HRA

[Boris]

"Because of the Affordable Care Act, near-universal health coverage is coming at last to the United States. That's not a clock that can or should be turned back. The conservative task ahead is to reform that new social commitment so that it is affordable and sustainable, so that it is financed in ways that do not discourage work, saving and investment. It's unexpected but welcome to see Ann Coulter enroll among those who favor that kind of pragmatic conservative reform. Could the ideological fever that has gripped the right over the past three years at last be breaking?"

- - David Frum

[jake]

Boris,

We have gone back on forth on this for years now, so I will not waste either of our times getting into the nitty gritty on Obamacare.

-At a high level, I do not think it is constitutional to force people to buy a product (insurance).
-It is very expensive, even more so now that they repealed the 1099 revenue source and stopped CARE.  I do not want to burden the next generations with more and more debt by adding more and more unfunded social programs.  I do not think that is right.
-There will be tremendous "unintended consequences" from Obamacare.  For example, we are already seeing the ramp up in boutique medicine.  The result is that middle class Americans will have less and less access to the best and brightest doctors.  So now (maybe) an additional 5-10% of Americans have insurance, BUT MY INSURANCE IS WORTH LESS.
-As discussed in this thread, it still leaves millions of people uninsured.
There is more, but we have gone over this too many times.

I get your personal need for Obamacare now, so I expect to see you fighting tooth and nail on this board defending it.  But our personal stakes in this are on opposite sides.  I want to make sure me and mine continue to have access to the best doctors around.  I want to make sure me and mine are not further burdened by the debt Obamacare brings to this country. 

PS- Your post from 1/1/12 really goes to show how far apart we are.  At its core, I take it to read that you want to pursue your happiness on a risk-free basis.  I disagree with that.  Why shouldn't workers take an ownership stake in their healthcare costs through high deductible HSAs that give the end user a financial reason to shop around for healthcare and question the costs?  Why shouldn't "lifestyle" come into play when pricing insurance (a drinker and smoker should pay more in premiums than me)?  People are free to pursue their happiness, but don't look to the rest of us to pick up the tab. 

[OakParkSpartan]

The rest of us pick up the tab for the roads you use.
For National Defense.
For the courts.

The whole "user pay" model is not sustainable on a large scale.
Why should healthcare be tied to a job?  Or to a job that provides health insurance?  It seems to me that lots of businesses would benefit from having healthier workers.

[Boris]

jake,

You seem to be echoing Mark Levin here, and Frum has these questions:

"Was it unconstitutional back in 1792 for the federal government to require male citizens of the appropriate age to buy guns and enroll in their state militias? What about requiring car insurance from all drivers? Is a compulsory vaccination against an infectious disease an abuse of government power if the injections are administered by private doctors?"

You're "unintended consequences" are really abstract. How, exactly, is your insurance worth less? Because you know of a doctor or two that has changed their practice to cater only to the very wealthy? One of my doctors did just that (he was at Northwestern), and guess what? The guy he referred me to is awesome. But that's neither here nor there.

Tease out your "boutique" argument, and it makes no sense.

I don't want risk-free happiness at all. But I do want some parity. Right now, as a self-employed individual I can buy an 80% coverage, after $1,700 deductible plan from Blue Cross for my wife and I for $480/month. Note, the $1,700 deducible includes prescriptions. So, in addition to paying $480/month, you also have to pay $1,700 out-of-pocket before the insurance even kicks in. So it actually works out to $621/month.

When she was "employed", we had 100% coverage, with $35 co-pay for office visits and no deductible for prescriptions for $325/month from Blue Cross. That included vision and dental care, which the plan I mention above does not include.

If I purchased this same plan as an individual, it would cost 3X more.

Why should I, as an entrepreneur making my own living ... going for the American Dream of self-reliance and happiness ... why should I be charged a higher rate for an inferior product, simply because I'm not "employed"? Is my money different somehow?

I don't mind paying at all ... I do mind being raped.

[buzz]

-There will be tremendous "unintended consequences" from Obamacare.  For example, we are already seeing the ramp up in boutique medicine.  The result is that middle class Americans will have less and less access to the best and brightest doctors.

Bogus.  Add up all those boutique doctors and you might get a whole 1% total, and those physicians already catered to the "rich and famous" in heavily populated areas like NY or LA.
Middle class Americans are already waiting to see doctors and it's because we don't have as many general practitioners and internists.  Everyone wants to be a specialist to get those referral dollars !  That's why the whole business model must/is changing to be more inclusive. 

[rbain]

The high cost of med school also drives the increase in specialization. It's much harder to pay off the huge student loans as a GP. Two more years of school makes it much easier.

[eno]

The rest of us pick up the tab for the roads you use.
For National Defense.
For the courts.

The whole "user pay" model is not sustainable on a large scale.
Why should healthcare be tied to a job?  Or to a job that provides health insurance?  It seems to me that lots of businesses would benefit from having healthier workers.

Although almost half don't pay any income tax, let's accept this "the rest of us pick up the tab" assertion as true for the sake of the following questions:

Why stop at roads, national defense, courts...and now health-care? Can anyone here make a compelling argument that access to health-care is a right, but not housing? Heating? Air-conditioning? How about access to transportation: everyone gets a car? Computers?

Where do we draw the line? Do we draw a line?

The argument is a serious one; it is one which determines whether we want a limited government or something more pervasive, more intrusive.

To call the private, health-insurance system (which we are slowly abandoning under Obamacare) a "user pay" model is inaccurate; costs were shifted in that model as well; a pure "user pay" model would not have lead to the kind of exorbitant medical costs to which we've become accustomed.

[OakParkSpartan]

The rest of us pick up the tab for the roads you use.
For National Defense.
For the courts.

The whole "user pay" model is not sustainable on a large scale.
Why should healthcare be tied to a job?  Or to a job that provides health insurance?  It seems to me that lots of businesses would benefit from having healthier workers.

Although almost half don't pay any income tax, let's accept this "the rest of us pick up the tab" assertion as true for the sake of the following questions:

Why stop at roads, national defense, courts...and now health-care? Can anyone here make a compelling argument that access to health-care is a right, but not housing? Heating? Air-conditioning? How about access to transportation: everyone gets a car? Computers?

Where do we draw the line? Do we draw a line?

The argument is a serious one; it is one which determines whether we want a limited government or something more pervasive, more intrusive.

To call the private, health-insurance system (which we are slowly abandoning under Obamacare) a "user pay" model is inaccurate; costs were shifted in that model as well; a pure "user pay" model would not have lead to the kind of exorbitant medical costs to which we've become accustomed.

I guess my question is how limited do you want government to be?  And at what cost?

As for housing, that seems to be already in place.

If you don't have income, would you have to pay a tax?

[Boris]

Personally, I don't have a problem with private the private health insurance system. But I do think that health insurance companies should be non-profit corporations.

That would insure that the bulk of our dollars goes to healthcare, instead of lobbyists, advertising and outrageous CEO compensation.

[jake]

OPS,

MY taxes pay for the roads I use, and so do the tolls I pay.  MY taxes pay for my national defense.  And MY taxes pay for the courts I use.  I am not one of the nearly 50% of Americans who do not pay income taxes. 

Once again, you falsely assume Obamacare is the only way.  Nobody said healthcare should be tied to a job. 

Should we apply your logic to all insurance?  Why should my car insurance be tied to anything, like my ability to pay it, the price of my car, my age, my driving record, the number of miles I will drive?  If I need my car for work, or to take my kids to school, or any other BS "societal benefit" crap I make up, why shouldn't we socialize the cost of my car insurance?  I may have 5 DUIs and 10 speeding tickets in the past year, but if I cannot pay my car insurance, then society would lose out.  I would no longer be able to work, my kids would not get to school, and if I drive illegally and hit your car, I would not have insurance to cover the damage. 

LOL, I will not even get into a life insurance example about my life insurance premiums being tied to my age, health, hell- the size of the policy.

[jake]

Mark, thanks for the Smite

markberwyn  05:32:27 PM Smiting a member.

[markberwyn]

Mark, thanks for the Smite

markberwyn  05:32:27 PM Smiting a member.

Plenty more where that came from. Keep typing, jake!

[Boris]

We're not talking about ALL insurance, we're talking about healthcare. The metric is different.

With auto insurance, you pay a certain amount and the company is betting that you (and everyone else) doesn't want to hit anything. Depending on your record and where you live, the bet has different odds.

Healthcare is different. Everyone pays in. But younger people pay more than they will likely use on a yearly basis. Older people pay less than they will use on a yearly basis ... and as they age, that disparity grows. Which is fine, because we all grow old, and we all "get our share".

The biggest argument from the right is always concerning "freeloaders". The fact that a percentage of people pay little or no income tax is a fact of life, like the sun coming up every day. We need to move forward regardless, and our visionary young president is doing just that.

[jake]

How is the metric different?   
I pay a certain amount to my health insurance company and the company is betting that I do not want to get sick.  Depending on my lifestyle (drinking, smoking, eating habits) that bet has different odds.

How is car insurance is different? Bad drivers pay more in on a yearly basis, and good drivers pay in less. 
And when someone does not have insurance, society pays the price...kind of like those people who visit the ER for primary care...so why not call for single payer auto insurance, or premiums based on ability to pay?

[Boris]

You'r talking pre- HCRA.

Now, health care is much more akin to medicare or social security. Everyone pays in, depending on their income, and everyone gets the same benefits.

If you can afford better...then go for it. No problem either way. Healthcare for all is something that the United States should strive for ... car insurance for all is not.

If you can't see or understand the reasons for that distinction, then there really is no point in your continuing to debate with me (or vice-versa).

[eno]

You'r talking pre- HCRA.

Now, health care is much more akin to medicare or social security. Everyone pays in, depending on their income, and everyone gets the same benefits.

If you can afford better...then go for it. No problem either way. Healthcare for all is something that the United States should strive for ... car insurance for all is not.

If you can't see or understand the reasons for that distinction, then there really is no point in your continuing to debate with me (or vice-versa).

God...er George Soros, help us!

Health-care akin to Medicare or Social Security? How is that good? How is that "sustainable"? Where do you think all this money will come from? What happens when it (soon) runs out?

I've recently subscribed to RAI (Italian television); tonight, I watched a debate where the young "Occupiers" are pissed off with the middle-aged "Occupiers" (all of them occupying Naples). The middle-aged "Occupiers" are pissed at the new prime minister, Mario Monti who predicted that, in the future, workers can no longer expect a secure, life-time job; the middle-aged "Occupiers" believe a life-time position is a right which must be guaranteed by government! The young "Occupiers" who can find NO work  were actually in favor of the Reaganesque Monti and against their middle-aged "Occupier" brethren...and went so far as to blame the traditional (in Italy) Socialist concept of a right to a life-time job as the cause for high unemployment in Italy.

Maybe another four years of Obama (and a clear Democrat majority in the House and Senate) is actually what this country really needs to wake us all up. Sometimes you gotta press your hand against the stove before you really believe it burns.

[OakParkSpartan]

We were burnt by 8 years of Bush. 

[jake]

You'r talking pre- HCRA.

Now, health care is much more akin to medicare or social security. Everyone pays in, depending on their income, and everyone gets the same benefits.

If you can afford better...then go for it. No problem either way. Healthcare for all is something that the United States should strive for ... car insurance for all is not.

Because you say so?  You completely fail to make the argument that we should not strive for car insurance for all.  There is a societal benefit to eveyone having it, so why shouldn't we socialize the cost? 

[jake]

It is funny how all of the defenders of Obamacare's mandatory coverage provisions pointed to car insurance in their weak attempt to justify it...and now Boris is telling me that car insurance is not like health insurance...

[Boris]

It is funny how all of the defenders of Obamacare's mandatory coverage provisions pointed to car insurance in their weak attempt to justify it...and now Boris is telling me that car insurance is not like health insurance...

Mandatory car insurance is a good thing, but not everyone drives. So socializing it makes no sense.

Surely, even you can see the difference.