The Affordable Care Act Greek Chorus Line

[Vampyr]

Duplicate

[blackshoe]

No, the government is losing twice. Take the Bush tax cuts. The first loss was the lowered taxes; the second loss was the interest paid when those lowered tax savings were used to buy treasury bonds which, ironically, were sold to cover the shortfall caused by insufficient tax revenues.

I'm not sure we should look at reduction in government revenues as the government "losing". Although, since government seems categorically unable to cut back spending when revenue is reduced, that's certainly a problem.

[mike777]

Clearly the voters have said they want bigger govt, more revenues, more control over the economy.

Any thing less is a loss.

 

Again if the govt is more efficient, better at asset/capital allocation, better at social justice and fairness then loss of revenue is a loss.

 

Winston points out the rich buy bonds, the govt spends. That is asset/capital allocation!

------------

 

 

As one poster put it health care is very difficult to steal, but many posters seem to feel it is easy to steal. We cannot even agree how easy/hard it is to steal.

[HighLow21]

Logic error:

Somebody said you "need health insurance". Wrong - you need air to breathe. You might want health insurance.

You don't need health insurance unless:

1) You have or will have a medical problem.

2) You can't just live with it now or when you get it.

3) You don't have enough money to pay for the care, if and when you need it, AND

4) You can't arrange to acquire the money to pay for the care, if and when you need it.

...

The remainder of this post has "Tea Party" written all over it. Riddled with non-sequiturs and arguments that have no purpose in a discussion on this or any other germane topic. I'm happy to point out many of them if anyone likes.

[blackshoe]

Health care is extremely difficult to steal.

Is it? I remember visiting my father (who was a cardiologist) a couple of decades ago and seeing a guy drive up in a truck and drop off several bushels of apples and peaches. Dad insisted I take a bushel of each home with me. When I asked him what the deal was, he told me the guy, a farmer, had been a patient, and when he told Dad he couldn't afford to pay the bill, Dad just forgave the whole thing. So the farmer insisted on giving Dad some of his crop every year. I asked my father if this happened often. He said "fortunately, not often enough to put me in the poorhouse." He also said that at the rate the farmer was "paying off the debt" it would probably take him a couple of centuries to get it done. Not counting interest. B-)

 

Okay, not stealing, exactly. I don't think the farmer went into the deal intending to get something for nothing. Still, it's a part of the problem. Will the ACA fix it? Probably not, but who knows? The law is so damn complex it's hard to tell what its effects will truly be.

[HighLow21]

I'm not sure we should look at reduction in government revenues as the government "losing". Although, since government seems categorically unable to cut back spending when revenue is reduced, that's certainly a problem.

Given that revenue began falling due to a long-term debt cycle decline (read: depression or deleveraging), one of the worst possible actions that could have been taken would have been to cut spending. All that would have done is further exacerbate the depression.

 

Actually, cutting taxes in that scenario is also one of the worst possible ideas, but Republicans still seem to dig it.

 

See:

http://dealbook.nytimes.com/2013/10/21/economic-theory-via-youtube-and-cartoon/?_r=5

[mike777]

/given 2013,,,,

 

 

1) more taxes much more

 

 

2) on health care we spend what...more?

 

 

ion any event 50 million and more don't have it

[Cthulhu D]

The remainder of this post has "Tea Party" written all over it. Riddled with non-sequiturs and arguments that have no purpose in a discussion on this or any other germane topic. I'm happy to point out many of them if anyone likes.

 

I love that he cannot see that, infact, air to stop you from dying and an emergency blood transfusion to stop you from dying are, infact, exactly the same.

 

People who think there is a free market for healthcare are, in a very real sense, idiots. We've known since Adam Smith that a free market requires several things:

 

A) Fully informed consumers

B) Who are able to make a rational choice

C) Have a number of options available that are in perfect competition.

 

Now, let me cite a real healthcare example. You are hit by a car and knocked unconscious in the accident. How are you a) Informed about anything, because you are unconscious b) able to make a rational choice from amongst the treatment options available to you because you are unconscious.

 

This fundamental healthcare scenario fails Adam Smith's precepts. There is no free market for healthcare, nor can there ever be. Should people wait for you to come around before calling an ambulance? What if you die in the mean time? What about if you are literally dying in an ER, and will not survive being moved to another hospital. The provider realises this, and suddenly the cost of his services is 'All of your possessions'. How does that meet point C?

 

People who do not understand this inability for there ever to be a free market for healthcare under any circumstances are quite literally one of two types of idiots - dunces (those incapable of learning) or ignoramuses (those who are uneducated or ignorant).

[mike777]

Posters make a strong argument that the President of America should be in charge of health care not free markets.

 

 

"This fundamental healthcare scenario fails Adam Smith's precepts. There is no free market for healthcare, nor can there ever be. Should people wait for you to come around before calling an ambulance? What if you die in the mean time? What about if you are literally dying in an ER, and will not survive being moved to another hospital. The provider realises this, and suddenly the cost of his services is 'All of your possessions'. How does that meet point C?

 

People who do not understand this inability for there ever to be a free market for healthcare under any circumstances are quite literally one of two types of idiots - dunces (those incapable of learning) or ignoramuses (those who are uneducated or ignorant)."

[hrothgar]

Posters make a strong argument that the President of America should be in charge of health care not free markets.

 

I don't recall anyone arguing that the President should be in charge of health care.

I wouldn't trust George W. Bush to wipe his own ass, let alone run health care.

 

A number of people, myself included, have stated that they think that the government should run health care in the United States (just as it does in every other developed economy).

[blackshoe]

INow, let me cite a real healthcare example. You are hit by a car and knocked unconscious in the accident. How are you a) Informed about anything, because you are unconscious b) able to make a rational choice from amongst the treatment options available to you because you are unconscious.

/quote]

Was a recent new item about a guy who passed out in his bathroom. Ambulance took him to some hospital that didn't recognize his insurance. He woke up several days later and the hospital presented him with a bill for $150,000.

 

"Dunces" and "ignoramuses" are pejorative. Ignorance, at least, is fixable. Stupid isn't, but that doesn't mean we should hold the stupid in contempt — they can't help being stupid.

 

And 'there can be no free market in health care' does not lead to the conclusion that the President ought to run the health care system — he's already demonstrated he's not competent to do so.

[ArtK78]

The fact that there is no free market in the health care system means that the health care system should be regulated.

 

It does not mean that the President runs the health care system. Anyone making that argument (or trying to make points by responding to it) is being ingenuous (I could use a stronger term, but they know who they are).

[Winstonm]

Given that revenue began falling due to a long-term debt cycle decline (read: depression or deleveraging), one of the worst possible actions that could have been taken would have been to cut spending. All that would have done is further exacerbate the depression.

 

Actually, cutting taxes in that scenario is also one of the worst possible ideas, but Republicans still seem to dig it.

 

See:

http://dealbook.nytimes.com/2013/10/21/economic-theory-via-youtube-and-cartoon/?_r=5

 

Here in the U.S., the two things that can be counted on from the political far right: reasonable ideas (Adam Smith) will be bastardized to fit a small government agenda (i.e., Reaganomics), while ideas that cannot be co-opted into small-government bumper stickers (John Keynes) will be demonized, (i.e., current tea party outcries over debt and spending).

 

It is the binary thinking process that underlies the ultra-conservative mindset that, IMO, must be overcome before any real progress can be made. I would think that anyone over the age of 10 could see that "free market good/government bad" is a silly, fantasy-based model that has no basis in reality.

 

Thus far,this is what the "market good" approach has wrought:

While the US spends more on healthcare than any other developed nation, it also has one of the lowest life expectancies: People living in the US die sooner, get sicker and sustain more injuries than those in other high-income countries.

 

Compared to 16 other affluent nations, the US has the highest mortality rate, according to a new report titled “US Health in International Perspectives: Shorter Lives, Poorer Health.

[Zelandakh]

What is the comparison after factoring out things that are beyond the scope of the direct healthcare system, such as diet, stress, gun use and violent crime, Winston?

[Winstonm]

What is the comparison after factoring out things that are beyond the scope of the direct healthcare system, such as diet, stress, gun use and violent crime, Winston?

 

Actually, I don't think that really matters all that much as the ideological conflict crosses all boundaries of discussion - whether discussing the negative effects of tobacco or acid rain or climate change or U.S. healthcare, there is a group of people dedicated to the ideology that government activity is bad and free markets are the ideal solution to every human problem.

 

If one reads all the threads, the dissenting point of view of taking any action is almost always a small government mindset.

[Zelandakh]

You quoted some statistics supporting the position that "market good" is a bad approach. It seems reasonable to question what those statistics are actually telling us. It might well be telling us that the healthcare system is wonderful and the problem is education; or law and order; or whatever. As it happens I am also not conveinced in a market-based solution but I would hesitate to use such statistics as evidence without knowing how they should be interpreted. It works in politics because noone can analyse the numbers in a sound-bite form and the initial effect is stronger than the counter-argument, since arguing against puts you in the defensive. But in a more considered debate you need better evidence. I point you to AI's attempts in the Climate Change thread as an example of how using bogus statistics can easily end up working against you.

[Winstonm]

You quoted some statistics supporting the position that "market good" is a bad approach. It seems reasonable to question what those statistics are actually telling us. It might well be telling us that the healthcare system is wonderful and the problem is education; or law and order; or whatever. As it happens I am also not conveinced in a market-based solution but I would hesitate to use such statistics as evidence without knowing how they should be interpreted. It works in politics because noone can analyse the numbers in a sound-bite form and the initial effect is stronger than the counter-argument, since arguing against puts you in the defensive. But in a more considered debate you need better evidence. I point you to AI's attempts in the Climate Change thread as an example of how using bogus statistics can easily end up working against you.

 

That's why I posted the link to the article - the article is clear that the high mortality rate is not simply poor healthcare but a combination of problems of a type that seems to stem from small-government viewpoints - less regulation is better that leads to no or poor insurance, no gun control, inequality of wealth, etc.

 

IMO the problem is not simply healthcare but the worldview heralded by Ronald Reagan and his followers.

[kenberg]

For me, it really is not a matter of big gov versus little gov. I don't much trust ideology whether if comes from the left or the right.

 

Here is my general view:

 

If I were to choose solely on self-interest, I would say leave things as they are (or rather as they were). it's a mess, but it's a mess I can cope with. Change is not always the same as improvement.

 

So to the extent that I support the ACA, and I do support it and hope it works, it's because I think that health care for many is really in a shambles. I think there is a limit on my obligations to me fellow man, but the current situation, for a fairly rich country, is an embarrassment.

 

Now what I want for my support, basically my bottom line demand, is that it be done competently. Maybe that will still happen, I hope so, but we are off to a truly bad start. The Pres signed the ACA into law some three plus years ago, it is widely regarded as his signature accomplishment. I hoped for a better launch. What on Earth were they thinking?

 

My primary reaction to the way it has gone is one of great sadness. I don't believe that history will judge the Obama presidency favorably.

[ArtK78]

That's why I posted the link to the article - the article is clear that the high mortality rate is not simply poor healthcare but a combination of problems of a type that seems to stem from small-government viewpoints - less regulation is better that leads to no or poor insurance, no gun control, inequality of wealth, etc.

 

IMO the problem is not simply healthcare but the worldview heralded by Ronald Reagan and his followers.

I wholeheartedly agree with this opinion. Ever since "The Great Communicator" served as President, it seems that the mainstream Republican Party has treated his ideas as Gospel (literally, not figuratively) and Reagan as the second coming of the Messiah. The Tea Party represents the fundamentalist sect of the mainstream Republican Party.

[hrothgar]

I'm pretty damn pissed as well. For years folks have been promising me FEMA death camps, black helicopters, and jack booted UN thugs.

What have to I gotten? Nada.

 

I'm a dues paying member of the New World Order.

I want some consideration for my support.

 

The day you can't trust the Bavarian Illuminati is a sad day indeed.

[HighLow21]

I'm pretty damn pissed as well. For years folks have been promising me FEMA death camps, black helicopters, and jack booted UN thugs.

What have to I gotten? Nada.

 

I'm a dues paying member of the New World Order.

I want some consideration for my support.

 

The day you can't trust the Bavarian Illuminati is a sad day indeed.

I have to remember the phrase "Bavarian Illuminati" for my next social gathering.

 

-T

[ArtK78]

For me, it really is not a matter of big gov versus little gov. I don't much trust ideology whether if comes from the left or the right.

 

Here is my general view:

 

If I were to choose solely on self-interest, I would say leave things as they are (or rather as they were). it's a mess, but it's a mess I can cope with. Change is not always the same as improvement.

 

So to the extent that I support the ACA, and I do support it and hope it works, it's because I think that health care for many is really in a shambles. I think there is a limit on my obligations to me fellow man, but the current situation, for a fairly rich country, is an embarrassment.

 

Now what I want for my support, basically my bottom line demand, is that it be done competently. Maybe that will still happen, I hope so, but we are off to a truly bad start. The Pres signed the ACA into law some three plus years ago, it is widely regarded as his signature accomplishment. I hoped for a better launch. What on Earth were they thinking?

 

My primary reaction to the way it has gone is one of great sadness. I don't believe that history will judge the Obama presidency favorably.

I disagree.

 

In time, these hiccoughs will fade from memory, and if the ACA performs as I expect it to in the fullness of time, it will be viewed in the same manner as Medicare and Social Security.

 

Remember, universal health coverage was a goal of the Clinton administration, and Clinton could not pull it off (one of the few things he could not pull off). Obama succeeded where Clinton failed, and this has earned him vilification from the right. In time, all that will remain will be universal health coverage, and that will be how history will judge the Obama presidency.

[kenberg]

The BBO Forum is a never ending prompt toward knowledge. I looked it up:

 

The Illuminati (plural of Latin illuminatus, "enlightened") is a name given to several groups, both real and fictitious. Historically the name refers to the Bavarian Illuminati, an Enlightenment-era secret society founded on May 1, 1776 to oppose superstition, prejudice, religious influence over public life, abuses of state power, and to support women's education and gender equality. The Illuminati were outlawed along with other secret societies by the Bavarian government leadership with the encouragement of the Roman Catholic Church, and permanently disbanded in 1785.^[1] In the several years following, the group was vilified by conservative and religious critics who claimed they had regrouped and were responsible for the French Revolution.

 

I didn't know half this stuff! (Or, any of it, actually, but don't blab.)

[Cthulhu D]

You quoted some statistics supporting the position that "market good" is a bad approach. It seems reasonable to question what those statistics are actually telling us. It might well be telling us that the healthcare system is wonderful and the problem is education; or law and order; or whatever. As it happens I am also not conveinced in a market-based solution but I would hesitate to use such statistics as evidence without knowing how they should be interpreted. It works in politics because noone can analyse the numbers in a sound-bite form and the initial effect is stronger than the counter-argument, since arguing against puts you in the defensive. But in a more considered debate you need better evidence. I point you to AI's attempts in the Climate Change thread as an example of how using bogus statistics can easily end up working against you.

 

Part of it depends how you measure: You can do population health with control for socio economic status, you can do patient satisfaction, and you can do quality of care. Looking at the UK vs the US.

 

Current evidence suggests that the quality of care in the NHS is of approximately equal quality to the care delivered by the US system (to people who present at GPs etc and have full medical records - so this is giving the US a 'free pass' on the uninsured who present at ERs). There are varying strengths and weaknesses, the NHS is vastly superior at managing chronic illnesses, US cancer treatment tends to be better, both are amazingly awful at treating alcoholism, but overall the quality is about the same. On patient satisfaction, of those that are admitted to hospital or have long term prescriptions the NHS vastly out scores the US (but, but, bizarrely, not with those who just go to the GP and don't have significant medication, though, imho, asking people who don't go to hospital how statisfied with the hospital system they are is dumb, I don't work for the WHO). Population health is less clear cut, and trying to draw conclusions there is difficult. They seem to indicate that the NHS is better, but honestly this is hard to tell.

 

Of course, while these measures are close (except patient satisfaction where the UK is leaps and bounds ahead), the UK total healthcare spending per capita (including private health insurance and spending) is like a third of US healthcare spending. Which to me suggests the US is getting a bum deal.

 

INow, let me cite a real healthcare example. You are hit by a car and knocked unconscious in the accident. How are you a) Informed about anything, because you are unconscious b) able to make a rational choice from amongst the treatment options available to you because you are unconscious.

Was a recent new item about a guy who passed out in his bathroom. Ambulance took him to some hospital that didn't recognize his insurance. He woke up several days later and the hospital presented him with a bill for $150,000.

 

"Dunces" and "ignoramuses" are pejorative. Ignorance, at least, is fixable. Stupid isn't, but that doesn't mean we should hold the stupid in contempt — they can't help being stupid.

 

And 'there can be no free market in health care' does not lead to the conclusion that the President ought to run the health care system — he's already demonstrated he's not competent to do so.

 

Amusingly this is something Adam Smith got wrong - he thought that could never happened because of basic human decency hahaha. Anyway, this is a market failure and the only solution in the case of market failures is government intervention. It has been shown time and time again that in the case of healthcare the most efficient and effective form is a single payer system ala the French, Canada or the NHS. Pick how much you want to pay and go with that.

[mycroft]

I'm pretty damn pissed as well. For years folks have been promising me FEMA death camps, black helicopters, and jack booted UN thugs.

What have I gotten? Nada.

Just a reminder to all the parents out there. Let’s talk about safety when taking your children out to play in the Scrub Lands and the Sand Wastes. You need to give them plenty of water, make sure there’s a shade tree in the area, and keep an eye on the helicopter colours. Are the unmarked helicopters circling the area black? Probably World Government. Not a good area for play that day. Are they blue? That’s the Sheriff’s Secret Police. They’ll keep a good eye on your kids, and hardly ever take one. Are they painted with complex murals depicting birds of prey diving? No one knows what those helicopters are, or what they want. Do not play in the area. Return to your home, and lock the doors until a Sheriff’s Secret Policeman leaves a carnation on your porch to indicate that the danger has passed. Cover your ears to blot out the screams.

 

-- Welcome to Night Vale, Ep. 1