ObamaCare - "Give up your phone to get it!!!"

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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby tzor on Sun Mar 24, 2013 9:38 pm

PLAYER57832 wrote:Are you truly serious!

Yes he is truly serious.
PLAYER57832 wrote:Healthcare is not an optional product. Health insurance is not an optional product.

Claptrap and bullshit.
"The God who gave us life, gave us liberty at the same time." Thomas Jefferson
To suggest that something is not optional is to suggest that someone does not have the liberty to decline.
The Federal Government isn't your Mommy.
PLAYER57832 wrote:The means of delivery of health insurance at this time is through people's employers or the government.

Which is crap. It may have been mediocre crap back in the previous century when most people worked at the same job for their entire lives, but it's absolute crap in the 21st century. The enforcement of crap into required crap is not just crap squared, it's crap cubed.
PLAYER57832 wrote:It is the government's role to ensure that PEOPLE, not private business interests are protected.

No it's not and no it doesn't. How in hell can the government ensure anything about the people? The only god damned thing that government cares for is government. There are no philosopher kings, there are no benevolent angels, there are only people who occupy a legal monopoly and want to keep it that way. Government never helps the people and never will help the people. People will only do the minimum things required to retain their positions within government. There is no difference between government and private business other than the former is allowed to have the power of law and the military.
PLAYER57832 wrote:We all know you want to do away with government.

And we all know you worship government and follow notions that are as old (and useless) as Plato's Philosopher Kings from his "Republic." I believe he (as well as myself) wants LIMITED GOVERNMENT. Because, in effect all government is monopoly and all monopolies are inherently bad because they have the means of killing off competition that would force them to become efficient.

The Government is not your Mommy.
It's more of a potential abusive parent, if you let it.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby jj3044 on Sun Mar 24, 2013 9:45 pm

BigBallinStalin wrote:
jj3044 wrote:

I just read most of the first link you put up there and I have concerns.

The purpose of insurance, of any kind, is to spread out the cost of risk; not to cover every undesirable and/or planned incident. Auto insurance covers the costs incurred from having a collision, not oil changes or flat tires. Home-owner's insurance pays for the loss of your residence to fire or other catastrophic events, not to fix peeling paint. Likewise, health insurance's proper role in our lives is to cover catastrophic and unpredictable events, like cancer. It is not intended to cover minor or planned events like doctor's visits, checkups, or prescriptions. If you want to pay a third-party to turn around and pay your doctor for you, of course it's going to be not only more expensive than insurance, but more expensive than just paying for these things yourself.

If health insurance turned into catastrophic-only insurance, our population would become much less healthier, because no one would go to the doctor to get their age/gender specific screenings, as it would cost several hundred dollars. There would then be significantly higher rates of otherwise preventable diseases, which are dozens of times more costly to treat when caught late compared to early detection and intervention. This approach would lower healthcare costs in the short term, but INCREASE costs and rate of disease in the long term.

Loosen or eliminate licensing restrictions for providers. Just as you do your research before choosing an auto mechanic, or any other provider, so would be the case with a health care provider. There is no need to artificially restrict the supply of providers, which necessarily raises costs, when people can use consumer reports, private certifications, referrals from friends, or any number of resources in order to find a qualified provider.

So, someone can just up and read a physiology and pharmacology book and start treating patients? As long as you have a good bedside manner people will refer you? Is this guy kidding?!?!


Licensing is monopolized by the medical profession. This began in the 1910s to counteract doctors who offered their services to the members of mutual aid societies at significantly lower prices. The established professionals did not like this competition, so they pleaded with their State governments to establish licensing procedures, thus granting them the monopoly over who would become a doctor.

Somehow this doesn't make me feel any better at all BBS. If I am going to listen to a physician or let one operate on me, I want to know that there was an objective test that he/she took where they had to demonstrate that they were qualified to give said advice, or cut me open.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby thegreekdog on Mon Mar 25, 2013 6:51 am

jj3044 wrote:
BigBallinStalin wrote:
jj3044 wrote:

I just read most of the first link you put up there and I have concerns.

The purpose of insurance, of any kind, is to spread out the cost of risk; not to cover every undesirable and/or planned incident. Auto insurance covers the costs incurred from having a collision, not oil changes or flat tires. Home-owner's insurance pays for the loss of your residence to fire or other catastrophic events, not to fix peeling paint. Likewise, health insurance's proper role in our lives is to cover catastrophic and unpredictable events, like cancer. It is not intended to cover minor or planned events like doctor's visits, checkups, or prescriptions. If you want to pay a third-party to turn around and pay your doctor for you, of course it's going to be not only more expensive than insurance, but more expensive than just paying for these things yourself.

If health insurance turned into catastrophic-only insurance, our population would become much less healthier, because no one would go to the doctor to get their age/gender specific screenings, as it would cost several hundred dollars. There would then be significantly higher rates of otherwise preventable diseases, which are dozens of times more costly to treat when caught late compared to early detection and intervention. This approach would lower healthcare costs in the short term, but INCREASE costs and rate of disease in the long term.

Loosen or eliminate licensing restrictions for providers. Just as you do your research before choosing an auto mechanic, or any other provider, so would be the case with a health care provider. There is no need to artificially restrict the supply of providers, which necessarily raises costs, when people can use consumer reports, private certifications, referrals from friends, or any number of resources in order to find a qualified provider.

So, someone can just up and read a physiology and pharmacology book and start treating patients? As long as you have a good bedside manner people will refer you? Is this guy kidding?!?!


Licensing is monopolized by the medical profession. This began in the 1910s to counteract doctors who offered their services to the members of mutual aid societies at significantly lower prices. The established professionals did not like this competition, so they pleaded with their State governments to establish licensing procedures, thus granting them the monopoly over who would become a doctor.

Somehow this doesn't make me feel any better at all BBS. If I am going to listen to a physician or let one operate on me, I want to know that there was an objective test that he/she took where they had to demonstrate that they were qualified to give said advice, or cut me open.


Then you can choose to go to a licensed professional to get your broken bone set. Perhaps I will go to an unlicensed person for the same service and pay less money.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby thegreekdog on Mon Mar 25, 2013 6:55 am

jj3044 wrote:

I just read most of the first link you put up there and I have concerns.

The purpose of insurance, of any kind, is to spread out the cost of risk; not to cover every undesirable and/or planned incident. Auto insurance covers the costs incurred from having a collision, not oil changes or flat tires. Home-owner's insurance pays for the loss of your residence to fire or other catastrophic events, not to fix peeling paint. Likewise, health insurance's proper role in our lives is to cover catastrophic and unpredictable events, like cancer. It is not intended to cover minor or planned events like doctor's visits, checkups, or prescriptions. If you want to pay a third-party to turn around and pay your doctor for you, of course it's going to be not only more expensive than insurance, but more expensive than just paying for these things yourself.

If health insurance turned into catastrophic-only insurance, our population would become much less healthier, because no one would go to the doctor to get their age/gender specific screenings, as it would cost several hundred dollars. There would then be significantly higher rates of otherwise preventable diseases, which are dozens of times more costly to treat when caught late compared to early detection and intervention. This approach would lower healthcare costs in the short term, but INCREASE costs and rate of disease in the long term.


Why would it increase costs in the long-term?

jj3044 wrote:[
Loosen or eliminate licensing restrictions for providers. Just as you do your research before choosing an auto mechanic, or any other provider, so would be the case with a health care provider. There is no need to artificially restrict the supply of providers, which necessarily raises costs, when people can use consumer reports, private certifications, referrals from friends, or any number of resources in order to find a qualified provider.

So, someone can just up and read a physiology and pharmacology book and start treating patients? As long as you have a good bedside manner people will refer you? Is this guy kidding?!?!


Your objections don't make sense. They are knee jerk reactions based upon you being conditioned to believe that healthcare is somehow different or better or special. Perhaps you trust a doctor with an MD after his or her name (or a D.O., which is different - do you feel different going to D.O.?) But that doesn't mean people NEED to go to a licensed practitioner.

jj3044 wrote:[
And lastly, charities can and will take care of those in need (12). It should be noted that the number of people unable to afford health care would plummet once the above measures were put into place.

Again, costs and disease prevalence would increase dramatically in the long term, as this does not support PREVENTION of disease. Having insurance cover preventive services and offering incentives to have people get those age/gender specific screenings is the #1 way to improve outcomes and make our population healthier, which will lower costs int he long run.
[/quote]

This also doesn't make sense to me. Why would somone not want to prevent themselves from getting a disease?
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby BigBallinStalin on Mon Mar 25, 2013 11:12 am

jj3044 wrote:
BigBallinStalin wrote:
jj3044 wrote:

I just read most of the first link you put up there and I have concerns.

The purpose of insurance, of any kind, is to spread out the cost of risk; not to cover every undesirable and/or planned incident. Auto insurance covers the costs incurred from having a collision, not oil changes or flat tires. Home-owner's insurance pays for the loss of your residence to fire or other catastrophic events, not to fix peeling paint. Likewise, health insurance's proper role in our lives is to cover catastrophic and unpredictable events, like cancer. It is not intended to cover minor or planned events like doctor's visits, checkups, or prescriptions. If you want to pay a third-party to turn around and pay your doctor for you, of course it's going to be not only more expensive than insurance, but more expensive than just paying for these things yourself.

If health insurance turned into catastrophic-only insurance, our population would become much less healthier, because no one would go to the doctor to get their age/gender specific screenings, as it would cost several hundred dollars. There would then be significantly higher rates of otherwise preventable diseases, which are dozens of times more costly to treat when caught late compared to early detection and intervention. This approach would lower healthcare costs in the short term, but INCREASE costs and rate of disease in the long term.

Loosen or eliminate licensing restrictions for providers. Just as you do your research before choosing an auto mechanic, or any other provider, so would be the case with a health care provider. There is no need to artificially restrict the supply of providers, which necessarily raises costs, when people can use consumer reports, private certifications, referrals from friends, or any number of resources in order to find a qualified provider.

So, someone can just up and read a physiology and pharmacology book and start treating patients? As long as you have a good bedside manner people will refer you? Is this guy kidding?!?!


Licensing is monopolized by the medical profession. This began in the 1910s to counteract doctors who offered their services to the members of mutual aid societies at significantly lower prices. The established professionals did not like this competition, so they pleaded with their State governments to establish licensing procedures, thus granting them the monopoly over who would become a doctor.

Somehow this doesn't make me feel any better at all BBS. If I am going to listen to a physician or let one operate on me, I want to know that there was an objective test that he/she took where they had to demonstrate that they were qualified to give said advice, or cut me open.


Licensing is allowable on a free market. There would be more than one license agency per state, so it would be much more competitive, thus more open to customer preferences, innovation, higher quality, lower prices, etc.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby jj3044 on Mon Mar 25, 2013 5:59 pm

thegreekdog wrote:
jj3044 wrote:

I just read most of the first link you put up there and I have concerns.

The purpose of insurance, of any kind, is to spread out the cost of risk; not to cover every undesirable and/or planned incident. Auto insurance covers the costs incurred from having a collision, not oil changes or flat tires. Home-owner's insurance pays for the loss of your residence to fire or other catastrophic events, not to fix peeling paint. Likewise, health insurance's proper role in our lives is to cover catastrophic and unpredictable events, like cancer. It is not intended to cover minor or planned events like doctor's visits, checkups, or prescriptions. If you want to pay a third-party to turn around and pay your doctor for you, of course it's going to be not only more expensive than insurance, but more expensive than just paying for these things yourself.

If health insurance turned into catastrophic-only insurance, our population would become much less healthier, because no one would go to the doctor to get their age/gender specific screenings, as it would cost several hundred dollars. There would then be significantly higher rates of otherwise preventable diseases, which are dozens of times more costly to treat when caught late compared to early detection and intervention. This approach would lower healthcare costs in the short term, but INCREASE costs and rate of disease in the long term.


Why would it increase costs in the long-term?

lol, I don't know how much clearer I could have wrote it... because under the proposed system, people would have to pay out of pocket hundreds of dollars for preventive services. So, most people won't do it. I work in the healthcare industry so I see these numbers on a daily basis. A lot of companies have terrible preventive service rates DESPITE the services being free! So if it costs a lot of money for these services, even less would get them done. Diseases and conditions that are not detected early are much more costly to treat in the long run. Ergo, there would be many more cases of significantly costly, advanced disease which will bog the system down with billions in otherwise preventable costs.
jj3044 wrote:[
Loosen or eliminate licensing restrictions for providers. Just as you do your research before choosing an auto mechanic, or any other provider, so would be the case with a health care provider. There is no need to artificially restrict the supply of providers, which necessarily raises costs, when people can use consumer reports, private certifications, referrals from friends, or any number of resources in order to find a qualified provider.

So, someone can just up and read a physiology and pharmacology book and start treating patients? As long as you have a good bedside manner people will refer you? Is this guy kidding?!?!


Your objections don't make sense. They are knee jerk reactions based upon you being conditioned to believe that healthcare is somehow different or better or special. Perhaps you trust a doctor with an MD after his or her name (or a D.O., which is different - do you feel different going to D.O.?) But that doesn't mean people NEED to go to a licensed practitioner.

In this case, I think we will have to agree to disagree then...
jj3044 wrote:[
And lastly, charities can and will take care of those in need (12). It should be noted that the number of people unable to afford health care would plummet once the above measures were put into place.

Again, costs and disease prevalence would increase dramatically in the long term, as this does not support PREVENTION of disease. Having insurance cover preventive services and offering incentives to have people get those age/gender specific screenings is the #1 way to improve outcomes and make our population healthier, which will lower costs int he long run.


This also doesn't make sense to me. Why would somone not want to prevent themselves from getting a disease?

It happens all the time. People (especially young people) think they are invincible... and if this mindset continues to flourish, they will always feel that way until one day they wake up with chest pains, go to the emergency room, and discover they have a 90% blockage and need surgery ...

As I mentioned above, I see it in my clients every day. The numbers vary per company, but in a typical group (without an incentive program) usually only has about 40-50% of their population having annual physicals... and that number scares me.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby jj3044 on Mon Mar 25, 2013 6:02 pm

BigBallinStalin wrote:Licensing is allowable on a free market. There would be more than one license agency per state, so it would be much more competitive, thus more open to customer preferences, innovation, higher quality, lower prices, etc.

See, this I wouldn't have an issue with, but TGD made it sound that he wanted to go to some schmuck with a camera and butterknife to do a knee replacement...

Are there any examples of how the licensing process today inhibits these things?
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Mon Mar 25, 2013 6:11 pm

tzor wrote:
PLAYER57832 wrote:Are you truly serious!

Yes he is truly serious.
PLAYER57832 wrote:Healthcare is not an optional product. Health insurance is not an optional product.

Claptrap and bullshit.
"The God who gave us life, gave us liberty at the same time." Thomas Jefferson
To suggest that something is not optional is to suggest that someone does not have the liberty to decline.

I see, so you have some magic way to just refuse to get ill? Share, please.

And until you do, you know darned well that if you, or more importantly your kids, get seriously ill, you will access healthcare, and if you don't have insurance and you are not independently wealthy(even many who are), you will depend on other taxpayers to support you.

tzor wrote:
PLAYER57832 wrote:The means of delivery of health insurance at this time is through people's employers or the government.

Which is crap. It may have been mediocre crap back in the previous century when most people worked at the same job for their entire lives, but it's absolute crap in the 21st century. The enforcement of crap into required crap is not just crap squared, it's crap cubed.

I agree, and have said so many times. Employers have no business in employee's healthcare. However, denying women specific coverage is not about that argument. Note the "at this time" bit.
Claiming that as justification for denying women's coverage specfically is not valid.


The rest of your post is just a bunch of rightwing claptrap that has as much to do with what I said as Viceroy’s ideas have to do with evolution.. .and note that your sourcing is pretty similar…. I will tell you the same thing I told him. To understand another opinion, you have to actually read that opinion, not what you think others are saying.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby thegreekdog on Mon Mar 25, 2013 6:18 pm

jj3044 wrote:lol, I don't know how much clearer I could have wrote it... because under the proposed system, people would have to pay out of pocket hundreds of dollars for preventive services. So, most people won't do it. I work in the healthcare industry so I see these numbers on a daily basis. A lot of companies have terrible preventive service rates DESPITE the services being free! So if it costs a lot of money for these services, even less would get them done. Diseases and conditions that are not detected early are much more costly to treat in the long run. Ergo, there would be many more cases of significantly costly, advanced disease which will bog the system down with billions in otherwise preventable costs.


I guess what I'm asking is why do you think the costs would be hundreds of dollars for preventative services? That's what those costs are now, sure, but why wouldn't they decrease under a new system?

jj3044 wrote:In this case, I think we will have to agree to disagree then...


Do you get your shots from a doctor or nurse or CVS?

jj3044 wrote:It happens all the time. People (especially young people) think they are invincible... and if this mindset continues to flourish, they will always feel that way until one day they wake up with chest pains, go to the emergency room, and discover they have a 90% blockage and need surgery ...

As I mentioned above, I see it in my clients every day. The numbers vary per company, but in a typical group (without an incentive program) usually only has about 40-50% of their population having annual physicals... and that number scares me.


Okay, I think we're ships passing in the night here. If it happens all the time now, when people have health insurance and don't have to pay much out-of-pocket for preventative medicine, how would a "free market" healthcare system be any worse than that? I would think it would actually be better. If I knew I would have to pay for surgery out of my own pocket, I might be more likely to engage in prevenative measures. I don't know if that's true or not for everyone, but I don't know why, logically, it would be worse. That's what I'm asking.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Mon Mar 25, 2013 6:22 pm

thegreekdog wrote: Then you can choose to go to a licensed professional to get your broken bone set. Perhaps I will go to an unlicensed person for the same service and pay less money.


The part of what you are saying that makes sense is that it does not really take an 8 years of medical training, residency, etc. to know how to properly set a bone.

HOWEVER, that means a lower level of license, not no license.

I will give you the comparision. An average person will, in most cases, represent themselves if they want to fight a minor traffic charge. If they are charged with anything from embezzlement to a capitol crime, they need a well trained attorney.

AND... as a point of information for you both, the truth is its unlikely a doctor will be the one who would set your bone, unless its complicated. That depends some on the state, the hospital, but its likely to be an assistant who does that.

That said, a doctor will likley look at you, make the determination that you do need a bone set and not something else (or something in addition). That is a good thing, for a lot of medical reasons too many to list here. I can name a few, but not all... I am not a doctor and not pretending to be one.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby Night Strike on Mon Mar 25, 2013 6:40 pm

PLAYER57832 wrote:Employers have no business in employee's healthcare. However, denying women specific coverage is not about that argument.


Then the employers shouldn't be paying for that healthcare.

And as you continue to fail to understand, specific coverages are denied under every single health insurance policy. It's just that you don't like when the ones you want are denied, so you turn to the government to force others to provide it for you.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby jj3044 on Mon Mar 25, 2013 10:28 pm

thegreekdog wrote:
jj3044 wrote:lol, I don't know how much clearer I could have wrote it... because under the proposed system, people would have to pay out of pocket hundreds of dollars for preventive services. So, most people won't do it. I work in the healthcare industry so I see these numbers on a daily basis. A lot of companies have terrible preventive service rates DESPITE the services being free! So if it costs a lot of money for these services, even less would get them done. Diseases and conditions that are not detected early are much more costly to treat in the long run. Ergo, there would be many more cases of significantly costly, advanced disease which will bog the system down with billions in otherwise preventable costs.


I guess what I'm asking is why do you think the costs would be hundreds of dollars for preventative services? That's what those costs are now, sure, but why wouldn't they decrease under a new system?

Because I don't realistically see that the cost of running an office practice declining. I don't think it has to go up either... say more than inflation... what makes you think these services would cost less in the system proposed?
jj3044 wrote:In this case, I think we will have to agree to disagree then...


Do you get your shots from a doctor or nurse or CVS?

A mixture of these professionals, and for the low hanging fruit (such as administering shots), I agree that a doctor doesn't have the be the one to do it. In fact a lot of the "retail clinic" models popping up (like MinuteClinic for example) work with nurse practitioners. They can handle a lot of the lower hanging fruit and refer the more serious/complicated cases to a doctor. I think this is a great model of care where you are seeing the appropriate person with the appropriate level of skill. That still doesn't mean that I want a nurse or a pharmacist deciding one day that they are going to pick up a knife and operate on me just because they can...
jj3044 wrote:It happens all the time. People (especially young people) think they are invincible... and if this mindset continues to flourish, they will always feel that way until one day they wake up with chest pains, go to the emergency room, and discover they have a 90% blockage and need surgery ...

As I mentioned above, I see it in my clients every day. The numbers vary per company, but in a typical group (without an incentive program) usually only has about 40-50% of their population having annual physicals... and that number scares me.


Okay, I think we're ships passing in the night here. If it happens all the time now, when people have health insurance and don't have to pay much out-of-pocket for preventative medicine, how would a "free market" healthcare system be any worse than that? I would think it would actually be better. If I knew I would have to pay for surgery out of my own pocket, I might be more likely to engage in prevenative measures. I don't know if that's true or not for everyone, but I don't know why, logically, it would be worse. That's what I'm asking.

Because it would be a disincentive to get your preventive tests done, especially in the younger population, and the low-income population (and hell, most middle class that are still living paycheck-to-paycheck). The health disparity among the low income population compared to higher income is already ridiculous...we are trying to bridge that gap, not make it wider. What IS working is incenting people to do things like get their preventive screenings (like the CVS program that is getting a lot of press). In these companies, they have a significantly higher rate of preventive screenings, and generally, lower total healthcare expenditures because of it.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby Night Strike on Mon Mar 25, 2013 11:01 pm

I wouldn't call the involuntary payment of $600 an "incentive program".
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Tue Mar 26, 2013 7:03 am

Night Strike wrote:
PLAYER57832 wrote:Employers have no business in employee's healthcare. However, denying women specific coverage is not about that argument.


Then the employers shouldn't be paying for that healthcare.

And as you continue to fail to understand, specific coverages are denied under every single health insurance policy. It's just that you don't like when the ones you want are denied, so you turn to the government to force others to provide it for you.

OH BULL.
Coverage is denied or approved based on cost-effectiveness formulae constructed by the insurance companies. Its very imperfect, but the basis is essentially objective costs. This is a few employers deciding to take some kind of moral bullying stance.

Its very different, so different the Supreme court has previously declared this to be discrimination.

And... since so much of your argument is about not wanting to pay more --- why do you keep ignoring the fact that providing birth control is far, far CHEAPER than not providing it?


The fact is that if this coverage were excluded, then any employer refusing it should have to pay MORE, not less -- to pay for all the extra children's health care coverage.

The ultimate answer is, yes, to have ALL ionsurance be offered independently. However, as long as employers provide the bulk of insurance, which will be as long as they get a tax benefit, then they need to provide full health covereage, not "pick and choose".
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby thegreekdog on Tue Mar 26, 2013 7:32 am

jj3044 wrote:Because I don't realistically see that the cost of running an office practice declining. I don't think it has to go up either... say more than inflation... what makes you think these services would cost less in the system proposed?


I can think of a few factors that could decrease costs under the system proposed. First, competition between insurance companies should generally drive down the cost of insurance. Second, competition between licensed doctors and licensed "other medical professionals" should generally drive down the cost of healthcare. Third, there is some substantial evidence that the government regulation of insurance and control of government insurance contributes to rising costs. This would be eliminated for the most part.

jj3044 wrote:A mixture of these professionals, and for the low hanging fruit (such as administering shots), I agree that a doctor doesn't have the be the one to do it. In fact a lot of the "retail clinic" models popping up (like MinuteClinic for example) work with nurse practitioners. They can handle a lot of the lower hanging fruit and refer the more serious/complicated cases to a doctor. I think this is a great model of care where you are seeing the appropriate person with the appropriate level of skill. That still doesn't mean that I want a nurse or a pharmacist deciding one day that they are going to pick up a knife and operate on me just because they can...


My children have seen nurse practitioners and my insurance company gets charged around the same amount (and my healthcare costs and health insurance costs don't decrease), despite that they have seen doctors. I'm certainly not suggesting you see a nurse practitioner or pharmacist to get your brain surgery, but for preventative care or for routine checkups or even for fixing broken bones, why would you pay for a doctor when you can pay less money for someone equally effective?

jj3044 wrote:Because it would be a disincentive to get your preventive tests done, especially in the younger population, and the low-income population (and hell, most middle class that are still living paycheck-to-paycheck). The health disparity among the low income population compared to higher income is already ridiculous...we are trying to bridge that gap, not make it wider. What IS working is incenting people to do things like get their preventive screenings (like the CVS program that is getting a lot of press). In these companies, they have a significantly higher rate of preventive screenings, and generally, lower total healthcare expenditures because of it.


I don't think I understand your point. Let me try to sum up my understanding:

- Right now people are not likely to engage in preventative medicine.
- Right now people pay for health insurance.

- Under a "free market system" people are not likely to engage in preventative medicine.
- Because under a "free market system" people would have to pay for preventative medicine.

I guess I still don't understand what you're asserting.

In any event, CVS screenings and the like can still be done under a free market system, I'm not sure why companies would stop incentivizing employees.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby jj3044 on Tue Mar 26, 2013 8:55 pm

Night Strike wrote:I wouldn't call the involuntary payment of $600 an "incentive program".

Whether it is a $600 hike in premiums, or a $600 reduction in premiums, it is still an incentive to participate. It is a more heavy handed approach, yes, but spinning it as a penalty often results in higher compliance.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby jj3044 on Tue Mar 26, 2013 9:33 pm

thegreekdog wrote:
jj3044 wrote:Because I don't realistically see that the cost of running an office practice declining. I don't think it has to go up either... say more than inflation... what makes you think these services would cost less in the system proposed?


I can think of a few factors that could decrease costs under the system proposed. First, competition between insurance companies should generally drive down the cost of insurance. Second, competition between licensed doctors and licensed "other medical professionals" should generally drive down the cost of healthcare. Third, there is some substantial evidence that the government regulation of insurance and control of government insurance contributes to rising costs. This would be eliminated for the most part.

While I don't disagree that free market systems usually do bring costs down, I'm not as sure as you are that it would help in the health insurance market. Example 1) Insurer competition. Competition is wonderful, but because they are already limited to spend at least 85% of all premium dollars on paying claims, many insurers are already operating on razor thin margins. That 15% has to include overhead. A common misconception is that the cost of healthcare is rising so fast because of the insurer profits. THis isn't the case. Premiums are rising because we are sicker than before, have to pay for better technology to treat these sicker people, etc. 2) Providers. If they all significantly reduced what they were charging, people wouldn't be able to afford to become a doctor, because what you would get paid would be dwarfed by the hundreds of thousands of dollars of student loan debt. Our national shortage of practitioners would get worse.
jj3044 wrote:A mixture of these professionals, and for the low hanging fruit (such as administering shots), I agree that a doctor doesn't have the be the one to do it. In fact a lot of the "retail clinic" models popping up (like MinuteClinic for example) work with nurse practitioners. They can handle a lot of the lower hanging fruit and refer the more serious/complicated cases to a doctor. I think this is a great model of care where you are seeing the appropriate person with the appropriate level of skill. That still doesn't mean that I want a nurse or a pharmacist deciding one day that they are going to pick up a knife and operate on me just because they can...


My children have seen nurse practitioners and my insurance company gets charged around the same amount (and my healthcare costs and health insurance costs don't decrease), despite that they have seen doctors. I'm certainly not suggesting you see a nurse practitioner or pharmacist to get your brain surgery, but for preventative care or for routine checkups or even for fixing broken bones, why would you pay for a doctor when you can pay less money for someone equally effective?

I agree with this point, as stated above. As long as the practitioner is qualified and licensed to treat your specific ailment, I am all for them going to a retail clinic that is typically much less expensive.
jj3044 wrote:Because it would be a disincentive to get your preventive tests done, especially in the younger population, and the low-income population (and hell, most middle class that are still living paycheck-to-paycheck). The health disparity among the low income population compared to higher income is already ridiculous...we are trying to bridge that gap, not make it wider. What IS working is incenting people to do things like get their preventive screenings (like the CVS program that is getting a lot of press). In these companies, they have a significantly higher rate of preventive screenings, and generally, lower total healthcare expenditures because of it.


I don't think I understand your point. Let me try to sum up my understanding:

- Right now people are not likely to engage in preventative medicine.
- Right now people pay for health insurance.

- Under a "free market system" people are not likely to engage in preventative medicine.
- Because under a "free market system" people would have to pay for preventative medicine.

I guess I still don't understand what you're asserting.

In any event, CVS screenings and the like can still be done under a free market system, I'm not sure why companies would stop incentivizing employees.

I hesitate to say "right now" on your two points above, because more and more employers are moving towards, or have moved to, an incentive based benefit. I just don't see any difference in people getting screenings under the "old" model and what has been proposed, because there still isn't an incentive to do so.

"Right now" companies are where CVS is, in building these programs to encourage these screening programs, saving costs in the long run.

In the proposed system where you had to pay out of pocket for preventive screenings, an employer based incentive program could nullify that, but it would basically just make the care free again. There still wouldn't be any financial incentive to get the screenings.

There are a lot of extrinsic motivators out there... people that need a gentle push, or a kick in the pants (wallet) in order to break through the barriers.

I'm pretty tired, so I hope that all made sense. :D If not, I can try again tomorrow!
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Wed Mar 27, 2013 7:21 am

jj3044 wrote:
BigBallinStalin wrote:Licensing is allowable on a free market. There would be more than one license agency per state, so it would be much more competitive, thus more open to customer preferences, innovation, higher quality, lower prices, etc.

See, this I wouldn't have an issue with, but TGD made it sound that he wanted to go to some schmuck with a camera and butterknife to do a knee replacement...
Are there any examples of how the licensing process today inhibits these things?

Actually, yes.... and we have posted them previously, but we have to be very careful.
As you say, medicine is one of those things where people do not always want the cheapest option. Quality really does matter. However, there is a lot of push about whehter, say PA's (Physician assistants) and Nurse practitioners should do more or are doing too much of basic exams. Midwivery is another area where this happens. In the case of midwives they have a very different approach, so its not just a matter of not having the same skills, its also a different way of doing things. Many modern hospitals are embracing midwives, trying to form relationships so that moms can use a midwive, but still have the full medical staff if something goes wrong. (just as an example).
So, there are cases where things can be simplified and costs reduced.
HOWEVER, there are 2 other issues. Medicine, ironically enough, is one of those things that responds negatively to competition. I posted a couple of articles on this before, specifically a stuffy of back care in Texas, but could not find that link again. Here is a journal article on the topic. Its orientation is how to prevent this from happening.
http://www.ncbi.nlm.nih.gov/pubmed/9952205
Abstract
The United States has experienced dramatic growth in both the technical capabilities and share of resources devoted to medical care. While the benefits of more medical care are widely recognized, the possibility that harm may result from growth has received little attention. Because harm from more medical care is unexpected, findings of harm are discounted or ignored. We suggest that such findings may indicate a more general problem and deserve serious consideration. First, we delineate 2 levels of decision making where more medical care may be introduced: (1) decisions about whether or not to use a discrete diagnostic or therapeutic intervention and (2) decisions about whether to add system capacity, eg, the decision to purchase another scanner or employ another physician. Second, we explore how more medical care at either level may lead to harm. More diagnosis creates the potential for labeling and detection of pseudodisease--disease that would never become apparent to patients during their lifetime without testing. More treatment may lead to tampering, interventions to correct random rather than systematic variation, and lower treatment thresholds, where the risks outweigh the potential benefits. Because there are more diagnoses to treat and more treatments to provide, physicians may be more likely to make mistakes and to be distracted from the issues of greatest concern to their patients. Finally, we turn to the fundamental challenge--reducing the risk of harm from more medical care. We identify 4 ways in which inadequate information and improper reasoning may allow harmful practices to be adopted-a constrained model of disease, excessive extrapolation, a missing level of analysis, and the assumption that more is better.
I won’t reiterate the abstract, it explains the points well.
The other issue you eluded to above and is very controversial. In most hospitals you have maybe 1-2 RNs who will supervise several Nursing Assistants. The nurse, either RN or LPN have degrees. The practitioners have certificates. They do a lot of the day-to day, labor-intensive care, such as bathing and feeding, moving patients, etc. Depending on the location and training they may do other things. The tendency of administrators is to cut back on Nurses and use more aids. On the one had, it makes sense to not have an RN or LPN just bathing a patient, but it also means that the nurses and doctors don’t see the patients as much as they used to… that means they are more likely to miss things, particularly in elderly patients, some other situations where things can change very rapidly. Further, the aids are often way overworked. One aid having to take care of 15 patients is not uncommon. Just think about trying to hand feed 6-7, never mind 10-12 patients in an hour and a half! Regulations mandating patient coverage ratios are being suggested and, I would say, are warranted, but they mean higher costs.
One factor making hospital costs particularly hard to manage are widely varying patient counts. Most hospitals have part-time people who work more when required and less when not required. That works, to a point, for them, but wreaks havoc on families. It is hard enough to get childcare on a nursing schedule (our area, for example, has no certified night care and very, very limited care after ), but when you don’t know when or if you will work from one day to the next, it can be impossible. Basically, you need to have a family member or friend willing to take your child or you are out of luck. The local hospitals and care homes each are understaffed, but they just laid off 3 Nurse Aids because they kept calling off, mostly for childcare issues. This is less of a problem in the bigger cities, but it is still a problem there.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby thegreekdog on Wed Mar 27, 2013 7:55 am

jj3044 wrote:While I don't disagree that free market systems usually do bring costs down, I'm not as sure as you are that it would help in the health insurance market. Example 1) Insurer competition. Competition is wonderful, but because they are already limited to spend at least 85% of all premium dollars on paying claims, many insurers are already operating on razor thin margins. That 15% has to include overhead. A common misconception is that the cost of healthcare is rising so fast because of the insurer profits. THis isn't the case. Premiums are rising because we are sicker than before, have to pay for better technology to treat these sicker people, etc. 2) Providers. If they all significantly reduced what they were charging, people wouldn't be able to afford to become a doctor, because what you would get paid would be dwarfed by the hundreds of thousands of dollars of student loan debt. Our national shortage of practitioners would get worse.


Again, the question is not necessarily whether a free market health insurance system would bring costs down. The question is whether it would make costs lower than the current system (i.e. the Affordable Care Act system). There has been and will continue to be a discussion on what effect the Affordable Care Act will have on, well, no pun intended, but affordable insurance. There are some (and an increasing number) who predict that healthcare costs will rise dramatically. There are others who still believe healthcare costs will decrease.

I'm also not sure I agree with your conclusion that insurance companies operate on razor thin margins, although I'm not going to vehemently push it because you are more of an expert here than me.

As for providers, again, we're talking about licensing and the like. So there wouldn't have to be many providers. Furthermore, I'm not sure I agree with your presumption that people wouldn't be able to afford to become a doctor.

jj3044 wrote:I hesitate to say "right now" on your two points above, because more and more employers are moving towards, or have moved to, an incentive based benefit. I just don't see any difference in people getting screenings under the "old" model and what has been proposed, because there still isn't an incentive to do so.

"Right now" companies are where CVS is, in building these programs to encourage these screening programs, saving costs in the long run.

In the proposed system where you had to pay out of pocket for preventive screenings, an employer based incentive program could nullify that, but it would basically just make the care free again. There still wouldn't be any financial incentive to get the screenings.

There are a lot of extrinsic motivators out there... people that need a gentle push, or a kick in the pants (wallet) in order to break through the barriers.

I'm pretty tired, so I hope that all made sense. If not, I can try again tomorrow!


Assuming under a free market system the employer still provides for a portion of health insurance, the employer would still be incentivized to provide an incentive for you to get preventative screenings. That's what my point is.

For example, a few years ago my firm started to pay for us to get physicals (on an interim depending upon our age). They did this to save health insurance costs. I'm not sure I understand why they would stop doing this under a free market system where insurance didn't pay for preventative screenings or physicals. Insurance would still pay for heart surgery, so my firm would still have incentive to get us free physicals.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby thegreekdog on Wed Mar 27, 2013 1:38 pm

http://blogs.wsj.com/washwire/2013/03/2 ... _uber_feed

Some people purchasing new insurance policies for themselves this fall could see premiums rise because of requirements in the health-care law, Health and Human Services Secretary Kathleen Sebelius told reporters Tuesday.


The administration has pointed to subsidies that will be available for many lower-income Americans to help them with the cost of coverage.


Higher insurance premiums AND more taxes? Where do I sign up?
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Wed Mar 27, 2013 2:06 pm

thegreekdog wrote:http://blogs.wsj.com/washwire/2013/03/26/sebelius-some-could-see-insurance-premiums-rise/?mod=rss_mobile_uber_feed

Some people purchasing new insurance policies for themselves this fall could see premiums rise because of requirements in the health-care law, Health and Human Services Secretary Kathleen Sebelius told reporters Tuesday.


The administration has pointed to subsidies that will be available for many lower-income Americans to help them with the cost of coverage.


Higher insurance premiums AND more taxes? Where do I sign up?

What you are missing is that the bill is moving a lot of very sick people BACK onto insurance instead of government programs. Neither I nor my husband are terribly sick, but we do have a couple of pre-existing conditions. (mine are minor, by husbands more serious orthopedic stuff). As a result, we could ONLY get government insurance up until the Affordable care act. Similarly, we wound up enrolling my kids in Medicaid becuase insurance companies would not cover them after we had a 30 day break in coverage.

Now, because of the affordable care act, we are all on the regular employer plan. The kids still get back-up coverage still from Medicaid, but that just picks up some of what the regular policy doesn’t cover.

This move back to private insurance is the biggest reason why a savings in tax dollars is projected. (along with preventative care access)

To counter this is the fact that more people are covered than before in the system as a whole, a lot of whom have “built up” needs because they have not seen doctors for such a long time.

However, the biggest reason why savings might not be realized has nothing at all to do with the bill itself. It is because so very many people are moving into the disability program. Disability has become the default for people, particularly those over 50, who get laid off and who don’t have ready skills to move into the jobs available today. Along with that disability, of course, comes government insurance coverage.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby Night Strike on Wed Mar 27, 2013 2:24 pm

PLAYER57832 wrote:This move back to private insurance is the biggest reason why a savings in tax dollars is projected. (along with preventative care access)


So the "Affordable" in the Affordable Care Act only applies to the government, not the peasants? (Although I'd contend it's affordable for neither.)

PLAYER57832 wrote:However, the biggest reason why savings might not be realized has nothing at all to do with the bill itself. It is because so very many people are moving into the disability program. Disability has become the default for people, particularly those over 50, who get laid off and who don’t have ready skills to move into the jobs available today. Along with that disability, of course, comes government insurance coverage.


Precisely the problem with the disability system: once people exhaust their unemployment income (that lasts way too long anyway), they just make up an ailment to get put on disability and no longer have to work. Yet the government refuses to cut out such fraud and abuse and actually require able-bodied people to work.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby PLAYER57832 on Wed Mar 27, 2013 2:46 pm

Night Strike wrote:
PLAYER57832 wrote:This move back to private insurance is the biggest reason why a savings in tax dollars is projected. (along with preventative care access)


So the "Affordable" in the Affordable Care Act only applies to the government, not the peasants? (Although I'd contend it's affordable for neither.)

Your comment makes no sense.

Some people (not all) are paying more in insurance, but taxes will go down – or at least more will go to things other than healthcare.

Night Strike wrote:
PLAYER57832 wrote:However, the biggest reason why savings might not be realized has nothing at all to do with the bill itself. It is because so very many people are moving into the disability program. Disability has become the default for people, particularly those over 50, who get laid off and who don’t have ready skills to move into the jobs available today. Along with that disability, of course, comes government insurance coverage.


Precisely the problem with the disability system: once people exhaust their unemployment income (that lasts way too long anyway), they just make up an ailment to get put on disability and no longer have to work. Yet the government refuses to cut out such fraud and abuse and actually require able-bodied people to work.

Your statement mixes truth and fiction. The real problem is that we don’t have a good way to deal with older Americans who can no longer do the well paid, but menial labor type jobs they had in factories. AND that the disability system was just rolled into the Social Security system without any real added input.

The reason “the government” refuses to cut it is because a lot of those people actually vote (as opposed to younger Americans) and politicians find it convenient to complain about the abuse, but not really cost-effective politically to make cuts.

You keep wanting to pretend that there is some kind of unified “government mind”. It makes most of your arguments ridiculous. Agencies and branches of the government all work against each other as much or more than with each other.

At any rate, that is outside of the Affordable Care Act.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby Night Strike on Wed Mar 27, 2013 2:57 pm

PLAYER57832 wrote:
Night Strike wrote:
PLAYER57832 wrote:This move back to private insurance is the biggest reason why a savings in tax dollars is projected. (along with preventative care access)


So the "Affordable" in the Affordable Care Act only applies to the government, not the peasants? (Although I'd contend it's affordable for neither.)

Your comment makes no sense.

Some people (not all) are paying more in insurance, but taxes will go down – or at least more will go to things other than healthcare.


You would think that if not all people were paying more in insurance, the liberal media would be eagerly searching out those people and doing stories on them in order to push the narrative that the law is good. We know they've done stories on people now getting insurance who couldn't previously, so stories on people paying less for insurance should be prime news if they exist. However, we continue to see story after story about people and businesses having to pay more and more for their insurance, so it appears that health insurance is not actually becoming "affordable" to the citizens as we were promised. And the mandate to purchase government approved plans hasn't even started yet.

And where will taxes go down? We've already highlighted the dozens of new taxes and thousands of new regulations that directly drive up taxes and costs.
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Re: Liberty VS ObamaCare: Back to Supreme Court

Postby BigBallinStalin on Wed Mar 27, 2013 8:09 pm

JJ, when you examine a particular market to do, you need to ask, "how does government constrain their options?" The reason people use the free market concept is to understand the fundamentals of market activities. Once that's clear, then you can compare it with mixed economies (e.g. the US).
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