Questions about Obamacare

[mooncliff]

1. If it is such a bad idea, how come everyone else in the industrialized world has it?

2. Without socialized medicine, why is the US number 29?

3. If it is such a bad idea, how come Hawaii has had it for 50 years and has the longest lifespan in the US?

Let the confabulation, motivated reasoning, and "mistakes were made, but not by me" begin!

(I am not talking about whether the US can afford to do this now that it is the greatest debtor of all time. About that I have no idea. The US should have done this in the 1950s when the economy was booming.)

Note that this is actually much worse than it looks. The US spends the most, like DOUBLE what everyone else is spending, and gets the WORST outcome.

The United States tied Norway for 29^th place in male healthy life expectancy and tied Estonia for 33^rd place in highest female healthy life expectancy.
Japan is the healthiest nation for men and women, a title it was first given by same study in 1990. [mooncliff comment: I think Japan was second last year because of the 20,000 people killed by the tsunami] For men, Singapore, Switzerland, and Spain ranked second, third, and fourth. South Korea, Spain, and Singapore ranked highest for women.
Highest Male Healthy Life Expectancy:

1. Japan
2. Singapore
3. Switzerland
4. Spain
5. Italy
6. Australia
7. Canada
8. Andorra
9. Israel
10. South Korea

Highest Female Healthy Life Expectancy:

1. Japan
2. South Korea
3. Spain
4. Singapore
5. Taiwan
6. Switzerland
7. Andorra
8. Italy
9. Australia
10. France

http://abcnews.go.com/blogs/health/2...est-countries/

[dcarrigg]

Re: Questions about Obamacare

The US should have done this in the 1950s when the economy was booming.

It is not that it wasn't tried.

Teddy Roosevelt tried to lay the groundwork for it. FDR tried to push it through, but could not.

Truman actually came closest. The Wagner-Murray-Dingell bill almost got through. That was the bill, here's a little history. Truman tried it November 19, 1945 - the day after armistice. It FDR had lived, he probably would have had the cache to get it through.

But for a couple of votes back in the 40's, or the untimely death of a single man, the US would look like every other first world country on healthcare now.

[aaron]

Re: Questions about Obamacare

You will find that many of those countries' citizens eat far less than Americans. But, a few trillion dollars can make up for that. YES WE CAN!

A real national health care system, with real benefits and limits could be cheap and effective. You pick the top 200 generic drugs and proven medical interventions, and give it to everybody. You want a million dollar hospital stay in your 80's? You best pay for it yourself or with private insurance.

A friend of mine, in his 40's broke his ankle in a hockey game. Of course, since he has medical coverage, he is entitled to spend $1.3 million dollars to fix it. Can you imagine how much REAL medical care $1.3 million dollars could provide?
Yeah, he wont limp too badly in the future.

1.3 million: 26000 people could have a generic prescription for 1 year. Or, 13000 people could be seen for a wellness exam. Or, 500 simple fractures could set. Or, 1/2 a million people could be given vaccine (prevent the loss of thousands of lives). Or you can train 6 new doctors, 30 new nurses, etc.

Life expectancy figures are hard to rely on. Our crack babies (or whatever is the newest drug) could throw off the numbers quite a bit. Those other countries also have less hangups about abortion. Kids that would not be well taken care of or with poor genetics are not making it into the pool. War also can be tough on those numbers. The U.S. has gets a steady number of dead soldiers. How many have their been? Plus, with such a large military, accidents happen.


But, yes, obviously a national health care system would be excellent. It just needs to be designed to contain costs. We did not get that, and it will be fun when if fails spectacularly. *

* Or, as I believe, this whole Obama care thing is one huge economic stimulus. If there are 5 million unemployed people who can be trained to provide health care services, and the deficit does not matter, and the only thing wrong with all the stimulus so far has been transmission to the people, then maybe this is the only way. the rest of the world can rightly complain about the US abuse of the dollar when we print money. They are not able to whine when our budget blows up because we are helping poor people get medical care (like they have done for decades).

[shiny!]

Re: Questions about Obamacare

It's all fine and good until it's your ankle on the line, your child that is sick. What you espouse is a very slippery slope towards a socialist utopia. The Nazis did it oh so well. Crippled? Retarded? Skin too dark? Bad genes! Toss 'em in the ovens!

The problem isn't that your friend wasted insurance money on his ankle. The problem is that the insurance industry caused his treatment to cost so much.

I don't want anyone else to pay for my health care because I don't want you or anyone on a committee having a say in what health care I can have. I don't like the current sick-care system, and I don't want a national healthcare system. The problem with the current insurance system, or a national healthcare system, is the premiums or taxes extracted to maintain them rob me of my ability to pay for the healthcare I want, the way I want it. Let me keep my blasted money and spend it the way I see fit.

I want to get rid of the I in FIRE, but I don't want to replace it with another government bureaucracy. Give me an open, competitive, truly free market health care system with transparent pricing. Let me deal with and pay my doctors directly, the way my parents did when I was a kid. Then doctors and hospitals can reduce their fees because they will have eliminated all the administrative costs demanded by the insurance companies.

It's already starting to happen.

[leegs]

Re: Questions about Obamacare

It's all fine and good until it's your ankle on the line, your child that is sick. What you espouse is a very slippery slope towards a socialist utopia. The Nazis did it oh so well. Crippled? Retarded? Skin too dark? Bad genes! Toss 'em in the ovens!

The problem isn't that your friend wasted insurance money on his ankle. The problem is that the insurance industry caused his treatment to cost so much.

I don't want anyone else to pay for my health care because I don't want you or anyone on a committee having a say in what health care I can have. I don't like the current sick-care system, and I don't want a national healthcare system. The problem with the current insurance system, or a national healthcare system, is the premiums or taxes extracted to maintain them rob me of my ability to pay for the healthcare I want, the way I want it. Let me keep my blasted money and spend it the way I see fit.

I want to get rid of the I in FIRE, but I don't want to replace it with another government bureaucracy. Give me an open, competitive, truly free market health care system with transparent pricing. Let me deal with and pay my doctors directly, the way my parents did when I was a kid. Then doctors and hospitals can reduce their fees because they will have eliminated all the administrative costs demanded by the insurance companies.

It's already starting to happen.

Shiny you seem to be referring primarily to regular or routine care. But this really should be seen separately from the need for insurance against catastrophic events. Even in a perfect world with real prices based on fair costs, the average person could not hope to pay for things like cancer treatment or say heart surgery, or being put back together after a bad car accident. So it seems to me that even in your example, insurance is required.
Assuming you agree, perhaps the first question is who provides (and I mean provides, not who pays for) this insurance - govt or private sector? Many of the follow on questions regarding this scenario are obvious.

[doom&gloom]

Re: Questions about Obamacare

I'm no fan of ObamaCare solely because it was hammered out by inductry lobbyists and there was really no 'sunshine' on this program. Thus my 'you are gonna get reamed' antennae come up immediately.

As a person with metal implants, and the possibility that some day I may have to replace such, I see ObamaCare for me as personally good. But for the nation in general, not really. It seems overly complex, loaded with 'favors; for 'favorites' in the HC industry, and increases bureaucracy immensely.

For those who question the idea of limits, I feel quite sure that this is going to give us limits, and long waiting times in the future. I don't see how it saves anyone money, in fact it is gonna cost the poor much more than they can probably ever afford, even though the curent system is clearly broken.

rewriting the entire HC system for a nation in a few short months is no way to run it, only to ruin it. I expect as a result those of us who can afford 'medical tourism' will end up doing so, and many of the rest will end up with rather marginal care.

In many countries in SA, you have a public/private system where you get decent basic care, and pay for anything above it. tha is probably the way to go. Not everyone needs maternity or diabetes services. For those that do there should be added costs involved. Asking people to subsidize the bad habits of others is just no way to run a system. And I say that as a 'fat guy' as well.

In the end, the Democrats 'own' and will continue to 'own' this travesty. They can try to blame the Republicans for not voting for it, but it was solely their bill.

Lastly, I should add that I have always believed we would get a good HC bill when everyone in government, especially the 'more equal' pigs of CONgress had to be 100% part and parcel of the new system. Anything less, and the rest of us sheeple get the shaft. We all know how that worked out, huh?

[Ghent12]

Re: Questions about Obamacare

1. If it is such a bad idea, how come everyone else in the industrialized world has it?

2. Without socialized medicine, why is the US number 29?

3. If it is such a bad idea, how come Hawaii has had it for 50 years and has the longest lifespan in the US?

Let the confabulation, motivated reasoning, and "mistakes were made, but not by me" begin!

(I am not talking about whether the US can afford to do this now that it is the greatest debtor of all time. About that I have no idea. The US should have done this in the 1950s when the economy was booming.)

Note that this is actually much worse than it looks. The US spends the most, like DOUBLE what everyone else is spending, and gets the WORST outcome.

Haha, Hawaii? Maybe they live so long because they're in paradise, ya? You know da kine.

Everyone else in the industrialized world has it because they are socialists who have long ago surrendered to the whims of the masses, rather than take up the challenge of good governance through republicanism. We here in America used to have a republic, but lately we believe in economic fascism so we let our corporations control us by and large.

Speaking of the time period of about 50 years ago, the American system was absolutely top notch. Still is. But now we see what decades of tax-exempt health insurance compensation has wrought--when the government sides with the corporations, everyone loses (except the insurance companies). We don't have a free market and we don't really have socialized medicine. We have fascist medicine, where the "death panels" are currently filled with insurance company bureaucrats. People without the ability to think through things would prefer that we fill those "death panels" with government bureaucrats. I, however, prefer the only solution that makes sense--no "death panels," and health care is provided commensurate with demand. A legitimate free market, in other words.

But oh, no, people have heart attacks, so we can't have a free market for regular medicine... Why do people lose their ability to think critically when it comes to health care?

The United States tied Norway for 29^th place in male healthy life expectancy and tied Estonia for 33^rd place in highest female healthy life expectancy.
Japan is the healthiest nation for men and women, a title it was first given by same study in 1990. [mooncliff comment: I think Japan was second last year because of the 20,000 people killed by the tsunami] For men, Singapore, Switzerland, and Spain ranked second, third, and fourth. South Korea, Spain, and Singapore ranked highest for women.
Highest Male Healthy Life Expectancy:

1. Japan
2. Singapore
3. Switzerland
4. Spain
5. Italy
6. Australia
7. Canada
8. Andorra
9. Israel
10. South Korea

Highest Female Healthy Life Expectancy:

1. Japan
2. South Korea
3. Spain
4. Singapore
5. Taiwan
6. Switzerland
7. Andorra
8. Italy
9. Australia
10. France

http://abcnews.go.com/blogs/health/2...est-countries/

Another rant about life expectancy as if that statistic meant anything. The US has numerous factors that are primarily negative contributors to life expectancy that have absolutely nothing to do with health care; our culture tends towards both violence and freedom and these are expressed mostly in the forms of guns and cars, and we don't place any reasonable training requirements on the operation of either. Then there is the obesity epidemic, which is only tangentially related to health care, but that is a lifestyle choice for the New America, where nobody is expected to be held accountable for their own actions. Good news for you, I suppose, since not being held accountable for your actions is one of the tenets of socialism.

Then of course there is the matter of infant mortality, which substantially influences life expectancy yet is tabulated in vastly different ways between countries. Did your three week old die of SIDS? In some countries, that isn't tabulated for infant mortality statistics--try telling that to the family, though. Statistics are not reality. Life expectancy statistics are not even remote reflections of reality, especially as a metric of measuring the effectiveness of health care.

[Thailandnotes]

Re: Questions about Obamacare

Even in a perfect world with real prices based on fair costs, the average person could not hope to pay for things like cancer treatment or say heart surgery, or being put back together after a bad car accident.

Actually, that's not the case in many countries. Most of the elderly expats I know in Thailand, the ones in their 70's and 80's don't have insurance. They claim they can't afford it, but they do have money set aside for the big expensive treatments that often go with the end of life. Decent insurance here costs 1,400 dollars per year for a 55 year old male. I can't speak to cancer and heart treatment costs specifically, but I know people in both situations who have no insurance and are by no mean being wiped out financially.

I recently had a colonoscopy. Five or six doctor visits, the procedure, and some drugs that would be rather expensive in the states altogether cost between 450 and 550 dollars. The hospital facilities were excellent. The doctor in his late 30's was excellent and speaks perfect English. I cannot guess how much this would have cost in the US. 20 - 30 thousand?

[shiny!]

Re: Questions about Obamacare

Everyone else in the industrialized world has it because they are socialists who have long ago surrendered to the whims of the masses, rather than take up the challenge of good governance through republicanism. We here in America used to have a republic, but lately we believe in economic fascism so we let our corporations control us by and large.

Speaking of the time period of about 50 years ago, the American system was absolutely top notch. Still is. But now we see what decades of tax-exempt health insurance compensation has wrought--when the government sides with the corporations, everyone loses (except the insurance companies). We don't have a free market and we don't really have socialized medicine. We have fascist medicine, where the "death panels" are currently filled with insurance company bureaucrats. People without the ability to think through things would prefer that we fill those "death panels" with government bureaucrats. I, however, prefer the only solution that makes sense--no "death panels," and health care is provided commensurate with demand. A legitimate free market, in other words.

But oh, no, people have heart attacks, so we can't have a free market for regular medicine... Why do people lose their ability to think critically when it comes to health care?

Thank you! Every sentence you wrote deserves to be bolded, IMO.

Health care has become as emotional an issue as gun control and the abortion debate. It's impossible to do meaningful long-term problem solving when people are frightened and grasping. It's like when a lifeguard is trying to save a drowning person who is panicking so badly he fights the lifeguard...

For anyone who supports government controlled health care, remember your last trip to the DMV. Rememer that highly intelligent, well-motivated individual behind the counter who "served" you? Remember your last trip to the airport, and the brilliant individuals from the TSA who provided such thoughtful and insightful care to "keep you safe"? You actually want to give those people the power to make life and death decisions over your life and the lives of your loved ones?

[jk]

Re: Questions about Obamacare

For anyone who supports government controlled health care, remember your last trip to the DMV. Rememer that highly intelligent, well-motivated individual behind the counter who "served" you? Remember your last trip to the airport, and the brilliant individuals from the TSA who provided such thoughtful and insightful care to "keep you safe"? You actually want to give those people the power to make life and death decisions over your life and the lives of your loved ones?

unfortunately the real world choice seems to be between such a bureaucrat and an insurance executive who gets a bonus if he figures out a way to deny you care.

[DSpencer]

Re: Questions about Obamacare

1. If it is such a bad idea, how come everyone else in the industrialized world has it?

Nobody else in the world has Obamacare. Obamacare is not nationalized healthcare. It takes the worst of both worlds approach we have now and makes it even worse.

2. Without socialized medicine, why is the US number 29?

Because our system is one which is partially socialized and heavily regulated but has few of the advantages of full scale socialized medicine or free market healthcare. Also our population is terribly unhealthy. Obesity is out of control, smoking is still a big problem and there's probably several other contributing factors such as the type of food we eat, attitudes towards health, etc.

3. If it is such a bad idea, how come Hawaii has had it for 50 years and has the longest lifespan in the US?

What does "it" refer to? Obamacare? Nationalized Healthcare? Something else?

[shiny!]

Re: Questions about Obamacare

unfortunately the real world choice seems to be between such a bureaucrat and an insurance executive who gets a bonus if he figures out a way to deny you care.

The third choice is freedom and true open markets w/ regards to health care, but few people even think about that possibility. FIRE and a too-powerful central government control the messages that come from media, so this third approach gets little serious consideration. Citizens who once treasured their independence have become sheeple craving security.

When I was a kid we paid out-of-pocket for most things, and had an insurance policy for the big stuff. The policy protected our family from destitution if something big happened but it didn't cause our destitution in an of itself. We can't say that about insurance anymore. It's become a super expensive chemotherapy that kills the cancer patient as thoroughly as the cancer itself, and costs more to boot.

[aaron]

Re: Questions about Obamacare

Shiny, I am not espousing that stuff. I am just bringing it up as possible reasons why other countries might have a higher lifespan. And, no, they have not become NAZIs . They do not throw kids in the oven.

I am a greedy bastard just like the next guy. I would spend millions of other people's money to fix my ankle. (but playing ice hockey in your 40's?). I would realize I am being a greedy bastard, however.

What I describe as a government health care system would work, be cheap, and would still allow for insurance companies to take your money. It is something that could be passed in both houses, if not now, then when the new system breaks the government finances.

I would rather FIRE go and die also. How likely is that?

[dcarrigg]

Re: Questions about Obamacare

Nobody else in the world has Obamacare. Obamacare is not nationalized healthcare. It takes the worst of both worlds approach we have now and makes it even worse.

Because our system is one which is partially socialized and heavily regulated but has few of the advantages of full scale socialized medicine or free market healthcare. Also our population is terribly unhealthy. Obesity is out of control, smoking is still a big problem and there's probably several other contributing factors such as the type of food we eat, attitudes towards health, etc.

What does "it" refer to? Obamacare? Nationalized Healthcare? Something else?

+1.

Obama care is a four-way combination of regulation, direct benefits, corporate tax write-offs, and personal tax write-offs piled on top of two levels of government (state and federal) in such a way that, even when it is all implemented, not a single person will be covered for anything.

Individuals then have to go, figure out how to use their tax break, figure out which corporation that uses the corporate tax break is offering them a decent deal, figure out what their state allows, figure out if they qualify for direct benefits or not, then sign up to a plan to buy private insurance.

The new regulations shape the private insurance policies somewhat. But they do not at all speak to what they can charge for services, nor do they speak to how much money they can extract from the system, even though they have semi-monopolistic pricing power.

I thought it was a bad idea when the Heritage Foundation came up with it, and I still think so now. Probably the best thing it will do is get some capital gains dollars in to sure up Medicare.

The third choice is freedom and true open markets w/ regards to health care, but few people even think about that possibility. FIRE and a too-powerful central government control the messages that come from media, so this third approach gets little serious consideration. Citizens who once treasured their independence have become sheeple craving security.

When I was a kid we paid out-of-pocket for most things, and had an insurance policy for the big stuff. The policy protected our family from destitution if something big happened but it didn't cause our destitution in an of itself. We can't say that about insurance anymore. It's become a super expensive chemotherapy that kills the cancer patient as thoroughly as the cancer itself, and costs more to boot.

I agree wholeheartedly with my libertarian friends here about the problem. But I may strongly disagree about the solution. This may be just because I have lived in other countries and the United States and used services in both places.

I found the German model to be quite good. The American model has also done alright at patching me up. But the model sucks so much indentured labor out of the sick as to be morally suspect. Here's my little personal anecdote.

When I was about 18-19 in the US my appendix popped. I had no insurance. Maybe that was my fault, although I'm not quite sure how I was supposed to afford it. Anyhow, the "freedom" to choose between death on one hand and half-a-decade of court, bills, garnishment threats, and nonsense on the other, didn't have me crying red white or blue tears. In fact, come to think of it, I don't think I was even allowed to chose death.

In fact, it felt a lot more like extortion than freedom. And what did it cost the hospital? One day's rent of a bed. Two hour's pay to a doctor. One hours pay to an anesthesiologist. A couple of hundred dollars in drugs and sutures and maybe for rent of tools. One day's board. Maybe four hours between a nurse and nurses' aides. Some incidental paperwork. Even at the expensive end of things, what should that be? $2,000? But that's about an order of magnitude less than I owed.

[stetts]

Re: Questions about Obamacare

When I was a kid we paid out-of-pocket for most things, and had an insurance policy for the big stuff. The policy protected our family from destitution if something big happened but it didn't cause our destitution in an of itself. We can't say that about insurance anymore.[/COLOR] It's become a super expensive chemotherapy that kills the cancer patient as thoroughly as the cancer itself, and costs more to boot.

I concur. I departed the military in '72 and went dairy farming with a new wife and two kids. Our next two kids were born in the community hospital. We paid cash (around $500-$700 each if I recall) for excellent care and went home. Regular visits cost $20 or so and we paid cash. We used a very high ($5000) deductible policy. We figured that'd really hurt, but we'd make it. Never needed it, fortunately. That hospital has changed hands several times and is now unrecognizable.
Another point--Obamacare is about getting covered by insurance. If you need care, that's just the piece of paper. Obamacare does nothing about actually making care available, and in fact will more likely reduce actual care. I think our discussions should carefully and clearly note whether we're talking about access to insurance or access to actual caregivers.
Take care. Stetts