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Posted by yossarian22c (Member # 1779) on :
 
So we are learning a bit more about what the senate bill may look like and I wanted to share a few opinions and see what you guys thought.

Health care reform started with a few key ideas to reform the insurance industry.

1) Eliminate preexisting conditions.
2) Because of 1 introduce a personal mandate.
3) Health care exchanges where all individuals would get a group rate (like people in large corporations).
4) Introduce a public option to compete with insurance companies.


While not a perfect plan it was one I could support. What we have left of that plan seems to be the following.

1) Eliminate preexisting conditions.
2) Because of 1 introduce a personal mandate.
3) Health care exchanges where all individuals would get charged an individual rate.
4) Reduce the Medicare age to 55.

I'm not sure if this new plan is any better than the status quo. The problems I see are:

1) The removal of the group rate in the health care exchange and the removal of the public option. If people with preexisting conditions can be charged 2-3 times as much as others (or more) then guaranteed issuance doesn't mean that much.
2) By removing the public option while still requiring a mandate the insurance companies will just have captive customer base with no increased competition.
3) By allowing an early buy in to Medicare at age 55 the rates would either have to be high or taxpayers would have to subsidize the new members. By only including the most expensive people in the government plan it will run over cost while private insurers rake in record profits.

I really don't think this bill is worthwhile anymore. Not for the same reasons many of the conservatives have been talking about but because it no longer does anything that worthwhile. Does anyone know of why this new plan is better? Are there benefits or problems I've missed?
 
Posted by Pyrtolin (Member # 2638) on :
 
Can you give backing that point 3 has changed? The entire point of the exchange is that there's a price listed up front rather than having to get an individual quote.

On number 4 you miss additional measures- tightly regulated national non-profit companies and group rate plans that are aggressively negotiated by the OPM as part of their negotiation for federal employee plans.

Why would the buy-in premium for Medicare necessarily be high? If anything, because of the rates it sets, it should be lower, and since the people buying in are younger and generally healthier than it's current constituency, it's more likely that they'll end up helping defray costs overall. It should still definitely qualify for income based subsidies, just like any other plan, though, otherwise it's a completely empty gesture. It would also generate longer term savings as people would be healthier on average when they reached 65, so there'd be fewer chronic problems that it would have to deal with across the board.

The exchange in and of itself is worth supporting, because even without a public option it forces some degree of competition between insurers. In everything I've read, I haven't seen any claim that it's essentially been eliminated in favor of going back to a individual quote system. Once the baseline is in place, it will be much easier to continue to extend it until everyone can use it, including people who work for large employers.

The Medicare buy-in will similarly help pave the way to lowering the age restriction until anyone who wants into it can buy in, and it would get cheaper and better funded with each step down as it brings in healthier people.

The premium plan tax will put some actual price pressure on insurance costs and it will serve to shift people pay from healthcare contributions to actual take home pay, which that can, in turn, choose to apply to plans that better suit them if they so desire.

It's not perfect by any stretch of the imagination, but it's a decent step toward fixing the system, and it overcomes the biggest hurdle of establishing a framework that can be the basis for easier incremental fixes afterwards.
 
Posted by DonaldD (Member # 1052) on :
 
Isn't this a health insurance bill, not a health care bill?
 
Posted by jasonr (Member # 969) on :
 
quote:
1) Eliminate preexisting conditions.
The idea of eliminating pre-existing conditions as a valid consideration in a health insurance policy is ludicrous. I can't even believe that this is seriously being considered.

Anyone care to explain to me how such a system could possibly function?

[ December 11, 2009, 11:38 AM: Message edited by: jasonr ]
 
Posted by kenmeer livermaile (Member # 2243) on :
 
In China, one only pays doctors while one is well. When one is sick, they go without pay until you're better again (or dead, at which point the contract is canceled).
 
Posted by G2 (Member # 2942) on :
 
quote:
Originally posted by Pyrtolin:
Why would the buy-in premium for Medicare necessarily be high? If anything, because of the rates it sets, it should be lower, and since the people buying in are younger and generally healthier than it's current constituency, it's more likely that they'll end up helping defray costs overall. It should still definitely qualify for income based subsidies, just like any other plan, though, otherwise it's a completely empty gesture. It would also generate longer term savings as people would be healthier on average when they reached 65, so there'd be fewer chronic problems that it would have to deal with across the board.

People that have real world experience running this thing have a different opinion on that:
quote:
Marilyn Moon, a health economist and former public trustee of Medicare, said that for people 55 to 64, Medicare premiums could be higher than premiums charged by private health plans.

Health policy experts said that the people who chose to enroll in Medicare were likely to be heavy users of health care, with higher-than-average costs.

Moreover, Ms. Moon noted, private plans would have large numbers of healthy people under the age of 55, whose premiums could help cover costs for those 55 to 64. “Such cross-subsidies would not be available under the new Medicare option,” she said.

Moon seems like someone who'd know what they're talking about so G2 will accept her evaluation until someone can show him any reason not to but there is this too:
quote:
According to the Congressional Budget Office, a family of four earning $54,000 in 2016, when the health legislation is fully in effect, would be eligible for a subsidy of $10,100 to help defray the cost of insurance under the health legislation being debated by the Senate. By then, one of the most popular federal plans, a nationwide Blue Cross and Blue Shield policy, is projected to cost more than $20,000.

That could leave the family earning $54,000, slightly more than the current median household income, with monthly premium costs of more than $825.

As for Medicare, right now, it has an unfunded liability exceeding $61 trillion and is expected to become insolvent within 8 years (the reserve fund, already being accessed, will be gone). Medicare is currently projected to consume 51% of all federal income taxes by 2042. And we want to expand this? These people proposing this have to be nucking futs. Seriously, this is crazy.

quote:
In total, Medicare and Social Security are now projected to cost nearly 15 percent of GDP by 2040. To put that number in context, if we spent 15 percent of GDP on these two programs today they would consume 95 percent of all federal revenues.
Absolutely bat**** crazy.

[ December 11, 2009, 01:20 PM: Message edited by: G2 ]
 
Posted by yossarian22c (Member # 1779) on :
 
quote:
Originally posted by jasonr:
quote:
1) Eliminate preexisting conditions.
The idea of eliminating pre-existing conditions as a valid consideration in a health insurance policy is ludicrous. I can't even believe that this is seriously being considered.

Anyone care to explain to me how such a system could possibly function?

That is where the mandate comes in. You guarantee everyone coverage but then you require them to buy the insurance.
 
Posted by yossarian22c (Member # 1779) on :
 
I'm actually going to say it, I agree with G2 about Medicare.

Here is a different quote that drives home the same point about lowering the Medicare age.

quote:
“The buy-in to Medicare is only for those 55 to 64 and it’s only for people who are not offered private health insurance through an employer. So it turns into just a subsidy to private health insurance: the taxpayers will pay for the high-cost patients and the health insurance industry can take the lower-cost patients.”

Woolhandler, who also practices primary care at Cambridge Hospital in Massachusetts, is a prominent advocate for single-payer national health insurance, sometimes called an expanded and improved Medicare for All. She says research has demonstrated that replacing today’s multi-payer system, with its wasteful paperwork and bureaucracy, with a streamlined single-payer system would save about $400 billion annually, enough to assure everyone comprehensive, quality care.


 
Posted by yossarian22c (Member # 1779) on :
 
quote:
Originally posted by Pyrtolin:
Can you give backing that point 3 has changed? The entire point of the exchange is that there's a price listed up front rather than having to get an individual quote.

On number 4 you miss additional measures- tightly regulated national non-profit companies and group rate plans that are aggressively negotiated by the OPM as part of their negotiation for federal employee plans.

I looked for what I claimed about 3 and couldn't find any source that clearly states either way right now. I remember hearing that group coverage had been removed but I can't clearly remember the source. After thinking about it I think the source was a pundit so the information should have gone into the "needs to be fact checked" part of my brain instead of the fact part. Sorry if this is a misrepresentation.

True I did leave out the national non-profit plans. From their description I don't see how they would be very effective, but that could be poor understanding on my part.
 
Posted by JoshuaD (Member # 1420) on :
 
quote:
Originally posted by kenmeer livermaile:
In China, one only pays doctors while one is well. When one is sick, they go without pay until you're better again (or dead, at which point the contract is canceled).

That can create incentives for doctors to just let clients die rather than give them costly treatment.

It probably won't manifest so clearly, but doctors will probably be more inclined to take risky, less expensive approaches that either solve the problem or kill the patient, rather than taking a more conservative, costly approach that has a higher chance of healing the patient with less risk of death, but at a higher cost.
 
Posted by Pyrtolin (Member # 2638) on :
 
That may well be true, but in a similar vein the Mayo Clinic and Kaiser Permanente both provide some good groundwork toward suggesting ways to move toward a salary based system rather than a fee-for-service, both to improve quality and to reduce cost of care.
 
Posted by shagdrum (Member # 6029) on :
 
A few questions...

How would an individual mandate be constitutional?

How does this bill actually address the sources of rising costs (not prices) of health care (medicare/medicaid reimbursement rates, excessive litigation and the excessive medical care to avoid litigation, etc.)?

Would a "public option" (if it ever materializes, and in whatever form) be allowed by Congress to fail, or would it be considered "too big to fail"? The concern here is that it could utilize medicare-like reimbursement rates (as a means of cutting costs, which will inevitably be a concern) to effectively undercut the pricing of private sector competition (predatory pricing made possible by the the government backing them on the taxpayer dime and not allowing them to fail if run poorly). This would effectively drive out private competitors. If you don't think this is possible, look at Fannie and Freddie; two "private sector" entities established by the government and not allowed to fail because they were too big. As to the possibility of medicare-like reimbursment rates, of which Senators/Representatives have assured us no "public option" would be allowed to utilize, I cite this passage from Section 1801 of the 1965 Medicare Act:

"Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine, or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer, or employee, or any institution, agency or person providing health care services."

Personally, I don't see the bill passing, especially after Liberman's recent statement to Senator Reid's face that he will not vote for any bill with a Public Option or an expansion of Medicare. No 60 votes and the bill is dead.
 
Posted by yossarian22c (Member # 1779) on :
 
I have an idea about the constitutionality of an individual mandate. I think they make it work by "taxing" people without health insurance.

As far as the too big to fail part I would bet that most of the major health insurance companies in the US are "too big to fail." Even if the company itself were to go away their obligations would almost assuredly be paid by the taxpayers. I still don't see how any public option will drive out private insurers. Fannie and Freddie haven't driven out competition in the mortgage market, the USPS hasn't eliminated competition in deliveries and the army hasn't even eliminated competition for fighting wars (blackwater, etc).
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
How does this bill actually address the sources of rising costs (not prices) of health care (medicare/medicaid reimbursement rates, excessive litigation and the excessive medical care to avoid litigation, etc.)?
Your question there is extremely loaded as it actively assumes that your assertions there are true.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
The concern here is that it could utilize medicare-like reimbursement rates (as a means of cutting costs, which will inevitably be a concern) to effectively undercut the pricing of private sector competition (predatory pricing made possible by the the government backing them on the taxpayer dime and not allowing them to fail if run poorly). This would effectively drive out private competitors.
No- it would force the other insurance companies to negotiate similar prices so they can stay competitive, rather than allowing a situation where little to no market pressure exists to negotiate on the price of care exists.

Medicare +5% or similar rates was, in fact, part of the initial Public Option proposal, but was already removed as a concession to obstruction.

[ December 14, 2009, 07:02 AM: Message edited by: Pyrtolin ]
 
Posted by Pyrtolin (Member # 2638) on :
 
"Too big to fail" is the wrong title to hand on health insurance companies- it's not a question of their direct economic footprint and the amount of the economy they'd directly drag down with them. "Too critical to fail" would be more to the point, as their impact would be more directly measure is loss of health and lives, which is a huge blow to basic national infrastructure.
 
Posted by shagdrum (Member # 6029) on :
 
As to that last question, what, specifically is loaded about it? What, specifically is assumed that you contest?

As to the economic consequences, it is claimed that the it would force insurance companies to "negotiate better prices", but that assumes they can; that the prices they charge can get around the laws of supply and demand and arbitrarily charge higher prices. If the prices in fact, do reflect the laws of supply and demand, then trying to lower prices would make no economic sense because it would mean lowering them to a point that would put the company in the red.

Also, the "too big to fail" comment was about a hypothetical "public option". Not about private insurers.

The economic effects of Fannie and Freddie cannot be overestimated in the recent housing boom and bust. Those effects have certainly driven out some competitors (and would drive out more if it weren't for the bailouts). However, that is tangential to my analogy. My only point is that Fannie and Freddie were not allowed to fail, so that can run in the red in perpetuity because they are backed by the taxpayer dime (a luxury that a private business does not have). However, the economics of the two situations are not the same and are not exactly compatible.

How does bringing in tax power make it constitutional? Tax power is not absolute and the Constitution specifically lists the powers of Congress while the Bill of Rights makes clear the limits of power.

The two typical arguments for the constitutionality are the Interstate Commerce Clause and/or the General Welfare clause (though those are based on, ultimately, specious reasoning). If you can make a case on the tax power allowing an individual mandate, I would love to hear it.

What is missing from this debate, IMO (and I am speaking at generally; nationwide) is a focus on the reasons for the current problem and the trade-offs of any possible "solution". If you don't know the causes of the problem, you cannot reasonably tackle it. And any potential "fix" entails many unforseen consequences and trade offs that could adversely affect the goals being espoused as being behind this bill. There are many ways to screw this up and make things worse, but relatively few ways to actually make things better. Frankly, government tends to do the former while hoping for the latter.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by shagdrum:
As to that last question, what, specifically is loaded about it? What, specifically is assumed that you contest?

All three of these:

quote:
medicare/medicaid reimbursement rates, excessive litigation and the excessive medical care to avoid litigation, etc.
you assert as accepted fact, when they are in fact completely debatable points.

Excessive medical test in particular being a result of defensive medicine is a big unfounded point there. Many facilities have tried to cut back on tests and lost money, not because of any increase in litigation, but because of a loss of revenue from said tests. If you want to look toward the root of that problem, look at the markup on medical equipment sold to US hospitals because they know that US hospitals have little to no leverage to negotiate better prices; they can pss the costs on to insurance companies, who in turn can pass them on to captive customers.

On the other hand, the most hospitals that have to work on leaner budgets- those that have a majority of Medicare patients, for example, use that money much more efficiently- it costs them less to provide the same degree of care.

But, per supply and demand, there is pressure toward working toward that kind of efficiency so long as they're free to demand whatever prices they want and their payers have no leverage or strong pressure to negotiate.

And that's a key factor- supply and demand only works to deliver fair prices when there's pressure to move toward fair prices. When the supplier can ask any price they want and the consumer has no choice but to pay that price, then the system falls apart.

Massachusetts, using this system, has already proven that it reduces healthcare costs and increases coverage significantly. Prices have dropped significantly there while they've strongly increased in the rest of the country, and 96% or residents are covered, giving them access to the care they need.

On the other hand, Texas has imposed strong caps on malpractice and has seen no benefit in either area because it has done nothing to introduce market pressure to reduce costs.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by shagdrum:
Also, the "too big to fail" comment was about a hypothetical "public option". Not about private insurers.

That fails logically because the only way the public option would fail would be if it were too small, not too big, and then its failure not only have a small impact, but suggest that private industry had properly realigned itself to be more effective and consumer oriented. Outright failure to attract customers, in fact, one of the two best overall outcomes (with the other extreme being that it results in a defacto single payer system if for-profit industry cannot function when forced to work for consumers instead of against them.)
 
Posted by whitefire (Member # 6505) on :
 
quote:
Excessive medical test in particular being a result of defensive medicine is a big unfounded point there. Many facilities have tried to cut back on tests and lost money, not because of any increase in litigation, but because of a loss of revenue from said tests.
I find this interesting, and telling. The cost savings for reducing tests is a savings for whoever is paying the bill - the person receiving the care or the insurer. Would the effect of an individual hospital losing revenue from tests be a net gain or loss for the health insurance system? Would costs in other areas have to rise to cover lost revenue, or would there simply be less waste overall and an adjustment to the income/payout structure for providers?
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by whitefire:
I find this interesting, and telling. The cost savings for reducing tests is a savings for whoever is paying the bill - the person receiving the care or the insurer. Would the effect of an individual hospital losing revenue from tests be a net gain or loss for the health insurance system? Would costs in other areas have to rise to cover lost revenue, or would there simply be less waste overall and an adjustment to the income/payout structure for providers?

Right now the insurance companies pass it to their customers, who have no choice but to pay the bill, because they can't easily switch providers and, even if they could, have no choices that are actually working to significantly reduce those costs.

(The one big push toward actively pushing controls it- managed care in the 90's- actually managed to very strongly to stop the cost of care from rising, but the system was so opaque and bureaucratic that people protested it out of existence. The big problem was that it rationed service instead of working to actually reduce the cost of services.)

On the other hand groups like Kaiser and the Mayo clinic, by charging on a patient basis rather than a service basis manage to overcome that problem- the MRI becomes an operating cost, rather than an expense that must be paid by use of the MRI, so there's no motivation to use it when it's not needed.

There are many possible variations and pitfalls, but the entire thrust of the current reform effort isn't to actively try to pick any single solution, but to put price pressure on the market so that it in turn forces providers and insurance companies to respond to that pressure by working out what models are best for them.

What we're doing is almost the opposite of a government takeover- instead it's finally establishing the baseline terms essential for a free market to actually function properly.
 
Posted by JWatts (Member # 6523) on :
 
quote:
Originally posted by yossarian22c:
4) Reduce the Medicare age to 55.

This portion of the current plan is pretty much absurd. Currently Medicare is expected to be completely in the red by 2017.

quote:
According to the Medicare Trustees, the hospital portion of Medicare will begin running a deficit in 2017. Medicare has a present-value unfunded liability of $13 trillion over the next 75 years.
Link

So basically we've got an expensive program, that we can barely afford now, won't be able to afford by 2020 and the plan is to substantially increase its costs. That's pretty much a completely irrational act.
 
Posted by shagdrum (Member # 6029) on :
 
quote:
All three of these:
My question simply listed those as examples. It did not hinge on those being assumed as fact. So again, I ask, what specifically makes my question a loaded one?

As to the defensive medicine concern, it is not "unfounded" as you say. It is a very legitimate and empirically backed concern that should be addressed in any serious legislation aimed at reforming healthcare. Here is a passage from a blog post by CBO director Douglas Elmendorf concerning an update to a CBO analysis of tort reform:

CBO now estimates that implementing a typical package of tort reform proposals nationwide would reduce total U.S. health care spending by about 0.5 percent (about $11 billion in 2009). That figure is the sum of a direct reduction in spending of 0.2 percent from lower medical liability premiums and an additional indirect reduction of 0.3 percent from slightly less utilization of health care services. (Those estimates take into account the fact that because many states have already implemented some of the changes in the package, a significant fraction of the potential cost savings has already been realized.)

Enacting a typical set of proposals would reduce federal budget deficits by roughly $54 billion over the next 10 years, according to estimates by CBO and the staff of the Joint Committee of Taxation. That figure includes savings of roughly $41 billion from Medicare, Medicaid, the Children’s Health Insurance Program, and the Federal Employees Health Benefits program, as well as an increase in tax revenues of roughly $13 billion from a reduction in private health care costs that would lead to higher taxable wages.


There is also this IBD article which points out:

The accounting firm PricewaterhouseCoopers says about 10% of the cost of medical service is attributable to medical malpractice lawsuits. Roughly 2% is caused by direct costs of the lawsuits; an additional 5% to 9% is due to expenses run up by defensive medicine.

It is not a concern that should be dismissed out of hand...

As to the Massachusetts example; Romneycare is hardly a shining example of success for the public option, quite the opposite actually. From a CATO Institute piece:

The most sweeping provision in the Massachusetts reforms — and the legislation before Congress — is an “individual mandate” that makes health insurance compulsory. Massachusetts shows that such a mandate would oust millions from their low-cost health plans and force them to pay higher premiums.

The article also points out...

"The effect," writes the Boston Globe, "has been to provide more comprehensive insurance than in most other states but also to raise costs." Premiums are growing 21 to 46 percent faster than the national average, in part because Massachusetts' individual mandate has effectively outlawed affordable health plans.

It is basic economics, you cannot increase medical coverage (a scarce resource) and reduce costs (through market forces). If prices do not fully cover costs then what you have is basically an unsustainable Ponzi-scheme.

I do agree that introducing market pressure to reduce costs is key here, but a "public option" does not do that. We have plenty of providers and one that can price in a predatory manner (due to being backed by the taxpayer dime) would only drive out private competitors.

In fact, the political scientist who originally sold the idea of a public option to Democratic candidates (Jacob Hacker) said it was to bring about a single-payer system by driving out private competitors.

As to the point about supply and demand pushing them toward greater efficiency, it already does that. Their prices are already at an equilibrium given the various restrictions on the healthcare industry already. Medicare doesn't increase efficiency; it distorts the market and increases costs (though effectively long term predatory pricing which drives up costs). In fact, doctors who have stopped treating medicare patients have been able to reduce costs to their remaining patients...
 
Posted by shagdrum (Member # 6029) on :
 
Pyrtolin , why do you think health care costs have increased at such a high rate? What factors lead to it's increase in your view?
 
Posted by Pyrtolin (Member # 2638) on :
 
The average price of premiums dropped 40% in Massachusetts during the time that it's bill has been implemented:

http://voices.washingtonpost.com/ezra-klein/Gruber%20House%20nongroup%20premium%20analysis%2011-2.doc
quote:
In their December 2007 report, AHIP reported that the average single premium at the end of 2006 for a nongroup product in the United States was $2,613. In a report issued just this week, AHIP found that the average single premium in mid-2009 was $2,985, or a 14 percent increase. That same report presents results for the nongroup markets in a set of states. One of those states is Massachusetts, which passed health-care reform similar to the one contemplated at the federal level in mid-2006. The major aspects of this reform took place in 2007, notably the introduction of large subsidies for low-income populations, a merged nongroup and small group insurance market, and a mandate on individuals to purchase health insurance. And the results have been an enormous reduction in the cost of nongroup insurance in the state: The average individual premium in the state fell from $8,537 at the end of 2006 to $5,143 in mid-2009, a 40 percent reduction, while the rest of the nation was seeing a 14 percent increase.
(You'll note that to get its numbers, the Cato institute included 3 years before the bill was in effect and nothing stopped premiums from rising apace with the rest of the country.)

And additionally, according to the Massachusetts DOR:

http://blog.hcfama.org/?p=3988

quote:
Fully 98.3 % of tax-filers complied with filing health insurance information with their taxes. The 2008 filing required month-by-month determinations, as opposed to 2007’s requirement of Dec. 31 only.
Over 96% of tax-filing adults who completed the Schedule HC had coverage at some point during calendar year 2008; almost 96% had coverage for the full year.
45,000 filers, uninsured and deemed able to afford insurance, were subject to a penalty—down 25% from last year’s 60,000 penalized.
Insurance was unaffordable for about 21,000 (plus 88,000 under 150% fpl) individuals for the full year of 2008 and 24,000 individuals (plus 47,000 under 150% fpl) for part of the year.
To date, the State has assessed $16.4 million in penalties, which will be deposited in the Commonwealth Care Trust Fund.

So yes you might get back as much as 1.5% on tort reform (though Texas didn't see that much even, because there's no motivation to pass that savings on to consumers) but that's peanuts compared to a system that has actually managed a 40% reduction in practice.

[ December 14, 2009, 11:00 PM: Message edited by: Pyrtolin ]
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by shagdrum:
Pyrtolin , why do you think health care costs have increased at such a high rate? What factors lead to it's increase in your view?

The number one factor is lack of consumer leverage to protest rising prices. Individual consumers cannot reasonably switch providers when costs are increased or services reduced, so people have no choice but to pay whatever price is asked or else lose critical care. Even those with employer benefits have only a narrow range of providers to chose between at best. Additionally, people don't understand that employer provided benefits come at a direct cost to their salaries and, in selecting toward more expensive plans when choosing jobs incur both a loss of wages and contribute to the rising cost of care.

On top of that, the fee for service model of care actively encourages unnecessary tests and procedures, because they translate directly into additional profits, but since there is no real pressure from the insurance companies to limit such practices (because they can transfer the costs back to their captive customers) The cost of the equipment for such test is also unconstrained because our hospitals can transfer the costs, so they accept markups that are at least and order of magnitude more that what other countries are able to negotiate the prices down to.

Most of all, though, the per-procedure cost of care (eliminating the situation of defensive medicine requiring additional procedures) it exceptionally high under Medicare and at least twice that from private payment sources.
 
Posted by Pyrtolin (Member # 2638) on :
 
http://www.fivethirtyeight.com/2009/12/why-progressives-are-bat****-crazy-to.html

Is a pretty good analysis of why the bill is still necessary as a baseline even if Liberman has managed to shift the goalposts several times in favor of insurance companies, even by reversing himself on a position he was advocating three months ago.
 
Posted by yossarian22c (Member # 1779) on :
 
I looked at the 538 post and the overall cost seems to be about the same. The fact that some of the cost gets shifted to federal subsidies doesn't really make me happy.
 
Posted by Pyrtolin (Member # 2638) on :
 
Yeah, we couldn't do with removing the financial burden of basic health care from lower and middle income families. They might actually have a chance for economic success.

More seriously though, relieving the direct financial pressure is the most important goal. Cost control measures are useful, but something needs to be done during the much longer time that they will require to take effect, especially if we're going to wait for the market to slowly create them naturally rather than explicitly imposing them.
 
Posted by Pyrtolin (Member # 2638) on :
 
And here's a good discussion that points out that nearly half the bill is actually devoted to testing out cost control programs:

http://www.newyorker.com/reporting/2009/12/14/091214fa_fact_gawande?currentPage=all#ixzz0ZlZtZebl

So cost control is definitely the lion's share of the bill, but we first need to find out which methods are the most effective before we can accurately predict how to project their effect.
 
Posted by shagdrum (Member # 6029) on :
 
quote:
Originally posted by Pyrtolin:
The average price of premiums dropped 40% in Massachusetts during the time that it's bill has been implemented...

...a system that has actually managed a 40% reduction in practice.

Mass may have reduced prices(though that is debatable) but not costs which are rising faster then the rest of the nation.

In fact the price thing is an illusion because, in large part, it is payed for by large state subsidies (which hide the actual price of the premiums). When you account for the true prices, the numbers you get are close to the CATO numbers.

If you are not lowering prices by lowering costs, then any lower price is artificial. The government has a number of mechanisms for this (like arbtrarily lowering medicare reimbursement rates,or subsidizing the price of premiums on the taxpayer dime). These simply transfer and hide the full price involved.

Also, as alluded to in the passage you cite, they are using the first year of this legislation as the baseline in reaching their conclusions. If you are looking to study the long term effects of this legislation you have to compare it to a time before that legislation was enacted (hence the three years before the legislation in the CATO article). What you choose as a baseline is very important in those type of analysis and is a way in which the numbers can be manipulated.

The big point, though, is that price is only relevant to this discussion as a reflection of cost. Only by reducing costs (not prices) can you reform healthcare for the better. Any policy that simply redistributes costs and covers up prices only makes this situation worse, in the long run.

quote:
The number one factor is lack of consumer leverage to protest rising prices. Individual consumers cannot reasonably switch providers when costs are increased or services reduced, so people have no choice but to pay whatever price is asked or else lose critical care. Even those with employer benefits have only a narrow range of providers to chose between at best. Additionally, people don't understand that employer provided benefits come at a direct cost to their salaries and, in selecting toward more expensive plans when choosing jobs incur both a loss of wages and contribute to the rising cost of care.
While I would disagree that this is the number one factor, and I am not to sure about your characterization of it, I do agree with you that it is one of the main issues. Why do you think the situation is how it is now? How did it come to be that consumers don't have the same level of choice in buying healthcare as they do in buying a car (for example) or most any other good?
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by shagdrum:
[While I would disagree that this is the number one factor, and I am not to sure about your characterization of it, I do agree with you that it is one of the main issues. Why do you think the situation is how it is now? How did it come to be that consumers don't have the same level of choice in buying healthcare as they do in buying a car (for example) or most any other good?

First and foremost- you can pick any car you want from any dealership you want. Once you buy a car from one, you're not penalized if you later decide to buy a car from another one. Not having a car doesn't mean that the price of a car is higher for you either.

Second- a suggested price is listed on each car that is static to the car. The dealership does not ask you to detail why you need a car then set the price higher based on the fact that you need one more.

Third- consumers don't mortally need cars. The vast majority can get by with a bike, public transit, or help from others with transportation. No one is buying a car in a life or death situation where they can't say "no".

Fourth (as appropriate)- your car isn't an employer tied benefit. They may help you get some perks toward getting one, but you still have a say in what you choose to get, and you get the money directly to pay for it, rather than having it bought for you. And your car isn't just taken away from you if you lose your job. You also see the price of the car when you get it and know how much of your income it's going to cost you.

The fact that all of the are true for health care means that consumers have little to no leverage against prices. Pre-existing condition limitations mean that if they have care, they cannot reasonably switch providers because the other providers can actively price them out of the market. It also means that their current provider can push the costs up arbitrarily high and they have to choose between paying the costs or not being able to afford treatment.
 
Posted by yossarian22c (Member # 1779) on :
 
quote:
Originally posted by Pyrtolin:
Yeah, we couldn't do with removing the financial burden of basic health care from lower and middle income families. They might actually have a chance for economic success.

More seriously though, relieving the direct financial pressure is the most important goal. Cost control measures are useful, but something needs to be done during the much longer time that they will require to take effect, especially if we're going to wait for the market to slowly create them naturally rather than explicitly imposing them.

I'm not opposed to subsidies. However with everything that has been cut out of the bill I think the mandate needs to bite the dust as well. With the mandate gone I would be fine with the rest of the bill passing, subsidies and all.
 
Posted by yossarian22c (Member # 1779) on :
 
I'll also note that Howard Dean and Keith Olbermann have now come out against this version of the bill. They are mostly noteworthy because of how ardently they have supported the bill to this point. So now the bill is becoming unpopular with the left as well.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
I'm not opposed to subsidies. However with everything that has been cut out of the bill I think the mandate needs to bite the dust as well. With the mandate gone I would be fine with the rest of the bill passing, subsidies and all.
Why? If you drop the mandate, you have to drop the ban on considering pre-existing conditions. If you do that, then competition is impossible.
 
Posted by yossarian22c (Member # 1779) on :
 
Health insurance companies have immunity from anti-trust laws. If we have a mandate with no government plan then there is no incentive for competition. We would have the government mandating you buy a product from potential monopolies. There will be no incentive to control costs when they can raise prices with impunity.

I'm not excited about dropping the mandate and pre-existing condition coverage but its about choosing the lesser of two evils at this point.
 
Posted by Pyrtolin (Member # 2638) on :
 
The thing there is, though, that government isn't the only way to fight a monopoly, as long as people have at least some mobility between competitors. On the other hand, blocking people for pre-existing conditions prevents any real mobility at all. So, while this move is less than ideal, it at least creates the potential for people to pull against monopolistic behavior by imposing regulations that limit such abuses.

The next steps can include measures to introduce more competition, but this first step is necessary to create the possibility for any competition in the first place.

On a related note, do you understand what the general point of the anti-trust exclusion for health insurance is?
 
Posted by yossarian22c (Member # 1779) on :
 
Changing insurers would still be very difficult and potentially require changing doctors. If mobility is the goal we could regulate that insurers have to accept pre-existing conditions when changing policies.

Given how Republicans have treated this debate and used the filibuster do you really believe anything will get added after this year? They will almost certainly add seats in 2010 so if it doesn't get done now I doubt it will happen with Obama as president.

I do not know why the health insurers have anti-trust exclusion.
 
Posted by JWatts (Member # 6523) on :
 
quote:
Originally posted by Pyrtolin:
The thing there is, though, that government isn't the only way to fight a monopoly, as long as people have at least some mobility between competitors. On the other hand, blocking people for pre-existing conditions prevents any real mobility at all. So, while this move is less than ideal, it at least creates the potential for people to pull against monopolistic behavior by imposing regulations that limit such abuses.

I think this is a very good point.

Competition will increase and it will be beneficial to our society to eliminate the "pre-existing condition" roadblock in US health insurance.

Of course, this does entail making health insurance coverage mandatory. At least I've heard of no other ideas that would prevent individuals from gaming the system.
 
Posted by Pyrtolin (Member # 2638) on :
 
When you get right down to it, the penalty under the individual mandate is effectively a catastrophic coverage plan. A low rate that allows you access to coverage if something occurs that would require it.

[ December 17, 2009, 03:43 PM: Message edited by: Pyrtolin ]
 
Posted by whitefire (Member # 6505) on :
 
We talk a lot about getting insurance companies to compete, but when, for example, was the last time you saw a commercial for a real insurance company (Blue Cross, etc) on tv advertising "rates starting at $99/month"?
Especially targeting the young?
Maybe the employer based system makes this not cost effective enough, I don't know.
I think they could provide plans for young folks without jobs providing insurance relatively cheaply (I'm 26 and have a high deductible plan that runs $75/month each for me and my wife so I know its possible).
Imagine the problems that would be solved if there was a huge push by insurers to sell to 18 year olds. Many pre-existing conditions wouldn't be, early prevention would be a way of life, and people could choose their doctors, get to know them, and not have to worry about loosing them if they get another job.
I also wonder if you wouldn't end up with good/longtime customer benefits like you get with other insurance?
My point is considering you can get a decent plan for less than the cost of most folks cell phone bill, where's the need for the mandate, and why isn't this happening already?
 
Posted by MattP (Member # 2763) on :
 
quote:
My point is considering you can get a decent plan for less than the cost of most folks cell phone bill, where's the need for the mandate, and why isn't this happening already?
Because, as you've said, those plans are only available to the young and healthy. Get sick with anything but the most mundane occasional illness and any lapse in coverage leads to you being uninsurable. The young and sick start out that way. If a once-sick child's parents ever let their insurance lapse (if they even have it in the first place) then they are out of luck through no fault of their own. People that have chronic illnesses can't necessarily afford the deductible of the high deductible plans.

In other words, there are a lot of cases that simply have no options under the status quo system. Additionally, even if you think your current plan is adequate, insurance rates are trending up at 10-20% a year. That $75/month will double in five years while salaries likely continue to stagnate.

I also have doubts about how decent your plan can be at $75/month. I know my insurance over ten times that, though it is a "premium" employer-paid plan. How much is your deductible? What is the yearly/lifetime maximum payout? Which insurance company is it and what is their record for denying services? Do they have broad prescription support or do they only pay for a limited set of generics? Is that $75/month guaranteed for life? How much does it go up after you have a major illness?
 
Posted by Pyrtolin (Member # 2638) on :
 
Here's a good note on other cost control measures in the bill to help keep some downward pressure on the insurance companies, above and beyond the normal market forces that come into play when you can comparison shop and pick the best price/service offerings:

quote:
That's the market's solution to this problem. But the exchanges actually have a fail-safe solution, too. Rewind the tape to BCBS's decision to jack up premiums. Imagine that BCBS insures 420,000 people in California's exchange. As directed by law, they duly submit a notice to the Exchange Board saying they're increasing premiums. The exchange sends a letter back noting that underlying health-care trends don't justify that increase, which they're allowed to do under the law. BCBS says it doesn't care. The exchange, which doesn't much feel like being bullied, says fine, you're decertified. BCBS loses more than 400,000 customers, and has to reapply the next year.

And then, of course, there's the excise tax. Jack up your prices enough and suddenly you're paying a 40 percent surtax on the plan you're offering. Now you're way more expensive than the competition, and you're hemorrhaging customers.

(From: http://voices.washingtonpost.com/ezra-klein/2009/12/can_insurers_use_monopoly_pric.html
In general Ezra Klein has had some very good coverage of what's going on in the bill and how it's system will work)
 
Posted by whitefire (Member # 6505) on :
 
Matt -
To answer some of your questions. As I said, its a a high deductible plan ($2400/year), but for an additional $100/month/person I can upgrade to no deductible, with a $30 copay for all doctor visits and procedures. Its through Blue Cross, and has no lifetime limit, and the prescription coverage is average. My rates have only gone up $5/month for me, and in fact (due to recent law changes) have gone down for my wife over the last 3 years.
Mine is a version of the plan that is the preferred plan for CSX Railroad employees, and based on their experiences I have heard of no major record of denying service. Of course, they have the Cadillac version.
My point is if we got everyone buying into the system early many of the uncertainties of how much premiums will go up will be mitigated. Just like with life insurance - start earlier get better rates since they have longer to use your money when you're not sick.
Another thing I like is the HSA. Employers have the ability to contribute to it directly. Meaning you could keep you insurance even if you change jobs and all that might change is the contribution amount.
As for your other comments, no insurance, save life, has rates guaranteed for life, and I have always doubted the value of those $500-1000 per person plans. If employees had to pay those costs directly, weighing that with the cost of paying some or most of their regular care themselves, I doubt very much those plans would continue to be so pervasive. Maybe that means that my cheap coverage would get more expensive, but I doubt how much because people would demand a low cost plan. If we could get away from a system that is near exclusively employer based we'd see some real competition.
My simple question is why was all this information so hard to find?
If the exchanges made it simpler that would be great, and I might support that idea. For now, I think that insurers have no incentive to promote their products directly to individuals.
My thought is instead of mandating coverage maybe we need to make it easier for individuals to get out of their employer based systems, and either let the market take over (in the form of advertising, etc) or if that fails, set up an exchange program.
 
Posted by FiredrakeRAGE (Member # 1224) on :
 
I would think that one major healthcare improvement would be to require that businesses give 'healthcare' money directly to the employees, who could then opt-in to the company healthcare plan. Divorcing businesses from the insurance industry would do more for competition and lowering prices than anything else I can think of.
 
Posted by JWatts (Member # 6523) on :
 
I'm very glad to see the latest version of the health insurance bill includes the following:

"Instead of a public option, the final bill would allow private firms for the first time to offer national insurance policies to all Americans across state lines. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress."

Link
 
Posted by Pyrtolin (Member # 2638) on :
 
Here's couple of pieces that should also please a few more folks here:

http://feeds.voices.washingtonpost.com/click.phdo?i=05eee275aa8ee90a7242fe0e48874fcd

States can ditch the individual mandate, and many other parts of the new system, if they can achieve equal or better results in other ways:

quote:
The waiver was inserted by Ron Wyden and it gives states considerable flexibility to walk away from parts of the bill if they believe they can better address cost and coverage on their own. The legislative language itself is complicated, but during the Senate Finance Committee's mark-up, Wyden clarified it with the committee's counsel. "My reading of what we have in the bill now," Wyden said, "is if a state can demonstrate that they can meet the criteria -- particularly on cost containment, improving the delivery system -- they can do it without an individual mandate. And can I ask, counsel, is that a correct reading of the Waiver Amendment that I offered?"

Counsel's reply was one word: "Yes."

Also:

http://feeds.voices.washingtonpost.com/click.phdo?i=3db468cbbc74c967efb3d12a63fb560c

States can opt to allow insurance companies to cross their borders:

quote:
The legislation allows states to form voluntary compacts with one another. California and Oregon, for instance, could decide that they want to allow insurers to offer products across both states, as that means a larger market for insurers to chase and thus more leverage for the California/Oregon exchange.

 
Posted by Pyrtolin (Member # 2638) on :
 
Oh and:

http://www.bobcesca.com/blog-archives/2009/12/the_sanders_ame.html

quote:
Bernie Sanders has successfully added $10 billion for primary care. Some details:

-Forgives medical school debt for doctors who choose primary care, increasing the number of primary care doctors by 20,000.


 
Posted by G2 (Member # 2942) on :
 
quote:
Forgives medical school debt for doctors who choose primary care, increasing the number of primary care doctors by 20,000.
no wait .... 500,000 ... no, 1,000,000 ... yeah, that's the ticket. If we're just gonna throw out made up numbers, let's make'em big! [Roll Eyes]

Hey by the way, according to this made up number, we could expect 20,000 new medical students. We all know there's not enough room for another 20,000 students so when the demand increases while the supply does not what happens? That's right, the price goes up. It's okay, shout it out when you know the answer.

How much will it go up? As much as the market will bear of course. When you'll never have to pay for the cost of medical school, how much can a medical school charge you before you think it's too much? $100,000 a year? $500,000 a year? Maybe a million? What the hell do you care? You don't even need to see a bill. Go to med school, go to primary care and you're free and clear. This little idea virtually guarantees soaring costs for medical school students as it distorts the market beyond rationality.

Freaking brilliant. Just freaking brilliant. [Roll Eyes]
 
Posted by Pyrtolin (Member # 2638) on :
 
" We all know there's not enough room for another 20,000 students so when the demand increases while the supply does not what happens? "

Or facilities expand so that supply can meet demand. Also, this didn't say total doctors- so some portion of those would be people who would have otherwise gone into more profitable but less necessary specialties going into primary care (which would implicitly bring down the need for specialists as well.)

Medical schools still need to attract students that won't be planning to apply for such relief as well, so this comparatively small amount isn't going to affect much in any case.

Tuition inflation in general is a separate problem that does need to be addressed though, as many such institutions use a lot of hand waving to milk the system or gain the prestige associated with higher price tags. I'd like to see a .5% or 1% tuition tax on all institutions that use aid programs as an incentive to keep them more honest in their pricing so that jacking up rates then selectively using internal scholarships to effectively reduce it for those that can't pull in external aide actually costs them something.
 
Posted by G2 (Member # 2942) on :
 
quote:
Originally posted by Pyrtolin:
" We all know there's not enough room for another 20,000 students so when the demand increases while the supply does not what happens? "

Or facilities expand so that supply can meet demand.

Expansion of medical schools? That has not been happening and there's no reason to believe this legislation will drive that.


quote:
Originally posted by Pyrtolin:
Also, this didn't say total doctors- so some portion of those would be people who would have otherwise gone into more profitable but less necessary specialties going into primary care (which would implicitly bring down the need for specialists as well.)

There is no proof of this assertion, implicit or otherwise.

quote:
Originally posted by Pyrtolin:
Medical schools still need to attract students that won't be planning to apply for such relief as well, so this comparatively small amount isn't going to affect much in any case.

There are about 67,000 medical students in the US. This is not a "comparatively small amount" they're talking about. It will most certainly affect the entire medical school structure.

quote:
Originally posted by Pyrtolin:
Tuition inflation in general is a separate problem that does need to be addressed though, as many such institutions use a lot of hand waving to milk the system or gain the prestige associated with higher price tags. I'd like to see a .5% or 1% tuition tax on all institutions that use aid programs as an incentive to keep them more honest in their pricing so that jacking up rates then selectively using internal scholarships to effectively reduce it for those that can't pull in external aide actually costs them something.

The problem is artificial manipulation of the market and your solution is even more artificial manipulation. When you're digging yourself into a hole, the first step is to stop digging.
 
Posted by munga (Member # 6006) on :
 
Pyrt,

Wouldn't it be great if the bill passed before Christmas?

Or, alternatively, think how monstrous the republicans will look, for denying people medical care over Christmas. It's a hollow victory but a victory still.
 
Posted by Pyrtolin (Member # 2638) on :
 
The Senate bill will be done, one way or another on the 24th (unless the Republicans stop playing absurd procedural games just for the sake of drawing out the process) Then the bills need to be consolidated into one and pass both chambers again; even if the House was going to rubber stamp the Senate bill, we'd need them to come back into session first.

We'll have the next step in the process by then at least, though.
 
Posted by kmbboots (Member # 6161) on :
 
quote:
Originally posted by JWatts:
I'm very glad to see the latest version of the health insurance bill includes the following:

"Instead of a public option, the final bill would allow private firms for the first time to offer national insurance policies to all Americans across state lines. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress."

Link

That is a good thing, but how is it "instead of a public option"? That isn't a replacment for a public option at all. It is sort of like saying, "instead of a sandwich, I built a bookcase."
 
Posted by munga (Member # 6006) on :
 
I mourn the losses to this bill, and yet hope the modified thing gets through somehow.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by kmbboots:
quote:
Originally posted by JWatts:
I'm very glad to see the latest version of the health insurance bill includes the following:

"Instead of a public option, the final bill would allow private firms for the first time to offer national insurance policies to all Americans across state lines. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress."

Link

That is a good thing, but how is it "instead of a public option"? That isn't a replacment for a public option at all. It is sort of like saying, "instead of a sandwich, I built a bookcase."
They're non-profit, and the rates are negotiated using the weight of the current government risk pool. It's definitely not Medicare +5% or anything as powerful as that, but it's more like a slice of toast, maybe with some butter, in comparison to the sandwich.
 
Posted by JWatts (Member # 6523) on :
 
quote:
Originally posted by kmbboots:
quote:
Originally posted by JWatts:
I'm very glad to see the latest version of the health insurance bill includes the following:

"Instead of a public option, the final bill would allow private firms for the first time to offer national insurance policies to all Americans across state lines. T

That is a good thing, but how is it "instead of a public option"? That isn't a replacment for a public option at all. It is sort of like saying, "instead of a sandwich, I built a bookcase."
My point was in regards to the finally offering insurance across state lines. I've always believed that the restricting policies to state by state coverage did great harm to competition and ends up with higher payer premiums.

As for the phrase "Instead of a public option", you'd have to ask the Washington Times. I'd imagine that it was part of the horse trading to get the bill through the Senate. i.e. some senator said I won't vote for a public option plan and another senator said I won't vote for it without a national insurance policy option.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by JWatts:
My point was in regards to the finally offering insurance across state lines. I've always believed that the restricting policies to state by state coverage did great harm to competition and ends up with higher payer premiums.

Except that all it actually does it prevent all the insurance companies from migrating to the state with the most lax restrictions, the way the credit card companies did as soon as such restrictions were lifted from them.

You should like even better the provision that allows states to agree to allow full interstate competition on an individual basis so that they have the needed control to ensure that their standards are met.
 
Posted by cb (Member # 6179) on :
 
The vote to end debate passed in the dark of night, made possible by your money and mine being used to bribe, conjole and influence votes. So much for Obama ushering in The Most Transparent Administration Ever and The Most Ethical Congress ever.

So many of you wanted this 2000 page monstrosity and...for all intents and purposes...you've got it. Now be prepared to be told when to jump and how high. The federal government will now have complete largess in telling us how to live our lives since they now have total vested interest.

Once Cap and Trade (or some other kind of eco-nonsense similar to it) is passed these same caring bureaucrats will be able to come into our homes and tell us what temperature to keep our homes, how much water we can use and, eventually, even where we can live; all in the name of "global warming".

What a lovely Brave New World we have before us.

[ December 22, 2009, 11:36 AM: Message edited by: cb ]
 
Posted by kmbboots (Member # 6161) on :
 
quote:
Originally posted by Pyrtolin:
quote:
Originally posted by kmbboots:
quote:
Originally posted by JWatts:
I'm very glad to see the latest version of the health insurance bill includes the following:

"Instead of a public option, the final bill would allow private firms for the first time to offer national insurance policies to all Americans across state lines. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress."

Link

That is a good thing, but how is it "instead of a public option"? That isn't a replacment for a public option at all. It is sort of like saying, "instead of a sandwich, I built a bookcase."
They're non-profit, and the rates are negotiated using the weight of the current government risk pool. It's definitely not Medicare +5% or anything as powerful as that, but it's more like a slice of toast, maybe with some butter, in comparison to the sandwich.
Ah...I didn't understand that the private firms mentioned where [i]non-profit[i] private firms.

cb, "we" didn't want a "2000 page monstrosity". "We" wanted a fairly simple public option or, better yet, single payer. "We" got a 2000 page monstrosity because of all the people who didn't want what "we" wanted.
 
Posted by Pyrtolin (Member # 2638) on :
 
Keep in mind that 2000 pages represents a lot of formal overhead because its written as amendments stacked on top of amendments and the like, rather than one finalized document.- the final bill when consolidated is likely to be about 400 pages.

(And about half of that is devoted to assorted cost control pilot programs that don't get much press because the CBO didn't rate them as their overall effectiveness was, as yet uncertain.)
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by cb:
The vote to end debate passed in the dark of night,



Nice use of incidental timing to connote shady business, when it was really just a logistical necessity because of procedural obstructionism.

quote:
made possible by your money and mine being used to bribe, conjole and influence votes.


AKA standard negotiation that has always been part of the process. The only shame there is that only one party was even willing to work out compromises to get something done; the Republicans' only goal here was to make sure that nothing happened.

quote:
So many of you wanted this 2000 page monstrosity and...for all intents and purposes...you've got it. Now be prepared to be told when to jump and how high. The federal government will now have complete largess in telling us how to live our lives since they now have total vested interest.
If by that you mean that now people will take a much more active interest in future healthcare reforms because we'll all be seeing the full costs, you're right. Now that the matter is acutely on the table, we won't be able to get away with ignoring the more fundamental problems for a decade and a half at a time, has has been the trend over the last half century or so.

quote:
Once Cap and Trade (or some other kind of eco-nonsense similar to it) is passed these same caring bureaucrats will be able to come into our homes and tell us what temperature to keep our homes, how much water we can use and, eventually, even where we can live; all in the name of "global warming".
And now you've left any form of apparent logic behind and just seem to be reciting fantasies designed to appeal to confirmation bias and scare people despite having not grounding in the real world.
 
Posted by JWatts (Member # 6523) on :
 
quote:
Originally posted by Pyrtolin:
Except that all it actually does it prevent all the insurance companies from migrating to the state with the most lax restrictions, the way the credit card companies did as soon as such restrictions were lifted from them.

That's a completely unproven assertion that has no basis in reality. The Credit card companies migrated to the state that taxed them the least and didn't cap their rates aka "Delaware".

Every credit card company must still abide by the laws of the state a customer lives in. Have you never even read a credit card contract? They have all kinds of exceptions for various states.

So your argument is flat out wrong and even the example you state is flat out wrong.
 
Posted by Pyrtolin (Member # 2638) on :
 
quote:
Originally posted by JWatts:
quote:
Originally posted by Pyrtolin:
Except that all it actually does it prevent all the insurance companies from migrating to the state with the most lax restrictions, the way the credit card companies did as soon as such restrictions were lifted from them.

That's a completely unproven assertion that has no basis in reality. The Credit card companies migrated to the state that taxed them the least and didn't cap their rates aka "Delaware".

Every credit card company must still abide by the laws of the state a customer lives in. Have you never even read a credit card contract? They have all kinds of exceptions for various states.

Some secondary conditions business conditions, sure, but as you note above, Delaware and South Dakota got most of them, because the were able to use local laws to skirt the usury lays in other states and ignore local State caps on interest rates. If those other regulations had been seen as equally important they could easily have spent the legal fees to get them officially loosened as well under the precedent they already had in their favor.
 


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