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[Health Care Reform] and you.

chidonachidona Registered User regular
edited December 2010 in Debate and/or Discourse
First of all, apologies if the old thread is still kicking around - I did a search and it didn't pop up, so here goes.

Right, so Health Care Reform is here. Well, more specifically, phase 1 of the affordable care act is being rolled out across the country. But let's step back for a second, why does the US need reform at all? What does the reform do? Well, both these questions are answered by this sublime video done by the Kaiser Family Foundation, and I implore you all to watch it and share with family and friends:

http://healthreform.kff.org/the-animation.aspx

http://www.youtube.com/watch?v=3-Ilc5xK2_E&feature=player_embedded

So it all sounds fairly dandy, right? Well, as noted at the end of the video, the 'mandatory health care insurance' provision is highly contentious; Republicans hate the idea of forcing people to purchase what, in their eyes, is a commodity. The Government should focus on incentives to achieve the optimal level of coverage, not top down regulation.

And so this happened: http://news.yahoo.com/s/afp/20101213/ts_alt_afp/ushealtheconomycourt
Yahoo wrote:
Judge rules Obama health reform unconstitutional

A US judge Monday ruled that a key provision in the Obama administration's landmark health care reform requiring all Americans to have medical insurance was unconstitutional.

It was the first major legal blow to President Barack Obama concerning the radical overhaul of the nation's health care system, which he has made a cornerstone of his administration.
The ruling by Judge Henry Hudson of the Eastern District Court in Richmond, Virginia, found that the new law's mandate that Americans must buy insurance or pay a fine goes beyond federal authority and violates the Commerce Clause, a key component of the US Constitution.

"Neither the Supreme Court nor any federal circuit of appeals has extended Commerce clause powers to compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market," Hudson wrote in his opinion.
Hudson, who was appointed by former president George W. Bush, ruled the provision "would invite unbridled exercise of federal police powers."

The big problem with letting mandatory insurance go is that the entire reform hinges around it. By far the largest problem the US faces vis-a-vis health care insurance is what economists call 'adverse selection'; the insurer finds it very difficult to ascertain the 'riskiness' of individuals in certain groups. Because high risks (that require high premiums) will always be better off mixing with low risks (who only require low premiums), insurers that offer plans to low risks will also attract high risks. This forces up the average cost of the premium (as the riskiness of the group rises), and low risks may drop out as they think they'll be better off without it. Once again, this raises the riskiness of the group and forces the premium up - this continues until the premium is sky high and the plan, effectively, breaks. The whole phenomena is given the rather cool name of: the 'adverse selection DEATH SPIRAL'. People with pre existing conditions have no chance of even getting that far; insurers deal with uncertainty and risk, but they can't handle certainty due to the nature of the actuarial model.

Hence, mandating premiums is needed to prevent people dropping out of schemes, allowing insurers to better gauge the riskiness of a certain population and charge a stable premium. If the mandating clause gets dropped then the reform will only be partial; people with pre existing conditions will be able to get insurance, but limited between a higher average population risk and an inability to raise premiums, insurance companies will struggle to provide any sort of decent coverage.

A little background about me: I'm actually from the UK, but am currently doing my undergraduate dissertation on the US health care reform - in part due to being interested in the debate it provoked here. It was interesting to see what Americans thought about their own system and where they thought the failings were, and what they wanted from reforms. So, because this board played a (small) part in stoking my interest in this subject, I felt I'd give back a little as well.

So, after all that; what do you feel about the reform package, a couple of months down the line? Have you been affected already? What about this mandating insurance thing that's going on?

chidona on

Posts

  • SniperGuySniperGuy SniperGuyGaming Registered User regular
    edited December 2010
    My family, who is just rife with illness is pretty positively affected by it. My mom also owns a daycare center, and while the insurance money she has had to pay has gone up, it hasn't gone up substantially. And that may just be the insurance company, not the health care bill.

    3 of my family members (Including myself) have Crohns, so it's nice about the preexisting conditions.

    Also, isn't there a clause about how they can't deny children coverage now? That seems like a good thing all around.

    From what I have seen, it seems most people who disagree with the health care bill just don't understand what it does. Like when people argue against Net Neutrality that aren't employees of Comcast. Maybe there are negative sides, but I personally haven't been witness to them.

    SniperGuy on
  • FencingsaxFencingsax It is difficult to get a man to understand, when his salary depends upon his not understanding GNU Terry PratchettRegistered User regular
    edited December 2010
    Yeah, if you notice, 2 other courts have upheld that part, and the judgement itself is considered to be fundamentally flawed from what I understand.

    Fencingsax on
  • FeralFeral MEMETICHARIZARD interior crocodile alligator ⇔ ǝɹʇɐǝɥʇ ǝᴉʌoɯ ʇǝloɹʌǝɥɔ ɐ ǝʌᴉɹp ᴉRegistered User regular
    edited December 2010
    Fencingsax wrote: »
    Yeah, if you notice, 2 other courts have upheld that part, and the judgement itself is considered to be fundamentally flawed from what I understand.

    Yeah, gotta love the media.

    One judge upholds the law. Newspapers/sites quietly mention it.
    Another judge upholds the law. Newspapers/sites quietly mention it.
    Another judge challenges the law. IS THIS THE END OF HEALTH CARE REFORM!?!?!?!111111

    Feral on
    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.

    the "no true scotch man" fallacy.
  • AngelHedgieAngelHedgie Registered User regular
    edited December 2010
    The ruling you mentioned in the OP is pretty much political theater, for a number of reasons. And, of course, let's not forget that said judge should have recused his sorry unethical ass from the case in the first place, considering he has a conflict of interest a mile wide here.

    AngelHedgie on
    XBL: Nox Aeternum / PSN: NoxAeternum / NN:NoxAeternum / Steam: noxaeternum
  • chidonachidona Registered User regular
    edited December 2010
    Fencingsax wrote: »
    Yeah, if you notice, 2 other courts have upheld that part, and the judgement itself is considered to be fundamentally flawed from what I understand.

    Yeah, but it's still early days as there are more rulings pending. The economist ran an interesting article about the whole thing:

    http://www.economist.com/node/17733377

    In the OP I essentially went with a hypothetical situation where the mandate was struck down. I'm unfamiliar with the specifics of US law however, so I don't really know how likely the ruling is to hold up - I can only suggest what the economic repercussions of such a ruling would be.

    chidona on
  • FencingsaxFencingsax It is difficult to get a man to understand, when his salary depends upon his not understanding GNU Terry PratchettRegistered User regular
    edited December 2010
    If the mandate is struck down, then the medical insurance industry is absolutely screwed, because recission and not allowing for pre-existing conditions are now illegal.

    Fencingsax on
  • FeralFeral MEMETICHARIZARD interior crocodile alligator ⇔ ǝɹʇɐǝɥʇ ǝᴉʌoɯ ʇǝloɹʌǝɥɔ ɐ ǝʌᴉɹp ᴉRegistered User regular
    edited December 2010
    Fencingsax wrote: »
    If the mandate is struck down, then the medical insurance industry is absolutely screwed, because recission and not allowing for pre-existing conditions are now illegal.

    Which would probably be the best result in the long term. I wouldn't want to be around during the fallout, though.

    Feral on
    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.

    the "no true scotch man" fallacy.
  • AngelHedgieAngelHedgie Registered User regular
    edited December 2010
    chidona wrote: »
    Fencingsax wrote: »
    Yeah, if you notice, 2 other courts have upheld that part, and the judgement itself is considered to be fundamentally flawed from what I understand.

    Yeah, but it's still early days as there are more rulings pending. The economist ran an interesting article about the whole thing:

    http://www.economist.com/node/17733377

    In the OP I essentially went with a hypothetical situation where the mandate was struck down. I'm unfamiliar with the specifics of US law however, so I don't really know how likely the ruling is to hold up - I can only suggest what the economic repercussions of such a ruling would be.

    Yes, there are more rulings pending, but there are also the fact that so far, it's two for, one against, and that the one against ruling is pretty hideously flawed. Not to mention that these cases go after the one bit of healthcare reform Big Insurance likes.

    As for how the ruling stands, what happens in the worse case is you have what's called a split decision, where a higher court (in this case, one of the Circuit Courts of Appeals) has to rule who's right. Again, this means that as things stand the against side is screwed because they have fewer wins, plus their win is exceptionally weak.

    AngelHedgie on
    XBL: Nox Aeternum / PSN: NoxAeternum / NN:NoxAeternum / Steam: noxaeternum
  • LawndartLawndart Registered User regular
    edited December 2010
    Feral wrote: »
    Fencingsax wrote: »
    If the mandate is struck down, then the medical insurance industry is absolutely screwed, because recission and not allowing for pre-existing conditions are now illegal.

    Which would probably be the best result in the long term. I wouldn't want to be around during the fallout, though.

    Protecting the health insurance industry was the main reason why an insurance mandate was originally proposed by Congressional Republicans during the Clinton-era debate on heath care, and why it's part of Romneycare.

    Lawndart on
  • FeralFeral MEMETICHARIZARD interior crocodile alligator ⇔ ǝɹʇɐǝɥʇ ǝᴉʌoɯ ʇǝloɹʌǝɥɔ ɐ ǝʌᴉɹp ᴉRegistered User regular
    edited December 2010
    I haven't seen a single substantive argument that the insurance mandate is unconstitutional.

    Oh, I've seen many arguments. They're all specious.

    "The government can't make you buy something."
    Oh yeah? How about Social Security?
    "That's offered by the government, not a private company."
    So when GWB was talking about privatizing SSI, was he arguing for something unconstitutional?
    When the government outsources a tax-paid service (like defense) to private contractors, is that unconstitutional?

    "The government can't penalize inaction."
    Oh yeah? How about not filing your taxes? Or registering for Selective Service?

    "Health insurance isn't covered by the interstate commerce clause because insurance companies don't operate across state lines."
    Raich v. Gonzales disagrees with you.
    Besides, you really want to argue that companies like Aetna and Kaiser don't operate across state lines?

    Feral on
    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.

    the "no true scotch man" fallacy.
  • monikermoniker Registered User regular
    edited December 2010
    Feral wrote: »
    I haven't seen a single substantive argument that the insurance mandate is unconstitutional.

    Oh, I've seen many arguments. They're all specious.

    "The government can't make you buy something."
    Oh yeah? How about Social Security?
    "That's offered by the government, not a private company."
    So when GWB was talking about privatizing SSI, was he arguing for something unconstitutional?
    When the government outsources a tax-paid service (like defense) to private contractors, is that unconstitutional?

    "The government can't penalize inaction."
    Oh yeah? How about not filing your taxes? Or registering for Selective Service?

    "Health insurance isn't covered by the interstate commerce clause because insurance companies don't operate across state lines."
    Raich v. Gonzales disagrees with you.
    Besides, you really want to argue that companies like Aetna and Kaiser don't operate across state lines?

    Technically they don't (except for UHC which actually does have national plans) but in 2014 they'll be able to under the ACA. State's can merge to create regional pools for exchanges, rather than leave it restricted within the State, and I'm pretty sure insurance companies can opt to go under OPM rules in order to be universally accepted by exchanges similar to how banks can be State regulated or Federally regulated.

    As for me, personally, I <3 this law and can't wait for it to be further improved over the next decade or so. It'll be nice to be under my dad's good insurance plan again, and know that I can't get discriminated against for pre-existing conditions relatively soon. Which is the only reason I actually have 'hit by a truck' insurance right now where I'm basically burning $80 a month and still have to see a free clinic if I'm sick but it insures I have continuation of coverage and otherwise wouldn't have as many problems in the future under the old setup.

    moniker on
  • RobmanRobman Registered User regular
    edited December 2010
    The natural endpoint for this is government-run single payer, and the more the insurance companies thrash the faster this happens.

    Robman on
  • tsmvengytsmvengy Registered User regular
    edited December 2010
    Here's all I have to say about the court decision: right now this thing is two steps away from the Supreme Court, and honestly I don't have a lot of faith that this Supreme Court is going to do anything except what's best for the giant health insurance companies.

    tsmvengy on
    steam_sig.png
  • SavantSavant Simply Barbaric Registered User regular
    edited December 2010
    tsmvengy wrote: »
    Here's all I have to say about the court decision: right now this thing is two steps away from the Supreme Court, and honestly I don't have a lot of faith that this Supreme Court is going to do anything except what's best for the giant health insurance companies.

    Well, the health insurance companies benefit the most from the individual mandate due to adverse selection, so if that reasoning is followed they will likely uphold the law as is.

    I have family that think the individual mandate is unconstitutional, which seems pretty silly, especially given that the only penalty for failing to get health insurance is a fee. By that standard there would be a ton of other stuff that the Federal government does with tax and other law that would also be unconstitutional.

    Savant on
  • chidonachidona Registered User regular
    edited December 2010
    Robman wrote: »
    The natural endpoint for this is government-run single payer, and the more the insurance companies thrash the faster this happens.

    This is pretty interesting; I've come across authors who see that any system that attempts to stay 'private' will inevitably have features that resemble that of a social insurance system. The reforms in the ACA really do seem to go a pretty far way, thanks in a large part due to the mandate. The question therefore arises; will the ACA reforms lead to a stable 'private' system, or are they just a half way house between a private health care market that's full of holes, and a social insurance system reminiscent of the ones in Western Europe?

    chidona on
  • RobmanRobman Registered User regular
    edited December 2010
    It's a finite period of time until someone suggests allowing people to purchase insurance from the VA or other bodies.

    Robman on
  • LawndartLawndart Registered User regular
    edited December 2010
    Robman wrote: »
    It's a finite period of time until someone suggests allowing people to purchase insurance from the VA or other bodies.

    Either that or a gradual or not-so-gradual lowering of the Medicare eligibility age.

    Lawndart on
  • monikermoniker Registered User regular
    edited December 2010
    Or Medicare going up on the exchange and us more or less winding up with a means tested Swiss model.

    moniker on
  • RobmanRobman Registered User regular
    edited December 2010
    I would seriously love to buy VA style coverage. Their philosophy on malpractice is like 20 years ahead of the industry.

    Robman on
  • Phoenix-DPhoenix-D Registered User regular
    edited December 2010
    Robman wrote: »
    I would seriously love to buy VA style coverage. Their philosophy on malpractice is like 20 years ahead of the industry.

    Can you elaborate here?

    Phoenix-D on
  • FeralFeral MEMETICHARIZARD interior crocodile alligator ⇔ ǝɹʇɐǝɥʇ ǝᴉʌoɯ ʇǝloɹʌǝɥɔ ɐ ǝʌᴉɹp ᴉRegistered User regular
    edited December 2010
    Lawndart wrote: »
    Robman wrote: »
    It's a finite period of time until someone suggests allowing people to purchase insurance from the VA or other bodies.

    Either that or a gradual or not-so-gradual lowering of the Medicare eligibility age.

    Or a not-so-gradual relaxation of Medicaid eligibility guidelines.

    Feral on
    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.

    the "no true scotch man" fallacy.
  • RobmanRobman Registered User regular
    edited December 2010
    Phoenix-D wrote: »
    Robman wrote: »
    I would seriously love to buy VA style coverage. Their philosophy on malpractice is like 20 years ahead of the industry.

    Can you elaborate here?

    They have a policy of admitting the fuckup ASAP, and working to rectify it. This results in a tiny fraction of the malpractice claims you get in comparable civilian programs. It turns out that clamming up and pretending you're infallible isn't very helpful.

    Robman on
  • surrealitychecksurrealitycheck lonely, but not unloved dreaming of faulty keys and latchesRegistered User regular
    edited December 2010
    This is all that really needs to be said if somebody complains about healthcare reform:
    International_Comparison_-_Healthcare_spending_as_%25_GDP.png

    It's not like it could get any MORE expensive >.>

    surrealitycheck on
    obF2Wuw.png
  • FeralFeral MEMETICHARIZARD interior crocodile alligator ⇔ ǝɹʇɐǝɥʇ ǝᴉʌoɯ ʇǝloɹʌǝɥɔ ɐ ǝʌᴉɹp ᴉRegistered User regular
    edited December 2010
    Robman wrote: »
    Phoenix-D wrote: »
    Robman wrote: »
    I would seriously love to buy VA style coverage. Their philosophy on malpractice is like 20 years ahead of the industry.

    Can you elaborate here?

    They have a policy of admitting the fuckup ASAP, and working to rectify it. This results in a tiny fraction of the malpractice claims you get in comparable civilian programs. It turns out that clamming up and pretending you're infallible isn't very helpful.

    It also helps to have an authority with the power to investigate and remediate medical errors before they go to litigation. In a managed care system (like the VA, or NHS, or Kaiser) if your doctor fucks up, you can go to your doctor's boss or the hospital's medical director; there's a bureaucratic ladder to climb. This provides the possibility of seeing results (or getting a reality check) before lawyering up.

    In any case, malpractice suits are responsible for a tiny fraction of healthcare costs in the US.

    Feral on
    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.

    the "no true scotch man" fallacy.
  • monikermoniker Registered User regular
    edited December 2010
    Feral wrote: »
    Robman wrote: »
    Phoenix-D wrote: »
    Robman wrote: »
    I would seriously love to buy VA style coverage. Their philosophy on malpractice is like 20 years ahead of the industry.

    Can you elaborate here?

    They have a policy of admitting the fuckup ASAP, and working to rectify it. This results in a tiny fraction of the malpractice claims you get in comparable civilian programs. It turns out that clamming up and pretending you're infallible isn't very helpful.

    It also helps to have an authority with the power to investigate and remediate medical errors before they go to litigation. In a managed care system (like the VA, or NHS, or Kaiser) if your doctor fucks up, you can go to your doctor's boss or the hospital's medical director; there's a bureaucratic ladder to climb. This provides the possibility of seeing results (or getting a reality check) before lawyering up.

    In any case, malpractice suits are responsible for a tiny fraction of healthcare costs in the US.

    I think he was meaning it more from the patient well being standpoint than financial concerns.

    moniker on
  • FeralFeral MEMETICHARIZARD interior crocodile alligator ⇔ ǝɹʇɐǝɥʇ ǝᴉʌoɯ ʇǝloɹʌǝɥɔ ɐ ǝʌᴉɹp ᴉRegistered User regular
    edited December 2010
    Sweden has a pretty interesting system for malpractice. They have a standard form that any patient can fill out; if they claim malpractice or a medical error, then it goes up to a government-appointed review board. The review board can then rule for or against the patient's claim. Once the review board has decided, the patient has the right to lawyer up and sue if they are unhappy with the decision.

    The review board also has the authority to sanction practitioners who fuck up, including revoking the practitioner's license.

    They also have caps on damages, which I don't entirely agree with.

    Here's a pretty good article on it: http://www.facs.org/fellows_info/bulletin/2004/adelman0104.pdf

    Moniker: ah, gotcha. Yeah, makes sense.

    Feral on
    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.

    the "no true scotch man" fallacy.
  • RobmanRobman Registered User regular
    edited December 2010
    Yeah the US practice of clamming up after fucking up is to give you a stronger legal position in case you get sued, and it absolutely sucks for patients. It's also, I would wager, the main foundation for the "Doctor God Complex" belief that a lot of people believe.

    Robman on
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