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First, not only the rich have good health care!  Very many people have adequate health care in the most menial positions.

 

I suppose you prefer a system of inadequate care, as long as everyone gets treated the same?

 

Calling the Canadian health care system "inadequate" is like calling the American health care system "the best in the world."  Meaning, it's for those who believe in the Easter Bunny and Santa Claus.

 

That doesn't measure the quality of health care, that's more reflective of health.  Americans are, in general, among the least healthy of all societies.  That's more of the problem than actual health care or insurance.

 

As I'm sure you understand, health care in general isn't just going to see a doctor.  Preventative health care, gov't initiatives such as posting caloric counts on menus, etc are all signs of a county understanding the seriousness of health.  Why is it that Americans are less healthy than their Westernized counterparts?  We could say diet but rice and pasta aren't exactly 'healthy' either.  Many Americans clearly lack coverage for health care and thus don't go see a doctor.  I know plenty of them as I'm sure you do.  There is a quite clear relationship with "socialized" health care and lack there of.


"You don't just walk into a bar and mix it up by calling a girl fat" - buildingcincinnati speaking about new forumers

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I bet you know many people who have health care and don't go to the doctor.  What should we do to make them go?  Should there be a law?  If there is a law limiting amount of soft drinks, I guess we could have a law like that.

 

Compared to the US Health Care plan, the Canadian plan is inadequate.  There is lack of specialized care, lack of equipment, lack of facilities.  Many people do come to the US for serious treatment, because if you wait the standard amount of time for your chemo or radiation treatments, chances are good you could die before treatment.

 

I lived there for a year.  I read an article in the Globe that Canadian cancer rates were lower than the US because people would just die sooner!  There was too great of a shortage.

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Many people want to go see a doctor but cannot due to insurance and/or costs (high deductable).


"You don't just walk into a bar and mix it up by calling a girl fat" - buildingcincinnati speaking about new forumers

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Many people want to go see a doctor but cannot due to insurance and/or costs (high deductable).

 

I'm one of them. After a teeth cleaning (in one visit to the dentist) and the replacement of three old fillings (in another visit), I've used up all of the amount that my insurer will pay until next year. I'm scheduled for my six-month cleaning this fall, but I cannot go unless I can somehow come up with more money.


"Life is 10% what happens to you and 90% how you respond." -- Coach Lou Holtz

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Are temp agencies exempt from the employer mandate?

If they have 50+ employees working 30+ hrs a week in assignments that have lasted a year, it seems they should be complying.

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Many people want to go see a doctor but cannot due to insurance and/or costs (high deductable).

 

I'm one of them. After a teeth cleaning (in one visit to the dentist) and the replacement of three old fillings (in another visit), I've used up all of the amount that my insurer will pay until next year. I'm scheduled for my six-month cleaning this fall, but I cannot go unless I can somehow come up with more money.

 

Why are preventative health care costs any different than other expenses?  I can understand long term illnesses, diseases, etc., but why preventative?  If you needed new tires on your car (bad example, I know), or a new appliance at home, would you expect it to be covered?  Of course not.  They are your teeth. If you want to keep them, get them cleaned and checked. It's not that expensive.

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^And that's where the divide is found.  When proponents of health care reform think of health care expenses, they equate (or at least hope to one day equate) them more to expenses for roads, military, schools, etc. than your car or other items of chattel you might own.

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I think if insurance companies are smart, they absolutely SHOULD cover preventative appointments because it's almost always less expensive to treat/catch illnesses in the early stages.  Likewise it's cheaper to pay for a dental cleaning now than having to pay for a root canal later.  In fact I thought it was pretty standard for dental plans to cover one cleaning per year, health plans to cover things like annual pap smears and breast exams (these are the examples I know I've specifically heard of, though I'm sure there are others), etc., etc. because they know that prevention and/or illnesses early saves money long-term (not to mention improves actual health outcomes).

 

If the government has to be involved in health insurance (and for that those don't agree, notice that I'm saying "if"), then they absolutely should be pushing for insurance companies to cover and encourage preventative medicine.  It's just smart policy.

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You are right, that is where the divide is.  One can see all sorts of personal freedoms going out of the window when the government starts to dictate your health care.  If some jobs offer health care, how long before the government tells you that your skills require a better position?  I will use KJP as an example.  I respect his desire to do a job in something he feels strongly about.  If that job does not have adequate health care, is it the governments responsibility to pay that he has adequate health care?  Can the government tell you what kind of job to have?

 

I agree preventative medicine is much better than waiting until its too late, but what happens when the government starts to decide what you can eat and drink?  Oops, too late! Seriously, what do you do to the people who don't follow the rules?  Are there no more personal choices?  Hts mentions roads, well on roads there are rules to follow because not following these rules can hurt other people.  If you don't follow them and get caught, it will cost you money or jail time.  Is that the same as overeating? Overeaters are not causing physical harm to others.

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^Overeaters wouldn't cause physical harm to others, but they would cause financial harm to others by means of higher premiums, higher deductables, potentially higher government debt or higher taxes to cover increased premiums on subsidized plans. 

 

I'm not at all arguing the government should be telling you what to eat or drink, but you can't play the card that someone is only hurting themselves by being generally unhealthy.  That's simply not the case.  An unhealthy lifestyle will lead to higher medical bills over the course of a life on average.  Those costs will be paid by someone.  So, you either increase the premiums on that individual or you spread that added costs out to all insured people.  And if that unhealthy person is receiving subsidized insurance than that unhealthy lifestyle will lead directly to increased costs to you and me.

 

I mean, what about smokers?  Do you think it's ok for insurance companies to charge higher premiums on smokers (which most of them seem to do now) or do you think it's an overreach for the insurance company to tell them what they can and can't do?

 

Look, if Coke was outlawed tomorrow I'd be leading the revolt against the government.  However, if they just say that I'll have to spend an extra 15% to drink that Coke because it's unhealthy I'm perfectly fine with that. 

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I mean, what about smokers?  Do you think it's ok for insurance companies to charge higher premiums on smokers (which most of them seem to do now) or do you think it's an overreach for the insurance company to tell them what they can and can't do?

 

Of course it's ok to charge smokers more, it's a lifestyle choice, not a predetermined condition.  Do bad drivers get charged more for auto insurance? 

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^And that's where the divide is found.  When proponents of health care reform think of health care expenses, they equate (or at least hope to one day equate) them more to expenses for roads, military, schools, etc. than your car or other items of chattel you might own.

 

And that equivalence disturbs me.  Roads, armies, and schools are owned by the state.  How are our health decisions comparable?  They're part of ourselvesWe are not property of the state.

 

The kinds of public health projects and services that I think more fairly analogize to roads, armies, and schools are things like sewer systems, water purification facilities, and quarantining potentially epidemic infections.

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^Overeaters wouldn't cause physical harm to others, but they would cause financial harm to others by means of higher premiums, higher deductables, potentially higher government debt or higher taxes to cover increased premiums on subsidized plans. 

 

I'm not at all arguing the government should be telling you what to eat or drink, but you can't play the card that someone is only hurting themselves by being generally unhealthy.  That's simply not the case.  An unhealthy lifestyle will lead to higher medical bills over the course of a life on average.  Those costs will be paid by someone.  So, you either increase the premiums on that individual or you spread that added costs out to all insured people.  And if that unhealthy person is receiving subsidized insurance than that unhealthy lifestyle will lead directly to increased costs to you and me.

 

I mean, what about smokers?  Do you think it's ok for insurance companies to charge higher premiums on smokers (which most of them seem to do now) or do you think it's an overreach for the insurance company to tell them what they can and can't do?

 

Look, if Coke was outlawed tomorrow I'd be leading the revolt against the government.  However, if they just say that I'll have to spend an extra 15% to drink that Coke because it's unhealthy I'm perfectly fine with that. 

 

Do you see how what you are saying leads eventually what you can and can't do?  No more skydiving, no more doing anything risky.  An unhealthy lifestyle is your choice and yours alone! No, you shouldn't be charged more because you eat differently, based really on someone's belief.  I don't need nutritional information on McDonalds food.  We all know people who are in perfect health and lead the perfect lifestyle, who drop over dead, or the unhealthy smoker who still smokes to 100.  If they go to the doctor more, let them pay more, its their choice.

 

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^And that's where the divide is found.  When proponents of health care reform think of health care expenses, they equate (or at least hope to one day equate) them more to expenses for roads, military, schools, etc. than your car or other items of chattel you might own.

 

And that equivalence disturbs me.  Roads, armies, and schools are owned by the state.  How are our health decisions comparable?  They're part of ourselvesWe are not property of the state.

 

The kinds of public health projects and services that I think more fairly analogize to roads, armies, and schools are things like sewer systems, water purification facilities, and quarantining potentially epidemic infections.

 

I'll give you that it makes your argument sound sexier when you replace limit the discussion to 'health care decisions'.  Let's look at England.  Sure, they have what most would call 'national healthcare'..... but does that mean the government controls your healthcare 'decisions'?.... does it mean there is some bureaucrat in a black suit 'standing between you and your doctor'".... of course not.  People are still free to buy their own health care in England, just as I am free to buy my children's education at a school of my preference.  Sure, it is going to put off my retirement quite a bit, but I am free to make that choice.  I can also choose to live on a private right of way.  I can choose to own a property that is not hooked up to any municipally controlled sewer system.  Just because government PROVIDES A SERVICE, does not mean that I have to go with that service.  Hell, I can hire a private army to protect my house if for some reason I am not satisfied with the national guard's ability to protect it in case of an invasion.  Point being, I never have and never will argue for a system where government controls my health care DECISIONS.  Injecting that phrase is a blatant strawman strategy.  Their might be some limitations in the services provided (should I choose to accept them), but I would never advocate for a system where I can't (regardless of means) choose to supplement those services on my own dime.

 

I see Dan has resorted to the slippery slope argument.... yet again.  Not surprising, but he has yet to answer my question from a few weeks ago about (since we have invaded Iraq and Afghanistan) what is stopping us from invading Canada or Greenland or Texas?  Shouldn't we be concerned about that given the precedent we set over the past 11 years?

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^^The slippery slope argument I see.  And of course the seatbelt law will eventually lead to the government outlawing driving because it's simply too dangerous... right?

 

An unhealthy lifestyle choice is yours alone to make, but the ramifications of that choice are not yours alone.  That lifestyle choice, in many cases, impacts society.  If society and/or our government decides that diabetes is costing this country $XXX million per year then I think they have not only the right, but an obligation to enact policies that combat that health epidemic.  If that includes taxing unhealthy, sugary foods and then using that revenue to educate and/or treat people with diabetes then I am fine with that.

 

And you can't continue to argue from the fringes of the data, Dan.  You can't argue for or against something based on uncommon outcomes.  So a lifetime smoker lives until they are 100 and then they get hit by a bus and die... so what?  So does that mean smoking is no longer bad for you?  It's totally illogical and distracts from the meaningful argument that needs to take place around healthcare in the US.

 

The most important thing is that everyone has access to affordable healthcare.  Why are you so against helping poor people become personally responsible for their health instead of relying on "free" ER care? 

 

I just haven't heard an argument against Obamacare that has resonated with me.  I don't understand what people are so afraid of.

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It's very simple, Hoot.  Health care reform is something the democrats have tried to accomplish for 60 years.  It creates a legacy for Obama.  It's going to be the defining moment of his presidency, no matter whether Romney is elected and able to repeal/replace.  That's what people are so afraid of...... putting aside that he only managed to pass a reform centered around a system championed (until it was not) by the Republican party.

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I can't say it any other way. I am not against "poor" people. I am against people abusing the system for many reasons.  Those truly "in need" can always get the help they require, and I think we should pay for it.  You guys simply dismiss anyones feelings or thoughts. Hts favorite phrase is a strawman arguement.  You can see the problems in everything the government has gotten involved in, starting with the Post Office.  No, I don't want to do away with the post office, but to use it as an example, it is losing money, and what do our politicians do?  Brown has a campaign to save to postal union.  Any private business would be out of business if they acted that way.

 

If I use examples, I'm told that they are anectotal, no matter what proof I give. If I say that our current system is the best in the world, my thoughts are laughed at because I am judging on quality, expediency, and most of you are judging on overall care.

 

I'm told the government has the right to run your health lives if you are unhealthy, but if most of the public asks the government to do something about other abuses, welfare for example, nothing can be done because it wouldn't be politically correct.  Did you read about the woman who lost her job because she wouldn't put someones cigarettes on his welfare card?  Why would cigarettes and beer be acceptable to be paid for by the rest of us?

 

Would the government quarantine any illness in this day and age?  I doubt it.

 

Hts, all the money in the world, unless you are very rich, and I'm guessing your not yet; won't change the problem I mentioned a few posts back about going to the ER with my daughter and grandson.  Drs. don't keep the kind of schedule they used to for many reasons.  You can't just pay more money to have your doctor available.  Things change, and malpractice premiums have a lot to do with it.  Being a doctor these days is not very lucrative when one considers the loans, the time, and the expenses.  Those are the kind of changes you will have no choice to make.

 

We have a lot of foolish laws already in my opinion, and I'm sure most of you will laugh and tell me how out of touch I am.  I'm tired of the rights of the unlawful.  We understand how dangerous drunk driving is, but we won't go to the sources of the problem.  We have to set up road blocks, announce them, then pull over everyone.  We pass laws preventing texting or using your phone while driving, yet there is nothing on the books preventing eating, drinking, reading, or putting on makeup.

 

Instead of having laws that deal severly with criminals, we have to have special hate crime laws to make sure that someone gets punished correctly.  How about if you tie a rope around someones neck and drag him from the back of your car, and he's not black; you get the same punishment as someone who does it because he's black?  You severely beat someone to death, what difference does it make if he's gay or not?  Why should the punishment be different?

 

Do you guys really think the costs of this new system are not going to fall on us?

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Well.... I think you pretty much covered all of the partisan lines (albeit not accurately) in society, Dan.

 

To answer your last question, the costs of the current system fall on all of us.  I don't see a major difference.  One way or another, I am going to pay for the care of some people that genuinely can't afford it.  What I like about the new system (and apparently what you despise) is that I will not so much have to pay for the care of those who can afford it but don't have the personal responsiblity to make sure that I don't.

 

As expected, it appears your silver bullet is tort reform.  Is that what you want Romney focusing on if elected?  Is that what Congress should work on passing on a national level?

 

And you don't have to set up roadblocks to pull over a drunk driver.  Not sure where you got that idea.

 

Regarding the food stamp story.... why do people feel the need to take one single outrageous story from one single state generated by one single outrageous employer and turn it into a national epidemic?  You can't buy beer (and similar items) here in Ohio with food stamps (at least not legally).

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^And that's where the divide is found.  When proponents of health care reform think of health care expenses, they equate (or at least hope to one day equate) them more to expenses for roads, military, schools, etc. than your car or other items of chattel you might own.

 

And that equivalence disturbs me.  Roads, armies, and schools are owned by the state.  How are our health decisions comparable?  They're part of ourselvesWe are not property of the state.

 

The kinds of public health projects and services that I think more fairly analogize to roads, armies, and schools are things like sewer systems, water purification facilities, and quarantining potentially epidemic infections.

 

I see Dan has resorted to the slippery slope argument.... yet again.  Not surprising, but he has yet to answer my question from a few weeks ago about (since we have invaded Iraq and Afghanistan) what is stopping us from invading Canada or Greenland or Texas?  Shouldn't we be concerned about that given the precedent we set over the past 11 years?

 

I don't remember you raising this last time, but I can field it this time: The difference lies between Congress having the ability to abuse powers that it clearly has and the ability to redefine terms to give it new powers to abuse.  In this case, that means expanding the definition of what is "commerce" that it can regulate, to include the decision not to engage in commerce in the first place.  (Roberts apparently agreed with this, both before and after his <a href="http://www.cbsnews.com/8301-3460_162-57464549/roberts-switched-views-to-uphold-health-care-law/">last-second change of mind</a>, which is why the court's opinion upholds it only as an exercise of the tax power.)

 

We can levy dumb taxes.

 

We can engage in dumb wars.

 

We can enter into dumb treaties.

 

We can even engage in dumb regulations of commerce.  We do so on a regular basis.  However, the definition of commerce is not so infinitely malleable to give the government power to regulate absolutely everything.  This is a reality that the left has been trying to change for a long time.  The opinion gives at least a small quantity of ammunition to those of us pushing back against such an infinitely malleable definition of commerce.

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If you have evidence that there are more people who can afford insurance but don't have it, than people who don't have it because they can't afford it, than please present it.  The current system falls on all of us, yet it doesn't require us to lose benefits or raise costs.

 

No, my silver bullet isn't tort reform. Its just one of the many problems.

 

And finally, you know exactly what I am talking about concerning drunk drivers and roadblocks, yet you have to play your little game of twisting things around.  Where did I say that you couldn't pull over drunk drivers?

 

Fine, I guess no one ever taught you to have a normal conversation sharing ideas without belittling the other person.  You are just so clever to use such phrases as:

 

-covered all of the partisan lines (albeit not accurately)

 

-(and apparently what you despise)

 

-As expected, it appears your silver bullet

 

-And you don't have to set up roadblocks to pull over a drunk driver.  Not sure where you got that idea.

 

 

 

A putdown in every paragraph!  You should win an award!

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The most important thing is that everyone has access to affordable healthcare.  Why are you so against helping poor people become personally responsible for their health instead of relying on "free" ER care?

 

First, I do not consider that "the most important thing."  I consider the preservation and expansion of liberty to be a priority of a higher order, all the more so for how embattled it is.

 

Second, I am thoroughly unconvinced of the argument that ObamaCare will guarantee that everyone has access to affordable care.  I predict that the healthcare provided by my medium-sized employer will only get progressively more unaffordable than it already was.  The notion that a Byzantine system of price controls, subsidies, and diktats will actually deliver better outcomes at lower cost than a free market system is mind-boggling to me, and I consider it a grave failure of our education system that so many otherwise-intelligent people are convinced that it will actually work.  The insurance companies would not have been such ardent champions of the individual mandate if they seriously thought it was going to cut into their revenues or profits.

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DanB, it's clear by your posting history you toe the Republican line to a degree of absurdity. None of your opinions are your own besides shaping personal events to fit your belief system. Your participation in this forum is practically unnecessary. We all own AM radios already.

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And, after repeated warnings that he was on thin ice, the Admins have chosen to suspend DanB's account permanently. Folks, you don't have to agree with each other, but you have to make an effort to be civil.

 

Permanently? Wow! Was there something that he said that was deleted or things from the past, because what Ive read above doesn't seem to be permanent ban level. Not trying to start anything, just wanted to know. Thanks

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Moderator Note

 

DanB has a "history" that goes back years, and he's been given countless opportunities to clean up his act. For the record: he wasn't banned for being a conservative; he was banned for being a jerk toward other members of UrbanOhio.

 

Now, back on topic, please. Any further off-topic posts will be deleted without warning. If you have a concern about the banning of DanB, take it to the appropriate venue or contact an admin via PM.

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The most important thing is that everyone has access to affordable healthcare.  Why are you so against helping poor people become personally responsible for their health instead of relying on "free" ER care?

 

First, I do not consider that "the most important thing."  I consider the preservation and expansion of liberty to be a priority of a higher order, all the more so for how embattled it is.

 

Second, I am thoroughly unconvinced of the argument that ObamaCare will guarantee that everyone has access to affordable care.  I predict that the healthcare provided by my medium-sized employer will only get progressively more unaffordable than it already was.  The notion that a Byzantine system of price controls, subsidies, and diktats will actually deliver better outcomes at lower cost than a free market system is mind-boggling to me, and I consider it a grave failure of our education system that so many otherwise-intelligent people are convinced that it will actually work.  The insurance companies would not have been such ardent champions of the individual mandate if they seriously thought it was going to cut into their revenues or profits.

 

And the free market has delivered us a monopolistic system that has us heading to spending half our GDP on healthcare.  There has to be a happy medium.  Not sure Obamacare is the best way there, but repealing and maintaining the status quo certainly doesn't solve the problem.

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^And that's where the divide is found.  When proponents of health care reform think of health care expenses, they equate (or at least hope to one day equate) them more to expenses for roads, military, schools, etc. than your car or other items of chattel you might own.

 

And that equivalence disturbs me.  Roads, armies, and schools are owned by the state.  How are our health decisions comparable?  They're part of ourselvesWe are not property of the state.

 

The kinds of public health projects and services that I think more fairly analogize to roads, armies, and schools are things like sewer systems, water purification facilities, and quarantining potentially epidemic infections.

 

I see Dan has resorted to the slippery slope argument.... yet again.  Not surprising, but he has yet to answer my question from a few weeks ago about (since we have invaded Iraq and Afghanistan) what is stopping us from invading Canada or Greenland or Texas?  Shouldn't we be concerned about that given the precedent we set over the past 11 years?

 

I don't remember you raising this last time, but I can field it this time: The difference lies between Congress having the ability to abuse powers that it clearly has and the ability to redefine terms to give it new powers to abuse.  In this case, that means expanding the definition of what is "commerce" that it can regulate, to include the decision not to engage in commerce in the first place.  (Roberts apparently agreed with this, both before and after his <a href="http://www.cbsnews.com/8301-3460_162-57464549/roberts-switched-views-to-uphold-health-care-law/">last-second change of mind</a>, which is why the court's opinion upholds it only as an exercise of the tax power.)

 

We can levy dumb taxes.

 

We can engage in dumb wars.

 

We can enter into dumb treaties.

 

We can even engage in dumb regulations of commerce.  We do so on a regular basis.  However, the definition of commerce is not so infinitely malleable to give the government power to regulate absolutely everything.  This is a reality that the left has been trying to change for a long time.  The opinion gives at least a small quantity of ammunition to those of us pushing back against such an infinitely malleable definition of commerce.

 

I don't disagree with the distinction.  In fact, I've mentioned it at least once in the Bloomberg-soda 'ban' thread.  But the ACA wasn't upheld under the commerce clause, so what's the point?  There is no "reality" as far as some collective effort on the part of the left to change the commerce power of congress.  The 'left' or the "right" want to get from point A to point B on any given issue.  How they get there is largely irrelevant to the group.  If an abortion ban was upheld in court, the 'pro-life' crowd wouldn't give two sh!tes what the court's rationale was.

 

You can also consider the specific context of the post I was responding to:

 

Do you see how what you are saying leads eventually what you can and can't do?  No more skydiving, no more doing anything risky.  An unhealthy lifestyle is your choice and yours alone! No, you shouldn't be charged more because you eat differently, based really on someone's belief.  I don't need nutritional information on McDonalds food.  We all know people who are in perfect health and lead the perfect lifestyle, who drop over dead, or the unhealthy smoker who still smokes to 100.  If they go to the doctor more, let them pay more, its their choice.

 

Read more: http://www.urbanohio.com/forum2/index.php/topic,27582.90.html#ixzz1zWpxadIN

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Actually, if a pro-life law were upheld in court by a decision that in some fashion gave more ammunition to those seeking an ever-expanding federal government (though I don't know what such a rationale might be), I think you would find a great many people who support overturning Roe v. Wade to be disappointed and disquieted, just like many liberals lauding Roberts' decision now because of its result are somewhat disquieted about the limitations on the commerce power that may or may not be contained therein.

 

And yes, there would be others, more ardently devoted to the pro-life cause itself and less to the more fundamental principles of federalism, checks and balances, and separation of powers who would cheer the decision no matter what.  But that would not be a universal truth among the supporters of the original law in question.

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Since the topic of personal responsibility was mentioned previously up thread, I found this article relevant.  The author undoubtedly has some bias, but its worth a read on what real reform should include:

 

http://www.politico.com/news/stories/0712/78063_Page2.html

 

"All of us have to take more responsibility — both for our own health and for the cost associated with it. The federal government now provides health care subsidies to people that are inappropriate and unaffordable. Frankly, these subsidies also encourage over-use of health services"

 

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^I think there's a lot of consensus around that quote.  But I think the political issue is much more fraught than a lot of people make it out to be (believe it or not). I suspect lots of people are in favor of the abstract concept of "reducing medical costs through competition" (i.e., private insurance) because they have in mind "fraud" and "administration costs" as areas that can be cut, but where the rubber meets the road, many of these same people may not be willing to reduce their consumption of healthcare.  I don't have my head as deep in this topic as I wish I did, but given the peculiarities of healtcare services, I think proponents of increased "competition" need to spend more time fleshing out the mechanism by which costs will be reduced through market forces and how this intersects with politics.

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There was an article in the Sunday Dispatch about how insurance companies in Columbus have found that MRI costs are all over the board. I can't find it online, but each hospital in town charges vastly different fees for MRIs. One charges $1300 where another might charge up to $4000. But the real deal is at dedicated MRI facilities away from hospitals. Some charge as little as $130 for the same procedure. That's how competition is supposed to work, but the industry has become so complex from there being so many different hands reaching for the money as it changes hands between the patient and the professionals that it's really tough for the pros (let alone the average person) to make sense of it all. That's why minimizing the number of greedy hands between you and the doc is best.

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^So why don't HMOs require their patients to use the cheaper facilities?  This is what I don't understand...there are already some structural incentives for competition.  Don't insurers want to minimize cash outlays?

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^So why don't HMOs require their patients to use the cheaper facilities?  This is what I don't understand...there are already some structural incentives for competition.  Don't insurers want to minimize cash outlays?

To some degree they do. That's why most have a list of "in-network" providers. The problem is that if they cut off facilities just because they're more expensive, consumers are willing to switch to a different provider that covers the facility they want to go to. Sometimes it's worth overpaying for care at a hospital/clinic/etc in order to keep customers.

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^Right, that's what I thought.  So in that case, there is at least some "competition" but enough insurers are still willing to pay the higher price for one reason or another. I know arbitrary pricing is a problem, but I wonder how much of a cost driver systemwide it really is.  Taming escalating costs can't be as easy as steering people to the cheaper MRIs versus getting people to have fewer MRIs.

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I doubt anyone truly comprehends the entire bill

 

Yet, the rest of your post would have us believe otherwise...

 

Now you want to fine/tax people for not going to the gym?  Because that is what that would be if you refuse to give them money (surely in the form of tax breaks/credits) if they don't comply with your exercise regime.  Not that I am against the plan, but can you imagine the reaction from the right if Michelle Obama proposes this?  Sheesh.... all she wanted to do is encourage healthy eating and exercise among kids and has been attacked for it...

 

It seems like you're just being argumentative.  Probably a by-product of your profession.  Obviously I haven't vetted out how incenting people to be healthy works, but there's no penalty for anything.  Only a reward for certain behavior.  So no, that's not a fine or a tax.

 

I don't know what the reaction would be if Michelle Obama proposed that.  I think any negative reaction to her promotion of healthy eating and staying fit is completely ridiculous.  Anyway, several companies - including the Cleveland Clinic - offer this type of incentive based program to their employees to help keep their health incurance premiums low.  I think the Clinic's program is if an employee signs into the work gym a certain # of times per month, they are rewarded financially.  They realized it was more cost effective to pay people to be healthy than pay for unhealthy employees health insurance premiums.

 

Addressing problems 1 at a time are much more effective than a 1,000+ page law that requires everyone to spend upwards of 7 percent of their income on health insurance or pay a fine of several thousand dollars.

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just like many liberals lauding Roberts' decision now because of its result are somewhat disquieted about the limitations on the commerce power that may or may not be contained therein.

 

That's an interesting question I heard some conversation about this past week - is Roberts ruling on the commerce power precedent or mere dicta?  I suppose sine the other justices wrote their own opinions and the rest of the 'majority' did not reach the same conclusion, then it is not binding precedent.  Doesn't really matter to me.  We got to point B and we got there the way I thought it should have been explicitly done in the first place by Congress.

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^^But what if a gym isn't really someone's thing? People like to play sports, ride bikes, run, all sorts of stuff. Gyms don't provide people with the visual, auditory, olfactory, adrenal and other nature-oriented rewards that some individuals need in order to be motivated to perform physical activity.

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There was an article in the Sunday Dispatch about how insurance companies in Columbus have found that MRI costs are all over the board. I can't find it online, but each hospital in town charges vastly different fees for MRIs. One charges $1300 where another might charge up to $4000. But the real deal is at dedicated MRI facilities away from hospitals. Some charge as little as $130 for the same procedure. That's how competition is supposed to work, but the industry has become so complex from there being so many different hands reaching for the money as it changes hands between the patient and the professionals that it's really tough for the pros (let alone the average person) to make sense of it all. That's why minimizing the number of greedy hands between you and the doc is best.

 

Interesting line of discussion here.  It seems to me that there is a real lack of transparency in pricing in the healthcare industry.  Occasionally when I'm looking for a new doctor I'll call around and ask about prices for regular appointments and rarely will I be able to get a straight answer.  It seems like this would be an important thing that an informed consumer should be able to find out and yet it's oftentimes difficult to get access to this information.  If competition were to ever be a key part of our healthcare system, it's stuff like this (and fair but honest doctor ratings) that patients will need to be able to easily research.

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^But most consumers don't pay the sticker price for appointments, only a fixed co-pay.  And I would guess most doctors have negotiated rates with major insurers, so there is no opacity in the pricing between the real consumer (the insurer) and the service provider.  In that sense, competition is already part of our system.  Or at least the incentives are there for it, assuming that insurers look to minimize out of pocket costs (among other goals) to maximize profits.  Admittedly things get a lot more complicated when sick people are seeking specialist care for which their insurer only pays a percentage of the cost.

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It seems like you're just being argumentative.  Probably a by-product of your profession.  Obviously I haven't vetted out how incenting people to be healthy works, but there's no penalty for anything.  Only a reward for certain behavior.  So no, that's not a fine or a tax.

 

It seems that speculation about my profession is the go-to card this month when a substantive response doesn't come immediately to mind.  Whatever makes you feel better..... but I think the obsession over my personal life (not just you) and any "by-product" thereof is a bit weird.  Back on topic.....  If what you propose is not a tax, then how would you propose paying for it?  Where would the "incenting" come from?  Or were you proposing a non-deficit neutral program?

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^But most consumers don't pay the sticker price for appointments, only a fixed co-pay.  And I would guess most doctors have negotiated rates with major insurers, so there is no opacity in the pricing between the real consumer (the insurer) and the service provider.  In that sense, competition is already part of our system.  Or at least the incentives are there for it, assuming that insurers look to minimize out of pocket costs (among other goals) to maximize profits.  Admittedly things get a lot more complicated when sick people are seeking specialist care for which their insurer only pays a percentage of the cost.

 

Yeah, you're probably right.  My insurance has some limits and doesn't always cover everything so I have to be a little more careful.  I still think that information would be nice to have for general consumption, but your point is valid, too.

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just like many liberals lauding Roberts' decision now because of its result are somewhat disquieted about the limitations on the commerce power that may or may not be contained therein.

 

That's an interesting question I heard some conversation about this past week - is Roberts ruling on the commerce power precedent or mere dicta?  I suppose sine the other justices wrote their own opinions and the rest of the 'majority' did not reach the same conclusion, then it is not binding precedent.  Doesn't really matter to me.  We got to point B and we got there the way I thought it should have been explicitly done in the first place by Congress.

 

Volokh Conspiracy has multiple detailed posts on that (and, as often happens among legal academics, a lot of qualifiers in front of guesses).  I would call it holding because there are 5 votes on the Supreme Court for that narrower interpretation of the Commerce Clause, and the principle of stare decisis is supposed to prompt lower court judges to rule on a given law in the fashion that they predict is least likely to be overturned on appeal--i.e., consistent with what the appellate courts above them have already stated.  Since a pure Commerce Clause mandate case would likely encounter 5 "no" votes on the Supreme Court, lower courts should rule against it.  However, the Supreme Court's own precedent regarding what a "holding" is doesn't read that way, giving lower courts room to make rulings that they might well believe would encounter 5 "no" votes at the Supreme Court, and so few cases make it up that high anyway that lower court judges have a great deal of room to ignore the Supreme Court in practice.  I'm not even fully sure if Roberts fully thought that through--I don't want to shortchange his intelligence, given his academic and professional history, but all evidence points to his Tax Clause holding being the product of an eleventh-hour switch, and Supreme Court justices are still human and can falter under time pressure and political pressure.  Moreover, while his four clerks are among the brightest young lawyers in the country, they still number only four, and redrafting at the last second in response to what candidly appears to be either a politically calculated or politically craven reversal (depending on your perspective) may not have left time to think through everything he would have wanted to, unless he really was planning this from the beginning.  Given both the clues in the opinions themselves and the leaks from within the Court, I consider the latter an unlikely possibility.

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I'm here to tell you, the quickest way to fix healthcare is to get rid of all employee sponsored health care.  The majority of people around me opposed to government intervention are spoon-fed a plan by their employer.  If they were true "conservatives," they would join the ranks of the uninsured and shop for their families' insurance on the open market.  Only then would they know what a mess it is.  Only then would they know if their employers are screwing them or not.  Only then would they know that they cannot buy the same policy as someone 50 miles away in a different zipcode.

 

The "free market" doesn't exist in healthcare now.  Threats of socialism are only thinly-veiled protections for the current monopolies. 

 

I'm not saying Obama care is the solution.  But the current system sucks.  There has to be a better way.

 

So I challenge all my white collar friends to cancel their employer sponsored plan, flex spending accounts and other tax dodges, and shop on the open market as an individual.  Suddenly Obamacare wouldn't seem so bad....

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The "free market" doesn't exist in healthcare now.  Threats of socialism are only thinly-veiled protections for the current monopolies. 

 

Bingo. That's one of the reasons the partisan public debate is so annoying. Obamacare isn't socialism. And the current state of healthcare isn't proof that a free market solution failed.

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^^Public option.  It's a compromise between universal coverage and the current system.  It would be much, much more effective at controlling/lowering costs than the ACA and anything is better than the skyrocketing system we had before the ACA.

 

^^^I certainly wouldn't underestimate Roberts' intelligence and I'm not sure I'm buying the 11th hour conspiracy theory.  He might have switched his official vote at the 11th hour, but I would be fairly certain he had the bulk of the opinion he was switching to already written in some form.

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^^^I certainly wouldn't underestimate Roberts' intelligence and I'm not sure I'm buying the 11th hour conspiracy theory.  He might have switched his official vote at the 11th hour, but I would be fairly certain he had the bulk of the opinion he was switching to already written in some form.

 

I don't think the 11th-hour switch qualifies as a "conspiracy theory."  There is a lot of evidence for it, both in the opinions themselves and in the Jan Crawford story (which appeared on CBS, not some fringe Web site).  I think it's the dominant belief of both supporters and opponents of the ACA.  Of course we'll never know for sure, but the greater weight of the evidence certainly leans that way.  That's the best one can generally do.

 

I'm also not sure that he had the bulk of the final opinion actually written before he switched his vote.  There might have been a bench memo from one of his clerks lying around somewhere on the possibility, but I would wager that there wasn't anything more than that, and maybe not even that.  Both supporters and opponents of the ACA noted that the writing of the lead opinion was not up to Roberts' normal standards and was somewhat disjointed in places, not signs of a product that was a long time in the making.

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