussion on healthcare costs related to ACA only takes government spending into account. There isn't any way to cover more people and get economies of scale without it coming from the government, so of course any major health reform will include an increase in government spending. I'm fine paying more to the government if the overall costs of healthcare decrease(or at least rise much slower.)

I do think the costs are important to bring down too and something we have avoided. It's why I think a lot of the healthcare reform is short sighted.

We do have to figure out what is minimum care. Does everyone get at CAT scan when they bump their head? Does everyone get the meningitis vaccine? And then with actual medication, shouldn't we be opening the borders here for purchases and forcing other countries to finally pay their fair share for the cost of drugs?

I think one of the problems is that we go into this looking strictly at coverage as opposed to increasing efficiency and lowering costs which makes the coverage part much easier.

[PilotMan]

Originally Posted by RainMaker

I do think the costs are important to bring down too and something we have avoided. It's why I think a lot of the healthcare reform is short sighted.

We do have to figure out what is minimum care. Does everyone get at CAT scan when they bump their head? Does everyone get the meningitis vaccine? And then with actual medication, shouldn't we be opening the borders here for purchases and forcing other countries to finally pay their fair share for the cost of drugs?

I think one of the problems is that we go into this looking strictly at coverage as opposed to increasing efficiency and lowering costs which makes the coverage part much easier.

OMG!!!! DEATH PANELS FOR ALL!!!!

[JediKooter]

The problem I have with the requirement to pay for insurance if you don't want it is...if health care wasn't a "for profit business", I'd have no problem. However, since it is a "for profit business", I'm strongly opposed to it. I really wish that I could invent a product that the government forces everyone to buy, I'D BE RICH BITCHES!!!!

[sterlingice]

Originally Posted by RainMaker

I do think the costs are important to bring down too and something we have avoided. It's why I think a lot of the healthcare reform is short sighted.

We do have to figure out what is minimum care. Does everyone get at CAT scan when they bump their head? Does everyone get the meningitis vaccine? And then with actual medication, shouldn't we be opening the borders here for purchases and forcing other countries to finally pay their fair share for the cost of drugs?

I think one of the problems is that we go into this looking strictly at coverage as opposed to increasing efficiency and lowering costs which makes the coverage part much easier.

And can I bring up the glib "DEEEEATH PANELS!!!"

EDIT: PilotMan beat me to it

God forbid we actually have a systemic approach to finding the best bang for the buck. As it is right now, Anthem gets to be my death panel instead of the government. I'd rather have the group that doesn't have a vested interest in XX% profit and a 20%+ overhead cost and go with the <5% administrative cost and 0% profit motive for Medicare.

SI

[JPhillips]

Even without rationing care we could save a shitton by paying the average of Canadian and European costs for most medical services. Look at how much we pay for a head CT compared to Canadians and Europeans.

[molson]

Death panels get such a bad rap.

Edit: I'm thinking it's the name. Maybe call it the "Reagan/Clinton government accountability and efficiency compassion healthcare committee". Who'd vote against that?

[SteveMax58]

Originally Posted by JPhillips

Even without rationing care we could save a shitton by paying the average of Canadian and European costs for most medical services. Look at how much we pay for a head CT compared to Canadians and Europeans.

Yeah, but those costs are just not apples to apples to compare since they ultimately tie to cost of living differences (and all that it entails including education, etc.) and profit margins for the service provider (obviously the insurance providers as well...but thats the crux of the argument).

Not saying they aren't fair assumptions but that data is not capable of making the compelling argument that one would like due to so many external (from healthcare) factors that influence it.

[SteveMax58]

Originally Posted by RainMaker

I do think the costs are important to bring down too and something we have avoided. It's why I think a lot of the healthcare reform is short sighted.

We do have to figure out what is minimum care. Does everyone get at CAT scan when they bump their head? Does everyone get the meningitis vaccine? And then with actual medication, shouldn't we be opening the borders here for purchases and forcing other countries to finally pay their fair share for the cost of drugs?

I think one of the problems is that we go into this looking strictly at coverage as opposed to increasing efficiency and lowering costs which makes the coverage part much easier.

I think this is ultimately the conversation the general public would like to hear but not what politicians will openly discuss (or not many of them).

It just goes back to the corrupt oligarchy in place...which is what anti-big government people fall back to as the default response to "you aren't getting to the root of the problem so this will be another item of corruption to unravel in the future". That response doesn't solve problems, in and of itself, but it is the longer term implications that I believe people see there...and they simply don't believe it will work out positively.

[RainMaker]

Originally Posted by SteveMax58

I think this is ultimately the conversation the general public would like to hear but not what politicians will openly discuss (or not many of them).

It just goes back to the corrupt oligarchy in place...which is what anti-big government people fall back to as the default response to "you aren't getting to the root of the problem so this will be another item of corruption to unravel in the future". That response doesn't solve problems, in and of itself, but it is the longer term implications that I believe people see there...and they simply don't believe it will work out positively.

I don't know if the public wants to have that discussion though. Lets take an example.

Meningitis kills about 500 people a year. There is a vaccine for this. It isn't full-proof, but it does help in many cases. That vaccine costs around $150 per person.

Now do we vaccinate everyone? From a fiscal standpoint, you'd probably have to say no. It would cost billions of dollars to do so. But you can't say that to the public. Because every Mother is going to want their kid to get that vaccination for the incredibly small chance their kid could die from it. The same goes for when a kid falls off the swingset and bumps his head. Not 99.999% of the time he's just fine, but there is that super small chance that something isn't right and a CAT scan would pick it up. What is a parent going to want?

It feels like an impossible subject to broach with the hysterics we have in politics. Those on the right will claim these are death camps and those on the left will claim that poor people aren't getting coverage (since rich people could fork over the $150 for the vaccine).

[JPhillips]

Originally Posted by SteveMax58

Yeah, but those costs are just not apples to apples to compare since they ultimately tie to cost of living differences (and all that it entails including education, etc.) and profit margins for the service provider (obviously the insurance providers as well...but thats the crux of the argument).

Not saying they aren't fair assumptions but that data is not capable of making the compelling argument that one would like due to so many external (from healthcare) factors that influence it.

When you look at other industrialized countries cost of living isn't a big factor. Profit margins certainly are a big factor, and that's the problem. As long as we're comfortable paying far more than other OEC countries because providers should get rich we'll continue to have massive problems with our healthcare system.

[SteveMax58]

Originally Posted by RainMaker

It feels like an impossible subject to broach with the hysterics we have in politics. Those on the right will claim these are death camps and those on the left will claim that poor people aren't getting coverage (since rich people could fork over the $150 for the vaccine).

I think people (well, most people) are much more willing to have that discussion though. I just think the majority of people simply don't understand how the costs are where they are. Of course, there's no shortage of politicians & hacks ready to step up & spew out the very simple reasons...insurance companies! government! Bush! The French!!...or whoever.

I think the bottom line is that there really needs to be a determination of basic care as a fiscal matter. And because it is somewhat of a strange (if not unconstitutional) provision, the individual mandate needs to go in favor of allotment from income taxes. Its easy to justify a percentage of income, since you are under no obligation to actually earn income, then to say you must purchase something (albeit, I believe there is a low income clause...but its still directing people to buy something as somebody else mentioned "just to be alive").

I honestly don't know that Medicare is the right benchmark for basic care either. Perhaps it is, but I'm just not sure it has the be the standard to start with.

[SteveMax58]

Originally Posted by JPhillips

When you look at other industrialized countries cost of living isn't a big factor. Profit margins certainly are a big factor, and that's the problem. As long as we're comfortable paying far more than other OEC countries because providers should get rich we'll continue to have massive problems with our healthcare system.

I don't disagree but I'm just saying the healthcare provider is also a vested profiteer in this as well. Sure they fight with insurance companies from time to time but it isn't like they are all trying to save the system money in any way either.

How many follow up visits should somebody have for a cold? Should there even be a follow up (or initial) visit for having a cold? I can tell you that there is no shortage of wait 30 minutes for a 5 minute office visit and then please schedule another follow up in 2 weeks just in case. Each of those running approx $100+. And of course the insurance provider is the only person with a direct interest in actually saving money (though not to be confused with lowering costs really...as inflated cost yields more gross income even if profit is flat).

So yeah, the entire system of health care is pretty much wrongly incentivized & screwed. I guess I just stated the obvious.

[DaddyTorgo]

Originally Posted by sterlingice

And can I bring up the glib "DEEEEATH PANELS!!!"

EDIT: PilotMan beat me to it

God forbid we actually have a systemic approach to finding the best bang for the buck. As it is right now, Anthem gets to be my death panel instead of the government. I'd rather have the group that doesn't have a vested interest in XX% profit and a 20%+ overhead cost and go with the <5% administrative cost and 0% profit motive for Medicare.

SI

This is such a basic concept, I'm surprised that even your average stupid American doesn't get it. Honestly.

[gstelmack]

Originally Posted by RainMaker

Meningitis kills about 500 people a year. There is a vaccine for this. It isn't full-proof, but it does help in many cases. That vaccine costs around $150 per person.

Now do we vaccinate everyone? From a fiscal standpoint, you'd probably have to say no. It would cost billions of dollars to do so.

Wouldn't the price go down if more were vaccinated? Wouldn't this fall in the same realm as tetanus, pneumonia, and other "occasional" vaccines?

[larrymcg421]

I find it interesting that the individual mandate is the part of the law that is supposedly some sort of socialist idea to control people. If Obama truly were a socialist, he'd have passed the law without the individual mandate, but with the requirement to cover people with pre-existing conditions. This would be way worse for the insurance companies as no one would then buy insurance until they needed it.

As for controlling costs, I think getting everybody insured and getting rid of co-pays for preventative care will accomplish that. More people getting preventative care = more conditions caught early = cheaper procedures = fewer expensive late term procedures necessary.

[RainMaker]

Originally Posted by gstelmack

Wouldn't the price go down if more were vaccinated? Wouldn't this fall in the same realm as tetanus, pneumonia, and other "occasional" vaccines?

I think a lot of the newer vaccines for this don't have a generic option yet so they cost more. Increase in demand may bring price down a bit. But even if we brought it down to the cost of say the measles vaccine ($10), that's still billions of dollars to vaccinate for something that doesn't kill a lot of people.

My point isn't necessarily about meningitis, it's just an example of one of many decisions that would have to be made. We'd have to put a price on lives at some point. We have to decide if tens of billions of dollars is worth saving a couple hundred lives.

There are many other examples we can use. Should everyone be getting colonoscopies? And at what age should we be starting them? Raising that age 5 years might save billions but cost some lives. Someone is going to have to make that decision where they say everyone should get X vaccine but we can't afford Y vaccine. That we should cover mammograms at such and such intervals but not a CT scan when someone has a bad cough.

[bhlloy]

Those kinds of decisions get made all the time in the UK.
People manage to survive without overthrowing the government and if they don't like it, they pay for private. But like you say, it's a debate that people aren't willing to even consider here for the most part

[RainMaker]

Originally Posted by bhlloy

Those kinds of decisions get made all the time in the UK.
People manage to survive without overthrowing the government and if they don't like it, they pay for private. But like you say, it's a debate that people aren't willing to even consider here for the most part

The UK isn't filled with mindless partisians who have such low self-esteem and self-worth they have to treat politics as sport and only care if their team wins.

[bhlloy]

I don't think that's true at all, FWIW. Just in the UK it's an accepted fact of life and here it never has been. If overnight there was national health care in the US and there was nothing anybody could do about it, I'd imagine people would get comfortable with it pretty damn quick

[RainMaker]

My point is more that it seems other countries can actually compromise on things. We bicker over what condiment someone uses on their burgers. I think it would work and be fine here, but I just don't see it happening for a long time. Too many people would rather "win" political battles over improving things. The game is more important than reality.

[JPhillips]

It's not about compromise, it's about the parliamentary system. Whatever party wins the election in England gets to pass laws. Things would be a lot different(I won't argue for the better or worse) if Obama had been able to pass laws on a simple majority.

[Marc Vaughan]

Originally Posted by JPhillips

It's not about compromise, it's about the parliamentary system. Whatever party wins the election in England gets to pass laws. Things would be a lot different(I won't argue for the better or worse) if Obama had been able to pass laws on a simple majority.

Actually thats not the case - the UK system isn't 'that' different to the US, we have two houses - with the House of Lords being a non-partisan house intended to balance against the politicians in the House of Commons - and thus veto anything suspect.

These days both houses have some party lines, but not to the black/white extent that the US appears to have, ie. you're correct compromises and work arounds do exist generally, which frankly I think would improve the US government hugely .... this 'black/white' stance the parties are taking really isn't helping anyone or improving their credibility at all imho (not that I get a vote anyway mind you ... I just get to pay taxes ).

PS - On the subject of 'death panels' why didn't anyone raise the fact that most health care has capped limits on spending when this stupidity was being discussed ... those 'caps' are exactly the same as any limits put in place by a government, ie. they prevent treatment over a certain cost for some things.

[RainMaker]

Originally Posted by Marc Vaughan

PS - On the subject of 'death panels' why didn't anyone raise the fact that most health care has capped limits on spending when this stupidity was being discussed ... those 'caps' are exactly the same as any limits put in place by a government, ie. they prevent treatment over a certain cost for some things.

Because people don't care about facts. They just want their team to win.

[JPhillips]

Originally Posted by Marc Vaughan

Actually thats not the case - the UK system isn't 'that' different to the US, we have two houses - with the House of Lords being a non-partisan house intended to balance against the politicians in the House of Commons - and thus veto anything suspect.

These days both houses have some party lines, but not to the black/white extent that the US appears to have, ie. you're correct compromises and work arounds do exist generally, which frankly I think would improve the US government hugely .... this 'black/white' stance the parties are taking really isn't helping anyone or improving their credibility at all imho (not that I get a vote anyway mind you ... I just get to pay taxes ).

PS - On the subject of 'death panels' why didn't anyone raise the fact that most health care has capped limits on spending when this stupidity was being discussed ... those 'caps' are exactly the same as any limits put in place by a government, ie. they prevent treatment over a certain cost for some things.

But laws still pass on a majority vote. There isn't a sixty percent requirement for every bill as is now the case in the US Senate. Cameron probably can't add the SIGames logo to the flag, but his tax and spending measures pass largely as the Tories and Lib Dems wish.

[Marc Vaughan]

Originally Posted by JPhillips

Cameron probably can't add the SIGames logo to the flag

Come the revolution this will change obviously

[sterlingice]

There's also the issue of proportional representation. You can't have one party that goes "government just doesn't work" as one of their major tenants. If that happens in a system like most European countries- that party is just viewed as not working and all of their power is marginalized as two and three other parties rise to take their place.

SI

[stevew]

What's broken is the notion of a senate being necessary in 2012.

[RainMaker]

The Senate is kind of a weird setup. A state of 600k has as many Senators as a state of 37 million. Seems a bit outdated with how large the population gaps have become.

[bhlloy]

Originally Posted by JPhillips

But laws still pass on a majority vote. There isn't a sixty percent requirement for every bill as is now the case in the US Senate. Cameron probably can't add the SIGames logo to the flag, but his tax and spending measures pass largely as the Tories and Lib Dems wish.

To an extent maybe, but like Marc says there's actually consensus across party lines on certain issues, plus the presence of other parties that can make a consensus easier to reach, and also I'd add the fact that MP's are elected by a relatively small group of people in a concentrated local area, so they are far more accountable than US politicians. I couldn't even tell you who any of my state senators or congressmen are over here, whereas I've met my local MP back in the UK a few times and know exactly where they stand on most issues (or at least did back when I lived there).

So, even if my MP was Conservative, he would probably want to not go too right wing or vote blindly with the party on every issue regardless of how his local constituents feel, otherwise he's pretty much guaranteed to be out on his ass next time and he's going to get an earful every time he's in the constituency.

Put it this way, if Cameron decided tomorrow that he wanted to abolish the NHS there's no chance in hell he could accomplish it, even with a decent majority in parliament. Whereas a republican president with control of the houses could probably undo Obama's healthcare laws in a matter of weeks I expect. It does make for a much less polarized political atmosphere and more chance for moderation in my opinion.

Honestly, the political system I'm the biggest fan of is the German way of doing things. Very proportional and involved at a local level but still enough power and consolidation to get things done at the state level. Probably why they are pretty clearly the dominant power in Europe and will be for a very long time.

[bhlloy]

DOLA - I don't want this to come across at all like I'm US bashing - there's a reason I live here and not in Europe (other than my wife hates the cold) but I think the lack of consensus in US politics is really reaching critical and dangerous levels. Sure it's always been a two party system but at least there have been enough differing viewpoints and people willing to work across the aisle that it's worked in the past. Now, the number of moderates that are hanging it up and being replaced by mouth breathers on both sides of the aisle and the hysteria when somebody even dares to voice an opinion that isn't the party line, we're not heading to a good place. A political system can't work on 4-8 year cycles of parties that hate everything about each other alternating and spending their entire time tearing down everything the "other side" stands for. The middle ground seems to be getting smaller and smaller and I don't even know how we get back there right now.