A Philosopher's Blog

Obamacare Ruling

Posted in Ethics, Law, Philosophy, Politics by Michael LaBossiere on June 28, 2012
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HR3590-Patient-Protection-and-Affordable-Care-Act_1 (Photo credit: Obama For America – California)

The big news today is the ruling on Obamacare. While I am not a constitutional lawyer, the ruling seemed to be fundamentally sound. First, it does seem accurate to say that the commerce clause does not explicitly empower the federal government to compel citizens to buy commercial products. As such, this view is in accord with a narrow interpretation. Second, it also seems accurate to say that the constitution provides congress with broad powers of taxation. The health care tax seems to be comparable to Social Security and Medicare/Medicaid taxes and they set a clear precedent for the ruling.

Interestingly, this ruling is also a victory for conservative principles. First, it validates Mitt Romney’s plan in Massachusetts as well as what his position was on health care until he changed his mind. Naturally, the fact that Obamacare is based significantly on Romneycare and Romney used to be for this approach does not prove that Romney is wrong now. That inference would be fallacious. However, all the arguments that Romney gave in favor of his earlier view still stand on their own merits. As do the reasons that he gives now against his previous view and the view of Obama. Second, it validates the constitutionality of the individual mandate which is not only the product of a conservative think tank but is also a conservative principle. After all, this mandate addresses the current free rider problem that I discussed in an earlier post on this mandate. It is, of course, ironic that the  Republicans are dead set on going after the aspects of the law that have the best conservative foundations. But, politics does not seem to be about holding to a consistent set of principles but rather about saying the other guy is wrong in what he says, even when one used to say the same thing and even gave the other guy the idea.

Obviously, this ruling is not a defeat for Obama. However, it is not a complete victory and the Republicans have the material they need to fuel some serious political rhetoric. First, the ruling makes it clear that it is about the constitutionality of the law and not its wisdom. On one hand, this can be seen as a case of explicit neutrality. However, it can also be seen as innuendo. After all, the assumption is that the court just rules on the constitutionality of laws and to pointedly say that the ruling is not on the wisdom of the law can be taken as implying that the law is unwise. The Republicans should be able to milk those remarks for some small political points. Second, the ruling makes it clear that the mandate is grounded by the power of congress to tax. As such, the health care law adds a new tax and potentially increases taxes (for people who chose to be potential  free-riders on the system by not having insurance). This can be a rhetorical silver mine for the Republicans-they can push the line that Obama went against his promise not to raise taxes on the middle class (while steering clear of the idea that the taxes are to help offset the cost of medical care for the uninsured) and they can hammer away at the whole tax thing, which should be music to the ears of the Tea Party folks.

While condemning Obama for spending so much time of health care, Romney says that his first act as president would be to get Obamacare repealed. This indicates that he thinks it is a matter of top priority. Of course, he can counter by saying that he has to get rid of Obamacare to save the economy. Whether that would work or not is rather an open question.

One rather obvious question is this: what would the Republicans and Romney offer in place of Obamacare? At this point, we have a great deal of vague and empty rhetoric and little in the way of specifics. This is not surprising. After all, Romney has repudiated his long-time views on health care and the conservative idea of the mandate has been bashed. As such, the Republicans and Romney need to start from scratch and that takes time.

I must admit that I have not read the entire act and I do not know what impact it will have. I do, of course, have concerns that it will have unintended negative consequences and I do believe that there are fundamental problems in health care that the law does not seem to address. I do think that we all agree that health care needs fixing. Unfortunately, we also seem to agree that the other guy is always wrong and hence there can be no meaningful compromise.

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78 Responses

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  1. magus71 said, on June 28, 2012 at 1:03 pm

    Hopefully you have more class than your DNC brethren. Here’s the executive director of the DNC after the ruling (on his Twitter feed):

    “it’s constitutional. Bitches.”

    DNC deleted another post that stated: “Take that mother-fuckers!”

    I’m sure it was all for the good of America. in any event, this (the court decision) will hurt Obama’s re-election chances. I’ll blog the reason soon.

    http://twitchy.com/2012/06/28/classy-dnc-director-new-media-outreach-director-react-to-obamacare-decision-constitutional-bitches-take-that-mothers/

    • Michael LaBossiere said, on June 28, 2012 at 3:13 pm

      I save my trash talk for where it belongs-XBox live and sports.

      The Republicans can hammer on the tax angle-that will be a good pragmatic angle. Plus, the act is so complicated and long that most voters have no idea what it means-making it fertile ground for straw man attacks.

  2. T. J. Babson said, on June 28, 2012 at 3:11 pm

    Ruling was correct. Clearly, if it is constitutional for the government to give you a tax rebate for purchasing solar panels it can give you a tax rebate for purchasing health insurance.

    At least we have some clarity and honest now. Obamacare imposes a large and very regressive tax on the middle class.

    • magus71 said, on June 28, 2012 at 3:25 pm

      TJ,

      Problem is, Obama said, in 2009, that his health insurance plan was not a tax.

      • Michael LaBossiere said, on June 29, 2012 at 9:23 am

        Speaking of 2009, Romney wrote this in an op-ed and even posted it on his web site:

        Our experience also demonstrates that getting every citizen insured doesn’t have to break the bank. First, we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages “free riders” to take responsibility for themselves rather than pass their medical costs on to others. This doesn’t cost the government a single dollar. Second, we helped pay for our new program by ending an old one — something government should do more often. The federal government sends an estimated $42 billion to hospitals that care for the poor: Use those funds instead to help the poor buy private insurance, as we did.

        Romney had it right: the mandate is a conservative approach that reduces the free-riders on the system. It is ironic that this conservative idea is being bashed as some sort of liberal device. So, if we hold the candidates to what they said in 2009, Obama was wrong about the tax thing and Romney is for the mandate. If it is okay for Romney to say he was wrong then and right now, the same would seem to apply to Obama. The reverse, of course, also holds.

        Getting back to the actual issue, Roberts seems to have it right. While the requirement for insurance is not a tax, the stick used to get people to get insurance is functionally a tax. Of course, this view would entail that almost any financial penalty imposed by the state would thus be a tax, but that is a position that could be easily argued for.

        Let us suppose that it is a tax. While the talking point these days is that taxes are bad, a fair question to ask is whether or not this penalty is a good idea. After all, Romney made a pretty good case for the mandate in 2009. While I am no fan of paying more to the state, I am also against people getting free rides at the expense of others. As such, this mandate essentially requires people to take financial responsibility. As far as I can tell, the key reason that the Republicans are attacking it today is because Obama accepts it rather than having principled and consistent arguments against it.

        • T. J. Babson said, on June 29, 2012 at 11:09 am

          Even Obama was against the mandate before he was for it.

          • Michael LaBossiere said, on June 29, 2012 at 12:23 pm

            Not surprising. After all, the mandate has a conservative pedigree and Romney wrote an editorial piece urging that it be incorporated into health care reform.

            • magus71 said, on June 29, 2012 at 7:54 pm

              I’m pretty sure Romney’s conservative pedigree has itself come into question.

              Here is Romney’s principled and consistent argument that you’re looking for.

              http://abcnews.go.com/Politics/video/mitt-romney-obamacare-is-bad-law-16670413

              The consistent case against Obamacare has been the economics. Romney says it raises taxes by $500 billion and lowers Medicare by $500 billion.

              America had the best healthcare system in the world. People from all over the world come here to have procedures done that they can’t get done anywhere else. Even the poor had access to it. In my poorest days I had my worst medical problems taken care of.

            • Michael LaBossiere said, on June 30, 2012 at 11:35 am

              While Romney has changed his view, the obvious question is this: which Romney position has the better supporting arguments? In his stint as governor, Romney backed and argued for a system that Obamacare was modeled on. In 2009 Romney wrote an op-ed arguing for the adoption of the mandate. In 2012 he switched his view to attack his previous system and views. While people have the right to change their views, their original arguments and reasons still stand. So, matching Romney 2009 up against Romney 2012, who has the better arguments? After all, Massachusetts seemed to be a success story in regards to health care. Also, the arguments given for the mandate by Romney and the conservative thinkers that came up with it seem pretty good.

              That is not a consistent case-after all, consistency means sticking with the same thing across time (at least in this context).

              We do have the best high end health care, just as we have some of the best mansions. However, this is different from having the best health care in terms of statistics. We are not the best in terms of cost effectiveness, medical effectiveness and so on. as far as people coming here, that is true. But people leave the US to get medical treatment elsewhere because it costs less for what is as good. I do not, of course, mean the medical scams, but the legitimate surgeries.

              I do wish we had the best health care system in the world, but I know that we do not. Accepting this is the first step in getting us to number one-we could and should be there.

            • magus71 said, on June 30, 2012 at 2:04 pm

              Romney’s flip-flopping is well noted, even among conservatives. Especially among conservatives.

              Another conservative argument against this, is the aspect of central planning. State and local governments are much more agile and responsive than the federal government. The federal government is just not good at meeting the specific needs of the people. These types of plans are not new. The Soviet system was the exact same thing and Soviets made the exact same arguments for why this could work. There were many people in the Soviet Union that really wanted to make a better society and they thought they could do it by careful calculation and central planning. Very precise and complicated central planning. It’s not about “Evil Communism”. It’s about a system that cannot be agile enough to plug its own holes.

              They were wrong.

              Central planning can work. But the bigger the pool of people, the worse central planning works. The average wait time for a Canadian in the emergency room is 9 Hours. Those who need to be admitted wait an average of 24 hours. The average time for a Canadian cancer patient to receive radiation treatment is 7 weeks. In Canada, the number of beds in a hospital is rationed. That’s how they control costs.

              And it’s telling when we take a look at articles written before this became the political football it is today( at least to this level). Now, there’s so much spin, you can’t find truth.

              In 2004,Dr. Robert Chinak, a past president of the Association of American Physicians and Surgeons, wrote the following about Canadian healthcare:

              “But more and more Canadians are awakening — not from a dream, but from a nightmare. The results are coming in. After years of government control, the medical system is badly injured and bleeding citizens’ hard-earned tax dollars…

              In 1999, Dr. Richard F. Davies described how delays affected Ontario heart patients scheduled for coronary artery bypass graft (CABG) surgery. In a single year, just for this one operation, 71 Ontario patients died before surgery, “121 were removed from the list permanently because they had become medically unfit for surgery” and 44 left the province to have their CABG surgery elsewhere, often in the U.S.

              In other words, 192 people either died or were too sick to have surgery before they worked their way to the front of the waiting line. Yet, the Ontario population of about 12 million is only 4 percent of the population of the United States.

              In an article in the journal Health Affairs, Robert Blendon describes an international survey of hospital administrators in Australia, New Zealand, Great Britain, the U.S. and Canada. When asked for the average waiting time for biopsy of a possible breast cancer in a 50-year-old woman, 21 percent of administrators of Canadian hospitals said more than three weeks; only 1 percent of American hospital administrators gave the same answer.

              Fifty percent of the Canadian hospital administrators said the average waiting time for a 65-year-old man who requires a routine hip replacement was more than six months; in contrast, not one American hospital administrator reported waiting periods that long. Eighty-six percent of American hospital administrators said the average waiting time was shorter than three weeks; only 3 percent of Canadian hospital administrators said their patients have this brief a wait.”

              http://seattletimes.nwsource.com/html/opinion/2001977834_cihak13.html

              And Brits don’t like their healthcare, an abject failure on most counts.

              “Such a system simply cannot create the right incentives to keep people healthy and on the job,” said Graham. “Although American-style, employer-based health care also has significant deadweight costs, at least the incentives to keep people healthy are better. This is one cause of higher American productivity.

              http://news.heartland.org/newspaper-article/2008/07/01/britains-health-care-system-costs-patients-and-businesses-billions

            • Michael LaBossiere said, on June 30, 2012 at 3:45 pm

              We certainly have plenty of models of what does not work.

              Health care reform also begins at home-many problems could be avoid by people eating wiser and exercising. Of course, T.J. will point out that these healthy bastards would burden the health care system by living longer than the fat bastards.

              Another problem that others have pointed out is that the financial model of health care is based on insurance, so the prices are based on the pool rather than set to what an individual can sensibly pay. While this makes sense in the case of catastrophic problems, it makes far less sense when it comes to the more basic services. T.J. had a good idea about the catastrophic insurance.

              There is also the fact that the current model rewards treatment and tests rather than prevention. Fixing this will be a challenge. One obstacle is best seen by this analogy: mechanics get paid for what they fix, not for not having cars come into the shop. Paying mechanics for not working on cars would seem odd, so would paying doctors for not seeing patients.

              This can, of course, be addressed in cases in which conditions arise and then can be mitigated or treated early-with the appropriate incentives.

  3. FRE said, on June 28, 2012 at 6:22 pm

    There is no such thing as perfect legislation. If Congress would pass only perfect bills, then it would accomplish nothing. No doubt problems will be found with the health care act that will require amendments to fix; that is perfectly normal and to be expected.

    Those condemning the act are short on specifics regarding what they would propose to replace it. It is unacceptable that in a prosperous country, people should have to choose between bankruptcy and dying, but that is the actual choice that some people have had to make. It seems that those opposing the health care act care nothing about them.

    • T. J. Babson said, on June 28, 2012 at 6:56 pm

      FRE, by making young, healthy people pay for excessive health insurance that they do not need, the ACA just compounds the ongoing theft from the next generation.

      Why do you think stealing from young people is especially compassionate?

      • Michael LaBossiere said, on June 29, 2012 at 9:43 am

        The cost of health insurance is a an important concern. I would say that the problem is not so much that people will need to be insured but that it is excessively expensive. Of course, it is expensive in part because medical care is so expensive. Somewhat ironically, medical care is so expensive in part because of insurance. It is also expensive because the people who have insurance are paying for the folks who use the emergency rooms and cannot pay.

        If we can get people who would otherwise use emergency rooms and not pay covered, this helps in two ways. First, they will be able to afford preventative care and this increases the chances that the problems will be addressed early on at a lower cost rather than expensively in the ER. Second, having fewer uninsured people means fewer unpaid bills that those of us with insurance pay for. That is, if you have insurance you are subsidizing the people who do not and who go to the ER. The average cost is $410 a year for an individual and $1,100 for a family. I’d rather not pay that. Now, if I have to pay anyway, I’d rather my $410 went to insuring the poor. After all, that way folks could get preventative care rather than just ER care which would be better for all of us.

        Of course, dealing with that problem won’t reduce the cost of insurance significantly. This will require fundamental changes in how health care operates in this country. There have been some very good local efforts to cut the cost of health care and these should be explored. Ideally, we would either have a system in which average folks can afford medical care or one in which people have reasonably priced insurance that can cover the costs.

    • Michael LaBossiere said, on June 29, 2012 at 9:31 am

      True-as problems emerge, they can be addressed. Interestingly, Romney seems to agree with Obama on most points except for the mandate.

  4. FRE said, on June 28, 2012 at 7:33 pm

    T. J.,

    I do not see that as stealing. Rather, I see it as spreading the risk so that everyone can afford health insurance. If people, including young people, bought health insurance only when their health situation indicated a serious need, then no one could afford it.

    A number of years ago, I had a coworker who hated his job, but he couldn’t leave. The reason was that he had developed diabetes and therefore would be unable to get health insurance if he left the company since his diabetes would then be considered a pre-existing condition. Note also that under the old system, it was frequently impossible for young children with pre-existing conditions to be covered by health insurance. Obviously that often put their parents in an impossible situation if they could not afford to pay for health care for their children.

    Why do you see it as especially compassionate for some people to be unable to get health insurance and be forced into bankruptcy when they become ill?

    • T. J. Babson said, on June 28, 2012 at 8:05 pm

      “..spreading the risk so that everyone can afford health insurance…”

      Sure, let’s make poor healthy young people pay for the health care of old rich people. Brilliant.

      • Anonymous said, on June 28, 2012 at 10:19 pm

        Turning health care into a type of class warfare? Brilliant.

        • T. J. Babson said, on June 28, 2012 at 10:38 pm

          Intergenerational warfare, to be precise, becasuse that is exactly what it is.

          • Michael LaBossiere said, on June 29, 2012 at 9:58 am

            Classifying it as warfare seems needlessly divisive. After all, the old folks are not the enemies of the young. They are their parents, grandparents, teachers, and so on. It would be more helpful to see ourselves as in this together, as Americans. After all, if we think in terms of warfare, enemies and so on, that changes how we look at problems and what solutions we will accept. We would, I think, be better served by thinking in terms of being friends who have legitimate concerns that are sometimes in conflict. As friends, we should work together to reach a solution that can work well for all of us.

            To use an analogy, I do not always want what my friends and family want. However, I do recognize that I cannot and should not always get what I want, because my friends and family have interests and needs that are just as legitimate as my own. Being ethical, I am willing to give up some of what I want so that my friends and family can have some of what they want. They matter to me and I matter to them, so we take the effort to work together. Likewise, I am not the only American nor does America exist just for me. Other people have legitimate needs and wants. Unless I am a selfish bastard, I have to recognize this fact and work with it.

            • FRE said, on June 29, 2012 at 12:40 pm

              Very good.

              Also, young people who have no consideration for old people will have no right to complain about lack of consideration when they become old. In fact, many people who are now old have no right to complain about lack of consideration since when they were young, they showed no respect for old people.

              Let us not overlook the fact that lack of medical care for old people often impacts their children who end up sacrificing their own welfare if their parents are unable to get adequate medical care.

              The thing that most disturbs me about this controversy is the egregious mean spiritedness and total selfishness of people who show no concern for others. They don’t seem to care if children die of easily treatable conditions or if people are forced into bankruptcy by medical conditions. The way I think about those who are forced into bankruptcy because of medical conditions is, “There but for the grace of God go I.” I am fortunate to be healthy and have good health insurance, but I realize that many people, either through no fault of their own or because of human error, are less fortunate.

              I believe in ultimate justice. In some way, those who show lack of concern for others will eventually pay a very high price, although that should not be the motivating factor for behaving like decent human beings.

          • Anonymous said, on June 29, 2012 at 3:01 pm

            Anonymously speaking, I didn’t use the phrase “old rich people”. You did. So let’s say it’s intergenerational class warfare. Brilliant. Young people, by and large, are healthier than old farts. And young’uns aren’t always so convinced they need to purchase insurance.

      • Michael LaBossiere said, on June 29, 2012 at 9:49 am

        Two replies.
        First, the young and healthy can become the young and sick/injured. Being a runner and a professor, I know lots of young and healthy folk. Interestingly enough, this does not make them immune to illness and accidents. True-they are less likely to be sick, but going without insurance is a gamble that could cost them everything. When I had my surgery, the bill was over $11,000. This was for a 40 minute surgery. Even the young and healthy are but one fall or traffic accident away from being financially broken.
        Second, the young will become old people (mostly), so even if we assume that they never need health care in their youth, they will get paid back when they are old, by the next generation.

        • T. J. Babson said, on June 29, 2012 at 10:19 am

          What makes sense for young, healthy people is an inexpensive catastrophic plan that would kick in if they get seriously sick or injured. If these are permitted under the ACA, I don’t have a problem.

          • T. J. Babson said, on June 29, 2012 at 10:21 am

            My understanding is that the ACA mandates things like contraceptive and all sorts of other coverage in every plan, but I have not looked into this in detail.

            • Michael LaBossiere said, on June 29, 2012 at 11:02 am

              Preventative care is covered and contraception is taken as being under this. I think the AMA made that recommendation. Covering preventative care is likely to be a cost saver-after all, illness is cheaper to prevent than treat (mostly).

          • Michael LaBossiere said, on June 29, 2012 at 11:01 am

            One of my friends had that sort of plan when she worked for the state, because her position did not come with benefits and she couldn’t afford normal insurance (law school is pricey). Fortunately, she never needed to use it-although she came close when a chicken coop fell of a truck and took off the front of her car.

            It does make sense for folks who are otherwise young and healthy-after all, it is most likely that the unlikely major problems would be the ones to get them.

            Until they can work out a way to make insurance costs reasonable, having different types of insurance would be an excellent idea.

    • magus71 said, on June 30, 2012 at 6:32 am

      “Note also that under the old system, it was frequently impossible for young children with pre-existing conditions to be covered by health insurance.”

      They were covered by Medicaid. I know, because it happened to me. Anyone under 18 or still in college can be covered by Medicaid.

      • FRE said, on June 30, 2012 at 4:33 pm

        If my understanding of Medicaid is correct, eligibility and funding are determined by the states and in many states, many people who have serious medical problems and are medically indigent cannot receive needed medical care.

        • T. J. Babson said, on June 30, 2012 at 10:56 pm

          FRE, do you actually know anybody who needed medical care but didn’t receive it? I don’t.

          • FRE said, on July 1, 2012 at 12:35 am

            Yes, I do. However, I have never excluded people of modest means from my contacts, but I can see how some people might not know anyone who has not received adequate medical care. My life has not been sheltered to that extent.

            Also, if you read medically related issues, you will find that a common reason for bankruptcy is inability to pay medical bills. And, when medical bills are not paid by those who have received medical care, the costs are covered by other means. That includes raising fees for those of us to can pay our medical bills thereby causing the cost of insurance to increase. It has also been found that medically indigent people often visit emergency rooms with problems which would have been less expensive to treat if they had visited a primary care physician sooner. There inability to afford preventive care runs up costs for all of us.

            Part of the reason for excessive medical care costs is unnecessary tests and procedures. I’ve had personal experience with that. A few years ago, I had a bladder infection. I was unable to get a timely appointment to see my usual provider, so I went to a place staffed by nurse practitioners. The practitioner, appropriately, prescribed an anti-biotic. It caused side effects which were exceedingly annoying, so she, appropriately, prescribed an alternative antibiotic. One of the known side effects of the first antibiotic, which I experienced, was a moderate headache. I hadn’t had trouble with headaches previously, so it was reasonable to assume that it was a side effect. To treat the headache, she gave me an unnecessary injection and put me on O2 for half an hour. Then she sent me to have an MRI scan of my brain and when that was normal, she had a Doppler test of my carotid arteries to see whether my brain was getting enough blood, which it was. The unnecessary tests and procedures added about $3,000 to the costs, which Medicare and Medigap completely paid. I couldn’t object to the unnecessary tests and procedures without risking being labeled uncooperative which could have compromised my medical care. One might assume that it was defensive medicine, but the circumstances were such that that seems unlikely.

            Just how much, on a country-wide basis, unnecessary tests, procedures, and fraud add to the cost of medical care, I don’t know, but I suspect that it is considerable. And it was also a problem when only private heath insurance was available. Obviously something should be done to minimize unnecessary expenses.

            People assert that our new health care system will be too costly. I see that as unclear. At least part of the increased costs may be offset by adequate preventive care.

          • magus71 said, on July 1, 2012 at 6:46 am

            TJ,

            I always ask this question, too. I don’t know anyone either.

          • Michael LaBossiere said, on July 1, 2012 at 8:13 pm

            After I graduated, I worked as an adjunct for a year ($2,000 per class, no benefits). I was lucky and only had a few minor illnesses, but I had to pay full price for everything. One bad accident or illness would have been a disaster. For example, if I had busted my leg then, the $11,000 hospital bill plus the brace and PT would have been almost my salary for that year. True-I could have chosen to go bankrupt and wrecked my financial future at age 27. When I got hired as a visiting professor, I ran to HR to get my medical insurance.

            • FRE said, on July 1, 2012 at 8:21 pm

              There are many people who, because of lack of medical insurance, would have been destroyed by a bit of bad luck. I can think of times when I was younger that bad luck would have destroyed me, just has it has destroyed many people.

            • T. J. Babson said, on July 1, 2012 at 10:47 pm

              How would it have helped if you were mandated to buy insurance?

            • Michael LaBossiere said, on July 2, 2012 at 11:43 am

              Apparently the ACA also helps with getting insurance when one is poor and/or does not get it through work. I was essentially gambling because the cost of getting insurance on my own would have been a big chunk of my salary.

            • T. J. Babson said, on July 1, 2012 at 10:55 pm

              “For example, if I had busted my leg then, the $11,000 hospital bill plus the brace and PT would have been almost my salary for that year.”

              Lots of kids go $30-40K in debt just for a bachelor’s degree. I know someone in the hole $190K for an engineering degree.

            • Michael LaBossiere said, on July 2, 2012 at 11:47 am

              I went into to debt for college as well. But there are some important differences:
              1. Student loans tend to be at a lower interest rate than other loans.
              2. Student loans have a well established deferral program: mine were on deferral all through grad school.
              3. Student loan repayments can generally be adjusted to match the person’s income.
              4. Student loan debt is “non-bad” in the sense that it is something of an investment: you go into debt $30-40K but you dramatically increase your income potential, plus you get that education thing.
              5. There is other financial aid, scholarships and so on to help with college costs.

            • T. J. Babson said, on July 1, 2012 at 11:23 pm

              Do you really want to argue that a construction worker who breaks his back all day earning a decent living should pay for the health insurance of a kid who first goes to college and then spends 10 years reading Foucault while looking for a “real” job?

            • Michael LaBossiere said, on July 2, 2012 at 11:50 am

              Of course not-that is why I am for the mandate. As it now stands, that construction worker is paying about $500 a year (or more if he has a family) to pay the costs of the uninsured who show up in the emergency room. I’m not sure how many of them are college kids who read Foucault while they wait to get treated for something they would have had treated long ago if they had insurance.

            • FRE said, on July 1, 2012 at 11:38 pm

              No, but the national system would permit the kid to be on his parents’ health insurance only until age 26 as I understand it.

              On a closely related matter, a major medical problem can result in a bill exceeding $100,000. For a family with a low income, it would be impossible to pay that bill. As to what medical problems could result in such a bill, being seriously injured by an uninsured driver with few assets could easily do it. If a young child were injured, he or she could, while growing, require a new prosthesis annually, and they are very expensive. Some cancers could result in such a medical bill.

              This is not an easy matter to address. For example, if it cost $100,000 to treat a cancer and the probability of a cure were only 10%, should the money be spent? Who should decide?

            • T. J. Babson said, on July 2, 2012 at 9:45 am

              The main problem in the U.S. is that health care costs too much. The ACA does absolutely nothing to control costs, and if anything will make the problem worse.

            • FRE said, on July 2, 2012 at 1:39 pm

              I agree that health care costs to much here in the U.S. Unnecessary tests and procedures which do nothing to improve outcomes, plus fraud, no doubt add significantly to costs; I have covered that in another post here.

              It is true that the new health care payment system may do nothing to control costs, except to the extent that making preventive care more readily available may reduce costs somewhat. But we agree that it is not a perfect system and that changes will have to be made to improve it, including changes shown necessary by experience. The system is only a start. As has also been pointed out, many times, we would make no progress if we waited for perfect solutions; we have to start someplace and continue on from there. There should be a thorough study to identify the most important causes of excessive costs and ways found to contain them.

              TV advertisements have implied that one of the bad things about the system is that it will interfere with the relationship between doctors and their patients. Considering that insurance companies are already interfering with the relationship between doctors and patients, that assertion is at best disingenuous. Even now, insurance company pen pushers often dictate to doctors what medical procedures they should use.

              Obama has been accused of rushing it through. Actually, attempts have been made several times since Teddy Roosevelt proposed it during his presidency OVER 100 YEARS AGO. Nixon and others, including Romney, have made similar proposals. Thus, it is clear that there has been no rushing. Finally someone has done what was required to get it enacted. Now we should concentrate on correcting problems with it to improve it.

            • Michael LaBossiere said, on July 3, 2012 at 1:56 pm

              The idea that the ACA comes between patients and doctors does seem rather odd, given that the insurance companies (as you noted) now do that. The folks at these companies decide what gets covered. As an anecdote, the brace that I needed for my quadriceps tendon repair was removed from being covered about a month before my surgery because it was deemed unnecessary. I asked the doctor (and researched the matter) and learned that the brace was rather essential (as I found out). Fortunately, I could afford the cost of the brace ($500, thanks to the previous insurance inflation).

            • T. J. Babson said, on July 2, 2012 at 3:20 pm

              “True-I could have chosen to go bankrupt and wrecked my financial future at age 27.”

              The genius of bankruptcy is that it allows you to save your financial future by starting over with a clean slate.

              In any case, lots of things in life–divorce, for example–are expensive and unpleasant. Maybe we can get those hard working construction guys to pay for people’s divorces, too.

            • Michael LaBossiere said, on July 3, 2012 at 2:05 pm

              For some odd reason, I would not consider going bankrupt to be a good option (laying aside the moral concern about not paying my debts). True, the slate would be sort of clean years later-I would just have to get by until then.

              As I noted, we already pay for the uninsured either through higher premiums or through taxes (or both). So, I’m not sure what the bite is in regards to your claims about hard working construction guys paying for things. Those hard working guys presumably drive on roads that are paid for with tax dollars. They might even be working on a state project, like the construction at my university, being paid for by taxes.

            • Anonymous said, on July 3, 2012 at 8:19 am

              All muddled here. Divorce expenses, college education expenses=health care expenses? Do people choose to suffer from Parkinsons? Testicular cancer?

  5. T. J. Babson said, on June 29, 2012 at 10:24 am

    You’ve got to keep in mind that the people now retiring are from the boomer generation–which is the most selfish, self-centered group of people ever to walk the face of the earth.

    • Michael LaBossiere said, on June 29, 2012 at 11:03 am

      Damn hippies. :)

    • FRE said, on June 29, 2012 at 12:47 pm

      So you are painting all of the people now retiring with the same brush. Simple fairness would require the use of a modifier such as one of the following: many, most, a lot, a significant number, etc. Lack of a modifier implies all.

      Actually, I would say that the wealthy people in England during the Victorian era and the robber barons here in the U.S. were far more selfish. However, people who have not studied history may not be aware of conditions at that time.

  6. T. J. Babson said, on June 29, 2012 at 10:32 am

    I guess we will now find out.

    • Michael LaBossiere said, on June 29, 2012 at 11:06 am

      We sure will. Not exactly the best approach-sort of like jumping into a dark lake, hoping that it will be deep water rather than full of rocks and crocs.

      While I am for some of the things in the ACA, I do worry that there are also some rocks and crocs in it.

      • FRE said, on June 29, 2012 at 3:17 pm

        No major piece of legislation is flaw free. No doubt amendments will be required as problems are found and the amendment process will continue for years. However, that is no excuse for not passing legislation.

  7. Anonymous said, on June 29, 2012 at 3:19 pm

    As FRE and many pundits and politicians have pointed out there is no such thing as perfect legislation. If Congress would pass only perfect bills, then it would accomplish nothing. No doubt problems will be found with the health care act that will require amendments to fix; that is perfectly normal and to be expected.
    But not in Nordquistian heaven. There whatever steps necessary to bring the government to its knees and drag it to the tub are justified.

    • T. J. Babson said, on June 29, 2012 at 4:02 pm

      You guys just don’t get it, do you. We can’t be both the “arsenal of democracy” and live in a Euro-style social welfare state. It is not sustainable. Something has to give.

      • Michael LaBossiere said, on June 29, 2012 at 4:09 pm

        False dilemma, plus hyperbole. But you are right that we cannot sustain defending the world on our dime.

        • T. J. Babson said, on June 29, 2012 at 4:25 pm

          Hardly a false dilemma, when both have to be paid for from the same treasury.

          • Michael LaBossiere said, on June 30, 2012 at 11:22 am

            The false dilemma is that there are clearly many other options besides being the arsenal and being a euro-style Socialist state. Also, we are hardly a socialist state and not very European. In any case, using the dysphemisms of ‘socialism” and “euro-style” doesn’t prove that socialism or Europe is defective. We should note that countries such as Finland and Germany seem to be doing quite well.

            The problem does not seem to be a European thing, but rather a PIGS thing.

            • T. J. Babson said, on June 30, 2012 at 2:20 pm

              Why do you claim that “social welfare” and “Euro-style” are dysphemisms? Many people use these as terms of approbation.

              Also, if you read my remarks carefully, I claimed that we cannot have both the level of defense spending we now have as well as a Euro-style social welfare state. Pointing out that the German economy is OK is irrelevant, because Germany does spend the same fraction of GDP on defense that we do.

            • Michael LaBossiere said, on June 30, 2012 at 3:52 pm

              True-one person’s dysphemism is another’s euphemism. However, this is set by context.

              Well, true-we cannot spend at the current rates and then tag on more spending without going into more debt (or raising taxes or both). However, we could adopt what some might regard as “socialist” or even “Euro” policies that could save us money, thus allowing us to continue to lead the world in defense spending while also having social programs.

              We should really consider world conquest. I think everyone would be happier under a full Pax Americana.

      • magus71 said, on June 29, 2012 at 7:34 pm

        TJ,

        Even Europe can’t afford a Euro-style social welfare state, All of the same arguments that Mike, FRE and others have made are not new arguments. They are decades old, and Europe implemented the same policies at that time. Almost all Euro-states have very weak militaries. They made their “one or the other” choice and they can’t even afford the one.

        Eventually we’ll be where they are now and the entire world will be worse for it I suspect.

        • T. J. Babson said, on June 29, 2012 at 9:37 pm

          Math: 1.2 Trillion Dollars/300 Million People = $4,000 per person.

        • Michael LaBossiere said, on June 30, 2012 at 11:26 am

          Not all of Europe is doing badly. The PIGS got into trouble not because of “socialism” but for other reasons. Also, there are European countries that are doing reasonably well. Finland is top in education, Germany’s economy is in decent shape, and so on.

          We do outspend everyone in military expenditures, in part because we are now operating as the world police. We protect Europe, we police the seas and so on. It is fair to say that the Pax Americana helps make the modern world economy possible by providing stability, order and allowing other nations to spend far less on the military.

          • T. J. Babson said, on June 30, 2012 at 2:45 pm

            “The PIGS got into trouble not because of “socialism” but for other reasons.”

            The PIGS do all tilt rather left of Germany, so I think the statement “left wing politics leads to economic ruin” is not completely off the mark.

          • T. J. Babson said, on June 30, 2012 at 2:48 pm

            Germans are very conservative people in their personal lives. They work hard, are careful with their money, etc.–all classic Tea Party values.

            • Michael LaBossiere said, on June 30, 2012 at 3:54 pm

              Since the Tea party is newer than Germany, we should rather say that the Tea party folks have classic German values.

            • T. J. Babson said, on June 30, 2012 at 4:58 pm

              Indeed.

            • FRE said, on July 1, 2012 at 12:38 am

              Forsooth!

  8. magus71 said, on June 29, 2012 at 9:12 pm

    Yet another consistent republican argument against:

    http://www.reuters.com/article/2012/04/10/us-usa-healthcare-budget-idUSBRE83905Q20120410

    And yet again it’s the economics.

    • Michael LaBossiere said, on June 30, 2012 at 11:44 am

      There are two problems with our available sources.
      1. Charles Blahous is the Republican trustee for the Medicare and Social Security entitlement programs for the elderly, which gives us grounds for being suspicious in terms of a political bias.
      2. The Obama administration is biased in favor of itself, which gives us ground for being suspicious.

      What is needed are neutral and objective studies done by experts who do not have a horse in the race.

      • Anonymous said, on June 30, 2012 at 4:17 pm

        That is, no one who is young or old, rich or poor, conservative or liberal.May we choose zombie experts (zombies with expertise in budgets and entitlements, not experts who know more than anyone else about zombies)?

      • FRE said, on July 1, 2012 at 12:40 am

        There are some subjects about which it is next to impossible to get neutral and objective information. Some illegal drugs fall into that category.

  9. T. J. Babson said, on June 30, 2012 at 5:07 pm

    Every trillion dollars of government debt equates to $4000 per capita debt. If median household income is about $50K, and average household size is about 4, each family is borrowing about $16K or roughly 30% of its income every year. How long can one keep spending 30% more than one earns?

    • FRE said, on July 1, 2012 at 12:42 am

      Obviously it is a situation that should be corrected. Even so, our federal debt is proportionally considerably less than it is in Germany. It isn’t an immediate problem, but unless corrected, it will result in negative consequences.

      • T. J. Babson said, on July 1, 2012 at 9:44 am

        FRE, what is your source for this statement?

        According to this source, Germany is is debt 82% of GDP, whereas US is in debt 103% of GDP:

        http://en.wikipedia.org/wiki/List_of_countries_by_public_debt

        • FRE said, on July 1, 2012 at 7:57 pm

          I no longer remember the source. However, it was for government debt only; it excluded consumer and other debt. The U.S. consumer and other debt was much higher.

    • Michael LaBossiere said, on July 1, 2012 at 8:09 pm

      Until one dies.

  10. FRE said, on July 6, 2012 at 5:52 pm

    Here is an an article about a woman who risked her life by delaying surgery until she was able to get onto Medicare:

    http://www.huffingtonpost.com/2012/07/05/evelyn-51-pound-tumor-removed-cancer_n_1647937.html?utm_hp_ref=mostpopular

    I suggest also reading the comments on the article.


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