Author Topic: What comes after the ACA?  (Read 956723 times)

Shane

  • Pencil Stache
  • ****
  • Posts: 878
  • Location: Independent
Re: What comes after the ACA?
« Reply #5450 on: April 16, 2019, 11:41:34 AM »
Tying healthcare to employment is a terrible idea and weíve known that for a long time. Among other things it ties employees to employeurs when they might otherwise look for a different or better job, volunteer, care for family members, or be entrepreneurial. It also prevents people from retiring when they are able, which one can argue ties up jobs that could go to other people, reducing opportunities. I just learned that the tax treatment of employee-sponsored health plans is the biggest tax expenditure, bigger than the mortgage interest deduction.

https://www.nytimes.com/2017/09/05/upshot/the-real-reason-the-us-has-employer-sponsored-health-insurance.html

More importantly in my mind, tying health care to work creates this awful catch-22 where you lose the critical coverage you need to stay alive at the very moment that you need it most. Because if you fall really sick and really need care then you likely arenít able to work to keep your coverage. To me that feels cruel, kicking someone when they are down. If we are okay with that as a society then I think that exposes a very ugly part of our collective nature.
Thanks for posting that link to the NYT article. Agree totally that healthcare needs to be completely decoupled from employment, as often the people who need healthcare the most are those not working, because they're sick. Duh!

Yesterday I asked a friend who has worked in the insurance industry for 30+ years what he thought would be the best way for our country to move forward on improving healthcare. After thinking for a minute, he said, "Cut out the middle man who is sucking huge profits out of the system, driving up the price and not really providing anything of value." TBH, I was surprised my friend said that. Although he doesn't personally sell health insurance, he's basically talking about cutting his industry out of the equation. Sounds good to me.

FIREstache

  • Stubble
  • **
  • Posts: 202
Re: What comes after the ACA?
« Reply #5451 on: April 16, 2019, 03:39:29 PM »
Tying healthcare to employment is a terrible idea and weíve known that for a long time. A
Thanks for posting that link to the NYT article. Agree totally that healthcare needs to be completely decoupled from employment, as often the people who need healthcare the most are those not working, because they're sick. Duh!

While working, I've always been good with it because I've had excellent benefits for around $50/mo with no deductible for much of the last couple decades.  But now that I'm closing in on retirement, I'm ok if that benefit goes away for workers.

Exflyboy

  • Walrus Stache
  • *******
  • Posts: 5991
  • Age: 57
  • Location: Corvallis, Oregon
  • Expat Brit living in the New World..:)
Re: What comes after the ACA?
« Reply #5452 on: April 16, 2019, 07:12:59 PM »
Personally I think healthcare bennies provided free with your job should be taxed on the market value of the benefit.

I think the bitching about HC costs from employed workers would become deafening!

pecunia

  • Pencil Stache
  • ****
  • Posts: 947
Re: What comes after the ACA?
« Reply #5453 on: April 16, 2019, 07:27:47 PM »
Personally I think healthcare bennies provided free with your job should be taxed on the market value of the benefit.

I think the bitching about HC costs from employed workers would become deafening!

What would be the result of this "bitching?"  Would the tax on employer supplied health insurance simply be repealed or would this lead to a call for a more wide ranging reform?

DavidAnnArbor

  • Handlebar Stache
  • *****
  • Posts: 1958
  • Age: 53
  • Location: Ann Arbor, Michigan
Re: What comes after the ACA?
« Reply #5454 on: April 17, 2019, 09:04:58 PM »


GM:  I don't think you want to go down that rabbit hole.  The really short version is:  the government took over GM, shafted bondholders and handed greater ownership to the unions.  The government got its loan back, but all those bondholders lost out to the unions' benefit.

In both cases, we already have a legal structure designed to handle precisely this sort of situation: Chapter 11.

What do you think a bankruptcy judge would have done in Chapter 11?  Shafted bondholders, and insured that the workers received payment for their work and their accrued benefits. Have you not taken a cursory business law class?

It makes no sense to liquidate the entire automotive manufacturing ecosystem with such effects felt throughout every county in the United States.
Our government can help maintain a vibrant economy. In fact I'm counting on it.

Sad that the Michiganders repaid the Obama administration with a 2016 Trump victory. But I heard there was some Russian tinkering in the election.

zolotiyeruki

  • Magnum Stache
  • ******
  • Posts: 3045
  • Location: State: Denial
Re: What comes after the ACA?
« Reply #5455 on: April 18, 2019, 05:26:54 AM »


GM:  I don't think you want to go down that rabbit hole.  The really short version is:  the government took over GM, shafted bondholders and handed greater ownership to the unions.  The government got its loan back, but all those bondholders lost out to the unions' benefit.

In both cases, we already have a legal structure designed to handle precisely this sort of situation: Chapter 11.

What do you think a bankruptcy judge would have done in Chapter 11?  Shafted bondholders, and insured that the workers received payment for their work and their accrued benefits. Have you not taken a cursory business law class?

It makes no sense to liquidate the entire automotive manufacturing ecosystem with such effects felt throughout every county in the United States.
Our government can help maintain a vibrant economy. In fact I'm counting on it.

Sad that the Michiganders repaid the Obama administration with a 2016 Trump victory. But I heard there was some Russian tinkering in the election.
I would have expected a judge to treat all creditors according to the law.  In this case, the bondholders' debt was equal to or greater in seniority to the unions'.  The workers' pay and benefits would have continued as is typical in a large-scale bankruptcy.  Instead, the gov't subverted the law and handed a greater share of the company to their allies (the unions).

As for the whole Russian Collusion story, I'm not sure if you've heard, but the special counsel investigating it basically announced last week that there was no collusion, much to the dismay of a whole lot of people in the media.

sol

  • Walrus Stache
  • *******
  • Posts: 8372
  • Age: 42
  • Location: Pacific Northwest
Re: What comes after the ACA?
« Reply #5456 on: April 18, 2019, 07:50:25 AM »
As for the whole Russian Collusion story, I'm not sure if you've heard, but the special counsel investigating it basically announced last week that there was no collusion, much to the dismay of a whole lot of people in the media.

This is way off topic, but wow there are like four different errors in that one sentence.  I suggest you get your news from anywhere other than the president's twitter feed.  He tends to bend the truth a little.

DavidAnnArbor

  • Handlebar Stache
  • *****
  • Posts: 1958
  • Age: 53
  • Location: Ann Arbor, Michigan
Re: What comes after the ACA?
« Reply #5457 on: April 18, 2019, 12:24:40 PM »
I would have expected a judge to treat all creditors according to the law.  In this case, the bondholders' debt was equal to or greater in seniority to the unions'.  The workers' pay and benefits would have continued as is typical in a large-scale bankruptcy.  Instead, the gov't subverted the law and handed a greater share of the company to their allies (the unions).

As for the whole Russian Collusion story, I'm not sure if you've heard, but the special counsel investigating it basically announced last week that there was no collusion, much to the dismay of a whole lot of people in the media.

A bankruptcy judge doesn't prioritize debt based on the size of the debt that each stakeholder has, rather the judge prioritizes debt based on the law. The law prioritizes worker pay, pension, and accrued benefits above and beyond bondholders.
Bondholders have a responsibility to get the financial statements of the corporation and understand the risks they are taking by looking at the financial metrics.

zolotiyeruki

  • Magnum Stache
  • ******
  • Posts: 3045
  • Location: State: Denial
Re: What comes after the ACA?
« Reply #5458 on: April 18, 2019, 04:06:04 PM »
A bankruptcy judge doesn't prioritize debt based on the size of the debt that each stakeholder has, rather the judge prioritizes debt based on the law. The law prioritizes worker pay, pension, and accrued benefits above and beyond bondholders.
Bondholders have a responsibility to get the financial statements of the corporation and understand the risks they are taking by looking at the financial metrics.
I agree with you, and I must not have been clear enough before--it was the debt owed to the unions (distinct from wages, benefits, etc owed to the workers) that's the issue.

protostache

  • Pencil Stache
  • ****
  • Posts: 888
Re: What comes after the ACA?
« Reply #5459 on: April 18, 2019, 05:41:37 PM »
A bankruptcy judge doesn't prioritize debt based on the size of the debt that each stakeholder has, rather the judge prioritizes debt based on the law. The law prioritizes worker pay, pension, and accrued benefits above and beyond bondholders.
Bondholders have a responsibility to get the financial statements of the corporation and understand the risks they are taking by looking at the financial metrics.
I agree with you, and I must not have been clear enough before--it was the debt owed to the unions (distinct from wages, benefits, etc owed to the workers) that's the issue.

I tried looking up what you meant by this and couldnít find anything. Could you explain how GM zoned the UAW money for things other than accrued pensions and health benefits?

DavidAnnArbor

  • Handlebar Stache
  • *****
  • Posts: 1958
  • Age: 53
  • Location: Ann Arbor, Michigan
Re: What comes after the ACA?
« Reply #5460 on: April 18, 2019, 09:31:45 PM »
The UAW was given money to manage the pension fund and retiree health benefits accrued to the unionized and salaried employees.


Exflyboy

  • Walrus Stache
  • *******
  • Posts: 5991
  • Age: 57
  • Location: Corvallis, Oregon
  • Expat Brit living in the New World..:)

talltexan

  • Handlebar Stache
  • *****
  • Posts: 2326
Re: What comes after the ACA?
« Reply #5462 on: May 02, 2019, 11:01:00 AM »
Kind of a nice 1-2 there to have Barr testifying about the Mueller report, grabbing all the headlines while they file this brief that basically points toward total evisceration of ACA. Media having to choose which thing to cover.

Paul der Krake

  • Magnum Stache
  • ******
  • Posts: 4458
  • Age: 11
  • Location: USA
Re: What comes after the ACA?
« Reply #5463 on: May 02, 2019, 11:53:34 AM »
The ACA is safe for the year 2020, right? What's the earliest that they could kill it, regardless of how?

seattlecyclone

  • Magnum Stache
  • ******
  • Posts: 4732
  • Age: 34
  • Location: Seattle, WA
Re: What comes after the ACA?
« Reply #5464 on: May 02, 2019, 12:13:02 PM »
The ACA is safe for the year 2020, right? What's the earliest that they could kill it, regardless of how?

A repeal has a snowball's chance in hell of making it through Congress before the next elections, so the quickest way would be a judicial overturn. If that happens after people have already started signing up for policies in the 2020 plan year, I have a hard time imagining a judge just cancelling the existing contracts between insurers and customers, but if it happens before open enrollment starts...Į\_(ツ)_/Į

sherr

  • Pencil Stache
  • ****
  • Posts: 641
  • Age: 33
  • Location: North Carolina
Re: What comes after the ACA?
« Reply #5465 on: May 02, 2019, 12:56:54 PM »
The ACA is safe for the year 2020, right? What's the earliest that they could kill it, regardless of how?

A repeal has a snowball's chance in hell of making it through Congress before the next elections, so the quickest way would be a judicial overturn. If that happens after people have already started signing up for policies in the 2020 plan year, I have a hard time imagining a judge just cancelling the existing contracts between insurers and customers, but if it happens before open enrollment starts...Į\_(ツ)_/Į

"The gears of justice grind slowly." It will probably be the end of the year before the Appeals Court rules, and then whatever happens it would probably be immediately appealed to the Supreme Court. I would say 2020 is definitely safe.

Paul der Krake

  • Magnum Stache
  • ******
  • Posts: 4458
  • Age: 11
  • Location: USA
Re: What comes after the ACA?
« Reply #5466 on: May 02, 2019, 01:02:36 PM »
Right, my understanding is that insurance companies start publishing their proposed rates for 2020 early in the summer of 2019, which means they've already started their work well before that. If a judge were to kill it tomorrow, they would immediately sue. In fact I suspect the lawsuits are probably already written and ready to go, just fill in the blanks and file.

But who knows.

pecunia

  • Pencil Stache
  • ****
  • Posts: 947
Re: What comes after the ACA?
« Reply #5467 on: May 02, 2019, 04:18:25 PM »
From the article:

"The court filing, while expected since late March, signaled a no-holds-barred effort by the Justice Department to wipe out a law that has extended health insurance to 20 million Americans."

If someone made a half-hearted effort, they could organize these folks.  This health care thing can mean a lot of votes.  Let's see how hard it could be.

Politician - Are you sick or do you know a friend or relative that is sick now or could be sick?

Potential Voter - Yeh, I guess

Politician - How would you like it if you were able to go to the doctor without major hardship?

Potential Voter - I'd like that.

Politicians - Vote for me and I'll make it happen.

Potential Voter - OK

radram

  • Pencil Stache
  • ****
  • Posts: 934
Re: What comes after the ACA?
« Reply #5468 on: May 02, 2019, 05:33:19 PM »
From the article:

"The court filing, while expected since late March, signaled a no-holds-barred effort by the Justice Department to wipe out a law that has extended health insurance to 20 million Americans."

If someone made a half-hearted effort, they could organize these folks.  This health care thing can mean a lot of votes.  Let's see how hard it could be.

Politician - Are you sick or do you know a friend or relative that is sick now or could be sick?

Potential Voter - Yeh, I guess

Politician - How would you like it if you were able to go to the doctor without major hardship?

Potential Voter - I'd like that.

Politicians - Vote for me and I'll make it happen.

Potential Voter - OK

That is almost word for word one of Trumps talking points when he was running last time. If fact, he said the same thing not 1 month ago for his reelection bid.. Something like the new plan is going to be so great, we can't even tell you about it until after 2020 elections. It worked last time.

pecunia

  • Pencil Stache
  • ****
  • Posts: 947
Re: What comes after the ACA?
« Reply #5469 on: May 02, 2019, 06:26:19 PM »
"That is almost word for word one of Trumps talking points when he was running last time. If fact, he said the same thing not 1 month ago for his reelection bid.. Something like the new plan is going to be so great, we can't even tell you about it until after 2020 elections. It worked last time."

In his case - Fool me once shame on you - Fool me twice shame on me.

In his case - I wonder if the guy actually believes his own BS in a strange sort of way.

Also - looks like it has already worked.  Now we need a politician who really wants to do it.

Paul der Krake

  • Magnum Stache
  • ******
  • Posts: 4458
  • Age: 11
  • Location: USA
Re: What comes after the ACA?
« Reply #5470 on: May 02, 2019, 07:04:16 PM »
"The court filing, while expected since late March, signaled a no-holds-barred effort by the Justice Department to wipe out a law that has extended health insurance to 20 million Americans."

If someone made a half-hearted effort, they could organize these folks.  This health care thing can mean a lot of votes.
You're joking right? This is one of the least politically-involved demographic, largely poor and hidden away. They polled the people who were going to benefit from it in 2014 when the law was coming into effect after YEARS of public discourse, and the majority couldn't tell you what the law did and for whom.

iris lily

  • Magnum Stache
  • ******
  • Posts: 3141
Re: What comes after the ACA?
« Reply #5471 on: May 02, 2019, 07:43:13 PM »
"The court filing, while expected since late March, signaled a no-holds-barred effort by the Justice Department to wipe out a law that has extended health insurance to 20 million Americans."

If someone made a half-hearted effort, they could organize these folks.  This health care thing can mean a lot of votes.
You're joking right? This is one of the least politically-involved demographic, largely poor and hidden away. They polled the people who were going to benefit from it in 2014 when the law was coming into effect after YEARS of public discourse, and the majority couldn't tell you what the law did and for whom.

 I wonder if you understand that these ďlargely poor and hidden away ďpeople who benefit from the ACA, a nice percentage of them anyway, think itís too expensive. They donít consider it a benefit because itís so costly.

Donít tell me how itís not expensive because I would agree with you, you would be preaching to the choir her with me, and besides our president Barack Obama promised everyone that it was affordable thatís why itís called the affordable care act. 🤔

MonkeyJenga

  • Walrus Stache
  • *******
  • Posts: 8000
  • Location: Don't Ask
  • Resting up for 2020
Re: What comes after the ACA?
« Reply #5472 on: May 02, 2019, 07:50:49 PM »
Were y'all paying attention to the midterm elections? Healthcare has already translated to a lot of votes for Democrats.

talltexan

  • Handlebar Stache
  • *****
  • Posts: 2326
Re: What comes after the ACA?
« Reply #5473 on: May 03, 2019, 09:36:44 AM »
Health care is a winning issue for Democrats. Polling showed this when House passed the "American Health Care Act" in spring 2017. The results of the 2018 midterms played this out.

I don't have enough understanding of the wheels of justice to know what this Attorney-General guidance can do, but I think releasing it the same day as Barr was testifying about the Mueller report was done to try to throw out this Hail Mary against the law with minimal political cost.

Exflyboy

  • Walrus Stache
  • *******
  • Posts: 5991
  • Age: 57
  • Location: Corvallis, Oregon
  • Expat Brit living in the New World..:)
Re: What comes after the ACA?
« Reply #5474 on: May 03, 2019, 01:28:01 PM »
Yeah sadly I think the political choice in 2020 will be healthcare plus wealth taxes Vs. the current insanity we have now..:(

pecunia

  • Pencil Stache
  • ****
  • Posts: 947
Re: What comes after the ACA?
« Reply #5475 on: May 03, 2019, 06:50:22 PM »
Were y'all paying attention to the midterm elections? Healthcare has already translated to a lot of votes for Democrats.

I saw a few Town Meetings held by Republican reps.  It was bad for them.  Some had to leave.  It certainly left an impression on me.

"Do you realize my wife will die if you change this law?"  Wow!

DavidAnnArbor

  • Handlebar Stache
  • *****
  • Posts: 1958
  • Age: 53
  • Location: Ann Arbor, Michigan
Re: What comes after the ACA?
« Reply #5476 on: May 04, 2019, 07:03:45 PM »
Yeah sadly I think the political choice in 2020 will be healthcare plus wealth taxes Vs. the current insanity we have now..:(

If you pay property taxes on a house that is a wealth tax that you're already paying.

The wealth tax wouldn't hit til someone had something like $50 million in assets.
I wouldn't worry about it.

"Elizabeth Warren's wealth tax. Senator Elizabeth Warren (D-Mass) recently announced her proposal for a wealth tax, which would apply to Americans with more than $50 million in assets. The tax, which Warren refers to as the "Ultra-Millionaire Tax," would raise $2.75 trillion over a 10-year period, according to economist Emmanuel Saez."

www.fool.com/taxes/2019/01/28/elizabeth-warrens-wealth-tax-heres-what-you-need-t.aspx

zolotiyeruki

  • Magnum Stache
  • ******
  • Posts: 3045
  • Location: State: Denial
Re: What comes after the ACA?
« Reply #5477 on: May 04, 2019, 09:18:44 PM »
Were y'all paying attention to the midterm elections? Healthcare has already translated to a lot of votes for Democrats.

I saw a few Town Meetings held by Republican reps.  It was bad for them.  Some had to leave.  It certainly left an impression on me.

"Do you realize my wife will die if you change this law?"  Wow!
Unfortunately, it's easy to show the tragic impact on an individual while ignoring the not-so-tragic (yet widespread and/or deferred) effects on other people who aren't in the room, and it's also easy to pretend that the ACA is the *only* thing keeping a person from dying, when there are likely other options available.

Let's turn it around to an issue on the other side of the aisle.  For example, a person could just as easily stand up in a Democratic candidate's town hall and say "it it were not for gun rights, I'd already be dead."

Classical_Liberal

  • Handlebar Stache
  • *****
  • Posts: 1088
  • Age: 43
Re: What comes after the ACA?
« Reply #5478 on: May 05, 2019, 03:00:45 AM »
Were y'all paying attention to the midterm elections? Healthcare has already translated to a lot of votes for Democrats.

If healthcare reform is modeled more like social security the dems have a HUGE winner, no doubt.  Part of the problem now, is that ACA subsidies fall of a cliff for middle income earners.  Hence they do not provide what is viewed as a "fair" compromise by many middle of the road, middle class conservatives.

I realize you're very active in the political realm. This is the type of information that can unite rather than polarize.  Maybe you can do something with it, nobody listens to me :(

yoda34

  • 5 O'Clock Shadow
  • *
  • Posts: 47
Re: What comes after the ACA?
« Reply #5479 on: May 05, 2019, 06:39:59 AM »
Yeah sadly I think the political choice in 2020 will be healthcare plus wealth taxes Vs. the current insanity we have now..:(

If you pay property taxes on a house that is a wealth tax that you're already paying.

The wealth tax wouldn't hit til someone had something like $50 million in assets.
I wouldn't worry about it.

"Elizabeth Warren's wealth tax. Senator Elizabeth Warren (D-Mass) recently announced her proposal for a wealth tax, which would apply to Americans with more than $50 million in assets. The tax, which Warren refers to as the "Ultra-Millionaire Tax," would raise $2.75 trillion over a 10-year period, according to economist Emmanuel Saez."

www.fool.com/taxes/2019/01/28/elizabeth-warrens-wealth-tax-heres-what-you-need-t.aspx

Wealth taxes as the Federal level without apportionment by state based on population are unconstitutional. It's why we have the 16th amendment authorizing income taxes without apportionment. Wealth taxes at the state and local level are certainly legal based on local laws and state constitutions.

pecunia

  • Pencil Stache
  • ****
  • Posts: 947
Re: What comes after the ACA?
« Reply #5480 on: May 05, 2019, 07:40:00 AM »
Were y'all paying attention to the midterm elections? Healthcare has already translated to a lot of votes for Democrats.

I saw a few Town Meetings held by Republican reps.  It was bad for them.  Some had to leave.  It certainly left an impression on me.

"Do you realize my wife will die if you change this law?"  Wow!
Unfortunately, it's easy to show the tragic impact on an individual while ignoring the not-so-tragic (yet widespread and/or deferred) effects on other people who aren't in the room, and it's also easy to pretend that the ACA is the *only* thing keeping a person from dying, when there are likely other options available.

Let's turn it around to an issue on the other side of the aisle.  For example, a person could just as easily stand up in a Democratic candidate's town hall and say "it it were not for gun rights, I'd already be dead."

That's a separate issue.  Besides, I don't think there are all that many people who have had to gun somebody down breaking into their home, attempting kidnapping or other heinous crimes.  There are millions who need health care and may live a better life if they have it.

Hunters and fishermen are the greatest asset to conservation this country has.  Maybe if you didn't have the right rifle you would have been mauled by a grizzly, but just doesn't seem to be a fair comparison.

There definitely have been many people who have died because they didn't have health care.  Even the low cost of preventive medicine would have saved their lives.

 

MonkeyJenga

  • Walrus Stache
  • *******
  • Posts: 8000
  • Location: Don't Ask
  • Resting up for 2020
Re: What comes after the ACA?
« Reply #5481 on: May 05, 2019, 10:57:00 PM »
Were y'all paying attention to the midterm elections? Healthcare has already translated to a lot of votes for Democrats.

If healthcare reform is modeled more like social security the dems have a HUGE winner, no doubt.  Part of the problem now, is that ACA subsidies fall of a cliff for middle income earners.  Hence they do not provide what is viewed as a "fair" compromise by many middle of the road, middle class conservatives.

I realize you're very active in the political realm. This is the type of information that can unite rather than polarize.  Maybe you can do something with it, nobody listens to me :(

I actually have tried. Not about this issue specifically, but generally about framing issues around people's values, even if their values are different than yours. If you're trying to win conservative voters, you can't just say, you should want to help other people, so support XYZ. Basic change management principle: WIIFM. What's In It For Me? George Lakoff writes about the framing issue well.

I have no impact on policy, but there's basically no chance of Warren's proposal being enacted. And I'm okay with some changes to the ACA if it actually improves it. I don't see the Republican party doing anything except try to undercut it or directly attack it, and they would need to sign on for any new law to pass the Senate. So, for me, the only option right now is to defend it.

zolotiyeruki

  • Magnum Stache
  • ******
  • Posts: 3045
  • Location: State: Denial
Re: What comes after the ACA?
« Reply #5482 on: May 06, 2019, 06:50:51 AM »
Were y'all paying attention to the midterm elections? Healthcare has already translated to a lot of votes for Democrats.

I saw a few Town Meetings held by Republican reps.  It was bad for them.  Some had to leave.  It certainly left an impression on me.

"Do you realize my wife will die if you change this law?"  Wow!
Unfortunately, it's easy to show the tragic impact on an individual while ignoring the not-so-tragic (yet widespread and/or deferred) effects on other people who aren't in the room, and it's also easy to pretend that the ACA is the *only* thing keeping a person from dying, when there are likely other options available.

Let's turn it around to an issue on the other side of the aisle.  For example, a person could just as easily stand up in a Democratic candidate's town hall and say "it it were not for gun rights, I'd already be dead."

That's a separate issue.  Besides, I don't think there are all that many people who have had to gun somebody down breaking into their home, attempting kidnapping or other heinous crimes.  There are millions who need health care and may live a better life if they have it.
There are LOTS of cases of guns being used in self defense, somewhere in the hundreds-of-thousands to millions per year, depending on the source of the statistic. They usually don't get much publicity, however. ("Nothing happened, more at 11!" doesn't make for good ratings).

My point here is not to bring a gun debate into this thread, but rather to point out the political difficulty of opposing any government-run social program, regardless of whether the program itself has merit.  The proponents of the program can point to someone who will be negatively affected.

maizeman

  • Magnum Stache
  • ******
  • Posts: 3575
Re: What comes after the ACA?
« Reply #5483 on: May 06, 2019, 11:01:59 AM »
There are LOTS of cases of guns being used in self defense, somewhere in the hundreds-of-thousands to millions per year, depending on the source of the statistic. They usually don't get much publicity, however. ("Nothing happened, more at 11!" doesn't make for good ratings).

Apologies for continuing to go off topic, but how would you define "using a gun in self defense?" To me that would mean actually shooting another person in self defense. While it's hard to know what that number it, it is quite easy to establish a ceiling for it. 

If we consider all fatal (32,000*) and non-fatal gun injuries (67,000*) to be self defense, that wouldn't quite get to event one hundred thousand, hundreds of thousands or millions. A substantial fraction of each of those categories are either accidents or suicides. For fatalities this breaks down as 64% suicides and accidents 36% everything else.* For nonfatal injuries 28% are accidents and self harm, and 72% everything else.* So we're left with ~11,500 fatal and ~48,000 nonfatal gun injuries which might result from either assault or self dense.* I have no way of estimating what the breakdown of those would be, especially since different people may perceive the same event as either self defense or assault/murder, but even if no one ever intentionally shot another human being, except in self defense, we're talking 60,000 cases/year max, not hundreds of thousands or millions.

Would you include brandishing a gun and hoping it'll scare people off but not firing it as using the gun in self defense?** Or include cases where a person is open carrying and something might have happened if they weren't but people could see they had a gun so it didn't? <-- these start to get very squishy and I cannot see a way you could quantity either accurately enough to get a nationwide count.

*Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700838/

**Also, from both practical and legal standpoints it is a very bad idea to do this.

zolotiyeruki

  • Magnum Stache
  • ******
  • Posts: 3045
  • Location: State: Denial
Re: What comes after the ACA?
« Reply #5484 on: May 06, 2019, 01:36:08 PM »
There are LOTS of cases of guns being used in self defense, somewhere in the hundreds-of-thousands to millions per year, depending on the source of the statistic. They usually don't get much publicity, however. ("Nothing happened, more at 11!" doesn't make for good ratings).
Apologies for continuing to go off topic, but how would you define "using a gun in self defense?" To me that would mean actually shooting another person in self defense. While it's hard to know what that number it, it is quite easy to establish a ceiling for it. 

...
Would you include brandishing a gun and hoping it'll scare people off but not firing it as using the gun in self defense?** Or include cases where a person is open carrying and something might have happened if they weren't but people could see they had a gun so it didn't? <-- these start to get very squishy and I cannot see a way you could quantity either accurately enough to get a nationwide count.
Defensive Gun Use (DGU) is not typically restricted to actually shooting another person.  It also includes brandishing, as well as firing and missing.

In any case, you're helping me make precisely the point I brought up earlier--it's difficult to defend a policy when your opponents can point to an individual and say "but your policy will kill them!"  Even if you believe the policy is better for society as a whole, and even if there are alternatives available, it is difficult to argue against the emotional impact of an individual tragedy.

maizeman

  • Magnum Stache
  • ******
  • Posts: 3575
Re: What comes after the ACA?
« Reply #5485 on: May 06, 2019, 02:10:28 PM »
Defensive Gun Use (DGU) is not typically restricted to actually shooting another person.  It also includes brandishing, as well as firing and missing.

Brandishing is both stupid and exposes you to substantial legal liability in many US states.

Lumping it in with actual cases where someone concealed carrying actually had to defend their life does no favors to either gun rights or the people who may be mislead into thinking brandishing is going to deescalate rather than escalate tense and dangerous situations.

https://www.usacarry.com/what-does-brandishing-mean/

sol

  • Walrus Stache
  • *******
  • Posts: 8372
  • Age: 42
  • Location: Pacific Northwest
Re: What comes after the ACA?
« Reply #5486 on: May 06, 2019, 02:22:55 PM »
I'm not sure why gun rights are even in this discussion.  It's not like any political party has advanced serious legislation to officially overturn the current American gun rights policy network, and then failed to succeed by a single vote.  The ACA was literally saved from wholesale extinction by a single (now dead) Senator.  These two things are not even remotely equivalently vulnerable.

Even if you feel that the loss of your personal gun rights would mean your imminent death, which is probably a bit of a stretch by comparison with healthcare, no one is even talking about repealing your gun rights.  Meanwhile we have a US president and half of Congress who are hell-bent on repealing your healthcare rights at all costs, making it a central campaign promise and advancing multiple separate legislative attempts to accomplish that goal.  Trump still tweets about it almost every day.  How often did Obama tweet about repealing the 2nd Amendment.  I'm going to guess "never"?

zolotiyeruki

  • Magnum Stache
  • ******
  • Posts: 3045
  • Location: State: Denial
Re: What comes after the ACA?
« Reply #5487 on: May 06, 2019, 02:55:23 PM »
I'm not sure why gun rights are even in this discussion.  It's not like any political party has advanced serious legislation to officially overturn the current American gun rights policy network, and then failed to succeed by a single vote.  The ACA was literally saved from wholesale extinction by a single (now dead) Senator.  These two things are not even remotely equivalently vulnerable.

Even if you feel that the loss of your personal gun rights would mean your imminent death, which is probably a bit of a stretch by comparison with healthcare, no one is even talking about repealing your gun rights.  Meanwhile we have a US president and half of Congress who are hell-bent on repealing your healthcare rights at all costs, making it a central campaign promise and advancing multiple separate legislative attempts to accomplish that goal.  Trump still tweets about it almost every day.  How often did Obama tweet about repealing the 2nd Amendment.  I'm going to guess "never"?
You're making three mistakes here:
1) You're missing the point I was trying to make, which was entirely about the politics and optics of the two issues, not their merits.  I'm not discussion gun rights here--heaven knows there are plenty of other threads on that topic.
2) The term "healthcare rights" is not an effective argument for a number of reasons, primarily because it's ambiguous to the point of being meaningless.  A meaningful definition of the term is needed before it can be discussed.
3) You're attempting to introduce the idea of "healthcare rights" with the ACA, which are two *very* different things.

sol

  • Walrus Stache
  • *******
  • Posts: 8372
  • Age: 42
  • Location: Pacific Northwest
Re: What comes after the ACA?
« Reply #5488 on: May 06, 2019, 03:30:06 PM »
1) You're missing the point I was trying to make, which was entirely about the politics and optics of the two issues, not their merits.

Well, please reiterate your point for me so we can all be clear.  With healthcare, we're literally talking about giving people the option to be treated for serious and life threatening medical conditions, and one major US party that wants to overturn the current system that guarantees that treatment.  If you want to make a gun analogy, it would only be about people who are currently being held at gunpoint.

Quote
2) The term "healthcare rights" is not an effective argument for a number of reasons, primarily because it's ambiguous to the point of being meaningless.  A meaningful definition of the term is needed before it can be discussed.
3) You're attempting to introduce the idea of "healthcare rights" with the ACA, which are two *very* different things.

I wan't trying to introduce new ideas, just reflect that the ACA is an existing law that mandates certain legal protections, such as guaranteed issue and free preventative care, that the republican party has campaigned on repealing.  No democrats are campaigning on repealing the 2nd Amendment.  It seems like a strained analogy to say "well you could turn it around..." when literally no one is turning it around.

pecunia

  • Pencil Stache
  • ****
  • Posts: 947
Re: What comes after the ACA?
« Reply #5489 on: May 06, 2019, 06:58:50 PM »
zolotiyeruki:

What do you think should be done about the problem with health care?  I hope you will at least admit this is a problem.  I hope you are at least humane enough to admit that sick people should have more than "access" to health care, but they should be able to receive the health care that they need.


talltexan

  • Handlebar Stache
  • *****
  • Posts: 2326
Re: What comes after the ACA?
« Reply #5490 on: May 07, 2019, 09:16:29 AM »
1) You're missing the point I was trying to make, which was entirely about the politics and optics of the two issues, not their merits.

Well, please reiterate your point for me so we can all be clear.  With healthcare, we're literally talking about giving people the option to be treated for serious and life threatening medical conditions, and one major US party that wants to overturn the current system that guarantees that treatment.  If you want to make a gun analogy, it would only be about people who are currently being held at gunpoint.

Quote
2) The term "healthcare rights" is not an effective argument for a number of reasons, primarily because it's ambiguous to the point of being meaningless.  A meaningful definition of the term is needed before it can be discussed.
3) You're attempting to introduce the idea of "healthcare rights" with the ACA, which are two *very* different things.

I wan't trying to introduce new ideas, just reflect that the ACA is an existing law that mandates certain legal protections, such as guaranteed issue and free preventative care, that the republican party has campaigned on repealing.  No democrats are campaigning on repealing the 2nd Amendment.  It seems like a strained analogy to say "well you could turn it around..." when literally no one is turning it around.

I do think Zolo is correct that the gun issue is generally a loser for Democrats. It's easy to point out a number of Red State Democratic Senators who are considerably more gun-friendly than what the Presidential candidates are proposing.

But you also have to look at the trajectory of the last twenty-five years. And that is--unmistakably and inexorably--toward more guns in more places.

waltworks

  • Magnum Stache
  • ******
  • Posts: 3174
Re: What comes after the ACA?
« Reply #5491 on: May 07, 2019, 09:25:51 AM »
I do think Zolo is correct that the gun issue is generally a loser for Democrats. It's easy to point out a number of Red State Democratic Senators who are considerably more gun-friendly than what the Presidential candidates are proposing.

But you also have to look at the trajectory of the last twenty-five years. And that is--unmistakably and inexorably--toward more guns in more places.

I'm generally friendly to guns and I like the 2nd amendment just fine. And I have NO idea what that has to do with healthcare policy.

We have a badly socialized system that costs a fortune and only does well for wealthy people right now. That's stupid from a macro standpoint. I guess you could say that similarly the ATF is incompetent or that we don't do a good job screening gun buyers who are nutso? But honestly one of the big problems with guns in the US is... wait for it... we do a shit job with healthcare including mental healthcare.

You could make an argument for no gov't involvement at all in healthcare but the political reality is that nobody is going to repeal EMTALA or Medicare, so in a way we've already made the choice on making healthcare a "right". So since that's how it's going to go down, we might as well finish the job and do it intelligently rather than continue with a system we *know* doesn't work well.

-W

zolotiyeruki

  • Magnum Stache
  • ******
  • Posts: 3045
  • Location: State: Denial
Re: What comes after the ACA?
« Reply #5492 on: May 07, 2019, 11:46:37 AM »
1) You're missing the point I was trying to make, which was entirely about the politics and optics of the two issues, not their merits.

Well, please reiterate your point for me so we can all be clear.  With healthcare, we're literally talking about giving people the option to be treated for serious and life threatening medical conditions, and one major US party that wants to overturn the current system that guarantees that treatment.  If you want to make a gun analogy, it would only be about people who are currently being held at gunpoint.
Gladly!  Actually, I already reiterated it in response to maizeman a few comments upthread:
Quote
...it's difficult to defend a policy when your opponents can point to an individual and say "but your policy will kill them!"  Even if you believe the policy is better for society as a whole, and even if there are alternatives available, it is difficult to argue against the emotional impact of an individual tragedy.

Shane

  • Pencil Stache
  • ****
  • Posts: 878
  • Location: Independent
Re: What comes after the ACA?
« Reply #5493 on: May 07, 2019, 12:12:05 PM »
1) You're missing the point I was trying to make, which was entirely about the politics and optics of the two issues, not their merits.

Well, please reiterate your point for me so we can all be clear.  With healthcare, we're literally talking about giving people the option to be treated for serious and life threatening medical conditions, and one major US party that wants to overturn the current system that guarantees that treatment.  If you want to make a gun analogy, it would only be about people who are currently being held at gunpoint.
Gladly!  Actually, I already reiterated it in response to maizeman a few comments upthread:
Quote
...it's difficult to defend a policy when your opponents can point to an individual and say "but your policy will kill them!"  Even if you believe the policy is better for society as a whole, and even if there are alternatives available, it is difficult to argue against the emotional impact of an individual tragedy.
Yale psychology professor Paul Bloom's 2016 book, Against Empathy: The Case for Rational Compassion deals with what I think you're trying to say Zolotiyeruki. The argument seems counter intuitive to most people, but if you think about it, it makes a lot of sense. Sometimes, empathy for individual cases leads to arguably immoral/unethical outcomes.

pecunia

  • Pencil Stache
  • ****
  • Posts: 947
Re: What comes after the ACA?
« Reply #5494 on: May 07, 2019, 05:43:42 PM »

Yale psychology professor Paul Bloom's 2016 book, Against Empathy: The Case for Rational Compassion deals with what I think you're trying to say Zolotiyeruki. The argument seems counter intuitive to most people, but if you think about it, it makes a lot of sense. Sometimes, empathy for individual cases leads to arguably immoral/unethical outcomes.

I'm glad you had the "sometimes".  I made the example above as to how the hoped for repeal of the ACA by Republicans would cause a man's wife to die because she couldn't receive health treatment to help her live.

I think most of us would have empathy for this individual case.  Why would we have this empathy?  It is because we know that what happened to the man's wife could happen to ourselves or our loved ones.

How would this be immoral?  Perhaps the money spent on the ACA would have been spent on an even more moral expenditure.  I cannot imagine what could be more moral than saving innocent people's lives.  Perhaps the man's wife was a serial killer and would have taken more lives that her own.  It could have then been judged immoral to save her. 

It struck me at the time and still does that the hoped for repeal of the ACA was immoral.  I cannot imagine how the repeal could have been more moral than the retention.  Most of us value human lives.  This is at the core of our beliefs.  Retaining the ACA saved lives.  The jettison of the ACA would have caused the loss of lives.

I do not think the empathy for the man's wife and the many other lives saved by the retention of this law was one of those "sometime" examples which led to an unethical / immoral outcome.  Disease can strike any of us at any time.  This law did not pick winners and losers among the population it helped.  The intent of the law was of a high moral purpose in saving lives and improving the quality of said lives.

You may make the counter-argument that winners and losers were picked since the healthy are to subsidize the unhealthy.  This is weak.  Even the strongest most fit individuals have succumbed to disease.  You may say that this is a small percentage of the healthy population that succumbs to disease.  This leads us back to the individual and empathy.  For that individual could be you.

Stalin said, "One death is a tragedy.  A million lives is a statistic."  Don't think like Stalin.  All human deaths are tragedies.  The ACA has been a good start in avoiding Stalin's statistic.

Shane

  • Pencil Stache
  • ****
  • Posts: 878
  • Location: Independent
Re: What comes after the ACA?
« Reply #5495 on: May 07, 2019, 11:27:27 PM »
Empathy has been used by Republicans to argue against "socialized medicine". Remember "death panels?" If someone can convincingly point to an individual case where the ACA caused a single person to die, people who heard about it might be able to imagine themselves or someone they loved also dying because of the ACA. But that doesn't mean the most moral thing would be to overturn it, because far more people are helped by the ACA than are hurt by it. We tend to empathize most with people who look like us and have similar backgrounds. Empathy causes most people to place a higher value on the lives of people they know and love, especially blood relatives. If you give a person a choice between her child or another close relative dying a horrible death or a million strangers who live in another country dying horribly, empathy leads most people to save their child and let the million strangers die, which is arguably not the most moral choice.

talltexan

  • Handlebar Stache
  • *****
  • Posts: 2326
Re: What comes after the ACA?
« Reply #5496 on: May 08, 2019, 08:58:09 AM »
Here's how I would build that:

I am a small business owner. The ACA forced me to lay off three staff to get below the fifty-employee threshold because I couldn't afford to offer benefits in-house. Because I live in a small area, I happened to be in contact with one of those three--who opted to pay the penalty and not sign up for an ACA-compliant plan--and she died from a condition that would have been easily treated. Under business-as-usual, she could have gotten a plan she needed to keep her alive.

For some reason, I haven't heard any stories like this????

Exflyboy

  • Walrus Stache
  • *******
  • Posts: 5991
  • Age: 57
  • Location: Corvallis, Oregon
  • Expat Brit living in the New World..:)
Re: What comes after the ACA?
« Reply #5497 on: May 08, 2019, 11:19:54 AM »
Here's how I would build that:

I am a small business owner. The ACA forced me to lay off three staff to get below the fifty-employee threshold because I couldn't afford to offer benefits in-house. Because I live in a small area, I happened to be in contact with one of those three--who opted to pay the penalty and not sign up for an ACA-compliant plan--and she died from a condition that would have been easily treated. Under business-as-usual, she could have gotten a plan she needed to keep her alive.

For some reason, I haven't heard any stories like this????

Hmm.. maybe because this is a relatively "complex argument". It doesn't fit on a bumper sticker or a red hat the way "Make America great again" or "America First".

Seems to me the Republican base is more motivated around dogma. This is rational.. Yes jobs HAVE been shipped overseas, yes there has been a war on coal (and the miners).

When you have a candidate show up and say "See its those rich elitist Demo's that have sold your jobs out from underneath you to make themselves rich, I am the one who is going to bring your jobs back!". Its a powerful and easily understood message.

Not too difficult to make the populous believe that "Those people" and everything they stand for is a giant conspiracy against good honest work class men and women.

Hence anything that looks like socialism is therefore evil and has undercut every one of our American values. Haven't we been murdering fighting against the Communists to prevent this very thing from happening?

DavidAnnArbor

  • Handlebar Stache
  • *****
  • Posts: 1958
  • Age: 53
  • Location: Ann Arbor, Michigan
Re: What comes after the ACA?
« Reply #5498 on: May 08, 2019, 01:56:15 PM »

Seems to me the Republican base is more motivated around dogma. This is rational.. Yes jobs HAVE been shipped overseas, yes there has been a war on coal (and the miners).

And yet automation is the main reason why most of these jobs are gone.

With mountain top removal for coal mining, it only takes a handful of jobs what used to be hundreds to dig underground tunnels for mining.

In West Virginia there are about 10 times as many jobs in health care as compared to coal miners. And the ACA provided support for the health care industry in West Virginia by expanding Medicaid.

SugarMountain

  • Pencil Stache
  • ****
  • Posts: 611
Re: What comes after the ACA?
« Reply #5499 on: May 08, 2019, 02:27:14 PM »
Here's how I would build that:

I am a small business owner. The ACA forced me to lay off three staff to get below the fifty-employee threshold because I couldn't afford to offer benefits in-house. Because I live in a small area, I happened to be in contact with one of those three--who opted to pay the penalty and not sign up for an ACA-compliant plan--and she died from a condition that would have been easily treated. Under business-as-usual, she could have gotten a plan she needed to keep her alive.

For some reason, I haven't heard any stories like this????

Maybe because if the 53 person company couldn't buy their employees insurance after ACA, they probably weren't buying it before the ACA came along, so this person didn't have any health insurance previously?  And if they were laid off and weren't able to find another job, they were most likely medicaid eligible, especially in states that expanded medicaid?  Or maybe the person had a pre-existing condition and would have been uninsurable at any price prior to ACA (in which case choosing to forgo coverage and pay the penalty was a bad decision).