The U.S. Supreme Court, sitting as a death panel, appears to be dealing a mortal blow to the Affordable Care Act.
Yesterday, the individual mandate was savaged:
[transcript] http://www.scribd.com/fullscreen/86924212
Today, the sentiment seems to be "wipe the slate clean" and let Congress have a do-over rather than preserve aspects of the Act, e.g. the ban on excluding pre-existing conditions:
[transcript] http://www.scribd.com/fullscreen/87060299
Every EREista, regardless of polictical stripe, should deplore employee-based group insurance. The tax breaks act as subsidies that distort the market and price the unemployed out of the market. Even if Medicare overcomes its moribund funding troubles, it won't kick in until one reaches 65. The whole premise of this community is that we don't want to work that long.
If the decision in June kills Obamacare, I will either have to start contemplating a move to a more civilized country or adopt a more hard-core Stoic attitude about the vagaries of disease and injury.
Obamacare R.I.P.
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jennypenny
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secretwealth
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Vermont will be offering a single-payer option, and I may relocate. The cheapest insurance I can get in New York state for my wife and me is over $400/mo. Unacceptable.
Anyone who has lived outside of America for even the briefest period of time supports a single-payer option. It's a shame most Americans are too parochial to learn from other nations.
Anyone who has lived outside of America for even the briefest period of time supports a single-payer option. It's a shame most Americans are too parochial to learn from other nations.
Completely agree with everyone. The sooner we realize how foolish we are about healthcare in this country the better for everyone.
What all the "dat dere is SOCIALISM! And, the devil" people don't realize is that healthcare is already socialized in this country, but it's done inefficiently. Not for profit hospitals (roughly 60-70% of all hospitals) are not allowed to turn anyone away and even many for profit hospitals won't turn people away. This means people without insurance go to the emergency room for everything, which is vastly more expensive than just giving these people health insurance.
What all the "dat dere is SOCIALISM! And, the devil" people don't realize is that healthcare is already socialized in this country, but it's done inefficiently. Not for profit hospitals (roughly 60-70% of all hospitals) are not allowed to turn anyone away and even many for profit hospitals won't turn people away. This means people without insurance go to the emergency room for everything, which is vastly more expensive than just giving these people health insurance.
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secretwealth
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I thought for-profit hospitals can't turn people away in emergencies either.
The emergency room trick is a useful--but extremely unenjoyable--option for the uninsured. It's such a hassle that a lot of people avoid going and thus avoiding needed care.
Then there's the issue of long-term illness treatment, expensive medicine, etc.
Because of Obamacare my mother's health insurance went down from 900/mo. to 230/mo. It's a bad plan for sure, but certainly better than the status quo was.
The emergency room trick is a useful--but extremely unenjoyable--option for the uninsured. It's such a hassle that a lot of people avoid going and thus avoiding needed care.
Then there's the issue of long-term illness treatment, expensive medicine, etc.
Because of Obamacare my mother's health insurance went down from 900/mo. to 230/mo. It's a bad plan for sure, but certainly better than the status quo was.
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George the original one
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@secretwealth:
"Anyone who has lived outside of America for even the briefest period of time supports a single-payer option."
Perhaps:
"I've only heard of one crazy guy who has lived outside of America and doesn't support a single-payer option."
Okay, that's not entirely true... I'm not entirely against single-payer healthcare, but I am against most versions of what people refer to as single-payer healthcare for the US.
As a country we spend $835billion per year on medicare and medicaid (2011 budget number). Some of that money comes from you. How much per month do you figure you are currently spending on medicare and medicaid? If $400/mo is unacceptable to insure you and your wife, what price per month is unacceptable for you to pay to insure other people?
I think it's okay for you to say that you find paying $400/mo for you and your wife to be unacceptable. But at what price does it become okay for me to say that the amount I am paying to insure other people is unacceptable?
"Anyone who has lived outside of America for even the briefest period of time supports a single-payer option."
Perhaps:
"I've only heard of one crazy guy who has lived outside of America and doesn't support a single-payer option."
Okay, that's not entirely true... I'm not entirely against single-payer healthcare, but I am against most versions of what people refer to as single-payer healthcare for the US.
As a country we spend $835billion per year on medicare and medicaid (2011 budget number). Some of that money comes from you. How much per month do you figure you are currently spending on medicare and medicaid? If $400/mo is unacceptable to insure you and your wife, what price per month is unacceptable for you to pay to insure other people?
I think it's okay for you to say that you find paying $400/mo for you and your wife to be unacceptable. But at what price does it become okay for me to say that the amount I am paying to insure other people is unacceptable?
@Mo I'm not sure the problem is that we don't want/have enough money to spend. We pay far more per person on healthcare in the US than in any other country in the world.
It's not that we're not spending enough or need everyone to spend more, it's more a problem of how the money is used and how inefficient the system is.
It's not that we're not spending enough or need everyone to spend more, it's more a problem of how the money is used and how inefficient the system is.
The only problem with that argument is that none of the "socialized" medicine countries spend more than the U.S. does per capita. In most cases the U.S. spends double or triple these countries, has larger growth in healthcare costs every year than these countries, and gets poorer results.
Just because we screwed up Medicare and the supposed free market healthcare system is a cancer on it, doesn't mean we shouldn't try something else considering how bad the "free market" system is screwing us right now.
Just because we screwed up Medicare and the supposed free market healthcare system is a cancer on it, doesn't mean we shouldn't try something else considering how bad the "free market" system is screwing us right now.
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secretwealth
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@Mo: You don't address the fact that the insured currently pay for others' medical care, since they subsume the costs of the uninsured receiving emergency care and not paying their bills.
I think Maus touched on an important point: the tax subsidies distort the market and price the unemployed out of the market. It also prices out independent contractors, and many companies are turning to those workers to cut costs. The current healthcare system was designed around a country where long-term or permanent employment was guaranteed, and it doesn't work in this new economy where labor is more modular and disposable.
I see the American healthcare system in the same light as the American housing market: both are heavily distorted due to a worst-of-both-worlds compromise between the impulse to regulate the market to the benefit of the poor from Democrats and the impulse to allow the free market to sort itself out from Republicans. These diametrically opposed ideologies have compromised with disastrous results: a secondary-mortgage market backed by government funds. This is not the work of one party or another. Fannie Mae and Freddie Mac were George Romney's brainchildren, although he's more famous for his actual child, Mitt Romney. Source: http://books.google.com/books?id=SNhE9G ... tt&f=false
Fortunately, there are options for the EREr. http://truecostblog.com/2009/08/09/coun ... e-by-date/
I really like where I live and don't want to move, but I've lived abroad before and I can do it again. If I get sick enough I just might have to.
I think Maus touched on an important point: the tax subsidies distort the market and price the unemployed out of the market. It also prices out independent contractors, and many companies are turning to those workers to cut costs. The current healthcare system was designed around a country where long-term or permanent employment was guaranteed, and it doesn't work in this new economy where labor is more modular and disposable.
I see the American healthcare system in the same light as the American housing market: both are heavily distorted due to a worst-of-both-worlds compromise between the impulse to regulate the market to the benefit of the poor from Democrats and the impulse to allow the free market to sort itself out from Republicans. These diametrically opposed ideologies have compromised with disastrous results: a secondary-mortgage market backed by government funds. This is not the work of one party or another. Fannie Mae and Freddie Mac were George Romney's brainchildren, although he's more famous for his actual child, Mitt Romney. Source: http://books.google.com/books?id=SNhE9G ... tt&f=false
Fortunately, there are options for the EREr. http://truecostblog.com/2009/08/09/coun ... e-by-date/
I really like where I live and don't want to move, but I've lived abroad before and I can do it again. If I get sick enough I just might have to.
@Maus
I'm a bit more optimistic then you. After reading some of the oral argument transcripts I now rank it as follows from most likely to least likely:
1. repeal mandate and repeal guaranteed issue (can't ban people for pre-existing conditions)
2. do not repeal mandate
3. repeal mandate + entire law
I view possibility 3 as still pretty unlikely. As long as 3 does not happen, as an individual you are probably in good shape. If the mandate is repealed it will not have any effect on what health care will cost you if you are <400% poverty line since the law caps health care expenses as a percent of income.
Mandate repeal will make health care cost more to the government per person and maybe significantly per person if only the mandate is repealed and not guaranteed issue. An interesting note is less people will be covered so the government may not end up spending more money total.
If you are over >400% poverty line and in the non-group market your health care costs will likely go up a lot if the mandate is repealed and not guaranteed issue.
I'm a bit more optimistic then you. After reading some of the oral argument transcripts I now rank it as follows from most likely to least likely:
1. repeal mandate and repeal guaranteed issue (can't ban people for pre-existing conditions)
2. do not repeal mandate
3. repeal mandate + entire law
I view possibility 3 as still pretty unlikely. As long as 3 does not happen, as an individual you are probably in good shape. If the mandate is repealed it will not have any effect on what health care will cost you if you are <400% poverty line since the law caps health care expenses as a percent of income.
Mandate repeal will make health care cost more to the government per person and maybe significantly per person if only the mandate is repealed and not guaranteed issue. An interesting note is less people will be covered so the government may not end up spending more money total.
If you are over >400% poverty line and in the non-group market your health care costs will likely go up a lot if the mandate is repealed and not guaranteed issue.
If America had a decent universal healthcare system (and there are several different models to choose from around the world), I would've quit my job by now. Sometimes I wonder if that's why the business community, which otherwise should be huge supporters of decoupling health insurance from employment, continues to support the status quo. So that employees are too scared to demand better treatment, higher wages, shorter hours, etc.
@Chad, I assume that you are referring to my argument with your comment, if not my apologies. I agree with both you and MikeBOS that part of the US problem is that we spend more per capita than the socialized countries on healthcare. I don't see health care costs going down, per capita, in the US in the current proposed US versions of universal coverage. That's my problem with it. I, too, want costs to come down, per capita.
Per capita, how much does the US pay in the VA system, which is essentially a government run single payer system currently operating in the US for a small percentage of the population? I'll save you the time-- it's far more than Europe. If you could provide a realistic proposal that would balance the budget AND provide universal coverage, I'm all ears. I'm sure I'm preaching to the choir with this, but even if we totally eliminated medicare and medicaid, and just had millions of people suffer, we'd still have to cut another 20% out of the federal budget just to break even. Our federal spending is so far out of control, we really don't have any idea what we can and cannot afford.
Per capita, how much does the US pay in the VA system, which is essentially a government run single payer system currently operating in the US for a small percentage of the population? I'll save you the time-- it's far more than Europe. If you could provide a realistic proposal that would balance the budget AND provide universal coverage, I'm all ears. I'm sure I'm preaching to the choir with this, but even if we totally eliminated medicare and medicaid, and just had millions of people suffer, we'd still have to cut another 20% out of the federal budget just to break even. Our federal spending is so far out of control, we really don't have any idea what we can and cannot afford.
I'm going to be the lone dissenting voice. And I say it with some selfish disappointment as someone to whom health insurance will likely be my single biggest expense in ER.
The problem is too much govt intervention. Too much complication, too much crony capitalism, too many OTHER mandates... Way, way too much BS [90%+ at the fed level] driving up costs and "protecting" parties from coming to their own agreements and decisions. What we currently have is a far, far departure from a free market. IMO, it is the clear failure of the unfree market that costs continue to explode.
My free[er] market is in "third world" countries and other countries with more reasonable and less stifling laws, where I'd prefer to have all my procedures done... It is frustrating, and I do not see this as a victory. Just wanted to point out what I see as the problem.
Now... we need a thread on strategic 2nd citizenship!
The problem is too much govt intervention. Too much complication, too much crony capitalism, too many OTHER mandates... Way, way too much BS [90%+ at the fed level] driving up costs and "protecting" parties from coming to their own agreements and decisions. What we currently have is a far, far departure from a free market. IMO, it is the clear failure of the unfree market that costs continue to explode.
My free[er] market is in "third world" countries and other countries with more reasonable and less stifling laws, where I'd prefer to have all my procedures done... It is frustrating, and I do not see this as a victory. Just wanted to point out what I see as the problem.
Now... we need a thread on strategic 2nd citizenship!
Good chart showing how ridiculously overpriced U.S. healthcare is.
http://www.ritholtz.com/blog/2012/03/co ... -overseas/
@Secretwealth
I am 100% sure non-profits have to accept all emergencies, but I'm not 100% sure on for profit so I didn't say all.
@M
No worries. I was replying to your response and at the time I thought my reply would directly follow yours. Thus, I did not do the "@" symbol.
I not sure your first argument is related to my first comment.
"If you could provide a realistic proposal that would balance the budget AND provide universal coverage, I'm all ears."
An easy realistic proposal is almost any European healthcare system or the Canadian one. All are cheaper and more efficient than the U.S. system. Of course, half the country would do everything possible to sabotage it just because it's "unAmerican", even though they would just be hurting themselves.
The budget is easy to fix. A few more taxes and a few cuts with defense being cut the most. We don't need 10-11 full carrier battle groups when no one else has even one comparable battle group. Yes, other countries have 1-2 carriers, but those aren't even half as powerful as a Nimitz class carrier. And, China doesn't even have a deep blue navy or a carrier that works.
This is one of those subjects in American policy that gets overwhelmed by belief no matter what the facts represent. It's pounded into us our entire lives that it is "evil."
@JohhnyH
It is impossible to have a free market for healthcare. Just too many factors that fight a free market such as: many procedures are emergencies, many areas only have one or two providers in the area, hard to compare services, impossible to compare prices, etc.
http://www.ritholtz.com/blog/2012/03/co ... -overseas/
@Secretwealth
I am 100% sure non-profits have to accept all emergencies, but I'm not 100% sure on for profit so I didn't say all.
@M
No worries. I was replying to your response and at the time I thought my reply would directly follow yours. Thus, I did not do the "@" symbol.
I not sure your first argument is related to my first comment.
"If you could provide a realistic proposal that would balance the budget AND provide universal coverage, I'm all ears."
An easy realistic proposal is almost any European healthcare system or the Canadian one. All are cheaper and more efficient than the U.S. system. Of course, half the country would do everything possible to sabotage it just because it's "unAmerican", even though they would just be hurting themselves.
The budget is easy to fix. A few more taxes and a few cuts with defense being cut the most. We don't need 10-11 full carrier battle groups when no one else has even one comparable battle group. Yes, other countries have 1-2 carriers, but those aren't even half as powerful as a Nimitz class carrier. And, China doesn't even have a deep blue navy or a carrier that works.
This is one of those subjects in American policy that gets overwhelmed by belief no matter what the facts represent. It's pounded into us our entire lives that it is "evil."
@JohhnyH
It is impossible to have a free market for healthcare. Just too many factors that fight a free market such as: many procedures are emergencies, many areas only have one or two providers in the area, hard to compare services, impossible to compare prices, etc.
@Chad: Maybe... Maybe. But can we at least "tweak" the market at the state level?... N=50, rather than the utter failure than N=1 has become.
I see state governments succeed at so many various tasks, and even turn around on a dime and go from failure to success... Once something becomes federal it seems like we are stuck with the failure (most usually) for generations.
I'd rather move a few hundred miles than burn my US citizenship in a different hemisphere.
I see state governments succeed at so many various tasks, and even turn around on a dime and go from failure to success... Once something becomes federal it seems like we are stuck with the failure (most usually) for generations.
I'd rather move a few hundred miles than burn my US citizenship in a different hemisphere.