Author Topic: What comes after the ACA?  (Read 78341 times)

EnjoyIt

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Re: What comes after the ACA?
« Reply #200 on: January 10, 2017, 08:56:52 AM »
No one talks about cost.  The cost of healthcare is more important than who will pay for it.  Cut the cost and almost everyone can afford it.  Only than can taxes cover those that can't.

Just out of curiosity for those that think healthcare should be free for all (paid by taxes)
1) Should people who continue to smoke despite multiple hospitalizations continue to get free care? Showing up in the hospital once or twice a month because they can't breath yet refuse to try and quit smoking?

2) Should smokers pay more money in taxes?  What about heavy drinkers and drug addicts? Should the American people subsidize someones poor choices and unhealthy lifestyles?

3) Should we continue free medical intervention and testing on those that are bedridden, confused, and can't comprehend their surroundings? No quality of life?

I ask because those items cost a huge percentage of the healthcare dollar.  I see no reason why those people can't get that care if they can afford it.  But I personally do not believe it should be paid by tax payer dollars.  BTW, I realize some of those are addictions, and we need to provide ample amounts of free addiction assistance programs if we are to cut people off from free health care.



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Re: What comes after the ACA?
« Reply #201 on: January 10, 2017, 09:03:07 AM »
2) Should smokers pay more money in taxes?  What about heavy drinkers and drug addicts? Should the American people subsidize someones poor choices and unhealthy lifestyles?

Just want to point out that they do pay more in taxes with every pack they buy, which makes me wonder where that money is currently going? That has to be a LOAD of money BTW at $1 per pack at the federal level, ~$15 billion per year, if you google the sales in the US per year.

http://taxfoundation.org/blog/how-high-are-cigarette-taxes-your-state
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radram

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Re: What comes after the ACA?
« Reply #202 on: January 10, 2017, 09:08:53 AM »
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

I don't believe this statement.  One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record.  Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves.  For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

Completely agree. It is not a RIGHT.

I do feel that there is SOMETHING there, but I can not describe it. Maybe moral obligation, but that does not sound right either. All I know is that if I see someone in distress, it just feels right to try to help. I feel better when I do, and sometimes feel like shit when I don't.

I believe one of the best achievements in mankind is the ability to feed its population. We do very well in the US. Even though there is struggle with the poor, there are very few that reach the level of undernourishment and starvation. Government, individuals, corporations, churches and non-profits all have some ownership in this achievement, and it does come with a price. Do people take advantage of that? Yup. It sucks. If that meant that others were suffering from starvation I would hope we would work more aggressively to prevent that from happening, either by going after the ones taking advantage, or working to provide more food. It feels like the right thing to do.

It feels to me that the ability to sustain and maintain a basic level of health services for all people in the US should be possible, and with advancement it is quickly rising to the level similar to feeding its people. This should include preventative care, treatment for minor health issues and some level of treatment for catastrophic care. I agree with you that calling all of this "insurance" is probably the wrong description, but that does not mean they need to be addressed separately. Maybe that would be the best way to do it, but it makes some sense to do so.

It should forever be a choice to provide health services to the entire nation, whereby the elected leaders can add or remove that service as they see fit, just like it is for social security, medicare, military, foodstamps etc. It does NOT need to remain each individuals choice to participate financially, just like it is not my right that I can say my taxes can not go to war or defense or a wall that some group in the future will demand that we "tear down this wall". I would like the US to choose yes on providing health services for all just as every other advanced nation does to varying levels. That might require making choices we are not yet prepared to make, including a shift in spending, or a rethinking of health in exchange for profit, or an increase in taxes.

It is my hope that our future selves look back to the time we did not provide health services to our own people with disdain.

I would like to add that Sol's idea has much promise for me, with maybe some sort of a combination of penalty for "bad bahavior" or discount for "good behavior". Devil in the details of course. Reasonable, rational, and everyone gets skin in the game. In other words, it has no chance :)

OurTown

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Re: What comes after the ACA?
« Reply #203 on: January 10, 2017, 09:22:13 AM »
Several people in this thread have mentioned that there is no way to make health insurance affordable to all Americans as long as healthcare costs are so high.  I think this is wrong.  There IS a way to give everyone affordable insurance without controlling costs at all.  Insurers and hospitals/doctors can continue to get rich, and everyone can have access to affordable care.  I think I've cracked the nut.

What secret sauce have I invented?  The key is in the definition of "affordable".  Just pay 100% of everyone's private health insurance premium with tax dollars. 

Think about this.  Taxes are already designed to be "affordable" to everyone.  They are progressive (for income tax, so the rich pay more) and they are also a flat tax (for OASDI, which everyone pays the same percentage regardless of income).  No one ever goes broke because of taxes.  If you have no income, you pay no taxes.  If you have lots of money, you pay lots of taxes but you still have lots of money.  In both cases, taxes are "affordable" to you.  Why can't health insurance work the same way?

The 100% covered premiums would have to be for basic services, of course, not cadillac plans.  Maybe make them similar to current subsidized silver plans, say 100% coverage for routine preventative care, $25 copays for other stuff, and $1k per person deductibles so everyone pays for their first basic care out of pocket.  People who want more than basic coverage could still buy it, if they can afford it.  Exclude cosmetic procedures.  Revoke HSAs.  Your doctor would bill your insurance company just like it does now, and your insurance company would bill Uncle Sam instead of you.  The private insurance industry would become just like the post office, a quasi-government for-profit corporation subject to federal oversight and regulation, that provides a uniformly available service for the common good and receives periodic bailouts when necessary and makes good money the rest of the time.

If you have employer-sponsored insurance, nothing would need to change.  The money your employer currently pays towards your insurance would get paid to Uncle Sam as taxes.  If you run a small business, you don't need to worry about providing healthcare to your employees if you don't want to.  If you are unemployed or retired, your health insurance is now covered just like your unemployment insurance and disability insurance are already covered under current law.

So this solutions obviously isn't a 100% free ride for everyone.  If Uncle Sam is paying all of this extra money for health insurance premiums, where is the money coming from?  Your taxes, of course.  You can either raise tax rates (either the progressive income tax brackets or the flat OASDI taxes or both, or other taxes) or you can cut spending.  Doesn't really matter.  The key is that taxes are always "affordable" by design, so we're piggy-backing on that system.  Theoretically, your savings from not buying your current insurance should cover your costs from higher taxes.

In either case, the government basically becomes the only end-consumer of health insurance.  They can negotiate rates with the private insurance companies, who can negotiate with providers, to bring long term costs under control.  Medicare already pays a fixed amount for MRIs, and that amount should be the MRI price for EVERYONE, not just old people.  Similar arguments apply for any other billable procedure.  They also get to ration care, for example by denying cosmetic surgery for old ladies who are vain or providing palliative care instead of invasive surgery for 90 year-olds with aggressive cancer.  If you are a billionaire 90 year-old with brain cancer, you can buy additional insurance or pay out of pocket, but even if you don't your basic care is covered just like it is for everyone else.

Everyone gets affordable health care!  You are covered, your rates are affordable to you, and no one will ever go medically bankrupt again!

There is no individual mandate!  You're not forced to buy anything.  The government is buying it for you, just like it buys national defense for you, because we all need it.

There is no denial for pre-existing conditions!  Everyone gets (reasonable) care regardless of health history.  And you can always buy more if you can afford it.

Health outcomes will improve!  Preventative care is free for everyone!  Here's your "how to quit smoking" pamphlet and free nicorette gum.

Emergency care is still available to everyone, but won't be the only care available to poor people!  There is no need to repeal EMTALA.

It's not single payer!  The insurance industry isn't nationalized, and they continue to exist as profitable private corporations.


I'm open to suggestions and criticisms of this plan.  There are clearly a thousand details to complicate the implementation, but the overarching idea of just raising taxes to pay for universally available private insurance seems like the only way to give everyone what they want.

This is a YUUUUUGE winner.  How do we convince the Republicans to run with this and think it was their idea?  Can you add in some random persecution of poor people, that might help.

The Republican congress sounds a lot like the Roman Senate in Mel Brooks' "History of the World Part One."  "FUCK THE POOR!"

protostache

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Re: What comes after the ACA?
« Reply #204 on: January 10, 2017, 09:22:52 AM »
No one talks about cost.  The cost of healthcare is more important than who will pay for it.  Cut the cost and almost everyone can afford it.  Only than can taxes cover those that can't.

Just out of curiosity for those that think healthcare should be free for all (paid by taxes)
1) Should people who continue to smoke despite multiple hospitalizations continue to get free care?

Yes.

Quote
2) Should smokers pay more money in taxes?

No.

Quote
3) Should we continue free medical intervention and testing on those that are bedridden, confused, and can't comprehend their surroundings? No quality of life?

This is entirely between the patient, the patient's family, and their doctors. Not you, not me, not the government.

These are not hard questions if you have even an ounce of compassion in your body.
« Last Edit: January 10, 2017, 10:12:34 AM by protostache »

bacchi

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Re: What comes after the ACA?
« Reply #205 on: January 10, 2017, 09:36:37 AM »
These are not hard questions if you have even an ounce of compassion in your body.

These types of questions have also been solved in numerous other countries around the world, including by our neighbors to the north and our closest allies (like Britain and Germany).

We're not figuring out logistics for a manned mission to Mars; this has been done before.

thenextguy

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Re: What comes after the ACA?
« Reply #206 on: January 10, 2017, 09:44:10 AM »
Just a counterpoint to those claiming the ACA has failed. More people than ever have just signed up for the exchanges.

http://www.cnbc.com/2017/01/10/obamacare-sign-ups-hit-more-than-11-million-nationally-up-slightly-over-last-year-as-gop-struggles-over-repeal-and-replace.html

It can use some tweaks, but it's definitely not collapsing if more people are signing up for it.

mm1970

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Re: What comes after the ACA?
« Reply #207 on: January 10, 2017, 09:49:44 AM »
No one talks about cost.  The cost of healthcare is more important than who will pay for it.  Cut the cost and almost everyone can afford it.  Only than can taxes cover those that can't.

Just out of curiosity for those that think healthcare should be free for all (paid by taxes)
1) Should people who continue to smoke despite multiple hospitalizations continue to get free care? Showing up in the hospital once or twice a month because they can't breath yet refuse to try and quit smoking?

2) Should smokers pay more money in taxes?  What about heavy drinkers and drug addicts? Should the American people subsidize someones poor choices and unhealthy lifestyles?

3) Should we continue free medical intervention and testing on those that are bedridden, confused, and can't comprehend their surroundings? No quality of life?

I ask because those items cost a huge percentage of the healthcare dollar.  I see no reason why those people can't get that care if they can afford it.  But I personally do not believe it should be paid by tax payer dollars.  BTW, I realize some of those are addictions, and we need to provide ample amounts of free addiction assistance programs if we are to cut people off from free health care.
This is an interesting point, and bears research and statistics.  I can't speak for NOW, but I do remember reading years ago (a decade, maybe?) that smokers actually cost LESS than non-smokers (from a medical stand point) because they die earlier.

Someone else mentioned the taxes you pay on cigarettes too.  I'd want to see the math on that - amount spent on cigs (should the taxes simply go into a medical "pool"?), cost of healthcare to treat a smoker who dies earlier, not to mention costs of social security - do typical lifelong smokers die before they collect?  (Both my parents smoked.  My dad lived to be 81 and was on SS for 20 years, but only got a small amount.  My mother died only a few years after collecting SS.  They were divorced.)

golden1

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Re: What comes after the ACA?
« Reply #208 on: January 10, 2017, 09:54:27 AM »
Quote
No one talks about cost.  The cost of healthcare is more important than who will pay for it.  Cut the cost and almost everyone can afford it.  Only than can taxes cover those that can't.

Just out of curiosity for those that think healthcare should be free for all (paid by taxes)
1) Should people who continue to smoke despite multiple hospitalizations continue to get free care? Showing up in the hospital once or twice a month because they can't breath yet refuse to try and quit smoking?

2) Should smokers pay more money in taxes?  What about heavy drinkers and drug addicts? Should the American people subsidize someones poor choices and unhealthy lifestyles?

3) Should we continue free medical intervention and testing on those that are bedridden, confused, and can't comprehend their surroundings? No quality of life?

I ask because those items cost a huge percentage of the healthcare dollar.  I see no reason why those people can't get that care if they can afford it.  But I personally do not believe it should be paid by tax payer dollars.  BTW, I realize some of those are addictions, and we need to provide ample amounts of free addiction assistance programs if we are to cut people off from free health care.

Smokers already pay more money in taxes.  I am blown away at how much smokers pay for a pack these days.  When I was a kid, my parents bought cigarettes for $30 a carton, now it's $20 a pack.

I don't beleive attacking addiction in a punitive way is effective, and the evidence is supporting that view.  Sure, make it anti-social, which worked for smoking, but don't criminalize it or tie someone's health care to it.  People don't make these decisions in a rational way.  People know that smoking will likely kill you, yet they still do it. 

I am all for mandatory end of life planning, but that got labelled as "death panels" so thats a non starter.  The majority of money spent on health care in your life will be spent in the last 6 months of it, which is just wasteful and usually stressful for everyone involved.   

rtrnow

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Re: What comes after the ACA?
« Reply #209 on: January 10, 2017, 10:06:13 AM »
No one talks about cost.  The cost of healthcare is more important than who will pay for it.  Cut the cost and almost everyone can afford it.  Only than can taxes cover those that can't.

Just out of curiosity for those that think healthcare should be free for all (paid by taxes)
1) Should people who continue to smoke despite multiple hospitalizations continue to get free care? Showing up in the hospital once or twice a month because they can't breath yet refuse to try and quit smoking?

2) Should smokers pay more money in taxes?  What about heavy drinkers and drug addicts? Should the American people subsidize someones poor choices and unhealthy lifestyles?

3) Should we continue free medical intervention and testing on those that are bedridden, confused, and can't comprehend their surroundings? No quality of life?

I ask because those items cost a huge percentage of the healthcare dollar.  I see no reason why those people can't get that care if they can afford it.  But I personally do not believe it should be paid by tax payer dollars.  BTW, I realize some of those are addictions, and we need to provide ample amounts of free addiction assistance programs if we are to cut people off from free health care.

1. yes
2. Both smokers and drinkers already pay more in taxes. If marijuana was legal and taxed a federal level that could be added to the list.
3. I think that has to be a individual/family decision. We could save tons by actually discussing end of life care in real terms. I assume almost no one really wants to live that life, but we often don't discuss wishes with our family and doctors don't have these discussions either. Perhaps just changing doctor training could solve this one.

webguy

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Re: What comes after the ACA?
« Reply #210 on: January 10, 2017, 10:18:24 AM »
It seems like the first logical step to fixing healthcare insurance is addressing the ridiculous prices that healthcare companies are charging. Lowering the cost of care then lowers the cost to the insurance company which lowers the cost for us. $450 for a 5 minute consultation with a "specialist" is beyond obsurd. Set restrictions on what companies can charge, or have insurance companies incentivize people to price shop for cheaper healthcare and suddenly the cost of care lowers and this entire mess gets sorted out.

Greenback Reproduction Specialist

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Re: What comes after the ACA?
« Reply #211 on: January 10, 2017, 10:25:41 AM »
Just a counterpoint to those claiming the ACA has failed. More people than ever have just signed up for the exchanges.

http://www.cnbc.com/2017/01/10/obamacare-sign-ups-hit-more-than-11-million-nationally-up-slightly-over-last-year-as-gop-struggles-over-repeal-and-replace.html

It can use some tweaks, but it's definitely not collapsing if more people are signing up for it.
I guess that depends on your definition of success... If by success you mean we are finally forcing every person to purchase health insurance, if they want it or not, and if not we are going to hit them with a fine(or tax, or what ever suits your legal description at the time to defend it), then yea you might call it a success.

But if success means its something financially sustainable, then that it is not... It has been a total and complete failure from any angle other than to funnel more money from your pocket into Washington DC.
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Roland of Gilead

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Re: What comes after the ACA?
« Reply #212 on: January 10, 2017, 10:26:34 AM »
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.   Pregnant women are certainly a drain, especially if they have a history of premature births.  Perhaps we should charge them more?  Sounds fair right?

Greenback Reproduction Specialist

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Re: What comes after the ACA?
« Reply #213 on: January 10, 2017, 10:31:27 AM »
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.   Pregnant women are certainly a drain, especially if they have a history of premature births.  Perhaps we should charge them more?  Sounds fair right?
I believe they already are.... from a health insurance perspective since they are more likely to need health care related services.

But why would you have a problem singling these people out for higher taxes? and not... lets say a single young adult? which is exactly what the ACA currently does. Are they not worth our compassion? Especially since it is probably the most difficult time in life financially.

Both are wrong in my opinion, but I don't get how the glove doesn't fit the other hand for supporter of the ACA.
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scantee

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Re: What comes after the ACA?
« Reply #214 on: January 10, 2017, 10:40:17 AM »
It seems like the first logical step to fixing healthcare insurance is addressing the ridiculous prices that healthcare companies are charging. Lowering the cost of care then lowers the cost to the insurance company which lowers the cost for us. $450 for a 5 minute consultation with a "specialist" is beyond obsurd. Set restrictions on what companies can charge, or have insurance companies incentivize people to price shop for cheaper healthcare and suddenly the cost of care lowers and this entire mess gets sorted out.

Why do we expect for-profit health insurance companies to limit costs? Their goal is to maximize profits and they do that in part through ever-increasing costs. A health care system funded through a system of for-profit insurance providers is at odds with a goal of cost control.

protostache

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Re: What comes after the ACA?
« Reply #215 on: January 10, 2017, 10:41:47 AM »
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.   Pregnant women are certainly a drain, especially if they have a history of premature births.  Perhaps we should charge them more?  Sounds fair right?
But why would you have a problem singling these people out for higher taxes? and not... lets say a single young adult? which is exactly what the ACA currently does. Are they not worth our compassion? Especially since it is probably the most difficult time in life financially.

ACA gives subsidies to people so they can afford health insurance and it specifically allows cheaper catastrophic plans for young adults and lets them stay on their parents plans until they're 26. In states that didn't reject Medicaid expansion for entirely political reasons there should be no case where a poor single young adult is worse off under ACA than they were before, either because they qualify for subsidies, they're on their parent's plan, or they're able to get Medicaid.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #216 on: January 10, 2017, 11:10:07 AM »
I guess that depends on your definition of success... If by success you mean we are finally forcing every person to purchase health insurance, if they want it or not, and if not we are going to hit them with a fine(or tax, or what ever suits your legal description at the time to defend it), then yea you might call it a success.

But if success means its something financially sustainable, then that it is not... It has been a total and complete failure from any angle other than to funnel more money from your pocket into Washington DC.

Anyone who can guarantee zero insurance utilization for the duration of their life should be welcome to opt-out. For the rest of us, get in the fucking pool.
The first step is acknowledging you have a problem, right?

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Re: What comes after the ACA?
« Reply #217 on: January 10, 2017, 11:15:07 AM »
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.   Pregnant women are certainly a drain, especially if they have a history of premature births.  Perhaps we should charge them more?  Sounds fair right?
But why would you have a problem singling these people out for higher taxes? and not... lets say a single young adult? which is exactly what the ACA currently does. Are they not worth our compassion? Especially since it is probably the most difficult time in life financially.

ACA gives subsidies to people so they can afford health insurance and it specifically allows cheaper catastrophic plans for young adults and lets them stay on their parents plans until they're 26. In states that didn't reject Medicaid expansion for entirely political reasons there should be no case where a poor single young adult is worse off under ACA than they were before, either because they qualify for subsidies, they're on their parent's plan, or they're able to get Medicaid.

And what about those over 26 and don't qualify for subsidies? Do these people not deserve a right to choose if they should pay for something they don't need or want?
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farmecologist

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Re: What comes after the ACA?
« Reply #218 on: January 10, 2017, 11:21:22 AM »
I guess that depends on your definition of success... If by success you mean we are finally forcing every person to purchase health insurance, if they want it or not, and if not we are going to hit them with a fine(or tax, or what ever suits your legal description at the time to defend it), then yea you might call it a success.

But if success means its something financially sustainable, then that it is not... It has been a total and complete failure from any angle other than to funnel more money from your pocket into Washington DC.

Anyone who can guarantee zero insurance utilization for the duration of their life should be welcome to opt-out. For the rest of us, get in the fucking pool.


Exactly..and obviously nobody can guarantee that.  I just love it when people use the "I'm healthy - I don't need insurance" bit.  That is just rationalization plain and simple.  It's just insane that anyone would think that way - ANYONE can get a major disease at any moment...regardless of how "healthy" you think you are.

Frankly, the very notion of insurance doesn't work if everyone doesn't pay in.  I'm not sure why people have a problem with the idea of this.  There are many other problems with our health care system ( or lack thereof ).  However, I'm not sure why there is ever any argument over the idea of the mandate.




NoStacheOhio

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Re: What comes after the ACA?
« Reply #219 on: January 10, 2017, 11:23:49 AM »
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.   Pregnant women are certainly a drain, especially if they have a history of premature births.  Perhaps we should charge them more?  Sounds fair right?
But why would you have a problem singling these people out for higher taxes? and not... lets say a single young adult? which is exactly what the ACA currently does. Are they not worth our compassion? Especially since it is probably the most difficult time in life financially.

ACA gives subsidies to people so they can afford health insurance and it specifically allows cheaper catastrophic plans for young adults and lets them stay on their parents plans until they're 26. In states that didn't reject Medicaid expansion for entirely political reasons there should be no case where a poor single young adult is worse off under ACA than they were before, either because they qualify for subsidies, they're on their parent's plan, or they're able to get Medicaid.

And what about those over 26 and don't qualify for subsidies? Do these people not deserve a right to choose if they should pay for something they don't need or want?

Do I get to choose whether or not my tax dollars goes to pay their ER bill when their break all their limbs heliskiing after spending all of their money on hookers and blow?
The first step is acknowledging you have a problem, right?

GuitarStv

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Re: What comes after the ACA?
« Reply #220 on: January 10, 2017, 11:26:10 AM »
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.

Actually, it should be cheaper for smokers and fat people.  They die quicker and because of this cost the health care system less . . . prolonging those last few years of life for healthy folk (and giving them years of treatment that they manage to survive) is really, really expensive.

http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html

Greenback Reproduction Specialist

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Re: What comes after the ACA?
« Reply #221 on: January 10, 2017, 11:37:42 AM »
Do I get to choose whether or not my tax dollars goes to pay their ER bill when their break all their limbs heliskiing after spending all of their money on hookers and blow?
These are Heliskiers, not rock stars, physical and mental fitness is important to them... They would blow their money on hookers and blow.... Common lets be sensible : )
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protostache

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Re: What comes after the ACA?
« Reply #222 on: January 10, 2017, 11:39:46 AM »
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.   Pregnant women are certainly a drain, especially if they have a history of premature births.  Perhaps we should charge them more?  Sounds fair right?
But why would you have a problem singling these people out for higher taxes? and not... lets say a single young adult? which is exactly what the ACA currently does. Are they not worth our compassion? Especially since it is probably the most difficult time in life financially.

ACA gives subsidies to people so they can afford health insurance and it specifically allows cheaper catastrophic plans for young adults and lets them stay on their parents plans until they're 26. In states that didn't reject Medicaid expansion for entirely political reasons there should be no case where a poor single young adult is worse off under ACA than they were before, either because they qualify for subsidies, they're on their parent's plan, or they're able to get Medicaid.

And what about those over 26 and don't qualify for subsidies? Do these people not deserve a right to choose if they should pay for something they don't need or want?

If you're over 26, don't qualify for subsidies, and live in a Medicare expansion state than by definition you're making enough money to afford health insurance or you're covered by an employer plan.

And they have every right to choose to go without health insurance, in which case they should pay the penalty which helps to pay for if they actually do need to go to the ER and choose to skip out on the bill.

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Re: What comes after the ACA?
« Reply #223 on: January 10, 2017, 12:00:16 PM »
Do I get to choose whether or not my tax dollars goes to pay their ER bill when their break all their limbs heliskiing after spending all of their money on hookers and blow?
These are Heliskiers, not rock stars, physical and mental fitness is important to them... They would blow their money on hookers and blow.... Common lets be sensible : )

Helisnowboarders, then. ;-)
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Re: What comes after the ACA?
« Reply #224 on: January 10, 2017, 12:18:31 PM »
If you're over 26, don't qualify for subsidies, and live in a Medicare expansion state than by definition you're making enough money to afford health insurance or you're covered by an employer plan.

And they have every right to choose to go without health insurance, in which case they should pay the penalty which helps to pay for if they actually do need to go to the ER and choose to skip out on the bill.
We talk all the time about how most people are literally straddled with debt and barely getting by, its their own fault, but in my opinion its not really fair to throw one more expense at them just because you think you know what is best for them.

Also, lets put thing in perspective a little. Everyone keeps talking about this "trip to the ER" like it is financially life ending. According to the Washington post and a few other sites, in 2013(sorry couldn't find a source for 2016), was around $1200.

https://www.washingtonpost.com/news/wonk/wp/2013/03/02/an-average-er-visit-costs-more-than-an-average-months-rent/?utm_term=.439bdb99ae9c

The last time I checked insurance prices for our family it was about $350 per month(this was at the time with employer sponsored, now it would be much higher). That means our family, for the same cost of coverage, could go to the ER 3.5 times. Or one visit per person, per year. If that $350 per month were put into a savings account for 10years (@2% interest)would be worth $46,453.10.....

In my opinion this does not make sense financially, odds of being in a life threatening car accident(which is probably most likely scenario) are pretty small, and $46k is pretty life changing for some.
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Iplawyer

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Re: What comes after the ACA?
« Reply #225 on: January 10, 2017, 12:29:16 PM »
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.   Pregnant women are certainly a drain, especially if they have a history of premature births.  Perhaps we should charge them more?  Sounds fair right?
But why would you have a problem singling these people out for higher taxes? and not... lets say a single young adult? which is exactly what the ACA currently does. Are they not worth our compassion? Especially since it is probably the most difficult time in life financially.

ACA gives subsidies to people so they can afford health insurance and it specifically allows cheaper catastrophic plans for young adults and lets them stay on their parents plans until they're 26. In states that didn't reject Medicaid expansion for entirely political reasons there should be no case where a poor single young adult is worse off under ACA than they were before, either because they qualify for subsidies, they're on their parent's plan, or they're able to get Medicaid.

And what about those over 26 and don't qualify for subsidies? Do these people not deserve a right to choose if they should pay for something they don't need or want?

Think of it differently - if you don't buy health insurance the tax penalty you pay is buying your trip to the ER when you need your life saved and you don't have regular insurance.

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Re: What comes after the ACA?
« Reply #226 on: January 10, 2017, 12:34:22 PM »

Also, lets put thing in perspective a little. Everyone keeps talking about this "trip to the ER" like it is financially life ending. According to the Washington post and a few other sites, in 2013(sorry couldn't find a source for 2016), was around $1200.


Just some clarification, the median cost for a trip to the ER may be 'only' a few thousand dollars, but that isn't what people are insuring against. Most visits to teh ER wind up being out-patient procedures - stitches or a sprain or viral infection that just has to run its course.
Depending on the locale, a single night in the ICU can cost $20k or more. In-patient costs can be between $3k-$5k/night

So while the median cost may be low, the real financial threat is when you need to be hospitalized for multiple days, like if you are in a bad car accident or puncture your spleen while running with scissors.

With insurance you aren't protecting against the routine, but rather the more unlikely extreme events that you otherwise couldn't afford.

*it's also important to note that most people say they can't afford even an unexpected $800 expense without going into debt.  Sad but true.
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Re: What comes after the ACA?
« Reply #227 on: January 10, 2017, 12:48:36 PM »
Think of it differently - if you don't buy health insurance the tax penalty you pay is buying your trip to the ER when you need your life saved and you don't have regular insurance.
Umm I don't think so, my debt doesn't magically go away because I paid my fee last year. I will still be on the hook for the bill, and will gratefully pay the bill since they saved my life. I would technically owe my existence to their awesome training that they paid good money for.

Besides, do you really think that forcing everyone to pay into a broken system is going fix everything? Would stop runaway costs? They don't say "more money, more problems" for nothing...and all things being equal, democrats allowed the most inefficient form of resource management to come in and take control of everything. My prediction is we are all going to continue to see rising healthcare costs, or a reduction in service or a reduction in quality.... Maybe even a little of each.
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Iplawyer

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Re: What comes after the ACA?
« Reply #228 on: January 10, 2017, 01:04:47 PM »
Think of it differently - if you don't buy health insurance the tax penalty you pay is buying your trip to the ER when you need your life saved and you don't have regular insurance.
Umm I don't think so, my debt doesn't magically go away because I paid my fee last year. I will still be on the hook for the bill, and will gratefully pay the bill since they saved my life. I would technically owe my existence to their awesome training that they paid good money for.

Besides, do you really think that forcing everyone to pay into a broken system is going fix everything? Would stop runaway costs? They don't say "more money, more problems" for nothing...and all things being equal, democrats allowed the most inefficient form of resource management to come in and take control of everything. My prediction is we are all going to continue to see rising healthcare costs, or a reduction in service or a reduction in quality.... Maybe even a little of each.

No - what I really think is that that this great, very affluent country, ought to be as progressive as others and make it possible for the humans who live here to get health care.  And I selfishly want to be able to buy it for myself.

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Re: What comes after the ACA?
« Reply #229 on: January 10, 2017, 01:23:28 PM »
No - what I really think is that that this great, very affluent country, ought to be as progressive as others and make it possible for the humans who live here to get health care.  And I selfishly want to be able to buy it for myself.

Well I wouldn't call you selfish for wanting that for yourself.
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Quidnon?

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Re: What comes after the ACA?
« Reply #230 on: January 10, 2017, 02:01:07 PM »

With insurance you aren't protecting against the routine, but rather the more unlikely extreme events that you otherwise couldn't afford.


Yes!  Yes!  That's it exactly!  And that is my complaint with Obamacare.  It has regulated such a high minimum standard of benefits, in order to be called "health insurance" in any legal context, that I can no longer actually buy real insurance in this field; at least not without also paying a tax penalty for not having official health insurance.  I'm relatively healthy for my age, with no major issues; and I have enough money between my HSA and other funds that I could take quite a hard hit.  But without true catastrophic and/or hospitalization insurance, I cannot be certain that I could absorb any hit that life could throw at me, regardless of the odds that I'll be hit at all.  I should have the right to buy whatever insurance I believe is right for myself, and self-insure to whatever level I am comfortable with financially, without special tax consequences and without being compelled to support the choices of others.
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Re: What comes after the ACA?
« Reply #231 on: January 10, 2017, 02:20:06 PM »
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.

Actually, it should be cheaper for smokers and fat people.  They die quicker and because of this cost the health care system less . . . prolonging those last few years of life for healthy folk (and giving them years of treatment that they manage to survive) is really, really expensive.

http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html

This may actually be true, on a life cycle perspective, since the healthy tend to live longer and have more opportunity to rack up charges.  Even still, tis just proves the point that there are many valid ways to look at it, and that also means that there can never be a consensus on what the ideal public plan should look like.
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Re: What comes after the ACA?
« Reply #232 on: January 10, 2017, 02:20:49 PM »
I live in the Midwest and am confident that I don't need protection from the Russians or from ISIS.  Quidnon: what is your argument for why I should be paying for your protection?   
That is one of the actual legitimate roles of a government is to provide defense of its citizens.

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sol

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Re: What comes after the ACA?
« Reply #233 on: January 10, 2017, 02:25:36 PM »

With insurance you aren't protecting against the routine, but rather the more unlikely extreme events that you otherwise couldn't afford.


Yes!  Yes!  That's it exactly!  And that is my complaint with Obamacare.  It has regulated such a high minimum standard of benefits, in order to be called "health insurance" in any legal context, that I can no longer actually buy real insurance in this field; at least not without also paying a tax penalty for not having official health insurance.  I'm relatively healthy for my age, with no major issues; and I have enough money between my HSA and other funds that I could take quite a hard hit.  But without true catastrophic and/or hospitalization insurance, I cannot be certain that I could absorb any hit that life could throw at me, regardless of the odds that I'll be hit at all.  I should have the right to buy whatever insurance I believe is right for myself, and self-insure to whatever level I am comfortable with financially, without special tax consequences and without being compelled to support the choices of others.

I am a real tough guy.  Nobody messes with me or tries to fight me.  Therefore, I should have the right to buy whatever [amount of defense protection from the federal government] I believe is right for myself, and [protect myself] to whatever level I am comfortable with financially, without special tax consequences and without being compelled to [pay for the protection of people who are weaker than me].

I live in the Midwest and am confident that I don't need protection from the Russians or from ISIS.  Quidnon: what is your argument for why I should be paying for your protection?   

This seems like a fun game, can I play?

I have a very secure job, and have almost no chance of being fired or needing to collect unemployment.  I should be able to buy the correct account of unemployment insurance that I think is right for me, without being compelled to pay for your unemployment insurance.  What is your argument for why I should be paying for your unemployment insurance?

Can I do your disability insurance next?  Same deal.

How about your old age insurance, aka social security? Same deal.

This whole argument is stupid, Q.  Congress has decided to provide these services to every American worker whether they think they need them or not.  They protect workers from catastrophic wipeout and they protect private insurer from adverse risk pools.  They are good for the country.  So is widely available affordable health insurance.

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Re: What comes after the ACA?
« Reply #234 on: January 10, 2017, 02:39:11 PM »
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

I don't believe this statement.  One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record.  Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves.  For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

Completely agree. It is not a RIGHT.

I do feel that there is SOMETHING there, but I can not describe it. Maybe moral obligation, but that does not sound right either. All I know is that if I see someone in distress, it just feels right to try to help. I feel better when I do, and sometimes feel like shit when I don't.


So help.  I can show you a dozen different ways that you can, personally, help others in need.  Some with an accompanying tax deduction, and some completely anonymously.  And I agree with the moral obligation to help, as that is literally written into the Christian teachings.  But I don't agree that a non-Christian is bound by that moral obligation, I don't believe that a taxpayer funded program satisfies that obligation, and I don't believe that there is only one way to do anything in a nation of over 300 million people.

Quote

It feels to me that the ability to sustain and maintain a basic level of health services for all people in the US should be possible,


Oh, it's certainly possible, depending upon the concept of "basic level of health services".  But it's not the place of the federal government to do this kind of thing, either for the states or instead of them.  And if it were, it would never work.  One size fits all programs don't ever fit all.  I'm a fine example of that.

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GuitarStv

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Re: What comes after the ACA?
« Reply #235 on: January 10, 2017, 02:42:34 PM »
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.

Actually, it should be cheaper for smokers and fat people.  They die quicker and because of this cost the health care system less . . . prolonging those last few years of life for healthy folk (and giving them years of treatment that they manage to survive) is really, really expensive.

http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html

This may actually be true, on a life cycle perspective, since the healthy tend to live longer and have more opportunity to rack up charges.  Even still, tis just proves the point that there are many valid ways to look at it, and that also means that there can never be a consensus on what the ideal public plan should look like.

There probably never will be a consensus.  (Here in Canada there's no consensus as to what the ideal role of government should be in health care.  I suspect you could find the same sort of argument going on in France, the UK, or anywhere else that public health care is provided.)  There are an awful lot of cases in life where waiting for a perfect solution will prevent you from accepting a good solution, to the detriment of all.



I live in the Midwest and am confident that I don't need protection from the Russians or from ISIS.  Quidnon: what is your argument for why I should be paying for your protection?   
That is one of the actual legitimate roles of a government is to provide defense of its citizens.

In your opinion.

In the opinion of many in this thread, one of the actual legitimate roles of a government is to provide health care for its citizens.

Quidnon?

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Re: What comes after the ACA?
« Reply #236 on: January 10, 2017, 02:45:24 PM »


Quidnon, your posts about health care in this and other threads are full of meaningless hyperbole. Everything you disagree with is PROPAGANDA and health care a serious incursion on your FREEDOM. People here are (rightly, I think) interpreting your comments as nothing more than ridiculous histrionics and are poking fun at you because of it. From what I can tell, your main objection to the ACA is that it is more expensive for you personally than plans you had in the old private insurance market. That's actually a legitimate beef! You're probably going to get more traction with the argument "the ACA is simply too expensive for individuals like me" than trying to connect it to some grave threat to your personal autonomy and the stability of the republic.

The loss of personal freedom and control of my own situation is a large part of my issues with the ACA, who are you to say that my complaints are illegitimate?
"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."
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sol

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Re: What comes after the ACA?
« Reply #237 on: January 10, 2017, 02:46:14 PM »
One size fits all programs don't ever fit all.  I'm a fine example of that.

Why do they need to fit everyone perfectly?  The US government provided a ton of services to everyone, regardless of their individual needs.  In the past few posts you've heard about unemployment insurance, disability insurance, and national defense, all of which are provided to every American regardless of their individual need.  We could also talk about the CDC, which you don't need unless you have an infectious disease, or the EPA, which you don't need unless you are drinking contaminated water.

But you do!  You need all of those services, whether you realize it or not.  You benefit from the army, you benefit from disease control and clean water and from disability insurance, even if you're not currently consuming them, because they benefit everyone and make America stronger.
« Last Edit: January 10, 2017, 02:57:16 PM by sol »

Quidnon?

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Re: What comes after the ACA?
« Reply #238 on: January 10, 2017, 02:47:37 PM »

Seriously, Quidnon, government policy is pretty much how we make decisions about things that affect all of us. Participate or don't, but acting like you're somehow not in a society is just obnoxious. If everyone else was a unicorn of personal responsibility like you, then we would live in a free market utopia where nothing bad ever happens.


Your health decisions should not affect me, nor should mine affect you.  This is not a business of the federal government.  Maybe of the state, but not the federal.
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Re: What comes after the ACA?
« Reply #239 on: January 10, 2017, 02:48:49 PM »
This whole argument is stupid, Q.  Congress has decided to provide these services to every American worker whether they think they need them or not.  They protect workers from catastrophic wipeout and they protect private insurer from adverse risk pools.  They are good for the country.  So is widely available affordable health insurance.

Only in the case of the ACA, congress didn't decide it as a governing body with consent of both sides, the democrats did it all by themselves as if it were a dictatorship.... In the same way that it is now going to be undone.
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Re: What comes after the ACA?
« Reply #240 on: January 10, 2017, 02:50:08 PM »
The loss of personal freedom and control of my own situation is a large part of my issues with the ACA, who are you to say that my complaints are illegitimate?
+1 and...

Your health decisions should not affect me, nor should mine affect you.  This is not a business of the federal government.  Maybe of the state, but not the federal.
+1
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bacchi

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Re: What comes after the ACA?
« Reply #241 on: January 10, 2017, 02:52:54 PM »
This whole argument is stupid, Q.  Congress has decided to provide these services to every American worker whether they think they need them or not.  They protect workers from catastrophic wipeout and they protect private insurer from adverse risk pools.  They are good for the country.  So is widely available affordable health insurance.

Only in the case of the ACA, congress didn't decide it as a governing body with consent of both sides, the democrats did it all by themselves as if it were a dictatorship.... In the same way that it is now going to be undone.

For fuck's sake, a majority vote in a democratically elected Congress and signed by a democratically elected President is not a "dictatorship."

http://www.dictionary.com/browse/dictatorship

Knaak

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Re: What comes after the ACA?
« Reply #242 on: January 10, 2017, 02:56:05 PM »
I live in the Midwest and am confident that I don't need protection from the Russians or from ISIS.  Quidnon: what is your argument for why I should be paying for your protection?   
That is one of the actual legitimate roles of a government is to provide defense of its citizens.

To provide the defense of what for its citizens?  You mean, like, their health?

We can create the Department of Health Defense.  The department will provide citizens a defense against domestic (hereditary) and foreign diseases.  Just like the DoD, the DoHD can go on the offensive and provide preventative measures for its citizens.  We can even keep insurance companies (like sol mentioned earlier) and call them defense contractors.  We all know Republicans love giving taxpayer dollars to defense contractors, so the department will be well-funded.

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Re: What comes after the ACA?
« Reply #243 on: January 10, 2017, 03:03:28 PM »
We can create the Department of Health Defense.  The department will provide citizens a defense against domestic (hereditary) and foreign diseases.  Just like the DoD, the DoHD can go on the offensive and provide preventative measures for its citizens.  We can even keep insurance companies (like sol mentioned earlier) and call them defense contractors.  We all know Republicans love giving taxpayer dollars to defense contractors, so the department will be well-funded.

Lol that's funny : )
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Re: What comes after the ACA?
« Reply #244 on: January 10, 2017, 03:04:15 PM »
For fuck's sake, a majority vote in a democratically elected Congress and signed by a democratically elected President is not a "dictatorship."

http://www.dictionary.com/browse/dictatorship

Yes I know it wasn't the correct word exactly, but you cant argue the whole thing wasn't a one side decision.
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Quidnon?

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Re: What comes after the ACA?
« Reply #245 on: January 10, 2017, 03:06:16 PM »
For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything.  But it would be mixed in with everything else the government buys with your tax dollars.  No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes.  At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

This is a key point. Of course the "taxes are theft" folks will still disagree on principle, but their principles are based on an ignorance of historical context, understanding of how the economy works, and/or empathy for others, so I'm not sure their opinions are particularly relevant.

Do you not proof read your posts first?  Or do you just not care how offensive you sound to those whose opinions you do not share?

Well, this is a fair objection, in some respects. I don't pretend to be tactful. The thing is that this is far from the first forum in which i have fought this particular fight. And it gets old. I'm sure those favoring your worldview feel the same
It certainly does.
Quote
So to repeat myself yet again, the short version here is that the opportunity (which is unprecedented in human history) to be collectively able to have this conversation, is based in the history of the society in which we reside, which was built upon taxation of the resident populous.
This is not true.  Direct income taxes didn't start till 1914, and were widely regarded as theft by fiat before that.  This means that for the first half of the Industrial Revolution, the United States did not have any universal income tax system.  Your perspective on the value of taxation to support your preferred government policy is based upon a false premise, that governments solve social problems better than individuals or the free market is able to do so, and thus the imposition of the taxes necessary to support those programs are practical and legitimate.  I disagree.  So do many others, including Historians Thaddeus Russel & Tom Woods, and Economists Bob Murphy, Walter Williams and Walter Block.  These are the people that I listen to and trust, and you have to address their complaints as well as my own, in order to win me to your side.
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Re: What comes after the ACA?
« Reply #246 on: January 10, 2017, 03:09:31 PM »
For fuck's sake, a majority vote in a democratically elected Congress and signed by a democratically elected President is not a "dictatorship."

http://www.dictionary.com/browse/dictatorship

Yes I know it wasn't the correct word exactly, but you cant argue the whole thing wasn't a one side decision.
Actually you can.  Because ACA is very much a compromise.  ACA is Romneycare expanded and was designed almost entirely by the heritage foundation.  The liberal way would have been single payer.   

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Re: What comes after the ACA?
« Reply #247 on: January 10, 2017, 03:09:50 PM »
These are the people that I listen to and trust, and you have to address their complaints as well as my own, in order to win me to your side.

Fortunately for all of us, Congress doesn't have to operate by unanimous consent.

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Re: What comes after the ACA?
« Reply #248 on: January 10, 2017, 03:14:59 PM »
Actually you can.  Because ACA is very much a compromise.  ACA is Romneycare expanded and was designed almost entirely by the heritage foundation.  The liberal way would have been single payer.   
If were a compromise, then why did all 178 republicans and 34 democrats in congress vote against the bill?
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rpr

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Re: What comes after the ACA?
« Reply #249 on: January 10, 2017, 03:19:25 PM »
For fuck's sake, a majority vote in a democratically elected Congress and signed by a democratically elected President is not a "dictatorship."

http://www.dictionary.com/browse/dictatorship

Yes I know it wasn't the correct word exactly, but you cant argue the whole thing wasn't a one side decision.

Obama and other democrats foolishly bent over backwards to  try and reach some compromise. But when you had the republicans deciding they would oppose anything Obama did on principle, there was no room.  At that time, one of their leaders was reputed to have said that they would do anything to make Obama a one term president.

FWIW, the Obamacare plan was based on Romneycare which was similar to the plan put forth by a conservative think tank. The republicans blindly opposed it because Obama. If the democrats really wanted no compromise, they would have gone for a single payer system.

The fact that they are trying to repeal it without providing any replacements must tell you something about their hatred. This is not based on any fundamental principles.  They have had the past 6+ years to come up with an alternate plan.

Number of Obamacare repeal votes in Congress -- 60
Number of Obamacare replacement votes in Congress -- ZERO.