The Bomb Buried In Obamacare Explodes Today-Hallelujah!
December 3, 2011 11:48 AM Subscribe

"This is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry."
posted by the young rope-rider (147 comments total) 28 users marked this as a favorite

Wow, that article is a roller coaster ride- I opened it as Forbes and expected right-wing nonsense but then he says this

Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Why? Because there is absolutely no way for-profit health insurers are going to be able to learn how to get by and still make a profit while being forced to spend at least 80 percent of their receipts providing their customers with the coverage for which they paid. If they could, we likely would never have seen the extraordinary efforts made by these companies to avoid paying benefits to their customers at the very moment they need it the most.

and I think "Wait, that's GOOD", but then I remember he called it the bomb in "Obamacare", but then he says the bomb goes off- Hallelujah! but then I remember nothing about Obama has led me to believe he'd ever enforce the teeth of legislation if it meant a corporation might lose even one penny but then the article writer said HHS is being strict and oh man.

I just do NOT know what to think, you guys!
posted by hincandenza at 11:54 AM on December 3, 2011 [21 favorites]

Also in Forbes: What Bomb Buried in Obamacare?

What confuses me here is that in a competitive market it’s entirely normal for an insurer to have a loss ratio higher than 80%. There are plenty of entirely profitable and growing insurance companies that have loss ratios over 100%. So I cannot really understand why the law insisting on an MLR of 80% (or 85% in the large group market) is going to cause all for profit insurance companies to fall over.

This idea of a loss ratio over 100% is a little odd, of course, but allow me to explain it. There are two entirely different income streams for an insurance company. One is the premiums that are paid in: we can all see that one and understand it. The second is the hidden one that most don’t understand is there: that’s the investment income gained from having those premiums in between their collection and the need to pay them out again on a claim.

posted by BobbyVan at 11:55 AM on December 3, 2011 [21 favorites]

Obama burying ILDs, Improvised Legislative Device?
posted by nathancaswell at 11:58 AM on December 3, 2011 [18 favorites]

So all they have to do is debate, delay and defer payments for months and years while more interest accrues? I guess I could be optimistic but.
posted by seanmpuckett at 12:00 PM on December 3, 2011 [4 favorites]

Here in Indiana, our State Department of Insurance petitioned the Feds for a waiver on this part of the healthcare act.

Indiana is home of Anthem/Wellpoint.
posted by Thorzdad at 12:04 PM on December 3, 2011 [7 favorites]

I don't know the numbers for health insurance, but it's very common in other insurance lines for the payouts to be MORE than the premiums -- that is, for every $100 they take in, they end up paying out $102 or $103, over time. But the 'over time' part is important; they're holding the premiums now, and that cash is called 'float'.

In essence, the insurance company is borrowing money from its customers. The amount that the payouts exceed the premium is the interest rate, or the 'cost of float'. They invest the borrowed money, and if their returns exceed their cost of float, they're profitable.

Good underwriters may actually achieve a negative cost of float, but if they're able to do that consistently, they usually means their insurance is overpriced, and someone is going to undercut them.

With just this general insurance knowledge, but absolutely no specific experience with healthcare insurance, I'd hazard the guess that an 80% payout will be almost entirely meaningless, because if healthcare insurance is competitive (and I don't know that it is), that percentage should already be substantially higher.

It seems like everyone is angry at the insurance companies for the high cost of healthcare, but it's not really their fault. They're just passing along the costs imposed on them by doctors and hospitals, and even if they're horrifically wasteful, which is not generally true of any successful insurance company, bringing the overhead down to 20% will only solve the healthcare money problem very briefly. It's the inflation in health care that's the problem, not the hard overheads. Even if we cut healthcare premiums by a flat 20% across the board (in other words, cutting overhead in half), that only buys us about 3.5 years at a 6% inflation rate.

It's solving, in other words, the wrong problem, going after the wrong targets. In an inflationary environment, blaming the vendors and imposing price controls never, ever works. All it does is result in shortages. Uncontrolled cost increases is usually either a supply/demand issue or a problem with the money supply, and given the Federal Reserve's hijinks over the last ten years, I'm betting on monetary disorder.

And, note, that this author is celebrating potential shortages as a good thing. He's saying, quite literally, that he would rather be unable to buy healthcare insurance at all, just so that nobody can make a profit selling it.
posted by Malor at 12:07 PM on December 3, 2011 [28 favorites]

I don't know enough about this to evaluate the article but I will say two things. One, if this is true, I'm surprised not to have heard anything about it before, given the apparent magnitude of the rule. And two, goddammit I hope it's true.

It's to a a large degree true of Dodd-Frank as well --- that's another massive omnibus whose success or failure depends a lot on how the civil servants and regulators which have to enforce it choose to interpret it.
posted by Diablevert at 12:07 PM on December 3, 2011 [2 favorites]

If you thought that the Obama Administration chickened out on pushing the nation in the direction of universal health care for everyone, today is the day you begin to understand that the reality is quite the contrary.

I'm certain the insurance companies are already pushing a two-front war of loopholes and lobbying. And, on preview, I'm right.
posted by Blazecock Pileon at 12:09 PM on December 3, 2011 [3 favorites]

If you thought that the Obama Administration chickened out on pushing the nation in the direction of universal health care for everyone, today is the day you begin to understand that the reality is quite the contrary.
I'm certain the insurance companies are already pushing a two-front war of loopholes and lobbying. And, on preview, I'm right.

Yeah, the day to believe that the reality is quite the contrary will be a few years after the dust settles on this. Which could be a long time in the future.
posted by b1tr0t at 12:13 PM on December 3, 2011

It seems like everyone is angry at the insurance companies for the high cost of healthcare, but it's not really their fault. They're just passing along the costs imposed on them by doctors and hospitals, and even if they're horrifically wasteful, which is not generally true of any successful insurance company, bringing the overhead down to 20% will only solve the healthcare money problem very briefly. It's the inflation in health care that's the problem, not the hard overheads. Even if we cut healthcare premiums by a flat 20% across the board (in other words, cutting overhead in half), that only buys us about 3.5 years at a 6% inflation rate.

It's a combination of the insurance companies paying whatever the care providers demand from them for services, and the lack of transparency about what the care providers are charging when it comes to the public consuming their services.

If you don't know what is actually being paid for a service, there are no market forces driving costs down and quality up.

Have you ever tried to shop around for the best price on a medical procedure? I have. It's basically impossible.

This part of the PPACA is probably hoping to push healthcare costs down by making it impossible for insurance companies to pay the inflated prices demanded by the care providers. Whether it will work or not remains to be seen.

But it's no secret that the PPACA was lopsided toward the payout end of the health care cost problem from the outset. Wasn't the plan from the start to have this be part one of a two part solution, with the second part working on forcing down costs directly from the provider end? I seem to remember reading that someplace.
posted by hippybear at 12:14 PM on December 3, 2011 [11 favorites]

My initial response was that 85% is not high enough, intuitively because nowhere in the article did the author give an analysis or justification of this number. Which makes the whole article a piece of false comfort.
posted by polymodus at 12:16 PM on December 3, 2011

The entire article seems based off of the claim in this blurb:

Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Why? Because there is absolutely no way for-profit health insurers are going to be able to learn how to get by and still make a profit while being forced to spend at least 80 percent of their receipts providing their customers with the coverage for which they paid. If they could, we likely would never have seen the extraordinary efforts made by these companies to avoid paying benefits to their customers at the very moment they need it the most.

But that just doesn't make any sense to me.

I mean, it's certainly possible that the reason they fought against reduced profits was because a reduction in profits would cause them to die, but that's not the only possible reason why they would fight against reduced profits.

Another reason that they would fight against reduced profits, for example: They want to make as much money as they can.

Am I missing something here?
posted by Flunkie at 12:20 PM on December 3, 2011 [7 favorites]

So strange to see people saying that an industry that sees profits in the hundreds of millions to billions is "paying whatever", and not adding to the cost of medical care. Complete nonsense, insurance companies set the reimbursements for visits and procedures.
posted by the young rope-rider at 12:22 PM on December 3, 2011 [9 favorites]

After reading the Forbes piece last night (it was posted on Reddit), I did a little checking on the medical loss ratio for the major health insurers here in Iowa (PDF). Turns out every single one of them reported loss ratios of over 80% during 2007, 2008 and 2009, with several of them being in the upper 80's/low 90 percentiles.

Assuming the new federal calculation of the loss ratio is roughly the same as the one used in the above report (Iowa, like the Feds, excludes sales commissions), then I'm not really sure this is such a big "bomb" waiting to go off.

Hopefully I'm wrong and this starts us down the path toward single payer of some sort.
posted by webhund at 12:22 PM on December 3, 2011 [1 favorite]

I don't know the numbers for health insurance, but it's very common in other insurance lines for the payouts to be MORE than the premiums

Absolutely--in fact if you see the word "mututal" it's likely they're not actually making their money from insurance premiums.
posted by Hoopo at 12:25 PM on December 3, 2011 [1 favorite]

First you say ....

I'd hazard the guess that an 80% payout will be almost entirely meaningless, because if healthcare insurance is competitive (and I don't know that it is), that percentage should already be substantially higher.

(which is wrong but you said it anyway) .... and then you say ...

It's solving, in other words, the wrong problem, going after the wrong targets. In an inflationary environment, blaming the vendors and imposing price controls never, ever works. All it does is result in shortages.

So on one hand you claim there is no problem because the great and wonderful insurance companies are already paying out more than this new rule requires so it's a non-issue... then just a few sentences later you say that there is a problem and that this new rule will create healthcare shortages .

Are you actually listening to yourself? Do you understand the realities?
posted by Poet_Lariat at 12:26 PM on December 3, 2011 [4 favorites]

This almost sounds like a false-flag operation. Hey everyone! Obama has sprung a masterful trap that will eventually destroy greedy private insurers! Everyone can stop paying attention to the health insurance debate! The war is over!

Health insurers meanwhile continue getting filthy rich off of loss ratios of 95%.
posted by Salvor Hardin at 12:26 PM on December 3, 2011 [4 favorites]

He's saying, quite literally, that he would rather be unable to buy healthcare insurance at all, just so that nobody can make a profit selling it.

Health is a public good, and profit made from institutionalized inefficiencies in delivering public health represents a market failure.
posted by clearly at 12:28 PM on December 3, 2011 [34 favorites]

Yeah, if they really wanted to take care of the MLR 'problem' they'd pay their top level execs and board members half the current amount. Problem. Fucking. Solved.

0.01%'s....
posted by Slackermagee at 12:31 PM on December 3, 2011 [1 favorite]

Malor: ...because if healthcare insurance is competitive (and I don't know that it is), that percentage should already be substantially higher.

It isn't competitive. It's explicitly exempted from antitrust regulations, in fact, and collusion and price-fixing that would lead to massive jail time in any other industry are routine and legal in insurance.

From the article: Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Can someone make sure we get a post here when that happens, so I can go to wherever those large parts of the private insurance industry are buried, dig them up, and piss on their corpses? Mere death, while sufficient, is really so much less than they deserve.
posted by rusty at 12:40 PM on December 3, 2011 [8 favorites]

Health is a public good, and profit made from institutionalized inefficiencies in delivering public health represents a market failure.

Health care is not a public good. That's what's being bought and sold--not health.
posted by planet at 12:40 PM on December 3, 2011

How can you have a public good which has no publicly maintenance program? That's ridiculous.

But then, I look at the state of the roads and bridges and other infrastructure in the US, and I realize that's the general philosophy these days.
posted by hippybear at 12:43 PM on December 3, 2011 [4 favorites]

...which has no publicly funded maintenance program.
posted by hippybear at 12:43 PM on December 3, 2011 [1 favorite]

Health is a public good -- healthy citizens cost less and produce more -- and health is ensured by health care.

You're saying that a lack of ignorance might be a public good, but providing education is not. It's nonsensical semantic hair-splitting, and would be laughable if it didn't in fact represent the standard American philosophy.
posted by rusty at 12:44 PM on December 3, 2011 [24 favorites]

(The "you" above is planet. Not you hippybear. We agree, you and I.)
posted by rusty at 12:44 PM on December 3, 2011

I guess I'm not very familiar with Forbes magazine, but it still lists Steve Forbes as Editor-In-Chief. I'm surprised they're publishing an opinion piece with such clear support for Obamacare and Universal Healthcare in general. And I read it as the author being please with the implementation of universal healthcare regardless of whether it eliminates private insurance company profits. And health insurance is different than other types of insurance because it pays for the vast majority of healthcare in the US; I can't think of any other industry so dependent and intertwined with an insurance system.
posted by PJLandis at 12:51 PM on December 3, 2011

I'm surprised they're publishing an opinion piece with such clear support for Obamacare and Universal Healthcare in general.

Surely you mean the Patient Protection and Affordable Care Act.
posted by hippybear at 12:54 PM on December 3, 2011 [10 favorites]

Any capitalist with an ounce of brain-tissue should be for publicly funded healthcare. Healthy citizens, healthy workers are essential for growth. As every single country outside the US and a few war-ridden failed states seems to have found out long ago...
posted by mumimor at 12:56 PM on December 3, 2011 [12 favorites]

I think ObamaCare sounds better than PPACA.
posted by PJLandis at 12:59 PM on December 3, 2011 [2 favorites]

P-PACA sounds like Alpaca.
posted by PJLandis at 1:00 PM on December 3, 2011 [1 favorite]

Completely boggles my mind that an article about this topic was written/edited/published without including any information on what current medical loss ratios are.
posted by Perplexity at 1:06 PM on December 3, 2011 [9 favorites]

P-PACA sounds like Alpaca.

It really sounds like it's derived from the word 'llama' (similar to how Gregor Samsa's name is derived from Kafka's).
posted by daniel_charms at 1:11 PM on December 3, 2011

Come on people, it's right there in his name! O-BOMB-a!
posted by blue_beetle at 1:17 PM on December 3, 2011 [1 favorite]

And, note, that this author is celebrating potential shortages as a good thing. He's saying, quite literally, that he would rather be unable to buy healthcare insurance at all, just so that nobody can make a profit selling it.

At which point, everyone gets really pissy and either a) demands the government provide health care or b) forms non-profit health co-ops with "concierge" style health care where the co-op would employ their own doctors (similar to how Group Health is run in Seattle).

So yes, between the lines he's screaming Burn, Healthcare System, Burn. But it's hard to say if he's arguing for high deductible plans or a single payer government system.
posted by dw at 1:23 PM on December 3, 2011

I opened it as Forbes and expected right-wing nonsense

I guess I'm not very familiar with Forbes magazine, but it still lists Steve Forbes as Editor-In-Chief. I'm surprised they're publishing an opinion piece with such clear support for Obamacare and Universal Healthcare in general.

Forbes.com was relaunched early this year as a blogging/news portal much like Huffington Post. Ungar is probably the leftiest lefty they have on board, but he's not the only one, and they seem pretty open to new ideas. Technically Forbes.com is under Forbes Digital Media, not the magazine.
Ungar wrote frequently about the Wisconsin protests, and every single time I had to explain this to people.
posted by dhartung at 1:26 PM on December 3, 2011 [2 favorites]

Poet_Lariat: So on one hand you claim there is no problem because the great and wonderful insurance companies are already paying out more than this new rule requires so it's a non-issue... then just a few sentences later you say that there is a problem and that this new rule will create healthcare shortages .

Are you actually listening to yourself? Do you understand the realities?

Well, whether I am or not, it sure doesn't look like YOU are. Let me try rephrasing it in super-digested form:

1. It probably won't make any difference.
2. Even if it does make a difference, it only helps for a year or two. The real problem is inflation, not the fixed overhead. When healthcare is going up 6 to 8% a year or more, even if you drop overhead by 20%, that only buys you maybe 3 years, and then you're right back where you started, with the problem still getting worse.

Nothing else really matters except that rate of increase. Any conceivable savings will be eaten almost instantly by that kind of inflation. If you're focused on fixed overheads with that kind of compounding cost issue, you're carefully building a five foot seawall with a 20 foot tsunami headed right for you.
posted by Malor at 1:30 PM on December 3, 2011 [2 favorites]

Nothing else really matters except that rate of increase. Any conceivable savings will be eaten almost instantly by that kind of inflation. If you're focused on fixed overheads with that kind of compounding cost issue, you're carefully building a five foot seawall with a 20 foot tsunami headed right for you.

Maybe we should be approving visas and importing massive amounts of healthcare professionals from poorer nations, undercutting the wages of doctors in the US and lowering costs.
posted by dibblda at 1:41 PM on December 3, 2011 [6 favorites]

If there is one thing I have learned over the past three years, inflation is not only not a problem, it is our only hope for relief from the current situation.
posted by Hypnotic Chick at 1:53 PM on December 3, 2011 [2 favorites]

that’s the investment income gained from having those premiums in between their collection and the need to pay them out again on a claim.

That's actually known as "reserves" in the insurance industry. Premiums get paid into a pool that the insurance company holds known as the "reserves". Those reserves are huge...enormous. The big money in insurance is holding onto the reserves and investing it for returns.

As it was explained to me, those premiums represent 4 large categories of costs: Retention (the amount expected to be paid out in claims) + Reserves (approximately the amount of 3-4 months of expected claim payouts in case you terminate the plan) + Administrative costs (what the insurance co. is telling you it has to pay to administer the plan) + Stop-loss/reinsurance (the cost of the premium that the insurance co. buys to cover extremely high claims). You and thousands of other people pay all of this to insurance companies every month. They hold onto any money not being directly paid out in claims per month and, after paying themselves a rather nice sum, they invest the rest. Any return on the investment they get on your reserves? Yes, they keep that, too.

Insurance companies are used to being flush....very flush. Their salaries and costs are so, so high. They were really living it up during the days of higher investment returns (I once had an insurance co. exec complain that they had to find a way to spend ALL of their training budget and how hard it was to do that because it was such a large budget. What??? BCBS offered to fly me in their private plane from Chicago to their Claims Center in Bourbonnais, Illinois--just a car ride away--in order to show off their claims facility when I was considering switching insurers.) Now that investment returns have taken a nose dive, they are stuck with less income but the same operating expenses in salaries, bonuses and so on. They can complain that reserves should be set higher (versus slashing their own budgets) and they can adjust the new premiums accordingly. Insurance companies will go bust because they are BLOATED and inefficient, not because they are paying out more claims than premiums taken in.

The pitch for self-insurance for corporations is that the corporations can hold and invest their own reserves. But you often are stuck STILL using an insurer for claims administration and having to pay them for that, as well as purchasing re-insurance to lower your risk.

Add that to the almost criminal lack of standardization in claims submission and billing which bloats the system even MORE. In the 70's, you might have one claims manager per medical office handling claim submissions and payments. Now, you have to have a whole team of people to keep up with the claims workload and every insurance company requires different forms, formats, etc. It is incredibly inefficient and costly. Which costs the medical practice money, which gets reflected in the the costs of care, which gets passed along to the consumer through higher health care costs. But insurance companies have no incentives to standardize or streamline. On the contrary. Every day that they can resist paying a claim is one more day to earn interest on the money that they hold in retention.

The deck is stacked to let the insurance companies prosper and patients + healthcare professionals lose. Already we see doctor's pay and work satisfaction dramatically reduced. It is getting harder and harder to find ANYONE who wants to practice as a generalist, versus specialist. Doctors who want to spend more than 10 minutes with a patient are being told "sorry, it's not cost effective to practice medicine that way." Instead of practicing medicine, doctors are being asked to keep the machine running. I have one good friend--a talented family practice doctor--who is so sick of the machine-mentality and the hours and hours of paperwork that add nothing to patient care that he is considering quitting medicine. EVEN though he has invested years and enormous amounts of money in becoming an MD. Insurance companies are the worst thing to happen to public health since corn syrup, IMHO.
posted by jeanmari at 1:58 PM on December 3, 2011 [59 favorites]

I don't understand the inflation argument. I was under the impression that healthcare costs were in significant part being driven higher by expensive technology and new treatments/drugs, as well as the insane costs of emergency/end of life care/older pop.. Even if inflation is so significant where do you get the numbers your quoting? I have a limited economics background, so I freely admit I don't fully understand the "realities."
posted by PJLandis at 2:00 PM on December 3, 2011 [1 favorite]

Maybe we should be approving visas and importing massive amounts of healthcare professionals from poorer nations, undercutting the wages of doctors in the US and lowering costs.

Are you being ironic? That's exactly the sort of thing that I would expect to help reduce healthcare costs. 30% of UK NHS professionals were born overseas. But I don't know enough about the US system to say whether it would help for sure.

Any capitalist with an ounce of brain-tissue should be for publicly funded healthcare.

The reason capitalism might not see publicly-funded healthcare as a benefit is that it won't generally help their workforce, which will tend to be people (men) between twenty and fifty, who don't need much healthcare. Sure, up to a fairly low point, you're right. But old people, children and pregnant women are the main beneficiaries of publicly-funded healthcare, not employees. So capitalists have no commercial reason to support publicly-funded healthcare.

(You should totally have publicly-funded healthcare, though. It's a Good Thing, and I'm pleased we have it here in the UK. But arguing that it's a benefit to capitalists I don't think works.)
posted by alasdair at 2:00 PM on December 3, 2011 [1 favorite]

If there is one thing I have learned over the past three years, inflation is not only not a problem, it is our only hope for relief from the current situation.

How sarcastic are you being, here? I honestly can't tell, and it would be condescending to presume you don't know the difference between debt and income.
posted by Diablevert at 2:03 PM on December 3, 2011

Malor wrote: It's solving, in other words, the wrong problem, going after the wrong targets. In an inflationary environment, blaming the vendors and imposing price controls never, ever works. All it does is result in shortages. Uncontrolled cost increases is usually either a supply/demand issue or a problem with the money supply, and given the Federal Reserve's hijinks over the last ten years, I'm betting on monetary disorder.

Yeah, that's why ACA has more provisions than just a required medical loss ratio.
posted by wierdo at 2:22 PM on December 3, 2011

I'm not being sarcastic at all...a higher inflation rate would help to restore the economy.
posted by Hypnotic Chick at 2:32 PM on December 3, 2011

AWAITING FURTHER ORDERS ON HOW TO HATE OBAMA FROM CMDR HAMSHER. STANDBY.
posted by joe lisboa at 2:45 PM on December 3, 2011 [2 favorites]

Just to nip the derail in the bud, people in this thread are using two different senses of the word inflation. Everytime Team Malor says "inflation" mentally translate it into "rate of increase" and continue the conversation as normal.
posted by gerryblog at 2:48 PM on December 3, 2011 [2 favorites]

Hypnotic Chick wrote: I'm not being sarcastic at all...a higher inflation rate would help to restore the economy

Not so much when it's specifically inflation of health care cost. Broad based, but below 4% or so inflation accompanied by wages keeping up would indeed help the economy significantly.
posted by wierdo at 2:48 PM on December 3, 2011

Atul Gawande has written a number of books about the US healthcare system I thought were good, informative and illustrated with interesting stories. So far this thread isn't very enlightening.

He has a very strong opinion about the general vs. specialist dichotomy in modern medicine and why the reluctance to specialize is hurting healthcare (Complications, I think). He uses an example of a Canadian hospital that specializes only in hernia operations, with few if any of the doctors having any background in the specialty or even surgery but consistently, and cheaply, performing hernia operations with unmatched low rates of complications. Interesting story and, as I said, a good read.
posted by PJLandis at 2:53 PM on December 3, 2011 [3 favorites]

Got it, my bad.
posted by Hypnotic Chick at 2:53 PM on December 3, 2011

Broad based, but below 4% or so inflation accompanied by wages keeping up

But they won't keep up, except in specialized disciplines.
posted by Malor at 2:57 PM on December 3, 2011

As the actual bits of the law are slowly rolled out people like it more and more. it won't be long before mitt Romney is running on his health reform as the model used by the nation.
posted by humanfont at 3:02 PM on December 3, 2011 [3 favorites]

It's explicitly exempted from antitrust regulations, in fact, and collusion and price-fixing that would lead to massive jail time in any other industry are routine and legal in insurance.

Cite, please? I'm unaware of the insurance exclusion in statute.
posted by ZenMasterThis at 3:03 PM on December 3, 2011

I'll make the capitalist's argument for universal health care. If you offer a salaried job in tech, insurance is a standard benefit. It costs a lot. Even if all of your employees are young and male, some are married and have or will have kids.

Decent (not gold plated, but decent) insurance like Kaiser, are presently 1600/mo for family coverage in my state.

As an employer, I would cover some of that cost, and a prospective employee (if married or a parent) will give as much weight to this benefit as they do to salary.

If Universal Health Care made this benefit less expensive, I could spend less to attract employees.
posted by zippy at 3:06 PM on December 3, 2011 [5 favorites]

ZenMasterThis: McCarran-Ferguson.
posted by rusty at 3:20 PM on December 3, 2011

Building on zippy: the broader case is that we're competing in the labor market with other industrialized countries who have public health care. Companies can and do build plants in Canada because it's cheaper to employ Canadians, both because they all have health care, and because they're healthier than Americans, because they all have health care. The current American system will eventually be seen as a horror and an abomination akin to the child-labor orphan sweatshops of Dickensian England.
posted by rusty at 3:23 PM on December 3, 2011 [12 favorites]

(I'll also note that living in a state with exactly one insurance company tends to highlight the negative effects of antitrust exemption.)
posted by rusty at 3:27 PM on December 3, 2011 [1 favorite]

The current American system will eventually be seen as a horror and an abomination akin to the child-labor orphan sweatshops of Dickensian England.

Be careful which Dickensian nightmares you use in your analogies because, you know, the GOP.
posted by auto-correct at 3:38 PM on December 3, 2011 [4 favorites]

...we are now on an inescapable path to a single-payer system for most Americans and thank goodness for it.

Revolujah!!

Great article. It really articulates what was long implicit in the AHA, and that is that, it does pave the way for a single-payer system. It IS a placeholder, and a serious one giving notice to the the for-profit industry that their profit margins are indeed under scrutiny to provide real and tangible services and not make people slaves to their capricious games.

I think the seriousness of the law to address what is a massive crisis in this nation is also the reason the law had to be enacted stepwise with the most egregious elements going online first and the benefits of the full program being held off until 2014, and it is that, there is a payday element, a certain bribe if you will, to it for the profit health insurers to raise rates and squeeze every last bit of profit they can before being hit with the changes.

tl;dr: AHA is the gateway and template for single payer universal health care progressives wanted all along, I don't think it can even work without a public option and that will have to be introduced down the line, but, the for profit insurers had to basically be bought off with 5 years of their BS in terms of inflated rates, to make them swallow the bitter pill. And those profits will go mostly to.....the 1%-ers. No surprise there. Fuck em. They're day of reckoning has come.
posted by Skygazer at 3:40 PM on December 3, 2011

I.E., The mandate is, in fact and intended, as a huge windfall/pay-off for the insurance Co.s.
posted by Skygazer at 3:43 PM on December 3, 2011 [1 favorite]

Are you being ironic? That's exactly the sort of thing that I would expect to help reduce healthcare costs.

Absolutely not. I'm serious. Near the Mexican border people cross over for drugs / dental / medical care. Medicine has been a privileged profession for a long time here and hasn't experienced the wage deflation everyone else has been experiencing. Looks like they are paid substantially more than any other industrialized nation's doctors. Maybe it's time for Doctors fees to be more in line with what their clients can afford.
posted by dibblda at 3:48 PM on December 3, 2011 [1 favorite]

It seems like everyone is angry at the insurance companies for the high cost of healthcare, but it's not really their fault. They're just passing along the costs imposed on them by doctors and hospitals, and even if they're horrifically wasteful, which is not generally true of any successful insurance company, bringing the overhead down to 20% will only solve the healthcare money problem very briefly. It's the inflation in health care that's the problem, not the hard overheads. Even if we cut healthcare premiums by a flat 20% across the board (in other words, cutting overhead in half), that only buys us about 3.5 years at a 6% inflation rate.

Obamacare does have some mechanism for cost controls. For one thing, it limits premium increases. So that puts a hard cap on how quickly healthcare costs can increase. Unfortunately, the annual increase cap is much higher then CPI, as far as I know. I think there are other things in there as well.

But that said, your argument about healthcare inflation kind of refutes your argument about floats. If the annual costs go up each year quickly, then the inflation will wipe out the 'float'. Healthcare providers won't be able to have 10 years of premiums saved up and only spend interest thing about it. Say you have a 100% medical loss ratio, and you make 5% interest on your investments, which are equal to 100% of your premiums.

If healthcare inflation is 10%. Then next year you raise your premiums 10%, and you keep your medical loss ratio 100%. Problem is, you only earned 5% on your pool, so now you only have a 95% pool. Each year you take out (medical inflation) – (interest) % from the pool. Only if earned interest is higher then medical inflation can you keep that going.

But this is kind of irrelevant. The reason this was in the bill was because many healthcare companies do not maintain a medical loss ratio over 85%, so this is definitely going to affect them. If an insurance company has a bad year on the markets (can anyone think of some recent examples) they can't just make it up by raising premiums.

Here's an interesting tidbit: They had originally wanted to impose a higher medical loss ratio (like 95%), but according to the CBO's rules, had they done that they would have made the insurance companies part of the federal budget. So even though it would have cost less money overall, it would have made the federal budget look much larger, simply due to a weird accounting quirk. (If I'm remembering this right)

Maybe we should be approving visas and importing massive amounts of healthcare professionals from poorer nations, undercutting the wages of doctors in the US and lowering costs.

Yeah, actually we should. If you're a 'true' capitalist then you should support a true free market in doctors, which mean foreign born doctors (It would actually even mean unlicensed doctors being allowed to practice, which is why no one actually wants a free market in healthcare. But allowing foreign doctors in is a good idea.)

The reason capitalism might not see publicly-funded healthcare as a benefit is that it won't generally help their workforce, which will tend to be people (men) between twenty and fifty, who don't need much healthcare. Sure, up to a fairly low point, you're right. But old people, children and pregnant women are the main beneficiaries of publicly-funded healthcare, not employees. So capitalists have no commercial reason to support publicly-funded healthcare.

The actual reason is that even if it helps their company's bottom line, it will hurt the CEOs after-tax income. Along with the after tax-income of the rich people who sit on corporate boards to 'represent' shareholders. However, the healthcare is paid for by a government they don't pay taxes for, like the one in Canada, it's awesome.

Just to nip the derail in the bud, people in this thread are using two different senses of the word inflation. Everytime Team Malor says "inflation" mentally translate it into "rate of increase" and continue the conversation as normal.

He's using inflation properly. The problem is that healthcare inflation outpaces the rest of the economy. And indeed, healthcare has been a boom industry over the past few years, as prices have been going up. It's been good for that sector of the economy.
posted by delmoi at 3:50 PM on December 3, 2011

Good luck getting a public option introduced "down the line" when it was impossible even when there were 60 dem senators. America is screwed as long as Blue Dogs can win democratic primaries.
posted by moorooka at 3:50 PM on December 3, 2011 [1 favorite]

Of course, this doesn't exist in isolation. Paired with mandatory enrollment, it produces a situation where the sick get taken care of where they wouldn't before, without being destroyed by premium hikes.

It's also not "buried", really. When PPACA passed, this was one of the things the defenders of the act were pointing to, even here on metafilter, but it got buried in the kneejerk Obama hate.
posted by kafziel at 3:56 PM on December 3, 2011 [2 favorites]

If you offer a salaried job in tech, insurance is a standard benefit. It costs a lot. Even if all of your employees are young and male, some are married and have or will have kids...
As an employer, I would cover some of that cost, and a prospective employee (if married or a parent) will give as much weight to this benefit as they do to salary.

You don't want employees who are married or parents. You want 22-30-year old men who believe that they are among the top 1 percent of programmers and are invincible in terms of both their career and their health. Therefore, they don't need reasonable hours, job security or benefits. You can then give them a foosball table and maybe a nice cafeteria and call it a day.
posted by Ralston McTodd at 4:00 PM on December 3, 2011 [11 favorites]

Moorooka: Good luck getting a public option introduced "down the line" when it was impossible even when there were 60 dem senators. America is screwed as long as Blue Dogs can win democratic primaries.

That's a whole other issue, but I feel very strongly the Right has over-played it's cards ridiculously with it's continued flirtation with the extreme Right and is going to come to a serious accounting next year and through the decade. All the growing demographics have been roundly denied a place at the table, and worse actively alienated from the current GOP, with the kind of messaging and vitriol that will not soon be forgotten.

OWS is going to sweep the youth, minority, ethnic, female vote next year, and even if the number one priority is decoupling corporate funds from elections and having Citizens United overturned, I think it will come out big for voting Democrat as the only reasonable pathway to that.

I'll even go out on a limb, and expect to be held on it, that possibly by 2012 and definitely by 2014, the Democrats will have decisive majorities in the House and Senate, as well as, Obama in the Executive.

Of course the GOP could always move way back to the center....

And who, seriously thinks that will happen without causing even greater damage to itself politically?
posted by Skygazer at 4:09 PM on December 3, 2011

humanfont writes "As the actual bits of the law are slowly rolled out people like it more and more. "

I've wrote it before: The right wing in the states is going to rue the day they decided to push the name Obamacare. It's going to result in the kind of lasting legacy the Reagan boosters can only dream of.
posted by Mitheral at 4:14 PM on December 3, 2011 [11 favorites]

ZenMasterThis: McCarran-Ferguson.
posted by rusty at 3:20 PM on December 3 [+] [!]

Thanks. I had no idea.
posted by ZenMasterThis at 4:19 PM on December 3, 2011

>... Maybe it's time for Doctors fees to be more in line with what their clients can afford.

I don't think that the fix is that easy. If I needed open-heart surgery, I would want the guy who has had extensive training in open-heart surgery, not the guy who only charges $499.99. But the guy with the extensive training probably borrowed $100k+ to get that training and needs to charge more to keep his head above water. It's not necessarily the doctors who are over charging, it's the people they owe.
posted by dogmom at 4:23 PM on December 3, 2011 [1 favorite]

I'm still at a loss to understand how the right managed to convince working class to lower-middle class Americans that universal health care is a terrible idea that would end up costing far, far more than the current system while offering fewer services at lower quality. Was it really just as easy as screaming "Taxes!" and "Socialism!" over and over?

No. Screaming "Taxes!" and "Socialism!" certainly seems to have been a large part of it, but there were more involved ideas put forward, too.

For example, during the heyday of the recent right-wing shoutfest, thanks to Facebook, I learned that some people I haven't seen since high school were seemingly both convinced and scared that something like 50% of doctors and nurses would retire overnight once the president signed the bill into law, because they wouldn't be able to make a living in their professions anymore.

And of course there was the whole thing about how in Canada you have to wait fifteen years for a doctor's appointment or whatever.

There were other things like that, too. They seemed genuinely scared of a bunch of totally inane things. Of course, in my mind, "genuinely scared of a bunch of totally inane things" pretty much sums up the heart of the conservative mindset, so maybe I'm biased, but that's the way it seemed to me.
posted by Flunkie at 4:25 PM on December 3, 2011 [3 favorites]

You want 22-30-year old men who believe that they are among the top 1 percent of programmers and are invincible in terms of both their career and their health.

The problem with those folks is threefold: 22-30 year old men are risktakers and have a higher rate of injury than 30-60 men, when they have medical expenses they are more often than not very expensive (car accidents, cancers, etc.), and you're going to burn them out quickly which creates a lot of employee churn.

Everyone I know in the local tech scene says running a company like that works for a year. Beyond that, you start getting screwed by the lack of experience.
posted by dw at 4:26 PM on December 3, 2011 [2 favorites]

ZenMasterThis: Me neither. I mean, WTF America? Some dispute the legal extent of the exemptions, but in practice, it doesn't seem like insurance companies get prosecuted for antitrust ever. I got this from Matt Taibbi's book "Griftopia" if you want more.

Skygazer: I think it will come out big for voting Democrat as the only reasonable pathway to that.

I don't think so. I don't see OWS turning anyone toward the Democrats, who look just as clueless and spineless as everyone else in power in the face of real demands for change. I'm not interested in putting the likes of Ben Nelson back in charge of anything. I mean, it's not turning them toward Republicans, but that was never a possibility. I think if anything it's underscoring how completely sold out we've been by those who claim to be our allies. I wouldn't get your hopes up for 2012.
posted by rusty at 4:29 PM on December 3, 2011 [3 favorites]

Flunkie: Of course, in my mind, "genuinely scared of a bunch of totally inane things" pretty much sums up the heart of the ~~conservative~~ American mindset.
posted by rusty at 4:30 PM on December 3, 2011 [2 favorites]

And speaking of startups, one of the reasons people don't start their own business is health insurance. Providing a national health plan would open the door to a new age of entrepreneurship in the US.
posted by dw at 4:31 PM on December 3, 2011 [9 favorites]

Was it really just as easy as screaming "Taxes!" and "Socialism!" over and over?
Probably. I met a couple of nice middle-aged ladies from Indiana on a trip to Russia this summer, and they kept asking me if "socialized medicine" in Canada was really as bad as they had heard because they were scared they would no longer have access to quality care in the US once "Obamacare" kicked in. Never mind the fact that 1) medicine in Canada is not socialized (we have a single-payer system, where our hospitals are privately-owned!) and 2) Canadian life-expectancy is higher than that of the US. It's easier to scare people when they don't have the facts.
posted by reformedjerk at 4:33 PM on December 3, 2011 [2 favorites]

Conservatives were also scared of 'death panels' for elderly and disabled folks, e.g. 'Obama will kill them'.

As a disabled person myself, I asked a conservative where I could find these death panels, because knowing when you're gonna die? SWEET! I could put my affairs in order and call it a day!
posted by spinifex23 at 4:39 PM on December 3, 2011

It's impossible to underestimate the level of political apathy in this country. People neither know nor care what's in the healthcare law.
posted by dirigibleman at 4:55 PM on December 3, 2011 [4 favorites]

Overestimate. I think. I need either more or less alcohol.
posted by dirigibleman at 4:56 PM on December 3, 2011 [1 favorite]

If you thought that the Obama Administration chickened out on pushing the nation in the direction of universal health care for everyone, today is the day you begin to understand that the reality is quite the contrary.

I'm certain the insurance companies are already pushing a two-front war of loopholes and lobbying. And, on preview, I'm right.

And this is a surprise? This is a long, hard battle and like everything worth having, we will have to fight for it.

Sometimes I think people's problem with Obama is really a problem with how hard things are:

The road ahead will be long. Our climb will be steep. We may not get there in one year or even in one term. But, America, I have never been more hopeful than I am tonight that we will get there.

I promise you, we as a people will get there.

There will be setbacks and false starts. There are many who won't agree with every decision or policy I make as president. And we know the government can't solve every problem.

But I will always be honest with you about the challenges we face. I will listen to you, especially when we disagree. And, above all, I will ask you to join in the work of remaking this nation, the only way it's been done in America for 221 years -- block by block, brick by brick, calloused hand by calloused hand.

What began 21 months ago in the depths of winter cannot end on this autumn night.

This victory alone is not the change we seek. It is only the chance for us to make that change. And that cannot happen if we go back to the way things were.

It can't happen without you, without a new spirit of service, a new spirit of sacrifice.

So let us summon a new spirit of patriotism, of responsibility, where each of us resolves to pitch in and work harder and look after not only ourselves but each other.

It has always been up to us.
posted by Ironmouth at 5:23 PM on December 3, 2011 [9 favorites]

You did it because you understand the enormity of the task that lies ahead. For even as we celebrate tonight, we know the challenges that tomorrow will bring are the greatest of our lifetime — two wars, a planet in peril, the worst financial crisis in a century.

It's true, that was a very nice speech. I wonder how all that stuff he was talking about turned out.
posted by gerryblog at 5:45 PM on December 3, 2011

Re: the Loss Ratios and 80% issue, and whether this new provision makes a difference to health insurance costs/profits: My very uninformed speculative reading of both Forbes articles leads me to this idea: perhaps the impact of the provision is that if affects what exactly can be counted in that loss ratio? That is, the cost of paying your insurance salesman can not be counted when determining your payout to premium ratio, only those things that are officially deemed medical care? That's my best guess.
posted by Saxon Kane at 5:52 PM on December 3, 2011

Insurance companies are used to being flush....very flush. Their salaries and costs are so, so high.

Our salaries are what?!?! I've yet to hit $40,000
posted by Hoopo at 5:55 PM on December 3, 2011

That was a good speech, he's a hella orator. And he gave that speech right before he loaded up his cabinet with Goldman alumni and held closed meetings with insurance companies and pharmacutical companies and they threw their lobbyists behind the law...which means that big money isn't worried about this mythical "bomb" any more than they were worried that they might be punished for treating mortgages like a giant slush fund.

Look, Barry seems like a great guy to have a beer with, but he's just as bought and paid for as every other politician. The only reason this passed is because the executives knew it wouldnt impact their bonuses.
posted by dejah420 at 5:56 PM on December 3, 2011 [4 favorites]

There's a lot of this at BCBS, Hoopo. You work for a U.S. Insurance Co. in the U.S., I take it?
posted by jeanmari at 6:00 PM on December 3, 2011

PAPACA (a.k.a ObamaCare) was supported by Phrma (Pharmaceutical Lobby) with significant money spent on advertising it. Was the insurance industry unilaterally opposed?
posted by PJLandis at 6:04 PM on December 3, 2011

Was it really just as easy as screaming "Taxes!" and "Socialism!" over and over?

Marisa Stole the Precious Thing: I think "Canada" and "The Post Office" were in there as well.
posted by Turtles all the way down at 6:06 PM on December 3, 2011

Look, Barry seems like a great guy to have a beer with, but he's just as bought and paid for as every other politician.

Who is this Barry fellow?
posted by humanfont at 6:11 PM on December 3, 2011 [1 favorite]

It's impossible to underestimate the level of political apathy in this country. People neither know nor care what's in the healthcare law.

Because it's fucking complicated? I worked for a Very Large health insurance company for the last four years. I still struggled constantly to barely understand the products or the funding, not because I'm stupid, but because both the law and the offerings change frequently, and there's no requirement to use standardized language, and oh yeah what state are you in, because it varies, and did your employer throw in a little caveat of "no birth control coverage, you sluts!", which they can totally do. And who's the consultant who brokered the deal between your insurer and your employer? That effects how good a deal you got, and then if you're a state agency or municipality, well, you have separate, and often contradictory, rules.

Any person whose ever had a procedure done that they thought was covered, then received an incomprehensible bill, or 12, knows that helpless, afraid feeling that no matter what they do or how carefully they read fine print or ask from help from customer support, they are going to get screwed and have to pay a shit ton out of pocket.

The apathy most people feel about healthcare stems from that feeling of helplessness IMO. You will never penetrate all the layers of gobbledygook, scammy billing practices, or inexplicable fees to understand your healthcare or know in advance what you will actually pay. After awhile, you stop trying, because if you think about it, you turn into a spittle-flecked raver. And more and more, you end up without any coverage whatsoever because it costs more than you can afford or just isn't being offered.

At this point, I think the feeling for most people is "Screw details. How could it be worse than what I have now?"
posted by emjaybee at 6:24 PM on December 3, 2011 [16 favorites]

humanfont: "Who is this Barry fellow?"
It's how people say the President's name when they want it to sound like more "American" like "George" or "Ronald."
posted by Dr. Zira at 6:28 PM on December 3, 2011 [1 favorite]

"Who is this Barry fellow?"

Can we not do the "Barry" thing, Please? Present company excepted (Dejah420), it's usually used around the web 99.99% of the time by people who're complete dickweeds.
posted by Skygazer at 6:52 PM on December 3, 2011 [8 favorites]

Back in the 1990s, insurers returned 97 percent of every premium dollar to patient care.

The current average is under 76 percent - largely because insurance companies went to Wall Street looking for investment dollars, and are now beholden to those investors to maximize profits.

It's not a bomb for health care - it's a modest adjustment to profits by Wall Street.

I cannot scream "Fuck you!" loud enough to these craven, greedy thugs. And a hefty "Fuck you!" to Forbes too, for carrying water for these scumbags.
posted by Xoebe at 7:04 PM on December 3, 2011 [5 favorites]

did your employer throw in a little caveat of "no birth control coverage, you sluts!", which they can totally do.

Not any more. Thanks to ObamaCare.

Can we not do the "Barry" thing, Please?

I say let them have their Barry thing for 5 more years.
posted by humanfont at 7:17 PM on December 3, 2011 [7 favorites]

I can't say this rule makes any sense to me. Health insurers have a lot of flexibility in what they call "administrative expenses" and what they call "medical expenses." If they come in at an MLR of 75%, they can just move some stuff from one bucket to another -- for example by requiring providers to take on more of the administrative hassle, and paying them for it. One article I read said they could just spend a few million on anti-smoking advertisements to raise the MLR, though I can't believe that would hold up in court.

I support health care reform, but these laws were hastily designed and gutted by lawmakers who didn't agree with the entire premise of health insurance. I can imagine a situation in which the cost of insurance on the health care exchanges ends up spiraling out of control -- as soon as it exceeds the penalty for not holding insurance, healthy people will opt out, insurance prices will rise, more healthy people will opt out, etc. The result is that there are still just as many uninsured people. That's even assuming that the mandate holds up in court, which it might well not.
posted by miyabo at 7:51 PM on December 3, 2011

I can't say this rule makes any sense to me. Health insurers have a lot of flexibility in what they call "administrative expenses" and what they call "medical expenses."

Did you read the article? They are explicitly not allowed to do that.
posted by atrazine at 9:45 PM on December 3, 2011

The article described one specific example of cost-shifting that was disallowed. I believe there are a lot of other kinds of cost-shifting that are basically impossible to keep track of and will allow the insurers to report arbitrarily high MLRs.
posted by miyabo at 11:03 PM on December 3, 2011

Good luck getting a public option introduced "down the line" when it was impossible even when there were 60 dem senators. America is screwed as long as Blue Dogs can win democratic primaries.

Moorooka: Do you think that a majority of democratic primary voters in Ben Nelson or Joe Lieberman's districts opposed the public option (Well, we know Joe Liberman lost the damn primary last time round, and won't even be running again. But that's another issue)

What about Max Baccus. Do you think a majority of dem primary voters opposed the public option? Do you think a majority of the voters in those states are dead set opposed but fine with the public mandate? (It's not clear if you do or not from your comment)

of course not. The biggest lie of all is that these compromises were made because of votes. Voters don't give a shit about the details of this stuff, and the public option was more popular then Obamacare overall. These compromises were made because of campaign contributions, and lobbying in general.

Conservatives voters have certain issues they vote on. the public option isn't one those issues, although the mandate is a bigger problem. Now some die-hard rush Limbaugh listener might jump through enough contralogical hoops to get to the point where they think a public option would out compete the private health insurance companies in the free market, gradually gaining a monopoly but most aren't even smart enough to understand that lie.

I'm certain the insurance companies are already pushing a two-front war of loopholes and lobbying. And, on preview, I'm right.
And this is a surprise? This is a long, hard battle and like everything worth having, we will have to fight for it.--Ironmouth

For the record, my phone corrected Barack to Barry. I think my 11+ years here proves I'm way left of the Dems.
posted by dejah420 at 6:38 AM on December 4, 2011 [6 favorites]

I'm still at a loss to understand how the right managed to convince working class to lower-middle class Americans that universal health care is a terrible idea that would end up costing far, far more than the current system while offering fewer services at lower quality. Was it really just as easy as screaming "Taxes!" and "Socialism!" over and over?

I think another facet of it is the hidden costs of health insurance. Your typical working class American generally gets his health insurance from his employer, with a token amount taken out of each paycheck. Mine, for example, is $40 a check, and I think $150 if you have a family.

What the GOP did, on purpose or not, was convince these people that's the cost of insurance. It is easy to imagine the government screwing up a system where you believe you get all this care for the low-low cost of $100 or three a month. If these folks knew how much it really costs, it would not be so easy.

I know the costs, and it *still* didn't resonate with me. There were a couple of years where pay didn't go up (management had to take a 10% hit in some cases) while our insurance deductions kept going up. WTF, I thought. But then I looked at what was happening to the premiums. I was getting hefty raises each year, but they were eaten up by the invisible healthcare costs.
posted by gjc at 7:00 AM on December 4, 2011

Seriously? It would be hard for them to find loopholes if they were out of fucking business, wouldn't it! Or if people had the choice to op out and join the public option, which is essentially what ever single person over 65 does in this country. But instead, we foreclosed on that idea so Ben Nelson and Max Baccus could keep their campaign contributions flowing, or whatever their problem was. Because it certainly had nothing to do with "representing the voters in their state" and it certainly had nothing to do with getting a deal with the republicans.

Being pissed off with Ben Nelson and Max Baucus (and don't forget Joe Lieberman) because they wouldn't support a public option is reasonable enough. Being pissed off with Obama because of this makes no sense whatsoever. Liberals seem to think that the President has some secret button he can push to make senators fall into line on votes if he really, really, really wants it. He doesn't.

More to the point, though, study after study showed that the public option would be adopted by relatively few people and would have, overall, a miniscule effect on total coverage. The fetishization of the public option by the US left is one of the more bizarre features of the Obama era.

The notion that because healthcare is a public necessity it must be entirely funded by direct government payouts is a pretty bizarre one. There are lots of things that are public necessities which we quite happily see being provided by public/private partnerships of various kinds. Let's just take one utterly essential item (far more essential than healthcare): food. Does the primacy of our need for food see us insisting that the government own and operate all farms? Are we shocked and outraged that farmers and food companies seek to earn sustainable profits? Do we yearn for collectivized agriculture and the endless bounty it has always brought those countries that tried it? Of course not. We let private businesses manage the food supply chains but we surround that with government regulation to ensure safety and quality and we provide public assistance (food stamps, unemployment insurance etc.) to support purchasing power for the disadvantaged.

There's no inherent reason that private health insurers, suitably regulated by the government, cannot efficiently manage the health insurance market so that total administration/fraud costs are held to a lower level overall than they would be if the same system was managed directly by the government. Look at the Swiss health system, for example. They have a system very similar (mutatis mutandis) to Obamacare. It is a system of compulsory private insurance. And the World Health Organization ranks their system higher than Canada's, higher than Australia's, higher than Sweden's, higher than Denmark's, higher than Germany's. The claim that government regulated universal private health insurance cannot lead to good outcomes would seem to be completely disproven by that simple fact.

Both the left and the right in the US have some pretty bizarre myths lodged firmly in their minds about the glories or the evils of single-payer healthcare systems. As someone who was born and raised in one single-payer system and has lived in a couple of others I can tell you that people living in such systems spend an awful lot of time bitching and moaning to each other about the limitations thereof--just as Americans spend a lot of time bitching and moaning about the tricks their health insurance companies get up to (not, of course, that we want the pre-Obamacare American system--which is pretty universally regarded as bonkers). Both systems are, essentially, rationing systems and nobody much enjoys living under a rationing system. Just as Americans rail against their HMO for not allowing such-and-such a treatment, people in single-payer nations rail against their nation's "pharmaceuticals board" or whatever for choosing not to cover such-and-such a drug. No system provides a panacea. No system in itself magically solves the problem of increasing medical costs (which, as Malor tried valiantly to point out upthread, has pretty much nothing whatsoever to do with the health insurance companies, which do not very significantly contribute to the total burden of health expenditure in the US). All systems have their discontents and their occasionally arbitrary-seeming rules and regulations.

Switzerland proves that a public-private partnership of the Obamacare variety can be a viable model for a humane approach to this always difficult and intractable problem. The devil, of course, will be in the regulatory details, but so far it looks like they're trying to do it right. It will certainly be a massive improvement over what came before. Unless, of course, liberals piss it all away by refusing to vote for the Democrats in the coming elections and giving complete control of the Senate, House and Presidency to the Republicans who repeal the whole shebang. Somehow, of course, this will really be a huge victory for progressives who can return to planning the full implementation of a single-payer health system in 2065 when their "We're not the Democrats" party finally seizes power. Except, well, you know, for that one member from Nebraska, Senator Flaucus, who ran under the "We're not the Democrats" ticket but, it turns out, is only willing to vote with them on 90% of their platform and won't, as it happens, support single-payer, even if the President really, really, really wants him too. But he will support a system that gets pretty much the same outcomes--it just has to be a public/private partnership. True progressives won't, of course, fall for that malarkey. They'll discard any attempt at reform and bide their time until 3015 when the "We're not the We're not the Democrats" party will FINALLY take full control...
posted by yoink at 8:05 AM on December 4, 2011 [7 favorites]

For the record, my phone corrected Barack to Barry. I think my 11+ years here proves I'm way left of the Dems.

Its usually those on the left who are disrespectful with "Barry." I've never heard a rightist use that term. They're too busy using his middle name.

And as for those claiming it isn't about votes? Really, you think that general election voters in Nebraska and Arkansas were for the public option?

Nelson and Lincoln were elected time and time again by collecting conservative votes.

As for Lincoln, she was primaried for that vote specifically and she won the primary.

In that speech, he said it was going to be hard--that it wasn't going to get done in one term. There was zero false advertising.

And think of it this way--we're arguing about healthcare legislation that has already passed and been signed into law. Nobody's ever done that before on a national level for the general public. Ever.

And I hear constantly about people from Goldman Sachs being in the Administration. Really? Who? More importantly, what decisions have these persons made, specifically, that you think are wrong?

This guilt by association crap ain't gonna pull it anymore. Because we're going into a situation where, for the first time in our lives we will have a very stark choice for President of the United States. Newt Gingrich is at the door, ladies and gentlemen. And 42% of people in this country are self ID'd conservatives according to Gallup's polling data from 2010. That number remains steady from years past.

Going into the darkness or staying in the light. That is the choice. And we are the ones who have to make it. If you want Gingrich to win, do nothing. If you don't, getting people on board at the coffee shops and at the water coolers is what we have to do.
posted by Ironmouth at 8:08 AM on December 4, 2011 [5 favorites]

Do you think that a majority of democratic primary voters in Ben Nelson or Joe Lieberman's districts opposed the public option (Well, we know Joe Liberman lost the damn primary last time round, and won't even be running again. But that's another issue)

What about Max Baccus. Do you think a majority of dem primary voters opposed the public option? Do you think a majority of the voters in those states are dead set opposed but fine with the public mandate? (It's not clear if you do or not from your comment)

As someone whose family is mostly registered Democrats who sound like Republicans, I have no problem believing that most Democrats in those states were against healthcare reform.
posted by dirigibleman at 9:00 AM on December 4, 2011

Going into the darkness or staying in the light. That is the choice.

That just emotional "lord of the Rings" style bullshit, Ironmouth.

And we are the ones who have to make it. If you want Gingrich to win, do nothing.

Yeah because if Romney won (and you know it will be Romney so don't play Gingrich games) we might have 2 ongoing mid-east wars, we might have 300,000 people completely dropping out of the work-force in a given month, we might have a Congress willing to pass indefinite detention for American citizens, we might have a Fed that gives 7.7 TRILLION dollar no-interest loans to banks (in secret) , we might have a President who looks the other way when Unions get screwed over, we might have a President willing to put Medicare and Social Security on the table for cuts...we might have.... we might have a Presidency that looks pretty much like the one that we have now .

Neither Romney nor Obama appears to be the answer to this country's real problems. I'm not voting next election for President. Not unless I'm offered a much better choice or things start really changing.
posted by Poet_Lariat at 9:57 AM on December 4, 2011

Its usually those on the left who are disrespectful with "Barry." I've never heard a rightist use that term. They're too busy using his middle name.

You kidding? The "Barry Soetero" meme is constant among birthers.
posted by kafziel at 9:59 AM on December 4, 2011 [3 favorites]

Yeah because if Romney won (and you know it will be Romney so don't play Gingrich games)

Actually, it looks more like Gingrich with each passing day. I'd still be a little more willing to put my money on Romney, but it's by no means a sure bet.

Yeah because if Romney won (and you know it will be Romney so don't play Gingrich games) we might have 2 ongoing mid-east wars,

Well, we only have one now, and under Obama very little prospect of a second. So you make this sound very scary right off the bat. Oh, and the one we have is the one that Obama constantly promised to wage throughout his campaign. Obama has done exactly what he said he'd do in both Afghanistan and Iraq.

we might have 300,000 people completely dropping out of the work-force in a given month,

You do realize that it is only thanks to Obama and the Democrats that federal unemployment insurance payments weren't stopped for most of the longer-term unemployed over two years ago, don't you? The notion that this, of all things, is the issue on which Democrats and Republicans are indistinguishable is just utterly bizarre.

we might have a Congress willing to pass indefinite detention for American citizens,

Yeah, we would. How is that Obama's fault, exactly? He, remember, is the one threatening to veto this legislation--although it might get a veto-proof majority. Again, that would not be the President's fault.

we might have a Fed that gives 7.7 TRILLION dollar no-interest loans to banks (in secret) ,

Good lord the reporting on that story has been absurd. No, the government does not have a secret 7.7 trillion extra on its deficit (which seems to be what some people think).

we might have a President who looks the other way when Unions get screwed over,

You mean a President who does not dictate to the states what laws they do and do not pass? Yes, I'm afraid that comes with the constitution as currently written.

we might have a President willing to put Medicare and Social Security on the table for cuts...

Yeah--because that's the worst imaginable scenario. I mean, it's not as if the major campaign issue for President Bush in his 2004 re-election campaign was privatizing the entire Social Security system. No, no Republican would ever suggest such a thing.

we might have.... we might have a Presidency that looks pretty much like the one that we have now .

Yes, and President Gore would have been exactly the same as President Bush--because, you know, in that alternate reality President Gore didn't quite manage to get Congress to sign off on a comprehensive plan to attack Global Warming, and it's ridiculous to think that anyone would have been asinine enough to go to war with Iraq after the 9/11 attacks.

The level of sheer willful blindness it takes to believe this "they're all the same" crap just never ceases to astonish me.
posted by yoink at 10:43 AM on December 4, 2011 [3 favorites]

Poet_Lariat wrote: we might have a Fed that gives 7.7 TRILLION dollar no-interest loans to banks (in secret)

If you're trying to imply that's what actually happened, you're either misinformed or a liar. It's easy to be misinformed when even Bloomberg doesn't grasp basic arithmetic or understand how loans work. By the standard that little factoid uses, the credit card companies gave me five and a half million dollars in the last year.

It's not as if the Fed has even hidden the volume of loans. They don't, and haven't in a long time if ever. They do, understandably, not disclose the identity of the particular institutions borrowing from the discount window, for the completely obvious reason. The maximum outstanding at any given time was about $110 billion.
posted by wierdo at 11:25 AM on December 4, 2011 [1 favorite]

Neither Romney nor Obama appears to be the answer to this country's real problems. I'm not voting next election for President. Not unless I'm offered a much better choice or things start really changing.

I do not understand. Someone will get nominated and run against Obama. The election will be held. Its not like buying a house or car where you can wait around for something better.

Yeah because if Romney won (and you know it will be Romney so don't play Gingrich games) we might have 2 ongoing mid-east wars

We're pulling out of Iraq. It is real. It is happening. They are getting on the planes.

we might have a President who looks the other way when Unions get screwed over

If you are talking about Wisconsin and Ohio, then I suggest a quick look at the Constitution. Obama is not the Governor of Wisconsin. Nor could he have convinced the GOP majorities in both chambers of the Wisconsin legislature to not pass the bill, or make Walker not sign it. What do you propose, sending in troops? Laughable.

In terms of unions, a subject I have a passing familiarity with, Obama has appointed very liberal members to the NLRB, members who nailed Boeing to the wall for siting their factory in a right-to-work state, and forced Boeing to keep thousands of jobs in Washington State.

As for cuts to Social Security, I haven't seen any. I see instead a trillion dollars in defense cuts over ten years. And the GOP can't say shit, because he got them to vote for it.

That's right--without a single cut to beneficiaries, he got the GOP to not only agree to his requested $300 billion in defense cuts for this year's budget, but he also got them to agree to another $650 billion in defense cuts over 10 years. And when the GOP made noise about undoing the trigger, he said in no uncertain terms that he would veto that.

Seriously, this is about not liking his image as someone not out to drink blood, not about the facts. Pure emotion. People wanted a liberal, partisan-appearing George W. Bush. When Obama did not provide, they try to tell us he's Bush redux.

Bullshit.
posted by Ironmouth at 12:00 PM on December 4, 2011 [6 favorites]

when even Bloomberg doesn't grasp basic arithmetic or understand how loans work

Was there a single news organization that approached that story with even minimal critical thinking? The thing that was most bizarre was that the same story was "broken" a month or so before Bloomberg picked it up (I think there was a thread here on Metafilter about it) and generally ignored by the media. I guess it was the fact that Bloomberg ran with this nonsense that gave it credibility to others (including, alas, The Daily Show which tends to turn their otherwise highly functioning BS detectors off when it comes to anything to do with TARP etc.).
posted by yoink at 12:20 PM on December 4, 2011

We're pulling out of Iraq. It is real. It is happening. They are getting on the planes.

Well, sort of.

Our troops are pulling out of Iraq.

The US is not leaving. We'll have thousands of contractors still in place once our military has left. Contractors who have been doing jobs which, in previous wars, were done by members of the military.

So yeah, we're pulling out. But not really.

/derail
posted by hippybear at 1:38 PM on December 4, 2011

And as for those claiming it isn't about votes? Really, you think that general election voters in Nebraska and Arkansas were for the public option?

Check out Ben Nelson's early life and career.

After graduating from law school, Nelson landed a job as assistant general counsel for Central National Insurance Group of Omaha. In 1975, he became state insurance director before going back to work for Central National Insurance as an executive vice president and eventually president.

Ben Nelson represents the insurance industry in the Senate. He happens to be elected by the suckers of Nebraska, but where Nebraska's interests differ from the insurance industry's interests... well, I'm sure Ben's never seen a case like that.
posted by rusty at 2:03 PM on December 4, 2011

(The fact that a bottom-feeding, corrupt, bought and paid-for scumbag like Nelson is allowed to act like he's a legitimate servant of the people is one of the things that is unforgivable about the current Democratic Party. Yes, without him, Nebraska may well be represented by a Republican. But if that Republican wasn't a complete crook, we'd all be better off. Democrats included.)
posted by rusty at 2:05 PM on December 4, 2011

FPP article says that the 80% expenditure rule will end for profit health insurance and lead to a single payer system. So why are you mad at Obama again? If you want single payer and socialized medicine you need to stop obsessing over the past and start laying the groundwork to win the battle for in implementation of HCR. the bill gives enormous powers to HHS over the insurance market. The initial regulations, the funding for implementation, the structure of cooperatives will all play out over the next decade as the law goes into effect. If you want single payer move to Vermont or start lobbying in your state and local politics to follow suit.
posted by humanfont at 2:17 PM on December 4, 2011 [2 favorites]

humanfront: I voted for Obama, because he ran on the promise of single-payer health care. I thought I was "laying the groundwork...". That's why I personally am pissed off at him. Single-payer was off the table the day after the election.
posted by rusty at 2:28 PM on December 4, 2011 [1 favorite]

Single-payer was off the table the day after the election.

In hindsight, that's a good thing, because it would never have passed the Senate.
posted by one more dead town's last parade at 2:32 PM on December 4, 2011

yoink wrote: Was there a single news organization that approached that story with even minimal critical thinking?

Yes, when the list of discount window loans first came out. Nobody made a huge deal about it other than to say "hey, even banks we thought were sound ended up needing hundreds of millions of dollars for a few days/weeks to remain liquid."

I ran the numbers for a few banks I was interested in the same way Bloomberg did recently and got absurd numbers, then realized that the term on the loans were one day, so each day's borrowing wasn't actually adding millions more to the bank's outstanding balance.

TDS seems to have been falling for a lot of Republican pack of lies BS lately.

The only question in my mind is who the Bloomberg piece helps politically. It's pretty clear either the reporter is an idiot or it was an intentionally misleading piece promulgated for someone's political gain.
posted by wierdo at 3:08 PM on December 4, 2011

I voted for Obama, because he ran on the promise of single-payer health care. I thought I was "laying the groundwork...". That's why I personally am pissed off at him. Single-payer was off the table the day after the election.

Please, link a transcript of any speech or debate where he promised single-payer health care.
posted by kafziel at 3:53 PM on December 4, 2011 [2 favorites]

Please, link a transcript of any speech or debate where he promised single-payer health care.

You know the one: it was right after he promised to end the war in Afghanistan as soon as he got into office and claimed that because he'd never agreed with the Iraq war in the first place, it would be fair for him to simply ignore any agreements the previous administration had made with the Iraqi government and that he didn't see that the US had any obligation to work towards an orderly draw down of forces in that country.

I mean, he must have made that speech hundreds of times because just about every soi-disant "progressive" voter seems to have heard it.
posted by yoink at 3:58 PM on December 4, 2011 [6 favorites]

The fact that a bottom-feeding, corrupt, bought and paid-for scumbag like Nelson is allowed to act like he's a legitimate servant of the people is one of the things that is unforgivable about the current Democratic Party. Yes, without him, Nebraska may well be represented by a Republican. But if that Republican wasn't a complete crook, we'd all be better off. Democrats included.

Why? I mean, in what possible universe is this true?

Politics is about getting the policies you favor implemented. It's not about feeling good about every single one of the people who affiliate with your "team." If Ben Nelson votes the way you want 70% of the time and the Republican will vote the way your want 10% of the time, that means that having the Republican in his place means losing a crucial vote on 60% of the issues that come before the senate.

Nate Silver has an interesting concept in this regard: The "most valuable Democrat" and the "most valuable Republican." It's not the one who votes the way you want most often. In most cases, that person's vote is irrelevant: no matter who was representing their state/district would vote the same way. It's precisely the Democrats in red state seats and the Republicans in blue-state ones who are the 'Most Valuable" to their parties. They're the ones who are actually moving the political goal line one way or the other.

Of course, this only matters if you care about actually achieving something through the political process. I have come to realize that for the majority of voters (left and right), they would rather lose every single battle as long as they received constant affirmation from their completely ineffectual representatives and President that the positions they held were indubitably the right ones and that everyone who disagrees with them is a poopyhead.
posted by yoink at 4:07 PM on December 4, 2011 [1 favorite]

I voted for Obama, because he ran on the promise of single-payer health care. I thought I was "laying the groundwork...". That's why I personally am pissed off at him. Single-payer was off the table the day after the election.

Seriously, that's the crack talking. Didn't you watch the debates? Hillary ran on the mandate and Obama was to her right.

So many people don't pay attention. I've seen people say Obama said he was going to end the Afghanistan war, despite the fact that he said the opposite. Where these people get this stuff, I have no idea.
posted by Ironmouth at 5:53 PM on December 4, 2011 [1 favorite]

Poet_Lariat: Neither Romney nor Obama appears to be the answer to this country's real problems. I'm not voting next election for President. Not unless I'm offered a much better choice or things start really changing.

I try to remain civil in these discussions, but this line of reasoning makes my blood boil. If the election comes down to a choice between Romney and Obama, you're just going to let everyone else decide for you? In what universe does that make sense? Assuming neither of the candidates is perfect, but that one is closer to that ideal than the other, why the f*** wouldn't you vote for that candidate? It makes absolutely ZERO sense to withhold your vote, and you're working against progressive interests if you truly go forward with your plan.

Let me just say in advance, "thanks a f'ing lot for your help" for all of the other sane progressives who will go to the polls and vote for the better of the two candidates.

rusty: (The fact that a bottom-feeding, corrupt, bought and paid-for scumbag like Nelson is allowed to act like he's a legitimate servant of the people is one of the things that is unforgivable about the current Democratic Party. Yes, without him, Nebraska may well be represented by a Republican. But if that Republican wasn't a complete crook, we'd all be better off. Democrats included.)

First off, you've set up a false dichotomy - who's to say that the Republican wouldn't be a complete crook, in the first place? Would a Republican who was a complete crook be any better than Nelson?

Second off, what's your reasoning behind the statement? If the Republican is an upstanding man of character, but he also happens to truly believe that Ayn Rand was the personification of Christ, gays and abortion are evil and government needs to be drowned in the bathtub, are you sure we'd all be better off with him in office?

---

What is it with so many progressives who seem to have such a tenuous grasp on reality? No understanding that progress takes time and hard work, and that a single president can't bring about a progressive utopia in one term - especially so when he's got fewer than 60 solid votes in the Senate and an opposition party that's decided to blockade every action he tries to take?

Wake the f*** up, people!
posted by syzygy at 6:08 PM on December 4, 2011 [6 favorites]

(The fact that a bottom-feeding, corrupt, bought and paid-for scumbag like Nelson is allowed to act like he's a legitimate servant of the people is one of the things that is unforgivable about the current Democratic Party.

You know I disagree with many of the man's positions. But "bought and paid for?" Seriously, he's been bribed? Any evidence for bribery? No.

People don't agree with our policy points--that doesn't mean they've been bribed.
posted by Ironmouth at 6:32 PM on December 4, 2011 [1 favorite]

humanfront: I voted for Obama, because he ran on the promise of single-payer health care. I thought I was "laying the groundwork...". That's why I personally am pissed off at him. Single-payer was off the table the day after the election.

Except that it isnt of the table. Vermont used the HCR changes to implement a single payer system. Health care cooperatives and requirements about how much gets spent on premiums means we are heading to single payer. You should be celebrating instead you are all upset because why exactly?
posted by humanfont at 7:22 PM on December 4, 2011

Apparently we don't agree deep down. You describe decades in the making policy and political achievements by our liberal president as nothing more than crumbs on the table. Millions of union manufacturing jobs saved, the military-industrial complex's agenda challenged and outflanked on Iraq, Financial Reform legislation, Health care reform, DADT repeal, a new transport bill focused on expanding rail and mass transit, green energy subsidies and two liberal supreme court justices.

The right's agenda after 2010 was:
-Repeal the Health Care Law
-Pass the Ryan Budget
-Make Tax Cuts on the Rich Permanent
-Force us to stay in Iraq
-Cut Spending

So far their major achievements have been:
-Cut spending for the 1996 Atlanta Olympic Games, and a few other line items we probably weren't going to spend anyway.
-Extend the tax cuts through 2013 in exchange for unemployment benefits and additional stimulus.
posted by humanfont at 10:41 AM on December 5, 2011 [1 favorite]

Rusty: This is you trying to explain how you're my team. Take your fake left-wing party and go fuck yourselves.

Perhaps Leftist's should take a "purity-test" of sorts then, eh Rusty? Would that be enough to prove people's Lefty credentials? Cos, that's working a treat, with the GOTP who seem not to want to have anything to do with anyone not to the Right of Attila-the-Hun.

Your anger, and indignation, while I'm sure it feels good, is misplaced, and self-defeating. When anger turns in on itself like that, it's no longer a good thing, it's something else.

It is the Left that has been soul-searching and keeping it together now over three decades of brutal sustained attacks, and it has and is even now emerging healthier for it. Stronger and more unified, whereas it is the Right that seems to be coming apart at the seams under the weight of it's own over-reach and arrogance.

Would you rather HCR in this admittedly imperfect iteration, hadn't passed?? Is moving forward somewhat, not a good thing, if it isn't as far as one wishes at each attempt?

Obama pulled off a coup. Literally, a coup that has been impossible for 60 years, probably because there were too many who would not bend to compromise whatsoever, and now a light at the end of the tunnel to what you call an institution as barbaric and antiquated as Debtors-Prison or Child Labor, can be seen. And that all happened, not in spite of, but because of the willingness to compromise on the Left.

And I think it's a sign of strength. And I'm going to say again, the Progressive movement is undergoing an awakening and renaissance in this nation that is going to enact breathtaking changes through this decade and the next, and big part of that lies in the fact that the Right has seriously painted inself into a moribund corner. And the overhaul it's going to need to make to make itself viable again are either going to fuck the nation forever once and for all in the direction of ironclad corporatism and authoritarianism, or they're going to have to come back to the center and back to supporting a middle class.

I'm not wrong on this.
posted by Skygazer at 11:15 AM on December 5, 2011 [2 favorites]

"I just do NOT know what to think, you guys!"
posted by hincandenza at 11:54 AM on December 3

Think of the worst possible 'unintended consequence' combined with the worst possible 'unanticipated outcome'.

Got it?

Double it. That's what you'll be ending up with.

Let's try... government pays the cost of health care, and private insurance goes bankrupt. Yay! Okay - then government pays out too much, goes even more into the deficit red spectrum than now. Boo! Taxes go up for medical costs. Boo! But wait - government can always make more money, since they own the printing presses. Yay! But wait - too much money in the money supply = hyperinflation! Boo!

End result? County medical services can no longer pay for immunizations for indigent children. Boo! Measles, mumps, rubella spread into the population. Boo! Due to no availability of health care (all eggs in one basket scenario, smash the basket and you got nada but a runny omelet) childhood diseases resurge, with pre-immunization fatality rates.

Plus a crashed economy - 'cause if the bozos there now can't figure out how to jumpstart things after the housing crash and the coming education crash, why would you even think to trust them with something as important as your health?

I'd love it if I thought the folks you hail as 'progressive' could convince me they've got a clue. But what I see is a mentality that demands results and product without any contribution, as if there's some magnificent pool of money and resources just waiting out there that can be tapped without any real-world repercussions. I look at the deficit, I look at our economy, I look at the real world repercussions of deficit spending in places like Greece and the rest of the EU, and go "Uh... let's just see how this plays out before we start tossing out trillions we don't have, 'kay?" If the Eurozone goes down, that'd be a fair indication that SOMETHING doesn't work.

Is it better to have an imperfect system that limps along for decades, or a perceived perfect system that wouldn't last a year, and which renders it impossible to recreate the imperfect system when it fails? Don't know about you, but if something doesn't work like it says on the label, I'd like some way to take it back and get what I had, no matter how it was sold to me.

The law of unintended consequences doesn't give a shit what your intentions are - reality will bite you in the ass every time. The question is - how big a bite do you want to give it, and why do you think that the folks who have legislated this into existence (who won't be affected by it) have thought through all the ways it can go wrong?
posted by JB71 at 1:13 PM on December 5, 2011

as if there's some magnificent pool of money and resources just waiting out there that can be tapped without any real-world repercussions

Well, as a right-winger, I'd point to the fact that health-care spending in the USA is higher as a proportion of GDP as indicating that you could run a perfectly good health-care system (France, Switzerland) for easily about 30% less cash. It might be that you WANT to spend more per head on healthcare, which is fine: but as a proportion of national income you seem to spend an unusual amount, which you're not spending on (for example) infrastructure, or education, or R&D. And as I pointed out upthread, it's not making your productive workforce any more productive, because they're not the main recipients of healthcare spending. It's going on unproductive - but voting - welfare recipients, notably the elderly and state employees and ex-employees (e.g. veterans).

So, you'll forgive me from saying, reality appears to suggest that the left-wingers are closer to a good public policy than you are.
posted by alasdair at 1:25 PM on December 5, 2011

I love President Obama and the Democratic Party. They are the only hope for the future of America. Ironmouth and Skygazer are right. We all must get in line and support our rightful leaders. I was once a shameful doubter but I have seen the error of my ways now. I only wish I had been reeducated sooner, before I did so much damage to the Party that loves me so. I will always be ashamed of this. But I will work doublehard to make up for my past. All of the Party's actions are right and good actions and all thoughts the Party gives me are right and good thoughts. I will think only right thoughts and do only right actions.

GMAFB, dude.

What are f*cking 14??

You got a better way to move forward on this country not being given over completely on a silver platter to the Oligarchs and the authoritarians, and further eroding the balance of wealth, and continuing to make the Bill fo Rights a fucking laughable farce, I'm all ears.
posted by Skygazer at 1:38 PM on December 5, 2011

I too am all ears! We should all be all ears. All ears is clearly the right thing for us, and for America, right now. I agree 100%.
posted by rusty at 2:15 PM on December 5, 2011

Let's try... government pays the cost of health care, and private insurance goes bankrupt. Yay! Okay - then government pays out too much, goes even more into the deficit red spectrum than now. Boo!

Your fantasy contradicts real outcomes where the public sector dominates healthcare. In fact what happens is that progressive tax revenue replaces insurance premiums resulting in increased lifespan and improved outcomes for all. A lower incidence of disease throughout the population is generally in ones individual interest.
posted by humanfont at 3:41 PM on December 5, 2011

Let's try... government pays the cost of health care, and private insurance goes bankrupt. Yay! Okay - then government pays out too much, goes even more into the deficit red spectrum than now. Boo! Taxes go up for medical costs. Boo! But wait - government can always make more money, since they own the printing presses. Yay! But wait - too much money in the money supply = hyperinflation! Boo!

End result? County medical services can no longer pay for immunizations for indigent children. Boo! Measles, mumps, rubella spread into the population. Boo! Due to no availability of health care (all eggs in one basket scenario, smash the basket and you got nada but a runny omelet) childhood diseases resurge, with pre-immunization fatality rates.

Plus a crashed economy - 'cause if the bozos there now can't figure out how to jumpstart things after the housing crash and the coming education crash, why would you even think to trust them with something as important as your health?

I'm not sure what reality you live in, but the above is not a description of the real reality.
posted by one more dead town's last parade at 5:11 PM on December 5, 2011

I love President Obama and the Democratic Party. They are the only hope for the future of America. Ironmouth and Skygazer are right. We all must get in line and support our rightful leaders. I was once a shameful doubter but I have seen the error of my ways now. I only wish I had been reeducated sooner, before I did so much damage to the Party that loves me so. I will always be ashamed of this. But I will work doublehard to make up for my past. All of the Party's actions are right and good actions and all thoughts the Party gives me are right and good thoughts. I will think only right thoughts and do only right actions.

You know, the fact that we disagree with you and that you got one fact wrong that we pointed out does not make this 1984. It just means we disagree.

I am interested though in where you get your ideas. I am interested in seeing where common ground exists because while Obama isn't perfect, I want him to be President for a second term. Many of the people on here will say things like Geithner worked for Goldman Sachs, or that Obama promised to get us out of Afghanistan, or that Single Payer was Obama's health care plan. These are not true and I'm wondering if people understood that they might see Obama as someone they have somethings in common with.
posted by Ironmouth at 8:19 PM on December 5, 2011

"So, you'll forgive me from saying, reality appears to suggest that the left-wingers are closer to a good public policy than you are."

Alsadair -

I'm not trying to control or suggest anything as far as a good public policy goes. Far from it - it's a very complex subject, and not open to simplistic solutions.

I'm simply trying to point out that the people writing this piece of legislation have (a) a LOCK on your vote because they tell you that they're 'progressive' (whether they really are or not is open to interpretation) who have (b) demonstrated an astounding amount of fiscal and budgetary stupidity (I mean, not even submitting a budget in the two years they had control of the House, Senate, and the Presidency? And how about all the money shovelled out to no good effect?) and (c) who don't need to give a shit about whether or not it's a good bill because THEY won't be affected by it and they've already got (a) who would vote for them no matter how bad the 'unanticipated results' are.

This thing got written in secret, didn't get discussed, didn't get analyzed or dissected, and was shoved out so fast that (in Nancy Pelosi's own words) you had to pass it to see what's in it.

Does that seriously sound like a piece of legisation that would (a) really do what's on the label, or (b) fit the criteria that "We've got to get some piece of shit out to please those noisy few who want universal health care on a European model, because we've got another election coming up and need the votes BAD."

And let's not even talk about the economic effects of such a bill, or what similar policies and costs have done in Europe.

The shaky situation of the Euro at this point, the collapse of Greece, the turning away in the UK from a 'government pays all' medical model - not to mention that we're running one hell of a deficit already and have an economy that's in bad shape even after 'stimulus' spending that makes the Bush years look like a model of thrift and economy - would make anyone who could add 2+2 together and get 4 consistently wonder if now's a good time to have government take on an unspecified amount of debt which would require one hell of a lot of people to administer (further driving up costs).

If this mess had been proposed by Republicans (never mind whether they would have or not) the folks here at Metafilter would have dissected anything down to the cellular level, all the while being skeptical as hell and looking at the finances behind it like a hyperactive auditor for the IRS. But put a 'progressive' label on it, and it's effectively shielded from all scrutiny and skepticism.

"Someone set us up the bomb."

Yeah. The folks in Washington.

"All your medcare are belong to us. You have no chance to survive, make your time."

Approach everything coming out of Washington with skepticism. The larger the bill for their 'help', the more skeptical you should be.
posted by JB71 at 4:46 AM on December 6, 2011

one more dead town's last parade -

The reality I live in... has an economy that's in sad shape. It's got a Congress that hasn't passed a budget in two/three years, and no foreseeable possibility of it until MAYBE 2012, and I wouldn't count on it then. It's got deficit spending per year that's half or more of the annual revenue. (But if you don't have a budget, it's not really deficit spending, is it?) It has clowns inside a very large circus ring called the Beltway that are convinced that there's no possible way to cut even a fraction of their spending, and they know that even if they could tax the fat cats at 100% they'd just get a few days respite.

(Kind of like the old story about the goose that laid the golden eggs. They may talk about killing the goose to get all the gold inside, but they wouldn't. Not as long as they can get some gold on a regular basis.)

The world economy where I live is in even worse shape. I see a group of countries with a common currency in a debt spiral, and one (Greece) has even pretty much collapsed as a welfare state. I see medical costs in otherwise reasonable countries spiralling out of control, taking up more and more of the budget as the population ages. I see unsupportable models everywhere - shakey economies, fearing a good push to shove them over, afraid that push is going to come from inside.

I see us in real economic trouble, a lot like someone making 20k/year deciding they can spend $35k/year indefinitely - just charge the extra money to their credit card. And I see Obamacare as being a new Ferrari that they can sign for - but the payments are going to bankrupt them.

Yoyur view may vary - but that's what I'm seeing. The thought of government taking on the costs of health care? I don't know about you - but I really don't see anything good coming from that, and the potential problems are massive.
posted by JB71 at 4:52 AM on December 6, 2011 [1 favorite]

JB71: The shaky situation of the Euro at this point, the collapse of Greece, the turning away in the UK from a 'government pays all' medical model...

You're conflating two issues here, universal healthcare and hypercapitalism/the IMF and and utterly morally bankrupt Wall Street culture.

Believe it or not, in spite of your concern for the great Right-wing bogey man of "deficits," they're discrete issues. It is not the "welfare state" you speak of, that has gotten the Euro in the spiral it is in right now. And indeed, it is Germany, and the Scandinavian nations which have all have quite robust social nets, and universal healthcare systems and strong unions and a healthy middle-classes that have weathered the crisis best of all. Indeed better than the United States even.

And you're wrong to think the HCR act isn't being dissected. That seems to be happening even in this thread. I think you're simply concerned it hasn't been dissected according to a certain ideological dogma, that can never ever, see anything outside of the all healing and all perfect and sacred perfection of the greatest myth economics: The Free Market and the idea that any control over it's potential, and presently very real litany of abuses against everyone, but the "1%."
posted by Skygazer at 8:34 AM on December 6, 2011

Shrug.

As I've said, other people's mileage may vary. Everything is interconnected, much as people would love to separate them and discuss them separately as if changing X won't have any effect at all on Y.

But it's one hell of a tangle of ropes, and pulling on one pulls them all. If Greece goes down, and Italy goes down, there'll be no repercussions to the European economies such as Germany? If the Euro is dropped, what repercussions will follow from that?

Does the ostensible success of the Scandinavian systems (IE Sweden) at 9 million people with the same ethnic and cultural background scale up to a non-homogenous society of 300 million like the US?

(And is it working that well to begin with?)

Are the folks inside the Beltway - who've demonstrated massive incompetence so far on both sides in damn near everything - suddenly geniuses who've created something like Obamacare, which will work exactly as designed with no 'unexpected' chunks taken out of the economy? (Ever noticed that's about the most common adjective used to describe news of the economy? Unexpectedly high unemployment, unexpectedly low revenues, unexpected problems in foriegn policy?)

I have my doubts - big ones - that the folks inside the Beltway can pull it off. Based on past performance, we're about to see a hell of a lot of money we don't have thrown at 'preferred providers' like the solar scam with Solyndra and Evergreen Solar. But hey, what's a few trillion more on the deficit?

I think they've sold a lot of gullible people a fat scam they know they won't be held responsible for, or affected by. And when it goes bust, all they'll need to do is whine that their intentions were good... and retire on a fat pension, laughing at the stupid marks who believed in their integrity and honesty as they go.
posted by JB71 at 11:27 AM on December 6, 2011

JB71: Does the ostensible success of the Scandinavian systems (IE Sweden) at 9 million people with the same ethnic and cultural background scale up to a non-homogenous society of 300 million like the US?

"We hold these truths to be self-evident: That ~~all~~ 9 million ethnically and culturally homogeneous men or whatever the amount made self-evident by the all-perfect, all-holy, all-wondrous and mighty market shows in it's infinite and miraculous wisdom, blessed be Ayn Rand and the Austrian prophet Von Mises, Amen. (.tm) are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness..."

That's a little weird, right? But that is what it comes down to doesn't it? According to supply-side Orthodox, that's pretty much what "liberty" and "freedom" comes down to, an exclusionary economic system that portends equality and meritocracy and leaving the Rights of Humans, to the whims of economic forces. Because, heaven help humans if they dare to dream beyond the bounds of nature.

Sorry. Too silly, too backwards, too concerned and too unimaginative. I don't want to live in that world and I don't know too many others who would want to save for those who've sold themselves a limited worldview and labelled it Individualism in the name of the all that is good primarily for themselves, but also because...well because they deserve prosperity, health and life, libery and the pursuit of happiness, more than others.

(And is it [Sweden's Healthcare system] working that well to begin with?)

From the link (emphasis mine):

Conclusion

While Sweden is a first world country, its health care system - at least in regards to access - is closer to the third world. Because the health care system is heavily-funded and operated by the government, the system is plagued with waiting lists for surgery. Those waiting lists increase patients' anxiety, pain and risk of death.

I see, so access to healthcare in Sweden is more akin to that found in a third world country.

It gives it away as total Right-Wing Randian Acolyte crap-logic.

That study was done by The National Center for Public Policy Research Wikipedia:

NCPPR is a member of the Cooler Heads Coalition, whose object is described as "dispelling the myths of global warming by exposing flawed economic, scientific, and risk analysis".

Disgraced lobbyist Jack Abramoff was a member of NCPPR's Board of Directors; he resigned in October 2004 after NCPPR's Board of Directors concluded he had violated the organization's conflict of interest policy.[1]

In October 2002, Abramoff directed the Mississippi Band of Choctaws to give $1 million to NCPPR, and then told Amy Ridenour to distribute the funds to Capital Athletic Foundation ($450,000), Capital Campaign Strategies ($500,000) and Nurnberger and Associates ($50,000).

Not to mention birtherism and denial that Obama is even a Christian makes the NCPPR no worthy of being cited.

And so, thanks for wasting everyone's time with your concern, and rambling suggestiveness and weak sources.
posted by Skygazer at 3:13 PM on December 6, 2011

Waitaminute? I can just go to my doctor tomorrow and ask for a knee replacement and have surgery the same day? I didn't realize our health care system had gotten so great in the last couple of years. All this time I thought I might have to wait for a few weeks or months to get the procedure done.

Oh, wait. That's right. I can't.
posted by wierdo at 3:34 PM on December 6, 2011 [2 favorites]

"Not to mention birtherism and denial that Obama is even a Christian makes the NCPPR no worthy of being cited."

If a Birther said 2+2 equalled 4, would you discount it? Broken clock, twice a day and all that crap?

Look I KNOW I'm goring sacred cows here. I'm suggesting you look at this matter with the same sort of scrutiny and skepticism that you'd extend to any proposal by a Republican - I'm thinking you'd be parsing numbers and ripping the thing to shreds if this had come from Bush as a completely unworkable pile of crap that would bankrupt the US, if it didn't get dismantled first.

But it didn't, so feel perfectly free to accept this, paid for by a blank check written on the future of all of us - in addition to the $15 trillion we're already stuck for, and the $5-10 tril we're supposedly in line for in deficit spending over the next 4 years. Run the numbers - the money simply isn't there.

Some day the check will come due.
posted by JB71 at 4:14 PM on December 6, 2011

Wierdo -

My brother used to live in Yakima, WA. He worked at a Wal-Mart there, making a wage that satisfied him. He had a heart attack about 5 years back - called 911 and was on the table getting stents put in in 45 minutes.

His total cost? Ended up spending about $75. He was broke - but they took care of him anyway. Various programs kicked in, and he was covered.

He wasn't so lucky with his second heart attack this summer. He apparently was reaching for the phone to call his doctor... and didn't make it.

It's made me more aware of my health, that's for damn sure. Once your heart stops, all the fun goes out of life.
posted by JB71 at 4:23 PM on December 6, 2011

JB71: Look I KNOW I'm goring sacred cows here.

You flatter yourself. It would be enlightening if you were goring anything here. All I'm getting are vague mysterious intimations of imminent disaster.

It doesn't seem like you've done the job of ripping the legislation "to shreds" and instead seem to be going by truth challenged shill extreme Right-Wing political groups like The National Center for Public Policy Research.

If you have a point go ahead and make it. Say what it is your trying to say, provide some support for it.. and stop beating around the bush.

While you're at it, explain why you think this nation can no longer can do BIG and incredible things that set the world standard, and can't adjust and find ways to make things work through trial and error. Even if it is at 300 million people.

My sense, and my suspicion is that when I read comments like yours or read bogus pseudo-scientific arguments liek that by the The National Center for Public Policy Research, or the American Enterprise Institute, or FOX News, or the Right wing noise-spin machine, or the supply-side purists, what I get loud and clear, is simply the intense fear and anxiety that Obamacare, might indeed end up working, and that must not be allowed to happen at any cost, so the Fear, Uncertainty and Doubt right-wing machine goes into overdrive.

Go ahead. Point to one salient fact that isn't an "if."
posted by Skygazer at 4:45 PM on December 6, 2011

He had a heart attack about 5 years back - called 911 and was on the table getting stents put in in 45 minutes.

And Obamacare de-prioritizes Stents or balloon angioplasty exactly how?? Does it close down Emergency rooms or emergency procedures, and if it does please point out where it says that.
posted by Skygazer at 4:50 PM on December 6, 2011

Skygazer -

Obamacare was sold, and sold hard, as something that took care of the people who didn't have insurance. There were other ways to do it, cheaper ways, and state and local agencies provided them - but the lure of a gigantic, massively expensive program wasn't something that Reid, Pelosi, and Obama could resist. After all, how better could they leave a legacy?

And I do think we're going to regret it badly. With 50 states and uncounted cities and counties and towns and hospitals all doing their separate thing, if something doesn't work for a town they can look at what does work for others and adjust accordingly. With one health care concern controlling everything for everyone - if that particular way doesn't work, you're screwed nationwide, not just locally.

(And no, I don't think they're smart enough in Washington to go beyond a central planning model. The very idea of a uniform health care system is that everything's done the same way all through the system - no variances allowed. They'll tell how to do things, and that'll be it.)

Your mileage varies - you see things from a different perspective than I do, and you think that it's going to be fine. That it'll do what's on the label, and be affordable. I really hope you're right, since we're currently stuck with it, but I just don't see how. I'm looking at the numbers - and short of (*then a miracle occurs*) it's not going to work. I don't care what any politician promises, when it comes to money if it's not there it's got to be borrowed. And what gets borrowed eventually has to be paid back... one way or another.

My observation and experience with government programs is that what's sold at a price is rarely delivered and pretty much never at the price quoted. I don't expect that this will be any different. We're running $1.5 tril a year in the red now, with $15 tril stacked up for the future to pay off. This isn't going to help balance the books at all.

I could be wrong. I hope I am. Time will tell, though.
posted by JB71 at 7:15 PM on December 6, 2011

JB71 wrote: Wierdo -

My brother used to live in Yakima, WA. He worked at a Wal-Mart there, making a wage that satisfied him. He had a heart attack about 5 years back - called 911 and was on the table getting stents put in in 45 minutes.

OK. Your point is what exactly? That we treat people with life threatening conditions immediately and without regard to their ability to pay, just like most other countries manage? Do you think we should get a gold star for meeting what should be the minimum standard?

Sorry about your brother's second, that sucks.

And in my experience, no. Most people who can't afford insurance don't qualify for Medicaid. If they're lucky, the hospital will still have some money around such that they can comp the bill. (not that that helps with the doctors) Not likely if it's one of the big for-profit hospital operators, though. There was a terribly interesting 60 Minutes story on just that a year or two ago.

What we have/had before was clearly completely broken. I'm not quite sure how a regulated private insurance market is so different from what we have now that it scares you.
posted by wierdo at 8:31 PM on December 6, 2011

JB71: I could be wrong. I hope I am. Time will tell, though.

Yes, it needs to play out. For now, there are quite tangible benefits. People can't be denied for pre-existing conditions, and caps are no longer allowed. Children are covered and so are young adults who can remain on their parents plans until 26 yrs old. These are real and are now. And yes, the Insurance co.'s are exacting their pound of flesh by raising rates, but they're days with that behavior are numbered. The Act absolutely, needs to be adjusted in the near future. It has to eventually include at least a public option in my opinion or else medicare needs to be extended to people who're younger, or follow that template. A working successful program. It can be done. It will be done. And there are HUGE economic benefits to come in the form of preventive care reducing extreme procedures and people being able to start their own businesses or taking manageable risks on new careers.

Anyhow, sorry to hear about your brother. Hang in there.
posted by Skygazer at 8:45 PM on December 6, 2011

Maybe if your brother had health insurance he could have received discounted statin drugs and avoided the situation. It cost way more than $75 fr your brothers open heart surgery. Perhaps that is what they charge him but the hospital costs were probable close to $100,000 which they tax payers ended up just eating. Your opposition to a same government funded healthcare system is literally killing your brother. I hate to be the one to tell you this. It may sound a bit dickish; but it is true.
posted by humanfont at 2:15 PM on December 8, 2011

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