Thank you Chief Justice Roberts, you are a wise man.

[Brad L]

What is wrong with a single payer system? Medicare for all?

What I don't understand is you seem to agree there is a problem (I think the majority of people do...healthcare costs are too high). And, I think most agree that insurance companies are at least part of the problem. So, it seems the options are to have what we had before Affordable Care Act (though, that seems clearly unsustainable), have something like we now have with the Affordable Care Act, or have a single payer system.

Do you see other options? If so, what are they and what do you think is the way to address the problem of healthcare costs being too high (especially for the outcomes we get for what we pay)? Or is it that you think we should have no policy and let the market function unregulated (though, if you believe that, then I think you will have to agree that many people simply will not have or be able to afford healthcare- i.e., if you are sick and can't pay, you will either stay sick or die; if so, is that okay? I also think you will essentially be arguing that Medicare should be abolished).

First, I don't believe this new solution will lower costs for the average middle class American. In fact I believe we'll be paying more and getting less, far less. The term affordable health care is meaningless and is named that only because law makers have the power to call their bills whatever they want. I think the country should have taken its time and created a system that was sustainable, preserved the open market, and guaranteed citizens will continue to have the right to choose their doctors and the medical procedures available to them. Should we really be adding another huge entitlement that we can't afford? Should we not look to Greece and our own debt problems as warnings?

Over the long term I believe a single payer system will decrease the quality and incentive of doctors and researchers; medical innovation will suffer. Obamacare was designed to evolve into a single payer system eventually, which is why I think a lot of people are so upset. I think a better solution could have tackled the problems of preexisting conditions and rising prices rather than pushing us into a single payer system. The new system does little to confront the main reasons that healthcare costs are rising.

 

[Brad L]

Jut FYI since we are all probably discussing this elsewhere and in-person.

The general European model in Germany. Switzerland and some others is NOT a National Health Service nor is it government taking over the medical industry. It is basically a health insurance model with REGULATIONS.....not that much different than Obamacare with a lot of enhancements.

In Germany, for instance, you have your pick of virtually dozens (maybe hundreds) of insurance companies but if you like you don't have to choose one and are automatically in the "default basic government run" plan.....which is somewhat like Medicare. (if anyone here is German, please correct me if I am wrong!).

Medicare, Brad, is government RUN......but it is not government providing the services making the profits, taking over the entire system, etc. - it is simply government administering the payments and making some regs to make sure they get what they pay for and the treatments are sound. That's a long way from a "government takeover" .

I know what medicare is and I know what medicaid is. There is no need for the caps.
If you look at my comment I was responding to someone who suggested the dissolution of all insurance companies.

 

[BGL]

The only way to get rid of medical insurance is for government to completely take over the medical industry.

Insurance isn't health care. Eliminating insurance industry from taxing health care does not affect health care other than eliminate 50% of current costs which is the insurance industry tax on US health care.

As for "take over the medical industry" that is factually incorrect. It is red herring hyperbole used to inflame a reactionary minority who think "Stop" signs are unconstitutional. Health care providers, MD's, RN's, hospitals, clinics, etc will continue exactly as they are today, not government employees. For example look at Pentagon and military spending. Pentagon is the sole buyer but are Boeing, Lockheed and the thousands of military contractors and millions of people in those companies "taken over by the gummint"? No. It's ideological nonsense.

Again look at the MANY systems in Asia/Pacific, Europe that provide 100% of the population with health care at 50% of the cost of US system with much better health care results.

There are many working models to choose from. US insurance industry based system does not work and never will.

 

[DBA]

Because they all have interlocking contracts of agreed pricing and networks which is why the fiction of "choosing your own" doctor is a fiction. The MD must be signed up with your insurance company and with a particular hospital. Also the fiction of "I can see my MD anytime" as anyone knows MD's are all booked so usual wait is about 30 days.

Again you're spewing stuff as if it were true across the board. I don't have a network to worry about and can go to any doctor I want. Last time I went to my MD I called and saw him the same day. I've also called and saw my Orthopedic doctor within 1 1/2 hours.

I'm curious as to what city/state you live in, maybe your area is overcrowded and has poor health care, however that doesn't mean that it's like that everywhere.

 

[jadmperry]

I think a better solution could have tackled the problems of preexisting conditions and rising prices rather than pushing us into a single payer system.

But how? What I am missing is the way to achieve the goals....

Part of "Obamacare" made it illegal to deny insurance coverage for pre-existing conditions. Isn't that what you are saying should be done?

 

[Digital Doctor]

Over the long term I believe a single payer system will decrease the quality and incentive of doctors and researchers; medical innovation will suffer.

Entirely incorrect.
Second of all, some healthcare is better than none, and with the soaring cost of healthcare combined with America going bankrupt, you could very well end up with nothing.

 

[BGL]

Last time I went to my MD I called and saw him the same day. I've also called and saw my Orthopedic doctor within 1 1/2 hours.

You'd want to look at actual statistics vs. personal anecdotes of exceptionalism.

Average wait time to see MD in US on non-emergency basis is 27 days in the US. In comparison, lets look at the EEEK! most socialized medical system in Europe, UK. Also the note the key about getting to the GP (general practitioner) early and often. One of the reforms in the current health care bill is incentives and higher payments by insurance companies for primary care MD's. Seeing the GP/primary care doc quickly is key to lowering health care costs and increasing positive health care outcomes.

Patients want to be able to see a GP at times that are convenient to them. That is why the Department of Health has asked every primary care trust (PCTs) to open a new GP health centre, which will enable any member of the public to see a doctor or nurse at a time that suits them between 8am and 8pm, 365 days a year. The new centres will provide more appointments, longer and more convenient opening hours and will promote better health, better access and greater choice and flexibility for patients.

 

[Brad L]

Over the long term I believe a single payer system will decrease the quality and incentive of doctors and researchers; medical innovation will suffer.

Entirely incorrect.
Second of all, some healthcare is better than none, and with the soaring cost of healthcare combined with America going bankrupt, you could very well end up with nothing.

I think we only got half of your argument. If America goes bankrupt then I think there would be major disruptions in a socialist or open market system. In that case I'd rather not be dependent on the government that just folded.

 

[BGL]

If America goes bankrupt then I think there would be major disruptions in a socialist or open market system. In that case I'd rather not be dependent on the government that just folded.

You seem to have it backwards, as we saw with previous depression in '29 and current depression of '08, both triggered by unregulated Wall St financial waste, fraud and abuse, the Government was the the only thing left to depend upon. It was Social Security, Medicare/Medicaid that were safe while the Wall St insurance companies that went bankrupt costing people lost their jobs, homes and savings.

But to health care, since the Wall St insurance companies provide no health care, their being in business or not doesn't affect ability to provide health care. To the current debate, the Wall St insurance companies tax the US health care system 40% of every dollar and are responsible for 50% of current costs, none of which provide health care.

The evidence for this is the European systems which cost 50% less, cover 100% of the population and get better health care results.

 

[dutchbb]

He showed Obama is a liar. It's a tax. The rest should be decided in the elections, although you can't really trust Romney either.

Still the supreme court should have declared the tax as unconstitutional as well. It shouldn't have given government the option to use taxes as punishment for not buying a service (or product). The fact that the tax isn't considered high enough to be considered a punishment is irrelevant, the precedent is set.

 

[BGL]

He showed Obama is a liar. It's a tax.

It's a tax if you don't purchase private insurance. Kind of like gasoline tax. You can avoid it.

The rest should be decided in the elections, although you can't really trust Romney either.

We did. Health care was a big part of 2008 election. Obama promised a public option (buying into Medicare) and that is the biggest flaw in Obamacare as a public option is what 99% of people would choose (it's why the insurance industry opposed it). That would have cut the insurance industry out of the equation and lowered US health care costs substantially.

Still the supreme court should have declared the tax as unconstitutional as well.

Taxes are constitutional. Government is constitutional.

Funniest part of the Tea Party/Birther/Fox News reaction to Robert's decision was they were going to flee to Canada since minor health care reform was somehow taking away their "freedom". Fleeing to "socialized medicine" Canada, how hilarious was that.

 

[dutchbb]

It's a tax if you don't purchase private insurance. Kind of like gasoline tax. You can avoid it.

Of course it's not like a gasoline tax. It's not a tax on something you buy, it's a tax on something you decided not to buy. You are being punished by a tax, because you decided not to buy a service/product. That is clearly a violation of the US constitution on itself, since government can't and shouldn't force you to buy anything.

Now the supreme court did not see it as a punishment, because the tax according to them was not high enough. Of course that's ridiculous, the principle is there. Government can tax you when you do not buy what they want you to buy. If it can do it for health care, it can basically do it for anything. The supreme court also does not clarify when, according to them, it does become a punishment. Is it at $100? $1000?

Of course the whole thing will not work anyway, exactly because the tax is not high enough. So healthy people will pay the tax, and people who do need health care will pay and get at least their money out. This is not how insurance is supposed to work. And it will not work for that reason.

We did. Health care was a big part of 2008 election. Obama promised a public option (buying into Medicare) and that is the biggest flaw in Obamacare as a public option is what 99% of people would choose (it's why the insurance industry opposed it). That would have cut the insurance industry out of the equation and lowered US health care costs substantially.

No cutting out the private sector does not make any service or product cheaper nor does it increase the quality. However getting government in does increase price/costs and lowers quality. It's also completely unsustainable as I mentioned above.

Taxes are constitutional. Government is constitutional.

All direct taxes must be apportioned according to the constitution (Article I, Section 2, Clause 3). The US government has been ignoring the constitution for a long time, you can call that an unconstitutional government if you want.

Funniest part of the Tea Party/Birther/Fox News reaction to Robert's decision was they were going to flee to Canada since minor health care reform was somehow taking away their "freedom". Fleeing to "socialized medicine" Canada, how hilarious was that.

Some have said that the decision may actually be bad for Obama, and purposely done by Roberts to give Romney something to campaign about. Anyway, here are some videos worth a watch:

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[craigiri]

You should let folks know Schiffs dad has rotted away in JAIL for not paying his taxes!

What a hero.........

Of all the ridiculous arguments against health care for all, the idea of being "forced" is perhaps the silliest. Firstly, we'd have to believe that the righties really cared about the 6% of the populated which are estimated to be subject to the penalty. I don't believe that for one second. After that, you'd have to ask why someone whose father and grandfathers all died by age 50...has to be "forced" to buy SS and Medicare. We are also forced into paying for many other things, as Ira Schiff (peter's dad) can tell you.
http://en.wikipedia.org/wiki/Irwin_Schiff

That's the great thing about the modern age - we can find "experts" to tell us exactly what we want to hear and, along the way, drop any vestige of thinking, reason and logic.

According to many of these pundits, the control of a country of 310 million people is exactly the same as how you control your family or a small business. No complex systems. No need to protect people from fraud, predatory corporations, disease, etc.....

Sorry, that's a joke. Simplistic arguments are for simplistic minds.

 

[craigiri]

Funniest part of the Tea Party/Birther/Fox News reaction to Robert's decision was they were going to flee to Canada since minor health care reform was somehow taking away their "freedom". Fleeing to "socialized medicine" Canada, how hilarious was that.

They could go somewhere in Africa......to their libertarian paradise.

Or Cuba...oh, sorry, they have universal health care! Rush says he's moving to Costa Rica - oh, shoot, they have universal health care!

 

[BGL]

Of course it's not like a gasoline tax.

It is in the sense that it is a totally avoidable tax which was the example made.

You are being punished by a tax, because you decided not to buy a service/product.

No. You are paying for health care you will use now or in the future so you or society doesn't have a huge bill for health care in the future with no contribution by you.

That is clearly a violation of the US constitution on itself, since government can't and shouldn't force you to buy anything.

That is pretty much what Roberts said. Government can't make you buy Wall St products in lieu of health care services but government can tax you for health care costs.

No cutting out the private sector does not make any service or product cheaper nor does it increase the quality.

True in some cases. Not in others. Irrelevant in this case since cutting out insurance companies which provide no health care but consume 40% of every health care dollar benefits everyone.

However getting government in does increase price/costs and lowers quality.

Health insurance company overhead is 20% plus 15% profit vs. Medicare 3% overhead. So health care proves that statement wrong.

It's also completely unsustainable as I mentioned above.

Until Wall St insurance companies' 40% tax on health care is removed, US health care is sustainable just 50% more expensive than it should be and causing deaths, bankruptcy and huge drag on the economy. A Medicare for All system would save $500B per year.

 

[Brad L]

It's nothing like a gasoline tax, that's absurd. Gasoline is a product that you purchase. When government fines you or sends you to jail for lack of health insurance, what product did you buy exactly that required tax? Even though the court has ruled I don't accept that this is constitutional and probably won't change my mind until the matter is revisited by the court years from now. I don't agree at all with the numbers you keep throwing out there. You seem to completely ignore the service that insurance provides. Insurance is not health care. You can get care without insurance.

 

[BGL]

It's nothing like a gasoline tax

It is because both are avoidable taxes. Call them usage taxes. In case of health care, everybody uses it sooner or later, so if you don't pay privately, the government will tax you to pay your share. That is how it works and that is what Justice Roberts and the majority said was why it was legal, it used the government's legitimate taxing power for health care. Interestingly, this will eliminate the Wall St dream of privatizing Social Security, that would be illegal while the Social Security tax is not.

Even though the court has ruled I don't accept that this is constitutional and probably won't change my mind until the matter is revisited by the court years from now.

The most right wing court in a century just ruled in Constitutional so you may be waiting while. I was glad they ruled the requiring purchase of Wall St products for health care was illegal while government taxing for health care was legal.

Another interesting aspect of ruling that government taxing to provide health was legal confirmed that the real solution to US health care problems, Medicare for All, legal.

I don't agree at all with the numbers you keep throwing out there.

Whether you agree with the facts doesn't change them. US spends 18% of GDP on health vs. 10% for European systems. European systems cover 100% of the population, US system only 70% and a large percentage of those would be bankrupted by illness as the insurance is inadequate. US ranks 37th in World Health Organization comparative stats while Europe's various systems rank in the top 10%.

You seem to completely ignore the service that insurance provides.

Absolutely none as far as health care is concerned, money spent for insurance is money not spent on health care, about 50% of every health care dollar in US is wasted due to insurance.

These are 2008 numbers, US has grown to 18% of GDP in 2012 which can confirm on the same Kaiser Family Foundation site.. The huge gap is all due to US insurance industry based system and the tax it imposes. For example, during the current Great Recession, insurance prices have gone up 20% while GDP declined, wages declined, income declined, personal wealth declined. You see this in the much faster health care spending rise in US vs. Europe.

 

[Bain]

Everyone needs healthcare.
I'm not paying your bill when you get in a car accident.
So mandatory healthcare insurance is reasonable.

My own insurance will cover that and so far in the 20 years I've been driving, I haven't been in an accident once.
Mandatory health insurance is only reasonable if the federal government has the funds to pay for it without penalties or taxes. In other words, without burdening the American Citizens.

 

[BGL]

Mandatory health insurance is only reasonable if the federal government has the funds to pay for it without penalties or taxes

Mandatory health insurance is reasonable if everyone in their lifetime will require health care and, like public education which is also mandatory, it is in society's best interests that everyone get health care and an education.

Since everyone will, in their lifetime, require health care and will usually require the most when they are least able to pay for it (when they get older) it is reasonable and in national interest for everyone to contribute similar to public education.

Medicare for All would be easiest way for US to transition to national health plan. The reason the insurance companies spent billion$ successfully lobbying against the public option (Medicare for All) in the current plan is everyone would have chosen it and the insurance industry would have been unable to tax the health care system.

 

[Brad L]

It is because both are avoidable taxes. Call them usage taxes. In case of health care, everybody uses it sooner or later, so if you don't pay privately, the government will tax you to pay your share. That is how it works and that is what Justice Roberts and the majority said was why it was legal, it used the government's legitimate taxing power for health care. Interestingly, this will eliminate the Wall St dream of privatizing Social Security, that would be illegal while the Social Security tax is not.

Fuel taxes are excise taxes. By definition an excise tax is not paid directly by the consumer. Now that you know that, please explain how the obamacare tax is an excise tax. If I'm confused about your post, please explain what type of tax you think it is. Under the constitution congress has very specific powers of taxation and this does not seem to fit into any of them.

As for your charts, I'm not sure what you're trying to prove with that data. Everyone agrees reforms and changes were needed. The debate is over the implementation.