Health Care Law Massacred in Supreme Court

[rwh11385]

What I am saying is that health care in this country represents far too large a share of GDP in this country for any private group to fund a meaningful amount of it.

Why? We can pay for it by taxing the 1% more, but it is impossible for people from the 1% donate monies to support causes? I'm not suggesting some donations cover everyone's health, that's dumb... but just that minority who don't have health insurance. Or at least provide health screening and information.

Personally, I would actually be OK with slashing government. We don't need to spend more than a small fraction of what we do on defense. Social security is a boondoggle. And Medicare/Medicaid are vastly more expensive than they need to be.

To reiterate: Our current medical care system is a disaster. It's hugely expensive and not that good. And the notion that small donations could add up quickly to a meaningful fraction of $2-3 TRILLION is utterly and completely laughable.

So, government = fail, yet government somehow will make health care better??

Okay yeah, it is a huge problem. Mind is all set in metric scientific scale, not Ms or Bs.

[Grand525]

[Ryan Stewart]

From what I see daily, that's really not true at all.

Oh, and the BMI's idea of "obese" is a joke.

What? I can easily see 2/3rds being overweight and probably 40% anymore being obese. Yeah the BMI is off but not by THAT much. People are big anymore, and not in a good way.

[2761377]

Medicare and Medicaid are a huge problem at least in part because they are not really permitted to behave responsibly. When rates and prices can't be set independently, you already have a huge issue. When end of life care is absolutely obscenely expensive because people spend hundreds of thousands of dollars, if not millions in an absurd effort to extend their lives by a few months, something is broken. (Here is a hint - doctors are far more likely to have a DNR on file than pret much anyone else. That's how highly they think of this sort of care.)

Of course, the problem was that all of this got pilloried as Death Panels and that the government was just going to kill Grandma. Not a rational discussion of whether it's better to keep someone alive in agonizing pain for a few months at an enormous cost to society.

As for non-profits, frankly, they have neither the money nor the clout to do this effectively. And you damned well know it. As it stands, the government already mandates 100% health coverage via the emergency room.

So really, the reason why it has to be the government is that NO ONE ELSE CAN DO IT. You can argue that people who can't afford medical care should not receive any, but saying that that is the role of non-profits is little more than a sop to the conscience. It's completely and utterly unrealistic.

As for the cost control problem, well, I will confess that I just don't really know how to solve that in our current kleptocracy. The Republicans are worse about it than the Democrats, but that's really like saying first degrees murder is worse than second degree. Somebody is still dead for no good reason. I have a fair number of thoughts on how to deal with that, but I don't see a chance in hell of any of them happening.

setting rates and prices in capitalist society is the function of the market, not a role of government. the current laws regulating health care insurers have stymied the market and are the proximate cause of out-of-control costs. health insurers must be allowed to operate across state lines and to exclude pre-existing conditons. this law does neither. of course, if one calls capitalism a 'kleptocracy' it may be presumed that person has carries antipathy for it.

the only voice that counts in a discussion of end-of-life care is that of the person in question, or their trustees. society hasn't a damn word to say about it. that is, in a society that values individual freedom above all else as the founders intended. of course, a socialist would disagree.

Overall Occupations with the most job openings in Washington, DC

1 - Lawyers
2 – General and operations managers
3 - Waiters and waitresses
4 - Janitors and cleaners (not including maids and housekeepers)
5 - Office clerks
6 - Post-secondary teachers
7 - Security guards
8 - Management analysts
9 - Accountants and auditors
10 - Cashiers
11 - Customer service representativers
12 - Executive secretaries and administrative assistants
13 - Retail salespersons
14 - Writers and authors
15 - Computer software engineers, applications


not too much in the way of actual productivity, eh?

hth,
robert w.

[KenC]

A double-mandate is one of the only ways to truly get costs under control. Would having everybody insured and preventing a large amount of unnecessary ED visits suddenly drive the cost of health care down to sustainable levels? No, certainly not, but it would make a big difference. There isn't some magical panacea that's going to solve the issue here, but having huge groups of uninsured and under-insured, which are effectively the same thing, is a huge financial burden.
You can toss out words like "competition" and "markets" as a solution, but blanket-statements is about as far as you'll get with those. Health care, as a product, is unique. Patients/consumers don't "buy" or "shop" for care like any normal commodity. Inpatients don't go across town to have a CBC or troponin drawn. You don't research interventional cardiologists when you're writhing in pain from an impending MI.
Insurance companies can only go so far when it comes to premium costs. If costs remain the same, your coverage is going to be directly correlated to your premium costs.
Health care is a $2.5T/yr industry in the US. It's foolish to suggest that the profitable portions are going to willingly reform themselves. There is no system in place to evaluate new medical technology. For example, if Product B outperforms Product A by 0.1%, but costs 1,000% more to perform, Product B is still used and patient's insurance companies are billed for it.
Another problem is that few lay-people have any idea why care costs so much. I'm 100% for tort reform, but to assert that it will make any difference in the overall cost of care is incorrect. If all "defensive medicine" was eliminated, we'd effectively decrease the cost of care overall by 0.1%. Another often suggested remedy is physician salaries. Yes, they're paid more in the US, but they often work longer hours and the cost of medical education is astronomical here (I'm looking at an estimated $276,000 for four years + 7% compounded interest). Decreasing salaries by 20%, would result in an estimated 2% decrease in medical costs. A drop in the bucket overall, but utterly demoralizing to care providers.
The biggest issue is that our care delivery and care coordination in the US is horribly inefficient.
OK my thumbs are tired... (iPhone).

[rwh11385]

What? I can easily see 2/3rds being overweight and probably 40% anymore being obese. Yeah the BMI is off but not by THAT much. People are big anymore, and not in a good way.

Maybe he's never been to Houston?

[KenC]

I'm sure Dr. Paul was a good physican, but that was unproductive buzz-word rambling.

[z31maniac]

What I am saying is that health care in this country represents far too large a share of GDP in this country for any private group to fund a meaningful amount of it.

And frankly, what makes you think that private, for profit health care achieves greater efficiency? If you measure outcomes (i.e. hospital infections, errors, lifespan, overall health, etc.), what you find is that we are spending vastly more than anyone else for an actual outcome that is equal to or worse than what others get.

What I am saying is that right now we are paying more than we would if we had a decent single payer system and that we are achieving no more than parity. This is flat out stupid..

Personally, I would actually be OK with slashing government. We don't need to spend more than a small fraction of what we do on defense. Social security is a boondoggle. And Medicare/Medicaid are vastly more expensive than they need to be.

To reiterate: Our current medical care system is a disaster. It's hugely expensive and not that good. And the notion that small donations could add up quickly to a meaningful fraction of $2-3 TRILLION is utterly and completely laughable.

Who do you think runs Medicare/Medicaid?

[nrubenstein]

setting rates and prices in capitalist society is the function of the market, not a role of government. the current laws regulating health care insurers have stymied the market and are the proximate cause of out-of-control costs. health insurers must be allowed to operate across state lines and to exclude pre-existing conditons. this law does neither. of course, if one calls capitalism a 'kleptocracy' it may be presumed that person has carries antipathy for it.

the only voice that counts in a discussion of end-of-life care is that of the person in question, or their trustees. society hasn't a damn word to say about it. that is, in a society that values individual freedom above all else as the founders intended. of course, a socialist would disagree.

Overall Occupations with the most job openings in Washington, DC

1 - Lawyers
2 – General and operations managers
3 - Waiters and waitresses
4 - Janitors and cleaners (not including maids and housekeepers)
5 - Office clerks
6 - Post-secondary teachers
7 - Security guards
8 - Management analysts
9 - Accountants and auditors
10 - Cashiers
11 - Customer service representativers
12 - Executive secretaries and administrative assistants
13 - Retail salespersons
14 - Writers and authors
15 - Computer software engineers, applications


not too much in the way of actual productivity, eh?

hth,
robert w.

Um, health insurance is socializing risk. Why shouldn't society have some input on whether or not to pay for $500,000 worth of care that will at best prolong a life for a couple of months in excruciating agony? If no one has any input, then no one should be required to pay for it.

[nrubenstein]

setting rates and prices in capitalist society is the function of the market, not a role of government. the current laws regulating health care insurers have stymied the market and are the proximate cause of out-of-control costs. health insurers must be allowed to operate across state lines and to exclude pre-existing conditons. this law does neither. of course, if one calls capitalism a 'kleptocracy' it may be presumed that person has carries antipathy for it.

the only voice that counts in a discussion of end-of-life care is that of the person in question, or their trustees. society hasn't a damn word to say about it. that is, in a society that values individual freedom above all else as the founders intended. of course, a socialist would disagree.

Overall Occupations with the most job openings in Washington, DC

1 - Lawyers
2 – General and operations managers
3 - Waiters and waitresses
4 - Janitors and cleaners (not including maids and housekeepers)
5 - Office clerks
6 - Post-secondary teachers
7 - Security guards
8 - Management analysts
9 - Accountants and auditors
10 - Cashiers
11 - Customer service representativers
12 - Executive secretaries and administrative assistants
13 - Retail salespersons
14 - Writers and authors
15 - Computer software engineers, applications


not too much in the way of actual productivity, eh?

hth,
robert w.

Markets are not always the best solution. And keep in mind that I work in finance.

When demand for a good or service is highly inelastic, pricing power is limited only by the ability of the consumer to pay.

I do not call capitalism a kleptocracy. I call Congress in its current form a kleptocracy. Look at my sig and you get a good idea of how much I like capitalism. (Hell, I used to be a Republican before they went full retard.) However, regulation is important. When you have a good for which demand is essentially unlimited, strictly market based pricing just leads to abuse.

[nrubenstein]

Why? We can pay for it by taxing the 1% more, but it is impossible for people from the 1% donate monies to support causes? (or small contributions from everyone could add up to what we'd need for the needy?) I'm not suggesting some donations cover everyone's health, that's dumb... but just that minority who don't have health insurance.



So, government = fail, yet government somehow will make health care better??

$2.3 trillion is the TOTAL US health care expense in 2010. And 84% of the country are covered by health insurance. The problem is not $2-3 Trillion large (although health care costs in themselves are high), but rather much less.

$320 million if 16% of total (the uninsured might have higher costs but those could be reduced if your logic about preventative care making it less expensive).

How much did Obama raise in 2008 from contributions $200 and less...

http://www.fec.gov/disclosurep/pnational.do

$335,139,233...

So just the people who donated less than $201 in 2008 could pay for the uninsured's health care (given the proportional assumption yet ignoring preventative care would make it cheaper).

Wouldn't THAT be a better solution (to have people donate and support preventative care and providing treatment to the needy, rather than take over THE ENTIRE health care system in the country by the government)?

I think you dropped a comma and three zeroes in your calculation there.

Edit: And no, taxing the 1% more is not the solution. Either overall spending has to go down, or taxes need to go up on *everyone.* Period.

[nrubenstein]

* Le Click *




Putting power from the hands of people who care and work in an industry to the oversight of bureaucratics is a poor move.

And assuming that private = for profit is choosing your argument carefully to stack the deck in your favor.

By your math, 71% of private health plans are for profit. What is your point here?

[nrubenstein]

Who do you think runs Medicare/Medicaid?

This goes back to the whole kleptocracy problem. The oxygen tank debacle is a great example of how that works.

[z31maniac]

This goes back to the whole kleptocracy problem. The oxygen tank debacle is a great example of how that works.

So, then how does giving them more power and money to execute those decisions = a better outcome in your mind?

[rwh11385]

By your math, 71% of private health plans are for profit. What is your point here?

If non-profit providers are better performing, then the market (decision makers who have the choice like HR) should buy from these organizations and motivate poor-performing yet profiting companies to do better. Going to crap companies and accepting crap gives them no incentive to improve.

My point was that free market != have to buy from for-profit corporations. I don't bank with for-profit corporations to their benefit, but it's the free market that keeps rates competitive and that I enjoy at my credit unions.

Simply forcing or telling people to be insured won't make healthcare companies better, besides having more potential customers that are more desperate.