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I've already read two different articles on the subject, so I only really skimmed that. I really don't think this is going to escalate. They South Koreans have ceased the flow of humanitarian aid already, and I think that's pretty much all they're going to really do - they've already retaliated. A war with North Korea would be quite mutually destructive and I think the South Koreans realise that.
Are they?
I wouldn't be so sure of that. The article states:
So, Congress should be allowed to force people to buy healthcare under the grounds that it is regulating an activity that substantially affects interstate commerce. The activity being, choosing to pay for healthcare when the time comes. I would imagine the health insurance industry and the healthcare industry participate in interstate commerce, so I'd argue that it's perfectly constitutional.
I thought in the two court cases mentioned, the precedent was established that Congress could regulate activities that substantially affected interstate commerce. Would you agree with the statement that the healthcare industry participates in interstate commerce to a substantial extent? And that health insurance affects the healthcare industry heavily?
Oh I see, that is where we differ.
Yes. That is exactly what should be done, except for healthcare. Healthcare for all, paid by all.
Will you? I thought that the trick was to choose treatments that your doctor prescribed.
But the thing is that everyone will be forced to buy health insurance in 3 years. So when the entirety of this law takes effect, you can't sign up only after you get sick, because you've already signed up.
No. I believe the current problem with the insurance industry only the people who believe they are likely to get sick sign up. The healthy, in general, don't foot the bill of the sick. So, you have only a few healthy people paying for the sick. This means that in order to make money, the insurance companies need to have high premiums. However, if you get everyone into the system, all the healthy people will be paying for the sick. Because of this, the burden of paying for the sick is spread out further, and the insurance companies can and probably will charge lower premiums.
I don't think that's entirely true. The individual mandate section of Obama's healthcare reform only requires you to have insurance that covers:
As written in the Law itself. It doesn't in anyway way force you take out insurance for cosmetics or acne medication, unless it's prescription medication.
But the business will. Why would a business want to pay more for the same package for its staff?
It's both. Many of the healthy don't bother getting insurance (in fact a third of those uninsured are between the ages of 19-29 as of 2007) and the already sick can't or have serious trouble. The people who get involved are those that think they're going to get sick, but who already aren't.
Insurance is different to cars. Insurance is about spreading the risk, or the cost of risk. The more people you can spread this risk over, the less it costs per person. Sure the cost of the risk will go up, but it should go up by a disproportionately low amount because all the healthy who didn't think they need it are joining the system. So, per person, the cost of the risk goes down. This means that the insurer can charge lower premiums.
But what's the point of that? Okay, maybe stepping up your coverage, but really I doubt it's going to completely ruin the system.
Yes. That is a problem with the bill, but I can't imagine all that many people doing it.
No, I'm not making it sound like the government has infinite money. They are levying taxes for this which should more than pay for this. Oh wait, you don't trust the Congressional Budget Offices so you can say whatever you like about what this bill is going to cost.
That's a small price to pay for dramatically decreasing the numbers of people without health insurance.
That's because you don't accept past precedent.
How would such a scheme work?
Medical malpractice?
They cover as much as possible so that they can make money in every medical instance that arises. There's nothing to be gained by not covering a specific illness or injury, because no matter which one you're looking at, the majority of people don't have it. The only exception (in the US) that I can think of is obesity, which is widespread, and not necessarily treatable by itself. However things like gastric bypass surgery -can- be deemed "necessary" by a doctor, and certain insurance policies will then cover the surgery.
It's never about the advantage for being healthy. You may go your entire life never getting drastically ill, and still be forking out thousands a year for insurance. That's insurance. That's the whole point of it... it's "just in case" money you're spending, it's a gamble. Sure you can choose not to pay for it, but there's nothing that says an insurer has to take you in if you suddenly become ill. There are not mandatory open enrollments, for instance, so you may end up getting sick and having to wait 6 months before you can get into your employer's plan. True you can opt into the government's plan, but many find their plan less valuable than what they can get through work.
It puts a drain on resources because people who typically choose not to have insurance rely on ER visits which cost as much as 20 times an insured visit, and they never pay the bill. I am one of those jerks ^^. I used to think insurance was a waste of money because I could just go to the ER, get treated (because it's the law they have to stabilize you) then just ignore the bill when it comes. Too many people doing this, i.e. bad debt = a bad economy.
This is only partly true. It's actually dependent on the state you live in. In Mississippi, for example, you have to full coverage if you have a lien on your car.
This makes no sense. Insurance companies lose money when you get sick. They would rather cover fewer things and have everyone be healthy so they never have to pay out. That's the original rationale for insurance companies paying for your general practitioner visits.
I know what insurance is, thanks.
Why do ER visits cost so much? I'd say it's due to government inefficiency in spending.
That makes sense if there is a lien ... presumably the other party is the one forcing you to insure your stuff.
Yes, but, it is in now way entirely due to the healthcare reform legislation passed although it is expensive. And what do you expect? The government is providing a service, of course it's going to cost it something. It's really a matter of priorities, the health of a state vs. the financial health of a state. They are both important, but I would put greater weight on the former rather than the later.
Did I? Sorry, point me to the ones you'd like me to address.
Yes, but by 2014, everyone will have to get insurance or pay the penalty. It'll be a very strong incentive to get insurance. So even the people who don't think they'll get sick will take it out anyway.
Although it is true that the health insurance scheme that comes with your job may not be the one you want, it is still better than being uninsured. And it is true that having health insurance tied to your job makes you reluctant to change jobs. However, these were problems the US is experienced before the bill was introduced anyway. The bill isn't going to make them that much worse. It's just going to make it affect more people. And in comparison to having 15% of people uninsured, I think it's a small problem.
I was exaggerating a lot and I used the words "in general".
Well, yes and no. It's bad for the people signing up, but good for the people who are insured.
First of all, the subsidies should make it easier to afford health insurance, so the number of people who cannot afford insurance will drop.
Yeah. Raising taxes is usually a bad thing. However, like I said it's about weighing up the nation's finances against the nation's health.
I believe that Sucumbio addressed that point.
Right I like the idea, but what if you can't afford those little things? Insurance means you only pay for your share of the cost of the risk. However, with this you could be paying for more or less. So, that means that if you're particularly unlucky you could end up emptying your health savings account and unable to pay for certain treatments, while if you're lucky you'd have it pretty much full. While with insurance everyone would be paying roughly the same amount, and would be able to access whatever they are covered for.
Insurance companies lose money when you get sick, but they make it back in the premiums. You have to pay to get the extra coverage, they'll probably do the math right so that the cost of providing the extra coverage will be lower than the money they're charging you. It's like selling more products if you're a manufacturing firm.
That is not necessarily true. To the insurance company now with this law, it doesn't really matter whether the claims spread over everyone, or concentrated in a small group. What matters is the total number of claims.
Well, frequency doesn't really matter all that much. What really matters is the total amount the insurance company is going to pay out in claims.
Yes, but that is what the individual mandate is for. The tax penalty.
Maybe because it's taking up valuable space and time in a high demand area?
Yes, I do like the idea of preventing moral hazard, but it's got to be done in moderation, otherwise people can't actually afford treatment. And of course buying less insurance coverage is going to cost less money.
I think that involving the government in industry tends to reduce economic efficiency. You also have to look at the cost of things at a time when the government is nearly bankrupt (trillion dollar defecits, massive national debt).
If the penalty is less than the cost of insurance, why would you get insurance? You can just purchase after you get sick.
"it is still better than being uninsured" - this is not necessarily the case at all. If companies didn't pay for people's health insurance, they could pay them more in salary, and some people might prefer that.
Good for the sick people that are already signed up, I suppose. But it is a flaw in the system which reduces price competition.
Subsidies are a deadweight loss economically.
What are the details of the Massachusetts system? Can companies there discriminate based on pre-existing conditions?
Well, that's the thing. You can't just keep throwing more and more resources at health care and expect to get efficient results. Things have a price, and I think that people should be able to determine whether they want to pay, not the government.
I still don't see anything wrong with people choosing to not have health insurance. Would you want to be forced to buy hurricane insurance?
Yes, it's possible to empty your health savings account, just like it's possible to run out of money in your normal savings account and not be able to eat. If you have money, you might have to readjust your spending. Things happen.
But them doing this math and covering every little thing is part of what leads to such high prices.
Huh? I'm saying that most people with insurance are getting payouts from the insurance company because they cover too many things. This means a lot of claims. What does this have to do with where claims are concentrated?
Yes but more frequency leads to more claims leads to more money being paid out. I'm not sure what you're trying to say here...
The tax penalty is not going to be higher than the price of insurance, is it? Unless it's higher than the price of all insurance this problem will still exist.
Lots of things take up valuable space and time in a high demand area. There's more to it than that.
Do people always need treatment for every possible malady? And how many people are really so poor that they cannot afford treatments below the deductible (say the deductible is like $1000)? Americans do have a big problem with budgeting...
Well, it's more about competition. By covering more, you encourage people to join you who want to be sure, for example, that if they need an air lift out of the Rocky Mountains they're covered. (Yes we have this coverage as part of the United Health Care "Plus" Package, swear its like picking a cable package, lol). As such we pay a higher premium each paycheck. We wanted a lower deductible as well, so the premium is up a bit from that too. All told though, it's about 100 bucks a week. 5,200 a year. True this is way more than a year's worth of Tylenol and bed rest. But that surgery I had a few years back originally billed at 54,000 dollars. 10 Times that of our yearly expense. True I may not need major surgery this year, or next, or ever again (hopefully) but... ya never know.
Now yer gettin' it. Premiums are where it's at. If I'm an insurance company, I'm going to package the various maladies and treatments not unlike Octane ratings at the gas pump, or packages for your cable television. Basic would not include advanced or experimental treatments for cancer, for instance. Then you'd have a premium package which does include. You also would vary the cost of premium, how its billed (weekly, monthly, yearly, etc.), how much the deductible is, whether or not you have to meet the deductible before X type of visit or sickness, etc etc etc. Before the bill, I'd also stipulate if a particular treatment required review for whether or not you already had it, such as cancer of the lung. Since we can't do that anymore, I'll just say that coverage that includes cancer treatments will cost Y amount, take it or leave it, but the guy over there who's my competition charges Y+Z amount, so since I'm cheaper, I must be better. (then it becomes a matter of which doctor accepts which insurance, meh)
I'm going to admit you've pointed out a fishy situation. There has to be some motivation to get the insurance and not be fined. I don't know what it is, and I don't know that the information is available, at least yet. But until this detail is reviewed, I must concede that you are correct, and that there will be people who simply opt to pay the fine until they really need the coverage, and then join up.
Nah. Private hospitals, firstly. It's honestly an expensive business to run a hospital. The MRI scan that I had, 20 seconds under the talking circle (HOLD YOUR BREATH. ... ... BREATH!) it's like, a 300,000 dollar piece of equipment built by GE. Requires servicing ofter. Etc. So they charge 5 Grand to use it. True GE makes a portable one that's a lot cheaper, and is in use in a lot of under-developed countries. But it doesn't meet FDA standards, so can't be used in US hospitals. I'll say THAT (the FDA) is definitely a government entity that's got one too many fingers in the pie, and should seriously be revamped. But overall the government isn't responsible for the cost of ER visits, it's up to the hospital itself, and they're all pretty much the same; insanely expensive to use without having insurance. Hell an ambulance ride costs 4 grand + mileage. Why? Well... it just does. You got the cost of the vehicle, the pay for the EMTs, the on-board equipment, gas, on and on.
For me, it was. But for many, who make a lot less than I do, it's not. What's a person supposed to do who can only make 100 bucks a week take-home, and end up with a 54,000 surgery? Even if they made "payment arrangements" they'd be dead from old age before paying back half of it, lol. And my surgery wasn't the most expensive you can have. Heart surgery for example can cost 6 figures easily. So then you just get people who opt to not bother. They die, and oh well.
My job involves dealing with the FDA. Without them, my bosses would screw over all of you. I'm not kidding. Anti-freeze used to be on the market as a form of medication.
I agree on the last point, but drugs to manage cholesterol are probably the best way to deal with those health conditions. Lifestyle changes are hard for a number of reasons. If you're poor, you might have little choice but to buy bargain brand foods. Bargain brand foods are almost always bad for you. They contain trans fat, high fructose corn syrup, and other additives that contribute to high blood pressure, cholesterol, and heart disease. But these ingredients are cheap and they bring down the cost of production, so they are usually the most economical choice for people on a budget.
Which treatments do you believe are necessary? I think separating matters into a simple life or death issue is a shallow view. Particularly because many conditions impact quality of life; an equally important measure. I suffer allergic rhinitis; there was a period where I honestly could not function properly if I did not receive medications. I don't need medications anymore, but if they had not worked I would have opted for surgery. In my case, I would certainly not regard treatment as "unnecessary".
Government agencies are much more prone to being corrupt, since politicians are getting continually lobbied by drug companies and the like. But the FDA has a monopoly on food regulation, so it doesn't matter how corrupt they are.
Competition is not perfect, but it's a lot better than no competition, which is what we have right now with the FDA.
This is an extremely important line to draw. What treatments deserve to be paid for by other people? Do you want to subsidize my acne treatments (surely these affect quality of life greatly)?
But there are other ways to treat blood pressure and cholesterol problems besides drugs.
The FDA has screwed up plenty of times. But the real problem is the massive cost that the FDA presents to businesses. Getting FDA approval is a gigantic hurdle to getting your products on to the market.
This is the case for every product. I don't have the time to test out every TV out there. But I can go look up on the internet which TVs get good ratings, even though there is no government agency giving a government approval for TVs.
It's a burden you already live with for every other product. The truth is that the government does a terrible and inefficient job of regulating anyway.
Fun topic. Gets debated all the time by newspapers in England.
I'll be honest. I don't know much about FDA so I don't have a real opinion on them. However, this does not strike me as necessarily negative. It should be difficult for food and medical products to reach the market.
Source? Too many claims.
I dislike the idea of the government making these decisions.
I wasn't making a specific claim about blood pressure or cholesterol drugs. It was a general example of how there are alternative treatments for things, and one will be cheaper than the other.
But that leads to tons of inefficiency and higher costs for consumers.
What? Are you sure TVs are regulated by a government agency?
But why would a TV manufacturer even want to do release dangerous products? If they release crappy or dangerous products, then they MAKE LESS MONEY.
So now I am going to go get expensive massages at every opportunity, when I could just buy a massage chair or have a friend/family member do it. See where the moral hazard comes in? Once I am no longer responsible for the cost, I won't make any effort to limit costs.
You asked how we should decide which treatments should be subsidized as if this is a difficult question or that there are no fair systems in place. I answered.
Being "cheaper" is not enough. It's far, far from the whole picture. Which treatment works better? Which treatment is better in the long term? Which treatment is cost effective? Which treatment improves length of life? Which treatment improves quality of life? Which treatment has unnacceptable side effects? Are there wider gains (monetary and psycho-social) for society by providing this treatment? It's surprising you think such matters haven't been thoroughly considered when a new drug is made available. The QALY system certainly accounts for it. Give me any drug provided on the NHS and I can make the exact same argument as I made for antihypertensives and cholesterol-lowering agents.
Source? I think ensuring safety standards are met is necessary even if that leads to "inefficiency" and higher costs.
Uhhh, yes. There are safety regulations that must be passed for electronic products to reach market. You can't just blindly release things.
Don't be obtuse. If the alternative treatment is a friend just rubbing it or buying a chair, then no. You get no expensive massage. You are alluding to a slippery slope argument and a problem already fixable through measures such as QALY.
The whole point of that was just to show that it's silly to simply say "health care is a right" (as I said in the previous post).
Obviously price is not the only factor ... when did I ever say differently? What I am saying is that people will have different ideas as to where the line is drawn. Some people might subscribe to this QALY system, others might not. I don't think you can MORALLY say that QALY is the right system.
Not when those higher safety standards would be met without government regulation anyway. My point is that private mechanisms can ensure safety without the inefficiency and higher costs brought about by government regulation.
I'm not sure that this is the case, but whatever, obviously if you sell a TV that explodes when you plug it in then you'll get sued. Do you really think that companies want to sell you TVs that don't work or will be unsafe for use? Do you really think that they will "blindly release" TVs without government interference? That would generate terrible publicity and people would stop buying from them.
I'm not aware of any such law, but if they sell a truly defective product then perhaps they could be sued if they don't accept a return. But many places accept returns even if the product is not broken or defective (and this certainly is not the law since some places don't accept returns).
And if they do, they pay the price by losing all their customers and making no money. Plus getting sued if they really did something dangerous.
You're taking that example too literally. I am just illustrating moral hazard. Once you say under QALY or whatever system that I am entitled to expensive treatments, I will have no incentive to switch to cheaper ones even if my problem gets better.