Conservatives and the ACA

From Urban Faith, by Christine Scheller, and this is but a small clip … read the whole thing:

On Tuesday, someone asked me what I thought of the Supreme Court ruling on the ACA. I took a deep breath and said I was glad it wasn’t struck down, because I need affordable health insurance sooner rather than later and the ACA is the engine that will give it to me.

I probably would have opposed it a decade ago when my husband was earning a six-figure income in home improvement sales and we were owners of an apartment building in addition to our own home.

But then my husband’s back gave out and he spent several years trying to do other kinds of work before he was forced to retire at age 47. He now lives in crippling pain every day and takes care of the house. His medical expenses will be covered for the rest of his life through Medicare, a supplementary plan that we pay for, and workers’ comp. He’s eligible, in part, for these benefits because he worked outside the home and was injured at work, while I mostly stayed home and raised children for 20 years.

So, what I’d also like to know is why the family values crowd thinks it’s okay to abandon women like me, who bought into their message and eschewed careers, but then had to re-enter the workforce because of death, divorce, or disability without the benefit of a strong work history? Is this really how they want to repay us?  You know, the uninsured mothers who serve as teachers’ aides in their children’s classrooms, or bring them their salad at The Cheesecake Factory, or wipe their aging parents’ bottoms so they don’t have to?…

I frequently hear insured people say that if the ACA survives, it will mean they won’t have access to timely medical care. This tells me they not only believe they have a right to health care, but that they have a right to the prompt delivery thereof. And yet, they don’t seem to think people like me and my son have any right to it at all. Well, I disagree with them. I need heathcare reform and I think I deserve it, not from “the government,” but from the society that my family and I have contributed to and served for most of our lives. I’m not saying Obamacare is the answer. I’m only saying that we need to solve this problem and the uncaring rhetoric of my conservative friends is speaking so loudly that I’m finding it difficult to hear anything else they’re saying about healthcare reform.

 

About Scot McKnight

Scot McKnight is a recognized authority on the New Testament, early Christianity, and the historical Jesus. McKnight, author of more than forty books, is the Professor of New Testament at Northern Seminary in Lombard, IL.

  • http://churchlandia.com Scott

    It is stories like this one that put on a face on this issue. Too often Christians talk about this as if it doesn’t include any people who are truly in need. Sadly, this nation is full of people like this woman and we need to realize that doing nothing isn’t a solution. Perhaps Obamacare isn’t the best answer but it is far better than watching injustice continue.

  • http://judybarrettblog.com Judy

    The problem stems from treating women as second class citizens. If the church teaches a man alone is to support his family, then the church must step up when the man cannot and not leave it to his wife to do so. It’s sad that we need to rely on the government to fix this problem. It is also why my daughters will have degrees that they can fall back on if something unfortunate happens.

  • RobS

    In a lot of ways, it seems conservatives did drop the ball on this issue for years. We didn’t see any effort to try to resolve a lot of healthcare related issues between Clinton and Obama.

    Personally, I’m worried that any organization that is as efficient as the Social Security Administration or the Department of Motor Vehicles is going to make health care management a mess. But if the conservatives had put forth a few universal ideas to try to contain costs or enhance care, it may be less than a crisis now. Some of the high deductible plans have helped (our family uses one with a pretty big deductible), but the government pouring (near) unlimited money into something is going to cause rapid cost increases (health care, higher education loans, etc)

  • JHM

    I have mixed feelings here. On one hand, I understand how people (especially conservatives) can come off as unconcerned about the plight of the poor and needed. Sometimes the emphasis on individual freedom and responsibility goes a little overboard. Bumper-sticker politics makes it worse.

    On the other hand, I feel like a lot of pro-ACA people (especially Christians) come across just as badly with an “if you don’t agree with ACA, you hate poor people and don’t care about injustice” attitude and I think that’s unfair. Republicans and conservative Christians I’ve talked to absolutely do want to help the poor and needed in our communities, but they believe ACA will not help in the long run.

    I really wish people would stop assuming that the motives of those who disagree with them politically are malicious. Democrats aren’t out to take away all freedom, Repulicans don’t want people to die. We do disagree on the “how”, but I think we agree very much on the basic idea that all people need affordable quality healthcare.

  • Kyle J

    @JHM

    I agree that reading into motives is dangerous, but it’s pretty tough in this case. GOPers are declaring a policy framework that members of their own party once supported–including the guy running for president on their ticket this year–as the “death knell of freedom.” And they have no coherent plan to replace it that would actually ensure coverage for the tens of millions who don’t have it right now. At some point, that position becomes an implicit statement that they simply don’t care whether the currently uninsured have health insurance, regardless of the initial motives of those who hold it.

  • Kyle J

    Longer take on that topic:

    http://nymag.com/daily/intel/2012/06/health-care-as-privilege-what-gop-wont-admit.html

    If there’s a plan out there that shows the GOP really just disagrees about the “how,” then great, but I have yet to see it and I’m paying pretty close attention.

  • Pat Pope

    Judy, your daughters will need more than degrees to fall back on. A lot of suburban women have degrees and chose to stay home, so when the time came for them to enter the workforce, they had little to no current or relevant work experience. It’s important that they have some sort of viable work experience because a degree alone will not cut it.

  • JHM

    Kyle J:

    Perhaps I should have clarified that the “what” that I mean with my “how” statement is not necessarily mean healthcare as a privilege, or even universal insurance coverage, I was specifically talking about the need for affordable quality healthcare. There is a lot of debate on what that means of course.

    As to the lack of a Republican alternative, while there are lots of little suggestions (tort reform, etc.) I largely agree the Republicans don’t seem to have a very comprehensive strategy. That doesn’t really mean they want the status quo either. It seems legitimate to me for Republicans to oppose and seek to reverse something (ACA) that they view as detrimental to American healthcare, even if they don’t exactly have a replacement yet. However, if ACA was reversed, I would then expect them to act fairly quickly in addressing the healthcare cost issue.

  • MatthewS

    Reading this, I can really feel those feelings of being left behind and ignored (even above and beyond the health care concerns). This isn’t just a debate about policy for someone who depends the health care, it’s their day to day quality of life.

    I would express that one of my concerns is that when you kill the goose you don’t increase your supply of golden eggs. If you kill the goose you will end up with more people who get subpar coverage, not fewer. If we had unlimited resources, we could pay for the health care coverage of every human in the world and that would be great.

    There is a medium sized company in my town that employs a good number of people and offers good benefits. Perhaps the fears are groundless, but they have expressed a concern that they will have to reduce benefits, reduce wages, and lay people off to afford this. Those people who get laid off are people, too, and they need health care, too. Is it sustainable to shift earners from the category of people who earn a decent salary and get decent benefits to the category of people on government care? Personally, I’m worried that Obamacare is going to kill the goose, even if it’s with the best of intentions. I do hope I’m wrong.

    Another concern is that people are looking to Obamacare with an idea of what sort of coverage it will provide. For various reasons, I’m worried they are looking at their own desires, not at the actual product that will be provided in the long run. It seems possible to me that the quality of health care in general in this country has now peaked.

    Regardless of what happens on the national stage, my heart goes out CAS’s family – chronic pain really takes a toll.

  • http://judybarrettblog.com Judy

    Pat- Thanks for clarifying that. It is an important point I should have included. I myself am a physical therapist who keeps her license current thru continuing Ed etc.

  • Kyle J

    @JHM

    Sure, it’s a legitimate position to oppose the ACA. But if, after three years of intensive debate, they don’t have a plan that expands access and address the very real problems raised in the piece above, then we shouldn’t pretend they’re going to suddenly come up with one over night when they take power. There’s being intellectually generous, and there’s being naive. Judge both sides on their records and their positions, not vague promises with no specifics to back them.

  • JHM

    Kyle J:
    The problem I have is, when I judge both sides on their records and their positions I don’t really see anything that I’m very confident will help the poor and needy. I have a hard time seeing where either party is really representing a King Jesus view so I don’t feel like I can either get behind or work against ACA. It tends to make me think that this issue won’t really be solved by political parties. My point was that what comes of as moral superiority of pro-ACA people isn’t necessarily warranted since many people on the other side also want affordable quality healthcare for all Americans.

  • http://www.lambpower.net Steve D

    Many of the problems that we face with healthcare have a great deal to do with the bureaucracy that has been built up within the medical/insurance industry. For example: co-pays and co-insurance are supposed to make those who consume healthcare think twice before using it. Co-pays are in essence a penalty for actually going to the doctor and getting treated or going for a checkup. The predicate is that most patients abuse the system (ie hypochondria). So, in order to control the supposed “abuse” of the healthcare system a penalty is assessed. There have been studies (I think either from Pew or Kaiser) that show that when co-pays are significantly reduced or eliminated, money is actually saved since treatment for more serious problems are detected earlier.

    I don’t see the ACA as being a magic bullet to solve all of the problems with healthcare. I do see that it does start to address some of the issues. I assume that it might take a couple of iterations of the law (amendments) to get it working well. However, what is needed is that the truth about the law be told. There have been exaggerations of the law on both sides of the discussion. Although, I have found that the conservative view has been much more hysterical and ultimately inaccurate in their narratives. I find this to be disingenuous. We do have a problem with our healthcare system, we need to address it and we need solutions. Threatening to repeal at this point in time is the equivalent to jamming on the brakes of a car going 60 miles an hour. Too much of the law has already been implemented to throw the whole thing out. Aside from that, the conservatives had no (public) plan to implement. I suspect that’s why Chief Justice Roberts switched his vote.

    What has bothered me the most is that we have lost sight of what the discussion should be about. How to get the best care for the best price. The focus seems to be on the mechanics of the law. Is it a tax or not should be second to whether or not people are being helped. There is a human side to this that seems to have gotten lost.

  • http://restoringsoul.blogspot.com Ann F-R

    Thank you for speaking out, Christine.

  • Seth

    I love the letter and agree with the spirit of it. JHM says it well that people often jump too quickly to accuse the opposing side of being malicious. I think almost all of us can agree that we’d like to see everyone who needs quality health care actually receive that without having to sacrifice basic needs like food and shelter to get it.

    I dont normally identify much with political conservatives, but I’ll say something on behalf of those who oppose the ACA. There is a difference between sharing/giving and forced sharing/giving. Jesus taught us to LOVE, not to vote in a candidate who would force everyone to give. Yes, King Jesus wants everyone in His kingdom to have enough, but that being a result of sharing borne out of true love and concern.

    If I had someone stop me in a parking lot at gunpoint and demand money from me so they could go feed the homeless downtown (whom Ive never met), I would probably not feel very gratuitous in giving them money to do it. If the same person came back once a week with his gun pointed at me, it would probably get old. TRUE that I might should give generously and with a smile, but lets have a little grace for people who arent that far along yet. TRUE that you could probably say I should already know the poor and needy around me, but lets have a little grace for people who build walls and stay in their comfort zone, because we do too. If we call for grace for the poor, lets remember to have grace for the rich (who are generally more miserable).

    Let us recognize that it is IMPOSSIBLE to care about a person you do not know exists. How could you? They are only an IDEA in your head until you know their story (Scot’s point in part). Imagine if you read the headline: “Man dies today in California.” So what. Who could care? Lots of men die everyday in California. And kids starve to death in Sudan. And earthquakes destroy homes in Chile. And Haitians die of simple diseases. And teenage gang members get shot in Detroit. And Im guessing not a single one of us reading this have been moved and stirred enough to give with any real deep, life-changing sacrifice to any of these causes (or we wouldnt be able to be online right now).

    So lets have grace towards people who are being “selfish” over the health care debacle. I mean, why choose to pinpoint the US Health Care system over the global food system or world violence or disaster aid, etc? My family is all on gov’t healthcare, but honestly, I would rather you use it to drill water wells for every town in Haiti first.

    Point is, to every side on this issue– lets have grace. Grace for those who disagree with us. Grace for those who withhold benevolence. Grace for people who abuse benevolence. Grace for people who fund it. Grace for those who refuse to. And please– grace for the poor. Whatever poor may mean.

  • Kyle J

    @JHM

    30 million people are going to obtain health insurance coverage due to the ACA. 30 million real people, many of whom have health issues just like the one described above. If you judge the costs created by doing that to be too large, that’s one thing. But you can’t just say that’s not real. I don’t understand trying to give credit to one side for something they’re not proposing to do.

  • http://LostCodex.com DRT

    JHM#12;

    ” It tends to make me think that this issue won’t really be solved by political parties.”

    Then who? And the government is us you do know, don’t you? We live in a democracy and the government is how we take action.

  • http://LostCodex.com DRT

    For those who toot the scarcity horn, what I hear is that you are afraid there will not be enough health care for you. You are obviously not worried about there being enough health care for the poor, because they don’t have it now, but if we give it to them then your worry is for yourself.

  • kierkegaard71

    I think it is only reasonable to ask why health insurance is so exorbitantly expensive. If you cannot answer why it is so expensive, then I have no idea how you can control cost. Put simply, health insurance is so very expensive because we have in place a legal structure and cultural expectation that every minor medical problem will be covered by insurance. The original intent of insurance is to help cover catastrophic situations by pooling resources across a population. However, by mandating coverage for every doctor visit, costs can go nowhere but up, because of the endless paperwork required to process insurance. The reason auto insurance has a reasonable cost is that we do not expect insurance to cover basic maintenance, such as oil changes. The ACA will not address cost, but it will only cause costs to further skyrocket through additional regulation. I want to say this carefully, but what we desperately need is economic literacy, not basing laws and legislation on emotional appeals alone. What we may find, as Europe is finding out right now, is that going the route of the welfare state, will end up bankrupting us all.

  • http://LostCodex.com DRT

    JHM, you say that you are not sure that it will really help. Well one thing is absolutely certain, doing nothing will not help. Boldness has genius in it. Take a step, step out! Do something!

    I find the scarcity and lack of efficiency arguments to be horrible. Those are things that can be fixed. My bet is that we are going to learn of new problems that were not anticipated and we will have to solve them. But we are trying. Isn’t that what Jesus wants, for us to try and take care of others?

    I hear you when you say that you have good reasons for not doing it. I just feel those reasons are selfish and short sighted compared with the problem.

  • http://LostCodex.com DRT

    kierkegaard71 #19,

    The health industry has found that getting regular maintenance decreases over all cost. That is why all the regular maintenance items are covered. They are covered because the expectation is that everyone needs to be getting them regularly.

    The car analogy is a poor one. Car insurance does not kick in if you do a bad job in maintenance. It kicks in if you have an accident. The equivalent for healthcare would be for it to not pay for cancer, but do pay for a broken arm.

    I too have a concern about the ACA helping to contain cost. But just because we pass this law does not mean that we can’t take additional steps once it is in place. But not passing the law ensures that the poor will not be covered.

  • kierkegaard71

    DRT #21,

    My point was to the economics of the issue alone. My point was that when you treat health care as a “right”, this inherently increases the cost of it and thus makes it less affordable for the poor. If you do not treat health care as a “right”, and thus eliminate or reduce the mammoth bureaucracy with its requirements, it makes sense that regular “maintenance”-oriented care would again become more affordable, as it once was. What the powers that be have decided is that a centralized planning mechanism that takes decision making out of the consumers’ hands and into the hands of bureaucrats is best for all. This is where we are headed. After ACA, cost-control will be implemented by means of restricting care where the bureaucracy deems that it should be restricted. To me, this does not empower individuals, including the poor. It makes us wards of the state. I am not defending the current corporatist system at all, but I fear that central government planning will make things worse.

  • Anna

    kierkegaard71,

    Mammoth bureaucracies restricting care is nothing new. Insurance companies have done it with impunity. They also have taken decisions out of the consumers’ hands and also out of the doctors’ hands by restricting what they will pay for or not pay for. Insurance companies are in business to make a profit, not to make anyone healthy; and making a profit happens through denying payment for medical care. My husband had a medical practice for several years. We saw it firsthand. And he provided lots of care he never got paid for.

    The issue here is not freedom from bureaucracies that restrict or deny access to medical care; the issue here is whether there are any checks on the corporate ones that have been in charge of the system for the last several decades.

  • Fish

    I would rather the government ration care than a corporation ration care.
    – A corporation will always take profit off the top.
    – A corporation will always seek to maximize profit.
    – A corporation is not accountable to the citizens it serves.
    – A corporation can do things with impunity that would get you or I sent to jail.
    – A corporation will hire the best lawyers available to fight you, right or wrong.
    – A corporation, structured by man with the sole goal of making money, is inherently in tension against the Kingdom of God.

    If my health care were to cost 1/2 or 1/3 of what it does now for a better product that serves all citizens, how specifically am I less free? Freedom and maximized profit are NOT the same thing.

  • http://www.lambpower.net Steve D

    kierkegaard71 #22
    “it makes sense that regular “maintenance”-oriented care would again become more affordable, as it once was. ”

    Actually, the reason why “regular maintenance oriented care” has become less affordable is that the rate of compensation for an Internist is substantially less than a specialist. If the Primary Care Physicians were compensated slightly better, there would be more of them and hence, the price would fall for the consumer. Sounds counter intuitive, but a PCP makes 50% less than a specialist in some cases. This causes a second problem in that EVERYONE wants to see a specialist when an Internist could do just as well.

    “What the powers that be have decided is that a centralized planning mechanism that takes decision making out of the consumers’ hands and into the hands of bureaucrats is best for all.”

    The decision making process has been out of your hands for years. Insurance companies make decisions on your care all of the time. Have surgery? You or your surgeon have to get the procedure approved by the insurance company’s Utilization Board. Have cancer treatment? a transplant? same thing.

    “After ACA, cost-control will be implemented by means of restricting care where the bureaucracy deems that it should be restricted. To me, this does not empower individuals, including the poor.”

    The only way that you get true empowerment is if you pay for it yourself. The big lie for the past 30 years is that you have been empowered with the present system of healthcare. No, you haven’t. You’re just not aware of the people making the decisions. Ignore the man behind the curtain.

  • JHM

    Fish:
    It’s interesting because I think those same things could all be said of government just as easily if you replace “profit” with “political power”.

    I do think much of the disagreement does come down to whether people trust government or free market/corporations more. I generally, though not always, feel better having individual corporations competing for my services rather than politicians coercing me. I don’t think either of these views is more Christ-like or moral, they’re just different, it seems to me. Do you disagree?

  • JHM

    DRT (17): Government is only one way in which “we” act, not the only way.

    DRT, I love your engagement and readiness for conversation here on Jesus Creed, but you seem to regularly attack the motivations to those you disagree with. It’s just not helpful. You’ve regularly accused conservatives of being malicious toward others and in this thread you said that they (and me?) are selfish. It just ends up offending people rather than persuading them. I think that’s probably not your intent, but it does come of as very judgmental, not of policy or position, but of motivation and heart.

  • http://LostCodex.com DRT

    JHM, thanks for the feedback, I will try to watch out for that in the future

  • joe mc faul

    Thanks for posting this. I think the documents demonstrate the problem–no serious alternative is being advanced.

    “I think it is only reasonable to ask why health insurance is so exorbitantly expensive. If you cannot answer why it is so expensive, then I have no idea how you can control cost.”

    The main problems with healthcare costs is that the people who pay for healthcare are not always the people who get it.

    Hospitals treat three kinds of patients:

    1. Those who are uninsured who enter the hospital through the ER. They re fist calls treatment for everything from untreated cancers, gunshot wounds,traffic accidents and imminent childbirths. They usually pay zero for these medical services. As a society we have made the decision that nobody will be turned away from the ER because they cannot pay for medical services. Hospitals obviously lose money on these patients.

    2. Those primarily insured by Medicare. The government fixes payments to be paid for services. These payments are far lower than the actual costs. The hospitals lose substantial money on these patients.

    3. Those wealthy (or lucky) enough to be self insured or who qualify for private insurance. Although private insurers can negotiate rates, the result is that hospitals make more than than it costs on these patients and, to stay in business, these patients and their insurers must in some sense subsidize the shortfalls above.

    The point above about primary care physicians is also very significant.

    ACA addresses these problems by requiring people to have insurance, providing low cost no-frill policies for those people and allowing those who have pre-existign conditions to obtain insurance. This allows hospitals and PCP’s to treat more insured patients than they do now. It also reduces the amount of insurer subsidy that is presently in place, and has a program to reduce costs overall while addressing certain inequalities, such as the PCP issues.

    Naysayers have not proposed any alternative that will deal with these three problems:

    1. Providing medical care to uninsured individuals;
    2. Allowing those with pre-exiting conditions to obtain health insurance;
    3. Control healthcare costs overall.

    ACA is not perfect (universal healthcare would be better) so there is room for improvement or for completely different programs, but any serious alternative should address these three problems. Otherwise, the conclusion that opposition to the ACA is uncaring rhetoric is entirely justified.

  • kierkegaard71

    Joe McFaul #29,

    Thanks for the input.
    Just a few questions/comments:
    1. What if you are an uninsured individual who does not want or need extensive health insurance? In our discussion, shouldn’t we separate those who want/need health insurance from those who don’t? There are many people who do not purchase insurance because they assume the risk and are generally healthy.
    2. Shouldn’t we drop the term “insurance” from our discussion because we are actually talking about direct subsidies rather than insurance? The standard definition of insurance is something you purchase to protect you as you encounter risk. Talking about health insurance for pre-existing conditions is a non sequitur. The issue we are talking about is providing funding for people’s health care, period. It is not insurance.
    3. I think you hit onto something with your comment about how universal healthcare system would be better. The ACA cannot work and will break in a few years. In the spirit of not letting a good crisis go to waste, the government will step in with a single-payer solution. I am a libertarian kind of guy and think that this is rather awful. But that is a value judgment I make.

  • http://LostCodex.com DRT

    kierkegaard71#30

    1. You say “There are many people who do not purchase insurance because they assume the risk and are generally healthy.” The trouble is that they cannot assume the risk. The risk is that they get a catastrophic illness that exceeds the financial capability of nearly everyone I know.

    2. While there are subsidies to help the poor get insurance, once people have insurance it is truly insurance. It takes the risk of problems in their health and uniformly spreads the risk over a large pool of people so that all pay the average risk. For instance, I have a couple of common medical issues that end up requiring me to have regular doctor visits every few months and then they check my blood. I was surprised to learn that the blood tests cost between $500 and $750 every time I go to the doctor. I am simply a high cholesterol slightly slow thyroid middle aged guy that they have to check to make sure I am healthy and that the drugs I get are not hurting me. That could easily happen to someone young as well as old and therefore we are indeed supplying insurance to ease the burden on those unlucky enough to have such conditions.

    3. Be as libertarian as you like, but I believe that, given universal health care, single payer is the obvious best way to go. You can lament as long as you want that we are taking away your rights because we are spreading the risk to everyone, but that is a nonsense argument as long as we have the ethic that we will treat people in the ER for catastrophic conditions. If you want to be effective in your approach then lobby to stop taking care of people in the ER! Then let’s see what people think.

  • Fish

    JHM: I do disagree, because a corporation exists for the sole reason of making a profit, while government is an institution created by God through which together we do things we could not do alone.

    Of course, that view may be influenced by the decades I spent in management within corporations. I’ve seen morality fall victim to making one’s numbers too many times. There is no right or wrong inside a corporation other than money.

    For example, I have no problems visualizing a health insurance executive making sure claims are denied, and therefore people dying, simply because his or her bonus is on the line. Sure, similar things can happen with government, but at least a government employee does not exist inside a structure that compensates them with more income the more claims they deny.

    To me, it partially boils down to making an idol of the free market. If the free market says that general practitioners in small towns are only worth 5% what a specialist makes in a large city, we accept that without question — as if the market were God.

    If one is willing to believe that the market is always totally correct, then in essence the market has been made divine.

  • Kyle J

    Fish/JHM

    Also worth pointing out that “privately provided” does not necessarily mean “free/competitive market.” The way most people get health insurance is not a competitive market–partly because of the bias we’ve built into the system for employer-provided coverage and partly just because health care is inherently different than other products (catastrophic risk, general unwillingness to let people just die if they don’t purchase the service).

    Simple ideological solutions just don’t work here. The situations described in the post linked to above illustrate that well.

  • Kyle J

    Addendum: I should have noted that the ACA will actually move us closer to real competition, with large numbers of people purchasing their own insurance from private companies on regulated, transparent exchanges. Again, this used to be a Republican plan.

  • http://LostCodex.com DRT

    I am not a lawyer, but ask from input from those who are.

    When the government grants rights to airwaves, TV, radio etc. I believe that there is a clause in there that they must uphold some aspect of the public good since the airwaves are publicly owned.

    Shouldn’t there be, or is there not, something similar with corporations? When they all seemed to think reputation was important then it did not matter as much. But those times are long gone.

  • kierkegaard71

    DRT #31,

    I would be perfectly fine with fully privatized ownership of hospitals with no mandate on them to provide care for people in the ER. I guess I have enough faith in the goodness of mankind to provide care where it is needed, without legal compulsion (call me naive; I await the verbal slings and arrows to arrive). I tend to view the free market, which in no way exists in the current health care industry, as a good thing because it tends to increase doctor accountability to the patient and decrease accountability to a bureaucracy (be it insurance or government). Given the current state of affairs, I would prefer to destroy the insurance cartel, increase competition, and, at the same time, have programs in place to help those who are at the margins economically. From my view, from what I can see of Europe (and the US), these states are in danger of financial collapse due to the tremendous cost of the social welfare apparatus. I think that going further in the direction of more government social welfare is a mistake.

    Thanks for the conversation.

  • joe mc faul

    “What if you are an uninsured individual who does not want or need extensive health insurance? In our discussion, shouldn’t we separate those who want/need health insurance from those who don’t?”

    I have no problem in principle with people who wish to be out of the health insurance system. But I don’t think we all understand what we mean when those people are out of the healthcare system. First, they must be able to pay in advance the “prime rates” for healthcare and waive in advance any claim for healthcare for which that they have not specifically negotiated the price in advance. Such people, pre-identiifed by a card or tattoo, would, for example, not be transported to the ER or be treated at the ER if they were injured in a traffic accident and unconscious. They waive completely, permanently, and in all situations, any form of health insurance benefit. They would have to pay as they go for all cancer treatments.

    Obviously, the waiver of health benefits would have to be enforceable. No children could make such a waiver, and parents cannot make such a waiver on behalf of their children.

    We’d also have to make a policy that hospitals and healthcare providers can refuse services to a dying individuals who would otherwise be saved but had opted out of the system. The healthcare providers and taxpayers would not have to bear the risk of non-payment.

    My guess is that a few high net worth individuals “might” choose such and option, but the fact is, anybody with both money and a lick of economic common sense would insure.

    “There are many people who do not purchase insurance because they assume the risk and are generally healthy.”

    Most are riding on my tailcoats and I resent it. There are motorcycle riders who don’t want to wear helmets because it infringes on their freedom–until they suffer otherwise preventable traumatic head injuries and send the medical bills, rehab bills and public assistance bills to me the taxpayer. They’re riding on my tax dollars, claiming an illusion of freedom but they are unwilling to endure the consequences of that freedom.

    Think about it for a minute. Nobody gets out of this life alive. Everybody either dies in poor health or as a result of an accident. I know of extremely few people who live to 60 who are insured and who are not taking mediations for heart conditions, cancer conditions, back, knee and neck injuries, arthritis or diabetes. And these people can be considered to be generally in good health, but their medical care is expensive and available only to those who are wealthy, insured or through the taxpayers. The number of people who can realistically opt out of medical care for their entire life is near zero.

  • http://LostCodex.com DRT

    joe mc faul#37 says:

    Such people, pre-identiifed by a card or tattoo, would, for example, not be transported to the ER….

    May I suggest the tattoo be either 666 or 616.

  • http://www.lambpower.net Steve D

    kierkegaard71 #36
    I lived 43 years of my life without a major problem. The only thing that I had been hospitalized for was a tonsillectomy when I was 5. The next 43 years I spent with minimal medical contact. Then I became very sick and needed a liver and kidney transplant. I tell you this because before i even had my first appoint with the doctors who would perform the transplant, they checked my insurance to see if it was covered.

    I am basically against for profit hospitals. After having been in both for and non-profit hospitals, the treatment I received in the non-profits was much better. For profits tend to look at the bottom line a little too carefully. It’s at the non-profit where there is free TV. It’s at the non-profit where there is free wifi. It’s at the non-profit where I get the responsive doctors and staff.

    Frankly, I think you are very naive if you believe that hospitals will treat those in need out of the goodness of their heart Ultimately, there is no motive for a for profit institution to do anything that cuts into their profit. The free market just doesn’t work as well as conservatives and libertarians would like.

  • JHM

    One thing I’ve wondered about lately in terms of American healthcare is that we’re already spending (as %GDP) as much as many European countries for public healthcare and about about twice as much as those countries total (public+private) [1].

    So if we expand public expenditure (partially by increasing private expenditure) through ACA, aren’t we going in the opposite direction of affordable healthcare in general? About the only mechanisms in ACA I’ve seen thrown out for decreasing actual cost is increased preventative care and possibly additional competition from the public option. Are there others?

    [1] http://www.economist.com/node/21557793

  • MHH

    The healthcare issue is exceptionally complex and doesn’t lend itself well to critique in our polarized political system. The fact that the ACA is often dubbed as all good or all bad is somewhat comical, in that it was law around 2000 pages including several momentous provisions. This was part of what made the news coverage so interesting– for ten minutes networks reported that the law was struck down based on the language on page one of a 193 page opinion.

    Just like the ACA, the issues impacting American healthcare system are equally complex. It is one of the few areas of American commerce where most end-users (you and me) aren’t exposed to the actual cost of the treatments we have. Those without insurance lose the bargaining power that those with insurance have, as insurance companies (insurers) negotiate rates discounted from a “market rate.” This means that a person with ABC insurance may pay $500 for a procedure, XYZ $350, and the market rate for someone uninsured may be charged $1000. Not exactly market forces at work– seems a lot like collusion to me.

    That’s not to say that the ACA was the right answer. I can relate to the post– I am a grad student with parents on social security and a congenital heart defect. I can’t get insurance on my own without some nonprofit or school stepping up and including me in a group. And I can’t exactly afford to live without it unless I want to ignore a potentially life-threatening condition. In that way, I celebrated the Supreme Court opinion. But is the ACA the right answer? I don’t think so. Do I think it was the best option in the political/social/economic climate? Absolutely. I hope that it is the first step in reform, whether government, business, or charitable.

    It’s important to remember, also, that it is very difficult to be objective when discussing healthcare. It’s an inherently personal, subjective issue, if for no other reason that, if you become seriously ill, you’ll likely pay whatever they charge for treatment. This isn’t a proper role for market analysis, unless you trust the invisible hand to potentially pull the plug. That’s not to say that I’m excited about a bureaucrat making care decisions; there’s nothing in the ACA to say that that will happen any more than that already does in the current Medicare/Medicaid system.

  • ADM

    As a Canadian it is interesting reading these comments. As you are all well aware we enjoy free health care. Yes, our waiting times are longer for certain things, but not all. And overall I think people get treated for things pretty early because they can more easily get regular check-ups. That being said, not everything is covered and the list of things that aren’t is growing, things like chiropractic, physio therapy, dentistry, podiatry and eye care are all not covered. Neither are doctors notes or when you need doctors to fill in health examination forms for certain things. The system isn’t perfect, but I wouldn’t trade it in for anything, and I, like many other Canadians would pay more tax (without going overboard) to keep the system going.

  • http://LostCodex.com DRT

    MHH#41, well stated.

    The critical part seems to me to be that no one else has come up with anything better. Or in the case of the repubs, anything at all.

  • Buddy

    my social security is frozen; the cost of living raises are “postponed?” and my medicare will almost triple in the next two years… it seems to me we’ll have less access rather than more? sure, there are some things that might be improved about our healthcare system, but i’m afraid we’ve thrown the baby out with the bathwater…

  • Kyle J

    @JHM

    Yes, the ACA will expand total health care expenditures slightly–although the increase is quite small considering that it buys near-universal health coverage. A lot of the changes are simply paying for health care costs in a more efficient/rational manner (replacing ER care, for example).

    http://www.huffingtonpost.com/2012/06/12/health-care-reform-report_n_1590672.html

    You raise a good point: If you take what we spend through private health care mechanisms, our “welfare state” is just as big as those in Europe.

    Here’s a good piece on parts of the law already making a difference in terms of cost growth by moving toward bundled performance-based payment systems:

    http://www.washingtonpost.com/blogs/ezra-klein/post/health-reform-at-2-why-american-health-care-will-never-be-the-same/2012/03/22/gIQA7ssUVS_blog.html

    At the end of the day, health care costs are going to be driven by changes on the provider side. Consumers don’t have enough information to drive huge changes with their decisions. And most of the costs are wrapped up in a minority of individuals with chronic/major health issues.

  • kierkegaard71

    Steve D #39,

    We have not had a free market in medical care for at least the last 50 years. Criticism of the current system does not equate to criticism of the free market. A for-profit hospital that enjoys a monopoly (one that is the “only game in town”) will never perform as well as one in competition with others. My guess is that the reason non-profit hospitals are well run is because they are well run, not because of the lack of a profit motive. The profit motive in a competitive environment benefits the consumer. The profit motive in a monopolistic environment will generally take advantage of the consumer. In general, however, the profit motive is a good thing because it will drive even an otherwise self-centered producer to meet the needs of a consumer.

  • RobS

    Thinking of Fish #32 and others, Certainly government and corporations both have flaws — I would say both are institutions of men. I don’t quite see government as an institution created by God. Certainly God asks us to respond to government in a responsible way and respect authority placed within the system.

    One more challenge I see is the government does not apologize for it’s flaws or seek improvement. Not all corporations do either, but I did fill out the survey about Wal-Mart’s poor service last week online because they sent it to me and asked for my feedback about how they might improve. Yes, they want me shopping there, and because of that, they have sought feedback to create improvement.

    Enter the government… who rejected a piece of paperwork last week because they changed the style of forms and now they reject the old form and do not process anything on it. They only care about processing the new form. I have no redress, there is no desire for improvement, there is no effort to keep my business or attention. I must fall in line behind their system or not participate. They fail to improve.

    I’ve related this story before, so will make it quick… disabled 40-something single woman living below the poverty line is overpaid (on accident) by the government (not huge amounts for her to notice). The government clawed back every single dollar of that overpayment. There is no redress, no mercy, no love, no apology. There is heartless bureaucracy that processes the paperwork and doesn’t give a care if someone is below the poverty line and struggling to pay back the multi-trillion dollar spending behemoth. To see what that does to a poor person’s budget is pretty rough. God’s real institution (the church) stepped in to help make sure food and medicine were still there… etc.

    So I’m jaded on the charitable impact of government in a lot of ways. :) I’m not saying all assistance should be stopped or something ridiculous… but outside the power to tax and distribute they have little charity in Washington (unless it buys votes, but that’s another story I think)

  • Kyle J

    @RobS

    Government certainly has its inefficencies, but you pick an odd example. Would this woman be better off if the government were making no payment to her at all? How much redress do you perceive low-income individuals have with private insurance companies?

    If there’s one competition government has fighting chance of winning a battle over efficiency/responsiveness with, it’s against health insurance companies.

  • Jane Barlow

    As a Christian, I take issue with the tone of lumping all conservatives into one basket. It’s like saying all stay at home moms like to gossip. As a pediatric nurse, I do agree that there are changes that are desperately needed in the health care system. However, we are on a financial path as a nation that we cannot sustain. The country has already borrowed against the Social Security System with no way to repay it for the first time in our nation’s history. We have mortgaged our country to China and other nations and have no way to pay back our debts. I do agree that there are some parts of the healthcare plan that are beneficial, but we need to look carefully at how those items will be paid for. Obama says tax the rich, but how is that going to help if it just drives people to place their money in places outside of our country. Never before has our country looked at the only way to finance our debt to require one sector of society to give more. It’s not that we don’t care, or are cruel, we just see this driving us down a path of no return.

  • Kyle J

    @Jane

    That’s a pretty gross oversimplification. The additional tax surcharge included in the ACA is only 0.9% of the income. There are a number of other financing mechanisms in the bill-including spending cuts. And, by any objective standard, tax rates on the wealthy are at their lowest levels in modern history.

    http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/07/09/the-bush-tax-cuts-for-the-rich-in-two-charts/

    Again, simple ideological statements don’t work here. The solution to the long-term deficit is to simply abandon people in the kinds of situations the woman who authored the blog post are in? If changes needs to be made, and there are better ways to make them, where is the plan?

  • unapologetic catholic

    Jane, The total cost of the Iraq and Afghanistan wars exceeds $3.7 trillion.

    Did you suggest that we could not afford to pay for those wars and therfore should not fight them?

    Did you suggest that the only way to to keep from going down the unsustainable financial path to ruin was to pay for these wars as we go by immediately raising taxes by $3.7 trillion to cover the costs? Yet, President Bush simultaneously engaged in these two wars and cut taxes. Inexcusable and financially reckless.

    I do lump conservatives in one basket because they appear to be willing to put wars on a national “credit card” but are unwilling to put healthcare on the same credit card “because we can’t afford it.” Conservatives seem to be pathologically unwilling to raise taxes for current wartime expenses.

  • http://LostCodex.com DRT

    RobS, I would like to hear a response to KyleJ

    “Government certainly has its inefficencies, but you pick an odd example. Would this woman be better off if the government were making no payment to her at all?”

  • http://LostCodex.com DRT

    Jane Barlow#49,

    How do you know that we have too much debt. Certainly trillions sound like a very big number but how do you know if the right number is 1 trillion or 20 trillion?

    Next question after you answer that is, don’t you think that it may be good to exceed what you feel is a long term sustainable debt given an unusual economic situation?

    For instance, say you strive to always have less than $500 in debt. But you don’t have much savings and the transmission in your only car goes out. If you don’t fix it you can’t work. Isn’t it worth going into debt?

  • http://LostCodex.com DRT

    …and I want to further put force behind what unapologetic catholic said.

    As long as conservatives operate politically as a block I will put them in one block. That is how they are behaving.

  • Kyle J

    Agree with DRT. Exhibit A is Romney essentially opposing his own health care plan.

  • Kyle J

    And that may be too harsh toward conservative commeners here. But, again, where is the alternative plan those conservatives support? I’ve been asking that question for at least a year and have yet to get a concrete response.

  • Brian

    Good policy is not necessarily constitutional. What is constitutional for state government is not always constitutional for the federal government.

  • RobS

    KyleJ (48) and DRT (52),

    Right, that’s a good question that deserves a fair response (& both you are smart and fair guys and I respect your responses on a lot of topics).

    If I didn’t bore anyone too badly in my original post, I did note at the bottom, “I’m not saying all assistance should be stopped or something ridiculous…” and I believe it. The regular assistance she has does help keep the lights on & medicine available. Ever since she lost her part-time job, it has been the biggest source of income she has had.

    So, no, I’m not a total angry ranting and raging “abolish all payments” kind of argument — although when the government fouled that one up, it was a true mess. It’s one that’s very close to home. We really all hope to get her employed soon as well and that’ll help a lot.


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