H.R. 3950 - Patient Protection and Affordable Care Act

[Gawain 0]

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Just a quick background on me to frame my comment.

I believe in health care reform. I believe in universal care. I wish everyone could go to the doctor for free. Basically, this is not a blind attack on a liberal policy for the sake of being argumentative.

Thoughtful questions, my personal answers below.

I think there are many paths to this destination. I am concerned with walking the path that requires people to pay for insurance. This path sounds like it's littered with alligators and ex-girlfriends... but maybe I'm missing something.

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1) What I learned in basic economic theory is that when demand for a product goes up, price goes up as well. If we require everyone to pay for insurance, doesn't this give all the leverage to the insurance companies? Where is their incentive to keep prices down?

From the summary I have read in this bill, there are mandates about affordability, but no real specifics. It will force compliance, so costs will go down, coverage will go up, at the expense of accessibility in my opinion.

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2) Can we find another example of forced purchases that aren't car insurance or food? I have problems with both... As mentioned, we aren't born with cars, so liability insurance fails. Not all states charge a tax on non-prepared food, and you can grow your own if you like, so that doesn't seem as applicable... If a forced purchase from an insurance company is the best way, then let's do it... I just wish I could see another place where this exists and has proven successful.

Therein lies the rub. I don't know of another example where this exists.

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3) Is mandatory insurance truly better than a more robust public option? As in, a government-run program that exists side by side with private ones. We've had such a system in education for years... Public universities have existed side-by-side with private, and many site our country as the world's best in secondary education.

Again, the public Universities while receiving public funding still get the majority of their dollars through tuition, fees and alumni grants to their endowments. They also have a fair amount of autonomy, which we know the government would not allow the insurance industry to do. In fact, this bill specifically cites insurance as an interstate commerce, thus subject to federal regulation. The University system is not managed like that.

A public option would be subsidized, have no financial incentive to perform, and essentially will never run out of money thanks to our government who refuses to stop printing money. Private health care providers will be taxed more here, and do not have a guarantee of endless financial backing.

So I try and I scream and I beg and I sigh
Just to prove I'm alive, and it's alright
'Cause tonight there's a way I'll make light of my treacherous life
Make light!

[turtlespeed 226]

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Just a quick background on me to frame my comment.

I believe in health care reform. I believe in universal care. I wish everyone could go to the doctor for free. Basically, this is not a blind attack on a liberal policy for the sake of being argumentative.

I think there are many paths to this destination. I am concerned with walking the path that requires people to pay for insurance. This path sounds like it's littered with alligators and ex-girlfriends... but maybe I'm missing something.

1) What I learned in basic economic theory is that when demand for a product goes up, price goes up as well. If we require everyone to pay for insurance, doesn't this give all the leverage to the insurance companies? Where is their incentive to keep prices down?

Exactly - and what we need to avoid is the gov't running all the insurance companies . . .

2) Can we find another example of forced purchases that aren't car insurance or food? I have problems with both... As mentioned, we aren't born with cars, so liability insurance fails. Not all states charge a tax on non-prepared food, and you can grow your own if you like, so that doesn't seem as applicable... If a forced purchase from an insurance company is the best way, then let's do it... I just wish I could see another place where this exists and has proven successful.

Because it hasn't happened and been successful - Social Security is an example.

3) Is mandatory insurance truly better than a more robust public option? As in, a government-run program that exists side by side with private ones. We've had such a system in education for years... Public universities have existed side-by-side with private, and many site our country as the world's best in secondary education.

No- - but the liberals in power do not want to settle for just a piece of the pie.
In a nut shell: There are programs that the libs want funded, but the cash flow won't allow for that, (Read: They are running out of places to creatively move money around) So, they ask themselves, "What is a viable market that we can take over and control to be able to add cash flow to the country?" Insurance. Actually, they would be better off taking over the oil industry, but they don't want to have to compete with other countries, they want easy money. They also found a platform that speaks to the hearts of their voting base. Great political strategy. But that is all it is.

Ask yourself this: Why do they not want to lower insurance costs by implementing Tort caps and reforms, even if it is the right thing to do?

One would logically assume that the lawyers that fund the majority of the lib's campaign would drop them like a bad habit, hmm? So we suffer for it. We are denied the best options for this plan. We are not given the full spectrum of options that we should be able to choose from.

It's a good thing that those politicians have our best interests at heart, wouldn't you say?

Oh and BTW - I am a proponent for healthcare, but not at the cost of the loss of my ability to afford to run the company that I own because I am being forced to supplement someone else.

Give me an option where the money that I earn goes to taking care of me and mine and not someone else, with me deciding where and to whom it goes, and I will vote for it.

I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama
BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun

[Ron 10]

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Curious as to why K-12 is a better example? I use college, as I didn't have a private school to choose from K-12. I prefer the system where there is an option, and think it makes a better example.

Because K-12 is not really an option... University is an option. The current legislation does not make participation an option. Therefore, mandatory schooling is a better example.

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and I've heard people say, "If we let the government have a program they'll take over everything..." Just haven't seen that in education.

Maybe, but with private education (K-12) even if you go to private school, you still PAY for public school.

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You mean this year, or when we actually look forward toward the budget.... problems? Hehehe, i agree that the government is not the only solution. My point was that I am uncomfortable with the government telling me to purchase insurance and I'd be fine with a gov't option side by side with other options.

Social Security and the Medicare/Medicaid programs all are not fiscally sound. The problem is only going to get worse.

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GREAT QUESTION!!! I think the answer is mixed. Both sides give us anecdotal answers that sound fishy.

There is plenty of hard data out there... such as France's system which is the closest to what people in the US are suggesting. France's system has been running a deficit for 20+ years in spite of raising taxes to pay for it.

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In 1990, 7% of health-care expenditures were financed out of general revenue taxes, and the rest came from mandatory payroll taxes. By 2003, the general revenue figure had grown to 40%, and it's still not enough. The French national insurance system has been running constant deficits since 1985 and has ballooned to $13.5 billion.

So it is pretty clear the French system is not really "working" unless you think that a program that runs a deficit and is getting worse year over year is a a good thing.

From NPR:

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http://www.npr.org/templates/story/story.php?storyId=92419273

To fund universal health care in France, workers are required to pay about 21 percent of their income into the national health care system. Employers pick up a little more than half of that. (French employers say these high taxes constrain their ability to hire more people.)

Last year, the national health system ran nearly $9 billion in debt. Although it is a smaller deficit than in previous years, it forced the government of President Nicolas Sarkozy to start charging patients more for some drugs, ambulance costs and other services. Debates over cost-cutting have become an expected part of the national dialogue on health care.

So even France's system is cutting services and raising costs and STILL running a deficit. Following down that path does not seem like a smart move.

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http://online.wsj.com/article/SB124958049241511735.html

In recent months, France imposed American-style "co-pays" on patients to try to throttle back prescription-drug costs and forced state hospitals to crack down on expenses. "A hospital doesn't need to be money-losing to provide good-quality treatment," President Nicolas Sarkozy thundered in a recent speech to doctors.

The problem is that Assurance Maladie has been in the red since 1989. This year the annual shortfall is expected to reach €9.4 billion ($13.5 billion), and €15 billion in 2010, or roughly 10% of its budget.

So there is plenty of data out there.

Albert Einstein once said “The definition of insanity is doing the same thing over and over again and expecting different results”. How is following down a path that has been shown not to work a good idea?

Why not look at ways to cut costs as opposed to just writing more checks on borrowed funds? One thing France does is they have removed the insurance Dr's are required to have... Do you know that Dr's pay about 55k a year in insurance?

"No free man shall ever be debarred the use of arms." -- Thomas Jefferson, Thomas Jefferson Papers, 334

[ChangoLanzao 0]

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You're requitred to pay taxes, that's Constitutional. This is basically a tax and in fact, if you don't buy ins the IRS will assess the tax. Sorrry, nice try, if ya don't like it - leave. Isn't that the rhetoric I've been hearing for 8 years?

you are not required to pay taxes for simply existing.

The people who simply exist and can't afford the premiums won't have to pay them. Only those who simply exist, have incomes, and refuse to get insurance will have to pay the tax. Teabaggers who are already on Medicare, Medicaid, collecting unemployment won't have to pay the tax either.

[ChangoLanzao 0]

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Give me an option where the money that I earn goes to taking care of me and mine and not someone else, with me deciding where and to whom it goes, and I will vote for it.

So, in your world,

the fire department would only anwser a call to your home if you were one of the people who decided to pay for the service (for you and your own),

the schools would all be private and only those who could afford to pay would be educated,

the police would all be private militias working for the wealthy,

the military would be mercenaries who are funded by large corporations,

there would be no public parks,

the roads and other infrastructure would be pay-as-you-go with toll roads and bridges everywhere,

people who have no money would have to beg on the street if they needed life-saving health care.


If this is true, you should be happy, because that's where we seem to be headed

[ChangoLanzao 0]

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The people who drafted this and those who will vote on it are elected representatives of the people. Taxation without representation is not an issue here.

And how many of those pages were in fact drafted by industry lobbyists?

And we already know how many reps will actually read the whole thing before voting on it: 0

These are two very good points. I think the SCOTUS has ruled that corporations are people who have the right to lobby and participate in the political process (or something like that), and as such they are also represented by our representatives. They have an advantage now in that they can vote with dollars. It's a very sad state of affairs. But that's another issue.

[mike_forsythe 0]

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Since I'm an American I don't have HC

Well I'm an American and I have great health care. It is affordable, the quality is very good and I have not had any claims or services denied.

I'm glad I don't live in your America.

[Gawain 0]

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Did you get a chance to read this section:

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Sec. 9002. Inclusion of cost of employer-sponsored health coverage on W–2.

Does this entail simply listing the cost of the employer's cost of the coverage, or does it seek to include the employer-paid portion of the coverage as income?

I tried scrolling through the 2000+ pages to find it, but wasn't able to. Did I miss something, or are the page numbers for each section/sub-section not listed?

From what I read, it adjusts a couple IRS codes, and then also includes more details as to what kind of deductions are being provided for Flex Spending Plans.

So I try and I scream and I beg and I sigh
Just to prove I'm alive, and it's alright
'Cause tonight there's a way I'll make light of my treacherous life
Make light!

[champu 1]

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Did you get a chance to read this section:

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Sec. 9002. Inclusion of cost of employer-sponsored health coverage on W–2.

Here's the text of that section:

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EC. 9002. INCLUSION OF COST OF EMPLOYER-SPONSORED HEALTH COVERAGE ON W-2.

(a) In General- Section 6051(a) of the Internal Revenue Code of 1986 (relating to receipts for employees) is amended by striking `and' at the end of paragraph (12), by striking the period at the end of paragraph (13) and inserting `, and', and by adding after paragraph (13) the following new paragraph:
`(14) the aggregate cost (determined under rules similar to the rules of section 4980B(f)(4)) of applicable employer-sponsored coverage (as defined in section 4980I(d)(1)), except that this paragraph shall not apply to--
`(A) coverage to which paragraphs (11) and (12) apply, or
`(B) the amount of any salary reduction contributions to a flexible spending arrangement (within the meaning of section 125).'.
(b) Effective Date- The amendments made by this section shall apply to taxable years beginning after December 31, 2010.

And here's the section of IRC1986 that this is talking about:

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Every person required to deduct and withhold from an employee a tax under section 3101 or 3402, or who would have been required to deduct and withhold a tax under section 3402 (determined without regard to subsection (n)) if the employee had claimed no more than one withholding exemption, or every employer engaged in a trade or business who pays remuneration for services performed by an employee, including the cash value of such remuneration paid in any medium other than cash, shall furnish to each such employee in respect of the remuneration paid by such person to such employee during the calendar year, on or before January 31 of the succeeding year, or, if his employment is terminated before the close of such calendar year, within 30 days after the date of receipt of a written request from the employee if such 30-day period ends before January 31, a written statement showing the following:

(1) the name of such person,
(2) the name of the employee (and his social security account number if wages as defined in section 3121 (a) have been paid),
(3) the total amount of wages as defined in section 3401 (a),
(4) the total amount deducted and withheld as tax under section 3402,
(5) the total amount of wages as defined in section 3121 (a),
(6) the total amount deducted and withheld as tax under section 3101,
(7) the total amount paid to the employee under section 3507 (relating to advance payment of earned income credit),
(8) the total amount of elective deferrals (within the meaning of section 402 (g)(3)) and compensation deferred under section 457, including the amount of designated Roth contributions (as defined in section 402A),
(9) the total amount incurred for dependent care assistance with respect to such employee under a dependent care assistance program described in section 129 (d),
(10) in the case of an employee who is a member of the Armed Forces of the United States, such employee’s earned income as determined for purposes of section 32 (relating to earned income credit),
(11) the amount contributed to any Archer MSA (as defined in section 220(d)) of such employee or such employee’s spouse,
(12) the amount contributed to any health savings account (as defined in section 223(d)) of such employee or such employee’s spouse, and
(13) the total amount of deferrals for the year under a nonqualified deferred compensation plan (within the meaning of section 409A (d)).

All of which is just changing what information will show up on your W-2... not all that interesting...

Why they are now including this information is because of section 9001, which has a tax on "excessive coverage"

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(a) Imposition of Tax- If--
`(1) an employee is covered under any applicable employer-sponsored coverage of an employer at any time during a taxable period, and
`(2) there is any excess benefit with respect to the coverage,
there is hereby imposed a tax equal to 40 percent of the excess benefit.
`(b) Excess Benefit- For purposes of this section

blah blah blah... anything over $8,500 for self-only coverage, and anything over $23,000 for other than self-only coverage (adjusted for inflation)

`(c) Liability to Pay Tax-
`(1) IN GENERAL- Each coverage provider shall pay the tax imposed by subsection (a) on its applicable share of the excess benefit with respect to an employee for any taxable period.
`(2) COVERAGE PROVIDER- For purposes of this subsection, the term `coverage provider' means each of the following:
`(A) HEALTH INSURANCE COVERAGE- If the applicable employer-sponsored coverage consists of coverage under a group health plan which provides health insurance coverage, the health insurance issuer.
`(B) HSA AND MSA CONTRIBUTIONS- If the applicable employer-sponsored coverage consists of coverage under an arrangement under which the employer makes contributions described in subsection (b) or (d) of section 106, the employer.
`(C) OTHER COVERAGE- In the case of any other applicable employer-sponsored coverage, the person that administers the plan benefits.

Which all basically says that if health insurance companies charge more than $8,500 per person, per year then 40% of what they charge over that will go to the government... which means your employer will pay 167% of what it used to for anything over $8,500 of coverage... which means your employer will probably drop that coverage option from the menu.

[kallend 2,230]

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Good points.

But a question about this one:

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As in, a government-run program that exists side by side with private ones. We've had such a system in education for years... Public universities have existed side-by-side with private, and many site our country as the world's best in secondary education.

When you compare private schools to public schools... Which do you think is better?

Private (6 of top 10 universities in the world are US private schools - source US News rankings) which goes to show that having a public option does NOT destroy the private option. Also, the other 4 in the top 10 are public.

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Do you think that public Elementary and High schools are doing a good job?

They are for those who can't afford private schools for their kids.

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Also, look at the balance sheets of other US Govt social programs... Are Social Security, Medicare or Medicaid running well?

Apparently AARP doesn't want to get rid of them.

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Look at Medical programs in other Country's... Are they running well?

The Dutch, Scandinavians, Germans, etc. seem to think so.

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It is foolish to think that the solution is to follow a path that has already been proven not to work time after time.

Like the US, which has life expectancies more in line with some 3rd world countries than with Europe.

...

The only sure way to survive a canopy collision is not to have one.

[airdvr 210]

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Private (6 of top 10 universities in the world are US private schools - source US News rankings) which goes to show that having a public option does NOT destroy the private option. Also, the other 4 in the top 10 are public.

Affordable option? I think not.

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Apparently AARP doesn't want to get rid of them.

"AARP has not endorsed any plan at this point," said Cheryl Matheis, AARP VP for Social Impact.

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Like the US, which has life expectancies more in line with some 3rd world countries than with Europe.

Please. 3rd world countries. Data please.

Please don't dent the planet.

Destinations by Roxanne

[Amazon 7]

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Private (6 of top 10 universities in the world are US private schools - source US News rankings) which goes to show that having a public option does NOT destroy the private option. Also, the other 4 in the top 10 are public.

Affordable option? I think not.

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Apparently AARP doesn't want to get rid of them.

"AARP has not endorsed any plan at this point," said Cheryl Matheis, AARP VP for Social Impact.

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Like the US, which has life expectancies more in line with some 3rd world countries than with Europe.

Please. 3rd world countries. Data please.

We are 50th on this list of countries..

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

Numerous third world shitholes with longer life expectancy

[Ron 10]

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which goes to show that having a public option does NOT destroy the private option.

In THAT example. But you know better than most that one example does not a data set make.

And of those Private schools.... Care to compare Tuition rates?

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They are for those who can't afford private schools for their kids.

John, care to answer the question instead of throwing a "Well its the best we got" Kinda BS answer?

Do YOU think that public schools (k-12) are less than, equal to, or better than private schools?

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Apparently AARP doesn't want to get rid of them.

You better than most know that one groups desires do not mean that it is a good program... This is nothing more than a lame attempt to avoid answering the real question.

John, do YOU looking at the balance sheets of other US Govt social programs... Are Social Security, Medicare or Medicaid running well?

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The Dutch, Scandinavians, Germans, etc. seem to think so.

Again, personal opinion is not what counts... How about you explain how France's system which is the closest to the proposed US system has been running a deficit for 20+ years. Or how that that Deficit is now around 9-13 BILLION dollars.

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Like the US, which has life expectancies more in line with some 3rd world countries than with Europe.

Sorry emotional rant with no data.

United States 77.1
United Kingdom 77.7
Finland 77.4
France 78.8
Germany 77.4

Lets look at some third world countries shall we?

Afghanistan 45.9
Angola 38.3
Botswana 39.3

Sorry... The data does not back up your personal opinion.

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http://well.blogs.nytimes.com/2009/08/19/us-life-expectancy-at-all-time-high/

Life expectancy in the United States has been on the rise for a decade, increasing 1.4 years — from 76.5 years in 1997 to 77.9 in 2007, according to the Centers for Disease Control and Prevention. The life expectancy data, compiled by the agency’s National Center for Health Statistics, are based on nearly 90 percent of the death certificates filed in the United States.

Doctors say that not only is lifespan increasing, but more important, the “active” lifespan is increasing as well.

"No free man shall ever be debarred the use of arms." -- Thomas Jefferson, Thomas Jefferson Papers, 334

[airdvr 210]

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Numerous third world shitholes with longer life expectancy

To bust into the top 10 we'd need to add...slightly less than 2 years to our average. You really think the HC bill is going to do that?

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

Take a good look at #49 and up. I wasn't aware that the EU was it's own country now.

Please don't dent the planet.

Destinations by Roxanne

[Amazon 7]

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United States 77.1
United Kingdom 77.7
Finland 77.4
France 78.8
Germany 77.4

Ron.. did Lucky math rub off on you

United States 77.1 < than all the others you list

[Ron 10]

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Ron.. did Lucky math rub off on you

United States 77.1 < than all the others you list

But 77.1 is NOWHERE near the 3rd world numbers Kallend claims. And +,- 2 years is not exactly Earth shattering and could be attributed to MANY things.

"No free man shall ever be debarred the use of arms." -- Thomas Jefferson, Thomas Jefferson Papers, 334

[Amazon 7]

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Ron.. did Lucky math rub off on you

United States 77.1

But 77.1 is NOWHERE near the 3rd world numbers Kallend claims. And +,- 2 years is not exactly Earth shattering and could be attributed to MANY things.

The list I posted showed a hell of a lot of what I consider to be third world shitholes after having visited those islands.... and they are in the top 49.. but We are right ahead of ALBANIA

[mnealtx 0]

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Like the US, which has life expectancies more in line with some 3rd world countries than with Europe.

Too bad that life expectancy is much more strongly influenced by lifestyle choices and diet instead of medical care - was a great soundbite, otherwise.

Mike
I love you, Shannon and Jim.
POPS 9708 , SCR 14706

[rushmc 23]

http://online.wsj.com/article/SB125900412679261049.html?mod=WSJ_hpp_LEFTTopStories

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[Gawain 0]

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Numerous third world shitholes with longer life expectancy

To bust into the top 10 we'd need to add...slightly less than 2 years to our average. You really think the HC bill is going to do that?

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

Take a good look at #49 and up. I wasn't aware that the EU was it's own country now.

Several in that list are also enclaves, not sovereign states (Andorra, Guernsey, Anguilla, Gibraltar, etc.).

So I try and I scream and I beg and I sigh
Just to prove I'm alive, and it's alright
'Cause tonight there's a way I'll make light of my treacherous life
Make light!

[DrewEckhardt 0]

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Like the US, which has life expectancies more in line with some 3rd world countries than with Europe.

Too bad that life expectancy is much more strongly influenced by lifestyle choices and diet instead of medical care - was a great soundbite, otherwise.

And lifestyle choices are strongly influenced by things like population density which strongly favor healthier Europeans.

Higher population density (the United States is ranked 178th world-wide at 80 people per square mile where European countries like the Netherlands break 1000) often mean that it takes less time to use some combination of trains, subways, busses, and human powered transportation for intermediate legs than it would to drive door-to-door.

In America, lower population density means that if you want to make exercise like that a side effect of daily activities you have to severely limit where you'll work+live and/or spend a lot more time than it would take to drive.

[kallend 2,230]

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which goes to show that having a public option does NOT destroy the private option.

In THAT example. But you know better than most that one example does not a data set make.

And of those Private schools.... Care to compare Tuition rates?

There are over 3,000 colleges and universities in the USA - hardly "one example". Quite a good data set, in fact, better than most opinion polls.

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They are for those who can't afford private schools for their kids.

John, care to answer the question instead of throwing a "Well its the best we got" Kinda BS answer?

Do YOU think that public schools (k-12) are less than, equal to, or better than private schools?

The best school in Chicago is a public school. So is the worst. The best school in Illinois is public. It's a STUPID question with no answer.

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Apparently AARP doesn't want to get rid of them.

You better than most know that one groups desires do not mean that it is a good program... This is nothing more than a lame attempt to avoid answering the real question.

John, do YOU looking at the balance sheets of other US Govt social programs... Are Social Security, Medicare or Medicaid running well?

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The Dutch, Scandinavians, Germans, etc. seem to think so.

Again, personal opinion is not what counts...

You have no hesitation in giving yours.

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How about you explain how France's system which is the closest to the proposed US system has been running a deficit for 20+ years. Or how that that Deficit is now around 9-13 BILLION dollars.

Are the French going to eliminate it and emulate our system, or fix theirs?

...

The only sure way to survive a canopy collision is not to have one.

[kallend 2,230]

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Like the US, which has life expectancies more in line with some 3rd world countries than with Europe.

Too bad that life expectancy is much more strongly influenced by lifestyle choices and diet instead of medical care - was a great soundbite, otherwise.

The usual lame excuse of the right whenever their favored policies produce shittier outcomes. You make the same LAME excuse over US gun homicide rates ("whine whine it's the culture whine whine").

Health care != medical care. Healthcare INCLUDES diet and lifestyle choices.

...

The only sure way to survive a canopy collision is not to have one.

[Ron 10]

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There are over 3,000 colleges and universities in the USA - hardly "one example". Quite a good data set, in fact, better than most opinion polls.

Nice dodge.... Care to compare the TUITION rates of the private Universities?

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The best school in Chicago is a public school. So is the worst. The best school in Illinois is public. It's a STUPID question with no answer.

Correction... It is only a stupid question because YOU can't answer.

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You have no hesitation in giving yours.

Yeah, but unlike you I have provided data to back up my opinion.

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Are the French going to eliminate it and emulate our system, or fix theirs?

And you think we should throw out our system and emulate theirs, or fix our system?

"No free man shall ever be debarred the use of arms." -- Thomas Jefferson, Thomas Jefferson Papers, 334

[rushmc 23]

Health care != medical care. Healthcare INCLUDES diet and lifestyle choices.