Luke Warm was right, I was wrong

[luke warm]

Lukewarm, the latest economic, sociological, and practical implementation studies actually show that high deductible for regular medicine actually worsens the effects all around.

i don't know for sure if you meant "medicine" as in drugs or medical services... if drugs, most plans have rx plans that are distinct from the health coverages... i'd like to look at one of those "latest" studies you're speaking of, if it concerns medical coverage

 

A major implementation against this at the moment is something called Value Based Insurance Design (VBID). It's been shown that over 50% of patients do not adhere to simple and cheap methods (such as taking insulin as needed, or staying on a course of antibiotics) for maintaining health.

insulin and antiboitics are, usually, a part of a plan's rx drug rider and, as such, are subject to completely different copay restrictions... for example, a plan might pay half the cost of a drug up to a max out of pocket (per drug, per month) of $50 or so, with an additional benefit of a yearly max out of pocket leading to reduced copays... and, of course, generics do cost less... are you saying that people who are prescribed insulin or antibiotics are simply not taking them?

 

It's also been shown that small financial incentives (removing copays for annual visits, and basic daily medicines) are much more effective uses of monies to maintain country-wide health.

i can understand how such a thing would be desired by you or me, as covered parties, because they are cheaper for us... however, i'm unaware of any studies showing that such methods reduce overall health care costs

 

Paying big bucks for psa tests and mammograms is largely money misspent (on average--in fact there's never been a medical study done which advocates for mammograms under 50; it's not a rational decision to get one or pay for one, it's emotional).

i agree, which is why most of those are free, but only if age-based

 

Likewise treating catastrophic non-accidental injuries is usually something that can be caught early on and treated more efficiently and cheaply--especially when removing financial disincentives from patients towards treating them.

hence the need for wellness programs, which are usually free (up to, as i mentioned, a pre-determined amount)

 

And as far as shopping for services, when the diagnosis is cancer, the last thing that crosses the mind is looking for the lowest bidder.

we were speaking of the costs... cancer is, usually, considered to be one of those catastropic illnesses we were speaking of, not on a par with going to the doctor every time you have the sniffles, simply because the copays are low or non-existent... as for lifestyle choices, don't worry so much about those - bloomberg has already outlawed big gulps, surely big macs are next

[BunnyGo]

i don't know for sure if you meant "medicine" as in drugs or medical services... if drugs, most plans have rx plans that are distinct from the health coverages... i'd like to look at one of those "latest" studies you're speaking of, if it concerns medical coverage

 

 

insulin and antiboitics are, usually, a part of a plan's rx drug rider and, as such, are subject to completely different copay restrictions... for example, a plan might pay half the cost of a drug up to a max out of pocket (per drug, per month) of $50 or so, with an additional benefit of a yearly max out of pocket leading to reduced copays... and, of course, generics do cost less... are you saying that people who are prescribed insulin or antibiotics are simply not taking them?

 

 

i can understand how such a thing would be desired by you or me, as covered parties, because they are cheaper for us... however, i'm unaware of any studies showing that such methods reduce overall health care costs

 

 

i agree, which is why most of those are free, but only if age-based

 

 

hence the need for wellness programs, which are usually free (up to, as i mentioned, a pre-determined amount)

 

A link to a number of publications by the VBID center: http://www.sph.umich.edu/vbidcenter/research/center_publications.html

 

Yes, most of the examples I gave were prescription, but the studies have also applied to doctors visits.

 

And yes, over 50% of people fail to adhere to prescribed courses of treatments (I gave just a couple examples). These are largely because of financial or implementation hardships (e.g. a pensioner trying to make a dose last longer, a single mother who can't afford to travel weekly to a center for treatment etc.)

 

As for mammograms and prostate tests under 50, they aren't free--they cost somebody money (usually insurance, sometimes a center like Planned Parenthood). This is a lot of money, and it's for a procedure that has been shown time and again to be a useless experiment. For example, if you're a 45 year old woman who receives a positive mammogram result--meaning you're told you have a growth--it's a lot more likely to be a false positive than an actual problem. These false positives then cost money, and physical pain and suffering due to side effects of treatments and biopsies. They cost not just money, but time and physical suffering. They should NOT be free (monetarily for the patient)...the massive amounts of monies devoted to these tests should instead be put to make proven preventative treatments free/more affordable. Prostate exams are considered even more frivolous, as most cases are again false positives and the actual disease usually (not in extreme cases) takes 15 years to kill you with minimal to no symptoms till the end--treatment usually has side effects more unpleasant than the disease itself, and many older men (60+) die from other causes before the cancer kills them.

 

Personally, I don't care too much about having my copays reduced. I have low enough copays, and enough spare income to cover any needed treatments without breaking the bank. What the major studies have shown is that these preventative reductions would raise quality of care for a majority of people to a point where they'd be sick less. It's predicted to be a "break even" prospect on the cost of medical care, but save people suffering and save the economy from lost productivity. With (nearly) everyone getting insurance in the next couple years, the question is how to do it in a way that will bring people benefit without breaking the bank. People like you and me are already well enough off that it can be hard to see the large population that doesn't find it easy to go see an doctor on a Wednesday morning (like I will tomorrow) because it's a financial hardship to take off of work in addition to the copays and cost of medicine. Removing what financial incentives can be removed helps these people actually take advantage of the health care they'll have before it's expensive for the insurance companies to cover them.

 

FWIW, the VBID center is largely funded by insurance companies, is consulting with several states on implementation on Obamacare, and is run by one of the most liberal doctors I've ever spoken with on the subject.

[lalldonn]

oh, an actuary? well that explains everything

Well you are on topic as much as usual but since it was funny I can smile. :)

[PassedOut]

... they cover the catastrophic illnesses at an acceptable level... so you end up paying for your own doc visits but the bigger illnesses are more or less paid for... it's kinda like you buying your own batteries and tires, but having geico pay when you get rear-ended

Your analogy has flaws:

 

When a person's poor health maintenance results in illness, that person gets medical attention whether or not he or she has insurance. When a car breaks down because of poor auto maintenance, the service station has no obligation to fix it without pay. And usually the car owner picks up the full tab for his or her own negligence.

 

If a driver does have an auto accident because of poor maintenance (only 1 of every 10 auto accidents results from poor maintenance), then insurance does come into play. However, the claim is limited by the value of the auto itself, and a badly damaged car can be junked.

 

If insurance payments for catastrophic medical care caused by poor health maintenance were capped at the potential earnings of the patient -- with no care provided beyond that -- then your analogy would be more accurate. But most of us don't want to junk patients.

[luke warm]

Your analogy has flaws:

 

When a person's poor health maintenance results in illness, that person gets medical attention whether or not he or she has insurance.

the whole discussion was about those who have insurance, not about people w/out insurance... it was about comparing various types of health insurance, not comparing those with and those w/out insurance... everyone knows that the uninsured will get what then need, when they need it (sometimes even when they don't need it), and that those of us with insurance foot the bill

 

i'll say it again: if universal healthcare is the only option being discussed, obamacare is next to useless... the costs far exceed any supposed benefits, and it will not do what it's designed (supposedly) to do... the *only* way to go (again, *if* universal healthcare is the only option) is a single payer system... nothing else will work and participation *must* be mandated, and it doesn't much matter whether you call that mandate a tax or a penalty... however, that's not to say that a single payer system is best, or, put another way, that universal healthcare is best... surely nobody is so closed minded as to want to limit discussion on various options

[PassedOut]

that's not to say that a single payer system is best, or, put another way, that universal healthcare is best...

Actually, I do consider universal healthcare to be best. What are the arguments against it?

[Winstonm]

we were speaking of the costs... cancer is, usually, considered to be one of those catastropic illnesses we were speaking of, not on a par with going to the doctor every time you have the sniffles, simply because the copays are low or non-existent... as for lifestyle choices, don't worry so much about those - bloomberg has already outlawed big gulps, surely big macs are next

 

I didn't see anything strictly about costs post diagnosis - the conversation seemed to be about weighing the costs of preventative treatment compared to post-diagnostic treatment.

 

I brought up cancer specifically because it is such a brutally expensive disease to address, and both the outcomes and the costs are reduced immeasurably with early diagnosis and treatment.

 

It would seem to me it would take very few early stage diagnostic "catches" to save enough money to cover costs of routine early-diagnostic procedures.

[luke warm]

Actually, I do consider universal healthcare to be best. What are the arguments against it?

which version?

 

It would seem to me it would take very few early stage diagnostic "catches" to save enough money to cover costs of routine early-diagnostic procedures.

okay, pretend you're in charge... what are your early stage diagnostic catches? on whom are they performed? how often? are they voluntary or forced?

[Winstonm]

which version?

 

 

okay, pretend you're in charge... what are your early stage diagnostic catches? on whom are they performed? how often? are they voluntary or forced?

 

Two of the easiest and most effective methods are colonoscopies and breast examinations. On whom? Whoever wishes. Forced? No.

 

Should someone be penalized for failure to get tested? No, as these tests are not foolproof.

 

The point is that it only takes a few preventative catches that halt a disease like cancer in its earliest stages to save enough to pay for the tests. If you are in or around the industry, you know that one can build up a $250K bill in the blink of an eye treating cancer.

 

The issue IMO should be about encouraging more the big savings of early diagnosis than on squeezing pennies after-the-fact.

 

On the side issue of single payer, it would seem to me any form would be better as it would virtually eliminate the overhead administrative costs associated with the U.S. healthcare system.

[PassedOut]

which version?

The single-payer version you had in mind when you made this statement:

 

that's not to say that a single payer system is best, or, put another way, that universal healthcare is best...

You seem to know something about health insurance, and I'm interested in what your arguments are against universal healthcare. I honestly don't know what those arguments might be.

[luke warm]

You seem to know something about health insurance,

some, yes

 

and I'm interested in what your arguments are against universal healthcare. I honestly don't know what those arguments might be.

to have universal healthcare, some things have to be agreed to... first, there can be absolutely no competition... there would have to be one insurance company, period.. second, the group must be as large as possible, meaning no opt outs, meaning participation is req'd... third, health care providers must be forced to accept the rate tables as established by, supposedly, the gov't...

 

will it work? if i were dictator, yes... i do not believe it can work in this country at this time, because the political will cannot be mustered by politicians of both parties in sufficient numbers to pass it (and don't fool yourself, plenty of democrats would abandon that ship, it wouldn't just be republicans - our politicians' #1 priority is staying in power)...

 

having said all that, i'm definitely against it in the form of the ACA... it does not do what it says it would do, and it does not do it far more expensively than rumored... before i'm accused of making the good the enemy of the best, read the above paragraph... the best is all there is, there is no "good"

 

one other thing, to put some elderly minds at ease... yes there will be "death squads," although they won't be named that... if someone has already outlived the actuarial tables, there is no reason to put him anywhere near the top of the list for a new heart/kidney/liver/cornea, etc... if someone has a chronic condition, and especially if treatment for that condition is expensive, and most especially if that person is elderly, well (paraphrasing spock) "the good of the many outweigh the good of the few"... if you want it to work, and if you don't want it to bankrupt the country, something like that has to be implemented

[PassedOut]

i do not believe it can work in this country at this time, because the political will cannot be mustered by politicians of both parties in sufficient numbers to pass it

I certainly agree with this. But I don't think that the political difficulty of achieving universal healthcare in the US today means that it is not the best approach.

 

And I agree that both democrats and republicans are in the pockets of their large contributors, which is why I'm an independent voter. (I was once a republican, but a lunatic fringe has all but taken over the party, so that's no longer a possibility for me.)

[mike777]

Actually, I do consider universal healthcare to be best. What are the arguments against it?

 

 

The concerns are 2:

1) quality will suffer, innovation will suffer

2) we cant afford it.

 

 

I use the word concerns rather than arguments against it.

 

I think proponents of universal healthcare just need to do a better job overcoming these concerns.

 

To put it another way if universal healthcare leads to better quality/innovation at the same or lowercost people will be less scared of it.

 

When proponents point to Europe or WHO result studies, people dont trust the results/studies.

 

Of course the present system is not working either.

[kenberg]

The question of "best" seems to provoke a question: Best for whom?

 

In general, I think one big problem here is that there are several desirable feature and it is unlikely that any one approach optimizes all of them

[luke warm]

The question of "best" seems to provoke a question: Best for whom?

yep, that's almost always the question... also, imo mike's two concerns are legitimate, accurate and unavoidable...

[kenberg]

Here are some of my thoughts:

 

Personal level: I am reasonably content. I think that there are quite a few MDs out there who I would not want taking care of me, but I seem to be able to cope. I just changed opthamologists, and I am hunting for a good dermatologist for an annoying but not particularly severe skin issue. I have good insurance. In particular, I go to the doc that I choose, no referral needed.

 

Nationally: We have to figure out what to do about those who have no means to pay for care. I seriously doubt we can afford to do everything for everyone, but currently there seems to be a rather strong element of randomness. As I understand it, and I do not much understand it, children in poverty situations are eligible for some fairly decent care if their parents can get their act together enough to access it. Adults without a job, or with a low paying job w/o insurance, are more or less screwed. My desired program would lie somewhere between "You're on your own, buddy" and "Whatever you need, we provide".

 

Those seeking political support would be well-advised to make note of my fair satisfaction, for my own needs, with the status quo.. Big changes can make things better, or they can make things worse. If I am to support change, I have to be convinced that the change will not adversely affect my own situation. I suspect I am far from the only person holding this view.

 

Here is a piece from Kathleen Sibelius.

http://www.washingto...ry.html?ilink=1

 

Here is an amusing mathematical challenge. From the article:

 

"Between 2000 and 2009, the average family premium more than doubled, from $6,438 to $13,375, an annual increase of 8.1 percent. "

Challenge: Where did the 8.1 come from?

 

 

ln(13375/6438) / 9=0.081241, approx 8.1 %

 

[luke warm]

Adults without a job, or with a low paying job w/o insurance, are more or less screwed.

under the ACA? yes, that's true... what's even more confusing is, a lot of those folks *support* the ACA, mainly because they support obama... of course a lot of older folks support romney, not knowing for sure where he stands on ssa and medicare... ayn rand is right once again... we'd all probably be better off is we acted, and voted, according to our own selfish needs... the trick is figuring out just what's actually in our own interests without some politician having to tell us

[Cthulhu D]

One can believe that wearing seatbelts and motorcycle helmets is a good idea, but still reasonably be against laws requiring everyone to wear them.

 

On what rational basis? It's pretty clear cut: Idiots on motorcycles without helmets costs society a lot of money. Whatever marginal utility idiots get for not wearing motorcycle helmets is far, far outweighed by the loss from injuries. It's theft. It would be a completely different situation if we didn't live in a world where the paramedics will pick the dude up and treat him regardless of his helmet wearing status or otherwise, but we don't (which is good), so helmets should be mandatory.

 

The concerns are 2:

1) quality will suffer, innovation will suffer

2) we cant afford it.

 

Both of these points are objectively wrong. Consider the NHS: It is both massively cheaper than US healthcare and just as effective (when considered as an entire system)! But the NHS is kinda shitty so let's move somewhere colder. The Finns have a healthcare system that is massively cheaper and more effective! What's not to love?

 

yep, that's almost always the question... also, imo mike's two concerns are legitimate, accurate and unavoidable...

 

I guess everyone has a right to an opinion, but this one is factually incorrect. See: Finland.

 

Those seeking political support would be well-advised to make note of my fair satisfaction, for my own needs, with the status quo.. Big changes can make things better, or they can make things worse. If I am to support change, I have to be convinced that the change will not adversely affect my own situation. I suspect I am far from the only person holding this view.

 

Check out patient satisfaction rates in one of the cuddly european countries. Like Finland! They have less waiting times, they do a better job, less people die and you'd save a fat chunk of cash. Exactly what do you possibly want from a healthcare system that isn't getting done here? Cheaper, more effective and more satisfying!

 

Amusingly I worked out if you could have the high levels of public sector efficiency (hahaha) associated with a country like the UK, for what the US government pays out in Medicare, Medicaid etc you could deliver NHS quality universal healthcare for your entire country.

 

The conclusion I draw is that Americans are somehow intrinsically masochistic and are willing to fight to the death to protect their right to be overcharged for bad service. I honestly cannot understand what the rationale here is. Does America just not like money, or the idea of a healthy population or something?

 

Seriously, people are defending their right to pay extra so poor people die of preventable illnesses. It is literally madness.

[PassedOut]

Adults without a job, or with a low paying job w/o insurance, are more or less screwed.

under the ACA? yes, that's true... what's even more confusing is, a lot of those folks *support* the ACA, mainly because they support obama...

Or, perhaps, because they are less screwed than they were before the ACA: Consumer Reports: Update on health-care reform

 

3. Help in finding and paying for health insurance. By late 2013, every state must have a health insurance exchange, a sort of Amazon.com or Expedia for health insurance, that individuals can use to find, compare, and purchase the coverage they’ll need come 2014. (To see what an exchange looks like, visit the RomneyCare Health Connector run by Massachusetts, which has had a mandate since 2007.) About 20 states are expected to be ready to operate their own exchanges by late 2013. In other states, the federal government will step in to do the job.

 

How am I supposed to afford this? Without financial help, you may not be able to. That is why the Affordable Care Act also includes subsidies to bring the cost of insurance down to manageable levels for Americans with low or modest incomes. If your household income is between 100 percent and 400 percent of the federal poverty level (here’s a current chart) you will get a subsidy, in the form of an advance tax credit, to help you pay your premium. For instance, a family of four with an income of 200 percent of poverty, or about $45,000 in 2011, will have to pay no more than $235 a month for health insurance. People with household incomes of less than 300 percent of poverty will also get subsidies to bring down their out-of-pocket costs, such as deductibles and coinsurance. Your state’s insurance exchange will tell you the size of your subsidy, if any.

[mike777]

On what rational basis? It's pretty clear cut: Idiots on motorcycles without helmets costs society a lot of money. Whatever marginal utility idiots get for not wearing motorcycle helmets is far, far outweighed by the loss from injuries. It's theft. It would be a completely different situation if we didn't live in a world where the paramedics will pick the dude up and treat him regardless of his helmet wearing status or otherwise, but we don't (which is good), so helmets should be mandatory.

 

 

 

Both of these points are objectively wrong. Consider the NHS: It is both massively cheaper than US healthcare and just as effective (when considered as an entire system)! But the NHS is kinda shitty so let's move somewhere colder. The Finns have a healthcare system that is massively cheaper and more effective! What's not to love?

 

 

 

I guess everyone has a right to an opinion, but this one is factually incorrect. See: Finland.

 

 

 

Check out patient satisfaction rates in one of the cuddly european countries. Like Finland! They have less waiting times, they do a better job, less people die and you'd save a fat chunk of cash. Exactly what do you possibly want from a healthcare system that isn't getting done here? Cheaper, more effective and more satisfying!

 

Amusingly I worked out if you could have the high levels of public sector efficiency (hahaha) associated with a country like the UK, for what the US government pays out in Medicare, Medicaid etc you could deliver NHS quality universal healthcare for your entire country.

 

The conclusion I draw is that Americans are somehow intrinsically masochistic and are willing to fight to the death to protect their right to be overcharged for bad service. I honestly cannot understand what the rationale here is. Does America just not like money, or the idea of a healthy population or something?

 

Seriously, people are defending their right to pay extra so poor people die of preventable illnesses. It is literally madness.

 

Unfortunely you do not quote me in full and simply avoided my point.

 

Advocates keep making the same mistake over and over again, you either dont quote studies or you quote studies that simply are thought to be faulty for many reasons.

 

Pointing to Europe which seems to be going broke and lacking in innovation will not carry the argument.

 

To put it another way, you may be right but your arguments are not believed by many for many reasons.

 

Telling Americans we should be much more like Europe is not overcoming peoples concerns.

Saying America should be like Finland a tiny, tiny country is not overcoming peoples concerns.

 

Finland has a population under 6 Million.

[blackshoe]

On what rational basis? It's pretty clear cut: Idiots on motorcycles without helmets costs society a lot of money. Whatever marginal utility idiots get for not wearing motorcycle helmets is far, far outweighed by the loss from injuries. It's theft. It would be a completely different situation if we didn't live in a world where the paramedics will pick the dude up and treat him regardless of his helmet wearing status or otherwise, but we don't (which is good), so helmets should be mandatory.

Your logic is flawed.

[blackshoe]

If "America should be like Europe" were a true statement, our ancestors would not have revolted against George III.

[Cthulhu D]

Advocates keep making the same mistake over and over again, you either dont quote studies or you quote studies that simply are thought to be faulty for many reasons.

 

I am happy to provide some studies, there are approximately a billion. However, to facilitate this process, we first need to define the principles that you want to see in understanding what makes a healthcare system 'effective' - as a starting point I would suggest

 

A) Cost per capita

B) Patient Satisfaction (for people admitted to hospital or present at an ER, measuring the satisfaction of people who don't use the healthcare system's satisfaction with it is a pointless exercise in futility).

C) Some measure of quality. This is the most difficult to measure so I would like your thoughts. If it's population health measures I need you to understand that the drivers of this are diet and smoking rates which mask the small differences in outcomes between the healthcare systems. If it's delivery of WHO recommended care, I will note that no study has been performed other than a single one which says there is no difference between the NHS and the USA.

 

Please note: No country in the OECD has as large a population as the USA. If smaller countries are not legitimate examples, there is no evidence that can pursade you.

 

If you have some other set of preferred principles please suggest them. It is impossible to proceed until it is clear what factors would satisfy you prior to gathering information.

 

 

Your logic is flawed.

 

Which step?

 

A. Not wearing helmets increases medical costs

B. Not wearing helmets is unauthorized in my country

C. At-least 40% of medical costs of motorcycle accidents are covered by the public or written off as loses by care providers regardless of jurisdiction

D. The remaining 40% or more is covered directly or indirectly by taxpayers and healthcare users (US numbers, higher in oz).

E. If costs are covered by taxpayers that results in increased tax burden

F. If costs are covered by care providers they amortise the loss over other patients, resulting in increased costs for healthcare users

G. I am a taxpayer and healthcare user

H. Therefore I pay for the medical care of people who have motorcycle accidents without a helmet

I. Non consensual re-purposing of funds is 'embezzlement'

J. Embezzlement is colloquially known as theft.

K. As this re-purposing of my funds is unauthorized (by the accident haver), they are committing theft.

 

 

If "America should be like Europe" were a true statement, our ancestors would not have revolted against George III.

 

This is insane. I presume you are going to stop pasteurising milk? Just because colonial imperialism is bad, all products of Europe ever are bad? Amazing.

 

Of course, people are really defending this system, so I guess things are beyond help?

 

CBS news

 

 

Some have been forced in this economy to drop their pricey medical insurance. A Loomis man without coverage says first responders forced him to the hospital after his motorcycle crash. Now he faces more than $40,000 in bills he doesn’t feel he should have to pay.

 

It was a cool summer’s day in August when Terry Barth was out riding his Harley in Plumas County. The winding country road in front of him took an unexpected turn. Thrown off his bike, Terry was roughed up and hit his head. When the paramedics arrived, he says he declined treatment.

 

“I said i told you i can’t go, I don’t have insurance,” he recalls.

 

Against his wishes, he says they loaded him up anyway.

 

“And I was still yelling the words in the ambulance, I can’t go. I told you I can’t go.”

 

Rushed to a hospital in Quincy against his will, doctors then loaded Terry into an air ambulance to Enloe Medical Center in Chico which was the closest trauma center. Terry learned he suffered a concussion and a broken bone around his eye. Against doctor’s orders, he walked out of the hospital and went home only to get slapped with bills totalling more than $40,000 for the care he says he never wanted.

 

“I was kidnapped, i felt,” he said.

 

So if you say no, you don’t want to go to the hospital, do they have to listen?

 

“Yes and no is the answer to that question,” said Sacramento Fire Paramedic Jonathan Burgess.

 

He says normally it is the patient’s decision, but if you have a head injury like Terry had, or if you’re intoxicated or having a diabetic emergency, first responders are required to make that decision for you. Otherwise they can be held liable if something happens to you later.

 

“Your license is at jeopardy for patient abandonment, if you show up to a person in need of care and you don’t take them to the hospital,” Burgess said.

 

Terry doesn’t think he owes a penny and feels someone else should pay the blistering bill.

 

“Who forced me to go when i said no. I just know if they had listened to me, I wouldn’t have a bill.”

 

[Zelandakh]

Telling Americans we should be much more like Europe is not overcoming peoples concerns.

Saying America should be like Finland a tiny, tiny country is not overcoming peoples concerns.

 

Finland has a population under 6 Million.

Try Germany then. It has a universal healthcare system that is massively cheaper than America, at least as effective and insurance-based with (some) competition and choice in the insurance market. I do not know of them personally but I understand France and Japan use similar models. Altogether this might represent a large enough sample, no?

 

However, one thing is clear. A universal healthcare system involves some people paying more than they currently do for little gain. Those people are likely to be the richest and most influential (call them Group 1). There would almost certainly be another sizeable chunk who will pay more than they do now but get back in return as much or more in terms of healthcare value. This is the group that Group 1 will be working very hard to convince they are worse off, even when they are in truth better off. Phrases such as "Don't let the government decide what you should do with your money" and the like will be heard. It is essentially the opinion of this second group that will decide whether America can ever move to a universal healthcare system. At present it looks sadly like the efforts of Group 1 are still winning the argument despite the obvious overall gains to be had from moving America away from the current model.

 

A question to Luke - why would poor people not support the ACA when the alternative is the old system? Sure, many of them may not immediately gain directly from the legislation but it is one step closer and for Americans to finally provide some kind of safety net for the poor it may well take such a halfway-house compromise to provide a stepping stone. One thing that must be 100% certain for any poor but clever/educated American is that they will surely never be worse off under Obama than Romney.

 

@Cthulhu: try this logic:-

 

1. I understand that wearing helmets is a good idea.

2. Therefore I wear a helmet and encourage everyone to do likewise

3. I believe fundamentally that the government should never have the right to require me to do something that does not threaten another individual directly.

4. Therefore I am vehemently opposed to any government legislation making the wearing of helmets mandatory.

 

By your logic, smoking and drinking alcohol should also be illegal. Both cost society money. Similarly for many dangerous activities such as handgliding. For that matter, chip pans are a major cost due to the fires and injuries they cause. Perhaps we should ban those while we are at it?

[blackshoe]

What's insane is complaining that society is paying for peoples' idiocy, and then complaining again when society tries to make an idiot pay when he refused treatment and told the paramedics he couldn't afford it.

 

As for "being like Europe", I was speaking in terms of politics - in particular for this thread the politics of health care. The other crap you brought up is a nice red herring, but that's all it is.

 

The flaw in your logic is that you need to examine why "idiots on motorcycles without helmets cost society a lot of money". Either society takes on responsibility for these (and presumably for all) idiots, or it does not. If people, idiots or otherwise, are (as they should be imo) responsible for their own actions, then the solution to "society's" problem seems obvious.

 

It is not the case that in a free society the answer to every problem is more government regulation. Of course, if you want to posit an unfree society, where the government is paramount and freedom is a myth, that's a different story.