Affordable Care Act in the United States

[Fatherted 129]

I wrote a massive opinion piece, but BLOODY SIMTROPOLIS deleted it.

 

I will say this though. The TEA Party proposals are effectively predecessors of Nazism. Forcing another party to just back down over a 4 year old proposal is ridiculous. One day, a TEA Party Republican will get elected as president with fake promises, and tell all Democrats and non-green card holders to leave the country within a month. Then the killings will start. America will collapse under a terribly oppressive dictatoral machine. The USA will declare war on Russia and China, prompting WWIII. Then the world will end.

 

TEA Party are surely unconstitutional somewhere. Someone needs to look.

[A Nonny Moose 8,263]

"If this goes on ..." eh, Meg?  Somewhere in the TEA Party, Nehemiah Scudder is hiding.

[Duke87 1,070]

 

Sure, you can pass laws stripping them of the right to refuse a patient, or making them public servants, or subjecting them to all sorts of new rules to make them do what you think they should be doing, but they have, and will always have, the ultimate trump card: leave the profession.

Strange that other countries can retain their doctors while simultaneously ensuring that everyone has access to healthcare and preventing doctors from turning down patients on anything other than medical grounds. 

 

Though I wonder how many doctors will actually quit their jobs. I mean, they did invest quite a lot of money, effort and time in becoming one. And the job pays pretty good. So yeah, they might be annoyed with the nonsense they have to put up with, but would that cause them to quit and start all over again in another job after all they did to get where they are? And to give up their secure income? 

 

Leave the profession at young to middle age? No. But some might retire a bit sooner. And many more college age students will choose not to enter the profession in the first place when they might if it were more attractive.

 

I don't claim to know what being a doctor is like in other countries. I don't know any. But I would venture to guess that the fact that they either literally or effectively work for the government makes their life a lot simpler. As does the fact that they have a much lower personal legal liability.

 

Point being, more government control over healthcare in the US can make things either better or worse, depending on whether we do the right things or the wrong things. And the problem is, we're doing more of the wrong things... because the right things go against the interests of people in positions of high influence (be they lawyers or pharmaceutical companies).

[Meg 368]

"If this goes on ..." eh, Meg?  Somewhere in the TEA Party, Nehemiah Scudder is hiding.

 

He is.   But sometimes it seems like you and I are the only ones who are even thinking about looking.

[AkemiAzula 280]

The government should be in charge of all public organisations and healthcare seems about as public an organisation as you can get as all are affected by it more or less. If ever an area required greater standardization and efficiency it was that.

[A Nonny Moose 8,263]

Government oversight of the healthcare system does not limit the College of Physicians and Surgeons.  They are simply part of the machine here in Canada.  Our healthcare system started in Saskatchewan as a result of terrible abuses by the "welfare" organizations under a Liberal government.  It took several years to sort the whole thing out, but in the tend, T.C. (Tommy) Douglas drove it right up the centre aisle of the House of Commons.  Mr. Douglas, after he retired from his seat in Parliament, was honoured with a chair at the Speaker's table.  I don't think any other Canadian has ever been so honoured.

 

One thing is for sure, however.  Private insurers are limited to offering extra coverage that is not in the Canada Health Act and the idea of an HMO never really took root in Canada.

 

The Obamacare model is not the most wonderful law in the world, but it is law in the U.S.  Too late for repeal.  It probably does need a considerable amount of tinkering as the flaws emerge.  The paediatric care provisions need to be looked at, for instance.  Households without children should be exempt, or seniors at least.  Once the kids have left the nest, the time for investment in them has ended.

[hym 358]

TEA Party are surely unconstitutional somewhere. Someone needs to look.

 

 That concept doesn't really exist in American politics.  You can be a blatant hate organization, such as the KKK, and the government can't touch you for that.  The First Amendment's protection on free speech is very broad.

 

[Fatherted 129]

TEA Party are surely unconstitutional somewhere. Someone needs to look.

That concept doesn't really exist in American politics. You can be a blatant hate , such as the KKK, and the government can't touch you for that. The First Amendment's protection on free speech is very broad.

In Britain, free speech is restricted by:

No Hate Speech or other Discrimination

No direct Slandering of others, although their actions can be

I think it's disgusting that the KKK have turned from a fiercely hated all-white racist organisation into something that you can sit down and have discussions with in the government's eyes. Speaking with them legitimises them.

[A Nonny Moose 8,263]

Canada has the same free speech attitude as Great Britain.  We saw no need to change it.

 

A lot of things in the U.S. constitution were built when the exasperation levels were too high to think about brakes on the cart.

[catty-cb 4,413]

The government should be in charge of all public organisations and healthcare seems about as public an organisation as you can get as all are affected by it more or less. If ever an area required greater standardization and efficiency it was that.

 

According to this site

 

http://www.wheresmytaxes.co.nz/

 

the New Zealand Government pays 13.98 billion  to give 4,485,394.00 people a "free" public health system and according to this site

 

http://www.cbpp.org/cms/?fa=view&id=1258

 

the American government pays $732 billion or 21% of its budget for having Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), that was in 2012 so its possible gone up since then and you are still paying for personal health insurance.

[LexusInfernus 908]

The problem is that the government doesn't have the money to give you that, and there isn't sufficient room for revenue creation to give it that.

That depends on how you set up the system. If you pay what you normally pay to insurance companies to the government, they can use that to get you the medical aid you need. They can probably spend that money a whole lot more effectively as well, since they don't have a profit incentive. They can essentially spend every dollar you pay in taxes on healthcare, rather than only a part of that dollar because they need the rest to still make a profit. 

 

Of course, it gets more difficult when you have a huge group of people that can't afford to pay taxes, let alone insurance. Essentially, Americans are to poor to afford proper healthcare. Hmm, that should make you wonder, one of the richest countries in the world can somehow not afford proper healthcare for all its citizens, while countries that are a lot less rich can. And why are there so many people in the United States that believe this is something to be proud of? 

[Fatherted 129]

For some reason I can't +1 you for this. Give yourself a mental +1.

[AkemiAzula 280]

Money seems to be at the root of this problem. Everyone seems to agree healthcare is something we should have these days, but nobody seems to be able to suggest a way of funding anything public. 

 

Maybe we need to replace money.

[A Nonny Moose 8,263]

The whole fiscal system is teetering on collapse.  The current impasse in the U.S. may be the final shove to knock over the whole house of cards.

 

If you ever wanted to see rampant capitalism out of control you need only look at the U.S. in the 1920s or, for that matter, now.  The question is can the U.S. survive a 1929 market crash and depression?

 

As for the ACA, it has holes in it you could drive a pantechnicon through.  Far too many people ground axes on its necessary provisions and added a lot of fat to it, I am sure.  U.S. law making leaves a great deal to be desired what with sweet-heart riders, and nepotistic deals.

[Easy Bakes 253]

The whole fiscal system is teetering on collapse.  The current impasse in the U.S. may be the final shove to knock over the whole house of cards.

 

If you ever wanted to see rampant capitalism out of control you need only look at the U.S. in the 1920s or, for that matter, now.  The question is can the U.S. survive a 1929 market crash and depression?

 

That may be the best thing that could happen.and may have been what they should have let happened a few years ago instead of bailing  every one out. you know capitalism!

[hym 358]

That depends on how you set up the system. If you pay what you normally pay to insurance companies to the government, they can use that to get you the medical aid you need. They can probably spend that money a whole lot more effectively as well, since they don't have a profit incentive. They can essentially spend every dollar you pay in taxes on healthcare, rather than only a part of that dollar because they need the rest to still make a profit. 

 

Of course, it gets more difficult when you have a huge group of people that can't afford to pay taxes, let alone insurance. Essentially, Americans are to poor to afford proper healthcare. Hmm, that should make you wonder, one of the richest countries in the world can somehow not afford proper healthcare for all its citizens, while countries that are a lot less rich can. And why are there so many people in the United States that believe this is something to be proud of? 

 

Back during the height of the Obamacare controversy,  several studies looked at whether a single payer system could reduce America's health care spending.  One of the studies regarded as taking a realistic approach to the issue of a single payer system suggested that the federal government would suddenly find itself saddled with a $3 trillion/year spending obligation (possibly higher).  The federal government has never taken in more than $2.6 trillion.  This obviously raises some questions about how the government is intending to raise trillions more in additional revenue.

 

In fairness to the federal government, implementing such a single payer system wouldn't require the federal government to actually raise $3 trillion in new revenue.  The federal government spent about $820 billion last year on health care expenses, and it would seem completely reasonable that those expenses could be rolled into the $3 trillion estimate, so let's give the federal government credit for already covering $820 billion of the $3 trillion.  This leaves the federal government a cool $2.18 trillion that it needs to come up with.  The Census Bureau currently estimates that there are a little less than 115 million households in the US.  If one assumes that each household spends an average of $4,500 per year on health insurance premiums, this gives the government an extra $518 billion of revenue that it could raise and politicians could argue that they aren't really hurting anyone.  This leaves the federal government with an outstanding $1.66 trillion that it needs to cover.  The government spent approximately $700 billion last year on the Department of Defense.  Cutting back to 2001 levels of defense spending would net the federal government approximately $400 billion in savings, and lower the deficit to approximately $1.26 trillion.

 

Side Note:  The $400 billion figure does not factor in the impact of inflation over that same time frame.  Factoring inflation into the calculation would significantly reduce the spending reduction the government would be able to claim.  It also does not factor in expenditures that cannot be rolled back to 2001 levels, which would further reduce the government's ability to claim cost savings.

 

Now things get incredibly interesting, because the government currently has an approximately $1.26 trillion deficit it needs to somehow close, and Congressional politicians are out of options that don't involve playing with political suicide.  Legislators could argue that, because the federal government is covering the cost of paying for every American's health care, state health care initiatives are redundant and thus pass a law effectively seizing all state incomes previously associated with state health care initiatives.  Assuming that federal lawmakers had the guts to steal money from their own states and had the spin doctoring skills to navigate that political no man's land, that would gain the federal government approximately $500 billion in new revenue, reducing the deficit to approximately $760 billion.  If the legislators stop here, they saddle America with a program that will inevitably drive the federal government bankrupt.    If they are going to close the deficit and provide the program its necessary financing, they are going to have to fight their greatest challenge of all: Bite the hand that feeds them and attack their corporate lobbyists and donors.  If they are to ensure that there is sufficient tax revenue from corporate America to cover the remaining expenses, Congressional legislators, Democrat and Republican, will have to join hands and walk into the political hell that is tax reform and they will have to do it with a measure of bipartisanship and humility that they haven't mustered in decades.  Anything less would almost certainly spell political suicide.

 

If Democrats and Republicans can somehow do the unthinkable and learn to work as a cohesive unit of adults who put the country above the political party and their election chances, the federal government could potentially build up a sufficiently large revenue base to be able to finance a single payer system like what is used elsewhere.  Until that happens, the government will almost certainly never be able to afford such a system.

[LexusInfernus 908]

Yes, but healthcare in the US is currently extremely overpriced (thank you free market). You guys pay way to much for your healthcare. So in all likelihood, you probably wouldn't actually have to come up with three trillion dollars. 

 

But granted, the US government first needs to get its act together, and reform a whole lot more than just the healthcare system. Healthcare is linked to so many other things, it would require a radical transformation on a lot of levels and across a lot of sectors before healthcare gets cheaper and the revenue base for a single payer system gets in place. But, if other countries that are a lot smaller and earn a lot less can do it, then surely an economy the size of the US would be capable of it as well. 

[hym 358]

Yes, but healthcare in the US is currently extremely overpriced (thank you free market). You guys pay way to much for your healthcare. So in all likelihood, you probably wouldn't actually have to come up with three trillion dollars. 

 

Actually, the $3 trillion estimate is considered to be the amount necessary just to keep the system going.  To actually turn it into a quality health care system for everyone would likely cost the federal government several hundred billion on top of that.  (Bear in mind that the insurance agencies aren't slouches at driving down costs either and they have been actively doing it for a long time.)

 

One of the things that doesn't get a whole of press in this entire debate is that there are a growing number of studies that are suggesting that, even if the government was handed complete control of the American health care system, it would be relatively impossible for the government to get the spending problem under control and achieve any meaningful cost reductions.  Yes, the fact that health care is driven by for-profit individuals and corporations does create an overhead that wouldn't exist under a government run program, but that does not mean that it would translate into cost savings for the American public (you can thank the federal government's legendary inefficiency and non-incentive to cut costs for that).

 

What is starting to show as the real problem here isn't whether the health care system is for-profit or not.  It's the combination of a whole bunch of factors together (none of which seriously deal with the for-profit issue).  Americans, by and large, live crappy lifestyles.  We eat too much, eat the wrong stuff, don't exercise enough, don't get enough sleep, work too much, are overstressed, etc.  Individually, none of these factors will likely seriously drive a person to need increased medical care (and thus raise their medical spending).  Together, however, it creates a rather insipid problem.  You become a Baby Boomer who has half a dozen chronic health problems that require regular monitoring, expensive drugs, and so forth.  I don't have the study in front of me, but it has been estimated that if you take out the costs associated with treating chronic health conditions that are entirely preventable, American health care spending roughly falls in line with the rest of the Western world.  Or to put it a different way, if you take a guy from Europe, put him in America for several years and he doesn't pick up the chronic health problems currently plaguing this country, the cost of providing him health care does not appreciably change.

 

If the federal government really wants to start reducing the cost of providing health care, some of the biggest targets it needs to be looking at include:

 

• Tort reform (you know you have a problem when doctors can be making over $500,000 per month in their practice and still can't afford their malpractice insurance)
• Promoting healthy lifestyle habits and preventative medicine
• Evaluating government regulation that encourages more costly medical procedures over cheaper alternatives and prevent some accepted alternatives from even being legal in the US

[LexusInfernus 908]

• Tort reform (you know you have a problem when doctors can be making over $500,000 per month in their practice and still can't afford their malpractice insurance)
• Promoting healthy lifestyle habits and preventative medicine
• Evaluating government regulation that encourages more costly medical procedures over cheaper alternatives and prevent some accepted alternatives from even being legal in the US

 

Heh, good luck with the second one. You saw how everyone reacted when New York banned large soda containers. 

 

Also, poverty relief. Ensuring a more equal distribution of wealth, preferably by strengthening the position of the middle class and making it easier for people to achieve middle class wealth will prevent a lot of ills. 

 

Oh as for the government lack of incentives. That is not true. Governments and private enterprises are not that different. They have exactly the same incentive. A private enterprise wants profit, which comes in the form of money, and a government wants profit in the form of winning the elections. Hence, forcing the government to adapt to the wishes of the public means voting for whoever promises to do exactly that. 

[A Nonny Moose 8,263]

Don't forget that that money is coming from somewhere now.  It is coming from the HMOs who are making a profit, so how are the premiums for health care, hmmm?  The system would be best served by cutting out the middle man and instituting a tax hike to cover it that could probably be less than the premiums paid by most HMO subscribers now. 

 

Our system provides only a bare minimum of care.  It pays for hospital stays, physician visits anywhere, surgical procedures, medications supplied in hospital and that's about it.  It is not feather bedded.  If you want extras, you pay.  But you can take out supplemental insurance to cover your expenses.

 

Let me give you an example:  When I had my arterial heart bypass in 2000, I had incisions that were closed by surgical staples when I was discharged by the hospital.  I had to pay for the tool to remove them.  Cute little bit of plastic they charged me five bucks for.  i'll bet the cost for it was probably around fifty cents.

 

If I wasn't a senior, I'd have to pay for my drugs outside of hospital.  The Ontario Senior's Drug Program pays for most of my drugs with an annual 100 dollar deductible and a $4.10 co-payment for each prescription.  I am on about 20 drugs, but fortunately, I get them in three month lots.

 

Currently, doctors are on a fee-for-service system and there is a schedule that controls that.  Doctor's take is audited regularly and if a doctor is seeing too many patients per hour (too many services per hour), an explanation and maybe loss of licence are in order.

 

For people with catastrophic drug expenses, there is the Ontario Trillium drug program.  If you can show that your annual drug expenses exceed some fixed part of your income, you are eligible.  When my wife was alive we were on that program because our drug cost in any one year was over $8,000.  Rather stiff for a couple of retired people.  It effectively reduced our drug bills to an annual deductible calculated on our previous year's income and the dispensing fee the same as the seniors plan.  After my wife passed away, I fell back on to the seniors plan because there was too much paper work and i could afford to pay for my drugs on the ODP.  No idea how the other provinces cope, but a quick look indicated that Ontario has the best plan.

 

One thing about the Canada Health Act is there is no restrictions like paediatric care.  Families are covered, period.  Breaking care categories up into specific areas is just more expensive red tape.  You don't need it.  This is obfuscation by the insurance companies even if it is in the act.

 

If the drafters of the ACA took a real look at our system, they would have been wise to just adapt it a little and take it as it stands.

[Duke87 1,070]

The costs aren't even the issue. The United States will never see single payer healthcare regardless of whether or not it can be cost effective, because the for-profit healthcare industry is too big an industry to regulate out of existence. Through the power of lobbying they will never allow it to happen.

 

Remember: government regulation in the US generally aims to protect profits first, and to protect the consumer second.

[Meg 368]

The costs aren't even the issue. The United States will never see single payer healthcare regardless of whether or not it can be cost effective, because the for-profit healthcare industry is too big an industry to regulate out of existence. Through the power of lobbying they will never allow it to happen.

 

Remember: government regulation in the US generally aims to protect profits first, and to protect the consumer second.

 

For example, the American Medical Association was not founded to promote the health of the American people.   It was founded to protect American doctors.   It is a lobbying organization, not a medical one.

[LexusInfernus 908]

What are you? A democracy or what? Use your votes and stop voting for all of those people that protect big business before you, the voter. Punish that kind of behavior rather than just apathetically sigh and move on. 

[A Nonny Moose 8,263]

^ Totally agree.  The horse has got the bit in its teeth.  What ever happened (again!) to government "of the people by the people and for the people"?

 

No organization or industry is too big to be put in its place.  There was lots of trust busting in U.S. history, and there really is no reason except for bought politicians that it can't happen again.  If corporate America has the people by the throat, it is time to issue a few "hands off" regulations.  Could be that the ACA is the thin edge of this wedge.

 

It is time for the American people to stop giving up little bits of freedom and get back to first principles.  Times have changed, but allowing corporations to restrict freedom is not one of the tenets of America.  Time to cut the nonsense and quit supporting the big business politicians.  Don't stay home or vote the party ticket blindly.  Get rid of the hoods and boodlers.

[LexusInfernus 908]

I'm pretty sure your fabled founding fathers did not intend to let the government fall into the hands of a small number of people who happen to have a lot of money to spend. 

[Fatherted 129]

I'm going to make up a little calendar for y'all on the other side of the pond.

17th October-Final day of normal operation

18th October-Paychecks fail to come through, not much difference to normal operation

25th October-1 week without pay. Riots. Border Staff in airports leave. No leaving the country by air.

27th October-Mass Riots, Police decommissions

28-29th October-Colossal Riots, exodus of law-abiding citizens

31st October-Border to Canada closes

3rd November-Terror strikes, homicides increase, Riots take over the country. NYC,Washington, Detroit, Chicago, Houston and Seattle fall over the week

5th November-Border to Mexico closes

7th November-Presidential evacuation out of USA

8th Novermber-Militia fails to control riots.

10th November-Power fails, supplies fail to enter American soil. Residents plunder farms and ravage warehouses

27th November-Supplies largely run out

29th November-American attempt to enter Canada illegally. Citizens are killed in the skirmish.

31st November-American Militia Remnants declare war on Canada, Mexico, and America's allies for not contributing to the aid. Bombs are dropped.

2nd November-UN declares USA occupation attempt

3rd November-USA drops nuclear bomb on Toronto

4th November-Nuclear missiles launched by Canada's allies

5th November-American Retaliation

6-8th November-Retaliation by allies of those countries, American retaliation

9th November-Sixty Minute War, end of the world

16th November-Nuclear fallout descends, killing all remaining unhidden life on the planet

Next Year, March 21st-Extinction of Humanity

[Cobraroll 138]

^I don't think the President and the goverment he represents would leave the US with facilities for launching, storing or producing nuclear weaponry remaining intact. I guess there are perfectly good procedures in place for making the entire arsenal entirely inoperable in an afternoon if the order came. And if the militias ever got hold of them anyway, I doubt Toronto would be their first target. Makkah or Tehran, perhaps, but Toronto? Give me a break. Also, you suppose the communication systems between all launch sites to be operable enough to launch an effective full-scale retaliation against a counter strike? A US with such a broken back wouldn't be able to get enough nukes in the air before an UN-sanctioned counter strike (or pre-emptive strike) had disabled all of the sites. After all, you just said that the President would leave the country, and he'd probably cooperate to secure that those weapons weren't being left for anybody to pick up and use.

 

Even if it went as far as collapse of the American Federal system, I guess the states would just rapidly segregate, possibly forming their own little unions. Given that Americans got no sudden reasons to start killing each large-scale other just because the government isn't supervising them for a month or two, I guess a new United States would be formed again rather soon, maybe with some of the segregated states slightly hesitant to join them.

[LexusInfernus 908]

The guys who would launch the nukes are also on furlough if it comes that far. On top of that, nukes require arming codes before you can detonate them, and only high ranking personal have them. Meaning the president and some other higher ups in the government. On top of that, why would they even bother with dropping a nuke on Toronto. What good will that do, except give the green light for the rest of the world to nuke the US out of existence. 

 

Furthermore, power and normal supplies are pretty much all controlled by private companies who are entirely unaffected by this shutdown given that they are not part of the government. Sure, if the US defaults on all its debts, it will have severe economic consequences, but basic necessities and basic supply of food running out is not one of those consequences. 

[AcmeSigns 97]

So, 3 years in the making and we get this...

http://apnews1.iwon.com//article/20131008/DA9A5DDG0.html

 

It's heartening to know that the administration ignored the one proviso that was most recommended...allow window shopping.

 

I'm sure the rest of it will run just as smoothly.

[BLANKBLANK 4,414]

An interesting article about who exactly benefits from Obamacare or the ACA. Anecdotal yes but still rather revealing.

 

http://www.zerohedge.com/contributed/2013-10-08/me-and-aca