"But I don't need health insurance"

[beltim]

which was that the higher costs of medical care in the US go in part towards funding research into health care.  I think that is an investment into future health care treatments, and a good thing.  Others disagree with me, and I think that is an interesting discussion to have.

You are wrong: http://www.fightchronicdisease.org/facing-issues/about-crisis

Truth #1    
Chronic diseases are the No. 1 cause of death and disability in the U.S.

Truth #4    The doubling of obesity between 1987 and today accounts for 20 to 30 percent of the rise in health care spending.

Truth #5    The vast majority of cases of chronic disease could be better prevented or managed.

Magic pills aren't going to reduce healthcare spending, well unless those pills result in death. A large factor of the situation in health spending is due to behavioral factors.

http://www.forbes.com/sites/rickungar/2012/04/30/obesity-now-costs-americans-more-in-healthcare-costs-than-smoking/

"annual medical spending for an obese person was $3,271 compared with $512 for the non-obese.”

  Gee, just a 638% increase in costs.

Do you think what you just wrote proves wrong the following statement: "the higher costs of medical care go in part towards funding research into health care?"

Because it doesn't.  I never said that there aren't other causes of higher health care costs.  There are.

[CDP45]

There are many other disorders for which obesity is a symptom, and there is no way to prevent them.  So, yes I am serious that obesity is not 100% preventable, because it is a scientific fact.]There are many other disorders for which obesity is a symptom, and there is no way to prevent them.  So, yes I am serious that obesity is not 100% preventable, because it is a scientific fact.

Is this your point? Because while the variability of caloric burn in humans is caused by different factors, when relating to weight it's merely a fixed (endogenous) factor. The variable is how many calories consumed. All mass is created by energy, the human body's mass can be changed due to the amount of energy (calories/food) consumed. Obesity is defined as too great of mass, and therefore a reduction in net energy will reduce mass, and that reduction is a choice of simply eating less.

Yes, that was a response to a subpoint that I'll stand by.  There are, in fact, many medical causes of obesity that cannot be cured by eating less.  I may have overreached in saying that eating less would be more dangerous to those people's health (such evidence is not quickly obtained).  But you'll note that medical treatment of these diseases do not include eating less.

Anyway, I'd like to hear your thoughts on IP and medicine.  Have you found any patent trolls in the medical field?

Wrong again, obesity is the symptom of over-eating. We know this because if you don't over eat, you will cease being obese. All cases of obesity are "cured" by eating less calories than burned. These diseases are likely just associating obesity as a symptom, because it's physically impossible for a disease or mutation to cause a gain in mass unless it somehow caused humans to have the ability to photosynthesize light.

If you accept the reality of physics, you can accept the reality of obesity.

Here's some discussion about patent trolls:
http://medcitynews.com/2013/09/patent-trolls-are-a-pain-for-both-startups-vcs-except-for-those-that-make-money-off-them/

[beltim]

Here's some discussion about patent trolls:
http://medcitynews.com/2013/09/patent-trolls-are-a-pain-for-both-startups-vcs-except-for-those-that-make-money-off-them/

Thanks for you link.  Do you actually know of any cases of patent trolls in pharmaceuticals or medical devices?  That link only links to another saying that suits "may become more common in the medical device and biotech industries?"

[Jamesqf]

And, as much as I'd enjoy engaging you on your other questions, doing so would only distract me from my original point, which was that the higher costs of medical care in the US go in part towards funding research into health care.

Fair enough.  I do think that might be an overlooked point when considering cost differentials between the US and other countries.  If BigPharma Inc can make enough profit on the US sales of some new miracle drug to cover R&D costs, then if it's forced to accept lower prices in other countries, whatever they do get is still almost pure profit.

Magic pills aren't going to reduce healthcare spending, well unless those pills result in death.

Sorry, but we do have quite a number of historic examples of "magic pills" that have reduced or even eliminated health care spending for particular diseases.  Vaccines for things like smallpox, polio, & tetanus,  Antibiotics.  Vitamin supplements for deficiency diseases like rickets.

A large factor of the situation in health spending is due to behavioral factors.

True, but the flip side of this is that a lot of the behavioral stuff is only showing up because medical research managed to find "magic pills" for things that killed people off before the behavioral factors could affect them.

[beltim]

Magic pills aren't going to reduce healthcare spending, well unless those pills result in death.

Sorry, but we do have quite a number of historic examples of "magic pills" that have reduced or even eliminated health care spending for particular diseases.  Vaccines for things like smallpox, polio, & tetanus,  Antibiotics.  Vitamin supplements for deficiency diseases like rickets.

A large factor of the situation in health spending is due to behavioral factors.

True, but the flip side of this is that a lot of the behavioral stuff is only showing up because medical research managed to find "magic pills" for things that killed people off before the behavioral factors could affect them.

I'm not sure why those show up as my quote, because I definitely didn't say that - that was CDP45.  I'm not sure where his ridicule of medical science as "magical pills" comes from.  I, on the other hand, am a strong supporter of medical research, pharmaceuticals included.

[Mr.Macinstache]

- No, states do not have the power to nullify federal laws.

Yes they do. Oregon and Colorado legalized pot. It's called the 10th amendment.

So no one has been arrested, tried, and convicted for possessing pot in those states since it was "legalized"?

It doesn't matter. The governors signed that law themselves. The feds have no authority on the issue over the states and they know it. All they have are threats and might, but no authority to conduct a drug war under the Constitution.

And before someone mutters "Supremacy Clause!", the fed govt is only supreme in pursuance of their enumerated powers. Learn the difference, our founders did not establish a 'King'. The states created the federal govt, not the other way around. The 9th and 10th amendments are very clear on this.

[grantmeaname]

And before someone mutters "Supremacy Clause!", the fed govt is only supreme in pursuance of their enumerated powers.

Found one.

[Mr.Macinstache]

And before someone mutters "Supremacy Clause!", the fed govt is only supreme in pursuance of their enumerated powers.

Found one.

A loophole large enough to fly a stealth B2 bomber through. The key word is "regulate". And in context, like the 2nd Amendment, a well "regulated" militia, does not mean fingerprint every gun owner and ban 11 round magazines. No, regulated meaning well facilitated. That clause does not give Congress the power to compel commerce. Congress ignores the original intent (like preventing states from imposing high tariffs on interstate goods) and abuses their power along with everything else, nothing new there.

[grantmeaname]

You're entitled to your opinion of the founders' intent but it's a fact that the Supreme Court has not interpreted that clause in the same way that you do and that an extension of the supremacy clause over states' drug policy by the Supreme Court using the Commerce Clause would be entirely consistent with the court's history. I understand why it makes you uncomfortable, and there are times that it makes me uneasy, but that doesn't change the facts.

[Jamesqf]

I'm not sure why those show up as my quote, because I definitely didn't say that - that was CDP45.

I don't know, either, other than me getting sloppy about cutting out the irrelevant bits.  It's hard to be sure what's what when there's more than a screenful of multiply-quoted stuff, with a couple of new lines tucked in at the bottom.  Sure would be nice if there was an automated way of doing it.

[Mr.Macinstache]

You're entitled to your opinion of the founders' intent but it's a fact that the Supreme Court has not interpreted that clause in the same way that you do and that an extension of the supremacy clause over states' drug policy by the Supreme Court using the Commerce Clause would be entirely consistent with the court's history. I understand why it makes you uncomfortable, and there are times that it makes me uneasy, but that doesn't change the facts.

It's not just my opinion..

The commerce clause was intended simply to give Congress the power to regulate foreign trade, and also to prevent states from imposing tariffs on interstate goods. In Federalist Paper No. 22, Alexander Hamilton makes it clear the simple intent behind the clause was to prevent states from placing tolls or tariffs on goods as they passed through each state– a practice that had proven particularly destructive across the many principalities of the German empire.

Do you think the Wickard v. Filburn case was within the authority of the Commerce Clause, as the Supreme Court ruled? Do you agree with the court ruling that the Federal govt had a Constitutional right there under the CC there?

http://en.wikipedia.org/wiki/Wickard_v._Filburn

The fact is the Supreme court has misused it's power, they are no exception. Especially when you put these authoritarian like creatures in positions of god-like power. They aren't going to rule on the side of individual liberty, or to restrain any federal power.

[gimp]

They aren't going to rule on the side of individual liberty, or to restrain any federal power.

Please. They have done both again and again and again and again, historically, recently, and under any reasonable definition you want. You're intelligent enough to know it. Why are you claiming otherwise? Because you don't want to pay a health care tax? You've probably posted a full quarter of the posts in this thread and similar ones.

[Mr.Macinstache]

They aren't going to rule on the side of individual liberty, or to restrain any federal power.

Please. They have done both again and again and again and again, historically, recently, and under any reasonable definition you want. You're intelligent enough to know it. Why are you claiming otherwise? Because you don't want to pay a health care tax? You've probably posted a full quarter of the posts in this thread and similar ones.

Please yourself. Put my quote in context, I referred to the authoritarian types on a Supreme Court. The ones who rule with their political agenda vs original intent.

Are you going to argue that Sotomeyer and Kagan are strict Constitutionalists? Ha.

The facts are Federal law does always not trump states rights and the Supreme court does not always rule within the confines of the Constitution.

[gimp]

Your quote in context, you said (I suppose implied, but very strongly, especially in the context of your other posts) that they are all authoritarian. You certainly made no distinction between them, or mentioned that some are not. Would you like to?

[Mr.Macinstache]

Your quote in context, you said (I suppose implied, but very strongly, especially in the context of your other posts) that they are all authoritarian. You certainly made no distinction between them, or mentioned that some are not. Would you like to?

Especially when you put these authoritarian like creatures in positions of god-like power. They aren't going to rule on the side of individual liberty, or to restrain any federal power.

They, meaning "the authoritarian types".

That was not an all inclusive statement for every supreme court judge in history.

Hope that clears it up for you.

[hybrid]

To those who find that incomprehensible I ask this one simple question.  Do you have catastrophic health insurance?  Yeah, thought so....   

Thought so what? I pay out of pocket for full coverage health insurance from BCBS. But way to ASSume and try to profile me.

There are a lot of reasons why the libertarians don't gain traction, but the principle and logical conclusion of the message is not one of them.

The individual mandate is rooted in the concept that you yourself do not own your body, that a nanny state has the authority to tax your existence for any potential liability you might incur. Forcing you to tithe to the state, for your health, is a form of implied ownership and servitude. How much does the state need to take care of you... 10%, 28, 65%? How much is enough?

Libertarians ARE pro-personal responsibility. (No one here is arguing that going without health insurance is a good idea). We are saying, let the market operate so that people can voluntary interact with it. The hallmark of a free society is voluntary interaction, not force or coercion.

Libertarians are not anti-tax. They are pro minimal government. They (generally) favor consumption or excise taxes over income and property taxes. Hope that helps your understanding.

I ASSumed your ASS (just like all of us with means) in fact has health insurance, and I ASSumed right.  You missed my point entirely.  No one forced you to buy health insurance, you bought it because it made sense (just like all of us with means).  Hardly a leap on my part.  So it's clearly no burden to expect others to also do the right thing.  Mandate that and it becomes force and coercion?  Please....

You Libertarians with all your over-the-top talk of force and coercion and tyranny and etc. etc. are just too much sometimes.  It often seems to me Libertarians just hate being told what to do, even when it is what every responsible person (including Libertarians!) does anyway.  This is why I argue the Libertarians are doomed to their fringe status in politics, because they too often sound like they are on the fringe.  As it reads, to me anyway, you have gone in this thread.

Your counter to my argument is that people should be free to choose whether to own health insurance.  This burdens the responsible taxpayer with having to carry his load and that of the freeloader when said freeloader gets hurt, the tyrannical gubmint then nurses him back to health, and the freeloader cannot pay the ensuing bill because they freely chose to be irresponsible. 

Laws and regulations exist because people don't always do the right thing.  That is neither force or coercion, that is the price we all pay to live in a civilized nation with rule of law.   

[Mr.Macinstache]

I ASSumed your ASS (just like all of us with means) in fact has health insurance, and I ASSumed right.  You missed my point entirely.  No one forced you to buy health insurance, you bought it because it made sense (just like all of us with means).  Hardly a leap on my part.  So it's clearly no burden to expect others to also do the right thing.  Mandate that and it becomes force and coercion?  Please....

Then your assertion made 0 sense. If you were trying to make a point that I voluntarily bought insurance because its a good practical idea, then that totally undermines your support for mandate to force someone to do it.

You Libertarians with all your over-the-top talk of force and coercion and tyranny and etc. etc. are just too much sometimes.  It often seems to me Libertarians just hate being told what to do, even when it is what every responsible person (including Libertarians!) does anyway.  This is why I argue the Libertarians are doomed to their fringe status in politics, because they too often sound like they are on the fringe.  As it reads, to me anyway, you have gone in this thread.

Ya think? LOL. Yes, we libertarians hate being forced to do anything, under threats of violence. Fringe? I guess 22% is considered fringe now, since a recent poll stated that's how many lean libertarian. You yourself said you're voting for one.

Your counter to my argument is that people should be free to choose whether to own health insurance.  This burdens the responsible taxpayer with having to carry his load and that of the freeloader when said freeloader gets hurt, the tyrannical gubmint then nurses him back to health, and the freeloader cannot pay the ensuing bill because they freely chose to be irresponsible. 

How does a hospital distributing the cost of doing business hurt the taxpayer? I've heard of no hospitals getting govt bailouts. The govt nurses people back to health? Please explain how the govt is giving healthcare to the average citizen. They give welfare, but that is hardly healthcare. This cost is all absorbed by the market. So the "free loader" argument doesnt apply when the govt complains about that. It's the market (insurance and care facilitates) that front the bill.

Laws and regulations exist because people don't always do the right thing.  That is neither force or coercion, that is the price we all pay to live in a civilized nation with rule of law.

Sorry, but a law is coercion and force. What do you think happens when you disobey the law, nothing?

[footenote]

"How does a hospital distributing the cost of doing business hurt the taxpayer? I've heard of no hospitals getting govt bailouts. The govt nurses people back to health? Please explain how the govt is giving healthcare to the average citizen. They give welfare, but that is hardly healthcare. This cost is all absorbed by the market. So the "free loader" argument doesnt apply when the govt complains about that. It's the market (insurance and care facilitates) that front the bill."

Hybrid's freeloader scenario is what happens every day. When 100 patients arrive at the hospital and 100 receive care, but only 95 patients pay for the care, the cost of the 5 patients' care is spread over the other 95 patients. Note that this is true regardless of how the 95 patients' care is paid for. Everyone who carries insurance bears the cost of the uninsured's care.

[sandiahiker]

I've heard of no hospitals getting govt bailouts.

Not many people have heard of it, but it does exist:

http://en.wikipedia.org/wiki/Disproportionate_share_hospital

In fact, the redistribution of DSH payments (from hospitals to Medicaid expansion and insurance subsidies) is one of the primary funding mechanisms for the ACA.

[hybrid]

You Libertarians with all your over-the-top talk of force and coercion and tyranny and etc. etc. are just too much sometimes.  It often seems to me Libertarians just hate being told what to do, even when it is what every responsible person (including Libertarians!) does anyway.  This is why I argue the Libertarians are doomed to their fringe status in politics, because they too often sound like they are on the fringe.  As it reads, to me anyway, you have gone in this thread.

Ya think? LOL. Yes, we libertarians hate being forced to do anything, under threats of violence. Fringe? I guess 22% is considered fringe now, since a recent poll stated that's how many lean libertarian. You yourself said you're voting for one.

Do let me know when Libertarians start actually getting more than 1% or 2% of the vote, and then your argument may actually carry weight.  This seems to be the crux of many of your arguments.

Potentially, people will vote Libertarian.  In reality, they don't.

Potentially, every responsible person will do the right thing (like you and me) and carry catastrophic health insurance.  In reality, they don't (and you have no meaningful answer for that).

Potentially, the gubmint uses force and coercion to get the sheep to comply.  In reality, we are a nation of laws and most folks are quite comfortable with the notion of the rule of law and don't view it as force or coercion at all.  And Libertarians like yourself remain a fringe element because you fail to make those distinctions.

Like I said, I am sympathetic towards much the Libertarians stand for.  But as a political movement (rather than individual issues), Libertarians are failing to win the hearts and minds of the electorate because the message doesn't resonate.  That is reality.  Reality, not potential, is all that ultimately matters.

[Mr.Macinstache]

"How does a hospital distributing the cost of doing business hurt the taxpayer? I've heard of no hospitals getting govt bailouts. The govt nurses people back to health? Please explain how the govt is giving healthcare to the average citizen. They give welfare, but that is hardly healthcare. This cost is all absorbed by the market. So the "free loader" argument doesnt apply when the govt complains about that. It's the market (insurance and care facilitates) that front the bill."

Hybrid's freeloader scenario is what happens every day. When 100 patients arrive at the hospital and 100 receive care, but only 95 patients pay for the care, the cost of the 5 patients' care is spread over the other 95 patients. Note that this is true regardless of how the 95 patients' care is paid for. Everyone who carries insurance bears the cost of the uninsured's care.

No, Its still not the taxpayers footing the bill of the uninsured, its the insurance companies and hospitals, both are not taxpayer funded.

If what you said was true, there's no way a hospital could stay in business with only 5% of people or even 50% of people paying for service.

I've heard of no hospitals getting govt bailouts.

Not many people have heard of it, but it does exist:

http://en.wikipedia.org/wiki/Disproportionate_share_hospital

In fact, the redistribution of DSH payments (from hospitals to Medicaid expansion and insurance subsidies) is one of the primary funding mechanisms for the ACA.

And this is for Medicare recipients, not the "uninsured".

Health care costs for the truly uninsured fall squarely on the private market to pick up the cost. The freeloader taxpayer funded argument only applies to those who are on govt benefits.

[Jamesqf]

Hybrid's freeloader scenario is what happens every day. When 100 patients arrive at the hospital and 100 receive care, but only 95 patients pay for the care, the cost of the 5 patients' care is spread over the other 95 patients.

Yet this is also true of many another business: some people don't pay their bills, go bankrupt, etc.  For one massive example, consider all the people doing short sales or getting part of their mortgage forgiven because they bought at the top of the housing bubble and are underwater.  Yet few people seem to be objecting to those bailouts, or insisting that all homeowners should pay into expensive new insurance schemes.

It'd also be interesting to see some actual numbers on this.  Certainly I haven't ever shown up at an emergency room, or anywhere else, and not been able to pay, so where do you get off calling me a freeloader?

Then there's another question that has puzzled me.  If I take my car to a mechanic for repair, and the repair breaks before I get home, I certainly don't expect to pay for the work.  Yet the medical industry can get away with charging large amounts even though the patient dies - and even when any competent physician should have known that would be the outcome.

[Mr.Macinstache]

You Libertarians with all your over-the-top talk of force and coercion and tyranny and etc. etc. are just too much sometimes.  It often seems to me Libertarians just hate being told what to do, even when it is what every responsible person (including Libertarians!) does anyway.  This is why I argue the Libertarians are doomed to their fringe status in politics, because they too often sound like they are on the fringe.  As it reads, to me anyway, you have gone in this thread.

Ya think? LOL. Yes, we libertarians hate being forced to do anything, under threats of violence. Fringe? I guess 22% is considered fringe now, since a recent poll stated that's how many lean libertarian. You yourself said you're voting for one.

Do let me know when Libertarians start actually getting more than 1% or 2% of the vote, and then your argument may actually carry weight.  This seems to be the crux of many of your arguments.

Potentially, people will vote Libertarian.  In reality, they don't.

Potentially, every responsible person will do the right thing (like you and me) and carry catastrophic health insurance.  In reality, they don't (and you have no meaningful answer for that).

Potentially, the gubmint uses force and coercion to get the sheep to comply.  In reality, we are a nation of laws and most folks are quite comfortable with the notion of the rule of law and don't view it as force or coercion at all.  And Libertarians like yourself remain a fringe element because you fail to make those distinctions.

Like I said, I am sympathetic towards much the Libertarians stand for.  But as a political movement (rather than individual issues), Libertarians are failing to win the hearts and minds of the electorate because the message doesn't resonate.  That is reality.  Reality, not potential, is all that ultimately matters.

Let's not confuse the Libertarian Party with people who lean libertarian or call themselves libertarian. The reason why the party gets only 2% of the vote is because the 2-party monopoly makes it all but impossible for any 3rd party to compete, much less get a voice in the debates. Corporate doners fund the 2 party system and the corporate media caters to it. THIS is why people don't understand what libertarianism is. People are BORN in the 2 party matrix, thanks to our corporate/political overlords. That is our reality.

As for laws, just because you make a law, does not mean you're going to change people behavior. Outlaw drugs and get the largest prison population on earth. Outlaw guns and will get the largest criminal network of gangs on earth. Laws serve the ruling class and the police state. Yes libertarians are for the rule of law, but not the rule of man. Pass a health insurance law and people still wont get it, but now have to pay a fine. All this does is embolden the IRS, the ruling class and so on. This is the reality.

I'm glad you're sympathetic to some libertarian ideals. I think a lot of people are. I agree the party is very much FUBAR'd for the reasons I mentioned below. Also the fact that we are individuals. The term "herding cats" is often used. LOL. We are not in unified lockstep like a Democrat party. Many are trying to take over the R party, with a lot of success, which is nice to see. But R's hate us just as much as D's do, and don't want a 3rd voice crashing their parties.

[grantmeaname]

Certainly I haven't ever shown up at an emergency room, or anywhere else, and not been able to pay, so where do you get off calling me a freeloader?

There is a significant chance that you will get a million dollar illness that all of us will pay for, even if you exercise and take aspirin. This argument has been mentioned about a dozen times - what don't you grasp about it?

[sandiahiker]

Health care costs for the truly uninsured fall squarely on the private market to pick up the cost. The freeloader taxpayer funded argument only applies to those who are on govt benefits.

This is flat out false.

I didn't provide the best link to illustrate what DSH payments do.  This one is better:

https://www.federalregister.gov/regulations/0938-AQ37/medicaid-disproportionate-share-hospital-payments-uninsured-definition-cms-2315-f-

and

http://healthaffairs.org/blog/2010/10/15/health-reform-uncompensated-care-costs-and-reductions-in-medicaid-dsh-payments/

The official term is "Medicaid Disproportionate Share Hospital Payments", and it is for "furnishing hospital services by the hospital to individuals who are Medicaid-eligible or "have no health insurance (or other source of third party coverage) for the services furnished during the year." It is also for Medicare recipients who can't afford certain costs (there are many costs and procedures that Medicare doesn't cover).

So there you have it.  Your tax-dollars at work paying for health care for those without insurance.   Did I just blow your mind? :)

[sandiahiker]

Certainly I haven't ever shown up at an emergency room, or anywhere else, and not been able to pay, so where do you get off calling me a freeloader?

There is a significant chance that you will get a million dollar illness that all of us will pay for, even if you exercise and take aspirin. This argument has been mentioned about a dozen times - what don't you grasp about it?

+1

[smalllife]

Hybrid's freeloader scenario is what happens every day. When 100 patients arrive at the hospital and 100 receive care, but only 95 patients pay for the care, the cost of the 5 patients' care is spread over the other 95 patients. Note that this is true regardless of how the 95 patients' care is paid for. Everyone who carries insurance bears the cost of the uninsured's care.

If what you said was true, there's no way a hospital could stay in business with only 5% of people or even 50% of people paying for service.

Check your math/reading comprehension.  Does that change your response?

[rocketman48097]

"at least someone is trying to fix it."

That's the problem, government started trying to fix it in 1965 with Medicare, and it's only gotten worse everytime they try to "fix it."  The individual health insurance market actually worked quite well before Obamacare.  Yes some paid more for being fat, but almost everyone could get insurance with the exception of a few unfortunate souls.  The reality is they wanted care for free, and didn't care to pay for it.  It would be like not getting house insurance, having your house burn down, and then claiming that the insurance company shouldn't deny you due to this pre existing condition. 

People also don't like high deductibles either, but I think these are a bargain compared to paying premiums, which are fixed whether or not you ever need the actual insurance.  I even argued to my wife that we didn't need employer sponsored dental insurance, for $900 per year, since we only use it for cleanings and cleanings are pointless for those who take good care of their teeth, but I lost as she loves getting cleanings and these are super expensive without insurance or at least where she wants to get them done. 

[footenote]

"at least someone is trying to fix it."

That's the problem, government started trying to fix it in 1965 with Medicare, and it's only gotten worse everytime they try to "fix it."  The individual health insurance market actually worked quite well before Obamacare.  Yes some paid more for being fat, but almost everyone could get insurance with the exception of a few unfortunate souls.  The reality is they wanted care for free, and didn't care to pay for it.  It would be like not getting house insurance, having your house burn down, and then claiming that the insurance company shouldn't deny you due to this pre existing condition. 

People also don't like high deductibles either, but I think these are a bargain compared to paying premiums, which are fixed whether or not you ever need the actual insurance.  I even argued to my wife that we didn't need employer sponsored dental insurance, for $900 per year, since we only use it for cleanings and cleanings are pointless for those who take good care of their teeth, but I lost as she loves getting cleanings and these are super expensive without insurance or at least where she wants to get them done.

As one of those "unfortunate souls" with a pre-existing condition, the healthcare system in this country most definitely did not "work quite well" for me. Eliminating the pre-existing condition bar to buying health insurance is one of the most popular things about ACA, and for good reason.

[sandiahiker]

The individual health insurance market actually worked quite well before Obamacare.

Unless you are a young, healthy male, nothing could be farther from the truth. 
If you think working well means that the insurance you've had for years suddenly drops you when you get cancer, then maybe. 
If you think working well means that women paying upwards of 50% more than men, then maybe.
If you think working well means that maternity coverage is nearly impossible to find, then maybe.
If you think working well means that people take jobs specifically for the employer's health insurance and to avoid the individual market, then maybe.

Fifteen years ago I had an accident (not a car accident) where I fractured two vertebrae.  My insurance covered my care and rehab, but since then I have had several "life events" that involved changing insurance, and I've always had a rider in my insurance that anything related to those fractured vertebrae would not be covered.  Fortunately, I've never had any issues, but maybe someday I might, right?  Then what?  If you call that an insurance market that is working well, I don't want to know what you think would be a bad one.

Face it, the free market has failed in the health insurance arena.  It just doesn't work.  You can't "shop around" while you are having a heart attack or after you've broken your leg.  And most importantly, you can't just decide, "oh, I don't need my leg fixed today." 

Market forces don't work, so the work-around right now, at least, is to force every one into the market.

It would be like not getting house insurance, having your house burn down, and then claiming that the insurance company shouldn't deny you due to this pre-existing condition.

A better analogy would be this: you have house insurance.  Your house burns down.  Your insurance company starts paying for rebuilding the house, and then after putting up walls, but no roof or windows, they say, "Oops, you've reached your lifetime benefit max.  Sorry, and good luck with that coming storm."  Then you get a new insurance policy, and they say, "you have a house-fire pre-existing condition, so we will not insure you against fire."

[Mr.Macinstache]

Health care costs for the truly uninsured fall squarely on the private market to pick up the cost. The freeloader taxpayer funded argument only applies to those who are on govt benefits.

This is flat out false.

I didn't provide the best link to illustrate what DSH payments do.  This one is better:

https://www.federalregister.gov/regulations/0938-AQ37/medicaid-disproportionate-share-hospital-payments-uninsured-definition-cms-2315-f-

and

http://healthaffairs.org/blog/2010/10/15/health-reform-uncompensated-care-costs-and-reductions-in-medicaid-dsh-payments/

The official term is "Medicaid Disproportionate Share Hospital Payments", and it is for "furnishing hospital services by the hospital to individuals who are Medicaid-eligible or "have no health insurance (or other source of third party coverage) for the services furnished during the year." It is also for Medicare recipients who can't afford certain costs (there are many costs and procedures that Medicare doesn't cover).

So there you have it.  Your tax-dollars at work paying for health care for those without insurance.   Did I just blow your mind? :)

So it's a Medicaid supplement first and a subsidy for the uninsured second. I'll give you that. So why then the need for a forced mandate? We are already cost sharing. All that is doing is forcing people who can't afford to pay for health insurance to pay for a fine. They aren't going to sign up because of a law... they'll pay the fine. Agree?

Here's the thing, the industry pushed for this and the health insurance industry is profiting MORE from it. Look at all the major stock prices for them. It's nothing but good for the health industrial complex.

I'm all for the good intentions, but in the end, corporatism benefits and government grows.

[Mr.Macinstache]

The individual health insurance market actually worked quite well before Obamacare.

Unless you are a young, healthy male, nothing could be farther from the truth. 
If you think working well means that the insurance you've had for years suddenly drops you when you get cancer, then maybe. 
If you think working well means that women paying upwards of 50% more than men, then maybe.
If you think working well means that maternity coverage is nearly impossible to find, then maybe.
If you think working well means that people take jobs specifically for the employer's health insurance and to avoid the individual market, then maybe.

My wife is a cancer survivor. Our policy has not been dropped due to that fact.

And the thing is, women cost more because of maternity care. There's no mystery there... the potential for higher health care is offset by higher cost. There's nothing discriminatory going on there.

Maternity coverage is not impossible to find. It just costs more!

[footenote]

The individual health insurance market actually worked quite well before Obamacare.

Unless you are a young, healthy male, nothing could be farther from the truth. 
If you think working well means that the insurance you've had for years suddenly drops you when you get cancer, then maybe. 
If you think working well means that women paying upwards of 50% more than men, then maybe.
If you think working well means that maternity coverage is nearly impossible to find, then maybe.
If you think working well means that people take jobs specifically for the employer's health insurance and to avoid the individual market, then maybe.

My wife is a cancer survivor. Our policy has not been dropped due to that fact.

Your single data point* does not invalidate the experiences of hundreds of thousands of insured Americans who have been dropped from their plans (often during treatment).

*You are lucky and I am happy your cancer-surviving wife still has insurance.

[sandiahiker]

So why then the need for a forced mandate? We are already cost sharing. All that is doing is forcing people who can't afford to pay for health insurance to pay for a fine. They aren't going to sign up because of a law... they'll pay the fine. Agree?

I would agree if the mandate were the only part of Obamacare.  If nothing changed and the individual market were to stay as sucky as it is now, I could see a lot of people just paying the fine.  But the fact is that there are MILLIONS of people who want insurance, and the only way to make it possible for the actuarial risk to work is to require everyone to be part of the pool.  And if you cannot afford insurance, you will probably get a handsome subsidy that would make your payment of the fine a wash.  Why pay the fine when you can get insurance for the same price.  If you can afford insurance, but you choose not to buy because of some philosophical argument that the government can't make you do stuff, you have to pay the fine, because on average the rest of us are going to be footing the bill for that uninsured person.

[Jamesqf]

Certainly I haven't ever shown up at an emergency room, or anywhere else, and not been able to pay, so where do you get off calling me a freeloader?

There is a significant chance that you will get a million dollar illness that all of us will pay for, even if you exercise and take aspirin. This argument has been mentioned about a dozen times - what don't you grasp about it?

Depends on what you define as significant.  I'd say the odds of that are about the same as winning the lottery - assuming for the sake of discussion that I was silly enough to play the lottery, of course.  But that's not really what I was trying to get at here.  There are two assumptions you're making that I haven't seen supported by evidence.

First, that the cost of people like me, who can and do pay for their own health care up to some large amount - let's say $100K just for a concrete number - and then get that million dollar illness is in fact a significant burden on the system.  (And aren't cases like that part of the reason I'm paying that 2.9% tax on my income?)

Second, why these rare events are a problem in health care, but apparently not in any other part of life.  I could e.g. run up credit card bills, get sued for something, have my business fail, or default on mortgage payments, and I could declare bankruptcy, thus passing on the cost of my debts to society at large.  That seems to be perfectly OK with a lot of people, so why should health care be different?

You've also passed over the fact that (as I've said before) I could be ok with something that covered that sort of catastrophic illness, if the cost was based on my actual risk.  But under Obamacare, that sort of policy is not available.  I'll be forced to pay for a level of coverage that I don't need or want, at a price that has no rational relation to my risk.

[grantmeaname]

Everything I'm about to say has been mentioned already. You're willfully ignoring it because it doesn't fit into your preconceived notion of how the world should work.

Depends on what you define as significant.  I'd say the odds of that are about the same as winning the lottery - assuming for the sake of discussion that I was silly enough to play the lottery, of course.  But that's not really what I was trying to get at here.

Several people in the United States win the lottery every day.

First, that the cost of people like me, who can and do pay for their own health care up to some large amount - let's say $100K just for a concrete number - and then get that million dollar illness is in fact a significant burden on the system.  (And aren't cases like that part of the reason I'm paying that 2.9% tax on my income?)

No, that is not what Medicare is.

Second, why these rare events are a problem in health care, but apparently not in any other part of life.  I could e.g. run up credit card bills, get sued for something, have my business fail, or default on mortgage payments, and I could declare bankruptcy, thus passing on the cost of my debts to society at large.  That seems to be perfectly OK with a lot of people, so why should health care be different?

Responsible lenders can and do legally deny uncreditworthy borrowers loans based on their credit history. Hospitals are legally required to treat everyone.

[Abe]

Sorry to jump in, but would like to mention a few statistics regarding lifetime risk of cancer (which can end up costing a lot of money, but usually less than a million):

Breast cancer (Females): 12%
Colon cancer: 5%
Leukemia/Lymphoma: 5%

There is some pre-disposition to the first two if you are obese, or have a genetic disorder, but mostly they seem to be due to random mutations that develop over our ever-lengthening lifespans.

I left out lung (6%) because that is mostly due to smoking. Prostate (13%) is also left out because it rarely needs major therapy.

All the other ones are fairly rare, but add up to about another 15%.

Anyway, I hope that informs the debate!

[Jamesqf]

Everything I'm about to say has been mentioned already. You're willfully ignoring it because it doesn't fit into your preconceived notion of how the world should work.

Seems like you could use a mirror here :-)

Several people in the United States win the lottery every day.

Sure, so at odds of 1 in 100 million per day, what's my expected return?

No, that is not what Medicare is.

Oh?  Then we've been sold a bill of goods all these years.

Hospitals are legally required to treat everyone.

So if a law causes a problem, the way to fix the problem is to enact another bad law?

And you're still ignoring the real problem, because  it doesn't fit into your preconceived notion of how the world should work.  Obamacare is not about requiring people to have insurance to cover their realistic probability of need, it's about forcing healthy and prosperous people to pay well over the odds in order to subsidize the unhealthy. 

Why should I have to pay for other people's pre-existing conditions, pregnancies, fertility treatments, or the quackery that is the vast majority of mental health "treatments"?

[grantmeaname]

Why should I have to pay for other people's pre-existing conditions, pregnancies, fertility treatments, or the quackery that is the vast majority of mental health "treatments"?

Because our society believes that equal access to healthcare is a social good and has decided that we are all willing to pay for it. Based on seeing you do this four other times I'm guessing what's coming next is "well I never decided that and can I please stop paying taxes and have only the benefits of living in a democracy funded by those same taxes", and the answer is again "No, that is not how society works".

No, that is not what Medicare is.

Oh?  Then we've been sold a bill of goods all these years.

No one has ever mentioned to you that Medicare is a medical insurance program for the elderly? Until yesterday you went through your entire life thinking it covered people in their forties who got cancer, and I've totally blown your mind by telling you something so obvious and fundamental it's in the first sentence of the wikipedia article?

So if a law causes a problem, the way to fix the problem is to enact another bad law?

The law doesn't 'cause a problem' from any perspective but yours. See the point above about access to healthcare being considered a right and a social necessity. And again, stop pretending you haven't heard this argument four times.

[Jamesqf]

No one has ever mentioned to you that Medicare is a medical insurance program for the elderly?

And Medicaid is a medical program for the poor, which I would be after spending however many $100K I have on medical care.

So if a law causes a problem, the way to fix the problem is to enact another bad law?

The law doesn't 'cause a problem' from any perspective but yours. See the point above about access to healthcare being considered a right and a social necessity. And again, stop pretending you haven't heard this argument four times.

Repeating your bad argument multiple times doesn't magically cause it to become correct.  (Even though that seems to be a favored tactic of the left :-))

And I wish you could explain how having to fork over many hundreds of dollars each month - probably more than I now spend on everything but my mortgage - for medical coverage* that I neither need nor want is not going to be a problem for me.

*And again, I'm not talking about high-deductible catastrophic coverage, but all the nonsense that's required to be covered under Obamacare plans.

[grantmeaname]

And Medicaid is a medical program for the poor, which I would be after spending however many $100K I have on medical care.

What does medicaid have to do with your FICA contributions?

[sandiahiker]

No one has ever mentioned to you that Medicare is a medical insurance program for the elderly?

And Medicaid is a medical program for the poor, which I would be after spending however many $100K I have on medical care.

So your plan for the country would be that everyone should be able to go on their own for health care, and once you are impoverished ("medical bankruptcy"), you would just go on Medicaid?

Maybe you might be interested in the fact that at least in Missouri (where I am most familiar with the laws), a childless adult is not eligible for Medicaid.

The law doesn't 'cause a problem' from any perspective but yours. See the point above about access to healthcare being considered a right and a social necessity.

So you don't think access to healthcare is a right and/or a social necessity?  What about police protection?  Do you think that our country would be more free, or function more efficiently if police protection was sold by insurance companies, and people in poorer, more crime-ridden areas would be forced to pay higher premiums than those in the affluent suburbs?

[grantmeaname]

Marktrumpet, Jamesqf didn't say that - I said that and he messed up the quote tags.

[CDP45]

I am perplexed why the VA isn't held as a model of govt healthcare by those who support obamacare. Fully administered by the gov, single payer, low admin costs, certainly not for profit, so why is it so unpopular? Why are some govt programs so unpopular yet some are? Why little consistency from such a large bureaucracy?

Why do the people who support the choice in murdering their children not support the choice for other to finance their own healthcare? If healthcare for people is a social good, doesn't that imply that people are the ultimate social good and there should be laws against their destruction? Is it because choice is a result and necessary condition of freedom?

The "sparse" plans that are being cancelled after individuals assessed their coverage choices on the market and then made a personal choice which to pick, cancelled due to obamacare, maybe we're acceptable to this 64 year couple who didn't need pregnancy/neo-natal preventative care.
http://hosted.ap.org/dynamic/stories/U/US_HEALTH_OVERHAUL_YOURE_CANCELED?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2013-11-02-09-44-38

Those dems are smart, they fought tooth and nail against delay even though no one can sign up so this wouldn't happen during the elections next year.

[lithy]

So you don't think access to healthcare is a right and/or a social necessity?  What about police protection?  Do you think that our country would be more free, or function more efficiently if police protection was sold by insurance companies, and people in poorer, more crime-ridden areas would be forced to pay higher premiums than those in the affluent suburbs?

Conflating 'access' to healthcare and the ability to pay for healthcare in order to make people look like they are in favor of actively refusing treatment to the sick is an overly simplistic way to demonize people like myself and jamesqf.  Everyone has access to healthcare, just like everyone has access to multi-million dollar mansions, 3 star Michelin restaurants, and Ferraris.  Only because the treatment of yourself or a loved one becomes an emotional issue we have moved healthcare from a basic good and service into the realm of inalienable human right. 

So while I don't want to speak for jamesqf, I would say for myself at least that no, I don't believe that 'free' healthcare is a right of anyone who cannot afford to pay for it anymore than I deserve a free Ferrari.  The 'we live in a society' argument is also bunk, because it assumes a right to force others to bend to a majority will.  People tend to use this argument and what they are trying to say is that everyone should give to charity to help the less fortunate, but what they end up saying is, I have no faith that you'll give to charity, so I will make that decision for you.  I do not believe that there is any right in this country to subordinate an unwilling minority.

As for the police, first point of order, the police do not provide 'protection', the Supreme Court has ruled on that, and all citizens would do well to remember that the police are not your friend.  Second, police (well, there is the NSA/FBI/CIA, but methinks that's not who you mean) are not employed or administered by the federal government.  Enact all of the state and local healthcare laws that you want, but it is not an appropriate function of the federal government.

I tend to view the pro-ACA arguments as a general mistrust of fellow man, a "we know what's best for you" mentality, that believes that without government intervention, doctors and hospitals will begin actively turning away the sick and dying for the benefit of a bottom line and that no such charity service could ever hope to fill the void.  If only people would own up to it and simply say that they want to force everyone to have insurance because that's just what they want, then at least I could respect that as their honest (but authoritarian) opinion.  As it is, I think a terrifying number of people are their own little dictators at heart, but fail to realize it.

[hybrid]

Unless I am mistaken, I don't think folks are arguing for free healthcare (I'm certainly not).  What many of us have argued is that when someone gets sick or injured and cannot pay then society ends up picking up the tab.  Even in the case of charity it is still someone else picking up the tab for others.  What I and others have argued is that there is no inherent right to shirk personal responsibility when the lack of that personal responsibility impacts others.  In the case of health care we simply do not turn away people from hospitals, nor should we.  I don't want to live in a country like that.  But those services don't come without significant cost. 

The pro-mandate argument does not represent a mistrust of our fellow man, it is the simple realization that left to their own devices many people will significantly and negatively impact the lives of others financially.

To assume otherwise seems almost hopelessly naïve. 

[footenote]

So you don't think access to healthcare is a right and/or a social necessity?  What about police protection?  Do you think that our country would be more free, or function more efficiently if police protection was sold by insurance companies, and people in poorer, more crime-ridden areas would be forced to pay higher premiums than those in the affluent suburbs?

Conflating 'access' to healthcare and the ability to pay for healthcare in order to make people look like they are in favor of actively refusing treatment to the sick is an overly simplistic way to demonize people like myself and jamesqf.  Everyone has access to healthcare, just like everyone has access to multi-million dollar mansions, 3 star Michelin restaurants, and Ferraris.  Only because the treatment of yourself or a loved one becomes an emotional issue we have moved healthcare from a basic good and service into the realm of inalienable human right. 

So while I don't want to speak for jamesqf, I would say for myself at least that no, I don't believe that 'free' healthcare is a right of anyone who cannot afford to pay for it anymore than I deserve a free Ferrari.  The 'we live in a society' argument is also bunk, because it assumes a right to force others to bend to a majority will.  People tend to use this argument and what they are trying to say is that everyone should give to charity to help the less fortunate, but what they end up saying is, I have no faith that you'll give to charity, so I will make that decision for you.  I do not believe that there is any right in this country to subordinate an unwilling minority.

As for the police, first point of order, the police do not provide 'protection', the Supreme Court has ruled on that, and all citizens would do well to remember that the police are not your friend.  Second, police (well, there is the NSA/FBI/CIA, but methinks that's not who you mean) are not employed or administered by the federal government.  Enact all of the state and local healthcare laws that you want, but it is not an appropriate function of the federal government.

I tend to view the pro-ACA arguments as a general mistrust of fellow man, a "we know what's best for you" mentality, that believes that without government intervention, doctors and hospitals will begin actively turning away the sick and dying for the benefit of a bottom line and that no such charity service could ever hope to fill the void.  If only people would own up to it and simply say that they want to force everyone to have insurance because that's just what they want, then at least I could respect that as their honest (but authoritarian) opinion.  As it is, I think a terrifying number of people are their own little dictators at heart, but fail to realize it.

You are incorrect about everyone having access to healthcare. I have a pre-existing condition that requires a monthly blood test at a medical lab. If I am out of my target lab result, a nurse adjusts my dose. Rinse repeat.

I cannot get the maintenance mediation I need without health insurance.

They will not perform this lab test if I do not have insurance.

I could not get health insurance on the private market before ACA because of the pre-existing condition.

Without the medication, I die. Even with the medication (which you could argue I could buy on the black market), if I can't get tested and I am out of target result, I die.

Many conditions are not situations in which an uninsured person has a heart attack, goes to the ER, gets life-saving treatment without insurance.

[Jamesqf]

So you don't think access to healthcare is a right and/or a social necessity?

No, health care is an economic good, no different that a car or cell phone.  Someone has to work to provide it, so if it is a right, then the providers have effectively become slaves. 

What about police protection?

You know, I really have little experience of police protection.  While my chosen way of life is such that it seldom impacts me directly, I'm still paying taxes to have police arrest and incarcerate people for everything from drug sales to underage drinking, even though I have absolutely no desire to be protected from such things.

[sandiahiker]

So you don't think access to healthcare is a right and/or a social necessity?

No, health care is an economic good, no different that a car or cell phone.  Someone has to work to provide it, so if it is a right, then the providers have effectively become slaves.

FamiliesUSA estimated last year that an American dies every 20 minutes for a lack of insurance.  Notice that last sentence ended with the word insurance, not care.

How many people die each year because of not having a car or cell phone? (And first you have to subtract the 30,000 or so people who are killed each year in car accidents and from texting or calling while driving.)

So let me get this straight, if someone has to work to provide a right and/or social necessity, that person is a slave?

What about public education?  Are teachers slaves?
What about the right to have an attorney? Are public defenders slaves?
What about police protection? Are the workers at 911 call centers slaves (not to mention the police officers)?
What about the right to vote? Is your county clerk a slave?

You know, I really have little experience of police protection. 

Yes, and this is the theme of all your arguments.  What is best for you, is all that is needed for the rest of the country. 

[hybrid]

Again I'll argue that people are tripping over loaded words.  I don't believe in a right to affordable health care.  But as a citizen of the wealthiest nation on Earth, knowing that other developed countries have tackled this problem, I have an expectation that we are capable of as much and more.  Same way that I have an expectation that we can pay for and benefit from other high quality services such as education, police and fire, national defense, etc.  Affordable (not free) healthcare is doable.  The devil is in the details, but it is certainly within our capacity.