4 ms·

> One more point was, one of his tear jerk cases said that due to her existing bad health she couldn't get insurance. Nonsense: All she had to do was move to a

by mpyne 13y ago

> One more point was, one of his tear jerk cases said that due to her existing bad health she couldn't get insurance. Nonsense: All she had to do was move to a state with 'community rating'. That's actually one of the points Justice Ginsburg addressed in her concurring/dissenting opinion about the Obamacare case. In the long term Obamacare systems have failed in individual states that have tried to impose it, because the inevitable result is that neighboring states dump their unhealthiest people into those states using a community rating. It's the same problem as any other actuarial scheme like life insurance or fire fighting. Having a lower whole-community rate for everyone only works when the most-expensive people can't unilaterally decide to arbitrage against the least-expensive community. With Obamacare the incentive for that type of arbitrage is drastically reduced, as wherever you are moving from will have some form of community rating as well. Of course with the old scheme it is likely that the state using community ratings would have moved to establish a firm time-based residency requirement. But then it would not be possible to claim that all someone has to do is move to the right state. For that 12-24(+?) month window that person would be essentially screwed.

graycat 13y ago
You are trying to take Obamacare seriously. Sure, it's a serious issue, and no doubt in the 2000 pages of the bill and the 10s of thousands of pages of 'regulations' there is some good thinking. But my overwhelming impression is that Obamacare was, in the end, poorly designed. Maybe enough writers of 'regulations' can make it helpful, but I doubt it. I just believe that the whole thing was politics, not healthcare. Or, I can't trust in the seriousness of something that made Nancy smile like a Homecoming Queen. And I can't trust the academic 'health care system economic planning' community. That's Karen Davis, right? I've been too close to such academics, and I wouldn't trust it to hand me a band aid. The exceptions have already started. Supposedly Congress doesn't want it for themselves (does this mean they actually read some of it or understood it was junk just on general principles?). Some states are fighting it. My guess is that after Obama leaves office there will be no one strongly supporting it. Then the IRS will torque off one too many people, and Congress will just repeal it. I'm just guessing of course.
- mpyne 13y ago
  Congress already has healthcare (tremendously good healthcare), so obviously they wouldn't want to replace it with Obamacare, as that is only what is good enough for everyone. Instead they will simply say the existing Congressional pension/healthcare system meets PPACA requirements and call it a day. That's the same thing they did for military Tricare health care (which is as socialist as they come, by the way :P). Instead of replacing Tricare with the national plan they simply declare that Tricare is a national plan that complies with the requirements for PPACA. I wouldn't be surprised if Obamacare is altered in the future but I would be surprised if it's repealed entirely, especially once people start to realize how many people have nothing else to rely on. And then in about 10-20 years or so we'll have people like today, screaming and protesting "KEEP GOVERNMENT OUT OF MY OBAMACARE" in completely unironic fashion, just as they do with Medicare today.
  - graycat 13y ago
    Yes, there are problems now, e.g., "how many people have nothing else to rely on.". But, really, the existing system has faced such problems for a long time and put in place a complicated, disorganized, collection of pieces, patchwork, to respond to it. E.g., there is the Hill-Burton hospital act where to build a hospital can get Federal money but then can't turn away patients who can't pay. So, do 'cost shifting' and charge more for patients who can pay. Or have a city run and funded hospital. Patchwork. Could we improve it? To borrow from Cheney, no doubt. Could we make it worse? No doubt. To me, the 'sausage making' process of Obamacare promises a poorly designed product. And the origins and motivations of Obamacare concern me: As I recall, really Obamacare was in its first drafts (did anyone read the 2000 pages enough to do a second draft?) was basically pulled off the shelf from where it had been stored by a health care team under Senator Ted Kennedy. There the dream, Ted did like the "dream", was simple -- socialized medicine. I suspect that 'socialized medicine' can be made to work well; maybe it does in Switzerland. But I don't trust the results of the people who want 'socialized medicine' in the US mostly just as I don't trust the people who just want socialism in the US. My guess is that too soon we will be paying too much (yes, we are now, also) or screaming about bad medicine like people do in the UK and Canada. In a sense Medicare and Medicaid have an advantage because they are mostly just payment mechanisms placed on top of what is roughly, very roughly, a 'free-enterprise' system. But if just socialize the whole thing, then can end up with a bad version of the USPS. I'm not against the Federal Government doing some things: In places what the Federal Government does works out great -- Hoover Dam, Bonneville Dam, TVA, Los Alamos, NSF, NIH, DARPA, funding of the top three dozen or so US research universities, the Interstate highway system, the FAA (the safety and engineering parts; some of the air traffic control parts), in the end most aspects of the USPS, the Agriculture Extension Service of the USDA, the FDA (pretty good on safety, a bit slow on efficacy), and more. For the VA, I don't know: There are complaints about the access and quality, but I know no details. So, for Obamacare, I'm concerned that in the US 'socialized medicine' is just super tough to get right and that the Nancy, etc. efforts are not even 10% as serious as needed. Then, from the structure of the 'board' or 'panel' appointed by the president, I'm concerned that Obamacare will become a 'political football' that results in low quality health care at high prices. "Political footbal"? For an example, that's my view of 'climate change' and 'clean energy': For fossil fuels, use 'climate change' as an excuse to tax them and throttle them. E.g., in his 2008 interview at the SF Chron., Obama explained his intention to raise carbon taxes enough to "bankrupt" our coal fired plants -- then 49% of our electric energy and, as I recall, ~23% of all our energy. I suspect he was just posturing, but it was dangerous. Then supposedly about $92 billion of the various 'stimulus' and TARP (I and II) funds went for 'clean energy' but turned out to be make-work jobs and campaign contribution kickbacks. Supposedly since then we've thrown another $45 billion at 'clean energy' -- to me, 99 44/100% about politics, e.g., campaign contribution kickbacks, and the rest water and not at all about energy or the even the climate (in my view, there's no very good evidence that the climate is at risk). So, with US socialized medicine, I fear 'waste, fraud, abuse' from a political football. E.g., now we've got NSA: Politics? Sure: No politician wants to get blamed for "being soft on terrorism". So, NSA suspends good judgment and goes overboard -- 'over reaches', e.g., data on calls of 120 million or so Verizon customers, maybe all the US e-mail traffic, maybe all the US phone voice data. E.g.? Sure: Snowden was a GED, contract, bottom level employee in Hawaii but apparently had his fingers directly on huge volumes of data, all at the NSA supposedly just terrific at 'computer security'. Why? Poor oversight. Poor execution. From the White House, don't give a sh!t about the details and otherwise a political football. I fear the same for a US national health care system. Yes, what we have could be better, but it could also be worse, and for having it worse Nancy is just the person to lead us there. Maybe in an honest moment Nancy would have said, "We will just pass it. That's all we can do. Then we will leave the details up to the execution of the Executive branch, in some big office buildings somewhere within 100 miles of the Washington Monument, and pass more bills if really necessary. So, we will just get it started and then let others make it work well." But they don't have to make it work well -- they might just make a mess. I'm thinking, re-engineer and rebuild a Boeing 747 in flight, with people who just started learning about sheet metal.

by mpyne 13y ago

graycat 13y ago

You are trying to take Obamacare seriously. Sure, it's a serious issue, and no doubt in the 2000 pages of the bill and the 10s of thousands of pages of 'regulations' there is some good thinking. But my overwhelming impression is that Obamacare was, in the end, poorly designed. Maybe enough writers of 'regulations' can make it helpful, but I doubt it. I just believe that the whole thing was politics, not healthcare. Or, I can't trust in the seriousness of something that made Nancy smile like a Homecoming Queen. And I can't trust the academic 'health care system economic planning' community. That's Karen Davis, right? I've been too close to such academics, and I wouldn't trust it to hand me a band aid. The exceptions have already started. Supposedly Congress doesn't want it for themselves (does this mean they actually read some of it or understood it was junk just on general principles?). Some states are fighting it. My guess is that after Obama leaves office there will be no one strongly supporting it. Then the IRS will torque off one too many people, and Congress will just repeal it. I'm just guessing of course.

mpyne 13y ago
Congress already has healthcare (tremendously good healthcare), so obviously they wouldn't want to replace it with Obamacare, as that is only what is good enough for everyone. Instead they will simply say the existing Congressional pension/healthcare system meets PPACA requirements and call it a day. That's the same thing they did for military Tricare health care (which is as socialist as they come, by the way :P). Instead of replacing Tricare with the national plan they simply declare that Tricare is a national plan that complies with the requirements for PPACA. I wouldn't be surprised if Obamacare is altered in the future but I would be surprised if it's repealed entirely, especially once people start to realize how many people have nothing else to rely on. And then in about 10-20 years or so we'll have people like today, screaming and protesting "KEEP GOVERNMENT OUT OF MY OBAMACARE" in completely unironic fashion, just as they do with Medicare today.
- graycat 13y ago
  Yes, there are problems now, e.g., "how many people have nothing else to rely on.". But, really, the existing system has faced such problems for a long time and put in place a complicated, disorganized, collection of pieces, patchwork, to respond to it. E.g., there is the Hill-Burton hospital act where to build a hospital can get Federal money but then can't turn away patients who can't pay. So, do 'cost shifting' and charge more for patients who can pay. Or have a city run and funded hospital. Patchwork. Could we improve it? To borrow from Cheney, no doubt. Could we make it worse? No doubt. To me, the 'sausage making' process of Obamacare promises a poorly designed product. And the origins and motivations of Obamacare concern me: As I recall, really Obamacare was in its first drafts (did anyone read the 2000 pages enough to do a second draft?) was basically pulled off the shelf from where it had been stored by a health care team under Senator Ted Kennedy. There the dream, Ted did like the "dream", was simple -- socialized medicine. I suspect that 'socialized medicine' can be made to work well; maybe it does in Switzerland. But I don't trust the results of the people who want 'socialized medicine' in the US mostly just as I don't trust the people who just want socialism in the US. My guess is that too soon we will be paying too much (yes, we are now, also) or screaming about bad medicine like people do in the UK and Canada. In a sense Medicare and Medicaid have an advantage because they are mostly just payment mechanisms placed on top of what is roughly, very roughly, a 'free-enterprise' system. But if just socialize the whole thing, then can end up with a bad version of the USPS. I'm not against the Federal Government doing some things: In places what the Federal Government does works out great -- Hoover Dam, Bonneville Dam, TVA, Los Alamos, NSF, NIH, DARPA, funding of the top three dozen or so US research universities, the Interstate highway system, the FAA (the safety and engineering parts; some of the air traffic control parts), in the end most aspects of the USPS, the Agriculture Extension Service of the USDA, the FDA (pretty good on safety, a bit slow on efficacy), and more. For the VA, I don't know: There are complaints about the access and quality, but I know no details. So, for Obamacare, I'm concerned that in the US 'socialized medicine' is just super tough to get right and that the Nancy, etc. efforts are not even 10% as serious as needed. Then, from the structure of the 'board' or 'panel' appointed by the president, I'm concerned that Obamacare will become a 'political football' that results in low quality health care at high prices. "Political footbal"? For an example, that's my view of 'climate change' and 'clean energy': For fossil fuels, use 'climate change' as an excuse to tax them and throttle them. E.g., in his 2008 interview at the SF Chron., Obama explained his intention to raise carbon taxes enough to "bankrupt" our coal fired plants -- then 49% of our electric energy and, as I recall, ~23% of all our energy. I suspect he was just posturing, but it was dangerous. Then supposedly about $92 billion of the various 'stimulus' and TARP (I and II) funds went for 'clean energy' but turned out to be make-work jobs and campaign contribution kickbacks. Supposedly since then we've thrown another $45 billion at 'clean energy' -- to me, 99 44/100% about politics, e.g., campaign contribution kickbacks, and the rest water and not at all about energy or the even the climate (in my view, there's no very good evidence that the climate is at risk). So, with US socialized medicine, I fear 'waste, fraud, abuse' from a political football. E.g., now we've got NSA: Politics? Sure: No politician wants to get blamed for "being soft on terrorism". So, NSA suspends good judgment and goes overboard -- 'over reaches', e.g., data on calls of 120 million or so Verizon customers, maybe all the US e-mail traffic, maybe all the US phone voice data. E.g.? Sure: Snowden was a GED, contract, bottom level employee in Hawaii but apparently had his fingers directly on huge volumes of data, all at the NSA supposedly just terrific at 'computer security'. Why? Poor oversight. Poor execution. From the White House, don't give a sh!t about the details and otherwise a political football. I fear the same for a US national health care system. Yes, what we have could be better, but it could also be worse, and for having it worse Nancy is just the person to lead us there. Maybe in an honest moment Nancy would have said, "We will just pass it. That's all we can do. Then we will leave the details up to the execution of the Executive branch, in some big office buildings somewhere within 100 miles of the Washington Monument, and pass more bills if really necessary. So, we will just get it started and then let others make it work well." But they don't have to make it work well -- they might just make a mess. I'm thinking, re-engineer and rebuild a Boeing 747 in flight, with people who just started learning about sheet metal.