Rachel's picture

Ouch. Not happy, guv.

Ouch. Not happy, guv.

Pam Strickland's picture

Have y'all not been paying

Have y'all not been paying attention? This is basically what he's been saying all along. He's been carrying water for the national GOP. It's not going to be pretty in Tennessee no matter what happens in the federal courts.

j.f.m.'s picture

Yeah it's mostly just

Yeah it's mostly just repeating what he said when the bill passed. I do love this line:

Our goal should be advocating for an approach that embraces healthy choices and personal responsibility and accountability for a healthy lifestyle.

Because if everyone is just "healthy" and "responsible," then nobody will ever get sick and die.

Andy Axel's picture

I must have missed the

I must have missed the organic foods aisle the last time I was at a Pilot truck stop.

Rachel's picture

:)

:)

agrarianurbanite's picture

organic food aisle at the Pilot....

If there was any time I wished for a 'like' button, it would be now...that is so flipping FUNNY.

Rachel's picture

Because if everyone is just

Because if everyone is just "healthy" and "responsible," then nobody will ever get sick and die.

But of course. Just like my husband, the guy who rides his bike 100 miles a week, works out, eats healthy, and is almost never sick.

The same husband that discovered he had a congenitally defective heart valve that required heart valve replacement surgery.

Without insurance, we would have spent our entire retirement fund on the bills from that one.

P.S. And before somebody rips on me for voting for Haslam, I distinctly remember listening to all the primary candidates (both D and R) answer a health care question from Matt Shafer Powell. Every one of their answers stunk.

R. Neal's picture

Have y'all not been paying

Have y'all not been paying attention?

I believe I tried to warn y'all all along. But whatever.

There weren't any good choices in this election. Haslam is turning out to be an even worse choice than expected.

At least I'll be able to say I didn't vote for the guy, and never even considered it.

j.f.m.'s picture

I'm not sure how he's worse

I'm not sure how he's worse than expected, at least to this point. He's just kind of doing and saying the same things he did and said during the campaign. (Including, as Humphrey noted the other day, not really taking positions on tricky issues.)

I'd say so far he's almost exactly what I expected.

(And I voted for him in the GOP primary, because I do actually think the other guys were worse, and the Republican candidate was clearly going to get elected this year. I voted Green Party in the general, just to vote for somebody.)

marytheprez's picture

Several points need to be made here:

First, the clause in the HCR Act that every one must purchase insurance does NOT mean that everyone must purchase the Blue Cross/Cariten/United Healthcare expensive coverage. It means that each individual and family will have access to a variety of options to plans THEY CAN AFFORD. This 'group purchase plan' will help pay for all the new benefits for all. This is the very clause that all the BIG DOGS paid the TEAs to fight it.

Second, this Judge in Florida explained that his ruling was based on a 'criticism' from the Family Research Council, a long time hate group who wants to outlaw ANY women's medical rights and absolutely tells lies about gays without being challenged. They worked hardest to prevent repeal of DADT. It has been considered one of the top 10 HATE GROUPS in the U.S. This was NO well reasoned decision. Just like Thomas and Scalia, this Judge is obviously tainted by friends like Tony Perkins and his FRC BULL, or Thomas's wife leading a TEA PARTY chapter in VA.

I am not surprised at the Governor, not when he made a big appearance at the TEA PARTY convention in Gatlinburg and promised he would support every little thing they were pushing on America.

Ann's picture

He already cut!

He is proposing cutting $300 million from Tenn Care! That's children and the sickest and poorest among us. But they won't be around much longer.

Churisakka's picture

I don't think Tennessee is part of that case in Florida

Unless Bredesen and company put Tennessee into the Florida case, I don't think Tennessee would be a part of it and if Bredesen did have Tennessee join in the Florida fun, I'd think Bredesen knew what he was doing. Bredesen had a lot more to say about ObamaCare than Haslam ever thought about saying and Bredesen even wrote a book about how wrong ObamaCare really is.

R. Neal's picture

Yes, Bredesen was pretty much

Yes, Bredesen was pretty much a butthead and a huge disappointment on health care, too.

michael kaplan's picture

after making his fortune on

after making his fortune in the business.

those egyptians in the streets might just teach us a few things ..

michael kaplan's picture

Noam Chomsky: Eliminating

Noam Chomsky:

Eliminating social programs has goals that go well beyond concentration of wealth and power. Social security, public schools, and other such deviations from the 'right way' are based on 'evil doctrines,' among them the pernicious belief that we should care, as a community, whether the disabled widow on the other side of town can make it through the day, or the child next door should have a chance for a decent future. These evil doctrines derive from the principle of sympathy that was taken to be the core of human nature by Adam Smith and David Hume, a principle that must be driven from the mind. Privatization has other benefits. If working people depend on the stock market for their pensions, health care, and other means of survival, they have a stake in undermining their own interests: opposing wage increases, health and safety regulations, and other measures that might cut into profits that flow to the benefactors on whom they must rely, in a manner reminiscent of feudalism.

(Hegemony or Survival, 2003)

B. Paone's picture

So why should I be forced to buy health insurance?

No, really. Why? I'm not forced to buy auto insurance; I can just take public transportation. I'm not forced to buy home insurance; I can just rent a house if I like.

So why on earth should people be forced to buy health insurance that's ridiculously overpriced, undereffective and damn well near worthless to people like ME until we get quite a bit older?

Case in point: Caught a feral kitten for TNR this past Friday. Little vixen put a through-and-through on my left index finger with her fangs. Went to the Minute Clinic. $118 later, treated.

$118 used to be the amount I'd have to pay for one month of insurance premiums back in the corporate world. And that was regardless of whether or not any feral cats decided to make a snack out of my hand.

No. Just... no. I'm not paying that much and I don't have to. If insurers want my business, they're going to have to lower their prices. A LOT.

So maybe people supporting this massive steaming load of failure should stop whining about everybody else not liking the concept of being forced to pay gobs of cash for something that is RARELY utilized enough to justify the expenditure of said gobs, and maybe start whining about the massive costs of healthcare in general and insurance in particular.

Just a thought.

metulj's picture

Uh, you are forced to buy car

Uh, you are forced to buy car insurance. It's required in Tennessee.

B. Paone's picture

Even if you don't own or operate a vehicle?

Wow. So how does that work? Are people supposed to call Progressive and just ask for the "I don't have a car but some guy on a blog told me I needed insurance anyway so give me the 'Don't Have A Car But Need Car Insurance Anyway' package?"

I bet you'd actually be fun to talk to if you spent more time thinking about the factual validity of your response, rather than whether it's snarky and condescending enough for your tastes. But hey, it's your world, right? :-)

So back to the original point:

If the single-greatest barrier to healthcare access in this country is COST, then it seems rather ridiculous to assume FORCING people to buy what they can't afford is a bassackwards way of lowering that cost barrier.

Lower costs, raise access. So why the complaints about the average Americans' concerns regarding being forced to buy something they just can't afford?

j.f.m.'s picture

Not if you don't own a

"Uh, you are forced to buy car insurance. It's required in Tennessee."

Not if you don't own a car.

But the analogy is faulty, because almost everybody eventually ends up needing health care. Even people without health insurance. But of course, if you don't have insurance, other people end up paying for your health care. (Other people pay for your care if you do have insurance, too -- that's how insurance works -- but the cost is distributed more widely over a longer period of time.) So the question really is, why should everyone else pay for your care if you're not willing to contribute?

I suppose if people wanted to sign a legally binding pledge that when they get sick they'll just crawl off and die quietly in the woods, you could make a case for allowing opt-outs. But I think we know people aren't going to do that.

The sad thing is that this issue only comes up because Obama tried to make the private insurance companies happy. A single-payer system modeled on Medicare wouldn't be vulnerable to the same challenges.

B. Paone's picture

Is it a faulty analogy?

I don't think so. While almost everyone will need to see a doctor at some point in their lives, so too will almost everyone require the use of some kind of vehicle to get somewhere.

Public transportation's available, is it not? As well as other methods of transportation that do not require insurance?

I also question the validity of the insurance system in regards to the amount I get back out of it vs. how much I pay in. Our cheapest option at the Paone household is $2,106 per year, but our medical expenses don't even meet the $1,000 deductible.

What happens to my leftover money? I don't get it back, and I sure as hell don't get a lower premium next year. So it seems a lot smarter to me to just save the $2,106 and pay my expenses out of that. Then I've got leftover cash AND my medical bills are paid.

Amazing how that works, isn't it? A little personal responsibility, a little preventative maintenance, a lot of common sense, and I'm a healthier, slightly richer person for it.

So why should I, and several million other Americans like me, pay more for the same service and treatment by purchasing ridiculously overpriced, underuseful health insurance?

No, seriously, I'm asking. I mean, do you think I want to bail YOU out any more than you want to do for me? Why should I and millions of others be forced into a questionable system? Please tell me you're not vainly hoping such an action is going to somehow make healthcare more affordable...

j.f.m.'s picture

What happens to my leftover

What happens to my leftover money?

Some of it goes to profits. Which is one reason we have the most expensive health-care system on the planet. Every single-payer or otherwise-government-mandated system in the world is cheaper than ours, and a lot of them have better overall health outcomes. If you're worried about health care costing you money, heading toward the kind of total privatization you're talking about is completely the wrong direction. You do not get market efficiencies from private health care, for a lot of reasons.

But yeah, it's true that mandatory health insurance funneled through private providers is not a very good way to go about this. One of the many problems with the Obama plan. A single-payer system that distributes risk and benefits as widely as possible is probably the best option from a cost standpoint.

The problem with the kind of "I'll take care of myself" line that you're espousing, though, is that for most people it's just not an option. I had a son born three months premature. His hospitalization and care probably cost in the vicinity of $1 million. If I had invested all the money I'd spent on health insurance in the 15 years prior to that, and had gotten phenomenal returns on it, I wouldn't have come anywhere close to having $1 million to pay for that. So in addition to having an infant in the ICU -- stressful enough to go through, I assure you -- I would have been facing years and years of debt to try to pay off the hospital bills. Instead, my insurance covered pretty much the entire thing. Now, if you get enough cases like that, yes, rates go up a little for everyone. But that seems like a much more preferable system to me than a sort of russian roulette of, "As long as you don't get sick or injured, you're OK."

B. Paone's picture

Loving the exchange, thanks! In order:

* See, that doesn't fly with me. I don't mind helping someone make some money, but I'm definitely not into helping someone just take my money and not get fair value in return. If I am going to pay $2,100+ a year for healthcare, I expect $2,100+ a year in goods and/or services.

I don't believe that's an unreasonable demand. What if you walked into a restaurant, paid for a full meal, but just got the drink and an appetizer?

* Seems kind of a convoluted way to address costs. When my granddad was still on this earth and in business, if he needed to get more people in the door he lowered his prices.

Making everyone buy insurance isn't going to lower prices, and I doubt a single=payer system can do the job without price-gouging regulations in place on healthcare products and services. So why not just work on lowering the prices so few seem to be able to afford as a way to... well, lower costs?

I don't know about you, but I don't believe a $1 bedpan should cost a hospital patient anywhere from $25-150. That's insane. If that kind of markup were on gasoline, there'd be riots. Honest-to-God, no-fooling, full-blown all-out riots.

* Waitwaitwait. Did you just say MOST people can't take care of themselves?

I disagree in the strongest possible terms, and with all respect due. There may be a lot of people that do not WANT to take care of themselves, or do not know HOW to best accomplish this, but most people in this country and on this planet DO have the capacity to ensure their own continued viability.

Granted, there are some that can't. It'd be kind of stupid to lump them in with the able-bodies, and I had assumed it was a given they would not be. I apologize for that obviously incorrect assumption. Yes, I am very much in favor of caring for those that CANNOT care for themselves.

Not WILL NOT. Not TOO IGNORANT TO DO SO. CANNOT. As in LEGITIMATELY UNABLE to pay for their own care. And we both seem to be of the belief that there aren't too many cases like that out there.

If the issue of healthcare costs were DIRECTLY attacked by implementing cost-cutting measures and enacting greater taxpayer subsidy of a system vitally important to our continued existence... I wonder how many fewer cases like that there'd be?

For once in our complicated history, can humankind not just take the Occam's Razor approach and do the right thing? I think we should.

bizgrrl's picture

You never did really answer

You never did really answer the question on how you would pay for a $118,000 or $1.8 million health care bill. I suppose you attempted to answer by putting it on Convenant or other hospitals saying they will finance the charges for you. Do you really think Covenant will finance that kind of money? They'll have to write-off a large portion, thus increasing costs for the rest of us. Thanks for your forward thinking. What's sad is there are many like you out there that can't think past a $118 kitty scratch.

B. Paone's picture

Good Lord, but you're bitchy today.

Or terribly attentive. But what the hell - if you're being this bitchy, I guess you're just trying to tell me that's how you want me to treat you. Kinda sucks, but if that's what you want...

* Take your head out of your wrinkled, self-righteous ass for a second and THINK. (Wasn't nice for me to talk down to you like that, was it? Can't help it; if you're going to treat others like this it tells me you want similar treatment.) For something as important as healthcare, SHOULD THERE BE MILLION-DOLLAR BILLS INCURRED BY PATIENTS?!?

I mean, DAMN! How blind, narrow-minded and wholly in lock-step with a particular ideology does one have to be to see that one LOWERS COSTS by LOWERING PRICES, not by forcing people to spend money they don't f*&^in' have!

No, seriously, I'm genuinely curious at this point. To make something more affordable, it has to be... well, more affordable, doesn't it.

Let's see what other mewling, juvenile garbage you've left me...

* That's correct, and frankly, it's not my fault they charge the prices they do. If their business model is so out of whack that they can't survive except by charging exorbitant prices to the point that few can afford 'em, then there's a fundamental error that needs to be addressed.

I'd much, MUCH rather see HSAs gain rollover ability and have greater public subsidy/price control of healthcare than to just plunk down cash for a system I know does not work. If I pay in a bunch of cash and only get half of what I paid for, THERE'S A F$*&IN' PROBLEM.

I really don't like sounding like this contrary to public opinion, so if it's just going to devolve into the same old garbage, then go get Neal and have him try site-banning me again. Or whatever you feel like doing, since acting with basic maturity and respect apparently seems impossible for you when talkin' to lil' ol' me.

Really, I have THAT much sway over your emotional capacities? You're just going to let what you think of me make YOU sound like THIS?

Your world, cupcake. Do it up.

j.f.m.'s picture

Waitwaitwait. Did you just

Waitwaitwait. Did you just say MOST people can't take care of themselves?

I don't think you understand very well where our health care costs come from. A huge chunk comes from end-of-life care. Which is very unpredictable. You can be healthy and responsible your whole life, and then suffer five years of incredibly expensive treatment for some kind of chronic illness. Those five years of treatment could well cost more than the average American earns in income in a lifetime. Of course, you can just say, if they can't afford it, they don't get it, and let being poor become an official cause of death (as it is already often an unofficial one). I don't think most people want to live in that society. You can also question why everything in the system costs so much, and I think that's a good discussion to have. There are a lot of things driving the expenses, and the bill we have doesn't do nearly enough about any of them. And you can question exactly how much care anyone should really get at the end of their life -- also probably a necessary discussion, but one that immediately get drowned out by people screaming about death panels.

But then of course, other major expenses come unpredictably. Going back to the case of my son. I've been healthy my entire adult life and have paid way more in health insurance premiums than I've ever used in actual health care. But those three months my son was in the hospital, hooked up to tubes and respirators and monitors, way more than made up for that. I guess your contention is just that, if you happen to have a premature baby (most likely caused by someone rear-ending my ex-wife on the Interstate), tough luck bub, welcome to a life of never-ending debt. Again, I don't think most people want to live in that society.

The risks and costs of health care are inherently unpredictable at the individual level. You're essentially advocating a great big roulette wheel for everyone. I prefer to do my gambling at the poker table.

B. Paone's picture

In order:

* It stands to reason that an individual healthy his entire life stands a low risk of suffering a CHRONIC disease, but I see the point you're trying to make. Can't predict everything, and sometimes the best of our abilities to plan aren't good enough. I get that.

What I don't get is how forcing millions of people that CAN NOT AFFORD - let me reiterate that for you: CAN. NOT. AFFORD. - health insurance to buy it anyway helps those individuals. What, because everybody's paying into a broken insurance system, the costs of materials and labor is supposed to magically decrease? Will private industry be able to lower the cost of a premium so that absolutely every American can afford it AND whatever their insurance doesn't cover? (It's not like insurance is all-inclusive, after all - co-pays, deductibles, prescription costs, all that still exists and still has to be paid for by people that can AND can't afford health insurance.)

* My question to you is this in RE: your personal example.

When I trapped that feral, I did so knowing I was at increased risk for damage because of a lack of hand covering. However, with a quick bit of math and a quick review of everything I've learned about catching the damn things, I knew my cost was going to be somewhere in the neighborhood of $200-500 and accepted that.

So, I knew what I was getting into by doing my homework first. Did you know what you were getting into? Did you and the missus try consciously to get pregnant? (Because if not, then the next bit is largely moot.)

j.f.m.'s picture

It stands to reason that an

It stands to reason that an individual healthy his entire life stands a low risk of suffering a CHRONIC disease

I have a sister with chronic lyme disease who would be very interested in debating this point with you. Plus, a lot of chronic diseases are genetic. Are you suggesting that people with MS or ALS are being punished for unhealthy lifestyles?

Did you and the missus try consciously to get pregnant?

Are you about to suggest that people shouldn't get pregnant unless they have a million dollars in the bank? This is the road you want to go down?

R. Neal's picture

Yes, that was totally out of

Yes, that was totally out of line.

Hildegard's picture

You think a glib, spiteful

You think a glib, spiteful remark about the irresponsibility of producing a sick, premature baby is out of line? Cage a feral cat with your BARE HANDS, and then talk to me about true courage.

B. Paone's picture

Meh.

Your opinion. And you're going to have it, complete with your own spin, regardless of what is actually said, aren't you.

I bet you'd hate it if I said fetuses were parasites. But I'd be curious to know why if you did given the factual basis of the statement. (And if you don't? Well, I have to be honest, I'd have a brand-new respect for you.)

B. Paone's picture

The opinion part was to Neal.

God, Randy, haven't you given up on Drupal yet?

Hildegard's picture

Ra-di-a-tion. Yes, indeed.

Ra-di-a-tion. Yes, indeed. You hear the most outrageous lies about it. Half-baked goggle-box do-gooders telling everybody it's bad for you. Pernicious nonsense. Everybody could stand a hundred chest X-rays a year. They ought to have them, too. When they canceled the project it almost did me in. One day my mind was full to bursting. The next day - nothing. Swept away. But I'll show them. I had a lobotomy in the end.

B. Paone's picture

In order:

* I said LOW risk, not NO risk. Difference. Big one.

* You better believe I do. There's a great deal to be argued for responsible parenting, and I argue that it begins well before the child is conceived.

But I don't think it's a road you can travel without losing your cool, given your response. You appear to be one of those folks that believes humanity is somehow more important or special than any other creature on the planet and that reproduction is some kind of inalienable right. Is that about in the ballpark?

j.f.m.'s picture

No. But I think someone who

No. But I think someone who thinks a society is well-served by letting only millionaires have babies is making a much worse argument than he thinks he's making. You started off with sort of intelligible points, but you've gone pretty much down the rabbit hole here. Say hello to the Mad Hatter.

B. Paone's picture

Wow.

I don't recall ever saying anywhere that only millionaires should have babies. Was this actually said by me, or assumed by you?

I didn't think you were up to that kind of conversation, so I shouldn't have tried to push it. My apologies.

R. Neal's picture

It seems you've crossed the

It seems you've crossed the line from repetitive troll to hurtful, uncalled for and cruel attacks. Is this part of your performance art to see how far you can push until you become the "victim"?

B. Paone's picture

Nah.

Mostly because I'd have to be offended to a certain extend, but given that this is exactly what I expected from you and some of your regulars it's kind of hard to reach that point.

But *I* have to wonder if this is the part in YOUR performance where you just get tired of it all and try to ban me again instead of trying a different tack. I mean, do you REALLY want me acting like this, or would you like to see me act in a different fashion?

Seriously, I'm asking you.

Somebody's picture

I believe Mr. Paone has taken

I believe Mr. Paone has taken trolling lessons from Mr. Mitchell. There is no point in responding to him further. He is demanding proof, facts, respect and direct responses while providing none himself. I would advise disengagement. He will think he "won," but he thinks that already, so there's not much point in getting further worked up about it is there?

B. Paone's picture

Okay.

What should I prove to you? I thought I was answering questions, but if you don't believe I am then please - help me to correct that if you can demonstrate factually that I'm not.

Of course, if you're just saying that to be dismissive, then I doubt you care to offer that kind of proof or assistance, so...

Oh, and I'm not here to "win" anything. The only way to win these kinds of things is to not play. I'm just here to see if my ideas are right by seeing if anyone can prove them wrong.

I imagine someone might be able to, but it doesn't seem like anyone's interested in discussing what I say so much as discussing who's saying it.

But hey, this is probably a wasted response. Best to ya.

michael kaplan's picture

buses are required to have

buses are required to have insurance, and every rider - through direct fares or taxes - shares in its cost.

B. Paone's picture

They do.

Though I have to wonder if they would do so if they only got halfway to where they were going or if they grossly overcharged, since people with insurance rarely get what they pay for in premiums and can't ride if they can't afford it.

On a related note: Lots of cost controls in public transportation, aren't there? Low=bid contracting, fuel cost caps (sometimes mandated, sometimes negotiated via contract), and a fair amount of public subsidy - what if healthcare had the same approach instead of consistently overcharging people that use it?

bizgrrl's picture

Public transportation's

Public transportation's available, is it not? As well as other methods of transportation that do not require insurance?

You are aware that public transportation is not always available, aren't you? Also, who do you think pays for public transportation? I suppose you could ride a bicycle everywhere, just hoping you don't have to go too far so the ride won't take most of your day getting to your destination.

B. Paone's picture

In order:

* Yeah, some locales just haven't gotten it together enough - or grown enough - to "get on the trolley", so to speak. And in those locales, I am sure they have alternative means of transportation.

* Beats being forced to pay for car insurance if you don't have the cash, though. And great exercise, too. :-)

Actually, I have a better idea than this playground back-and-forth stuff. Why don't we discuss the ISSUE instead of sitting here trying to see who can come up with the snarkiest response?

I'll start:

How would forcing all Americans to purchase healthcare insurance lower the cost of healthcare insurance so that all Americans can afford it?

sobi's picture

You're off-base in at least a couple of important ways.

Actually, I have a better idea than this playground back-and-forth stuff. Why don't we discuss the ISSUE instead of sitting here trying to see who can come up with the snarkiest response?

I'm not seeing the snark except coming from you. This is a great discussion, and it's very sharply focused on the issue. JFM is offering you a valuable bit of education, free. I hope you'll do your part to keep the discussion from fulfilling your prophecy.

You also seem to miss, on a very fundamental level, the point of insurance of all kinds, including healthcare. The point is to spread risk. That's what you do when you pay into a system, whether you're doing it by paying taxes or otherwise. Your "paying for a meal in a restaurant" analogy is logically incoherent.

Quit thinking you're here to win an argument, and stop being so damn defensive. But by all means, keep asking your questions. This discussion's richer and creamier because of them.

B. Paone's picture

Fair enough. In order:

* Then you're not looking, but I do admit to firing first. Sure looks that way, anyway.

But as far as this JFM character, so far he hasn't proven how mandatory insurance is better for me than my current system for dealing with my health. He HAS proven to be a jerk of formidable proportions, though, so points for that.

* That's the thing. I'm not interested in being forced to cover your risk. That's YOUR job. YOU cover YOUR risk. I cover MINE.

And since I do not get all of my money back under private insurance, I'd say the "paying for a full meal at a restaurant and getting only the drink and appetizer" is quite logically coherent. In both instances, I did not get what I paid for.

We're using the same definition of "logic" here, you and I, right? I'm using this one:

"a (1) : a science that deals with the principles and criteria of validity of inference and demonstration : the science of the formal principles of reasoning (2) : a branch or variety of logic (3) : a branch of semiotics; especially : syntactics (4) : the formal principles of a branch of knowledge"

So, unless you're using a different definition, I don't really see your point as to how the comparison is illogical.

* Oh, you don't have to worry about all that. My only concern is whether the questions asked can be answered with something other than lock-step party rhetoric. (So far... no.)

R. Neal's picture

How would forcing all

How would forcing all Americans to purchase healthcare insurance lower the cost of healthcare insurance so that all Americans can afford it?

By making people like you pay into the pool, spreading the entire cost to everyone instead of making responsible people and government pay for it. So no, it wouldn't lower the cost (unless there are caps on some things, like insurance company profits) but it would spread the risk and the costs around making it affordable to everyone in the pool. Which is sort of the point of insurance.

B. Paone's picture

Ah.

So, instead of doing something to proactively lower healthcare costs - something I think we agree is the single-largest barrier to universal access in this country - we're just going to lump everyone together and "spread the risk" in a way that you seem to admit does nothing meaningful for the COST of the insurance.

Which is, again, the prime barrier. Cost. But maybe I'm also not interested in being forced to pay into an inefficient system just to help cover YOUR butt in some intangible way.

No offense, but what if I don't want to cover your risk? I don't recall ever asking you to act in a way that covers mine. If you're stuffing your face full of Mickey D's and clacking away at the computer all day, what makes you think I want to cover your increased risk?

What do I get in return, seeing as my way of paying for my own healthcare is more cost-effective and, I believe, socially responsible than just forcing everyone else to cover my risk?

R. Neal's picture

It will lower the cost of

It will lower the cost of premiums for individuals. That's what you want, right?

How much return on your investment in an nuclear warhead equipped ICBM do you expect in dollars, or a nuclear attack submarine? You're paying for it, right? What benefit do you get?

B. Paone's picture

Really?! In order:

* Well, that's great news! Forcing everyone to buy in will lower premiums!

...but wait. Every vehicle owner in this state is ALSO forced to buy into car insurance. But my premium doesn't go down. Does your premium go down?

If the mechanism doesn't work for car insurance in regard to making insurance more affordable, then what operates differently under a forced health insurance mandate that lowers the premiums?

* So long as we have the defense capacity, the likelihood of attack by another country is reduced drastically. The concept's called "mutually assured destruction" and unfortunately at this stage in human history, it's actually the most effective mechanism we have. (VERY interesting example you came up with, though.)

R. Neal's picture

How much would auto insurance

How much would auto insurance premiums cost if every motorist wasn't required to buy insurance?

So, you can't put a dollar value on the return on your investment in thermonuclear weapons?

B. Paone's picture

In order:

* Hmm. Since premiums in Tennessee prior to its financial responsibility laws (1977, I've got - you got the same starting point?) seem to be lower than they are now... ;-) But one would have to adjust for inflation, so if you like I'd be happy to find that out for you with inflation factored.

* I'm not the kind of person that quantifies everything I like or dislike with a dollar amount. So, no, I can't. Or, more accurately, don't really care to waste the time quantifying the concept and creating some meaningless personal benchmark that will do me no personal good to know.

Why, is that what you do?

B's picture

You're dumber than dirt.

You're dumber than dirt.

R. Neal's picture

Also, auto insurance isn't

Also, auto insurance isn't really a good analogy, any more than thermonuclear weapons.

With auto insurance, the collision damage property loss risk is known (value of the vehicle) and the liability damage is capped.

Health insurance risk, even if capped, is not as easily known or calculated.

B. Paone's picture

So if that's the case...

...then how would forcing everyone to buy health insurance help us better know or calculate said risk, which you argue reduces costs? (And yeah, I figured you'd duck away from both examples.)

Seems to me like the more pragmatic approach would be to do something directly about the actual costs of healthcare rather than have everyone buy into healthcare insurance because some people seem to think it's somehow more "fair" (which I also don't get).

So let me ask you directly, since I've been respectful enough to answer your questions - how would directly addressing and limiting the actual costs of healthcare (labor/supplies/services/etc.) be an inferior approach to mandatory healthcare insurance in regard to making healthcare affordable and accessible?

Please be as specific as possible.

R. Neal's picture

You were the first to use

You were the first to use auto insurance as an example of making every motorist buy insurance doesn't reduce premiums. You can't back that up, and even if you could it isn't a good analogy as I explained.

As for public expenditures like nuclear weapons (if that's what you're referring to), you choose not to assign a risk v benefit v cost value. That's your choice.

B. Paone's picture

And you were the first to use the thermonuclear reference.

Now that we've established all of this, I believe I asked you a question. Or are you one of those types that doesn't believe in the common respect of reciprocity? I DID answer yours, y'know...

R. Neal's picture

I believe I have responded to

I believe I have responded to all your questions, against my better judgement. It's difficult to tell who you are talking to, though.

B. Paone's picture

Doesn't look like it.

The question again was this:

"So let me ask you directly, since I've been respectful enough to answer your questions - how would directly addressing and limiting the actual costs of healthcare (labor/supplies/services/etc.) be an inferior approach to mandatory healthcare insurance in regard to making healthcare affordable and accessible?"

I don't really see anything from you except vague references to the possibility of the premiums decreasing (that has yet to be substantiated by anything but supposition), and to be fair, that doesn't address with any specificity (or at all) how the proposal you favor is superior to direct cost control via price caps for materials and services consumed by healthcare providers.

So, if you'd like, I'd appreciate knowing why you believe the idea you support is better than the idea I support.

metulj's picture

I wanted to see if he'd go

I wanted to see if he'd go down that boring argument's road. And he did.

"The sad thing is that this issue only comes up because Obama tried to make the private insurance companies happy. A single-payer system modeled on Medicare wouldn't be vulnerable to the same challenges."

It is what will eventually happen. I suggest a read of a biography of Tommy Douglas to give pause...

bizgrrl's picture

worthless to people like ME

worthless to people like ME until we get quite a bit older

That's the attitude that gets us in trouble. What if something happened to people like YOU that cost you $118,000 or $1.8 million? You're expecting me to pay for it? Why do you think insurance rates are so high? Because people like YOU are hurting the system.

B. Paone's picture

No, I'm not expecting you to pay for it.

I'm expecting to pay for it myself. Why on earth would I want YOU to bail me out?

Then again, my efforts toward healthcare reform have been a lot more focused on lowering costs instead of forcing a bunch of people to buy something they can't afford.

But in order to answer your question more fully, I'd need a few specifics on your scenario. Was the injury/illness in question inflicted by myself or someone else? Does your scenario assume I have no savings or do I get to utilize what I've saved by planning ahead and sticking to a budget?

Bottom line? It's not the fault of the poor that healthcare reform as we know it is failing. It's because no one advocating this plan seems to get we can't afford the damn premiums.

Really, what good is going to come of forcing people to buy something they can't afford?

bizgrrl's picture

The the injury/illness in

The the injury/illness in question inflicted by yourself.

If you have enough money to pay for the $118,000 or $1.8 million dollar illness/injury, then you have enough to pay for health insurance. Budgeting.

If someone can't afford insurance there is something in the plan to help them.

Oh, and a by the way, if you are renting a place to live instead of purchasing, I would suggest you have renter's insurance. But, it is not required, just a good idea if you can afford it.

B. Paone's picture

Good deal, thanks! In order:

* Then I've got to live with the consequences. It could be argued the injury suffered last week fits the bill, if not the price tag. (Though it's safe to say hitting the ER instead of self-treatment and a trip to the Minute Clinic would have cost a lot more.)

I am a 31-year-old adult human being responsible for my own care and preservation. Whining for help isn't an option where I come from. Negotiating a fair exchange of services is. That's why if I'm ever down on cash and need a quick buck, I go bleed or offer a sale on computer repair in order to get it.

But anyway, that's how yours truly would handle caring for a self-inflicted injury. Other experiences may vary.

* Ah, but you're assuming I have all that cash on-hand and ready-to-go NOW. You're also assuming I'm going to be able to get back or use all of the premium money paid into an insurance plan. As stated above, if my cheapest option for insurance is $2,106 per year and I only have $1,000 in medical expenses, then something's wrong. I should be getting that money back.

But, since I can't, it makes a LOT more sense to me just to keep socking away $30-100 at a time in a savings account (REGULAR savings - I like to keep my money and roll it over into the following years, thanks), paying my actual expenses and having that lost money back in my pocket where it belongs.

So why should I pay for insurance?

Also, most hospitals have debt repayment plans that are very easy to follow. Covenant's especially good about it. So, yeah. Many ways to pay without having insurance OR being a burden on society.

I find it interesting to note, however, that you don't seem to bat an eye at the possibility of something as critically important to the nation's viability as American public healthcare can routinely result in 5, 6, even 7-figure bills.

Do you think healthcare in America is priced fairly and reasonably given its importance?

* And finally:

We tried it once, through State Farm, but found Domenik and a self-monitored alarm system were much more effective. (Especially Domenik). But it might work for some.

...thank God renters aren't forced to buy it though! :-)

j.f.m.'s picture

I am a 31-year-old adult

I am a 31-year-old adult human being responsible for my own care and preservation.

No, you aren't.

The myth of rugged individualism and self-sufficiency has a whole lot to answer for. Amazing how many Americans buy into the fairy tale. Why is it so threatening to people to understand that you're part of an interconnected society full of mutually dependent people? Is your ego really that fragile? Seems very 13-year-old to me. "I'm my own person!" Uh-huh. Sure you are.

B. Paone's picture

Let's review:

* I was born in April 1979, which places me at just under 32 years of age. Or, in general terms, the age of 31.

* By medical and legal definition, I am an adult. I am capable of sexual reproduction and I am, as demonstrated previously, 31 years of age - well over the age of legal responsibility as defined in state and Federal law.

* According to medical science, my genetic makeup is 100% human. So, unless there's a way to have that happen and still be of another species of creature, it's safe to declare that I am a human being.

* And finally, going back to the age of responsibility thing - since I'm over that age and of sound mind and body (I actually have proof of this, but what the hell - I'm sure someone's got a snarky remark for that and far be it for me to prevent 'em from making it) I am legally responsible for my own actions.

So... yeah. Despite your petulant little rant there (and it's disappointing to see this because you were conversing SO much more respectfully before), I AM a 31-year-old adult human male that is responsible for my own actions.

You can believe whatever you want and act as childish as you like if you think that will help paint your perception of reality as ACTUAL reality. Unfortunately, in cases like this your perception can only mirror reality or not. It won't change it.

So are we done with civil conversation, you and me? Because I'm just as good with acting like a jerk if that's how you want me to treat you. I try to be accommodating, ya know? ;-) (Seriously, though, let's get this conversation back on a more civil track. There's no need for that noise, is there.)

Somebody's picture

The 31-year-old healthy,

The 31-year-old healthy, rugged individual who figures on pay-as-you-go actually turns out to be a scofflaw. Why? Because that person's plan actually turns out to be pay-as-you-go until he figures that he's getting older and buying insurance looks like a better option. So maybe he stays real healthy until he's 48 or 52, then decides to go for the insurance, because, healthy or not, his bones are starting to creak, and it just feels like those insurance premiums might be a better bet. Maybe not this year, but real soon, he figures, he'll start getting more out of the system than he pays in.

Well what about all those years he went without paying in? Scofflaw. If everyone had followed Mr. young and healthy's model, the premiums when they turn 52 would be more astronomical than they already are. Insurance is not an individual savings account. Waiting until you're older is just cheating the system, and is fundamentally an effort to steal from all the other folks who have been participating all along.

This is why there needs to be a requirement that everyone buy into the system. People who think they're just being self-reliant are not going to refuse needed medical treatment when they figure it's going to cost more than what's in their checking account. They're just going to be self-reliant until they find they need someone else to carry them. It's a cheat.

Ah, but what if he remains true to himself and never buys insurance? Still probably a cheat, unless he manages to find a way to die quickly before the paramedics arrive. Heart attack, stroke, cancer, alzheimers, or something will eventually catch up to him, and unless he checks out very, very quickly, he'll find he needs more care than he can afford, and it's very unlikely he'll just say, "no thank you, I can't afford that. I'll just waste away over here and slowly die." It's a cheat.

EricLykins's picture

Sorry about that.

j.f.m.'s picture

You're 31. That means that,

You're 31. That means that, to date, you have been a legal adult capable of being held fully accountable for your actions and decisions for approximately 42 percent of your life. You need to live another 5 years before you've been responsible for yourself for even half your life, and another 23 years before you can claim responsibility for 2/3 of your life. You were born into a society and culture that had a lot of things going for it. I would guess, if you're anything like the average American, that your mother didn't die in childbirth, you had adequate food and shelter as a child, your town was not periodically overrun by bandits or thugs, your father was not detained and hauled away by secret police because of something someone overheard him saying at the supermarket, your schools were not troubled by outbreaks of malaria or cholera, you actually had schools to go to, and roads to get there on, you had easy access to clean drinking water, your parents did not have to work for company scrip that could only be spent at the company store, and they even got weekends and holidays off to spend time with you and help instruct and nurture you. Am I off in any of that? Do you have any idea how many millions of hours and dollars other people invested over years and years and years to make all of those things possible for you? And how lucky you are that they did?

And now you're some self-created, self-sufficient, autonomous being? What you mostly sound like is ungrateful.

B. Paone's picture

In order:

* Regardless of how long I've been at it, the fact remains that I am an adult responsible for my own continued viability. But if the extraneous math makes you feel better about your point of view, don't let me stop you.

* You're absolutely correct in your list of assumptions regarding the general environment in which I was raised, but I fail to see your point in regard to my position on currently-proposed healthcare reform that mandates purchase of private health insurance.

And since the area in which I was raised had been in family control for generations (it's easy to control a village), I'm acutely aware of the work my family and others put into making that happen - intelligently. :-)

* So let me get this straight - because I was a child at one point in my life, I can never attain self-autonomy? And this quest for self-autonomy makes me UNGRATEFUL?

For what?

Look, if you guys want to have an actual conversation on the topic, you're not really doing it right.

j.f.m.'s picture

because I was a child at one

because I was a child at one point in my life, I can never attain self-autonomy? And this quest for self-autonomy makes me UNGRATEFUL?

Yup. I'll give you points for reading comprehension. You do not have self-autonomy. No matter how much you assert it. It's like me coming on here insisting I can fly if I flap my arms hard enough. Just not true.

And I don't have a problem with objecting to a mandate for private health insurance. Like I said, I think the way this plan is set up is far from ideal. But yes I think a system where everybody pays and everybody benefits is the only that makes sense, in one way or another. Your idea of some kind of bogus self-sufficiency is not a functional alternative. (It's also morally pretty repugnant, but leaving that aside, it's unworkable.)

B. Paone's picture

Wow, I was actually being sarcastic.

You genuinely believe this? We do not grow from childhood into self-sufficient, self-responsible adulthood? We are ALWAYS dependent, at all times, no matter what?

Bollocks. Sheer bollocks. If this were true, no adult would ever be held criminally liable for their own actions and we'd all be in neverending handout lines. Maybe it's time for another definition check. This is the one I'm using for "self-sufficient":

"self-sufficient, self-sufficing
adj
able to provide for or support oneself without the help of others"

I'm curious - what help have I received in maintaining my own home and life? I work for everything I have and don't accept gifts. I have earned everything in this house right down to the dust.

So... how does being the product of the sexual actions of two other human beings negate the definition above if I meet the criteria for it? Do you believe I do not meet the criteria above, and can you demonstrate this belief if so?

* Hey, you seem like a decent sort that just has his panties in a bunch at the moment. So, instead of a smartass reply to the second bit, I'd like instead to inquire if you read the basic counterproposal outlined above.

If so, I'm curious to know what you find morally repugnant about it.

If not, you may want to read it.

So I'm not self-sufficient because I was born. Y'know, there's an egghead joke in here somewhere, but I'll try to refrain. ;-)

j.f.m.'s picture

what help have I received in

what help have I received in maintaining my own home and life? I work for everything I have and don't accept gifts. I have earned everything in this house right down to the dust.

Really. Fascinating. You arrived on this land (how? where did you come from? you manifested yourself through pure will?) and, then what? Found it completely unoccupied? Did you plant a flag and claim it for the State of Paone? Did you have to chase off the natives? Where is this?

Because if it's in the United States, you are relying on an entire legal structure built up around property rights and personal privacy that you are almost entirely dependent on other people for both the creation and maintenance of. What help have you received? Are you serious? If you're an American citizen, you are the direct beneficiary of centuries of effort and investment by millions of people who came before. A great many of them worked a lot harder than you ever will, and for a lot less money. (Some of them were slaves.)

No, you do not ever become "self-sufficient." Any more than you sprout wings. You become accountable for your actions, absolutely. You have control over a lot of things in your day to day life -- how you interact with other people, what you choose to spend your money on, who you marry (unless you happen to be gay, of course). But all of those choices occur within a social context that you are just one small part of, that you can influence in some ways but do not control, and for which you are (as much as the idea obviously pains your adolescent heart) very, very dependent on the actions of other people.

And you know what? There is nowhere in the world you can go where that won't be true.

B. Paone's picture

About damned time.

In order:

* I was born here. Once I reached the age of responsibility, I worked for my money and purchased my land according to the laws of this country. Since all of this money - every penny - was earned through labor and contract negotiation with another party, none of the money was gifted to me.

Therefore, yes. Everything I have, I have earned because I have worked for it. I traded my time and labor for items in accordance with the laws of this country and society.

How does this bolster your claim that I am not self-sufficient, if everything I have and am is a direct result of my own labor? Nobody else worked for my paychecks. I earned them. I provided the labor that earned the money, and therefore provided myself with the means.

That's not self-sufficiency in today's society? Or were you maybe trying to apply standards of times past to the here and now that don't exactly fit?

* I'm not RELYING on it so much as subscribing to its importance and helping to maintain it by being a responsible citizen. Since spending my lifetime on this planet slaughtering people that threatened my existence doesn't seem like an enticing way to spend my days (and I believe most people over the course of history have agreed with this notion), I subscribe to and help maintain the legal structure of this country as a more pragmatic alternative.

After all, *I'M* not going to die if the legal system were to vanish. Hence, it's difficult to argue a reliance on it that cripples self-sufficiency. (Especially since man can produce and enforce their own laws, albeit so doing in this day and age is more complicated than the days of old. How'd you think we got laws in the first place? They weren't ALWAYS there, y'know.)

* I would argue that I am not dependent on the reactions of other people so much as that I am responsible for adjusting to them if required. Especially considering that no other person on this planet produces a product or service that I absolutely need in order to survive without society. You know lots of people have chosen to go fully "off-the-grid" and attain complete self-sustenance, right?

Maybe YOU, sir, live a life that is completely dependent upon society. Maybe society is more accepting of you. But that's not the case for me. The rest of you could die off tomorrow; I'm just going to alter my routine and go about my new life.

So, in sum... it's exactly the response I expected. And now I realize it isn't a matter of you not wanting to prove me wrong in this regard - it's that you don't appear to be able to conceptualize life without anyone else.

metulj's picture

He's getting ready to

He's getting ready to flounce. Wait. For. It.

Hildegard's picture

Now I know what G. Gordon

Now I know what G. Gordon Liddy would sound like if he worked in a cubicle.

Barker's picture

no kidding

Paone likes to think he's self-sufficient, but he's not. If, god forbid, he is paralyzed in a car wreck tomorrow, then he will receive more benefits (no matter who pays for it) over the course of his lifetime than he could ever afford himself. But the same goes if he never buys insurance and at age 60 develops a cancer that requires expensive treatment and saves his life. Without some sort of health insurance, public or private, that covers everyone, then death panels will become a reality.

B. Paone's picture

So many "what-ifs".

And topped off with a death panel reference. Nice.

Scott, if that's you (and I sincerely doubt it is), we need to have a chat. Call me.

Barker's picture

Oh, it's me. Send me an email

Oh, it's me. Send me an email with your number.

B. Paone's picture

It's on the 'net.

865-604-9139, but if I were you I wouldn't call with that attitude. For some odd reason or another, I still have quite a bit of respect for you personally and I'd hate to lose that over some petulant nonsense.

But hey, it's your world. I can't tell you what to do; I can only hope you'll act appropriately. Or is this something that's going to require a shot or two of vodka down at the Pub?

Anyway, I seem to have butthurt a number of individuals because I didn't walk lock-step with their ideology. Should I just go away, guys? Is talking about the matter with a dissenter just too much to deal with at present?

I've got a feral to pick up, so you guys think about that while I'm out.

Hildegard's picture

I hope you stick around.

I hope you stick around. You're hilarious. And a deeply brilliant, mature, self-assured and virile young man deserving of much praise and attention. I salute you.

B. Paone's picture

Now THAT'S top-notch sarcasm! ;-)

I'll take "self-assured" and argue the rest, but later. Stuff awaits.

Barker's picture

Hey, I ain't gonna call just

Hey, I ain't gonna call just to argue.

You're the one who put yourself out there as an example of rugged individualism. I didn't and JFM didn't. So don't use yourself as an example and then expect no criticism of you as the example.

The goal of health care reform should be to address the problem: we spend more on health care than any other developed country and our outcomes - in terms of infant mortality, life expectancy and other measures - are much lower. Every other developed country with better outcomes than ours has figured out a way to make sure every citizen has health care coverage. That tells me that we should figure out a way for everyone to have health care coverage here.

Your personal example, which you threw out here, is evidence of the problem. The healthy have to be in the pool - whether it's a private pool or a public one - or private insurance doesn't work.

On a personal level, you might be able to get away with not buying insurance now, but it will catch up to you - all of us are mortal - and when it does you should thank the rest of us for keeping the system going for your benefit.

B. Paone's picture

I don't think you'll call at all, personally.

And that's damned disappointing. In order:

* Don't expect said criticism to be attacked based on its veracity - or, in the case of your declaration that I am not self-sufficient, lack thereof. I demand proof of your accusations, and if you had any honor you'd, as some like to say, "put up or shut up".

* I agree. It's called "make healthcare more affordable", not "make everyone pay for insurance". Prices aren't going to trend downward enough (if at all) just by everyone having insurance, but if you'd like to prove in detail how it can I'm all ears.

Or would you prefer instead that I prove my point in detail, thus sparing you any possible embarrassment? Your call, I don't really care.

* ...so instead of finding something that doesn't require a mandate to purchase something that, for all intents and purposes, REDUCES the amount of money a person has for healthcare (I wouldn't have been able to pay for my medical expenses last week if I had insurance - funny, isn't it?), you're fine with just forcing the rest of us to buy into an inefficient system.

Very interesting. And nonsensical. Costs are effectively lowered by controlling prices. They're not effectively lowered by forcing everyone "into the pool". Otherwise, car insurance would be cheaper in locales that have mandatory car insurance purchase and maintenance laws.

...I've yet to see my car insurance premium go down, though. How are the premiums lowered in healthcare by forcing everyone "into the pool" if the same concept is being tried with lesser insurance and it doesn't appear to be working?

Or is it? Am I the only person whose premiums have not decreased?

* Actually, with any luck, my generation and the generations following it will do a lot more than just maintain the same broken, inefficient system that our predecessors did. And if you guys keep this up, you'll be ensuring that we have no other choice.

So by all means, go for it! Break that system! Make people buy something useless despite there being better alternatives! Motivate my generation, Scott! ;-)

metulj's picture

"Don't expect said criticism

"Don't expect said criticism to be attacked based on its veracity - or, in the case of your declaration that I am not self-sufficient, lack thereof. I demand proof of your accusations, and if you had any honor you'd, as some like to say, "put up or shut up"

Do you have parents?

B. Paone's picture

Answer:

Yes. I wasn't created in a test tube.

So the logic is... if you have parents, you can never be self-sufficient?

Ever?

This is going to be pretty entertaining. :-)

WhitesCreek's picture

Here's the deal, BP

First off, if you don't have insurance and get deathly ill you aren't just left to die. You get served by a public hospital, so in fact you do have a level of insurance no matter what. How are you paying for that? You may not be. it may be everyone else's taxes that pay. It's a lower level of care but it is care, none the less. The insurance that everyone will be "forced" to buy is heavily subsidized for lower income workers. It is a deal for them, but frankly that is what insurance is anyway...a deal for those who need it, subsidized by those who take an actuarially calculated risk, pay into the system and then hope they never need anything back. In a sane world there would be no insurance companies. There would be risk pools managed by actuaries, much like many other countries already do.

Now, regardless of your libertarian objections (I'm sure you don't want and refuse to pay for police protection as well as medical insurance) you have not offered an alternative to the current plan that will actually work. why don't you outline a plan that will cover everyone in America with basic health care insurance and hold the cost to, say, 12% of the Gross Domestic Product. That would still make it the most expensive health care system in the world but would reduce costs by one third.

Put up or shut up.

B. Paone's picture

I'm a Libertarian now?

Whoo hoo! Full gamut in a week, and it's only Tuesday! I've been called liberal, socialist, neo-con and now Libertarian all this week. Awesome. But the correct answer? Rule utilitarian. (It's something like liberalism, except far less whiny and quite a bit more logical.)

Anyway, in order:

* How am I paying for it? Depends. If cash or credit is not available, it would be a payment plan. Gotta pay the debts, after all.

But wouldn't it be just SO much easier to pre-empt such a situation by, say, making sure costs for healthcare goods and services got to and stayed at a level where people could RESPONSIBLY afford it?

Just a guess. I understand it flies in the face of capitalism, but I don't know... is it crazy to think there are some aspects of life that should just function efficiently and properly regardless of profit or loss?

Yeah, that might be too crazy. But in a sane world, that's how things would be run. A $1 bedpan would cost $1 plus operating markup, and operating markup (not private insurances' profit margins) would be the facet receiving the heavy subsidization. You know, to keep those costs down.

Hey, wait. Wasn't the whole problem with this healthcare thing the fact that it's so expensive? Lowering costs and publicly subsidizing said costs to keep them low, then... is it just me, or would that work?

Private insurance companies would probably vehemently disagree, but I'm not talking to them - I'm talking with you. (At least, what you people aside from that Mr. Lykins fellow believe to be "talking", but it is what it is. So much do I value your opinions that I'm willing to put up with an otherwise intelligent man acting like a complete prat.)

* You had only but to ask.

- REIN IN HEALTHCARE COSTS. The most efficient way to lower a consumer's cost is to lower the price they must pay. The most effective way to do that in healthcare is NOT by subsidizing the insurance agency, but by providing direct cost relief to healthcare PROVIDERS in the form of materials/services cost caps for the goods and services they need to buy in order to treat us.

- MAKE HSA A VIABLE OPTION. We have something like a healthcare savings account, except it's a regular savings account that we use only for medical emergencies. Why do this instead of a "real" HSA?

Simple. In most cases, that HSA cash doesn't roll over from one year to the next. It needs to. And instead of taking out $80 a paycheck for health insurance? Take out $40-50 a paycheck and sock it away into an HSA that keeps your balance from year-to-year (allowing it to build) and offers a small amount of tax-free interest accrual (to build it up even more). These HSAs, of course, can only be tapped for healthcare. No exceptions.

- ELIMINATE MEDICAID AND RESTORE MEDICARE TO ITS ORIGINAL PURPOSE. That being to care for the truly disadvantaged. Take the Medicaid funding and all compatible and NECESSARY components, merge them into Medicare, set a sliding co-pay based on income, and maintain as necessary.

It's a start, but getting into more details requires more information from you in regard to what you specifically want to address.

So, yeah. There you go. And all ya had to do was ask nicely. (I considered that "nicely" given where I am at present.)

metulj's picture

Utilitarianism is illogical

Utilitarianism is illogical based on its insufficiency alone. Keep trying.

Barker's picture

paone

Dude, you seriously don't understand insurance. You might pay more in premiums now, at age 31, than you spend on overall healthcare this year, but when you get older - age 61, say - and you have to have a colostomy bag in order to go out of the house it's a different story. God forbid you should develop Alzheimer's.

bizgrrl's picture

Exactly. It seems he's

Exactly.

It seems he's gambling on having plenty of money when he's older or that the health care providers will give him a break, at our expense.

MemphisSlim's picture

Federal government can't mandate life insurance, pet insurance

travel insurance,college savings plans, 401(k)s, burial insurance, nursing home insurance, or cancer insurance, however, prudent people from time to time will purchase these products to alleviate a financial burden from falling on someone or create an opportunity for someone besides themselves. Others, chose not to purchase these products and ignore the potential rammifications if certain events were to transpire.

For far too long we have assumed equal opportunity should transpire to equal outcome and equal result, but people are different and the federal government is the last structure on the planet that should be telling people what they need to do.

WhitesCreek's picture

I suspect BP is being

I suspect BP is being intentionally dense. He spouts too many talking points to have given much actual thought to this. i wonder which training session he went to?

cafkia's picture

An Idea

Let's all petition BP to open a hospital. It is clear that with his skill and knowledge set, it could be the model for the nation while providing those of us lucky enough to live nearby with excellent, safe, and reasonably priced health care.

If not that, then I suppose we could petition Gov Haslam to appoint him head of TennCare.

B. Paone's picture

A better idea:

Instead of being passive-aggressive, why not inquire about what I posted above and attack the message instead of the messenger?

I know, I know, it's generally not the MO around here, but what the hell, right? ;-)

B. Paone's picture

I'm typing a little fast for

I'm typing a little fast for you guys so I'll take a short break and let y'all catch up. Maybe even try calling Scott again.

cafkia's picture

Could you point out exactly

Could you point out exactly where I "attacked the messenger"?

I'm largely with JFM on this in that I HATE the requirement to purchase insurance. I HATE the idea that alleged Christians think that it is reasonable for somebody to make a profit if a 6 year old running in a public park should trip and break an arm. I HATE the amounts of money that hospital and HMO administrators get paid as well as insurance executives but, my personal experience as an employee of a medical diagnostics equipment company suggests that those salaries are not the primary driver of health care costs.

I agree with you that personal responsibility, were it to become suddenly in vogue, could lower costs significantly. IF we were to reduce our fast food consumption by 90%, if we were to make sure that our intake of fiber and our exposure to the Sun for sufficient generation of vitamin D, that our diets were primarily leafy green and orange vegetables and fruits, and that all of us were at or slightly below our "ideal" weight, medical costs would certainly go down very drastically. However, that would in no way positively affect the situation that JFM found himself without a potential negative offsetting factor.

The tone of most of your posts here would be offensive if there was a reason to take you seriously. You seem to imply ignorance and lazyness for anyone who dares disagree with you at the same time as you give lip (keyboard?) service to respectful interaction. I actually doubt that you are anywhere near as dense as your posts would indicate leading one to believe that you have a specific agenda, that you consider this performance art, or that you simply enjoy believing that you are somehow controlling people.

Whatever.

B. Paone's picture

In order:

* The entirety of your response here:

"Let's all petition BP to open a hospital. It is clear that with his skill and knowledge set, it could be the model for the nation while providing those of us lucky enough to live nearby with excellent, safe, and reasonably priced health care.

If not that, then I suppose we could petition Gov Haslam to appoint him head of TennCare."

...can be strongly argued to be a passive-aggressive attack on the person writing as opposed to what the person wrote. This is what is meant by "attacking the messenger". Unless you were being serious about your desire to help me build a hospital, which is highly doubtful given your attitude.

* You're right, of course, in those very specific examples. People working in healthcare DO have to be paid a reasonable amount for their services.

Reasonable.

Now, how much did those diagnostic machines you mentioned cost to produce, operate and service? I bet it wasn't cheap, and I bet your company didn't eat a whole lot of the production or stocking costs. (It's simply not the nature of a business to do that, so no shame in being truthful about the numbers.)

* Actually, I argue that you can accomplish a similar depression on prices by enacting strict price controls and offering greater taxpayer subsidy of direct healthcare providers. Probably a lot easier to accomplish too. What do you think of that instead of a major miracle like sudden self-responsibility becoming all the rage?

* I imagine it would seem like that to anyone with either preconceived notions of who I am and what I believe... or someone who was called to task for silly passive-aggressive comments being the opener of conversation, but as Sobi rightly pointed out it can be argued that I did the same. Care to start over between the two of us, or is your mind already set in stone? :-)

cafkia's picture

So, essentially you are

So, essentially you are saying that it is fine for you to extrapolate a meaning and intent different from what the words say in my post but, if someone does that with one of your posts, after reading the many on this thread, they are being disrespectful of you.

You then say that those of us who have expressed a dislike for the insurance requirement as being just like everybody else except you, that we are all just agreeing with each other.

No. I don't believe there would be any benefit to me or this board from us "starting over".

B. Paone's picture

In order:

* So you really do believe my plan is good enough to run a hospital under it? Or you were being passive-aggressive and just don't care to admit it?

* I dislike the hell out of it. But that is NOT a sentiment shared by this particular community at large, is it?

* Then we continue with your regularly-scheduled programming already in progress. :-)

R. Neal's picture

Getting back to the question

Getting back to the question of how making everyone buy insurance would lower costs, consider the following 2008 per-capita health care expenditures from the OECD and you tell me:

Country	         USD
United States	7538
Norway	        5003
Switzerland	4627
Luxembourg	4237
Canada	        4079
Netherlands	4063
Belgium	        3995
Austria	        3970
Ireland	        3793
Germany	        3737
France	        3696
Denmark	        3540
Sweden	        3470
Iceland	        3359
Australia	3353
United Kingdom	3129
Finland	        3008
Spain	        2902
Italy	        2870
Japan	        2729
Greece	        2687
New Zealand	2685
Slovenia	2329
Israel	        2165

I don't know how that works, but there does seem to be a pattern. Many (most?) of these (except the U.S.) have national health insurance or a socialized, government run health care system that covers 100% of their population. Some even do it through a combination of government funding and private insurance, hospitals, and doctors. just like us. Some have a basic right to health care in their constitution. And many have better outcomes.

Barker's picture

Most, if not all, have better

Most, if not all, have better outcomes. That's why we have to find a way to cover more of our citizens.

B. Paone's picture

Interesting to note:

...we're the largest country on that list by far. (Well, Canada's catching up.) More people, more infrastructure, more maintenance, more cost.

So unless we're considering culling some of the population down to the sizes of these other countries that are doing better than we are in healthcare, I would still suggest directly addressing healthcare costs is the most pragmatic long-term solution.

I still don't see why some of you think this is an inferior solution, but mostly because no one has taken the time to sit there and say "I believe mandatory health insurance for everyone is better than directly reducing the costs of healthcare with price caps and subsidization because (insert detailed reason here).

Frankly, all I've seen are the same talking points supporters have been drilling with for some time now. And those talking points, unfortunately, don't seem to demonstrate how mandatory health insurance is the best approach.

But maybe that's just something no one wants to discuss. If that's the case, let me know and I'll clear the way for you guys to go back to just agreeing with yourselves. Promise.

j.f.m.'s picture

we're the largest country on

we're the largest country on that list by far. (Well, Canada's catching up.) More people, more infrastructure, more maintenance, more cost.

Haha, Ok, so we're adding "per capita" to the list of things you don't understand.

I would still suggest directly addressing healthcare costs is the most pragmatic long-term solution.

I still don't see why some of you think this is an inferior solution, but mostly because no one has taken the time to sit there and say "I believe mandatory health insurance for everyone is better than directly reducing the costs of healthcare with price caps and subsidization because (insert detailed reason here).

Health care costs absolutely need to be addressed, and the existing law doesn't do nearly enough about that. Mostly because those steps would be unpopular with (variously) insurance companies, doctors, and hospitals. There are a lot of ideas for this we can talk about if you're actually interested. None of them have much to do with the pay-your-own-way model you're enamored of.

And no matter how you structure the system, someone will have to pay for it. Since it is a system that almost everybody uses but can't predict when or how, you get the best economies of scale and greatest distribution of risk and cost by having everyone pay for it.

B. Paone's picture

Wow. This is getting kinda sad. Or is it?

In order:

* The more people serviced by a system, the more the overall cost rises both per-person and overall. Healthcare costs don't rise in lock-step with the number of people served. They rise based on a number of variables, the most important arguably being the base cost of goods and services consumed by direct healthcare providers.

It's hard to justify charging $350 for a set of sutures if the sutures only cost $.25 as opposed to $250. And it's hard for healthcare costs to be as soaring as they are in this country if base costs are so low. (At least, with proper anti-profiteering controls.)

* By ALL means, have at it. Anything's better than the garbage back-and-forth.

* I agree in principal, but not with the proposed solution. The base problem with people not having health insurance is the fact that it costs so damned much, not that they don't want it period. (Okay, most. Some people are idiots.) If my premiums dipped to the point that I would no longer be saving money by paying my own way, I'd be ALL for it.

But that's not going to happen just by making everyone buy insurance. To paint it with a broad brush, we're looking at a system that should be largely nationalized.

j.f.m.'s picture

To paint it with a broad

To paint it with a broad brush, we're looking at a system that should be largely nationalized.

Yes. If you'd just said that at the beginning instead of going on about paying your own way and autonomy and whatever, this would have been a much shorter thread.

Rachel's picture

The more people serviced by a

The more people serviced by a system, the more the overall cost rises both per-person and overall.

Really? "The more people serviced by a system, the more the overall cost rises both per-person.."

I guess all that stuff I learned in micro economics about economies of scale is just outdated b.s.

B. Paone's picture

Yeah, you must be right.

All medical treatments costing the same and all. And never mind infrastructure costs that get added as the population grows; all facilities cost exactly the same to build and refurbish.

Barker's picture

Covering all citizens, which

Covering all citizens, which would put us in the same ball park as other developed countries, should be the goal. How that goal is achieved should be the only consideration.

B. Paone's picture

You mean regardless of cost?

Highly irresponsible. Not everyone's a wealthy editor, y'know. So I doubt simply covering everyone should be the only goal.

Covering everyone to the point that they can afford, while IMPROVING the quality of the care we receive? Much more responsible, but also much more difficult.

Don't tell me you don't like a challenge...?

Barker's picture

wealthy?

I'm not wealthy by any standard. I live in a 600-square-foot house and drive a car that's 17 years old. If you think that's wealthy, then you need to re-evaluate.

Covering everybody should be the goal. How we get there is where the debate lies.

cafkia's picture

Randy you forgot to mention

Randy you forgot to mention that pretty much that entire list of nations enjoys greater longevity than does the U.S.

R. Neal's picture

Another thing I forgot to

Another thing I forgot to mention is that many/most have removed profits from the balance sheet of health care costs.

B. Paone's picture

I bet that has a pretty profound effect...

...on the direct cost of services.

:-)

B. Paone's picture

I think you guys have had enough of me today.

And for a few days. Maybe that Lykins guy will pop on and have something to say. Always a pleasure talking with that guy.

It used to be that way for a lot of you people too. But I guess we couldn't agree to disagree. Oh well. Sucks, but that's life.

Best of luck and best of health to you guys. I mean that. (Even Toby and Neal.)

metulj's picture

And he flounced. We've

And he flounced. We've established that he doesn't understand demographics, philosophical movements, insurance as a concept, and the notions of society, culture, nation-state, and political economy all in one neat thread.

cafkia's picture

neat?? Not the way I

neat??

Not the way I understand that word.

Rachel's picture

This thread has managed to

This thread has managed to make me bored with the health care debate. Never thought that would happen. Thanks, BP.

JaHu's picture

So under this plan, if a

So under this plan, if a person refused to pay for health insurance, would they be thrown in jail?

Hildegard's picture

No. My understanding is it

No. My understanding is it gets assessed as a tax. If you get caught driving a car without insurance, there's a fine, but it's not considered a crime.

JaHu's picture

But if a person refused, or

But if a person refused, or for some reason were unable to pay this fine, would they then ultimately wind up in jail? If they would, this sounds to me like a convenient way to imprison homeless, or the poor. A position each of us here could find ourselves in at the drop of a hat. You don't even have to pay income taxes if you don't earn an income. Will we now have an agency more feared than the IRS? That's just what we need! I feel an ulcer coming on.

I'm deeply concerned that there is an ominous cloud hanging over this plan.

metulj's picture

It's not a fine, so you can't

It's not a fine, so you can't jail them and debtor's prisons are against the law. The current healthcare law provides for this case you specify.

Hildegard's picture

It's not that dark or

It's not that dark or ominous. If you blow off a fine in this state - whether it's for speeding or no insurance or some other offense that doesn't carry time - the penalty is revocation of your driver's license by the DOS. Plus outrageous court costs when you try to get your license restored.

bizgrrl's picture

If you get caught driving a

If you get caught driving a car without insurance, there's a fine, but it's not considered a crime.

I thought you could drive in the State of Tennessee without insurance if you could show "financial responsibility".

metulj's picture

No. You have to have

No. You have to have insurance. This is a big-time myth in this state. I was hit by a woman who had no insurance. When she got the ticket for violating the financial responsibility law, she freaked out on the cop saying she had a checking account and that's all you need. He told her exactly that: "It's a myth, ma'am. You must carrying minimum insurance on your vehicle."

My costs were pretty big. Busted up leg and scrapes and new (to me) motorcycle. She couldn't pay so my insurance company sued her. In TN, you had better have uninsured motorists insurance because of people who think like her.

bizgrrl's picture

It would appear that the

It would appear that the Financial Responsibility Law is valid. It is a little more formal than showing you have a checking account.

State of Tennessee
Evidence of Financial Responsibility

or a certificate from the Department of Safety noting that a cash deposit or bond has been posted in the amount required by the Tennessee Financial Responsibility Law of 1977, or that a person has qualified as a self-insurer under Section 55-12-111,

It would also appear that the lady could have proven financial responsibility after the fact if she had formally agreed to pay.

I whole-heartedly agree that a person should have uninsured motorists insurance. A car I was driving many years ago was hit by an uninsured motorist. There is an old saying, "you can't bleed a turnip."

metulj's picture

I think the disconnect for

I think the disconnect for people is that cash or bond requirement. Somehow it has gotten into peoples' heads that just having a bank account covers that requirement. It doesn't.

Like I said, always carry uninsured motorist's insurance in this state. Always.

bizgrrl's picture

I was surprised when moving

I was surprised when moving back here that we were not required to show a proof of insurance when registering our vehicles. However, in states that do require it, people have found a way to work around it by buying insurance for one month. They do get caught if they are in an accident but that is a little too late.

metulj's picture

There is a whole policy

There is a whole policy product from GEICO that serves that market. New Jersey:

According to the information we found, a first time infraction of NJSA 39:6B-2 (driving without liability insurance) includes a fine of at least $300 and up to $1000, community service, DMV surcharges of $250 for 3 years, and the loss of license for up to one year. There are court costs and fees that are required to be paid as well as the penalties listed above.

A second offense comes with penalties of a fine up to $5000, a mandatory jail sentence of 14 days, 30 days community service and a license suspension for 2 years or more. State laws and statutes are always being changed and updated though so if you were cited for being an uninsured motorist in NJ, you may want to contact the courts to find out what exact penalties you are facing.

We have it EASY in TN on this stuff. I have a long post coming up about this stuff.

Hildegard's picture

Ah, never mind

What metulj said.

reform4's picture

Don't forget...

The HCRA also included provisions to cap profit taking by ensuring a certain percentage of premiums had to got towards.... well, HEALTH CARE.

We got only one if several items sought to reduce costs. If we had gotten the public option to give TRUE competition, it would even be mote effective.

Oh, and the scare tactics of insurance agencies hiking rates because of the initial requirements (no more lifetime caps) and in planning of future caps? Didn't happen on my end. Our premium increase was astoundingly low, literally less than one-SIXth our normal premium hike.

I'll also add that perhaps a better analogy is fire/ambulance service. In the city, it's required, part of your taxes, government supplied and works well. On the county, it's optional, but you need to own your home free and clear (your bank isn't stupid enough to let you go without it).

What happens if your home goes up in flame and you have no Rural Metro subscription? Don't know. I doubt they'd let it burn down. They'd probably bill you for something, but spread the cost around to the rest of us subscribers. Hard to know because most people here aren't stupid enough to do it, and a $15k fire call still doesn't compare to a $1M health event. But it's a better analogy than car insurance.

R. Neal's picture

Also, if you have no income

Also, if you have no income you can get health care via MediCaid.

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