18 ms·

The House Passed the Health Bill

54 points by raintrees 17y ago

raintrees 17y ago
Now if we can only reform medical insurance...
- old-gregg 17y ago
  Medical insurance? What a barbaric concept. I paid $30K in taxes last year. I don't quite understand why would I even have to think about terms like "insurance" and "money" when/if I get sick. I'm not an American, although I've been living here for 11 years, yet the thought of PAYING for medical care still feels shameful and medieval. If there isn't enough money in the budget to pay doctors then start cutting: on "defense", on bureaucrats, I don't care. Medical care must be absolutely the highest priority federal expense: not a single government employee should be paid until the last US citizen who needs medical attention gets help.
  - deleted 17y ago
    [deleted]
  - Dilpil 17y ago
    Why should medical care be a higher priority than food?
    - rdtsc 17y ago
      Or a higher priority than endless wars for oil overseas. But I digress... The reason is because most people can still afford food in US, but cannot afford $3k/day hospital stays.
      - BRadmin 17y ago
        Isn't the crux of the problem that it costs $3k/day for a hospital stay to begin with?... A bloated health care industry that inflates prices on medical services, making "insurance" the only viable option for payment, seems like the main issue that demands reformation.
        jamesbritt 17y ago
        Worse , the bulk of debate is focused on how to shift responsibility for covering that $3K/day rather than figuring out why is costs that much and how to make it cost less.
    - lionhearted 17y ago
      And moreover, why should we have to pay for food? By God, I pay taxes. It seems so barbaric and 8th century to make people pay for the food they eat.
      - old-gregg 17y ago
        Your comment (and its upmods) is why, my friend, even the most educated and interesting Americans sound like incoherent cavemen when it comes to discussions about finally having a health care in this country: here we tend to look at each other as consumers and customers first, and human beings - second. What an unfortunate cultural difference, to say the least... I have no idea where this sudden drop comes from. Do you really have to be born somewhere else to clearly see the difference between healthcare and food? You don't charge people who are scared, in pain or unconscious. It's like urinating in public or having sex with your sister: does it need to be explained why you don't do that?
        lionhearted 17y ago
        > Your comment (and its upmods) is why, my friend, even the most educated and interesting Americans sound like incoherent cavemen... Totally unnecessary to having a discussion. But I'll address your point: > ...here we tend to look at each other as consumers and customers first, and human beings - second. What an unfortunate cultural difference, to say the least... Many people who are opposed to the healthcare bill, including me, do care quite a lot about people. I've run charity events for St. Jude's Children's Hospital in the Stats and Great Ormond Street Children's in London. I donate to charity too, including trying to get a therapy dog program going in Tokyo. With me so far? Okay, I care about people. I'm not looking at people as consumers or customers. I think the more say elected and appointed officials get over medicine, the worse medicine will be. Elected and appointed officials typically do a terrible job with any science, business, or production that they try to run. For every success story, there's 3-10 dramatic failures. > Do you really have to be born somewhere else to clearly see the difference between healthcare and food? They're both essential for survival. The difference is that we've made food very accessible, largely without the help of government. Medicine will get there too, given time. In fact, over the counter medicines today are incredibly powerful by historical standards. The fact that we can get anti-inflammatories and mild topical steroids over the counter is incredible. We'd be able to get antibiotics too, if it wasn't for the government legislation requiring prescriptions. It's rationalized by saying people could abuse or mistake antibiotics, leading to more antibiotic-resistant strains of diseases. But this hasn't been found to be true in countries with over the counter antibiotics. > You don't charge people who are scared, in pain or unconscious. 1. The vast majority of medicine isn't trauma medicine, it's fairly routine and predictable thing that you can make educated, thought out judgment calls on. 2. Doctors need to get paid like anyone else to practice their profession. Someone needs to pay them. 3. I'm unwilling to pay for other people's medicine under threat of force. I will actually pay for someone's medicine in some circumstances - I'll run a charity event, donate money, help out a friend or relative. But I do not accept being mandated to buy insurance, pay a tax, or be arrested. I think it's bad for me as an individual and bad for society. > It's like urinating in public or having sex with your sister: does it need to be explained why you don't do that? Look, I've seen your comments. People reply to you with intelligent points. Do you care? You talk past people, you ignore their points and respond with more rhetoric. -- My points: 1. Doctors need to be paid to practice their profession. 2. I'm unwilling to pay doctors for other people's medicine under threat of force for failing to do so. You're willing to have me arrested for refusing to play along? That's the argument. I want healthy people too. I care about society. I've done more to help sick people I don't know than the vast majority of people stumping for government run healthcare. But I think it's wrong on an individual and societal level.
    - conflux0 17y ago
      Because the majority of the voting population has no problem obtaining food.
      - deleted 17y ago
        [deleted]
    - runningdogx 17y ago
      In no small part, food is medical care. Good food is good preventive medical care. Bad food is like trying to perform a back-alley abortion. But I take your point. Medical care doesn't have a higher priority, but its nature makes it a more important issue for government to deal with. The statistical nature of medical costs is that the vast majority of people cannot prepare for the worst without buying into an insurance plan of some sort. Food costs, although they can go up a lot during crises, never reach such heights. Barring a severe depression or massive food shortages -- which it should be noted affect everyone, not just a small portion of the population -- people living above poverty can shift their budgets to be able to afford food even if the price goes up 50%. Hardly anyone can modify their budget to be able to afford bypass surgery or treatment for cancer. However, another side to the issue is that the government already interferes substantially in food costs and food policy. There are substantial subsidies paid to corn and soy farmers, for instance, driving consumer costs of many food products below the actual costs of production if you take away government subsidies.
  - natrius 17y ago
    I don't understand how paying for medical care can possibly seem strange. Single-payer systems are merely an arrangement for paying for medical care. In my opinion, it's not a very good arrangement. Everyone who needs health care should be able to obtain it. Most people in developed countries can already obtain health care. Why insert the government into the situation where it isn't needed? Any time you disconnect the amount paid for goods and services from the receipt of those things, the market (i.e. mass human psychology) will work less efficiently. Perhaps the price the government decides to pay will be less than is needed to convince enough people to provide the services in question, resulting in a shortage. Subsidize health care for those who can't afford it. Everyone else should pay their own way privately. Similar changes should be made to the other non-public goods we subsidize, like roads, transit and education.
  - ryanwaggoner 17y ago
    This kind of over-the-top rhetoric is great for rallying the masses, but it breaks down under the lightest of logical scrutiny. Here are three of my favorite issues with your position: 1. Why is medical care the highest priority? What about food? Shelter? Safety from rape, murder, and other forms of violence? What about electricity, water, and other infrastructure? While most people don't get very sick, pretty much everyone needs the things above. Why should medical care be the highest priority federal expense? 2. You think it's barbaric to think about paying for medical care, but guess what: you do pay for it. Everyone does. Your "right" to healthcare is not free; someone has to pay for it. And because you think you're entitled to that free of charge, someone else out there is having money taken from them under the threat of force so that you don't have to worry about healthcare. The right to private property far outweighs the right to healthcare, according to the US Constitution, but your system reverses this relationship. 3. The decoupling of supply and demand in the type of system we're about to pass is likely to result in dramatically higher costs and lower quality care over the long run, not to mention the fact that we have no way of paying for it. Granted, our current system is screwed up, but this is far from a fix. This is just moving further in a bad direction. EDIT: Added a third item :)
    - deleted 17y ago
      [deleted]
    - fnid 17y ago
      The health care system in the u.s. is immune to supply and demand. The doctors control the supply of doctors. Laws control supply of medications. Insurance companies control supply of procedures. I agree with the post you are replying to. I think if people didn't have to worry about whether or not their health was at stake, they could make better decisions about the work they do. They'd be more productive and worry less and have more brain waves to devote to a better life. People seem to complain a lot saying the government can't do things well. But they run our defense industry and it's the best in the world. They run the roads and we have plenty to drive on. They control the dams and those aren't breaking. Many are lasting way longer than they thought. Furthermore, plenty of governments around the world run their health care systems and they get better care for less money than Americans do.
  - pmorici 17y ago
    If you want to know where your money goes just look at this list... http://washingtontechnology.com/toplists/top-100-lists/2009.aspx http://washingtontechnology.com/toplists/top-100-lists/2009....
  - raintrees 17y ago
    Medical care is a service. I keep myself very healthy, so I pay very little for medical service. I am willing to pay for Medical Insurance, because like automobile insurance, I may find it difficult to pay for drastically large bills that arise, and may be quite large due to the reimbursement system for emergency services. In car collisions, pain and suffering is a scary demand. In emergency medical care, all those fancy machines to figure out what is going on with my body right now is likewise rather expensive. A long term plan to adopt a good diet, exercise, stretch, brush my teeth, etc. is a relatively easy way to avoid paying for large amounts of medical care. And, I am fortunate enough not to have any major body/mind disability.
vaksel 17y ago
So the Dems gutted the bill(from single payer), just to gain a single Republican vote?
- spamizbad 17y ago
  The bill didn't start from single payer - it started as offering a public option, which would co-exist with existing private plans, which would theoretically be available to all citizens as an option. The United States attempted implementing a single-payer system during the FDR Administration, which fizzled before it left the white house, and then again during the LBJ Administration, which was cut down to what we now call Medicare/Medicaid via the Social Security Act of 1965.
  - vaksel 17y ago
    which just goes to show you that dems don't know how to negotiate. You never start off with a compromise, you start off with something you have no hope of getting and slowly get down to the compromise position.
- btilly 17y ago
  Single payer was never on the table. Despite having majority support in public surveys, even thinking about it would galvanize all aspects of the health care system to fight tooth and nail against the bill. Big pharm would fight because they'd expect to see the price of drugs drop. Insurance companies would fight because they would no longer have a business. The AMA would fight because they have too many connections with the other two not to unify. In fact even the massively watered down version called "the public option" is marginal. Which is why you keep on hearing about how it is in this version, out of that one, in the next, and so on.
- trominos 17y ago
  If you have no idea what you're talking about, please don't use incendiary language.
  - davidw 17y ago
Zak 17y ago
Individuals would be required to obtain insurance or pay a fine of as much as 2.5 percent of income. This seems like a horrible violation of property rights, perhaps to the point of being a violation of the fifth amendment.
- mattmcknight 17y ago
  The challenge comes in the definition of a minimal insurance plan. What exactly does it have to cover to count as insurance? Am I going to have to put my policy number on my 1040 next year? Many things to worry about given the sordid history of bureaucratic implementation.
  - protomyth 17y ago
    part of the requirement is the deductible. So, people who have the $2,000 deductible (because you have other means to deal with the smaller stuff) would be out of compliance.
  - jpcx01 17y ago
    I'm pretty happy with my high deductible plan. I'm guessing this bill will put the kibosh on that, though I'm not totally sure. I'll add reading the 1,900 page bill to my todo list.
    - protomyth 17y ago
      The sad part is that a conference committee will come up with the final legislation. The Senate has their own version, then the conference committee will write the final. For example, it is likely the "no pay of abortions" will be removed there.
- pg 17y ago
  I agree it's a bit big brotherish. For a while after we sold Viaweb I didn't have health insurance, because I figured I had enough in effect to be my own insurer. I ended up getting health insurance eventually, because I found the system won't treat you without it; you can't simply offer to pay doctors with a credit card, the way you can with dentists. But from a civil liberties point of view it is a bit alarming to think the government could force you to purchase something, and jail you if you didn't. I hope they don't enforce that too diligently, or we could end up with a string of Ruby Ridges.
natrius 17y ago
This seems like it will be a rare political discussion on HN that won't be flagged, so I'd like to take the opportunity to copy/paste a comment I made on reddit a while back about how the public option is a bad idea, and see if intelligent discussion follows this time around. A government run plan will be able to easily attract customers because it gets free advertising, making it more attractive than even private, non-profit insurers. Once the government plan has enough customers, it will be able to demand lower prices while still getting the same quality of care for its customers. If doctors refuse to accept it, they'll be turning down a huge chunk of potential customers. The government's even lower prices will draw more customers, thereby intensifying the effect until we get to the point where the government dominates the insurance industry and can set whatever price it wants. In a functioning market with several players, prices stabilize at a level that customers are willing to pay for the goods or services in question. Healthcare costs have been rising so much because we've always valued healthcare greatly, and lower costs of food and other necessities leave more money for us to spend on it. As a result, advances in medicine come fairly quickly. If the government uses its power as the dominant insurer to drive down prices, advances in medicine will come more slowly because less money will be available. Most of the arguments I've seen for the public option seem to assume that cost reductions will come solely from eliminating non-medical expenses, like advertising. If you think that's the case, can you explain how that will happen? When the government tells doctors what its willing to pay for certain services, are they going to pay no less than private insurers are paying? That's not what happens today with Medicare, and that's not what a private insurer would do if it became the dominant insurer. This isn't about hating government; it's about how markets don't function properly when few players rule them. A public option will almost guarantee that outcome. The public option is undoubtedly the best way to lower the cost of healthcare. However, I don't think that should be our goal. Our goal should be to maximize the quality of care for everyone, not minimize the price. We should ensure that everyone can afford healthcare by subsidizing it for those who can't, but trying to create dominant government insurer so we can provide healthcare for everyone isn't necessary. Let's get rid of silly things like preexisting conditions and the antitrust exemption, then pay what it costs to ensure everyone is insured and maintain the progress in healthcare technology that we enjoy today.
- WesleyJohnson 17y ago
protomyth 17y ago
I just cannot understand how we can keep looking at medicaid, medicare, and social security projections and think that this will save us money. I find the rhetoric and fiscal foolishness of this bill to be beyond the pale. Also, how is this the top priority. Perhaps some of the congressmen need to check the unemployment rate and economic numbers.
- elblanco 17y ago
  It's pretty simple math. The U.S. pays 2x the (nationally) for health care for comparable (and usually a more poorly ranked) level of care. The U.S. ranks relatively poorly -- near the bottom of the industrialized countries -- on almost every measure of performance. The only exception are measures where simply paying unlimited amounts of money into your care will get you something. If we can move cost down from 20% of GDP (or whatever the figure is), to a level that everybody else enjoys, like 10% of GDP, we'll have realized a very large savings at a national level. Even if the cost of the program grows north of all estimates.
  - lionhearted 17y ago
    > The U.S. pays 2x the (nationally) for health care for comparable (and usually a more poorly ranked) level of care. The United States also has only 5% of the world's population (304M/6,700M), but produces a heck of a lot more than 5% of the world's medical innovation. Over the next 20 years, one side effect of this sort of bill might be to slow that innovation down. > The U.S. ranks relatively poorly -- near the bottom of the industrialized countries -- on almost every measure of performance. With an incredibly unhealthy lifestyle, it's pretty incredible how long American longevity is. A fine on obesity would probably do more to increase American health than a fine on being uninsured, but that's unlikely to happen.
    - roundsquare 17y ago
      Over the next 20 years, one side effect of this sort of bill might be to slow that innovation down. Is that definitely true? There are no exceptions etc... in the bill for newly discovered drugs? Even if it is, there is the argument that the American people are paying the price for new drug invention that the rest of the world (eventually) gets the benefit of. Note: I'm not making a pro-American argument here, just looking at what I think are some important consequences. A fine on obesity would probably do more to increase American health than a fine on being uninsured, but that's unlikely to happen. At some point I think they were considering a reward for preventive measures. If that includes eating healthy and regular exercise, it would be great!
protomyth 17y ago
Why can I buy car insurance across state lines, but not health insurance? The funny part is that the "public option" crosses state lines, but current insurance companies can't.
- ars 17y ago
  You can't. Your car insurer needs to be licensed in your home state. And especially Massachusetts where car insurance is completely run by the government, and few regular insurance companies operate there. (Every plan by all companies costs exactly the same amount - AAA has a 5% discount for members, so the other companies are allowed to offer a discount too if you ask for it.)
  - protomyth 17y ago
    You are correct in the "McCarran Ferguson Act" leaves health, auto, homeowners to the state regulators, but it sure seems to be easier to buy my car insurance from a national company then any attempt at health. Good to know about Massachusetts, I had never heard of a state pulling that.
  - vlad 17y ago
    This is no longer true as of a year and a half ago. Another change in Massachusetts is that everybody must submit proof of health insurance with their tax return, or else pay a penalty.
- natmaster 17y ago
  Strange, I get full coverage anywhere I go (including other countries).
natmaster 17y ago
Great, now I have buy into the screwed up healthcare system or become a felony and goto prison and lose all my rights. What kind of country do I live in now?
gojomo 17y ago
The most sensible package of market- and technology-friendly health reforms I've seen proposed: http://www.willwilkinson.net/flybottle/2006/03/19/health-care-fantasia/ http://www.willwilkinson.net/flybottle/2006/03/19/health-car... In particular, it doesn't call things 'insurance' that are not insurance, and faces the reality that some people are going to be charity cases, and that society will (one way or another) ration the care that goes to charity cases. The house bill hides difficult choices in mandates that turn 'insurance' into something else entirely -- a compulsory social service, run by 'companies' that have essentially become federal agencies collecting taxes. Nationalizing the industry outright would be more honest.
physcab 17y ago
What the bill provides: >>Required coverage for preventative care >>Starting next year, private insurers could no longer deny anyone coverage based on preexisting conditions, place lifetime limits on coverage or abandon people when they become ill >>Insurers would be required to disclose and justify proposed premium increases to regulators, and could not remove adult children younger than 27 from their parents' family policies. >>the House package would immediately offer discounts on prescription drugs and reduce a gap in Medicare prescription drug coverage, closing it entirely by 2019. >>Uninsured people who cannot get coverage could join temporary high-risk insurance pools, and unemployed workers would be permitted to keep their COBRA benefits until the public plan and insurance exchanges started in 2013. >>Tax-free benefits for domestic partners just like health benefits provided to the family of an employee married to a person of the opposite sex. >>Provide grants to states for home visitation programs in which nurses and social workers counsel pregnant women and new mothers in low-income families. >>Nutrition labeling requirements for snack food sold in vending machines and many restaurants.
DanielBMarkham 17y ago
I'm going to step out on a limb and predict that if this passes both houses and is signed, the Supreme Court will strike it down. You just can't have a law that requires people to buy something. There's nothing in the Constitution that can be remotely construed to allow the government forcing people to purchase things. Now at the state level it's a different matter entirely. Congress could have easily come up with some kind of reward-punishment system that required states to find some solution. And then you'd have 50 states each trying different ideas. They could harvest the best from each other. But it does not appear (to me) that the goal here is iterative, incremental solutions to a pressing problem. It appears that the goal is Big Design Up Front, Top-Down control, and over-engineering every possibility.<sarcasm>An obvious recipe for success</sarcasm> In the last decade, and with this bill especially, I think we've finally reached the end-game of the American federalist experiment. It's become obvious that we can't meet our current obligations, and it's also become obvious that politicians get elected making promises for even more obligations, not fixing the ones we currently have. So the goal isn't to "fix the system" The goal is to gin up new and various ways to keep making more promises while blaming all problems on the other party. The party's over, but it might be another 20 years before the cops show up, so let's have fun while we can!
Mz 17y ago
My issue with this is that it presumes "healthcare" and "medical care" are the same thing. Study after study after study indicates that diet and lifestyle are major factors in health outcomes and greatly influence your odds of suffering the deadliest conditions. But getting a prescription for a pill is a lot easier than making dietary and lifestyle changes, so a great many people will go that route and then complain about the high cost of medicine when they wouldn't need medication and frequent doctor's visits if they just took care of themselves. If you really want to bring down medical costs, people will have to start taking better care of themselves. Restructuring how we pay for it won't do a heckuva lot towards lowering costs if people continue to pursue self-destructive lifestyles. To the degree that it adds regulation and bureaucracy, the odds are good it will increase costs.
tptacek 17y ago
It's interesting to see people who supported Obama, or even paid attention to the '08 election at all, acting surprised about the health insurance mandate. Obama was pummeled over the concept during the race, most notably by Clinton during the primary. This was a long time coming. As for the concept of a mandate, it's simply the flip side of guaranteed issue. Without a mandate, guaranteed issue screws insurers: it creates --- as a matter of law --- an incentive for people not to get insurance until they get sick. Adverse selection is the enemy of insurance. It seems to me that you can't argue about whether an insurance mandate is confiscatory or overreaching without at the same time arguing about whether people with preexisting or chronic conditions (or some statistical disposition to same) should be excluded from the health care system. And yet: all I see here is arguments about whether politicians should run the health care system. Finally, I'll just note that the dollar amounts being discussed for the fine accompanying the mandate are a fraction of what someone would pay for actual health insurance, and probably lower that one would pay even for low-deductable coverage. I think lots of people don't realize that, because right now, the cost of coverage is very stealthily deducted from their income at the fiat of HR directors and the health insurance reps that instruct them.
- DanielBMarkham 17y ago
  Couldn't you just allow cross-state insurance pools, insurance portability, require direct payment and encourage the states to have their own pooling solutions, much like some states currently do with automotive insurance? I don't think it's an either-or question -- pooling/mandate or not -- at the national level. Sure, I think lots of folks would like it to be that way, but it doesn't have to be. It doesn't have to have a centralized answer for it to have a solution. Co-ops, for instance, have been left on the floor so far.
  - tptacek 17y ago
    Cross-state insurance seems like such an obvious proxy for insurance de-regulation that I'm surprised its advocates don't just come out and say it: "we should work with the minimum possible regulation on insurance companies". I'm wholly ambivalent about whether states or the federal government should operate the government-sponsored risk pool. You already know where this discussion is going to go with me, so think about whether you want to wade into it. Pick your poison: government by the Government, or government by the insurance companies. I'm not wild about what the federal government is coming up with (though not because of the mandate, which seems sensible), but the major insurance companies are both inept and actively evil, and the system we have today is rigged to favor them decisively whether we regulate or not.
jamesbritt 17y ago
Nicely done on a Saturday night. Dems must be proud of their work.
sachinag 17y ago
The best thing about my new gig at oneforty is that I'm in Massachusetts and I can get health insurance via the Massachusetts exchange. I seriously, seriously believe that if health insurance doesn't pass that startups who aren't looking to raise money locate in Massachusetts for this reason alone (and there are a ton of other good things about the community here).

54 points by raintrees 17y ago

raintrees 17y ago

Now if we can only reform medical insurance...

old-gregg 17y ago
Medical insurance? What a barbaric concept. I paid $30K in taxes last year. I don't quite understand why would I even have to think about terms like "insurance" and "money" when/if I get sick. I'm not an American, although I've been living here for 11 years, yet the thought of PAYING for medical care still feels shameful and medieval. If there isn't enough money in the budget to pay doctors then start cutting: on "defense", on bureaucrats, I don't care. Medical care must be absolutely the highest priority federal expense: not a single government employee should be paid until the last US citizen who needs medical attention gets help.
- deleted 17y ago
  [deleted]
- Dilpil 17y ago
  Why should medical care be a higher priority than food?
  - rdtsc 17y ago
    Or a higher priority than endless wars for oil overseas. But I digress... The reason is because most people can still afford food in US, but cannot afford $3k/day hospital stays.
    - BRadmin 17y ago
      Isn't the crux of the problem that it costs $3k/day for a hospital stay to begin with?... A bloated health care industry that inflates prices on medical services, making "insurance" the only viable option for payment, seems like the main issue that demands reformation.
      - jamesbritt 17y ago
        Worse , the bulk of debate is focused on how to shift responsibility for covering that $3K/day rather than figuring out why is costs that much and how to make it cost less.
  - lionhearted 17y ago
    And moreover, why should we have to pay for food? By God, I pay taxes. It seems so barbaric and 8th century to make people pay for the food they eat.
    - old-gregg 17y ago
      Your comment (and its upmods) is why, my friend, even the most educated and interesting Americans sound like incoherent cavemen when it comes to discussions about finally having a health care in this country: here we tend to look at each other as consumers and customers first, and human beings - second. What an unfortunate cultural difference, to say the least... I have no idea where this sudden drop comes from. Do you really have to be born somewhere else to clearly see the difference between healthcare and food? You don't charge people who are scared, in pain or unconscious. It's like urinating in public or having sex with your sister: does it need to be explained why you don't do that?
      - lionhearted 17y ago
        > Your comment (and its upmods) is why, my friend, even the most educated and interesting Americans sound like incoherent cavemen... Totally unnecessary to having a discussion. But I'll address your point: > ...here we tend to look at each other as consumers and customers first, and human beings - second. What an unfortunate cultural difference, to say the least... Many people who are opposed to the healthcare bill, including me, do care quite a lot about people. I've run charity events for St. Jude's Children's Hospital in the Stats and Great Ormond Street Children's in London. I donate to charity too, including trying to get a therapy dog program going in Tokyo. With me so far? Okay, I care about people. I'm not looking at people as consumers or customers. I think the more say elected and appointed officials get over medicine, the worse medicine will be. Elected and appointed officials typically do a terrible job with any science, business, or production that they try to run. For every success story, there's 3-10 dramatic failures. > Do you really have to be born somewhere else to clearly see the difference between healthcare and food? They're both essential for survival. The difference is that we've made food very accessible, largely without the help of government. Medicine will get there too, given time. In fact, over the counter medicines today are incredibly powerful by historical standards. The fact that we can get anti-inflammatories and mild topical steroids over the counter is incredible. We'd be able to get antibiotics too, if it wasn't for the government legislation requiring prescriptions. It's rationalized by saying people could abuse or mistake antibiotics, leading to more antibiotic-resistant strains of diseases. But this hasn't been found to be true in countries with over the counter antibiotics. > You don't charge people who are scared, in pain or unconscious. 1. The vast majority of medicine isn't trauma medicine, it's fairly routine and predictable thing that you can make educated, thought out judgment calls on. 2. Doctors need to get paid like anyone else to practice their profession. Someone needs to pay them. 3. I'm unwilling to pay for other people's medicine under threat of force. I will actually pay for someone's medicine in some circumstances - I'll run a charity event, donate money, help out a friend or relative. But I do not accept being mandated to buy insurance, pay a tax, or be arrested. I think it's bad for me as an individual and bad for society. > It's like urinating in public or having sex with your sister: does it need to be explained why you don't do that? Look, I've seen your comments. People reply to you with intelligent points. Do you care? You talk past people, you ignore their points and respond with more rhetoric. -- My points: 1. Doctors need to be paid to practice their profession. 2. I'm unwilling to pay doctors for other people's medicine under threat of force for failing to do so. You're willing to have me arrested for refusing to play along? That's the argument. I want healthy people too. I care about society. I've done more to help sick people I don't know than the vast majority of people stumping for government run healthcare. But I think it's wrong on an individual and societal level.
  - conflux0 17y ago
    Because the majority of the voting population has no problem obtaining food.
    - deleted 17y ago
      [deleted]
  - runningdogx 17y ago
    In no small part, food is medical care. Good food is good preventive medical care. Bad food is like trying to perform a back-alley abortion. But I take your point. Medical care doesn't have a higher priority, but its nature makes it a more important issue for government to deal with. The statistical nature of medical costs is that the vast majority of people cannot prepare for the worst without buying into an insurance plan of some sort. Food costs, although they can go up a lot during crises, never reach such heights. Barring a severe depression or massive food shortages -- which it should be noted affect everyone, not just a small portion of the population -- people living above poverty can shift their budgets to be able to afford food even if the price goes up 50%. Hardly anyone can modify their budget to be able to afford bypass surgery or treatment for cancer. However, another side to the issue is that the government already interferes substantially in food costs and food policy. There are substantial subsidies paid to corn and soy farmers, for instance, driving consumer costs of many food products below the actual costs of production if you take away government subsidies.
- natrius 17y ago
  I don't understand how paying for medical care can possibly seem strange. Single-payer systems are merely an arrangement for paying for medical care. In my opinion, it's not a very good arrangement. Everyone who needs health care should be able to obtain it. Most people in developed countries can already obtain health care. Why insert the government into the situation where it isn't needed? Any time you disconnect the amount paid for goods and services from the receipt of those things, the market (i.e. mass human psychology) will work less efficiently. Perhaps the price the government decides to pay will be less than is needed to convince enough people to provide the services in question, resulting in a shortage. Subsidize health care for those who can't afford it. Everyone else should pay their own way privately. Similar changes should be made to the other non-public goods we subsidize, like roads, transit and education.
- ryanwaggoner 17y ago
  This kind of over-the-top rhetoric is great for rallying the masses, but it breaks down under the lightest of logical scrutiny. Here are three of my favorite issues with your position: 1. Why is medical care the highest priority? What about food? Shelter? Safety from rape, murder, and other forms of violence? What about electricity, water, and other infrastructure? While most people don't get very sick, pretty much everyone needs the things above. Why should medical care be the highest priority federal expense? 2. You think it's barbaric to think about paying for medical care, but guess what: you do pay for it. Everyone does. Your "right" to healthcare is not free; someone has to pay for it. And because you think you're entitled to that free of charge, someone else out there is having money taken from them under the threat of force so that you don't have to worry about healthcare. The right to private property far outweighs the right to healthcare, according to the US Constitution, but your system reverses this relationship. 3. The decoupling of supply and demand in the type of system we're about to pass is likely to result in dramatically higher costs and lower quality care over the long run, not to mention the fact that we have no way of paying for it. Granted, our current system is screwed up, but this is far from a fix. This is just moving further in a bad direction. EDIT: Added a third item :)
  - deleted 17y ago
    [deleted]
  - fnid 17y ago
    The health care system in the u.s. is immune to supply and demand. The doctors control the supply of doctors. Laws control supply of medications. Insurance companies control supply of procedures. I agree with the post you are replying to. I think if people didn't have to worry about whether or not their health was at stake, they could make better decisions about the work they do. They'd be more productive and worry less and have more brain waves to devote to a better life. People seem to complain a lot saying the government can't do things well. But they run our defense industry and it's the best in the world. They run the roads and we have plenty to drive on. They control the dams and those aren't breaking. Many are lasting way longer than they thought. Furthermore, plenty of governments around the world run their health care systems and they get better care for less money than Americans do.
- pmorici 17y ago
  If you want to know where your money goes just look at this list... http://washingtontechnology.com/toplists/top-100-lists/2009.aspx http://washingtontechnology.com/toplists/top-100-lists/2009....
- raintrees 17y ago
  Medical care is a service. I keep myself very healthy, so I pay very little for medical service. I am willing to pay for Medical Insurance, because like automobile insurance, I may find it difficult to pay for drastically large bills that arise, and may be quite large due to the reimbursement system for emergency services. In car collisions, pain and suffering is a scary demand. In emergency medical care, all those fancy machines to figure out what is going on with my body right now is likewise rather expensive. A long term plan to adopt a good diet, exercise, stretch, brush my teeth, etc. is a relatively easy way to avoid paying for large amounts of medical care. And, I am fortunate enough not to have any major body/mind disability.

vaksel 17y ago

So the Dems gutted the bill(from single payer), just to gain a single Republican vote?

spamizbad 17y ago
The bill didn't start from single payer - it started as offering a public option, which would co-exist with existing private plans, which would theoretically be available to all citizens as an option. The United States attempted implementing a single-payer system during the FDR Administration, which fizzled before it left the white house, and then again during the LBJ Administration, which was cut down to what we now call Medicare/Medicaid via the Social Security Act of 1965.
- vaksel 17y ago
  which just goes to show you that dems don't know how to negotiate. You never start off with a compromise, you start off with something you have no hope of getting and slowly get down to the compromise position.
btilly 17y ago
Single payer was never on the table. Despite having majority support in public surveys, even thinking about it would galvanize all aspects of the health care system to fight tooth and nail against the bill. Big pharm would fight because they'd expect to see the price of drugs drop. Insurance companies would fight because they would no longer have a business. The AMA would fight because they have too many connections with the other two not to unify. In fact even the massively watered down version called "the public option" is marginal. Which is why you keep on hearing about how it is in this version, out of that one, in the next, and so on.
trominos 17y ago
If you have no idea what you're talking about, please don't use incendiary language.
- davidw 17y ago

Zak 17y ago

Individuals would be required to obtain insurance or pay a fine of as much as 2.5 percent of income. This seems like a horrible violation of property rights, perhaps to the point of being a violation of the fifth amendment.

mattmcknight 17y ago
The challenge comes in the definition of a minimal insurance plan. What exactly does it have to cover to count as insurance? Am I going to have to put my policy number on my 1040 next year? Many things to worry about given the sordid history of bureaucratic implementation.
- protomyth 17y ago
  part of the requirement is the deductible. So, people who have the $2,000 deductible (because you have other means to deal with the smaller stuff) would be out of compliance.
- jpcx01 17y ago
  I'm pretty happy with my high deductible plan. I'm guessing this bill will put the kibosh on that, though I'm not totally sure. I'll add reading the 1,900 page bill to my todo list.
  - protomyth 17y ago
    The sad part is that a conference committee will come up with the final legislation. The Senate has their own version, then the conference committee will write the final. For example, it is likely the "no pay of abortions" will be removed there.
pg 17y ago
I agree it's a bit big brotherish. For a while after we sold Viaweb I didn't have health insurance, because I figured I had enough in effect to be my own insurer. I ended up getting health insurance eventually, because I found the system won't treat you without it; you can't simply offer to pay doctors with a credit card, the way you can with dentists. But from a civil liberties point of view it is a bit alarming to think the government could force you to purchase something, and jail you if you didn't. I hope they don't enforce that too diligently, or we could end up with a string of Ruby Ridges.

natrius 17y ago

This seems like it will be a rare political discussion on HN that won't be flagged, so I'd like to take the opportunity to copy/paste a comment I made on reddit a while back about how the public option is a bad idea, and see if intelligent discussion follows this time around. A government run plan will be able to easily attract customers because it gets free advertising, making it more attractive than even private, non-profit insurers. Once the government plan has enough customers, it will be able to demand lower prices while still getting the same quality of care for its customers. If doctors refuse to accept it, they'll be turning down a huge chunk of potential customers. The government's even lower prices will draw more customers, thereby intensifying the effect until we get to the point where the government dominates the insurance industry and can set whatever price it wants. In a functioning market with several players, prices stabilize at a level that customers are willing to pay for the goods or services in question. Healthcare costs have been rising so much because we've always valued healthcare greatly, and lower costs of food and other necessities leave more money for us to spend on it. As a result, advances in medicine come fairly quickly. If the government uses its power as the dominant insurer to drive down prices, advances in medicine will come more slowly because less money will be available. Most of the arguments I've seen for the public option seem to assume that cost reductions will come solely from eliminating non-medical expenses, like advertising. If you think that's the case, can you explain how that will happen? When the government tells doctors what its willing to pay for certain services, are they going to pay no less than private insurers are paying? That's not what happens today with Medicare, and that's not what a private insurer would do if it became the dominant insurer. This isn't about hating government; it's about how markets don't function properly when few players rule them. A public option will almost guarantee that outcome. The public option is undoubtedly the best way to lower the cost of healthcare. However, I don't think that should be our goal. Our goal should be to maximize the quality of care for everyone, not minimize the price. We should ensure that everyone can afford healthcare by subsidizing it for those who can't, but trying to create dominant government insurer so we can provide healthcare for everyone isn't necessary. Let's get rid of silly things like preexisting conditions and the antitrust exemption, then pay what it costs to ensure everyone is insured and maintain the progress in healthcare technology that we enjoy today.

WesleyJohnson 17y ago

protomyth 17y ago

I just cannot understand how we can keep looking at medicaid, medicare, and social security projections and think that this will save us money. I find the rhetoric and fiscal foolishness of this bill to be beyond the pale. Also, how is this the top priority. Perhaps some of the congressmen need to check the unemployment rate and economic numbers.

elblanco 17y ago
It's pretty simple math. The U.S. pays 2x the (nationally) for health care for comparable (and usually a more poorly ranked) level of care. The U.S. ranks relatively poorly -- near the bottom of the industrialized countries -- on almost every measure of performance. The only exception are measures where simply paying unlimited amounts of money into your care will get you something. If we can move cost down from 20% of GDP (or whatever the figure is), to a level that everybody else enjoys, like 10% of GDP, we'll have realized a very large savings at a national level. Even if the cost of the program grows north of all estimates.
- lionhearted 17y ago
  > The U.S. pays 2x the (nationally) for health care for comparable (and usually a more poorly ranked) level of care. The United States also has only 5% of the world's population (304M/6,700M), but produces a heck of a lot more than 5% of the world's medical innovation. Over the next 20 years, one side effect of this sort of bill might be to slow that innovation down. > The U.S. ranks relatively poorly -- near the bottom of the industrialized countries -- on almost every measure of performance. With an incredibly unhealthy lifestyle, it's pretty incredible how long American longevity is. A fine on obesity would probably do more to increase American health than a fine on being uninsured, but that's unlikely to happen.
  - roundsquare 17y ago
    Over the next 20 years, one side effect of this sort of bill might be to slow that innovation down. Is that definitely true? There are no exceptions etc... in the bill for newly discovered drugs? Even if it is, there is the argument that the American people are paying the price for new drug invention that the rest of the world (eventually) gets the benefit of. Note: I'm not making a pro-American argument here, just looking at what I think are some important consequences. A fine on obesity would probably do more to increase American health than a fine on being uninsured, but that's unlikely to happen. At some point I think they were considering a reward for preventive measures. If that includes eating healthy and regular exercise, it would be great!

protomyth 17y ago

Why can I buy car insurance across state lines, but not health insurance? The funny part is that the "public option" crosses state lines, but current insurance companies can't.

ars 17y ago
You can't. Your car insurer needs to be licensed in your home state. And especially Massachusetts where car insurance is completely run by the government, and few regular insurance companies operate there. (Every plan by all companies costs exactly the same amount - AAA has a 5% discount for members, so the other companies are allowed to offer a discount too if you ask for it.)
- protomyth 17y ago
  You are correct in the "McCarran Ferguson Act" leaves health, auto, homeowners to the state regulators, but it sure seems to be easier to buy my car insurance from a national company then any attempt at health. Good to know about Massachusetts, I had never heard of a state pulling that.
- vlad 17y ago
  This is no longer true as of a year and a half ago. Another change in Massachusetts is that everybody must submit proof of health insurance with their tax return, or else pay a penalty.
natmaster 17y ago
Strange, I get full coverage anywhere I go (including other countries).

natmaster 17y ago

Great, now I have buy into the screwed up healthcare system or become a felony and goto prison and lose all my rights. What kind of country do I live in now?

gojomo 17y ago

The most sensible package of market- and technology-friendly health reforms I've seen proposed: http://www.willwilkinson.net/flybottle/2006/03/19/health-care-fantasia/ http://www.willwilkinson.net/flybottle/2006/03/19/health-car... In particular, it doesn't call things 'insurance' that are not insurance, and faces the reality that some people are going to be charity cases, and that society will (one way or another) ration the care that goes to charity cases. The house bill hides difficult choices in mandates that turn 'insurance' into something else entirely -- a compulsory social service, run by 'companies' that have essentially become federal agencies collecting taxes. Nationalizing the industry outright would be more honest.

physcab 17y ago

What the bill provides: >>Required coverage for preventative care >>Starting next year, private insurers could no longer deny anyone coverage based on preexisting conditions, place lifetime limits on coverage or abandon people when they become ill >>Insurers would be required to disclose and justify proposed premium increases to regulators, and could not remove adult children younger than 27 from their parents' family policies. >>the House package would immediately offer discounts on prescription drugs and reduce a gap in Medicare prescription drug coverage, closing it entirely by 2019. >>Uninsured people who cannot get coverage could join temporary high-risk insurance pools, and unemployed workers would be permitted to keep their COBRA benefits until the public plan and insurance exchanges started in 2013. >>Tax-free benefits for domestic partners just like health benefits provided to the family of an employee married to a person of the opposite sex. >>Provide grants to states for home visitation programs in which nurses and social workers counsel pregnant women and new mothers in low-income families. >>Nutrition labeling requirements for snack food sold in vending machines and many restaurants.

DanielBMarkham 17y ago

I'm going to step out on a limb and predict that if this passes both houses and is signed, the Supreme Court will strike it down. You just can't have a law that requires people to buy something. There's nothing in the Constitution that can be remotely construed to allow the government forcing people to purchase things. Now at the state level it's a different matter entirely. Congress could have easily come up with some kind of reward-punishment system that required states to find some solution. And then you'd have 50 states each trying different ideas. They could harvest the best from each other. But it does not appear (to me) that the goal here is iterative, incremental solutions to a pressing problem. It appears that the goal is Big Design Up Front, Top-Down control, and over-engineering every possibility.<sarcasm>An obvious recipe for success</sarcasm> In the last decade, and with this bill especially, I think we've finally reached the end-game of the American federalist experiment. It's become obvious that we can't meet our current obligations, and it's also become obvious that politicians get elected making promises for even more obligations, not fixing the ones we currently have. So the goal isn't to "fix the system" The goal is to gin up new and various ways to keep making more promises while blaming all problems on the other party. The party's over, but it might be another 20 years before the cops show up, so let's have fun while we can!

Mz 17y ago

My issue with this is that it presumes "healthcare" and "medical care" are the same thing. Study after study after study indicates that diet and lifestyle are major factors in health outcomes and greatly influence your odds of suffering the deadliest conditions. But getting a prescription for a pill is a lot easier than making dietary and lifestyle changes, so a great many people will go that route and then complain about the high cost of medicine when they wouldn't need medication and frequent doctor's visits if they just took care of themselves. If you really want to bring down medical costs, people will have to start taking better care of themselves. Restructuring how we pay for it won't do a heckuva lot towards lowering costs if people continue to pursue self-destructive lifestyles. To the degree that it adds regulation and bureaucracy, the odds are good it will increase costs.

tptacek 17y ago

It's interesting to see people who supported Obama, or even paid attention to the '08 election at all, acting surprised about the health insurance mandate. Obama was pummeled over the concept during the race, most notably by Clinton during the primary. This was a long time coming. As for the concept of a mandate, it's simply the flip side of guaranteed issue. Without a mandate, guaranteed issue screws insurers: it creates --- as a matter of law --- an incentive for people not to get insurance until they get sick. Adverse selection is the enemy of insurance. It seems to me that you can't argue about whether an insurance mandate is confiscatory or overreaching without at the same time arguing about whether people with preexisting or chronic conditions (or some statistical disposition to same) should be excluded from the health care system. And yet: all I see here is arguments about whether politicians should run the health care system. Finally, I'll just note that the dollar amounts being discussed for the fine accompanying the mandate are a fraction of what someone would pay for actual health insurance, and probably lower that one would pay even for low-deductable coverage. I think lots of people don't realize that, because right now, the cost of coverage is very stealthily deducted from their income at the fiat of HR directors and the health insurance reps that instruct them.

DanielBMarkham 17y ago
Couldn't you just allow cross-state insurance pools, insurance portability, require direct payment and encourage the states to have their own pooling solutions, much like some states currently do with automotive insurance? I don't think it's an either-or question -- pooling/mandate or not -- at the national level. Sure, I think lots of folks would like it to be that way, but it doesn't have to be. It doesn't have to have a centralized answer for it to have a solution. Co-ops, for instance, have been left on the floor so far.
- tptacek 17y ago
  Cross-state insurance seems like such an obvious proxy for insurance de-regulation that I'm surprised its advocates don't just come out and say it: "we should work with the minimum possible regulation on insurance companies". I'm wholly ambivalent about whether states or the federal government should operate the government-sponsored risk pool. You already know where this discussion is going to go with me, so think about whether you want to wade into it. Pick your poison: government by the Government, or government by the insurance companies. I'm not wild about what the federal government is coming up with (though not because of the mandate, which seems sensible), but the major insurance companies are both inept and actively evil, and the system we have today is rigged to favor them decisively whether we regulate or not.

jamesbritt 17y ago

Nicely done on a Saturday night. Dems must be proud of their work.

sachinag 17y ago

The best thing about my new gig at oneforty is that I'm in Massachusetts and I can get health insurance via the Massachusetts exchange. I seriously, seriously believe that if health insurance doesn't pass that startups who aren't looking to raise money locate in Massachusetts for this reason alone (and there are a ton of other good things about the community here).