SCOTUS UPHOLDS OBAMACARE

[glassgowkiss]

News Flash: bhoener near tears...

 

he is just trying to remember the taste of KKK cock.

[KaskadskyjKozak]

News Flash: bhoener near tears...

 

Au contraire, he's happy as a clam. Now he's got ammunition to raise money and energize his base.

[pink]

Libs are so cute when they show their authoritarian colors.

 

Conservatives are especially cute when the only math they can do relates to the money in their own pockets. Which - when it comes to their real costs, risks, and roi of healthcare (and often vaccines )- seems to entirely elude them anyway.

 

so true joseph, conservatives are so concerned with the money in their pockets, but i find that liberals are overly concerned with the money in the conservatives pockets and it isn't even their money.

[pink]

Libs are so cute when they show their authoritarian colors.

 

Conservatives are especially cute when the only math they can do relates to the money in their own pockets.

 

The only math libs do relates to the money in others' pockets.

you are a complete retard, the worst case. THIS IS REPUBLICANS, who built a system to raid other pockets- vide financial collapse of 2008. who was the president? Short memory facko.

 

so someone is raiding ur pocket? no, u spend ur time climbing and other people spend their time collecting money. i've learned to do a little of both. don 't feed the animals

 

[kevbone]

Written by a friend of mine. Since I am a simpleton I will just pass it along.

 

 

Here is my problem with the 'healthcare bill' as it is.

 

Right now (as my recent visit to the hospital's resulting bill indicated) prices at hospitals are completely out of control. The reason for this as far as I can tell are largely because all of the players involved know that money will come to pay for it.

 

Forcing insurance on everyone only makes this problem worse. The only way to drive down the price of a thing is to reduce its demand and to increase its supply.

 

Instead we are subsidizing the American overuse of medical assistance, and as a result we will get more of it as newly insured people try to 'get their money's worth' out of their new insurance.

 

I NEVER visit hospitals, but I am not being told that I have to pay about 8% of my income to medical care or the IRS will start banging on my door.

 

Small employers like my father are holding off hiring new people out of fear of the added expense.

 

Insurance companies are winning. Corporate hospitals are winning. Pharma companies are winning. This is not healthcare reform, this is a VERY large new tax with disproportionate returns. Sure we will hear 'stories' about how it helped some people, but we won't hear the stories of the families who were right on the edge being nudged down into the poverty bracket and forced onto govt assistance because of this.

[Phil K]

Kev, if you really were a simpleton that would be excusable. But you are just willfully ignorant like 99% of the Tea-tard/Ron Paul/Faux News kooks. You could have a clue, but you refuse to; shame on you.

[KaskadskyjKozak]

Kev, if you really were a simpleton that would be excusable. But you are just willfully ignorant like 99% of the Tea-tard/Ron Paul/Faux News kooks. You could have a clue, but you refuse to; shame on you.

 

It takes someone like Boner to make you look smart; you should be more gracious to him.

[JayB]

What people seem not to understand, is that by having a disproportionate percentage of the population uninsured, not only are "we" (the insured population) paying for the inevitable costs of caring for the uninsured, but are paying much more when they show up at the ER with advanced diseases that could have been treated cheaper and yielded better outcomes had they had access to basic medical services to begin with. That's a big part of why the US pays more as percent GDP than any other country for poorer results.

 

I'd like to see how the righties come up with the figures which they're trying to terrorize the Tea-tards with now which describes this a giant huge new tax burden on ordinary 'Muricans. I call BS. It's not like they aren't pathological liars already.

 

 

Exactly. I can think of several studies i've read looking at elderly care and medicares costs per person that have all shown that it's much less expensive to pay up front with prevention, monitoring, and support than to pay on the back end for acute cases.

 

Even going locally I had a chance to talk to some folks who worked at Harborview and were well versed in the topic and some local work had shown the cost in ER visits for local homeless folks per year was more than 2x what the cost would be to house them.

 

Right now these same folks are all getting healthcare, it's just a shell game of when, where and who picks up the tab.

 

I'm not trying to pick on you in particular - but I'll respond to your post since you seem like a smart, reasonable guy and you seem to be sympathetic to the arguments put forward by everyone else who supports the mandate.

 

Which studies are you referring to? Systematic reviews of the costs and benefits of "prevention" do not support any such generalization.

"Our findings suggest that the broad generalizations made by many presidential candidates can be misleading. These statements convey the message that substantial resources can be saved through prevention. Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not."

 

http://www.nejm.org/doi/full/10.1056/NEJMp0708558

 

The notion that the uninsured are the primary driver of cost shifting that other payers have to bear is also false. That distinction belongs to medicare and medicaid, both of which systematically pay less than it costs to provide care for those covered by the programs, and the costs of the shortfall are passed onto private payers. Cost shifting from Medicare and Medicaid adds roughly 15% to private payer premiums(1). The uninsured add less than two percent(2).

(1)http://publications.milliman.com/research/health-rr/pdfs/hospital-physician-cost-shift-RR12-01-08.pdf

(2)http://www.kff.org/uninsured/upload/7809.pdf

 

Finally - if you support mandating the purchase of health insurance on the grounds that those who do not do so are imposing costs on everyone else, how would you feel about the government mandating that everyone in the country maintain a healthy body weight and fining those who refuse to comply with the mandate on the basis that they are imposing costs on everyone else? It's not clear to me how a logically consistent person could support the former and not the latter.

 

[Phil K]

What people seem not to understand, is that by having a disproportionate percentage of the population uninsured, not only are "we" (the insured population) paying for the inevitable costs of caring for the uninsured, but are paying much more when they show up at the ER with advanced diseases that could have been treated cheaper and yielded better outcomes had they had access to basic medical services to begin with. That's a big part of why the US pays more as percent GDP than any other country for poorer results.

 

I'd like to see how the righties come up with the figures which they're trying to terrorize the Tea-tards with now which describes this a giant huge new tax burden on ordinary 'Muricans. I call BS. It's not like they aren't pathological liars already.

 

 

Exactly. I can think of several studies i've read looking at elderly care and medicares costs per person that have all shown that it's much less expensive to pay up front with prevention, monitoring, and support than to pay on the back end for acute cases.

 

Even going locally I had a chance to talk to some folks who worked at Harborview and were well versed in the topic and some local work had shown the cost in ER visits for local homeless folks per year was more than 2x what the cost would be to house them.

 

Right now these same folks are all getting healthcare, it's just a shell game of when, where and who picks up the tab.

 

I'm not trying to pick on you in particular - but I'll respond to your post since you seem like a smart, reasonable guy and you seem to be sympathetic to the arguments put forward by everyone else who supports the mandate.

 

Which studies are you referring to? Systematic reviews of the costs and benefits of "prevention" do not support any such generalization.

"Our findings suggest that the broad generalizations made by many presidential candidates can be misleading. These statements convey the message that substantial resources can be saved through prevention. Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not."

 

http://www.nejm.org/doi/full/10.1056/NEJMp0708558

 

The notion that the uninsured are the primary driver of cost shifting that other payers have to bear is also false. That distinction belongs to medicare and medicaid, both of which systematically pay less than it costs to provide care for those covered by the programs, and the costs of the shortfall are passed onto private payers. Cost shifting from Medicare and Medicaid adds roughly 15% to private payer premiums(1). The uninsured add less than two percent(2).

(1)http://publications.milliman.com/research/health-rr/pdfs/hospital-physician-cost-shift-RR12-01-08.pdf

(2)http://www.kff.org/uninsured/upload/7809.pdf

 

Finally - if you support mandating the purchase of health insurance on the grounds that those who do not do so are imposing costs on everyone else, how would you feel about the government mandating that everyone in the country maintain a healthy body weight and fining those who refuse to comply with the mandate on the basis that they are imposing costs on everyone else? It's not clear to me how a logically consistent person could support the former and not the latter.

 

'Couple of points: The NEJM article you linked to discusses the topic of whether or not preventative care, increased screenings, etc. reduces overall costs. Not the effect of cost shifting for unreimbursed (uninsured and unable to self pay) care, which is more what I was referring to. This does contribute significantly to facility "overhead" which is eventually paid for somehow, by somebody.

 

I just finished a good quick read on the subject; The House Of Hope And Fear by Audrey Young, MD who is an ER doc at Harborview. Their policy of not turning any patient away means that they are the local medical safety net, and end up seeing many indigents who would have better outcomes at vastly lower costs if they had access to (and chose to use) basic medical care before they end up face down in some alley.

 

A big part of the problem is that many of these people consistently make bad choices in their lives, and to some degree, we either all are going to end up paying for those choices, or as said above, let 'em die lake rats in the street. I choose the former. YMMV. The basic premise of a universal insurance pool is that the costs are spread across the whole of society, and that to some degree, yes, healthy folks, people who make better lifestyle choices, do share some of that burden. We do live in a society where too many people make too many bad choices, but that is a vast, stubborn problem which is likely beyond the means of the CC.com brain trust to solve.

 

As to charging a "fat tax" for our BMI challenged brethren, sure go for it. But then, we'd have to start putting premiums on everything under the sun. Smoker? Going to cost you. Enjoy more than 1 drink per day? Pay up. Climber? Mmmmmm, no free ride for you bucko. Terminally stupid? Pay up front, please.

 

See where that leads?

[kevbone]

Kev, if you really were a simpleton that would be excusable. But you are just willfully ignorant like 99% of the Tea-tard/Ron Paul/Faux News kooks. You could have a clue, but you refuse to; shame on you.

 

I am not a Fox new watcher. I think they are pathetic. The only reason I like Ron Paul is for is foreign policy. He is the only candidate who openly talks about our spending.

 

Obama just turned our county in a fascist state by signing the NDAA law into law. How can you respectfully support such an act?

 

Please tell me because I would like someone to defend this? See if you can.

 

If not then who will you be voting for.

 

You guys make it out to be black and white. Like either i love Obama or hate him. Why cant I like just some of his policy's? Same for Ron Paul.

 

 

[glassgowkiss]

70% of people in this country are overweight or obese, hence almost three quarter of population are at high risk of developing cardio-vascular disease, stroke and type 2 diabetes. There is NO HEALTHCARE SYSTEM that can sustain it! The only way the system will work is if there are more healthy people then sick people. If this ratio is reversed you have to switch to pay as you go system. And if people would stop eating shit and start exercising, the cost would go down. I bet more then half of you fuckers here have BMI over 25, or body fat percentage over 25%, which makes you a part of the problem. So if you want real change, start with real good look in the mirror.

[rob]

Bone, its no different than public school -- you are paying for public school even if you don't want it. Only in this case, the government will give you a rebate on the tax if you buy insurance. They're not forcing you to buy anything -- they're giving you an opportunity to avoid the tax if you are already spending money on insurance or have it from an employer. Its actually MORE fair than how we pay for public schools (except for states that have a school vouchers system). The government similarly allows you yo pay less tax if you mortgage a property. There is nothing weird about this new tax, I just think everyone is scared by the nomenclature ("mandate", etc.)

 

Nobody is gonna force you to buy insurance. But, if you're uninsured you'll pay a health care tax. Just like you pay a public school tax and a military tax, etc. You should be happy in this case that you have a way to avoid the tax. Yay for avoiding taxes, right? I wish they gave me a way to opt out of the public school tax if I pay for private school. I don't understand the fear and panic around this issue.

Edited June 30, 2012 by rob

[kevbone]

So if you want real change, start with real good look in the mirror.

 

How profound.

[dougd]

Finally - if you support mandating the purchase of health insurance on the grounds that those who do not do so are imposing costs on everyone else, how would you feel about the government mandating that everyone in the country maintain a healthy body weight and fining those who refuse to comply with the mandate on the basis that they are imposing costs on everyone else? It's not clear to me how a logically consistent person could support the former and not the latter.

 

Maybe a "fat tax" could work...

 

Not a bad idea Jay...

 

d

 

 

[JayB]

What people seem not to understand, is that by having a disproportionate percentage of the population uninsured, not only are "we" (the insured population) paying for the inevitable costs of caring for the uninsured, but are paying much more when they show up at the ER with advanced diseases that could have been treated cheaper and yielded better outcomes had they had access to basic medical services to begin with. That's a big part of why the US pays more as percent GDP than any other country for poorer results.

 

I'd like to see how the righties come up with the figures which they're trying to terrorize the Tea-tards with now which describes this a giant huge new tax burden on ordinary 'Muricans. I call BS. It's not like they aren't pathological liars already.

 

 

Exactly. I can think of several studies i've read looking at elderly care and medicares costs per person that have all shown that it's much less expensive to pay up front with prevention, monitoring, and support than to pay on the back end for acute cases.

 

Even going locally I had a chance to talk to some folks who worked at Harborview and were well versed in the topic and some local work had shown the cost in ER visits for local homeless folks per year was more than 2x what the cost would be to house them.

 

Right now these same folks are all getting healthcare, it's just a shell game of when, where and who picks up the tab.

 

I'm not trying to pick on you in particular - but I'll respond to your post since you seem like a smart, reasonable guy and you seem to be sympathetic to the arguments put forward by everyone else who supports the mandate.

 

Which studies are you referring to? Systematic reviews of the costs and benefits of "prevention" do not support any such generalization.

"Our findings suggest that the broad generalizations made by many presidential candidates can be misleading. These statements convey the message that substantial resources can be saved through prevention. Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not."

 

http://www.nejm.org/doi/full/10.1056/NEJMp0708558

 

The notion that the uninsured are the primary driver of cost shifting that other payers have to bear is also false. That distinction belongs to medicare and medicaid, both of which systematically pay less than it costs to provide care for those covered by the programs, and the costs of the shortfall are passed onto private payers. Cost shifting from Medicare and Medicaid adds roughly 15% to private payer premiums(1). The uninsured add less than two percent(2).

(1)http://publications.milliman.com/research/health-rr/pdfs/hospital-physician-cost-shift-RR12-01-08.pdf

(2)http://www.kff.org/uninsured/upload/7809.pdf

 

Finally - if you support mandating the purchase of health insurance on the grounds that those who do not do so are imposing costs on everyone else, how would you feel about the government mandating that everyone in the country maintain a healthy body weight and fining those who refuse to comply with the mandate on the basis that they are imposing costs on everyone else? It's not clear to me how a logically consistent person could support the former and not the latter.

 

'Couple of points: The NEJM article you linked to discusses the topic of whether or not preventative care, increased screenings, etc. reduces overall costs. Not the effect of cost shifting for unreimbursed (uninsured and unable to self pay) care, which is more what I was referring to. This does contribute significantly to facility "overhead" which is eventually paid for somehow, by somebody.

 

I just finished a good quick read on the subject; The House Of Hope And Fear by Audrey Young, MD who is an ER doc at Harborview. Their policy of not turning any patient away means that they are the local medical safety net, and end up seeing many indigents who would have better outcomes at vastly lower costs if they had access to (and chose to use) basic medical care before they end up face down in some alley.

 

A big part of the problem is that many of these people consistently make bad choices in their lives, and to some degree, we either all are going to end up paying for those choices, or as said above, let 'em die lake rats in the street. I choose the former. YMMV. The basic premise of a universal insurance pool is that the costs are spread across the whole of society, and that to some degree, yes, healthy folks, people who make better lifestyle choices, do share some of that burden. We do live in a society where too many people make too many bad choices, but that is a vast, stubborn problem which is likely beyond the means of the CC.com brain trust to solve.

 

As to charging a "fat tax" for our BMI challenged brethren, sure go for it. But then, we'd have to start putting premiums on everything under the sun. Smoker? Going to cost you. Enjoy more than 1 drink per day? Pay up. Climber? Mmmmmm, no free ride for you bucko. Terminally stupid? Pay up front, please.

 

See where that leads?

 

 

1. Yes - the NEJM link only deals with the costs and benefits of preventive care. The links below deal with cost-shifting estimates.

 

The estimates are all imperfect - but there's not many people that have looked at the data that conclude that the cost shifting from the uninsured onto private payers is anywhere near the magnitude of the shift from Medicare/Medicaid onto private payers.

 

Even if this reform incentivizes people to purchase insurance, rather than simply paying the much lower penalty and purchasing insurance once they are sick - the net outcome will be to significantly increase the magnitude of the major source of cost shifting by expanding the number of the publicly insured. If you think this doesn't matter, ask anyone who deals with finances at, say, Swedish what happens when the payer balance shifts towards more publicly insured patients.

 

What will most likely *actually* happen is that the cost-shift from public to private payers, coupled with the community rating and the ban on pre-existing conditions means that the shift of costs onto people in the private sector who pay premiums continuously will drive rates higher than they would have been in the absence of the ACA. People will have even more of an incentive to stay out of the insured pool until they are sick, and the magnitude of the cost shift from people who do not continuously pay premiums for private health insurance from those who don't will increase significantly.

 

Medical loss rules regarding higher deductible plans will also work wonders on the cost of premiums, which will only exacerbate the problems outlined above.

 

2. Evidence for your "dying like rats on the street argument." I hear that one all of the time, but have yet to see any evidence that people were devoid of the moral sensibilities necessary to assist the less fortunate until they were compelled to do so via a government program. Start from the pilgrims and work your way to the present. Hell - start with the Clovis people and work your way forward if that will help.

 

2. Yes - I see where "that" leads, which is why I opposed the mandate. That's now the direction we're heading, at least for the time being. Should be interesting.

[AlpineK]

Bone, its no different than public school -- you are paying for public school even if you don't want it.

 

Ya know I've been paying taxes long enough to have payed off my public school debt twice over.

 

I want, no I demand, a refund. I ain't got no kids. Screw everybody else.

[dougd]

Finally - if you support mandating the purchase of health insurance on the grounds that those who do not do so are imposing costs on everyone else, how would you feel about the government mandating that everyone in the country maintain a healthy body weight and fining those who refuse to comply with the mandate on the basis that they are imposing costs on everyone else? It's not clear to me how a logically consistent person could support the former and not the latter.

 

Maybe a "fat tax" could work...

 

Not a bad idea Jay...

 

d

 

 

A perfect guy to get the fat tax started would be that fat, blowhard, new Puerto Rican rush limbaugh. He would pay at least until the day he renounces his US citizenship...

 

With him leading it off, and all the other fatties paying in, we could reduce the debt in a serious way.

 

d

[KaskadskyjKozak]

Bone, its no different than public school -- you are paying for public school even if you don't want it.

 

Ya know I've been paying taxes long enough to have payed off my public school debt twice over.

 

I want, no I demand, a refund. I ain't got no kids. Screw everybody else.

 

and you've incurred other expenses

[glassgowkiss]

 

and you've incurred other expenses

hookers and blow don't count.

 

[KaskadskyjKozak]

*** You are ignoring this user ***

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FOAD, AssholePiss!

[Off_White]

You remind me of my girlfriend.

 

No offense intended to Crazy Polish Bob, but your girlfriend must be pretty ugly.

[glassgowkiss]

You remind me of my girlfriend.

 

No offense intended to Crazy Polish Bob, but your girlfriend must be pretty ugly.

 

[Skeezix]

Hey, did you guys hear that the Supreme Court upheld Obamacare?!

[Off_White]

I think making Bob laugh is at least as important as the impact of our influential debate.

 

[pink]

70% of people in this country are overweight or obese, hence almost three quarter of population are at high risk of developing cardio-vascular disease, stroke and type 2 diabetes. There is NO HEALTHCARE SYSTEM that can sustain it! The only way the system will work is if there are more healthy people then sick people. If this ratio is reversed you have to switch to pay as you go system. And if people would stop eating shit and start exercising, the cost would go down. I bet more then half of you fuckers here have BMI over 25, or body fat percentage over 25%, which makes you a part of the problem. So if you want real change, start with real good look in the mirror.

 

BANN forks, knives and spoons! Problem Solved