Affordable Care Act in the United States

[LexusInfernus 908]

That's nothing more than a massive welfare state. When you give people money that they haven't earned they'll just expect more. And I seriously doubt that any of those beneficiaries will be using their new-found wealth (which would probably be tax-free anyway) to pay taxes or do anything to better themselves so they could move up the financial ladder on their own. Where would be their incentive to do so?

 

Although this does sound like something the left-leaners would be in favor of. That way people would be even more dependent on the government. That would be oh-so-swell.

 

Redistribution of wealth doesn't automatically mean giving poor people a bag of money each month. It can also mean taxing the rich and closing the loopholes in the tax code to ensure that those same rich people can't secretly move around their money so they end up paying no taxes at all. It can mean subsidizing colleges and universities so you can ensure that students no longer finish university while being tens of thousands of dollars in debt. It can mean assistance to the middle class. 

 

What it basically means is that the whole 'trickle down economics' myth where the rich get all the assistance gets thrown in the garbage can where it belongs. 

[A Nonny Moose 8,263]

The right wing has had its flight feathers clipped, but they'll grow back in the new year.

[AkemiAzula 280]

The trickle down effect would function if the people were a coordinated well oiled machine. Alas people tend to act individually, and rich people don't act in the best interests of the poor and poor people turn to drugs and violence to amuse themselves and nothing gets achieved. 

 

An example of the TD effect in action is consumer products. Experimental tech like cellphones and computers begins in big business and the wealthy and trickles down to everyday Joes on Jobseekers. Pity houses can't do this. 

[Duke87 1,070]

Actually executions are more expensive than jail time. You know, you have to pay for those 7 appeals and all the administration that comes with it, along with the DA and judges who need to be paid for their time. And the appeals which can take up to a decade if not longer in which the prisoner also has to make use of the prison system.

 

Only because of red tape. If a death sentence were as easily carried out as a prison sentence it would be far cheaper.

 

Also, the people that are against abortions are generally also the people that are completely fine with the death penalty. Not to mention that they are also the same people who are actively seeking the mothers who would want an abortion with any care or support after the baby is born. Hence, these people essentially force a baby to be born, in a life of poverty with no help from the state, and when these babies turn to crime (which statistically speaking they have a very high chance of doing) those same people that wanted them to be born are the ones that want him executed.

 

Note, first off, that the converse is also true: the people that are against the death penalty are generally also the people that are completely fine with abortions.

 

It depends, of course, on how you approach each issue. The people you're talking about might argue that taking the completely innocent life of an unborn baby is very different from taking the life of a convicted criminal (i.e., the exact opposite of innocent). The belief system at play here can be summed up as "protect the innocent, smite the wicked". As for the question of welfare, well, people tend to not look at it as having any relation to abortion or capital punishment. They just see it as unnecessary government interference with society.

 

The opposing viewpoint, of course, approaches these issues in a different way: abortion is looked at as the right of the mother to do with her body as she pleases and as a societal good by preventing unwanted children from being born. But then execution is looked at as killing someone with no benefit. And welfare is also seen as a societal good.

 

The trickle down effect would function if the people were a coordinated well oiled machine. Alas people tend to act individually, and rich people don't act in the best interests of the poor and poor people turn to drugs and violence to amuse themselves and nothing gets achieved.

 

Essentially yes. Trickle down economics don't work when the people at the source of the trickle keep trying to close the faucet as tight as they can, and the government keeps allowing them to do so. If you want to throw incentives at companies it needs to be stipulated that some minimum percentage of the profit end up in the pockets of employees rather than in the pockets of the board members. Or better yet, stop throwing so many freaking incentives at companies that they don't need in order to profit.

[LexusInfernus 908]

Only because of red tape. If a death sentence were as easily carried out as a prison sentence it would be far cheaper.

 

Note, first off, that the converse is also true: the people that are against the death penalty are generally also the people that are completely fine with abortions.

 

It depends, of course, on how you approach each issue. The people you're talking about might argue that taking the completely innocent life of an unborn baby is very different from taking the life of a convicted criminal (i.e., the exact opposite of innocent). The belief system at play here can be summed up as "protect the innocent, smite the wicked". As for the question of welfare, well, people tend to not look at it as having any relation to abortion or capital punishment. They just see it as unnecessary government interference with society.

Yeah, but the red tape is there, so for now executions cost more than sending them to prison.

 

 And yet further proof of their hypocrisy. They think welfare is unnecessary government invasion in their daily lives, but are the first to suggest trans-vaginal ultrasounds for everyone who wants to have an abortion. Because a government mandated stick up someones vagina and forcing them to look at a pictures of their unborn fetuses is not invasive in any way. At the one hand they yell that all life is sacred, but they happily look the other way when that life is the life of a mentally slow person accused of murder. They think that the government giving help to people who need it is government interference in their lives, but having the government decide what women can and cant do with their bodies or who people sleep with in their bedroom is fine. 

[hym 358]

Please return to the topic of the thread.

[A Nonny Moose 8,263]

Well, not having read the entire ACA, does it provide for contraception and/or abortion on demand?

 

---

 

And here is an Op. Ed. piece from one of my favourite writers for the CBC:

 

U.S. shutdown climbdown: the 'triumph' of the Republican surrender monkeys

 

If he's right, we'll get Republican soup with our breakfast, lunch and dinner until the media finally gets fed up.  However, the media are insatiable for stories like "man bites man", so don't hold your breath waiting.

[Ocram's Razr 964]

BTW, medication is more expensive in the USA because we subsidize Europe. There is no profit margin for selling prescriptions to Europeans, while there is a reasonable one in the USA. Pharmaceutical companies have a far narrower profit margin than Microsoft and Apple and medication is far more critical than a phone or slate. Apple also uses unfair business practices, including patent trolling, breaking other patents, tax evasion, and contracting sweatshops and slavers.

--Ocram

[LexusInfernus 908]

BTW, medication is more expensive in the USA because we subsidize Europe. There is no profit margin for selling prescriptions to Europeans, while there is a reasonable one in the USA. Pharmaceutical companies have a far narrower profit margin than Microsoft and Apple and medication is far more critical than a phone or slate. Apple also uses unfair business practices, including patent trolling, breaking other patents, tax evasion, and contracting sweatshops and slavers.

--Ocram

Eh, I'm pretty sure Europe subsidizes itself. The US government does not pay so we in Europe have cheap medicine. Also, Pharmaceutical companies also pay no taxes. And its not tax evasion, that's illegal. This is simply 'tax optimization'. 

[Duke87 1,070]

The argument is that the US subsidizes pharmaceutical companies in the sense that because we are the only developed country with no price controls, they jack up their prices here to compensate for the fact that they're making meager profits elsewhere.

[SimCoug 5,977]

So the US government attempts to build a website and fails like only government can (while spending hundreds of millions of dollars) and now seeks to fix the problem by calling in private businesses?  There has to be some irony in there somewhere... 

[Odainsaker 2,137]

So the US government attempts to build a website and fails like only government can (while spending hundreds of millions of dollars) and now seeks to fix the problem by calling in private businesses?  There has to be some irony in there somewhere... 

 

The irony gets even far better when you read through the uppermost forums right here on Simtropolis involving the online rollout of this year's "SimCity 2013."  Who knew gaming publisher EA was also managing online health insurance marketplaces!

[LexusInfernus 908]

The argument is that the US subsidizes pharmaceutical companies in the sense that because we are the only developed country with no price controls, they jack up their prices here to compensate for the fact that they're making meager profits elsewhere.

Yeah, thats not how subsidies work. They don't actually lower the prices in Europe, its just that the consumer pays a lower price in the store. The price difference is paid for by the government. In the end the consumer still pays through the taxes, but by now the burden has been spread across every tax paying citizen. And this is only the case with patented medicine. Stuff where the patent has expired are subject to the normal free market forces, so those things end up getting cheaper and cheaper until there is only a minimal profit margin. 

[A Nonny Moose 8,263]

On pharmaceuticals, once the protected period has passed, the drugs can be manufactured by generic manufacturers who have no R & D overhead.  While this reduces the price of some drugs, physicians in Canada (at least) are free to insist on the original maker.  This is necessary in some cases due to sensitivity of some patients to the secundum pharma used by generic makers.  They tend to use alternate fillers and dispersants to keep their own costs down.

 

As far as European drug distribution, I suspect the drugs are manufactured in European domiciles.  I wonder where some people get their information out there on the extreme west coast of the U.S.  Sounds like uninformed conservative cant to me.

[SimCoug 5,977]

The irony gets even far better when you read through the uppermost forums right here on Simtropolis involving the online rollout of this year's "SimCity 2013."  Who knew gaming publisher EA was also managing online health insurance marketplaces!

lol - I should have know EA was trying to get into the government contract business 

 

It didn't seem possible that EA would loose it's 'online fail of the year' award.  That really takes special talent. 

[Easy Bakes 253]

they released info today on our companies open enrollment.

 

apparently even employers are required to have an "affordable" option.

 

not over 9.5% of your income.

[AcmeSigns 97]

Ah...government at work: an initial 93 million dollar website blossomed to 263 million. Managing healthcare should be a walk in the park for them.

[A Nonny Moose 8,263]

Clearly a program (the web site) designed by a committee.  With several years in which to get it right the first time, who will carry the can for this?  Sounds like some snivel serpents picked the wrong contractor.  Send for Mike Holmes.

[Easy Bakes 253]

probably way more applicants  then they expected

[Odainsaker 2,137]

Of course, Obamacare is not a single-payer system, and so the government is not actually directly managing most health care plans.  It does set minimum levels for private or employer-provided coverage, subsidizes coverage for certain classes, and makes some form of health insurance, be it private, employer-provided, or government subsidized, mandatory for everyone.  The website is supposed to be a marketplace where the many types of health insurance plans being offered both privately and through subsidy can all be pooled together in one place and crafted to the particular shopper, facilitating them in acquiring their mandatory coverage.  Even understanding a single health insurance plan from one employer-subsidized private provider is a complicated undertaking...the website is trying to pool them all together and filter them for different users.  Moreover, along with a Federal online marketplace were supposed to be 50 state-level marketplaces, but 34 states for various political reasons opted out of this program and only 7 of those have plans in the works to add their own marketplaces in the near future, leaving the Federal website to take on the burden of handling the additional load from all these 34 states.  $263 million, or $5.3 million per state, suddenly reads like a comparatively cheap figure for a complex program of such national scope.  My city's local library system costs more than $5.3 million, and they are not trying to pool and coordinate health insurance plans across my entire state.

 

But, all that is short-term technical issues, which, like EA's "SimCity 2013" debacle, can be generally resolved with time and resources.  The bigger issue for Obamacare is how the health insurance industry, with its byzantine and overlapping mosaic of private, employer-provided, and now government-subsidized plans, finally settles over the long-term.  The individual mandate and government subsidies would bring a great deal more money into the still-private system, offsetting the costs from expanded coverage.  Also, people would be moved from risky and costly uninsured emergency care scenarios into properly insured plans.  Over the long term, this should overall bring already escalating costs for the greater system down, or perhaps more realistically, keep them from rising at the skyrocketing rates they already have been.  However, in the short-term, private insurers will continually modify their plans as they adapt to the new health care landscape while maintaining their profits, and that will mean that plans and prices will be unstable for many until the industry has a greater grasp on how much more money they are bringing in versus how many more claims they must fulfill.  This isn't anything new as it is how the business has always worked, only now it's on a bigger scale affecting more people more immediately.  What remains to be seen is whether the rescaled industry landscape settles enough after the individual mandate kicks in beginning next year such that by the next election there are not more perceived insurance losers than winners.  Otherwise, an election with chaotic politics calling for a new round of system-wide health insurance upheavals will just throw more rippling chaos into the system and bring yet more costs for everyone.  Of course, there are those who see maintaining and extending chaos as convenient politics.

 

I suspect that the already growing health insurance industry will, as everyone is mandated into paying enrollment and government subsidies start moving, make for a profitable investment regardless of how costs and coverage change for the insured.

 

Ah well, my employer's provided plan had coverage above the minimum required by the Obamacare law, and did not significantly change as a result of that law during their current open enrollment season.  The costs went up a bit for me, but no more than they have in the past as a result of the runaway costs of health care that have been rising for decades now--I took a bigger hit during the Bush years when my coverage was radically slashed and the costs doubled as my employer at that time changed their partnered insurer.  Actually, my employer's current plan actually added minor additional coverage for this coming year.

[A Nonny Moose 8,263]

Well, you know that Canada's system is not single-payer either.  Each province is the paymaster of the system,  while governed by the Canada Health Act as amended, each is free to devise its own system within the framework.  I was looking at moving to another province.  My research led me to stay put in Ontario. 

 

A rich province has a better system than some of the poorer ones, and I was thinking of moving to New Brunswick at one time.  Their system isn't nearly as good as Ontario.  The system has to fall within the means of the payer.

 

Most European countries would actually be like provinces of Canada in a public medicare system.  The scale of this country has to be lived in to be appreciated.

[Fatherted 129]

^^^ Would they? Look at Switzerland and tell me it's the same size as a province. It's smaller than EVERY American state (except possibly Hawaii). France manages roughly a US-state size. Combine all of Northen Europe, and you get a roughly Ontario-Sized area.

Yes Canada is big.

[A Nonny Moose 8,263]

I was being generous.  Switzerland is probably bigger than Price Edward Island.  The main difference between Provinces and European States is population density.

 

There has been some thought taken to all of this, and if you look at Canada, the population is mostly a layer of slime along the U.S. border.  The people are spread out in some areas and other places are quite empty of people.  We also have large areas of uninhabitable wilderness, and yet people insist on living in flood plains and other seriously dangerous areas.

 

U.S. populations tend to cluster along the east and west coasts, with large wilderness tracts in the centre of the country except along the father of waters (Mississippi river).

[A Nonny Moose 8,263]

The ACA Website.

 

How on earth do you split up a contract to build a website?  A website is a computer program like any other.  How do you control multiple outfits doing a thing like this?  Whoever dreamed up the idea of more than one programming team needs their heads read.

 

It doesn't matter how "massive" the job is, co-ordinating a thing like this complicates matters by the cube of the number of firms involved.  It has never been satisfactory in my some fifty years of systems and programming experience.  Everyone should remember that a moose is a deer designed by a committee.

 

Whoever wrote the specification of the site probably wasn't even a systems analyst nor a business analyst either.  It is really too bad they rushed the implementation, but they probably started about a year too late.  This is a critical system.  If the private sector was to be involved, the oversight was not what it should have been.

 

BBC's report on this.

 

Lots of finger pointing and buck passing going on.

[Jasoncw 12,060]

I was being generous.  Switzerland is probably bigger than Price Edward Island.  The main difference between Provinces and European States is population density.

 

There has been some thought taken to all of this, and if you look at Canada, the population is mostly a layer of slime along the U.S. border.  The people are spread out in some areas and other places are quite empty of people.  We also have large areas of uninhabitable wilderness, and yet people insist on living in flood plains and other seriously dangerous areas.

 

U.S. populations tend to cluster along the east and west coasts, with large wilderness tracts in the centre of the country except along the father of waters (Mississippi river).

 

That's not really true...

 

The only wilderness in the US that I can think of are some places in the rocky mountains and some of the deserts.  There's also the Appalachian mountains, but they're dotted in old mining towns.  All of the center of the US is literally all farmland, like the area between Calgary and Winnipeg.

 

Canada on the other hand has tons of actual wilderness.  The majority of canada is literally uninhabited (except for the occasional small indigenous group) wilderness.

[A Nonny Moose 8,263]

You forgot to mention the mosquitoes living in the muskeg.  They are large enough and mean enough to be considered a native population.

[A Nonny Moose 8,263]

Back on topic:  An Op. Ed. piece from Neil Macdonald (CBC's chief Washington correspondent).

A peculiarly American debate over the right to buy lousy stuff

 

"Simply put, the question is whether the American government has the right to stop people from making stupid, self-destructive choices."

 

Every American should be thinking not of his own little puddle but the principles of small-d democracy they claim to love so much.  In this case "The greatest good for the greatest number."

 

And get off Obama's case.  He is stuck with most of the stuff he inherited from Dubya and his predecessors.  If anyone thinks a country like the U.S.A can be moved in the mere 8 years of one administration, he doesn't know about political inertia.  Current problems have roots that go as far back as Lincoln and maybe even farther.

[metarvo 712]

Honestly, I haven't seen anything "affordable" about this act.  I've seen too many Americans holding up cancellation letters and heard too many discussing their rate increases to ever believe any of that.

[A Nonny Moose 8,263]

Take a breath and examine the content of the policies that were cancelled.  Were they "sub-standard", not providing necessary coverage or with weasel out clauses?  An insurance company in general will spend much more than any claim to try to avoid paying out and setting any kind of precedent.  Maybe what the ACA is doing is bringing U.S. Health Insurance up to something real, instead of just taking premiums under false pretences.  Some of those cheap policies are not worth the ink they are written with.

 

Frankly, the system is wrong.  You need to get the insurance companies out of the act with respect to main coverages like hospital stays, major surgeries, and the like.  Let them issue supplementary or extended care policies, and let the states be the insurer of first resort (single payer).  This is the only way this is going to work.  Look at the health plans in the Canadian provinces and other countries that have been in place for several decades, and get over the idea that this is socialistic.  Capitalism alone can't handle this, but needs to be tempered with a little social conscience.

[hym 358]

Frankly, the system is wrong.  You need to get the insurance companies out of the act with respect to main coverages like hospital stays, major surgeries, and the like.  Let them issue supplementary or extended care policies, and let the states be the insurer of first resort (single payer).  This is the only way this is going to work.  Look at the health plans in the Canadian provinces and other countries that have been in place for several decades, and get over the idea that this is socialistic.  Capitalism alone can't handle this, but needs to be tempered with a little social conscience.

 

A system that denies paying its customer's medical expenses because they weren't sick enough at the time they sought treatment.  A system that tells its customers they are perfectly healthy, even when every actual doctor says otherwise, all without the benefit of ever having met the patient.  A system that, the mere fact a patient is eligible to receive benefits from, can be justification for the doctor to deny treatment to the patient.  A system that hides its true cost by underpaying doctors and forcing private insurance to pick up the rest of the tab.  A system governed by rules set up by people who either lack the knowledge or the guts to institute real health care reform.  

 

I want nothing to do with that and I will resist you every step of the way.