Affordable Care Act in the United States

[AcmeSigns 97]

I don't think president Obama is a lawyer (that might be his wife) but he was a professor of Constitutional Law. I get the distinct feeling that what he taught may well have been how to circumvent the Constitution, more than how to follow it.

 

But back to the Affordable Care Act...do I, as a 64-year-old male, really need to be paying the premium on a health insurance policy that includes 'Pediatric Care' and 'Maternity and Newborn Care'? What possible reason would I ever have for those? The reason people's policies were cancelled (and, yes, most policies are annual and come up for renewal, modification, etc.) was because they did not meet the ACA's 'minimum' standard. The policies were not 'sub-standard' as the government likes to call them. They were exactly what the policy holder's wanted/needed. It's the ACA that changed the definition of what 'standard' or 'minimum' was. The administration (and all of their talking heads) refer to any policy before the ACA as 'sub-standard' because they are trying to sell America on the p.o.s. that is the ACA.

 

My new, favorite part of the ACA (even though I knew about this back in 2010):

http://www.opposingviews.com/i/health/affordable-care-act-makes-it-harder-married-couples-obtain-health-insurance#

 

I can't wait until even more 'stuff' crawls out of it.

[LexusInfernus 908]

I assume that is to collectivize certain costs. You might not need insurance against newborn care, but plenty of other people do. By collectivizing certain costs, you raise prices for one group of people a little, while at the same time making it cheaper for another group of people. Now you might not like having to 'subsidize' healthcare for other people (in this case one of the most vulnerable groups of people in the US), but you do live in a country and you are part of a society. And that means that to some extend you do have to look out for other members of that society and this is how you do that. That aside, I think that in the minimum insurance package there are also some insurances against things that generally more useful for 64 year old males, which 28 year old females will also have to pay for. So you pay some and you also gain some.

 

Unless of course, you don't believe you are part of society, in which case you should vote for the Libertarian party and let Social Darwinism run its course. 

[A Nonny Moose 8,263]

 

That is a very good point.  I wonder how many of them contribute to the Republican party?  They may very well be in a zugzwang situation.  This is where they have to make a move but will be checkmated if they do.  Sounds like some creativity is lacking.

Do you really believe  they only donate to one party?

 

Perhaps some do and some don't.  The problem with politicians is that most of them are not honest.  When you buy them, they don't stay bought.

[Duke87 1,070]

Indeed, some of the difficulties families face is that things like pediatric care and maternity care can be expensive. If you pay for this coverage only when you need it, it is a huge cost spike. On the other hand, if everyone pays for these costs throughout their lives (presuming most people will have a need for them at some point), it makes life easier since now the burden is spread out. Young, not yet married individuals can think of it as an investment in their future. Older folks, well, it sucks for them now since they're paying for it when they already paid for it, but fast forward a few decades and the system becomes more equitable - older folks then will be paying extra premiums they didn't already pay when they were younger.

 

As for the issue that the subsidy floor for married couples is lower than for two single individuals combined... that is a definite flaw and you have to question why the law was written that way. Economic incentives to avoid getting married are a horrid thing, it's not something we want to discourage.

[A Nonny Moose 8,263]

The idea of an insurance program of any kind is "the larger the pool the more the risk is spread".  People who opt out simply assume the entire risk.  For those who opt out, then any insurable service should be provided to them on a "cash at the door" basis and pay as you go as well. 

 

The more users in the pool, the less the premiums need to be.  The idea of a subsidy floor that is different depending on marital status simply encourages common law living or worse.  What ever happened to the democratic ideal of equal access for all?

 

It would appear that the American people have forgotten that one of their principles is supposed to be "the greatest good for the greatest number, including minorities".  Selfishness in this consumer age has truly taken hold.

[Ocram's Razr 964]

1. I think that Medicare (which is for old people) should not cover pediatric care or Maternity/Newborn care. Since the government pays for it, that is part of the Waste, Fraud and Abuse that some progressives, politicians, liberals, or foreigners ignore (or rather be ignorant of).

2. I think that discouraging Civil Unions (yes, I only, ONLY refer to legal unions as Civil Unions, regardless of gender; matrimony is a religious ceremony and I believe in Separation of Church and State) is bad. There should be incentives to encourage people to marry, not against it. I have a feeling like the government wants to form a population of single mothers on government welfare with indoctrinated children.

3. I really am opposed to government interference by both the progressives and conservatives and usually vote Libertarian (or against the incumbent).

--Ocram

[AcmeSigns 97]

Then I guess I'm being selfish. I look out for & provide for me & mine. Seeing as how I have never asked anyone else to supply me with something I wanted but couldn't afford (neither individual or government), I'm hard pressed now to be forced to pay for someone else's 'something'. I really don't buy into the whole 'collective' or 'greater good' mentality. Never have, really. Mostly because I have to wonder what those who are doing the asking would do if the shoe was on the other foot. It's easy to ask for something when you have nothing. It's harder to give when you have 'just a little but not too much'.  In other words...what is the benefit to me by my paying towards someone else's health care? How will they, who are asking for others to support them, repay that kindness? My guess is...they won't! They'll simply ask for 'more'.

 

And while it's all & good to quote Jeremy Bentham, from what I've read he was never an American, and so I fail to see how his ideologies apply to America/ACA. Granted, his utilitarian musings may have inspired some of the Founders, even so far as the classical definition of 'liberalism' goes, but I have yet to find a definitive link.

 

Or, to quote Wikipedia (which, I should point out, I abhor)...

 

"The central concept of utilitarianism, which was developed by Jeremy Bentham, was that public policy should seek to provide "the greatest happiness of the greatest number". While this could be interpreted as a justification for state action to reduce poverty, it was used by classical liberals to justify inaction with the argument that the net benefit to all individuals would be higher."

 

But I'm more than willing to be educated differently.

[LexusInfernus 908]

Then I guess I'm being selfish. I look out for & provide for me & mine. Seeing as how I have never asked anyone else to supply me with something I wanted but couldn't afford (neither individual or government), I'm hard pressed now to be forced to pay for someone else's 'something'. I really don't buy into the whole 'collective' or 'greater good' mentality. Never have, really. Mostly because I have to wonder what those who are doing the asking would do if the shoe was on the other foot. It's easy to ask for something when you have nothing. It's harder to give when you have 'just a little but not too much'.  In other words...what is the benefit to me by my paying towards someone else's health care? How will they, who are asking for others to support them, repay that kindness? My guess is...they won't! They'll simply ask for 'more'.

 

 

Since those others are also paying into the system, they either pay for care that for example old people find more useful, even though they don't need it at that moment, or they pay for the next group of people who require maternity support. 

 

But what you are really asking is how being part of a society benefits you, because that is what this comes down to. By being part of a society of people you inherently assume some measure of responsibility to take care of other members of that society who need a little more help then you do. Well generally you also stand to benefit from it because in return society also has to take care of you when you are down on your luck. But it also provides you other things, like collective security and a whole range of services of which you have probably made use at some point in your life. I mean, went to public school? Had to call the police or fire department? Made use of a freeway? Yeah, SOCIETY paid for all those things, even though most people hardly make use of these things. 

 

 

And while it's all & good to quote Jeremy Bentham, from what I've read he was never an American, and so I fail to see how his ideologies apply to America/ACA. Granted, his utilitarian musings may have inspired some of the Founders, even so far as the classical definition of 'liberalism' goes, but I have yet to find a definitive link.

 

 

So, what does the guys origin have to do with anything? Democracy is from Greece, Republics were Roman, the American law system has been decisively based on Roman law, and most of the founding ideals (the whole inalienable rights, pursuit of happiness, etc) are ripped right from the enlightenment which was European. Are you saying that all these things are not applicable to the United States because they weren't invented by Americans? 

 

Or, to quote Wikipedia (which, I should point out, I abhor)...

 

"The central concept of utilitarianism, which was developed by Jeremy Bentham, was that public policy should seek to provide "the greatest happiness of the greatest number". While this could be interpreted as a justification for state action to reduce poverty, it was used by classical liberals to justify inaction with the argument that the net benefit to all individuals would be higher."

 

But I'm more than willing to be educated differently.

 

The classical version of liberalism wanted the state to take care of three things. National safety which as I argued before includes poverty relief (I admit that classical liberals would have disagreed with me on that point), the administration of justice and finally any and all public services that cannot be administered more effectively by private individuals. In other words, any and all public services that cannot turn a profit without seriously jepordizing its status as 'public service'. In todays world, that would be public transport, education, the road network and yes, also healthcare. Because healthcare is a public service that does not run profitably under a free market system without seriously restricting consumer access through excessively high costs. So, even the classical liberals would agree that healthcare is supposed to be a task the government takes on itself, and really, until the 70's that was pretty much the concensus in every Western state including the US. Only after Nixon did healthcare become increasingly privatized. And really, it was under Reagan and Thatcher that the West became increasingly more obsessed with the free market and turned it into some kind of unofficial state religion, turning it into something not even classical liberals like Adam Smith would have recognized or agreed with. 

[AcmeSigns 97]

Just so we're clear here...I am not now, nor will I ever be one of those 'it takes a village' thinkers.

 

The people who can't afford health care will get it for free. They will not be paying into the system (and probably never will) to aid others. At no point was I asked to either be born nor to be a part of 'society'. And from what I've witnessed of 'society' in general...I'm better off without them.

 

Nonny implied that the quote was American-based..."It would appear that the American people have forgotten that one of their principles is supposed to be "the greatest good for the greatest number, including minorities"." (emphasis is mine).

 

Yes, I've used both the national highway system (paid for, in part, by my tax dollars) and the state highways (paid for and maintained with the fuel taxes I pay) so I fail to see how I owe 'society' for either. To be able to use the highways I have to own a vehicle (on which I pay registration & license fees) and purchase gas (on which I pay sales & fuel tax that is used to maintain the roadway). If I didn't own a vehicle then the highway system that the nation's citizen's tax dollars built would be useless to me. The Sheriff's Department (local police don't apply to me) is paid for in part by my property tax. If I never have need of the Sheriff's services, then that portion of my property taxes, paid for years on end, only benefits the rest of 'society'. I'm fine with that, as I am with paying to support the local school districts (which I have no need of) through my property taxes. And states are burdened with maintaining the highway system, not the federal government. There is no federal Department of Road Maintenance. There are many instances in this country where roadways have been turned over to private companies and have proven to function much better than when government controlled.

 

And I disagree that health care is a 'public service'. If that was the case we wouldn't need health insurance because we'd simply go to one of the government-controlled doctors/hospitals and pay a small fee (collectivism). 'Public', in this instance means, that it is owned by/benefits the 'public' (general populace)...i.e. government buildings (post offices, court houses, libraries, etc.), parks, etc. Any one of these would probably run better and at less cost if privately controlled (Postal Service vs UPS/FedEx?).

[Duke87 1,070]

There is no federal Department of Road Maintenance.

 

There are, however, some roads that are maintained by the federal government: most roads within national parks and some minor roads within national forests are maintained by the agencies responsible for the surrounding land. And you could argue that the federal government indirectly maintains every road in the District of Columbia since DC's city government is not autonomous, congress has a lot of control over it.

 

But otherwise you are correct: almost all public roads in the US are maintained by a state, a county, or a municipality. The distribution between those three entities varies from state to state (most states maintain between 10 and 25 percent of the roadway within their borders but New Jersey maintains as little as 5.98% and West Virginia maintains a whopping 89.41%), but in all states the federal government is usually only involved to provide funding for improvements and set design policies (see: AASHTO Green Book, MUTCD).

 

*crawls back into roadgeek dork hole*

 

 

At any rate, to try and steer this back on topic: even if the federal government is usually not involved in operating roads, it is often involved in providing funding for them. This, incidentally, is also somewhat the case with Obamacare: the federal government does not operate health insurance except in special cases such as Medicare (the so-called "public option" was nixed), but it does set standards and in some cases provide funding (in the form of subsidies).

[LexusInfernus 908]

Just so we're clear here...I am not now, nor will I ever be one of those 'it takes a village' thinkers.

 

 

The people who can't afford health care will get it for free. They will not be paying into the system (and probably never will) to aid others. At no point was I asked to either be born nor to be a part of 'society'. And from what I've witnessed of 'society' in general...I'm better off without them.

That is a problem of having such a large number of poor people living in your country. People who are poor thanks in large parts to the way you guys set up your system. 'Trickle down economics' they call it. 

 

But that aside, your alternative is to let these people starve. Do you honestly believe that Social Darwinism is an acceptable alternative to helping people in need? 

 

 

Yes, I've used both the national highway system (paid for, in part, by my tax dollars) and the state highways (paid for and maintained with the fuel taxes I pay) so I fail to see how I owe 'society' for either. To be able to use the highways I have to own a vehicle (on which I pay registration & license fees) and purchase gas (on which I pay sales & fuel tax that is used to maintain the roadway). If I didn't own a vehicle then the highway system that the nation's citizen's tax dollars built would be useless to me. The Sheriff's Department (local police don't apply to me) is paid for in part by my property tax. If I never have need of the Sheriff's services, then that portion of my property taxes, paid for years on end, only benefits the rest of 'society'. I'm fine with that, as I am with paying to support the local school districts (which I have no need of) through my property taxes. And states are burdened with maintaining the highway system, not the federal government. There is no federal Department of Road Maintenance. There are many instances in this country where roadways have been turned over to private companies and have proven to function much better than when government controlled.

 

What? You think that your tax dollars alone could have build those roads? Those roads exist because everyone is supposed to pay taxes, if it was just you you wouldn't have gotten a meter of road anywhere. As is the case with all those other services. Your taxes alone couldn't afford a full time police department, or even a sheriff. Your contribution in taxes also isn't enough to fund a teacher, let alone an entire school. Those things are possible only because a lot of people pay taxes, essentially pooling their resources in order to afford services that everyone can use and that are generally beneficial for everyone. 

 

Also, states are simply another level of society. For the purpose of society vs individuals states are equal to the federal government. 

 

And no, private companies taking over government services do not work better. In fact, they work worse for everyone who uses them. Sure, they are probably better maintained. You also have to pay a fee to use those roads. And you pay for those roads in taxes, because honestly, do you really think that one can own a road and profit from it? Yeah no, maintenance costs way to much. As is the case with a lot of privatized public services. They were sold by the government to private companies, but only with guarantees for those companies that they receive support in order to maintain the roads, generally because a road is of such importance to the local economy that it can't be 'shut down' because the guy owning the road went bankrupt. So what these companies essentially did is privatize the profit while socializing the cost. In other words, you pay twice for using such road, first in fees and then in tax dollars needed to keep those companies from shutting down roads because they are unprofitable. And what if you can't afford to pay a fee every day when going to work? Well then to bad, you can't use the road and you are restricted in your movement. 

 

 

And I disagree that health care is a 'public service'. If that was the case we wouldn't need health insurance because we'd simply go to one of the government-controlled doctors/hospitals and pay a small fee (collectivism). 'Public', in this instance means, that it is owned by/benefits the 'public' (general populace)...i.e. government buildings (post offices, court houses, libraries, etc.), parks, etc. Any one of these would probably run better and at less cost if privately controlled (Postal Service vs UPS/FedEx?).

You pay health insurance exactly because the system has been privatized to a large degree. But what is health insurance if not a tax? Only instead of paying it to the government, you pay this tax to the insurance company. 

 

And again the myth of privatization. Look, those services generally do not run better if privatized. They also don't run at less costs because private companies are more efficient. They run at less cost because private companies want to profit and as a result cut corners whenever they can. Or because they slim down the operation, meaning they close every library and park that does not get enough visitors. Which for some services, well fine, you will just have to accept that if you live in a rural area your package takes much longer to deliver. But do you think it would be acceptable that if you live in a small town in a rural area they close down the library because its not profitable enough to keep them open? The government runs those things exactly because they do not operate solely to make a profit. 

 

And the government realizes this, so every time they have to privatize a service, they tell the guy that is buying it that this is essentially a public service and needs to remain accessible to all. Which means the guy that buys it can't run it profitably so he requires insurance from the government that they either subsidize him heavily or he simply doesn't want to buy the service anymore. So in the end, the company does end up making a profit, but that is only because you are paying twice to make use of the same service. Isn't privatization great! 

[AcmeSigns 97]

If I choose not to purchase health insurance that is my choice to make. Under the ACA I no longer have that option so, in essence, my 'free will' has been taken away from me. Also, I am now forced to pay premiums for services I will never need, so that someone else who might need them can have them at no cost to themselves. Also, my decision to purchase something does not make it a 'tax' by any stretch of the imagination. A 'tax' is mandatory (that would be something over which I have no control). My decision to purchase something is not. But whatever. You have your views, I have mine and we clearly will never see eye-to-eye.

 

Back on topic...

Now it comes out that buried in the ACA is provision that will have the government supplementing the insurance companies income (for the first 3 years at least) in case they suffer a shortfall. In essence, a portion of my tax dollars will be used to bail the insurance companies out. Oh...and there's no prerequisite amount/percentage/profit-loss number for when the support funding will kick in. This thing is such a mess.

[LexusInfernus 908]

You never had complete free will to begin with. There are thousands of other laws that state you cannot do certain things. Like beating someone up, shooting them in the face, joke calling 911, buying a cheap Indian car that does not meet up any of the safety regulations, smoking in certain spaces, walking around the streets naked, paying a prostitute for sex, drinking and driving, setting off fireworks outside certain dates and the list goes on and on (and yes, I realize some of the examples are regulated on a state level). But nobody fusses about those things because most people accept that living together with other people means that they cannot just do everything they want. Its a compromise that comes with living with other people. And then I'm not even going into the philosophical aspect of free will (summary: it doesn't exist).

 

And the way health insurance is set up resembles taxation very closely, where the only difference is that indeed, health insurance wasn't mandatory. That is literally the only difference it had compared to normal taxes. 

[krbe 193]

What is wrong with no society? No police, no public roads to either drive on nor transport goods you buy (even if you don't have a car), no military to defend any "America", no control of air space, no pollution controls, no right to property, life or liberty, no nothing. Every man for himself.

 

Affordable healthcare - healthcare in itself - is not something no-society geographical locale need.

[AcmeSigns 97]

Every day it's something new.

Now it's...

http://apnews1.iwon.com//article/20131120/DAA6H8501.html

[A Nonny Moose 8,263]

What is wrong with no society? No police, no public roads to either drive on nor transport goods you buy (even if you don't have a car), no military to defend any "America", no control of air space, no pollution controls, no right to property, life or liberty, no nothing. Every man for himself.

 

Affordable healthcare - healthcare in itself - is not something no-society geographical locale need.

You like the idea of anarchy?  Try living in a hunter-gatherer society and you'll find out that life under those conditions is short, dark and ugly.  Just step back to, say, 1930 to see what life was like with primitive medicine.

[Duke87 1,070]

A more positive spin on things.

 

The article, of course, does not address the question of what the costs of providing care to all these destitute people will be and who's going to pick up the tab. There is a fear that the of ratio of older needy people signing up for the program to young healthy people in good economic standing signing up for the program is not panning out as intended and that once insurance companies realize this everyone's premiums for 2015 are going to go up massively.

[AkemiAzula 280]

"At no point was I asked to either be born nor to be a part of 'society'"

 

Oddly enough neither was I, nor anyone. (although my pot smoking cousin once raved on about how we choose to exist yaddah yaddah)

 

But seeing as society exists, and seeing as utilitarian logic is the most practical logic for a democratic state... 

 

I grew up hating the idea of community fiercely. I grew up in Australia which is a wealthy nation, but I was poor myself due to my stupid parents. Then it dawned on me that had the government been able to force my parents to be proper, I wouldn't be poor.

 

At any rate these days I tend not to be an idealist any more, but while I do tend to sympathise with 'every man for himself', at the same time I see the logic in roads hospitals and schools being government owned and operated. A central efficient organisation... But yes I was an idealist once so...

 

The problem with the 'every man is his own sovereign state' philosophy is that as you say none of us choose to be part of society, and thus we are born at unequal positions within it. This is why the concept of levelling and socialism appeals to poor people so much, as a revenge on their superiors.

 

Obviously neither socialism nor free market capitalism have no flaws. It be my recommendation that government should set standards of practice, universally applicable (think railroad guage) and that private individuals may operate within these standards of practice.

 

Obviously that is a generalisation of my policy.

 

P.S anybody else think it odd that at a Simcity website there is so much feeling against government controlling healthcare? Just a humorous observation

[A Nonny Moose 8,263]

The ACA system is coming to the crunch.  The rush to sign up in impoverished areas of some states will indeed force the private sector insurers to up the premiums drastically.  This is normal capitalism in action.  It is also folly.

 

Sorry, folks, but a national system of health care based on the actuarial good will of the private sector insurers will soon result in a bankrupt insurance pool or premiums that only the Rockefellers of the world can afford.  This cannot be done without a serious backstop by the public purse (the cost of government).  Expect the government to step in and create its own public insurer, and fairly soon despite the horse manoeuvres in the congress.  The ACA is the thin edge of the wedge of a mixed social/capitalist system, and it is not so thin, either.

[A Nonny Moose 8,263]

Program in haste, repent at leisure.

 

The people behind this fiasco had better hope for a Democratic administration after the next election.

[A Nonny Moose 8,263]

Now for a rewind.

 

Maybe this time they won't ask a politically attached outfit to set up a server system for them.  If they have fixed the servers, now all they have to fix is the act which most certainly, like all omnibus laws, has a large set of warts.

[AcmeSigns 97]

The problem with the shot in your attached 'Time for a rewind' article is those five people behind President Obama...they are the only five in the whole country that have benefited from the ACA.

[A Nonny Moose 8,263]

You should try to take a broader view.  It isn't only your ox that is about to be gored.