Why the individual mandate philosophically is right/ or wrong

[BoberFett]

We are in debt because we spend 40% of the entire world's military budget while having 4% of the world's population and are surrounded by 2 oceans and 2 peaceful countries.

I agree, the military should be scaled back drastically.

Of course cutting a few hundred billion dollars out of that budget will put a lot of people out of work too, so be prepared to see unemployment increase a percent or two.

 

[xBiffx]

Anyone can get hit by a metaphorical bus at any time. Everyone should have insurance if they are going to receive medical care by default.

That's not what some people think health insurance is for so therefore they don't purchase it. They don't feel the need to insure for what if scenarios. Insuring for the cost of preventative care is one thing but if you are capable of weathering an "ah fuck" scenario then I see why you might not want to purchase insurance. Forcing people to buy it doesn't make it any more needed. Now they have a white elephant that they don't have a use for.

It was working on a national revenue level until YOUR party started fucking with it in 1980 and then really fucked it all up from 2000-2008.

My party, that's hilarious. Guess all you can do is agree that it doesn't work and try to assign blame as to why. Instead try figuring out that its not going to work for healthcare for the same reasons, there are always going to be people who disagree with your line of thinking.

 

[Fern]

-snip-
In 2005 every foreign automaker it was able to have a $1,500 dollar competitive advantage on GM because they don't have to worry about health care costs aside from the part taxes they pay out on their revenues that goes to the health care system of their countries. Given the trend with inflation it's probably an even larger advantage 7 years later.

I lived and worked in France for a number of years. I worked for a French firm so I was covered under UHC. French employers pay a ton for employees' SS, which includes UHC.

So, I think the guy complaining from GM is talking FUD.

He somehow fails to notice that US employers pay SS at a rate of only 7.62%

Check out what French employers have to pay for their workers:

http://www.french-property.com/guid...taxation/social-security/employers-employees/

It's about 31.% (The total of the first 4 line items, plus main pension. So, I'm being conservative because French employers pay ANOTHER mandatory 21% for additional pension and unemployment.)

Fern

 

[sactoking]

Simple answer: Let hospitals purchase insurance that covers them for treating poorer people with no insurance.

Fern

Unfortunately that's not a simple answer as no single customer is large enough to constitute an insurable risk. Credit insurance does exist but it does not cover small losses as the risk charge is basically dollar-for-dollar.

In other words a hospital insuring $1,000,000 of receivables from individual patients would likely pay $1,000,000 or more in premium, which is just silly.

 

[Fern]

Unfortunately that's not a simple answer as no single customer is large enough to constitute an insurable risk. Credit insurance does exist but it does not cover small losses as the risk charge is basically dollar-for-dollar.

In other words a hospital insuring $1,000,000 of receivables from individual patients would likely pay $1,000,000 or more in premium, which is just silly.

So it's like insuring a pre-exisitng condition?

Fern

 

[sactoking]

So it's like insuring a pre-exisitng condition?

Fern

Not really. I guess it's the same in that they both have premiums equal to the anticipated cost, but it's not really the same from a technical standpoint.

Here's an example:

You're a business owner with $10,000,000 in annual revenue from 10,000 customers. Your average annual revenue per customer is (obviously) $1,000. In any given year 5% of your customers would go out of business or otherwise stiff you on their bills. The average anticipated loss to bad debt would be 5%, or $500,000. If this scenario held as true then insurance on you receivables would cost ~$500,000 and there would be no incentive to purchase insurance. You could retain the risk and self-insure for the exact same cost.

Now let's say you have $10,000,000 in annual revenue from 10,000 customers but 10 customers account for $9,000,000 in sales. That means that the average annual revenue for the remaining 9,990 customers is ~$100 each. If the risk of bad debt is still 5% and the 10 large customers all contribute $900,000 each then the anticipated average loss in any year due to bad debt would be:

($9,000,000 * 0.1% * 5%) + ($1,000,000 * 99.9% * 5%) = ($450) + ($49,950) = $50,400.

So your average anticipated loss has decreased from $500,000 to $50,400. Now you run the risk that of the 500 (5%) account that go bad each year 10 of them will be your big customers.

You can insure against the risk that all 10 (or some, or one) of those 10 goes out of business using credit insurance since the sample is not homogeneous to the population and risk can be isolated, but you cannot insure against the other 9,990 since that sample is representative of the population and loss costs become certainties (i.e. there is no actuarial risk).

Hospitals' economic models function like the first example where each patient is such a proportionately small portion of the population that loss costs become certainties and insurable risk drops to zero.


Again, for anyone late to the party, this is only in regards to patients paying their bills.

 

[werepossum]

Where I have a problem with this "mandate" is low income people who can't afford insurance to begin with and make too much to qualify for Medicaid. These people, in one fell swoop, will become criminals or forces them to live without many essentials. It's foolish to think this is only a very few people but it's going to hurt a lot of people. Like almost everything the government does when it starts fucking around is it will hurt the very people it's supposedly trying to help. Let's ask another - who is the biggest winner with this mandate? It damn sure isn't any of the poor folk is it?

Bingo. I have no problem philosophically with the mandate; since hospitals are required to give you treatment (at least for emergencies and life-threatening conditions) it only makes sense to mandate buying health insurance.

I have a huge problem with the idea that the mandate is some sort of solution. If the problem is that many people can't afford health insurance - and it is - then saying we'll force them to buy health insurance or fine their asses is no solution. While it brings in more money for the government, it also means less money for those who already can't afford health insurance.

 

[sactoking]

Bingo. I have no problem philosophically with the mandate; since hospitals are required to give you treatment (at least for emergencies and life-threatening conditions) it only makes sense to mandate buying health insurance.

I have a huge problem with the idea that the mandate is some sort of solution. If the problem is that many people can't afford health insurance - and it is - then saying we'll force them to buy health insurance or fine their asses is no solution. While it brings in more money for the government, it also means less money for those who already can't afford health insurance.

Just FYI- starting 1/1/14 the eligibility threshold for Medicare can be no lower than 133% of the Federal Poverty Level and the exchange tax credits won't fully phase out until 400% of the FPL, so there is a decent amount of help available.

400% of FPL for a family of 4 is $89,400.

 

[dank69]

That's not what some people think health insurance is for so therefore they don't purchase it. They don't feel the need to insure for what if scenarios. Insuring for the cost of preventative care is one thing but if you are capable of weathering an "ah fuck" scenario then I see why you might not want to purchase insurance. Forcing people to buy it doesn't make it any more needed. Now they have a white elephant that they don't have a use for.

Health insurance isn't necessary for the preventative care, it is necessary for the unforseen 'ah fuck' scenario that can happen to anyone. Very few people are capable of 'weathering' an 'ah fuck' scenario. $100000+ bills can happen before you even know what hit you. How many people do you know that can weather something like that?

My party, that's hilarious. Guess all you can do is agree that it doesn't work and try to assign blame as to why. Instead try figuring out that its not going to work for healthcare for the same reasons, there are always going to be people who disagree with your line of thinking.

I didn't agree that it doesn't work. I am not assigning blame, the evidence is right there for all to see if they just look at it objectively. Guess all you can do is deny deny deny.

 

[Craig234]

I lived and worked in France for a number of years. I worked for a French firm so I was covered under UHC. French employers pay a ton for employees' SS, which includes UHC.

One question: In a sentence, maybe paragraph, describe the quality of care in France.

 

[cybrsage]

A new car can't guarantee that you won't still be hurt. Having health insurance can guarantee that you won't have to declare bankruptcy due to unforseen medical expenses.

No, it does not. Not everything is covered 100%. Many things are 90% or 80% covered. Could you suddenly come up with your 20% portion of a $500,000 bill for cancer treatment?

 

[cybrsage]

So what is the difference between state level mandates, or federal, its still a mandate.

What's the difference between the Fed saying you have to have Health Insurance and States demanding that everyone has Car insurance?

100% this, I looked into it.

So you are ok with a state forcing you to do something but not the fed gov? How is that really any different in the grand scheme of things?

Everyone who drives in my State car insurance is mandatory and I don't see collective outrage of citizens protesting in the streets over it.

The Constitution gives the states the powers that are not expressly listed for the fed gov. That is a very large, and very important, difference.

 

[Fern]

One question: In a sentence, maybe paragraph, describe the quality of care in France.

I only saw a doctor once. Well, twice exactly. Before you receive your French 'green card' you have to pass a medical exam.

The other time I had the flu or something. Like here, you call to make an appointment, you go, you wait, the doc sees you, asks some questions, you get a prescription. Take medicine go to bed. Totally routine.

Otherwise, I can't personally say much about it. I can say I never heard anything bad about it. Not from the French or the other Americans who lived there.

At the time, the only thing I was made aware of is that French doc's make much less than the US doc's.

Fern

 

[cybrsage]

The problem with the French system is that they need to radically change it or they will eventually use 100% of their GNP just to pay for healthcare...but the cost will continue to go up even then.

It is an unsustainable system...we should not copy a system which has been proven to be a bad one.

 

[Craig234]

I only saw a doctor once. Well, twice exactly. Before you receive your French 'green card' you have to pass a medical exam.

The other time I had the flu or something. Like here, you call to make an appointment, you go, you wait, the doc sees you, asks some questions, you get a prescription. Take medicine go to bed. Totally routine.

Otherwise, I can't personally say much about it. I can say I never heard anything bad about it. Not from the French or the other Americans who lived there.

At the time, the only thing I was made aware of is that French doc's make much less than the US doc's.

Fern

So, nothing too scary compared to our system - if 'outcomes are similar', and costs are much lower, it would raise the question:

Is our Medicare cost crisis better dealt with by slashing spending on Medicare and reducing benefits to citizens and trasferring the money saved to tax cuts for the rich, or by moving to a single-payer system which provides as good or better care for far less money than the current high-profit private insurance system, the only one in the advanced world?

 

[cybrsage]

By "the rich" you mean "everyone who is paying taxes" right?

 

[Fern]

So, nothing too scary compared to our system - if 'outcomes are similar', and costs are much lower, it would raise the question:

Is our Medicare cost crisis better dealt with by slashing spending on Medicare and reducing benefits to citizens and trasferring the money saved to tax cuts for the rich, or by moving to a single-payer system which provides as good or better care for far less money than the current high-profit private insurance system, the only one in the advanced world?

Neither.

Neither addresses the underlying problem of exploding health care costs.

I have posted at length on this, citing studies by The New England Journal of Medicine and remarks from the head of the AMA.

Identical patients, with identical medical problems, in identical health receive vastly different care measured in the hundreds of thousands of dollars for no reasons that can be identified.

The study concluded that:

* Patients were receiving expensive redundant and unnecessary treatment.

* That the medical community needs nationwide standards of care like of other professionals such as CPA and engineers.

* That fear of malpractice, or desire to keep your patient happy, or even more profit motivates physicians to accede to patient demands that the physician knows are unnecessary.

* Neither the physician or the patient will be paying for the unnecessary procedures so there is no disincentive to unnecessary procedures/treatment currently in our system.

^^That^^ is from Physicians.

Until we fix this fundamental underlying problem most everything else is just so much BS.

Fern

 

[Craig234]

Neither.

Neither addresses the underlying problem of exploding health care costs.

I have posted at length on this, citing studies by The New England Journal of Medicine and remarks from the head of the AMA.

Identical patients, with identical medical problems, in identical health receive vastly different care measured in the hundreds of thousands of dollars for no reasons that can be identified.

The study concluded that:

* Patients were receiving expensive redundant and unnecessary treatment.

* That the medical community needs nationwide standards of care like of other professionals such as CPA and engineers.

* That fear of malpractice, or desire to keep your patient happy, or even more profit motivates physicians to accede to patient demands that the physician knows are unnecessary.

* Neither the physician or the patient will be paying for the unnecessary procedures so there is no disincentive to unnecessary procedures/treatment currently in our system.

^^That^^ is from Physicians.

Until we fix this fundamental underlying problem most everything else is just so much BS.

Fern

Rejecting the Republican plan is a start.

And I have seen good info that there are serious reforms needed in the Medicare structure.

However, nothing in your post says anything about why a single payer system - not just Medicare as it is - isn't the solution.

 

[xBiffx]

However, nothing in your post says anything about why a single payer system - not just Medicare as it is - isn't the solution.

You sure about that?

Neither addresses the underlying problem of exploding health care costs.
.
.
.
Until we fix this fundamental underlying problem most everything else is just so much BS.

 

[Fern]

-snip-
However, nothing in your post says anything about why a single payer system - not just Medicare as it is - isn't the solution.

Again, the problem is the underlying costs of medical care.

Changing who writes the check for it will do nothing to solve the underlying problem of exploding medical care costs. The check writer, whether it be an HI company or the US govt does NOT actually provide any medical care whatsoever. We have got to drill to the level where the problems are.

Fern

 

[Craig234]

Again, the problem is the underlying costs of medical care.

Changing who writes the check for it will do nothing to solve the underlying problem of exploding medical care costs. The check writer, whether it be an HI company or the US govt does NOT actually provide any medical care whatsoever. We have got to drill to the level where the problems are.

Fern

That's complementary to the single-payer system.

In your own post, you mentioned lower salaries for doctors in France, for example.

I've heard the same thing about other systems, such as in England.

So, address the 'underlying costs of the care' AND the inflated costs of the private insurance system.

 

[dank69]

...

* Patients were receiving expensive redundant and unnecessary treatment.

* That the medical community needs nationwide standards of care like of other professionals such as CPA and engineers.

* That fear of malpractice, or desire to keep your patient happy, or even more profit motivates physicians to accede to patient demands that the physician knows are unnecessary.

* Neither the physician or the patient will be paying for the unnecessary procedures so there is no disincentive to unnecessary procedures/treatment currently in our system.

...

Looking at the four problems outlined above, single payer could possibly address point one. Single payer would ideally mean single point of truth so redundancies could be avoided.

It might even partially address point three, fear of malpractice since apparently malpractice as a whole is insignificant to the overall picture. The government isn't going to go bankrupt due to malpractice suits. However, I don't necessarily agree that this is a good thing. I tend to be of the philosophy that it is better to err on the safe side. If fear of malpractice is motivation to take extra precautions then it might be worth it.

Regarding point four, I can't think of any realistic way to fix that issue without sacrificing highest level of care.

 

[Hayabusa Rider]

The problem is the age old "the end justifies the means" attitude. Obamacare is irrelevant to the moral/philosophical argument. What is happening is that the government which cannot force people to buy something is now effectively taxing for something not being provided in order to punish them for not obeying what the government has no legitimate right under the Constitution to begin with. We now depend on the kindness of the government to not punish us for something it wants us to do regardless if it's legitimate under the Constitution. People are quick to ignore the authority which defines what's allowed when it suits them. This is merely a kinder, gentler authoritarianism. Thanks, but I'll pass. Instead of punishing, the government could have allowed premiums to be fully tax deductible since this is going to cost a fortune anyway, but that means a loss of power and control and that's really what people object to or support whether they realize it or not. It's better to usurp the rights of the people than to limit government in pursuit of a goal. That I cannot abide.

 

[fskimospy]

The problem is the age old "the end justifies the means" attitude. Obamacare is irrelevant to the moral/philosophical argument. What is happening is that the government which cannot force people to buy something is now effectively taxing for something not being provided in order to punish them for not obeying what the government has no legitimate right under the Constitution to begin with. We now depend on the kindness of the government to not punish us for something it wants us to do regardless if it's legitimate under the Constitution. People are quick to ignore the authority which defines what's allowed when it suits them. This is merely a kinder, gentler authoritarianism. Thanks, but I'll pass. Instead of punishing, the government could have allowed premiums to be fully tax deductible since this is going to cost a fortune anyway, but that means a loss of power and control and that's really what people object to or support whether they realize it or not. It's better to usurp the rights of the people than to limit government in pursuit of a goal. That I cannot abide.

What I don't get about this whole 'it's tyranny' thing is that the government has already had for many years what is in fact much greater coercive power.

What they could have done instead is simply tax you for whatever costs there were, bought the insurance for you from private industry, and then given it back to you (if they felt like it). In fact had you not wished to have insurance you could just as easily been taxed for something you weren't getting either.

In such a case you would have had far less freedom over what you wanted to do with your life and your money, but nobody would argue that the government had the power to do that. The idea that this sort of legal structure is some sort of assault on freedom is pretty hard to arrive at when you look at the situation rationally.

 

[fskimospy]

Looking at the four problems outlined above, single payer could possibly address point one. Single payer would ideally mean single point of truth so redundancies could be avoided.

It might even partially address point three, fear of malpractice since apparently malpractice as a whole is insignificant to the overall picture. The government isn't going to go bankrupt due to malpractice suits. However, I don't necessarily agree that this is a good thing. I tend to be of the philosophy that it is better to err on the safe side. If fear of malpractice is motivation to take extra precautions then it might be worth it.

Regarding point four, I can't think of any realistic way to fix that issue without sacrificing highest level of care.

Single payer could very likely address point 1, and it would probably address point 2 more easily than any other mechanism actually. (easiest way to set standards is through the pocketbook) Complaint 3 isn't actually that big an issue, but regardless if you provided a set of standards such as listed in point 2, you wouldn't have the same schizophrenic approach to malpractice.

Problem 4 has been (and will always be) a problem, but other states have been far better at controlling these costs with their single payer structures than we have.