The Money Mustache Community
Other => Off Topic => Topic started by: caracarn on January 12, 2017, 08:08:28 AM
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I've seen this brought up a few times, including the requests for a topic of its own to discuss. I certainly feel the ACA is not the best it can be and needs changes, but there are provisions that are extremely valuable, in my opinion, such as pre-existing conditions, removal of cap limits and lengthened insurance eligibility for children. I am curious to see what the discussion will reveal.
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you may want to join the discussion here:
http://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/ (http://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/)
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"Why do we need to repeal the ACA at all costs?" WE DON"T.
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It's actually part of the republican green initiative. People are the leading cause of climate problems and pollution. Less health care means more people die (but mostly just the poors) AND less taxes. It's win-win.
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It's actually part of the republican green initiative. People are the leading cause of climate problems and pollution. Less health care means more people die (but mostly just the poors) AND less taxes. It's win-win.
+1 yep, I don't understand why democrats are against climate change all of a sudden.
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It's actually part of the republican green initiative. People are the leading cause of climate problems and pollution. Less health care means more people die (but mostly just the poors) AND less taxes. It's win-win.
...wait, less people = higher tax burden on those that survive to maintain similar or improved infrasturcure and military.
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It's actually part of the republican green initiative. People are the leading cause of climate problems and pollution. Less health care means more people die (but mostly just the poors) AND less taxes. It's win-win.
...wait, less people = higher tax burden on those that survive to maintain similar or improved infrasturcure and military.
No, the economy will be more productive with fewer people receiving less healthcare. We'll pay for it with tax cuts.
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I'm hoping Quidnon provides us with his/her answer, as this was the source of my question. It was not directly answered in the thread in the first reply, since that went off in another direction of what comes after, not why it needs to go "at all costs".
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Republicans need to repeal the ACA at all costs because the ACA benefits people who do not support their party. That's the simple answer.
The ACA provides health insurance to poor people, who generally don't vote for Republicans. And people under 26, who generally don't vote for Republicans. And the unemployed, who generally don't vote for Republicans. Basically all of the groups that don't vote for the party of capitalist affluence.
Reason number two is that the ACA includes a 3.8% surtax on investment income above $200k/year. It's literally a tax on rich people, who ARE the party's core constituents. They're just looking out for their own.
So you see the problem. The ACA is perceived to be, on average, bad for Republicans and good for Democrats. That can't be allowed to stand.
That's it. There is no great mystery here.
All of the philosophical objections they have raised, such as "the individual mandate infringes my freedom" were previously addressed by the neocon Heritage Foundation when they proposed it in the first place, as a free-market solution to controlling healthcare costs. They rightfully pointed out that everyone uses healthcare, and anybody who avoids paying for it by refusing to buy insurance is a slimy freeloader and probably a closet liberal. It's that whole bootstrap mentality, self sufficiency and personal responsibility and all that. They said freeloaders shouldn't be welcome in America. They hate welfare queens and they hate people who don't pay for medical coverage, for the exact same reasons.
Now the law isn't perfect, by any stretch. The subsidies are implemented clunkily. Insurers aren't regulated enough. They delayed implementation of some important provisions for too long, and they allowed some states to opt out of a plan that really works best when everyone opts in. So I agree there is room for improvement, but it also got tens of millions of previously uninsured Americans into preventative care plans, it was 100% paid for with new taxes and spending cuts, and it reduced projected future deficits by controlling long term costs. It made health insurance incrementally better. It got a lot of things right, and I think we should be having a discussion about which parts we as a nation liked and which parts still need improvement, instead of a conversation about whether to repeal it on January 27th or March 14th of this year.
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Some very creative explanations here.
Here is Paul Ryan's health care page, which explains some of the concerns
http://paulryan.house.gov/issues/issue/?IssueID=9978
Here is an interesting article about the changing restaurant industry, and it covers some of the effects of increased minimum wage and insurance requirements on waitstaff -- the effect is, more waitstaff losing jobs.
https://www.thrillist.com/eat/nation/american-restaurant-industry-bubble-burst?curator=thereformedbroker
Then there's health care. For the better part of its history, the restaurant business was a health care-free zone, which is ironic, given this Bureau of Labor Statistics' description of the back-of-house work environment: "Kitchens are usually crowded and filled with potential dangers." With the introduction of Obamacare, most restaurant workers finally got the coverage they've needed for years through the employer mandate, but critics often talk about the strain it puts on small-business owners due to a puzzling and controversial element that defines "full time" as 30 hours per week, and not the 40-hour workweek used almost everywhere else (the Save American Workers Act proposes to move this back to 40 hours).
Though this mainly affects bigger restaurants with staffs of 50 or more full-time workers, independent sit-down restaurants still need to provide suitable coverage (meaning it has to be affordable, less than 9.5% of the employee's income) or face fees of $2K per employee. Consider AQ. Semmelhack told me that in 2012 they paid $14,400 for health care costs. In 2015, they paid $86,400. That's an increase of $72K MORE per year than 2012, or 29% of their best year's profit.
This was a very interesting article. The point is, more restaurants are closing. The new concept will be counter-service with fewer workers. There are multiple reasons affecting this change, but health care is a part of it.
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Some very creative explanations here.
Here is Paul Ryan's health care page, which explains some of the concerns
http://paulryan.house.gov/issues/issue/?IssueID=9978
Here is an interesting article about the changing restaurant industry, and it covers some of the effects of increased minimum wage and insurance requirements on waitstaff -- the effect is, more waitstaff losing jobs.
https://www.thrillist.com/eat/nation/american-restaurant-industry-bubble-burst?curator=thereformedbroker
Then there's health care. For the better part of its history, the restaurant business was a health care-free zone, which is ironic, given this Bureau of Labor Statistics' description of the back-of-house work environment: "Kitchens are usually crowded and filled with potential dangers." With the introduction of Obamacare, most restaurant workers finally got the coverage they've needed for years through the employer mandate, but critics often talk about the strain it puts on small-business owners due to a puzzling and controversial element that defines "full time" as 30 hours per week, and not the 40-hour workweek used almost everywhere else (the Save American Workers Act proposes to move this back to 40 hours).
Though this mainly affects bigger restaurants with staffs of 50 or more full-time workers, independent sit-down restaurants still need to provide suitable coverage (meaning it has to be affordable, less than 9.5% of the employee's income) or face fees of $2K per employee. Consider AQ. Semmelhack told me that in 2012 they paid $14,400 for health care costs. In 2015, they paid $86,400. That's an increase of $72K MORE per year than 2012, or 29% of their best year's profit.
This was a very interesting article. The point is, more restaurants are closing. The new concept will be counter-service with fewer workers. There are multiple reasons affecting this change, but health care is a part of it.
Sounds like a strong argument for separating healthcare and employment.
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It's the only significant piece of legislation Obama managed to pass, and Republicans who were hell bent on denying Obama any legislative victories whatsoever therefore decided it had to be repealed and spent the next six years vilifying it, undermining it, and openly sabotaging it. After spending so much time obsessing over it, they can't back down now that they actually have the political power to repeal it.
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Sounds like a strong argument for separating healthcare and employment.
That's OK but who's going to pay for it? It's all in the details.
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Sounds like a strong argument for separating healthcare and employment.
That's OK but who's going to pay for it? It's all in the details.
Killjoy. Stop with the practical consideration, already. I hate grownups. :)
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Sounds like a strong argument for separating healthcare and employment.
That's OK but who's going to pay for it? It's all in the details.
Many, many other countries have figured this out. There are plenty of examples to look at for ideas.
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Sounds like a strong argument for separating healthcare and employment.
That's OK but who's going to pay for it? It's all in the details.
Organic increases in taxes paid on higher wages because companies shift compensation to cash instead of non-cash?
Or they'll just use the money for buybacks and C-level bonuses instead.
I don't mind paying for my healthcare/insurance. I already do. It's really just a matter of who's receiving the premiums, and how much they're spending on actual care. Somehow when the premiums are going to a government-affiliated entity, and they magically become a "tax," everything suddenly becomes evil.
This isn't rocket surgery.
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Sounds like a strong argument for separating healthcare and employment.
That's OK but who's going to pay for it? It's all in the details.
Many, many other countries have figured this out. There are plenty of examples to look at for ideas.
Great, let's get specific then.
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Organic increases in taxes paid on higher wages because companies shift compensation to cash instead of non-cash?
Or they'll just use the money for buybacks and C-level bonuses instead.
I don't mind paying for my healthcare/insurance. I already do. It's really just a matter of who's receiving the premiums, and how much they're spending on actual care. Somehow when the premiums are going to a government-affiliated entity, and they magically become a "tax," everything suddenly becomes evil.
This isn't rocket surgery.
Well I think you should consider your insurance costs before you decide whether you mind what you pay or not. I mean, what is it costing you and what are the benefits you receive? That's smart shopping, right? Part of the problem with the ACA is that many people were getting large increases this year, right at election time.
You should care about how much you will pay!
I am fine if insurance is separate from employment, and I am also fine taking care of my health, going self-pay for a lot of things, and having only a catastrophic type plan.
How much will it cost?
Why should the government run it?
I am intrigued by these mutual aid societies, the Christian groups that do cost sharing memberships. I may end up doing that type of thing in retirement.
There are no free lunches!
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The nice thing about the market is that companies can compete to give lower prices.
Maybe I can just pay my doctor direct most of the time.
I just had a breast infection a couple weeks ago, and it could also have been inflammatory breast cancer (rare and very deadly). So I had the experience of thinking what it would be like to have what I imagine are pretty massive bills for treatment. We have savings. I don't know how it would have gone, to be honest.
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Organic increases in taxes paid on higher wages because companies shift compensation to cash instead of non-cash?
Or they'll just use the money for buybacks and C-level bonuses instead.
I don't mind paying for my healthcare/insurance. I already do. It's really just a matter of who's receiving the premiums, and how much they're spending on actual care. Somehow when the premiums are going to a government-affiliated entity, and they magically become a "tax," everything suddenly becomes evil.
This isn't rocket surgery.
Well I think you should consider your insurance costs before you decide whether you mind what you pay or not. I mean, what is it costing you and what are the benefits you receive? That's smart shopping, right? Part of the problem with the ACA is that many people were getting large increases this year, right at election time.
You should care about how much you will pay!
I am fine if insurance is separate from employment, and I am also fine taking care of my health, going self-pay for a lot of things, and having only a catastrophic type plan.
How much will it cost?
Why should the government run it?
I am intrigued by these mutual aid societies, the Christian groups that do cost sharing memberships. I may end up doing that type of thing in retirement.
There are no free lunches!
I work at a hospital. We're (basically) self-insured. The cost for my "Family I" plan (3-4 people incl. me) is less than what one of our friends pays for an employee-only plan. I understand that my costs are insanely low, and my coverage insanely good.
I personally think we should put everyone on Medicare (and tweak the structure), but that's not going to happen.
I'm fine with the basic structure of ACA, and premiums would probably come down if we ended employer-sponsored health insurance, because there would be more people in the pool. The basic structure is just vanilla health insurance. ACA needs some modifications to be better, but scrapping it is petty and vindictive.
Government didn't raise premiums this year, for-profit insurance companies did. You can say it's because of big bad regulations, but the simple fact is, prior to ACA, the insurance companies were doing all sorts of unethical, but legal, nonsense to maximize profits at the expense of their policyholders' health. If you don't think that's a problem, then it's kind of an impasse.
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Sounds like a strong argument for separating healthcare and employment.
That's OK but who's going to pay for it? It's all in the details.
Many, many other countries have figured this out. There are plenty of examples to look at for ideas.
Great, let's get specific then.
One of the biggest issues in this country is tying health insurance to jobs. (Another big issue is tying school funding to real estate taxes - that will never work out for the poor communities)
Everyone should be insured (for peace of mind, but also because cancer doesn't check you bank account before it decides to invade); not everyone has a job or even a good job or a full-time job or a job with benefits. There are many businesses hiring people for 29 hours / week just to avoid paying benefits. People ending up working 2 to 3 jobs just to make ends meet and still don't have insurance. OR they are on their own in the ridiculous 'pool of one' - a boon for insurance companies.
If there was just one pool (single payer) that issue could be eliminated, but insurance cos. will never go for it because ... profits.
Rarely does anyone in power talk about controlling insurance costs and if this could be done (but again...profits) many of the so-called problems could be fixed.
It could be possible to pay for a single payer option if we went to a transaction tax system like this:
http://www.apttax.com . It's a solution that I haven't seen discussed here on MMM.
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Why should the government run it?
I don't think anyone is saying that the government 'has to' run it. If you started up a private company tomorrow that provided healthcare to all Americans then I think liberals would stop asking the government to take care of it. The problem is, conservatives are not proposing anything like that. They're just proposing to do nothing and hope that a private entity will take care of it eventually. I really don't understand why conservative go into government in the first place. If the private sector has a better solution to every problem, why aren't they in the private sector working on those solutions instead of in government trying to stop those working on government solutions?
On the other hand, why shouldn't government run it?
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Politics.
Giving people access to health care has the potential to win a party a lot of voters. The Republicans said it years ago, their main mission in life was to make Obama a failed president, and part and parcel to that was to frame the Affordable Care Act as "Obamacare" (which was the brainchild of Romney and works fairly well in MA today) and begin the propaganda tarnishing it. They were against it before they heard any details and they made no real efforts to provide any workable plan or alternative. If they had opposed the ACA and provided alternatives, that would be one thing, but the truth is, they have no good alternatives because there aren't any that significantly differs from the ACA in any measurable way.
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Sounds like a strong argument for separating healthcare and employment.
That's OK but who's going to pay for it? It's all in the details.
Many, many other countries have figured this out. There are plenty of examples to look at for ideas.
Great, let's get specific then.
Sure. A good place for you to start is to google "universal healthcare" and look for countries that have it. Then you can start comparing and contrasting how they do it.
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It's actually part of the republican green initiative. People are the leading cause of climate problems and pollution. Less health care means more people die (but mostly just the poors) AND less taxes. It's win-win.
...wait, less people = higher tax burden on those that survive to maintain similar or improved infrasturcure and military.
No, the economy will be more productive with fewer people receiving less healthcare. We'll pay for it with tax cuts.
I don't know, but this exchange is gold!
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I've seen this brought up a few times, including the requests for a topic of its own to discuss. I certainly feel the ACA is not the best it can be and needs changes, but there are provisions that are extremely valuable, in my opinion, such as pre-existing conditions, removal of cap limits and lengthened insurance eligibility for children. I am curious to see what the discussion will reveal.
well 26 is not a child.. its a dude that started drinking 5 years ago
also, I believe for me with a family of 4 it would be about $700 a month with a $12,000 deductible I would need to pay before it did anything. If I had to sum it up in a word... Arizona.
Certain provisions I find valuable such as the pre-existing conditions clause, however, if it makes you broke and you can't afford to use it pre-existing clauses don't mean a damn thing.
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We need to repeal so that wealthy people can pay less taxes, so that difference between rich and poor is even wider.
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Too many people sucking up all the oxygen. Once we've switched over to a CO2-based biology it should be ok. Until then, got to have the extra people kick the bucket faster.
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It would take a populist strongman to ram single payer health care through as legislation.
Wait...
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well 26 is not a child.. its a dude that started drinking 5 years ago
I don't think anyone is claiming that a 26 year old isn't an adult, but in our modern society it's reasonable for a such a person to still have little/no earned income.
Doctors, lawyers, any occupation requiring an advanced degree means the indivudual probably won't be finished with school until on/around age 25. That of course is assuming that they don't take any breaks, switch majors or take a gap year.
Hence why the provision to keep your child on your health care until age 26.
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It would take a populist strongman to ram single payer health care through as legislation.
Wait...
see, I have actually wondered about that.
If the The Donald could commission an economic study that convincingly demonstrates single payer system would be now, and for the next 12 years, cheaper for the country in all aspects than the current clusterfck, convincingly mind you, I would be on board. It would be funny if he was the man to do it.
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If the The Donald could commission an economic study that convincingly demonstrates single payer system would be now, and for the next 12 years, cheaper for the country in all aspects than the current clusterfck, convincingly mind you, I would be on board. It would be funny if he was the man to do it.
Well it's pretty easy to commission a study these days that will conclude whatever you want it to. That's why Trump's tax plans are both debt-neutral and the greatest adder to the national debt in history (depending on who's study you read). The source of the study matters as much as anything.
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If the The Donald could commission an economic study that convincingly demonstrates single payer system would be now, and for the next 12 years, cheaper for the country in all aspects than the current clusterfck, convincingly mind you, I would be on board. It would be funny if he was the man to do it.
Well it's pretty easy to commission a study these days that will conclude whatever you want it to. That's why Trump's tax plans are both debt-neutral and the greatest adder to the national debt in history (depending on who's study you read). The source of the study matters as much as anything.
Sigh. i know. If only we could all get together to agree on facts, but you are right, there doesnt seem to be any conclusive economic facts about much of anything. This of large scale, anyway.
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If Donald Trump proposes single-payer healthcare, then I will call my Democratic senators and tell them to support Donald Trump. I really don't see that happening any time soon, though.
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If Donald Trump proposes single-payer healthcare, then I will call my Democratic senators and tell them to support Donald Trump. I really don't see that happening any time soon, though.
You know he has made noises friendly to the concept, right?
Doesnt mean he will "propose" it or cause it to be enacted, of course.
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If Donald Trump proposes single-payer healthcare, then I will call my Democratic senators and tell them to support Donald Trump. I really don't see that happening any time soon, though.
You know he has made noises friendly to the concept, right?
Doesnt mean he will "propose" it or cause it to be enacted, of course.
He's expressed every possible position on every possible issue at one point or another, except for his suspiciously consistent praise for Putin. I mean a real proposal, backed by his republican colleagues in Congress.
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If Donald Trump proposes single-payer healthcare, then I will call my Democratic senators and tell them to support Donald Trump. I really don't see that happening any time soon, though.
You know he has made noises friendly to the concept, right?
Doesnt mean he will "propose" it or cause it to be enacted, of course.
This would be amazing. Maybe in 2018 after the ACA repeal issue flops, someone can swoop in to propose this and President Trump can ram it through... Call it 'gutting medicare' for those that wish to do that and call it "Trumpcare for all" for those that want to view it that way. I mean, we can always hope.
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Sounds like a strong argument for separating healthcare and employment.
That's OK but who's going to pay for it? It's all in the details.
Many, many other countries have figured this out. There are plenty of examples to look at for ideas.
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Great, let's get specific then.
Sure. A good place for you to start is to google "universal healthcare" and look for countries that have it. Then you can start comparing and contrasting how they do it.
No country with similar health care costs as the US has ever enacted universal health care. Tort reform, cheaper medical education, cheaper medications and at least some rationing of care are all requirements for affordable universal health care. There would be a huge public outcry and opposition from some very powerful lobbies. Having to appease the pharmaceutical and medical insurance lobbies has been one of the big causes for the problems with Obamacare. Unaffordable health care is by definition not universal.
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So, in other words, it's just TOO DAMN HARD to change it.
Not exactly a can do attitude from the people in power.
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The 800 lb gorilla is the cost of health care in the US. There are many special interest groups that benefit from the cost of health care. That makes lowering the cost of care so challenging. These powerful lobbies are not going to just sit and wait for someone to stop the flow of honey. They are going to do whatever they need to do in order to stop cost control reforms. But these reforms are needed to make health care universal and affordable.
When obamacare was enacted, the insurance industry and pharmaceutical companies were super excited. The reason was simple: being able to charge the same and having many more customers guaranteed. The problem is now showing up in the cost of health insurance. If you get subsidies for your obamacare plan, good for you. It just means your neighbors are helping to pay your health care bills. But the medical bills are growing and someone is paying those bills.
In many countries, doctors have an incentive to prescribe less drugs or cheaper drugs. Not doing so may even get them audited. In the US, doctors have an incentive to prescribe drugs and tests. For one, the threat of lawsuits is always there, so better order that extra test. In other countries health care professionals are protected from frivolous lawsuits and have an incentive to prescribe less medications and order less tests. The prices of many drugs are simply set by the government, not by a monopoly of a drug company with a patent. Those are the type of countries that have universal affordable health care.
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i find it kinda funny.
Obama helps get it into law, then trump will remove it then put something else just as bad in itself place.
Two people, 2 sides, 1 coin.
Anything that takes money from someone and gives it to another is morally wrong. Just that simple in my book.
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Anything that takes money from someone and gives it to another is morally wrong. Just that simple in my book.
Is it also morally wrong for a doctor to look someone in the eye and say "You are going to die because you don't have enough money to pay me to make you better"?
Or is that morally acceptable, but insurance isn't?
Do you also think social security is immoral?
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Anything that takes money from someone and gives it to another is morally wrong. Just that simple in my book.
Yes, it is simple.
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Reason number two is that the ACA includes a 3.8% surtax on investment income above $200k/year. It's literally a tax on rich people, who ARE the party's core constituents. They're just looking out for their own.
I wonder if this was a requirement of the law, or it was a free choice on the part of the drafter of the legislation.
If it was the latter, I think it was a strategic blunder to give every rich taxpayer a specific line and every business another specific line to point to and know precisely how much Obamacare was costing them, personally. Nothing will raise the ire like seeing a large five or six figure sum being specifically labelled as "Obamacare surtax".
If instead they could have rolled into the brackets, the sum might have been the same, but it wouldn't be itemized for every CPA interaction.
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Anything that takes money from someone and gives it to another is morally wrong. Just that simple in my book.
Is it also morally wrong for a doctor to look someone in the eye and say "You are going to die because you don't have enough money to pay me to make you better"?
Sometimes more money isn't the answer. Even very rich people die.
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Sometimes more money isn't the answer. Even very rich people die.
I'm not sure I understand your argument. Are you saying that since everyone dies anyway, it's okay to let poor people die of easily treatable conditions just because they are poor?
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I'm not sure I understand your argument. Are you saying that since everyone dies anyway, it's okay to let poor people die of easily treatable conditions just because they are poor?
That is different than saying that it's never ok to say "it costs too much to treat you." At some point it is unsustainable, and probably unreasonable, to keep everyone alive for as long as might be medically possible.
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At some point it is unsustainable, and probably unreasonable, to keep everyone alive for as long as might be medically possible.
I see. I agree that infinite money will not keep you alive forever, but I don't think that has any bearing at all on whether or not zero money should keep you alive for no time at all. You cannot prove something by disproving the converse.
I think people with no money, who have easily treatable conditions, should get treatment despite their inability to pay. I find it barbaric that the most advanced and supposedly virtuous society on the planet would let its own citizens die, when they could be easily saved, just because they are poor.
Like orphans are poor, right? Should we let her die in the street with a broken leg, just because she's a five year old girl with no parents who doesn't have any money? We've had like ten people in these very threads argue that YES SHE SHOULD DIE IN THE STREET because it's just so "immoral" to pay for her medical care by "taking" money from other people and "giving" it to that five year old with the broken leg. These posters need to have their heads examined, IMO. Their concept of morality escapes me.
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At some point it is unsustainable, and probably unreasonable, to keep everyone alive for as long as might be medically possible.
I see. I agree that infinite money will not keep you alive forever, but I don't think that has any bearing at all on whether or not zero money should keep you alive for no time at all. You cannot prove something by disproving the converse.
I think people with no money, who have easily treatable conditions, should get treatment despite their inability to pay. I find it barbaric that the most advanced and supposedly virtuous society on the planet would let its own citizens die, when they could be easily saved, just because they are poor.
Like orphans are poor, right? Should we let her die in the street with a broken leg, just because she's a five year old girl with no parents who doesn't have any money? We've had like ten people in these very threads argue that YES SHE SHOULD DIE IN THE STREET because it's just so "immoral" to pay for her medical care by "taking" money from other people and "giving" it to that five year old with the broken leg. These posters need to have their heads examined, IMO. Their concept of morality escapes me.
I think the difficulty is drawing the line of 'easily treatable.' Heroin overdose? Here's $.50 worth of naloxone, go away. Anaphylaxis? Here's $10 worth of epinephrine, stay away from peanuts. Aggressive brain tumor? Here's $100,000 of experimental medication. I mean, why not, it could work.
There's a line somewhere, perhaps; hard to draw it though.
As for the orphan with the broken leg, I'm sure it would be preferable if she had been terminated in utero; quality of life and all that.
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Post deleted, as I realised I didn't really follow the argument correctly the first time around.
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As for the orphan with the broken leg, I'm sure it would be preferable if she had been terminated in utero; quality of life and all that.
Wait. What the F?!
I have two beautiful and typically healthy kids. If my wife and I are killed in a traffic accident and then one of my kids breaks a limb, the best medical solution would be a time machine that would abort them in utero?
Did I miss a sarcasm tag somewhere along the way?!
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I think the difficulty is drawing the line of 'easily treatable.' Heroin overdose? Here's $.50 worth of naloxone, go away. Anaphylaxis? Here's $10 worth of epinephrine, stay away from peanuts. Aggressive brain tumor? Here's $100,000 of experimental medication. I mean, why not, it could work.
There's a line somewhere, perhaps; hard to draw it though.
In response to your question about line drawing, I suspect that a reasonable case can be made for not covering experimental/unproven treatments. A reasonable case can be made to not cover treatments with survival percentages below 95%. If we grant the elderly the right to choose to die painlessly and with dignity, then I suspect that an awful lot of tough decisions would be taken off of the table to begin with.
It is difficult to draw that line. Since when has 'difficult' meant that we should just give up entirely?
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I think the difficulty is drawing the line of 'easily treatable.' Heroin overdose? Here's $.50 worth of naloxone, go away. Anaphylaxis? Here's $10 worth of epinephrine, stay away from peanuts. Aggressive brain tumor? Here's $100,000 of experimental medication. I mean, why not, it could work.
The difference between the first two and the last one is that the last one is part of a clinical trial. Research is a completely different ballgame than welfare, and we're doing ourselves a disservice if we only allow people with money into clinical trials.
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I think the difficulty is drawing the line of 'easily treatable.' Heroin overdose? Here's $.50 worth of naloxone, go away. Anaphylaxis? Here's $10 worth of epinephrine, stay away from peanuts. Aggressive brain tumor? Here's $100,000 of experimental medication. I mean, why not, it could work.
There's a line somewhere, perhaps; hard to draw it though.
In response to your question about line drawing, I suspect that a reasonable case can be made for not covering experimental/unproven treatments. A reasonable case can be made to not cover treatments with survival percentages below 95%. If we grant the elderly the right to choose to die painlessly and with dignity, then I suspect that an awful lot of tough decisions would be taken off of the table to begin with.
It is difficult to draw that line. Since when has 'difficult' meant that we should just give up entirely?
This is an interesting suggestion. So cancer treatment, for example. If the survivability rating for cancer X is less than 5% (or 10%? Maybe?) then do we give zero treatment? (Other than palliative care) Even if the treatment, while not curing the cancer, would allow the patient to survive for two or three years as opposed to 6 months untreated? What about something like HIV - no cure, is almost certainly going to kill the infected; what level of care should be provided for diseases of this nature?
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I think the difficulty is drawing the line of 'easily treatable.' Heroin overdose? Here's $.50 worth of naloxone, go away. Anaphylaxis? Here's $10 worth of epinephrine, stay away from peanuts. Aggressive brain tumor? Here's $100,000 of experimental medication. I mean, why not, it could work.
There's a line somewhere, perhaps; hard to draw it though.
In response to your question about line drawing, I suspect that a reasonable case can be made for not covering experimental/unproven treatments. A reasonable case can be made to not cover treatments with survival percentages below 95%. If we grant the elderly the right to choose to die painlessly and with dignity, then I suspect that an awful lot of tough decisions would be taken off of the table to begin with.
It is difficult to draw that line. Since when has 'difficult' meant that we should just give up entirely?
This is an interesting suggestion. So cancer treatment, for example. If the survivability rating for cancer X is less than 5% (or 10%? Maybe?) then do we give zero treatment? (Other than palliative care) Even if the treatment, while not curing the cancer, would allow the patient to survive for two or three years as opposed to 6 months untreated? What about something like HIV - no cure, is almost certainly going to kill the infected; what level of care should be provided for diseases of this nature?
In my ideal world, everyone would get free treatment for everything. That said . . . we have budgets and cost limitations in reality that must be accounted for.
If survival rate is below a particular cut-off, or if survival is known to be for an extremely limited time then it would make sense not to pay for treatment. Note, I'm not saying that zero treatment should be available . . . just that it wouldn't be subsidized. While it's not an ideal situation, this would seem to be a reasonable solution to keep medical care prices in check.
Diseases where a treatment exists which can reasonably be expected to extend (decent quality of) life for a long time should be covered though.
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I think the difficulty is drawing the line of 'easily treatable.' Heroin overdose? Here's $.50 worth of naloxone, go away. Anaphylaxis? Here's $10 worth of epinephrine, stay away from peanuts. Aggressive brain tumor? Here's $100,000 of experimental medication. I mean, why not, it could work.
There's a line somewhere, perhaps; hard to draw it though.
In response to your question about line drawing, I suspect that a reasonable case can be made for not covering experimental/unproven treatments. A reasonable case can be made to not cover treatments with survival percentages below 95%. If we grant the elderly the right to choose to die painlessly and with dignity, then I suspect that an awful lot of tough decisions would be taken off of the table to begin with.
It is difficult to draw that line. Since when has 'difficult' meant that we should just give up entirely?
This is an interesting suggestion. So cancer treatment, for example. If the survivability rating for cancer X is less than 5% (or 10%? Maybe?) then do we give zero treatment? (Other than palliative care) Even if the treatment, while not curing the cancer, would allow the patient to survive for two or three years as opposed to 6 months untreated? What about something like HIV - no cure, is almost certainly going to kill the infected; what level of care should be provided for diseases of this nature?
We counsel patients about the realities of what they're facing, and all of their options, and those options' likely outcomes. But there isn't an ICD-10 code for that, so we don't do it.
The data supports end-of-life counseling and good palliative care. Where it's been studied, there's basically no downside. People end up living longer with less pain, and costing less money. They don't end up dying after a week in the ICU. Sometimes people even get better. It doesn't necessarily mean no disease treatment at all, either.
It isn't death panels. It's real conversations between providers, patients and their families about what they want, and what they should expect.
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As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.
Mostly these treatments are designed to prolong life by a few days or weeks, and often the drugs merely counteract the worst symptoms of the disease. If the patient lives longer it isn't because of the treatment, but because of the patient himself.
We are afraid of dying and will cling to any hope, regardless of how faint or expensive or invasive it might be.
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Anything that takes money from someone and gives it to another is morally wrong. Just that simple in my book.
Is it also morally wrong for a doctor to look someone in the eye and say "You are going to die because you don't have enough money to pay me to make you better"?
Or is that morally acceptable, but insurance isn't?
Do you also think social security is immoral?
I think that is acceptable. You dont have a right to live at all costs.
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I'm embarrassed to be part of a groupmwith some of the posters in this thread that suggest the richest country in the world should punatively deny care to the poor, helpless and children because the taxes might slighly inhibit their average consumption levels (like a new car every 5 years unstead of 3).
Since when did christians conservatives buy into this ideology of becoming general haters. I used to like these guys, now i feel they are mindless repeaters of fox news propaganda. Probably going to stop posting in any social thread.
Bye all.
Jesus was radically right wing and money-grubbing. Look at all these examples:
"It is easier for a camel to pass through the eye of a needle than for a rich man to enter the kingdom of heaven."
"woe unto ye who are rich"
"blessed are the meek"
"blessed are the peacemakers"
"Blessed are the merciful"
"If you want to be perfect, go, sell your possessions and give to the poor, and you will have treasure in heaven."
"And if any man will sue thee, and take away thy cloak, let him have thy coat also. And whosoever shall compel thee to go a mile, go with him twain. Give to him that asketh thee, and from him that would borrow of thee turn not thou away"
“No one can serve two masters, either he will hate the one and love the other, or he will be devoted to the one and despise the other. You cannot serve both God and Money.”
And let's not forget all the free health care that he gave the poor, the lepers, and the prostitutes . . .
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As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.
Actually the HepC cure is pretty much exactly what you describe above. Death sentence to cure in about 8 weeks with 1 pill a day.
And remember the movie "Dying Young". Back in the day, having AIDS pretty much meant get your affairs in order and start your gradual decline into looking like a Somali refugee. Not so anymore.
But yeah, those drug companies sure are evil.
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As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.
Actually the HepC cure is pretty much exactly what you describe above. Death sentence to cure in about 8 weeks with 1 pill a day.
And remember the movie "Dying Young". Back in the day, having AIDS pretty much meant get your affairs in order and start your gradual decline into looking like a Somali refugee. Not so anymore.
But yeah, those drug companies sure are evil.
Not at all what I was talking about. HepC is an approved treatment with a very good track record, as are treatments to manage HIV/AIDS.
I'm talking about the more invasive, last ditch attempts that many wil undergo even when doctors tell their patients it has a very small chance of working, carries significant risks and probably won't return the patient to a basic level of quality of life.
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As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.
Actually the HepC cure is pretty much exactly what you describe above. Death sentence to cure in about 8 weeks with 1 pill a day.
And remember the movie "Dying Young". Back in the day, having AIDS pretty much meant get your affairs in order and start your gradual decline into looking like a Somali refugee. Not so anymore.
But yeah, those drug companies sure are evil.
Not at all what I was talking about. HepC is an approved treatment with a very good track record, as are treatments to manage HIV/AIDS.
I'm talking about the more invasive, last ditch attempts that many wil undergo even when doctors tell their patients it has a very small chance of working, carries significant risks and probably won't return the patient to a basic level of quality of life.
But at some point those are probably going to work too. It is kind of like solar and electric cars. You can't really just say "lets not invest and experiment until the payoff is really good". If we had that thinking, solar cells would still be $5 a watt and only 12% efficient.
So yes, a drug that only reduces your cancer tumor by 20% in volume for 8 months doesn't sound really great but eventually there is hope for a true cure. It is probably not going to happen without the crappy treatment progression.
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I'm embarrassed to be part of a groupmwith some of the posters in this thread that suggest the richest country in the world should punatively deny care to the poor, helpless and children because the taxes might slighly inhibit their average consumption levels (like a new car every 5 years unstead of 3).
Since when did christians conservatives buy into this ideology of becoming general haters. I used to like these guys, now i feel they are mindless repeaters of fox news propaganda. Probably going to stop posting in any social thread.
Bye all.
One main important thing to understand about online forums is that you must be mature enough to handle all topics and all responses. This is how things gets improved, is by an open minded understanding of all sides. Denial is what got us to where this country is at right now.
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As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.
Actually the HepC cure is pretty much exactly what you describe above. Death sentence to cure in about 8 weeks with 1 pill a day.
And remember the movie "Dying Young". Back in the day, having AIDS pretty much meant get your affairs in order and start your gradual decline into looking like a Somali refugee. Not so anymore.
But yeah, those drug companies sure are evil.
Not at all what I was talking about. HepC is an approved treatment with a very good track record, as are treatments to manage HIV/AIDS.
I'm talking about the more invasive, last ditch attempts that many wil undergo even when doctors tell their patients it has a very small chance of working, carries significant risks and probably won't return the patient to a basic level of quality of life.
But at some point those are probably going to work too. It is kind of like solar and electric cars. You can't really just say "lets not invest and experiment until the payoff is really good". If we had that thinking, solar cells would still be $5 a watt and only 12% efficient.
So yes, a drug that only reduces your cancer tumor by 20% in volume for 8 months doesn't sound really great but eventually there is hope for a true cure. It is probably not going to happen without the crappy treatment progression.
I'm not saying that at all. Designing better treatment therapies is exactly what clinical trials are for.
I believe where we are running off the rails is the idea that because a treatment is for some patients in some circumstances that it is good for all patients in all circumstances. building on your example: treating cancer with invasive surgery - it might make sense to attempt in healthy 30 year old patients, but not for a frail 82 year old.
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As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.
Actually the HepC cure is pretty much exactly what you describe above. Death sentence to cure in about 8 weeks with 1 pill a day.
And remember the movie "Dying Young". Back in the day, having AIDS pretty much meant get your affairs in order and start your gradual decline into looking like a Somali refugee. Not so anymore.
But yeah, those drug companies sure are evil.
Not at all what I was talking about. HepC is an approved treatment with a very good track record, as are treatments to manage HIV/AIDS.
I'm talking about the more invasive, last ditch attempts that many wil undergo even when doctors tell their patients it has a very small chance of working, carries significant risks and probably won't return the patient to a basic level of quality of life.
But at some point those are probably going to work too. It is kind of like solar and electric cars. You can't really just say "lets not invest and experiment until the payoff is really good". If we had that thinking, solar cells would still be $5 a watt and only 12% efficient.
So yes, a drug that only reduces your cancer tumor by 20% in volume for 8 months doesn't sound really great but eventually there is hope for a true cure. It is probably not going to happen without the crappy treatment progression.
More importantly, those trials are generally funded with research money allocated for that specific thing. People higher up the food chain have decided that it's research worth doing for either humanitarian or (more likely) commercial reasons. At that point, you want as many people in the trial as you can get because more data is better.
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If the ACA is repealed and not replaced, it is estimated that 45,000 people more will die every year. I'm willing to deal with the cost of providing health insurance if less people die.
Source?
I think many poeple are willing to "deal with the cost of insurance." The point is that there is a more efficient way than universal insurance.
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As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.
Actually the HepC cure is pretty much exactly what you describe above. Death sentence to cure in about 8 weeks with 1 pill a day.
And remember the movie "Dying Young". Back in the day, having AIDS pretty much meant get your affairs in order and start your gradual decline into looking like a Somali refugee. Not so anymore.
But yeah, those drug companies sure are evil.
Not at all what I was talking about. HepC is an approved treatment with a very good track record, as are treatments to manage HIV/AIDS.
I'm talking about the more invasive, last ditch attempts that many wil undergo even when doctors tell their patients it has a very small chance of working, carries significant risks and probably won't return the patient to a basic level of quality of life.
But at some point those are probably going to work too. It is kind of like solar and electric cars. You can't really just say "lets not invest and experiment until the payoff is really good". If we had that thinking, solar cells would still be $5 a watt and only 12% efficient.
So yes, a drug that only reduces your cancer tumor by 20% in volume for 8 months doesn't sound really great but eventually there is hope for a true cure. It is probably not going to happen without the crappy treatment progression.
I'm not saying that at all. Designing better treatment therapies is exactly what clinical trials are for.
I believe where we are running off the rails is the idea that because a treatment is for some patients in some circumstances that it is good for all patients in all circumstances. building on your example: treating cancer with invasive surgery - it might make sense to attempt in healthy 30 year old patients, but not for a frail 82 year old.
This is an interesting topic.
My husband's grandmother had cancer when she was in her late 60's. Went through treatment, recovered.
It came back when she was in her 90s. Do they treat it again, or make her comfortable? FIL opted to make her comfortable, but it was a tough choice. I think he regretted it because she lived THREE YEARS (until age 96 I think), and was in increasing amounts of pain and discomfort.
Another anecdote. My dad has an aneurysm in his aorta burst when he was 2 months shy of 82. The doctor told my sis that a younger man would have a 50% chance of surviving the surgery, but not him, not likely. They did the surgery anyway. He died. I wonder how much the state / medicare paid for that? I mean, he died on the table.
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If the ACA is repealed and not replaced, it is estimated that 45,000 people more will die every year. I'm willing to deal with the cost of providing health insurance if less people die.
Source?
I think many poeple are willing to "deal with the cost of insurance." The point is that there is a more efficient way than universal insurance.
How do you define efficiency? If you define efficiency as cost per person, than there should be no health insurance and we let God sort it out. If you define efficiency in terms of maximizing lives saved, universal insurance makes more sense, unless you are arguing that single payer with no insurance is a better system.
good point. We deal with this in manufacturing also. There's ebb and flow and, for example, 30 different pieces of equipment, and 20 lots that have to go through 280 steps each.
If you use good manufacturing practices for flow, everything moves at a reasonable pace. If you decide that this *one* lot is uber important and has to get out faster, everything else has to wait and it slows down - but far more than you'd expect. It basically screws up the entire fab if there's too much focus on one individual.
The health care/ insurance thing is similar. If you just let things "run" and use best practices - yeah, everyone gets decent care. You have to stop and take time out to fix things that are broken, recover things that had a problem, and sometimes - you lose them. But everything moves along - nothing is a rock star.
Unfortunately we have individuals. And each individual is often looking out for themselves. What might be "efficient" won't necessarily be best for THEM.
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It's funny, the efficiency thing has already been extensively debated and it's not actually a very hard thing to figure out - you just use "QALY" analysis - read up all about it here: https://en.wikipedia.org/wiki/Quality-adjusted_life_year
You can bicker about exactly how to define the variables, but it's going to produce similar results: you will spend most of your resources treating young people and doing cheap preventative work. You will spend very little on, say, hip replacements for 85 year olds.
Medicare being available only to those over 65 basically does the opposite, of course. If you wanted an efficient outcome for public healthcare spending, you'd put most of your resources into children and young adults and very little into caring for the elderly.
-W
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You can bicker about exactly how to define the variables, but it's going to produce similar results: you will spend most of your resources treating young people and doing cheap preventative work. You will spend very little on, say, hip replacements for 85 year olds.
Medicare being available only to those over 65 basically does the opposite, of course. If you wanted an efficient outcome for public healthcare spending, you'd put most of your resources into children and young adults and very little into caring for the elderly.
Maybe the Republicans will combine their love of firearms with their public health policy . . . say, open hunting season on all people over the age of 65? It should increase sales of guns (guns = freedom) and reduce those expensive over 65 year old freeloaders.
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Good point. I would assume that Obamacare with it's emphasis on free preventative services would rate well. Not sure what the republican plan is for preventative services.
Medicare is like social security in that the people who use it also paid into it their whole life, so it's hard to complain about that.
I'm a bit surprised the idea of replacing the ACA/Obamacare with a free preventative and catastrophic sort of thing hasn't been floated. It would be (relatively) cheap and it would do most of the most important stuff that people aren't good at doing when left to their own devices.
Folks with chronic conditions would be sort of screwed, but my assumption is that they will be anyway going forward. Good preventative care starting in infancy would hopefully prevent some of those 30 years down the road.
-W
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Medicare being available only to those over 65 basically does the opposite, of course. If you wanted an efficient outcome for public healthcare spending, you'd put most of your resources into children and young adults and very little into caring for the elderly.
People tend to forget that Medicare was created for the benefit of the private insurance industry. It's a subsidy to for-profit insurance corporations, because it nationalizes their least profitable risk pool.
The whole point of Medicare is to get those people off of the private insurance plans before they start to get expensive. Private insurers then get to charge premiums to only younger people, who use less healthcare. Without Medicare, we would all pay higher insurance rates because our plans would have to cover all of that end of life care that is currently insured by the government instead.
Medicaid is the same deal. Poor people can't afford to pay private insurance rates, so they drop out of the potential customer pool for private insurers. Private insurers hate this, not only because they lose paying customers (until the ACA came along) but because they know they will later inherit people with expensive conditions that could have been treated cheaply, when those folks eventually grow up and get better jobs and do because customers. So Medicaid covers that care, to make rates on the private market lower for the rest of us.
Together, this leaves only the wealthy (above Medicaid cutoff) young (below Medicare cutoff) people looking for private insurance, which is the private insurance industry's wet dream. This is exactly the population they want to insure to maximize profits.
Which is exactly why universal coverage single payer healthcare is more cost effective than the current system. The government already insures the worst populations, while letting the private insurance market profit off of the healthy folks. If they just lumped everyone into the existing Medicaid/Medicare risk pool, rates would go down for everyone.
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Medicare being available only to those over 65 basically does the opposite, of course. If you wanted an efficient outcome for public healthcare spending, you'd put most of your resources into children and young adults and very little into caring for the elderly.
-W
Actually you would spend the least on young children. Why spend thousands or millions on kids who are not going to live long enough to be productive members of society? A 24 year old doctor in residency who has a treatable form of cancer is a much better investment than a 2 year old who we have not spent a lot of society resources on yet.
I mean this is super cruel, but just an addition to what you posted.
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Medicare being available only to those over 65 basically does the opposite, of course. If you wanted an efficient outcome for public healthcare spending, you'd put most of your resources into children and young adults and very little into caring for the elderly.
-W
Actually you would spend the least on young children. Why spend thousands or millions on kids who are not going to live long enough to be productive members of society? A 24 year old doctor in residency who has a treatable form of cancer is a much better investment than a 2 year old who we have not spent a lot of society resources on yet.
I mean this is super cruel, but just an addition to what you posted.
Perhaps you misunderstood. The number of potential years of life you get out of a treatment is the biggest variable. So even very expensive treatments for a young child would be "efficient". Generally there's not an IQ test or something like that, every life-year is treated as equally valuable.
-W
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I've seen this brought up a few times, including the requests for a topic of its own to discuss. I certainly feel the ACA is not the best it can be and needs changes, but there are provisions that are extremely valuable, in my opinion, such as pre-existing conditions, removal of cap limits and lengthened insurance eligibility for children. I am curious to see what the discussion will reveal.
Your healthcare system is inherently flawed, beginning with the exact same medication and healthcare services having wild and unjustifiable fluctuations in price at one and the same place instead of working like regular business.
ACA in many ways protects the monopolistic entities in their exploitation of those in need.
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Perhaps you misunderstood. The number of potential years of life you get out of a treatment is the biggest variable. So even very expensive treatments for a young child would be "efficient". Generally there's not an IQ test or something like that, every life-year is treated as equally valuable.
-W
No, think about it. Imagine a drug that would prolong someone's life by 20 years.
Society would benefit a lot more from administering that drug to a 20 year old than a 2 year old. The 2 year old is barely going to be useful by the time they die.
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If the ACA is repealed and not replaced, it is estimated that 45,000 people more will die every year. I'm willing to deal with the cost of providing health insurance if less people die.
Source?
I think many poeple are willing to "deal with the cost of insurance." The point is that there is a more efficient way than universal insurance.
How do you define efficiency? If you define efficiency as cost per person, than there should be no health insurance and we let God sort it out. If you define efficiency in terms of maximizing lives saved, universal insurance makes more sense, unless you are arguing that single payer with no insurance is a better system.
Terrible source, btw.
But yes, efficiency (under the definition I was using) would # lives saved/cost. Going for one or the other side of the equation is a poor way to use resources that could otherwise be allocated to helping others. Getting rid of insurance would be the most logical step towards this goal.
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Perhaps you misunderstood. The number of potential years of life you get out of a treatment is the biggest variable. So even very expensive treatments for a young child would be "efficient". Generally there's not an IQ test or something like that, every life-year is treated as equally valuable.
-W
No, think about it. Imagine a drug that would prolong someone's life by 20 years.
Society would benefit a lot more from administering that drug to a 20 year old than a 2 year old. The 2 year old is barely going to be useful by the time they die.
It'd be even better to use on a 40 year old - more taxes to be collected from their higher earning years.
But what about the scenario of say, a heart transplant. This would not increase life a static number of years, but allow the person to live through their natural lifespan. In this instance it would make more sense to use the money and resources on a 2 year old as the added years of life for the 20 year old has less usefulness to society than the added years of life for the 2 year old.
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In this instance it would make more sense to use the money and resources on a 2 year old as the added years of life for the 20 year old has less usefulness to society than the added years of life for the 2 year old.
How so? The 2 year old still has to go through pre-school, elementary school, high school, and college, just to get to the point where he/she can start producing instead of consuming. The 20 year old is already at or near the producing stage of life.
You are saying a fresh plot of ground has more value than the plot where a energy efficient four bedroom house has been built.
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Roland, go read the link. A year of functional life = value of 1. If you are 2 years old, and you have a treatable condition, you can get 75 years of life out of treating that condition. If you are 25, you can only get 52.
-W
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You are saying a fresh plot of ground has more value than the plot where a energy efficient four bedroom house has been built.
I think that the discrepancy here is that the referenced formula values a year of life as a year of life, regardless of the economic productivity of that year. A five year old's next year is equally valuable to 100 year old's next year.
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You are saying a fresh plot of ground has more value than the plot where a energy efficient four bedroom house has been built.
I think that the discrepancy here is that the referenced formula values a year of life as a year of life, regardless of the economic productivity of that year. A five year old's next year is equally valuable to 100 year old's next year.
Exactly. This is a eudaemonic efficiency calculation.
-W
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You are saying a fresh plot of ground has more value than the plot where a energy efficient four bedroom house has been built.
I think that the discrepancy here is that the referenced formula values a year of life as a year of life, regardless of the economic productivity of that year. A five year old's next year is equally valuable to 100 year old's next year.
Yes. Of course the argument can be made that person A is worth more per year than person B, as Roland points out - these would be conversations that would need to be had if extremely expensive, low success rate care was to be rationed.
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You are saying a fresh plot of ground has more value than the plot where a energy efficient four bedroom house has been built.
I think that the discrepancy here is that the referenced formula values a year of life as a year of life, regardless of the economic productivity of that year. A five year old's next year is equally valuable to 100 year old's next year.
Yes. Of course the argument can be made that person A is worth more per year than person B, as Roland points out - these would be conversations that would need to be had if extremely expensive, low success rate care was to be rationed.
The argument above assumed the 24 year old was adoctor in residency. Hardly typical of the average member of the population.
Roland - perhaps if the 24 year old was one of Romney's 47% who don't pay any net tax contributions your argument might be different? :D
My view is there is enough money floating around to save both the 2 year old and the 24 year old in need. There is not currently enough money to give every 80+ year old a replacement heart or lungs or kidney etc etc and at some point (as discussed earlier up this thread), doctors and patients need to have appropriate respectful conversations about end of life care.
However if a (democratically elected) government decides it is important to keep prolonging life indefinitely, it needs to be accepted that the electors of said government are going to have to pay for it one way or another.
If Republican policy is "pro-life", then I would expect to see a Republican government raise sufficient taxes to pay to keep people alive. If only the wealthy can afford expensive care without bankrupting themselves, then I think anyone who espouses pro-life views is being facetious.
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You are saying a fresh plot of ground has more value than the plot where a energy efficient four bedroom house has been built.
I think that the discrepancy here is that the referenced formula values a year of life as a year of life, regardless of the economic productivity of that year. A five year old's next year is equally valuable to 100 year old's next year.
Yes. Of course the argument can be made that person A is worth more per year than person B, as Roland points out - these would be conversations that would need to be had if extremely expensive, low success rate care was to be rationed.
The argument above assumed the 24 year old was adoctor in residency. Hardly typical of the average member of the population.
Roland - perhaps if the 24 year old was one of Romney's 47% who don't pay any net tax contributions your argument might be different? :D
My view is there is enough money floating around to save both the 2 year old and the 24 year old in need. There is not currently enough money to give every 80+ year old a replacement heart or lungs or kidney etc etc and at some point (as discussed earlier up this thread), doctors and patients need to have appropriate respectful conversations about end of life care.
However if a (democratically elected) government decides it is important to keep prolonging life indefinitely, it needs to be accepted that the electors of said government are going to have to pay for it one way or another.
If Republican policy is "pro-life", then I would expect to see a Republican government raise sufficient taxes to pay to keep people alive. If only the wealthy can afford expensive care without bankrupting themselves, then I think anyone who espouses pro-life views is being facetious.
Where would you suggest we draw the line? (If I may ask.) Is there enough money to save everyone under 45 years old? 55 Years old? 65 years old?
And back to the other scenario - is say 5 years of life-extending treatments worth the price for a 2 year old? And an 85 year old? Or should life-extending treatments be self-funded, and only life-saving treatments be covered by insurance/health care coverage?
I'm pretty torn on where to draw the line on many of these topics.
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is say 5 years of life-extending treatments worth the price for a 2 year old? And an 85 year old? Or should life-extending treatments be self-funded, and only life-saving treatments be covered by insurance/health care coverage?
I'm pretty torn on where to draw the line on many of these topics.
The NHS goes pretty big on the life-saving treatments, at least until other reasons for limiting treatment kick in, such as extreme old age. Life-extending treatments for children are also almost never limited for financial reasons: this is probably as much for the parents and rest of the family as for the child being treated. Organ transplants are rationed for reasons that include old age, but that is because of availability not cost.
The big cost arguments in the NHS seem to be mostly about expensive new cancer drugs that can prolong life for a few weeks or months without offering a cure: on a national basis, spending hundreds of thousands of pounds for one person to live a few more months prevents that money from being spent on more cost-effective life-saving or disability-saving treatments. Even then, the NHS will continue care and administer the drugs if the individual can raise the money to pay for them.
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You are saying a fresh plot of ground has more value than the plot where a energy efficient four bedroom house has been built.
I think that the discrepancy here is that the referenced formula values a year of life as a year of life, regardless of the economic productivity of that year. A five year old's next year is equally valuable to 100 year old's next year.
Yes. Of course the argument can be made that person A is worth more per year than person B, as Roland points out - these would be conversations that would need to be had if extremely expensive, low success rate care was to be rationed.
The argument above assumed the 24 year old was adoctor in residency. Hardly typical of the average member of the population.
Roland - perhaps if the 24 year old was one of Romney's 47% who don't pay any net tax contributions your argument might be different? :D
My view is there is enough money floating around to save both the 2 year old and the 24 year old in need. There is not currently enough money to give every 80+ year old a replacement heart or lungs or kidney etc etc and at some point (as discussed earlier up this thread), doctors and patients need to have appropriate respectful conversations about end of life care.
However if a (democratically elected) government decides it is important to keep prolonging life indefinitely, it needs to be accepted that the electors of said government are going to have to pay for it one way or another.
If Republican policy is "pro-life", then I would expect to see a Republican government raise sufficient taxes to pay to keep people alive. If only the wealthy can afford expensive care without bankrupting themselves, then I think anyone who espouses pro-life views is being facetious.
Where would you suggest we draw the line? (If I may ask.) Is there enough money to save everyone under 45 years old? 55 Years old? 65 years old?
And back to the other scenario - is say 5 years of life-extending treatments worth the price for a 2 year old? And an 85 year old? Or should life-extending treatments be self-funded, and only life-saving treatments be covered by insurance/health care coverage?
I'm pretty torn on where to draw the line on many of these topics.
Why do you have to draw the line? I don't have to. We have healthcare professionals and government officials who are trained to make that decision. I may lean towards moving the line, but I don't have all the facts on every situation. Situations which are all unique to the individual. I may not agree with all of it, but I believe our doctors are trained to recognise the difference between assisting a patient and needlessly prolonging terminal illness.
I have never been personally affected by this dilemma, so for now, my answer is that I would leave that to be a conversation between doctor and patient. My country believes treatment should be available to those who need it, and then the choice can be made by the patient and family. Sure we all pay for it here, but our spending on health is much lower than yours on a per capita basis. My health insurance costs a little more than a thousand bucks a year, and taxes are not overly burdensome. Small price to pay IMO.
I am merely pointing out to all and sundry the hypocrisy of the Right in holding pro-life viewpoints and simultaneously calling for rationing of healthcare to only those who can afford it. You can't believe in saving some lives and not others, if you believe all life is sacred.
One life is not worth more than another, and you as the armchair critic certainly don't get to decide it.
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I have never been personally affected by this dilemma, so for now, my answer is that I would leave that to be a conversation between doctor and patient. My country believes treatment should be available to those who need it, and then the choice can be made by the patient and family. Sure we all pay for it here, but our spending on health is much lower than yours on a per capita basis. My health insurance costs a little more than a thousand bucks a year, and taxes are not overly burdensome. Small price to pay IMO.
I mostly agree that the choices should be discussed and largely decided at the doctor/patient level, but that brings in a massive principal agent problem, where the patient is incented to work in his/her own best interests (seems reasonable), but the doctor has an agency problem. Certain choices bring them more vs less money (or interest, or scientific/medical learning, or challenge). I don't think it's generally a large enough issue to warrant making this unusual, but if you ask your barber if you need a haircut, your suit-maker if you need a new suit, or your baker if you should buy a cake for your kid's birthday, you can't really expect an unbiased answer.
One life is not worth more than another, and you as the armchair critic certainly don't get to decide it.
That is your opinion, perhaps, but as a society, we certainly act in ways contrary to that position. Some treatments are restricted by age, others rationed by other medical condition, we have literally thousands of people working full-time to keep POTUS alive.
I would rather a heart transplant go to a 25-year old than a 60-year old or to a(n otherwise) healthy 60-year old than a sickly 60-year old. That might have the unfortunate consequence of giving more transplants to rich people than poor people (as rich people are more likely to be healthy at 60 than poor people) or might have the opposite bias (that poor people might be more likely to need a heart transplant due to life circumstances).
Healthcare procedures and funds will never be unlimited. How can those that are societally-paid be spent to greatest societal good is always going to be a question IMO.
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why don't we give every person on the day they are born a set amount of money to be used for the rest of their lives for their health care? if you're a sickly kid, you blow through the money early. if you stay healthy you get to use the money to prolong your life as you see fit.
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why don't we give every person on the day they are born a set amount of money to be used for the rest of their lives for their health care? if you're a sickly kid, you blow through the money early. if you stay healthy you get to use the money to prolong your life as you see fit.
Because that's patently unfair?
Some people will need an awful lot more health care than others, through no fault of their own and they have the greatest need. At the same time, some people can skate through life with perfect health . . . why would you reward someone with money for being a lucky accident of birth? Particularly when it's money that should go to the person with greatest need.
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One life is not worth more than another, and you as the armchair critic certainly don't get to decide it.
That is your opinion, perhaps, but as a society, we certainly act in ways contrary to that position. Some treatments are restricted by age, others rationed by other medical condition, we have literally thousands of people working full-time to keep POTUS alive.
Fair point, don't disagree.
Ask yourself though. If you needed expensive healthcare and couldn't afford it entirely yourself, would you want Metric Mouse* deciding whether you live or die?
*Sorry to pick on you MM, but you were the one with an equivocating opinion on whose life is worth saving...
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Ask yourself though. If you needed expensive healthcare and couldn't afford it entirely yourself, would you want Metric Mouse* deciding whether you live or die?
Here's the thing though - if it's government sponsored some government formula is used to distribute care. If it's private insurance then the company decides who gets care (and it's in their interest to deny as much care as possible).
Either way - someone decides if you get the treatment you need to save your life or possibly just improve your QOL.
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Ask yourself though. If you needed expensive healthcare and couldn't afford it entirely yourself, would you want Metric Mouse* deciding whether you live or die?
*Sorry to pick on you MM, but you were the one with an equivocating opinion on whose life is worth saving...
Well, *someone* has to decide.
Suppose two people, A and B are desiring and in need of the marginal (very last) single treatment X.
If Person B gets X, person A doesn't (and dies or suffers).
If Person A gets X, person B doesn't (and dies or suffers).
We have to choose somehow, because there aren't infinite dollars or hearts or livers or qualified surgeons or ICU beds or whatever other of a hundred limits to infinite healthcare. I believe in a finite world you can reduce the problem of allocation to the A vs B for X situation. You may complicate or obfuscate it with formulas, guidelines, quotas, or other means, but it boils down to different mechanisms of that problem.
If person A is 80 and person B is 35 and all else is equal, I genuinely believe that person B should get the treatment. Even if *I* am Person A.
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If person A is 80 and person B is 35 and all else is equal, I genuinely believe that person B should get the treatment. Even if *I* am Person A.
Do you not see any situations in which you would make a different decision?
What if the 35 year old is a mentally handicapped coma patient, and the 80 year old is the POTUS, and the treatment is a knee replacement?
I'm just saying that age is far from the only deciding factor. I agree that somebody has to make these decisions. If it's not going to be the patient and their doctor, then I would rather it be made by the government than by a for-profit corporation.
At least the government decision makers are marginally accountable to the people they represent, and are paid to make good decisions for people. The insurance company is literally paid to make bad decisions for people.
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If person A is 80 and person B is 35 and all else is equal, I genuinely believe that person B should get the treatment. Even if *I* am Person A.
Do you not see any situations in which you would make a different decision?
What if the 35 year old is a mentally handicapped coma patient, and the 80 year old is the POTUS, and the treatment is a knee replacement?
Then the bolded section of the premise is not held.
It's unclear to me why a coma patient would benefit from a knee replacement, but anyone in a persistent coma would be very, very low on my personal pecking order for a knee replacement.
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The 80 year old walks 4 miles a day and has a family history of people living to 100
The 35 year old is a heroin user who has failed in recovery three times.
Who gets the liver?
It is all so tricky to try and put rules on.
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It's absolutely tricky, which is all the more important reason to be thoughtful about who gets to set the rules.
Here's a case where I do think a government run single-payer healthcare system would be better. I predict you'd see the same type of private supplemental health insurance spring into being that we see in several European countries with single-payer basic healthcare coverage.
Livers I'm comfortable letting the government program run. Knee replacement (which is limited only by money as far as I know), I'm happy to have a government program with its own eligibility and suitability guidelines, but to allow private healthcare (either insurance or out-of-pocket buyers) to buy knee replacements at their own expense if denied (or too delayed) by the government.
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As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.
Actually the HepC cure is pretty much exactly what you describe above. Death sentence to cure in about 8 weeks with 1 pill a day.
And remember the movie "Dying Young". Back in the day, having AIDS pretty much meant get your affairs in order and start your gradual decline into looking like a Somali refugee. Not so anymore.
But yeah, those drug companies sure are evil.
HepC (HCV) is a fantastic example to discuss. First of all, RoG perfectly proved nero's point about an unrealistic understanding. The "death sentence" is not at all displayed in the data.
From http://www.healthline.com/health/hepatitis-c/hepatitis-prognosis-and-life-expectancy#Takeaway5
Some highlights:
15-30% clear the virus without treatment, the remaining develop chronic HCV.
5-20% of those with chronic HCV will develop cirrhosis, in about 20 to 30 YEARS.
1-5% of cirrhosis cases lead to death.
Newest treatment is up to 12 weeks @ $1,000 per day, or about $85,000 for full treatment with a cure rate as high as 95%. Note that cured patients can be re-infected.
So that is maybe 5%, OF 20%, OF 85% dying after 20 to 30 years with HCV. I would in no way describe this as "death to cure".
There are many treatments at a lower cost, with a lower cure rate, and a more inconvenient regiment (injection vs pill). There is a huge time frame to treat (20 to 30 years from detection). As many as 80% have no symptoms and do not even know they have it.
HepC is a prime example where you could escalate the drug use based on cost and progression of the disease. Not saying this is my solution, only a very interesting talking point on the subject. Many conditions do not offer these options.
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why don't we give every person on the day they are born a set amount of money to be used for the rest of their lives for their health care? if you're a sickly kid, you blow through the money early. if you stay healthy you get to use the money to prolong your life as you see fit.
Because that's patently unfair?
Some people will need an awful lot more health care than others, through no fault of their own and they have the greatest need. At the same time, some people can skate through life with perfect health . . . why would you reward someone with money for being a lucky accident of birth? Particularly when it's money that should go to the person with greatest need.
Sounds like a perfectly rational theory for a 100% estate tax. How about we use the money on healthcare :)
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Will your ACA insurance cover the hepc treatment costs? Just curious, I think - but I'm not sure - that it would be hard to get coverage for that in Canada.
In my case, I'd just fork over the money instead of dying of cirrhosis, but most people can't seem to save a few thousand let alone 100K for this sort of emergency. Recently my doctor was astounded that I was willing to pay $175 for a very useful test not covered by public insurance. He says, "We could do this test, it's very specific, but it costs about $200 and it's not covered by government insurance. Most people can't afford it so I didn't mention it sooner"
Arrghh. We could have done this 3 months ago. It's just bizarre.
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Sounds like a perfectly rational theory for a 100% estate tax. How about we use the money on healthcare :)
I can't think of a greater handout to the life insurance and trust lawyer/trustee business than the creation of a 100% estate tax...
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Sounds like a perfectly rational theory for a 100% estate tax. How about we use the money on healthcare :)
I can't think of a greater handout to the life insurance and trust lawyer/trustee business than the creation of a 100% estate tax...
I can.... TAX CUTS :)
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There are many treatments at a lower cost, with a lower cure rate, and a more inconvenient regiment (injection vs pill). There is a huge time frame to treat (20 to 30 years from detection). As many as 80% have no symptoms and do not even know they have it.
The standard of treatment before the one pill a day cure had a much lower cure rate as you say, used interferon with some pretty harsh side effects, and I think was around $300,000.
A liver transplant operation and the meds needed after that were even more.
Yes not everyone dies of HepC but I think it is a good example of modern medicine actually coming through with a cure and not just a couple month extension of life.
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There are many treatments at a lower cost, with a lower cure rate, and a more inconvenient regiment (injection vs pill). There is a huge time frame to treat (20 to 30 years from detection). As many as 80% have no symptoms and do not even know they have it.
The standard of treatment before the one pill a day cure had a much lower cure rate as you say, used interferon with some pretty harsh side effects, and I think was around $300,000.
A liver transplant operation and the meds needed after that were even more.
Yes not everyone dies of HepC but I think it is a good example of modern medicine actually coming through with a cure and not just a couple month extension of life.
Edit for clarity: Total of $44,000 for 11 months of treatment, as of July 2016. http://www.healthline.com/health/hepatitis-c-medications-costs-side-effects-and-more#Traditionaldrugs2
I agree regarding modern medicine advancement. This article believes a course of treatment for Hepc might fall to as little as $200 by 2025. http://www.infohep.org/Hepatitis-C-treatment-costs-could-fall-to-200-per-treatment-course-for-much-of-the-world-after-2025/page/2701845/
I believe future medical advancement is going to soar and I hope it raises the bar for all. Time will tell.
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One life is not worth more than another, and you as the armchair critic certainly don't get to decide it.
That is your opinion, perhaps, but as a society, we certainly act in ways contrary to that position. Some treatments are restricted by age, others rationed by other medical condition, we have literally thousands of people working full-time to keep POTUS alive.
Fair point, don't disagree.
Ask yourself though. If you needed expensive healthcare and couldn't afford it entirely yourself, would you want Metric Mouse* deciding whether you live or die?
*Sorry to pick on you MM, but you were the one with an equivocating opinion on whose life is worth saving...
While I wasn't actually advocating for one life over the other, as I struggle to define the line myself, I understand that I could be inserted for any other person who is drawing that line. It's a tough question, for sure. I think this thread has brought up many good points on the issue.
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why don't we give every person on the day they are born a set amount of money to be used for the rest of their lives for their health care? if you're a sickly kid, you blow through the money early. if you stay healthy you get to use the money to prolong your life as you see fit.
Because that's patently unfair?
Some people will need an awful lot more health care than others, through no fault of their own and they have the greatest need. At the same time, some people can skate through life with perfect health . . . why would you reward someone with money for being a lucky accident of birth? Particularly when it's money that should go to the person with greatest need.
Sounds like a perfectly rational theory for a 100% estate tax. How about we use the money on healthcare :)
It could work. But then the stay-at-home spouses, or young children, would have no assets when their partners/parents died.
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why don't we give every person on the day they are born a set amount of money to be used for the rest of their lives for their health care? if you're a sickly kid, you blow through the money early. if you stay healthy you get to use the money to prolong your life as you see fit.
Because that's patently unfair?
Some people will need an awful lot more health care than others, through no fault of their own and they have the greatest need. At the same time, some people can skate through life with perfect health . . . why would you reward someone with money for being a lucky accident of birth? Particularly when it's money that should go to the person with greatest need.
Sounds like a perfectly rational theory for a 100% estate tax. How about we use the money on healthcare :)
It could work. But then the stay-at-home spouses, or young children, would have no assets when their partners/parents died.
That's a good point. There could easily be an exemption for dependents, that expires when the dependent turns a certain age (or in the case of a dependent spouse, dies).
Personally, I really like the idea of a 100% estate tax. I'm too close to the issue to tell if this is simply because of my situation (will likely receive no money at all when my parents die) or because of a weighted analysis of the social benefits though.
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All that will do is create a lot of work for trust attorneys and a lot of sales for life insurance companies and multiple-survivor annuity products.
If you managed to acquire any substantial sized estate, it would take a vanishingly small amount of time and imagination to figure out how to get around the tax...
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All that will do is create a lot of work for trust attorneys and a lot of sales for life insurance companies and multiple-survivor annuity products.
If you managed to acquire any substantial sized estate, it would take a vanishingly small amount of time and imagination to figure out how to get around the tax...
I think this is correct. Rich people would liquidate and tranfer into insurance or gifts, while poor people with little assets or possibly multi generational housing will be hit hardest.
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All that will do is create a lot of work for trust attorneys and a lot of sales for life insurance companies and multiple-survivor annuity products.
If you managed to acquire any substantial sized estate, it would take a vanishingly small amount of time and imagination to figure out how to get around the tax...
Can someone explain to me how you can get around estate tax using a trust? I thought the only benefit to a trust was avoiding probate unless you actually transfer ownership of the assets to your children.
One way is to put assets in a trust that would be above the life time exclusion, which at the moment is $5.49M, the trust can be a perpetual trust that give distributions to your children that fall below annual personal exclusion gift amount, currently $14K a year. It can also be directed to pay for educational or medical expenses of the beneficiary that circumvent the exclusion gift amount.
This way when that individual passes his estate can be kept under the $5.49M to avoid the 40% estate tax while structuring the assets to distribute funds to the individuals descendants. If done correctly and early enough the trust can continue to grow provide the descendants funds for many generations. Think Rockefellars, Rothchilds, Mellons, ect...
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All that will do is create a lot of work for trust attorneys and a lot of sales for life insurance companies and multiple-survivor annuity products.
If you managed to acquire any substantial sized estate, it would take a vanishingly small amount of time and imagination to figure out how to get around the tax...
Can someone explain to me how you can get around estate tax using a trust? I thought the only benefit to a trust was avoiding probate unless you actually transfer ownership of the assets to your children.
The simplest way is to just not die for a few more years. I think there is little chance there is anything other than a 0% estate tax by the time Trump leaves office.
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All that will do is create a lot of work for trust attorneys and a lot of sales for life insurance companies and multiple-survivor annuity products.
If you managed to acquire any substantial sized estate, it would take a vanishingly small amount of time and imagination to figure out how to get around the tax...
Can someone explain to me how you can get around estate tax using a trust? I thought the only benefit to a trust was avoiding probate unless you actually transfer ownership of the assets to your children.
The simplest way is to just not die for a few more years. I think there is little chance there is anything other than a 0% estate tax by the time Trump leaves office.
I'd take $50 on the other side of that. But I've been wrong on everything else Trump has accomplished, so the odds are at least fair.
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Im surprised nobody has brought up fat people. What effect do they have on prices?
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If I'm in a situation where my wife and I have $10MM+, the fact that money that I place in trust for my kids is no longer accessible to me is not a significant barrier to doing that, especially if the alternative is that it 100% goes to the government as a death tax.
Would I rather have it go 100% to my kids or 100% to the government? Not a hard question.
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Im surprised nobody has brought up fat people. What effect do they have on prices?
There's a parallel thread to this one, but short answer: It has, but there's evidence that obese people actually use less total healthcare because on average they die decades earlier than non-obese, and they tend to have rapid declines before death instead of a decade+ of declining health as with otherwise fit 80 year olds.
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Im surprised nobody has brought up fat people. What effect do they have on prices?
There's a parallel thread to this one, but short answer: It has, but there's evidence that obese people actually use less total healthcare because on average they die decades earlier than non-obese, and they tend to have rapid declines before death instead of a decade+ of declining health as with otherwise fit 80 year olds.
Yep. A good cure for out of control health care expenses appears to lie in convincing people to become obese and smoke.
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That link is tenuous at best due to the heterogeneity of obese patient's health. Obesity defined as BMI >35 in itself is not a major health cost. What is expensive are the resultant diseases it predisposes one to: diabetes (major cost), heart disease, stroke, certain cancers, etc. Studies that show obese patients die earlier and thus may save somewhat on healthcare costs neglect the economic costs of people being on disability and/or unemployed at an earlier age.
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There were a number of reasons for the Republicans to come out against the ACA early on. First and foremost it was an easy line of attack against Obama and Democrats in general:
Government Expansion (overreach check)
May force certain religious groups to provide insurance which pays for birth control (check)
Cost the government money for a social service for the poor (check)
Lastly it ended up costing people more money, generally because everyone was forced to pay for a better minimum level of insurance. That made the law prime pickings for attacking Democrats and rallying voters to come out against the law. I am certain they have won votes simply based on people feeling like they couldn't afford health insurance under the new law. Especially in states that didn't agree to expand medicare.
At this point they are cornered into acting against given the public outcry they have riled up. It is now probably a double edged sword because if they truly gut the program people in their own voting base will get hurt.
The ACA has some real issues and even in a fixed state their may be better options. But it does not "need" to be repealed. They stand to hurt and help people when they chose to start meddling with the law.
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May force certain religious groups to provide insurance which pays for birth control (check)
This is a line of argument I have never understood. These people claim they are morally offended that their taxes are being used to provide birth control, but not offended at anything else the government uses their taxes for? Where was this same level of outrage over government torture?
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Well, I think the birth control thing all comes down to controlling women. If you let them have birth control, they will all go out and screw anything that moves, because they are all evil seductresses.
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Well, I think the birth control thing all comes down to controlling women. If you let them have birth control, they will all go out and screw anything that moves, because they are all evil seductresses.
If it only took birth control to turn women into evil seductresses I suspect that teenage boys around the world would happily foot the bill and we could all stop arguing about this.
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Well, I think the birth control thing all comes down to controlling women. If you let them have birth control, they will all go out and screw anything that moves, because they are all evil seductresses.
If it only took birth control to turn women into evil seductresses I suspect that teenage boys around the world would happily foot the bill and we could all stop arguing about this.
That's funny, I would have sworn there was an inverse relationship between the number of condoms a teenage boy carried on his person and how often he scored.
...if only I had known!
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i find it kinda funny.
Obama helps get it into law, then trump will remove it then put something else just as bad in itself place.
Two people, 2 sides, 1 coin.
Anything that takes money from someone and gives it to another is morally wrong. Just that simple in my book.
So buying things at a supermarket is morally wrong? After all, it takes money from you and give it to someone else. Should everything be free?
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May force certain religious groups to provide insurance which pays for birth control (check)
This is a line of argument I have never understood. These people claim they are morally offended that their taxes are being used to provide birth control, but not offended at anything else the government uses their taxes for? Where was this same level of outrage over government torture?
I always equated along the lines of the pro-lifers that are for capital punishment or were for the war in Iraq.
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i find it kinda funny.
Obama helps get it into law, then trump will remove it then put something else just as bad in itself place.
Two people, 2 sides, 1 coin.
Anything that takes money from someone and gives it to another is morally wrong. Just that simple in my book.
So buying things at a supermarket is morally wrong? After all, it takes money from you and give it to someone else. Should everything be free?
The libertarian argument is typically that paying for explicit services rendered (like buying things at a supermarket) is good, but paying for implicit services rendered (pollution control, police, firefighters, a national park system, a network of roads/highways, etc.) is bad.
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May force certain religious groups to provide insurance which pays for birth control (check)
This is a line of argument I have never understood. These people claim they are morally offended that their taxes are being used to provide birth control, but not offended at anything else the government uses their taxes for? Where was this same level of outrage over government torture?
I always equated along the lines of the pro-lifers that are for capital punishment or were for the war in Iraq.
The many contradictions of the conservative party lines.
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May force certain religious groups to provide insurance which pays for birth control (check)
This is a line of argument I have never understood. These people claim they are morally offended that their taxes are being used to provide birth control, but not offended at anything else the government uses their taxes for? Where was this same level of outrage over government torture?
I always equated along the lines of the pro-lifers that are for capital punishment or were for the war in Iraq.
The many contradictions of the conservative party lines.
This is the inherent problem when religion gets involved in the politics of a multi-cultural state.
Oddly enough, one lesson many never learned is that the entire concept of "separation of church and state" was driven by church not wanting the state to interfere with religion, not the other way around. Now certain groups want to push "Christian Values" into law, not appreciating that it's a two-way street; when religion meddles in politics, politics meddles with religion.
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May force certain religious groups to provide insurance which pays for birth control (check)
This is a line of argument I have never understood. These people claim they are morally offended that their taxes are being used to provide birth control, but not offended at anything else the government uses their taxes for? Where was this same level of outrage over government torture?
I assume they can be outraged at more than one thing at a time. The ACA one was thing where their imput was asked. I'm not certain that religious groups were consulted about the creation of torture facilities.
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May force certain religious groups to provide insurance which pays for birth control (check)
This is a line of argument I have never understood. These people claim they are morally offended that their taxes are being used to provide birth control, but not offended at anything else the government uses their taxes for? Where was this same level of outrage over government torture?
I assume they can be outraged at more than one thing at a time. The ACA one was thing where their imput was asked. I'm not certain that religious groups were consulted about the creation of torture facilities.
I first interpreted your statement about torture facilities to be about abortion clinics. I'm sure to some extremists on the anti-abortion spectrum that's what they are.
Regardless, I think the broader point is that the self described 'compassionate/religious conservatives' wish to ban all abortions and limit contraceptives and sex-ed courses, while being very pro-military and extremely hawkish in our international dealings. They are among the loudest voices for constricting immigration.
To those of us that do not share their views, it seems very hypocritical to claim to be "pro-life" yet also advocate for killing more people and blocking others. It comes off as caring more about embryos than non-citizen human adults.
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I first interpreted your statement about torture facilities to be about abortion clinics. I'm sure to some extremists on the anti-abortion spectrum that's what they are.
Regardless, I think the broader point is that the self described 'compassionate/religious conservatives' wish to ban all abortions and limit contraceptives and sex-ed courses, while being very pro-military and extremely hawkish in our international dealings. They are among the loudest voices for constricting immigration.
To those of us that do not share their views, it seems very hypocritical to claim to be "pro-life" yet also advocate for killing more people and blocking others. It comes off as caring more about embryos than non-citizen human adults.
Sorry for any confusion. My comment was not related to women's clinics.
I see both sides of the issue. I know that many would view someone who would allow a baby to be killed but argue that a murderer should be spared the death penalty to be hypocritical. It's a fine line, no doubt.
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I first interpreted your statement about torture facilities to be about abortion clinics. I'm sure to some extremists on the anti-abortion spectrum that's what they are.
Regardless, I think the broader point is that the self described 'compassionate/religious conservatives' wish to ban all abortions and limit contraceptives and sex-ed courses, while being very pro-military and extremely hawkish in our international dealings. They are among the loudest voices for constricting immigration.
To those of us that do not share their views, it seems very hypocritical to claim to be "pro-life" yet also advocate for killing more people and blocking others. It comes off as caring more about embryos than non-citizen human adults.
Sorry for any confusion. My comment was not related to women's clinics.
I see both sides of the issue. I know that many would view someone who would allow a baby to be killed but argue that a murderer should be spared the death penalty to be hypocritical. It's a fine line, no doubt.
There is perfectly rational and consistent reasoning behind those abortion/death penalty views -
1. There is a right to life. Neither State nor other individuals may interfere with that right.
2. The right to life necessarily includes the right to bodily integrity. An individual controls what is done to their own body, and neither State nor other individuals may interfere with that bodily integrity.
3. The State may imprison a person in order to maintain the rights of others, but should do so only to the extent necessary, and the death penalty is not necessary when imprisonment (including in rare cases imprisonment for the rest of a person's natural life) is available.
4. The individual's control of their own body includes the right to control any medical or other procedures done to that body by others.
5. A foetus which is within the body of another person is necessarily subject to the control that other person exercises over their own body, including any procedures which result in the foetus no longer living within that body.
Three further points -
6. The death penalty is a hangover from the days when imprisonment was not a practical option because 1) cost and 2) inadequate facilities (in particular, until the nineteenth century the lack of sewage systems made keeping more than a handful of people in the same building for any length of time completely impractical).
7. The regulation of people carrying out procedures on other people (ie doctors and clinics providing contraceptive and abortion services) should be limited to what is necessary for those services to be provided safely. Regulation in much of the USA appears to go well beyond this standard.
8. The State has a duty to prevent individuals from interfering with the right to life and bodily integrity of others. It therefore has a duty to protect the provision of contraceptive and abortion services from individuals who would interfere with the provision of those services.
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Well, I think the birth control thing all comes down to controlling women. If you let them have birth control, they will all go out and screw anything that moves, because they are all evil seductresses.
I never really got the "controlling women" argument. It is nothing more than who pays for the birth control, most of which can be had relatively cheap, with or without insurance and before/after the ACA.
I got a vasectomy last year and had to pay just over $600 out of pocket for it. Is someone trying to control me because I had to pay for my birth control? I would argue if any birth control should be covered, the vasectomy should be pretty high on the list. A woman can only have one pregnancy at a time, but a guy can cause multiple at a time. Joking aside, it is something to think about.
In the broader scheme of the thread, as far as the ACA goes, it needs to be repealed or drastically changed. I help with our company insurance policy at work and even switching companies to lower priced, higher deductible plans (and even now on to partially self-insuring) the minimum that we have been able to keep the increases to over the last two years is 59%. It simply is not sustainable. Even half of it is not sustainable. If you want to talk about something that could put a serious hurt on the economy if gone unchecked.
I am very close to the healthcare industry. I personally think that everyone needs skin in the game for it to work. It makes me sick to see someone that pays little to nothing for healthcare, be able to utilize services without a second thought, then have someone that waited until the last minute to go get a needed service, because it is going to cost them thousands. I have watched someone go from the ER to the pharmacy, then back to the ER, because they did not want to pay a $3.20 copay on a $400+ medication - all of this while most people won't make it out of the ER for less than a few grand out of pocket.
So in short, we created a system that subsidizes and creates bad habits, punishes people that have to pay for most of it, and it is quickly becoming less affordable than it was. This is far from the only problem, but the ACA helped create it. There are good portions of it too, but it requires an overhaul. Currently, there are too many ways to work the system. If we are going to keep privatized insurance and make it affordable, loopholes need to be closed. I personally think it was designed to fail with the hopes of implementing a single payer system.
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It makes me sick ...
I see what you did there :)
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It makes me sick ...
I see what you did there :)
Ha! Completely unintended, but nice catch.
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I first interpreted your statement about torture facilities to be about abortion clinics. I'm sure to some extremists on the anti-abortion spectrum that's what they are.
Regardless, I think the broader point is that the self described 'compassionate/religious conservatives' wish to ban all abortions and limit contraceptives and sex-ed courses, while being very pro-military and extremely hawkish in our international dealings. They are among the loudest voices for constricting immigration.
To those of us that do not share their views, it seems very hypocritical to claim to be "pro-life" yet also advocate for killing more people and blocking others. It comes off as caring more about embryos than non-citizen human adults.
Sorry for any confusion. My comment was not related to women's clinics.
I see both sides of the issue. I know that many would view someone who would allow a baby to be killed but argue that a murderer should be spared the death penalty to be hypocritical. It's a fine line, no doubt.
Thank you Metric Mouse. You are a consistent voice of reason.
It is silly to not be able to understand, or pretend to not understand, the difference between an "innocent life" (terminology used by those who support pro-life choices) and adult lives lost in war when sometimes those adults made choices to end up in war. Granted, there are plenty of "innocent" lives lost in war and that is a tragedy.
I tire of the broadbrush characterization of conservatives as anti abortion, anti birth control, anti sex.
The conservatives I know range from "don't care about abortion" to " abortion is wrong" with some in between who have changed ncern about it taking place too often and for frivolous reasons. But NONE of them wish to restrain birth control access. not a one. In fact, the opposite characterizes their opinions.
I am not a hypocrite in the eyes of poster above because I support both abortion AND capital punishment. But here's the thing--it doesnt concern me that poster above thinks I may be a hypocrite. I dont care. I am using a different decision grid than he is, and I come to those conclusions from a separate reasoning process.
I also do not buy the "controlling women's bodies" idea, and I think that is a lazy argument. Why are women unable to pay for their own birth control? Nanny gubmnt dictates it be available at no cost in insurance coverage. Why this drug and not others? I'll tell you why: this is paternalistic pandering to the monolithic American Woman by the federal government to get votes. There are plenty of women who make enough money to pay for birth control they use, and for the birth control used by their daughters. Of course, poor women who cannot afford birth control or any other drug need subsidies. That is not part of this scenario.
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69mach, excellent point about skin in the game. That is essential.
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I also do not buy the "controlling women's bodies" idea, and I think that is a lazy argument. Why are women unable to pay for their own birth control? Nanny gubmnt dictates it be available at no cost in insurance coverage. Why this drug and not others? I'll tell you why: this is paternalistic pandering to the monolithic American Woman by the federal government to get votes. There are plenty of women who make enough money to pay for birth control they use, and for the birth control used by their daughters. Of course, poor women who cannot afford birth control or any other drug need subsidies. That is not part of this scenario.
If women are buying health insurance (through work or otherwise), then they are "paying for their own birth control", just as much as they are paying for any other health services through insurance. If your point is that men should not be required to pay for women's birth control, then you are missing half the problem.
Removing the question of money, the question is then: should insurers be required to cover health services providing birth control as they cover other health services. Well, why not? What is so special about birth control health that it should be excluded? Even if your mother and grandmother haven't talked about the consequences of not having access to birth control, the health and social consequences of not having access to birth control are still, in the 21st century, being played out across the poorer parts of the world. I wouldn't wish those consequences on any woman.
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I first interpreted your statement about torture facilities to be about abortion clinics. I'm sure to some extremists on the anti-abortion spectrum that's what they are.
Regardless, I think the broader point is that the self described 'compassionate/religious conservatives' wish to ban all abortions and limit contraceptives and sex-ed courses, while being very pro-military and extremely hawkish in our international dealings. They are among the loudest voices for constricting immigration.
To those of us that do not share their views, it seems very hypocritical to claim to be "pro-life" yet also advocate for killing more people and blocking others. It comes off as caring more about embryos than non-citizen human adults.
Sorry for any confusion. My comment was not related to women's clinics.
I see both sides of the issue. I know that many would view someone who would allow a baby to be killed but argue that a murderer should be spared the death penalty to be hypocritical. It's a fine line, no doubt.
Thank you Metric Mouse. You are a consistent voice of reason.
It is silly to not be able to understand, or pretend to not understand, the difference between an "innocent life" (terminology used by those who support pro-life choices) and adult lives lost in war when sometimes those adults made choices to end up in war. Granted, there are plenty of "innocent" lives lost in war and that is a tragedy.
I tire of the broadbrush characterization of conservatives as anti abortion, anti birth control, anti sex.
The conservatives I know range from "don't care about abortion" to " abortion is wrong" with some in between about it taking place too often and for frivolous reasons. But NONE of them wish to restrain birth control access. not a one. In fact, the opposite characterizes their opinions.
I am not a hypocrite in the eyes of poster above because I support both abortion AND capital punishment. But here's the thing--it doesnt concern me that poster above thinks I may be a hypocrite. I dont care. I am using a different decision grid than he is, and I come to those conclusions from a separate reasoning process.
I also do not buy the "controlling women's bodies" idea, and I think that is a lazy argument. Why are women unable to pay for their own birth control? Nanny gubmnt dictates it be available at no cost in insurance coverage. Why this drug and not others? I'll tell you why: this is paternalistic pandering to the monolithic American Woman by the federal government to get votes. There are plenty of women who make enough money to pay for birth control they use, and for the birth control used by their daughters. Of course, poor women who cannot afford birth control or any other drug need subsidies. That is not part of this scenario.
The bolded is incorrect. The list of no cost drugs as set forth in the PPACA does include a long list of birth control. However, it also includes pre-natal vitamins, aspirin for the elderly, vitamin D supplements for the elderly, and certain medicines and supplements for children. Why haven't I seen anyone sputter about the indignities of being forced to subsidize aspirin for grandma (WHY DIDN'T GRANDMA MAKE BETTER LIFE CHOICES?!?!?!)? Why do basement-dwelling dudes on the internet always bring up the indignity of having to pay for insurance that covers pregnancy when they don't get pregnant but never seem to bring up the fact that insured women also pay for insurance that covers prostate cancer that they will never use? If the examples that make people angry always come back to women's reproduction, maybe it's because people have issues with it that they don't want to face.
Birth control is medicine. It is used by the vast majority of parents of reproductive age. It is used by the vast majority of women of reproductive age. It is used by people who are not sexually active. The percentage of American women who use medical or barrier contraceptives for any reason over the course of their lifetime is over 90%. Thus, because birth control is one of the most common medicines used by women, has numerous medical benefits, and has positive outcomes for society in general, I see no reason that it would not have special status as a no cost share prescription. It is not the only medicine that has been given such status.
https://www-static.bouldercolorado.gov/docs/No_Cost_Preventative_Medication_List-1-201609081026.pdf
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I first interpreted your statement about torture facilities to be about abortion clinics. I'm sure to some extremists on the anti-abortion spectrum that's what they are.
Regardless, I think the broader point is that the self described 'compassionate/religious conservatives' wish to ban all abortions and limit contraceptives and sex-ed courses, while being very pro-military and extremely hawkish in our international dealings. They are among the loudest voices for constricting immigration.
To those of us that do not share their views, it seems very hypocritical to claim to be "pro-life" yet also advocate for killing more people and blocking others. It comes off as caring more about embryos than non-citizen human adults.
Sorry for any confusion. My comment was not related to women's clinics.
I see both sides of the issue. I know that many would view someone who would allow a baby to be killed but argue that a murderer should be spared the death penalty to be hypocritical. It's a fine line, no doubt.
Thank you Metric Mouse. You are a consistent voice of reason.
It is silly to not be able to understand, or pretend to not understand, the difference between an "innocent life" (terminology used by those who support pro-life choices) and adult lives lost in war when sometimes those adults made choices to end up in war. Granted, there are plenty of "innocent" lives lost in war and that is a tragedy.
I tire of the broadbrush characterization of conservatives as anti abortion, anti birth control, anti sex.
The conservatives I know range from "don't care about abortion" to " abortion is wrong" with some in between about it taking place too often and for frivolous reasons. But NONE of them wish to restrain birth control access. not a one. In fact, the opposite characterizes their opinions.
I am not a hypocrite in the eyes of poster above because I support both abortion AND capital punishment. But here's the thing--it doesnt concern me that poster above thinks I may be a hypocrite. I dont care. I am using a different decision grid than he is, and I come to those conclusions from a separate reasoning process.
I also do not buy the "controlling women's bodies" idea, and I think that is a lazy argument. Why are women unable to pay for their own birth control? Nanny gubmnt dictates it be available at no cost in insurance coverage. Why this drug and not others? I'll tell you why: this is paternalistic pandering to the monolithic American Woman by the federal government to get votes. There are plenty of women who make enough money to pay for birth control they use, and for the birth control used by their daughters. Of course, poor women who cannot afford birth control or any other drug need subsidies. That is not part of this scenario.
The bolded is incorrect. The list of no cost drugs as set forth in the PPACA does include a long list of birth control. However, it also includes pre-natal vitamins, aspirin for the elderly, vitamin D supplements for the elderly, and certain medicines and supplements for children. Why haven't I seen anyone sputter about the indignities of being forced to subsidize aspirin for grandma (WHY DIDN'T GRANDMA MAKE BETTER LIFE CHOICES?!?!?!)? Why do basement-dwelling dudes on the internet always bring up the indignity of having to pay for insurance that covers pregnancy when they don't get pregnant but never seem to bring up the fact that insured women also pay for insurance that covers prostate cancer that they will never use? If the examples that make people angry always come back to women's reproduction, maybe it's because people have issues with it that they don't want to face.
Birth control is medicine. It is used by the vast majority of parents of reproductive age. It is used by the vast majority of women of reproductive age. It is used by people who are not sexually active. The percentage of American women who use medical or barrier contraceptives for any reason over the course of their lifetime is over 90%. Thus, because birth control is one of the most common medicines used by women, has numerous medical benefits, and has positive outcomes for society in general, I see no reason that it would not have special status as a no cost share prescription. It is not the only medicine that has been given such status.
https://www-static.bouldercolorado.gov/docs/No_Cost_Preventative_Medication_List-1-201609081026.pdf
I havent seen the list of special drugs singled out for apecial treatment. That doesnt change my question, why some and not others are free? It is ALL pandering,, but some off the choices at least seem to address groups of people who may reside in poverty (elderly and children.) and the fact that the ACA requires a free annual exam once a year is yet another pandering action. While it partially addresses preventitive care, it also sets up everyone to belly up to the freebie table.
Now I am curious to see the complete list of drugs that must be furnished for free to be ACA compliant, so I am off to Google that. I can see, theoretically, an insurance company deciding to pay all or a large part of the cost of birth control because it might (theoretically) save them money over costs of pregnancy and delivery. But that would be a capitalistic cost-benefit decision entirely within their purview for furnishing a product, insurance.
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I first interpreted your statement about torture facilities to be about abortion clinics. I'm sure to some extremists on the anti-abortion spectrum that's what they are.
Regardless, I think the broader point is that the self described 'compassionate/religious conservatives' wish to ban all abortions and limit contraceptives and sex-ed courses, while being very pro-military and extremely hawkish in our international dealings. They are among the loudest voices for constricting immigration.
To those of us that do not share their views, it seems very hypocritical to claim to be "pro-life" yet also advocate for killing more people and blocking others. It comes off as caring more about embryos than non-citizen human adults.
Sorry for any confusion. My comment was not related to women's clinics.
I see both sides of the issue. I know that many would view someone who would allow a baby to be killed but argue that a murderer should be spared the death penalty to be hypocritical. It's a fine line, no doubt.
Thank you Metric Mouse. You are a consistent voice of reason.
It is silly to not be able to understand, or pretend to not understand, the difference between an "innocent life" (terminology used by those who support pro-life choices) and adult lives lost in war when sometimes those adults made choices to end up in war. Granted, there are plenty of "innocent" lives lost in war and that is a tragedy.
I tire of the broadbrush characterization of conservatives as anti abortion, anti birth control, anti sex.
The conservatives I know range from "don't care about abortion" to " abortion is wrong" with some in between about it taking place too often and for frivolous reasons. But NONE of them wish to restrain birth control access. not a one. In fact, the opposite characterizes their opinions.
I am not a hypocrite in the eyes of poster above because I support both abortion AND capital punishment. But here's the thing--it doesnt concern me that poster above thinks I may be a hypocrite. I dont care. I am using a different decision grid than he is, and I come to those conclusions from a separate reasoning process.
I also do not buy the "controlling women's bodies" idea, and I think that is a lazy argument. Why are women unable to pay for their own birth control? Nanny gubmnt dictates it be available at no cost in insurance coverage. Why this drug and not others? I'll tell you why: this is paternalistic pandering to the monolithic American Woman by the federal government to get votes. There are plenty of women who make enough money to pay for birth control they use, and for the birth control used by their daughters. Of course, poor women who cannot afford birth control or any other drug need subsidies. That is not part of this scenario.
The bolded is incorrect. The list of no cost drugs as set forth in the PPACA does include a long list of birth control. However, it also includes pre-natal vitamins, aspirin for the elderly, vitamin D supplements for the elderly, and certain medicines and supplements for children. Why haven't I seen anyone sputter about the indignities of being forced to subsidize aspirin for grandma (WHY DIDN'T GRANDMA MAKE BETTER LIFE CHOICES?!?!?!)? Why do basement-dwelling dudes on the internet always bring up the indignity of having to pay for insurance that covers pregnancy when they don't get pregnant but never seem to bring up the fact that insured women also pay for insurance that covers prostate cancer that they will never use? If the examples that make people angry always come back to women's reproduction, maybe it's because people have issues with it that they don't want to face.
Birth control is medicine. It is used by the vast majority of parents of reproductive age. It is used by the vast majority of women of reproductive age. It is used by people who are not sexually active. The percentage of American women who use medical or barrier contraceptives for any reason over the course of their lifetime is over 90%. Thus, because birth control is one of the most common medicines used by women, has numerous medical benefits, and has positive outcomes for society in general, I see no reason that it would not have special status as a no cost share prescription. It is not the only medicine that has been given such status.
https://www-static.bouldercolorado.gov/docs/No_Cost_Preventative_Medication_List-1-201609081026.pdf
I havent seen the list of special drugs singled out for apecial treatment. That doesnt change my question, why some and not others are free? It is ALL pandering,, but some off the choices at least seem to address groups of people who may reside in poverty (elderly and children.) and the fact that the ACA requires a free annual exam once a year is yet another pandering action. While it partially addresses preventitive care, it also sets up everyone to belly up to the freebie table.
Now I am curious to see the complete list of drugs that must be furnished for free to be ACA compliant, so I am off to Google that. I can see, theoretically, an insurance company deciding to pay all or a large part of the cost of birth control because it might (theoretically) save them money over costs of pregnancy and delivery. But that would be a capitalistic cost-benefit decision entirely within their purview for furnishing a product, insurance.
Yes, and if children are residing in poverty, the women raising them are likely also residing in poverty and would benefit from effective birth control to prevent adding additional children to the mix. However, what you call pandering I call providing incentives. No co pay annual exams incentivize people to check in with their doctor once a year. The high deductibles of many plans out there provide the skin in the game. You can go to the doctor for free, but you can't go hog wild with additional treatments without an additional 4 figures of your own money. But if the additional treatments are, say, chemo, you'll find the money. If the additional treatments are, say, surgery to address your knee pain, you might rethink it and try losing weight or changing your exercise regimen. It's not a perfect system, but it does provide some real improvements over the pre ACA landscape.
As for why most plans didn't incentivize birth control per ACA, I suspect the issue was more a narrow band of approved types rather than it being available at all. For example, the IUD is the gold standard of birth control, but was typically only available with an $800 co pay prior to the ACA. I bet an actuary would tell me that this is because the benefit of the IUD stretches out over time (5-10 years), requires additional doctor visits for insertion, and due to plan switching, an individual provider would statistically only capture a portion of the benefit. Therefore, it was a better cost benefit to a provider to offer only monthly birth control. One the best, best things about the ACA is the wider availability of long acting reversible contraceptives like the IUD. I think we are only beginning to see the huge societal benefits of more women having IUDs in place. Fewer unplanned pregnancies (fewer abortions!) and the resultant improved economic outcomes. I really hope that the republicans don't halt this progress, because it has the potential to change lives.
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...Yes, and if children are residing in poverty, the women raising them are likely also residing in poverty and would benefit from effective birth control to prevent adding additional children to the mix. ..
Mega dittos. Of course!
And your analysis anout cost of iUD is i teresting, but who k owa inthe Byzintine world of insurance charges of medical costs that are cloaked in darkness and mystery.
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I havent seen the list of special drugs singled out for apecial treatment. That doesnt change my question, why some and not others are free? It is ALL pandering,, but some off the choices at least seem to address groups of people who may reside in poverty (elderly and children.) and the fact that the ACA requires a free annual exam once a year is yet another pandering action. While it partially addresses preventitive care, it also sets up everyone to belly up to the freebie table.
For the same reason we have (had?) rules about clean water. It's a public health concern.
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I also do not buy the "controlling women's bodies" idea, and I think that is a lazy argument. Why are women unable to pay for their own birth control? Nanny gubmnt dictates it be available at no cost in insurance coverage. Why this drug and not others? I'll tell you why: this is paternalistic pandering to the monolithic American Woman by the federal government to get votes. There are plenty of women who make enough money to pay for birth control they use, and for the birth control used by their daughters. Of course, poor women who cannot afford birth control or any other drug need subsidies. That is not part of this scenario.
If women are buying health insurance (through work or otherwise), then they are "paying for their own birth control", just as much as they are paying for any other health services through insurance. If your point is that men should not be required to pay for women's birth control, then you are missing half the problem.
Removing the question of money, the question is then: should insurers be required to cover health services providing birth control as they cover other health services. Well, why not? What is so special about birth control health that it should be excluded? Even if your mother and grandmother haven't talked about the consequences of not having access to birth control, the health and social consequences of not having access to birth control are still, in the 21st century, being played out across the poorer parts of the world. I wouldn't wish those consequences on any woman.
My point was that it isn't controlling women. It merely puts the responsibility of obtaining a medication that most of the time can be obtained relatively cheap or free, back on the person using it. No different than any other drug that are as, or more vital to anyone else, except there were/are more outlets to receiving it. Nobody is saying exclude it - but I am not saying that it should receive special status and be completely covered. Again, skin in the game. That is also why I brought up the vasectomy, which most men have to pay for on their own - is the government controlling men by not paying for their birth control?
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I also do not buy the "controlling women's bodies" idea, and I think that is a lazy argument. Why are women unable to pay for their own birth control? Nanny gubmnt dictates it be available at no cost in insurance coverage. Why this drug and not others? I'll tell you why: this is paternalistic pandering to the monolithic American Woman by the federal government to get votes. There are plenty of women who make enough money to pay for birth control they use, and for the birth control used by their daughters. Of course, poor women who cannot afford birth control or any other drug need subsidies. That is not part of this scenario.
If women are buying health insurance (through work or otherwise), then they are "paying for their own birth control", just as much as they are paying for any other health services through insurance. If your point is that men should not be required to pay for women's birth control, then you are missing half the problem.
Removing the question of money, the question is then: should insurers be required to cover health services providing birth control as they cover other health services. Well, why not? What is so special about birth control health that it should be excluded? Even if your mother and grandmother haven't talked about the consequences of not having access to birth control, the health and social consequences of not having access to birth control are still, in the 21st century, being played out across the poorer parts of the world. I wouldn't wish those consequences on any woman.
My point was that it isn't controlling women. It merely puts the responsibility of obtaining a medication that most of the time can be obtained relatively cheap or free, back on the person using it. No different than any other drug that are as, or more vital to anyone else, except there were/are more outlets to receiving it. Nobody is saying exclude it - but I am not saying that it should receive special status and be completely covered. Again, skin in the game. That is also why I brought up the vasectomy, which most men have to pay for on their own - is the government controlling men by not paying for their birth control?
I get that you are arguing that you just want birth control to go back to regular drug status and not special free status. However, I am asking you to consider why it is that birth control is the thing that bothers you instead of, say, the many, many other drugs that are also free per the ACA. Why did the debate turn on birth control and not folic acid supplements? These drugs all fall under the category of preventative treatments (aspirin for preventing heart attacks, folic acid for pregnant women, vitamin supplements for kids, vitamin supplements to prevent falls in the elderly).
For the record, I am all for vasectomies being covered 100%. Hell, I am for covering them 200% and paying people to get them. Do you want a start a PAC with me and lobby for this?
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For the record, I am all for vasectomies being covered 100%. Hell, I am for covering them 200% and paying people to get them. Do you want a start a PAC with me and lobby for this?
Would they be voluntary? :)
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I also do not buy the "controlling women's bodies" idea, and I think that is a lazy argument. Why are women unable to pay for their own birth control? Nanny gubmnt dictates it be available at no cost in insurance coverage. Why this drug and not others? I'll tell you why: this is paternalistic pandering to the monolithic American Woman by the federal government to get votes. There are plenty of women who make enough money to pay for birth control they use, and for the birth control used by their daughters. Of course, poor women who cannot afford birth control or any other drug need subsidies. That is not part of this scenario.
If women are buying health insurance (through work or otherwise), then they are "paying for their own birth control", just as much as they are paying for any other health services through insurance. If your point is that men should not be required to pay for women's birth control, then you are missing half the problem.
Removing the question of money, the question is then: should insurers be required to cover health services providing birth control as they cover other health services. Well, why not? What is so special about birth control health that it should be excluded? Even if your mother and grandmother haven't talked about the consequences of not having access to birth control, the health and social consequences of not having access to birth control are still, in the 21st century, being played out across the poorer parts of the world. I wouldn't wish those consequences on any woman.
My point was that it isn't controlling women. It merely puts the responsibility of obtaining a medication that most of the time can be obtained relatively cheap or free, back on the person using it. No different than any other drug that are as, or more vital to anyone else, except there were/are more outlets to receiving it. Nobody is saying exclude it - but I am not saying that it should receive special status and be completely covered. Again, skin in the game. That is also why I brought up the vasectomy, which most men have to pay for on their own - is the government controlling men by not paying for their birth control?
I get that you are arguing that you just want birth control to go back to regular drug status and not special free status. However, I am asking you to consider why it is that birth control is the thing that bothers you instead of, say, the many, many other drugs that are also free per the ACA. Why did the debate turn on birth control and not folic acid supplements? These drugs all fall under the category of preventative treatments (aspirin for preventing heart attacks, folic acid for pregnant women, vitamin supplements for kids, vitamin supplements to prevent falls in the elderly).
For the record, I am all for vasectomies being covered 100%. Hell, I am for covering them 200% and paying people to get them. Do you want a start a PAC with me and lobby for this?
To your first point, I only chose birth control because people (as in my first post) say it is controlling women. I do not agree with that point of it. Also, I am against getting almost anything for "free." Free is not free (someone is paying for it), but it can, and a lot of time does, diminish the value. Not to open a new subject, but that is why I am against "free" college. I think that overall, people need skin in the game to value something, and use it as intended or to its potential. I just think there are better ways to solve problems.
I like your idea on vasectomies. To me, vasectomies make more sense than anything. In a committed relationship, it ends the on going cost(s) associated with birth control. It is just as, if not more effective. In non-committed relationships, it could keep multiple women from getting pregnant. Not to mention the reason I went in for it - because birth control (pills, iud's, etc.) can create a lot of problems for women, especially as they get older. I have seen too many women have issues to ask my wife to keep taking birth control, especially if we do not want any more kids.
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IUDs are similar in outcome to vasectomies in terms of effectiveness, are cheaper, and are reversible. They are basically nearly perfect birth control. But covering vasectomies 100% could be a fairly minor tweak to the ACA that I'm completely in favor of.
Another interesting point is that there is compelling evidence that birth control use has expanded following implementation of the ACA. So, women value it sufficiently under the ACA that they use it in greater numbers. And I agree that it isn't free. It's subsidized under existing premium payments. I'm ok with that. I think helping women have a planned and desired number of children one of the best things we can do for society, for men, women, and children, and I'm delighted that my tax dollars go to help pay for it. I'd love to divert some more money to it.
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I think helping women have a planned and desired number of children one of the best things we can do for society, for men, women, and children, and I'm delighted that my tax dollars go to help pay for it. I'd love to divert some more money to it.
Well said and completely agree!
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For the record, I am all for vasectomies being covered 100%. Hell, I am for covering them 200% and paying people to get them. Do you want a start a PAC with me and lobby for this?
Would they be voluntary? :)
At that price, I'd take two!
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For the record, I am all for vasectomies being covered 100%. Hell, I am for covering them 200% and paying people to get them. Do you want a start a PAC with me and lobby for this?
Would they be voluntary? :)
At that price, I'd take two!
"You have no idea the physical toll that 3 vasectomies has on a person" - Michael Scott
https://www.youtube.com/watch?v=uJGw6wCmTcY
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For the record, I am all for vasectomies being covered 100%. Hell, I am for covering them 200% and paying people to get them. Do you want a start a PAC with me and lobby for this?
Would they be voluntary? :)
At that price, I'd take two!
"You have no idea the physical toll that 3 vasectomies has on a person" - Michael Scott
https://www.youtube.com/watch?v=uJGw6wCmTcY
SNIP SNAP SNIP SNAP
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For the record, I am all for vasectomies being covered 100%. Hell, I am for covering them 200% and paying people to get them. Do you want a start a PAC with me and lobby for this?
Would they be voluntary? :)
At that price, I'd take two!
"You have no idea the physical toll that 3 vasectomies has on a person" - Michael Scott
https://www.youtube.com/watch?v=uJGw6wCmTcY
SNIP SNAP SNIP SNAP
Followed by SNIP SNAP of course :)
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For the record, I am all for vasectomies being covered 100%. Hell, I am for covering them 200% and paying people to get them. Do you want a start a PAC with me and lobby for this?
Would they be voluntary? :)
At that price, I'd take two!
"You have no idea the physical toll that 3 vasectomies has on a person" - Michael Scott
https://www.youtube.com/watch?v=uJGw6wCmTcY
Oh my...