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Someone please explain what happened today
billwill
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Can someone basically summarize what was passed today concerning health care in America? What it infringes on, what it adds, what it takes away? Thanks. Links would be great as well.
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Now, it is passed and obama can sign it into law, as for the final result of the bill and what exactly is going into law, I have no idea, I haven't looked at the final details of the legislation so I'll have to come back to you on that.
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Can someone please tell me why everyone is bitching about it being unconstitutional?
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People are fucking stupid and yell about guns and their right to call black people Attractive and Successful African-Americans while thinking it's A OK to lock some brown people up indefinitely and torture them for "information" while letting the police kick down doors and shoot hippies for having a prescription for medical marijuana.
Most people are cafeteria constitutionalists, the only people you should listen to WRT that term are actual legal experts (opinions that kind of matter) and the supreme court (the only opinion that really matters).
I know they've got a lot of bias, but is there any truth to that, or could someone express the opposing viewpoints better?
Edit: How does/will the U.S. health care system compare to universal health care systems in Europe after this bill becomes law?
Their concern is that it's a step towards a single-payer system where the government handles all medical insurance. This is largely bullshit, as there's not even a government-run option in the bill that passed, so I don't know what your friends are griping about. Ask them to be more specific next time they bring it up.
Besides, you know who can pick their doctors? Medicare patients. Guess what also is a government-run health insurance plan.
It doesn't. Private insurers will still cover the vast majority of the insured.
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It's a government program. I think the only possible response is, "Who the fuck knows?"
It should be noted that in Australia the vast amount of people are at least partly insured if not fully.
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Well I cant say anything about the US system. But here in the Netherlands it works like this:
- You pay taxes based on income (more income is more tax)
- The goverment pays a portion of your social health care to your insurance agency (basic insurance).
- You pay your insurance agency (based on what package you want but its up to 80 euros a month minimum).
- The goverment might pay you extra social benefits if your income is below 30000 euros per year (less income is more benefits) to pay for a better package.
If any dutch people have any comments please feel free to quote and edit
It's mostly correct. Basicly there are a number of different systems in Europe.
Brittain has a Single Payer system (National Health Service), as does Germany. This basicly comes down to the government paying for everything out of taxes. They own the hospitals, pay the doctors. There is private healthcare as well, for those who wish faster treatment for nonthreatining conditions, want nonstandard treatments etcet. This is very expensive to the individual.
The Dutch system is based on on the government having a mandated list that every insurer has to offer, and every citizen has to be insured for. This means that on the basic insurance, the only competition can be on price and quality of service. Treatments that are not on this list can be gotten through additional insurance (dental, alternative medicine, plastic surgery, higher levels of care). Switzerland employs a similar system.
But then of course we have the horrid death panels, luckily this is a trade-off we're willing to handle.
Prior to this bill, there was only a limited amount of regulation of health insurance from the Federal government, with most of it handled by the individual states. For obvious reasons, this meant that there was a very wide amount of variation in the health insurance regulations in different states, and some states had very lax regulation while others were quite a bit more stringent.
As a result of this, there is a strong element of regional monopolization in health insurance companies in the US, where a company or a handful of companies will dominate the market in one state, while in another state a different company or handful of companies will dominate its market. The bill just passed makes some attempts to deal with this market concentration by creating regulated health insurance exchanges for insurers to compete on, but it is uncertain as to how effective this will be. One of the key arguments for the public option, which was basically just a health insurance company ran by the government, was that it would directly inject competition into the market that would not have the same incentives towards exploiting an monopoly or oligopoly for financial gain.
Anyways, the central idea of the bill is shifting towards community rating for pricing health insurance away from risk rating as well as adding guaranteed issue. Basically, without the bill, in many states health insurance companies can set your premiums based on your medical history, and/or if you are too risky and likely to be too expensive to cover they would outright deny coverage. This is most commonly described as the "pre-existing condition" issue. So what the bill does is ban denial of coverage for children based on pre-existing conditions this year, and once the Exchanges open in 2014, health insurers will be banned from denying coverage based on medical history outright to operate on the market. Additionally, they will be required to charge the same premium to everyone in the same demographic group in the market regardless of medical history, and could only vary the level of premiums across specifically defined groups by a set ratio. I forgot what the exact numbers were because they differed in the different bills that were being considered, but it was something along the lines of insurers only being able to charge 4 times as much in premiums for the oldest people than they charge in premiums for the youngest people.
The motivation for community rating is that a lot of the sick become unacceptably risky and uninsurable in an unregulated health insurance market, which means that they will only get as much care as they can afford before going bankrupt. The problem with community rating in isolation is Adverse Selection, which in short means it creates some very problematic incentives that can lead to an insurance death spiral. If someone can not be denied coverage or charged higher levels for being sick or having a poor medical history, then this creates the incentive for people to forgo health insurance until the moment they need it. And the sick will have an even stronger incentive to get insurance because it will be priced much less than their expected cost of care. Less healthy people on insurance means that premiums will go up because the pool is composed of more costly individuals, which creates a feedback loop pushing even more healthy people off as premiums continue to rise. This is the motivation for the mandate to buy insurance, which in the bill just passed is a fine on your taxes if you don't find some way to get insurance. This fine starts small in 2014 and will ramp up in the following years to a maximum of roughly ~2.5% of household income.
Of course, forcing people to buy insurance when they can't afford it is really really stupid, so the final piece of the puzzle is subsidies. The lower your income, the more the government will foot the bill of your insurance premiums, or the government will provide insurance to you outright if you are eligible for Medicaid. These subsidies trail off and I believe completely disappear at incomes above 400 percent of poverty level (which is supposedly $88,200 for a family of four now, but will change depending upon inflation), and are set to try to cap the percentage of income individuals and families pay out of their pocket on health care.
The subsidies are the really expensive part of the bill, because the government is outright paying part of the way for health insurance for the bulk of the population. To increase revenue, the bill raises payroll taxes for high income earners (incomes of over $200,000 for individuals and $250,000 for families), putting an excise tax on health insurance premiums above $10,200 for individuals and $27,500 for families, and add some taxes to parts of the health care sector like pharmaceutical companies. Additionally, there's cost cutting measures in there, a lot of which aimed at slowing the growth in costs of Medicare and putting some big cuts in Medicare Advantage.
TLDR: there's a lot of stuff in this bill, and I only covered the main top level points of it.
The bottom line is that the Federal Government has never mandated individuals to buy something, and it's really unclear if telling people what to buy falls under the commerce powers as they are presently defined. The issue isn't whether insurance is interstate commerce, the issue is whether an individual's decision not to buy insurance has a substantial effect on interstate commerce.
The funny thing is that the individual mandate was actually a Republican idea, from back in 1994 when Democrats wanted an employer mandate.
It's actually more silly goosery than you might think at first glance. Because if all you do is run afoul of the mandate, you won't be charged with any sort of crime nor will you face a lawsuit. Rather, you will have to pay a penalty, which with their implementation means you'll pay higher taxes. The only crime you'll be hit with is if you try to go for the tax evasion route.
There's a lot of cases of being variations in taxation levels based on individual economic behavior. The current events example is the First-Time Homebuyer Tax Credit. It seems a stretch to me to argue that the mandate is unconstitutional if this sort of thing is constitutional. Would it be unconstitutional because one raises taxes while the other provides a tax credit?
It really doesn't make much sense to me.
Also, with regards to the UK system, don't listen to any insane republican types who say we have less freedom and whatnot. You absolutely get to choose your doctor, doctors get paid a very nice wage (my stepdad, for instance, is very comfortably off) and bureaucrats do not get to decide what treatments you get, by and large doctors can give whatever treatment they think is best for you (as long as it isn't both less useful and more expensive than an alternative, and they can't justify it)
If you want to get any more in-depth than that--or discuss health care in general--there is a D&D thread and an SE++ thread.