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Thursday, October 03, 2013

Enforcing Obamacare

It never occurred to me to imagine that the federal government wouldn't enforce its fines for failure to engage in required economic activity with its usual bag of tricks, including seizing bank accounts and placing property liens:
If true, the implementation of Obamacare is going to be a whole lot more draconian than Americans have been led to believe. 

"I actually made it through this morning at 8:00 A.M. I have a preexisting condition (Type 1 Diabetes) and my income base was 45K-55K annually I chose tier 2 “Silver Plan” and my monthly premiums came out to $597.00 with $13,988 yearly deductible!!! There is NO POSSIBLE way that I can afford this so I “opt-out” and chose to continue along with no insurance.

"I received an email tonight at 5:00 P.M. informing me that my fine would be $4,037 and could be attached to my yearly income tax return. Then you make it to the “REPERCUSSIONS PORTION” for “non-payment” of yearly fine. First, your drivers license will be suspended until paid, and if you go 24 consecutive months with “Non-Payment” and you happen to be a home owner, you will have a federal tax lien placed on your home. You can agree to give your bank information so that they can easy “Automatically withdraw” your “penalties” weekly, bi-weekly or monthly! This by no means is “Free” or even “Affordable.”"

The federal government has consistently denied that any fines pertaining to Obamacare non-compliance could be seized from bank accounts, despite reports last year that the IRS had hired 16,500 new agents to harass citizens who attempt to evade the new law.
The system is breaking down, and it appears to be breaking down increasingly fast. Once people stop paying their Obamacare fines, how long will it be before they stop paying other taxes? And using the banking system as an enforcement device for the sake of compliance is more likely to break the banking system than it is to allow this expansion of the tax system to function as envisioned.

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208 Comments:

1 – 200 of 208 Newer› Newest»
Anonymous Vidad October 03, 2013 9:02 AM  

I wonder how far overseas their paws will reach.

Anonymous Salt October 03, 2013 9:03 AM  

I've mentioned such to a few Obama-bot liberals and their minds simply cannot fathom such an eventuality.

I envision the rise The Cash Society.

Anonymous Disgusted October 03, 2013 9:06 AM  

See how much simpler a single-payer system would have been?

Anonymous Susan October 03, 2013 9:07 AM  

Rush and Sarah Palin talked about this particular poison pill at least a year ago.

Between that and the "death panels" she was painted as quite the idiot, trash talker and fear monger. She was profusely laughed at by the media.

The media isn't laughing so hard today, are they?

Blogger swiftfoxmark2 October 03, 2013 9:11 AM  

Anyone ever read The Forever War? I think the final resulting society of clones (from one DNA strain with only gender being a difference), bisexual humans in that novel is the objective of the Left and other assorted Statists.

Of course, just about any science fiction Utopia could be cited as influencing these Gamma Nerds who run the government.

Anonymous jay c October 03, 2013 9:13 AM  

The faster the better. More taxes, more regulations, more racism, more cronyism, more corporatism, more war, more injustice. There has to be a back-breaking straw in there somewhere.

Anonymous fred October 03, 2013 9:19 AM  

@Salt

"I envision the rise The Cash Society."

I more envision the rise and enforcement of the cashless society.

Blogger JartStar October 03, 2013 9:22 AM  

Yes they will deduct the fines from your tax returns but:

Patient Protection and Affordable Care Act: The Secretary [of Health and Human Services] shall not file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section … or levy on any such property with respect to such failure.

So I'm wondering if this is a hoax post on FB.

Anonymous Brother Thomas October 03, 2013 9:29 AM  

The various forms of Statism have one thing in commen, they're all really oppressive and horrible.

Anonymous Josh October 03, 2013 9:39 AM  

I expect an emerging new market of obamacare penalty certificates, where you can pay someone's obamacare penalty, collect annual interest, and after two or three years of non payment by them, place liens on their assets and garnish their wages.

Anonymous BillB October 03, 2013 9:43 AM  

Worse. The Federal government was not granted any police powers to enforce any tax or commerce laws.

Before you flame me read Article I, Section 8 and ask yourself when Paragraph 6 and 10 were written, "Why were they written?" Did the Framers think those two police powers were more important than all others? If the Framers had to explicitly grant those two police powers, why is it that today the government can exercise police powers that were not granted? How could the supreme court allow a clear violation of state authority (police power)?

Some will claim that the Necessary and Proper clause adds police powers to the granted powers but don't paragraph 6 and 10 in the same section as the N&P clause prove the Framers did not recognize that concept?

The feds have all of 7 police powers that are easily found in the Constitution. All the rest of their laws on murder, etc are not Constitutional. The separation of powers concept was not simply three branches. The true separation of powers was that the federal government might pass certain laws BUT only the States could enforce those laws because the police power was left with the States. And thus if the States considered something the feds did to be unconstitutional, that law would receive no enforcement.

We are so far from a constitutional government I don't know if we can get it back. The trek down the wrong path began with the first Congress.

Anonymous allyn71 October 03, 2013 9:46 AM  

"Patient Protection and Affordable Care Act: The Secretary [of Health and Human Services] shall not file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section … or levy on any such property with respect to such failure."

That assumes they will be playing by the rules. They have already unilaterally changed the clear language of the bill via executive action a couple of times.

Wouldn't surprise me at all that they are claiming the ability to place liens on assets for non-compliance regardless of whether it is a legal claim or not.

Anonymous Jake October 03, 2013 9:46 AM  

See how much simpler a single-payer system would have been?

I think that's the point. If you can't get a single-payer system pushed through, then you do everything you can to make the alternative completely unbearable until the masses plead and beg for you to socialize their healthcare.

And two decades later all the history books will record that markets didn't work in healthcare and after years of reluctance the government finally stepped in and made things better by dictating who gets what and paying for it all out of the public funds.

Anonymous bw October 03, 2013 9:48 AM  

See how much simpler a single-payer system would have been?

And yet no less immoral or coercive.

Anonymous aero October 03, 2013 9:53 AM  

They are curing the preexisting condition of having your own money.
Between you and your doctor there is tens of thousands of pages that you both have to understand and comply with before any medical treatment.

Anonymous Judge Dredd October 03, 2013 9:53 AM  

Ah, yes! The inevitable overreach! I was wondering when they were going to cross the line! They always seemed to want to cross it, but always stepped back before falling off the cliff!

Looks like Wile E. Peyote has finally led the liberals to take the fateful step!

Blogger swiftfoxmark2 October 03, 2013 9:55 AM  

See how much simpler a single-payer system would have been?

It would have be, if men were angels.

Anonymous Josh October 03, 2013 9:55 AM  

Wouldn't surprise me at all that they are claiming the ability to place liens on assets for non-compliance regardless of whether it is a legal claim or not.

And even if it's not legal, they'll go ahead and place a lien because most people will just pay to remove the lien rather than challenging them in court.

Blogger Bob October 03, 2013 9:55 AM  

I wasn't around to see the fall of Rome, but I'm a living witness to the fall of America.

Anonymous Anonymous October 03, 2013 9:55 AM  

Met with our insurance broker this summer to discuss the health plan for our church (we cover 12 employees). We were reviewing plan changes, and decided to for with an HSA with BC/BS with a high deductible. Fortunately, the gov. allowed small businesses to lock in a new renewal date (e.g. changing it from Feb 2014 to Dec 2013 allows us to lock in a set rate for at least one more year).

After that? The same health plan will go up anywhere from 35-100% (we were lucky in that our plan will only increase a paltry 14% - with a higher deducitible and out of pocket).

This notion that Obamacare isn't bad for small business / large businesses is a joke. I also am friends with two people who serve on boards for hospitals. Both hospitals (who employ around 2-3k each) are considering eliminating health care insurance altogether, and simply take the penalty, leaving those poor souls left to navigate the 8th level of hell that is obamacare.

I have yet to speak with a physician that sees this as a good thing. Two of our local doctors have retired, one of my friends is thinking about moving to Canada, and another is considering functioning on a cash basis only. Glad I have basic medical training - I may need it.

Blogger Bob October 03, 2013 9:59 AM  

I wasn't around to see the fall of Rome, but I'm a living witness to the fall of America.

Anonymous Hanjour Air October 03, 2013 10:02 AM  

You can say that again Bob!!

Anonymous bluto October 03, 2013 10:03 AM  

I love that someone who is getting a very good deal, (I was looking at plans for a friend and mr type 1 diabetes will probably receive many times his premium in benefits based on some pretty low estimates) is complaining about how unaffordable his options for insurance are. If the potential winners aren't liking Obama care, the program is in deep, deep trouble.

Blogger Guitar Man October 03, 2013 10:08 AM  

This is a push for the single-payer health coverage. Anyone should realize that this program was probably designed to push into a UK style system.

Anonymous Dr. Doom October 03, 2013 10:08 AM  

Oh, but the winners aren't the sick, Bluto, its Holder's people that really matter dontchaknow?

As long as its free, the denizens of the Ghettos will take anything they throw at them!

Anonymous Porky October 03, 2013 10:11 AM  

Boot, face.

Anonymous Will Best October 03, 2013 10:14 AM  

At its largest the fine is 2% AGI... so I don't know where he is getting $4000 from if he is claiming 55k AGI.

Anonymous DonReynolds October 03, 2013 10:15 AM  

I have already been through this fight. Back in 1993-95 it was called Hillarycare, another 1,300 page piece of whale dropping. Now they added 26 new taxes, created slave markets.....er uh insurance exchanges, and fleshed out the enforcement. Unlike Hillarycare, Obamacare passed Congress, signed by the Prez, and survived Supreme Court challenge. Now we have a "privatized" version of socialized medicine with government enforcement....a Liberal Leftist wet dream.

So I say f*uck you people and go straight to hell. I am all but hoarse from screaming from the rooftops at night warning everyone about the Federal takeover of health care. I warned you (for years) and you did it anyway.

I opposed Hillarycare/Obamacare before it even had a name as a Medical Economist back in 1979 when I won against Hillary's good friend Linda Bilheimer, who wrote this crap to start with and got an award from the liberals at the Rockefeller Foundation..... titled "Paying Too Much For The Wrong Thing". Winning against Linda Bilheimer cost me my job in 1980. Seventeen years later, I was rehired by Huckabee in the same job and later fired for opposing the idea of government takeover of health care. In 1993, as Fiscal Regulatory Analyst for the health care association, I opposed Hillarycare to the governor's office and the state board of health. We won and yes, it cost me my job again, but we won. Now it is back and you let it in the house. I am getting too old to win the fight any more. Some of you young bucks need to get off the bench and take an interest in the game before it is completely lost.

Anonymous Porky October 03, 2013 10:15 AM  

I'd like to see that "ominous warning email" though. Sounds like BS.

Anonymous Stirner October 03, 2013 10:18 AM  

This posting is referring a BS post that has gone viral on Facebook.

Obamacare is bad enough, that one doesn't have to exaggerate to describe it in the proper light.

The real penalties and fees are not going to be draconian, but they will be a PITA in a few years.

In the much shorter term, we have the real downsides of Obamacare:
Doctors being chased out the profession
Coverage networks being meaningfully contracted to cut the price of policies
Higher monthly premiums for the middle class
High deductibles and co-pays.

At the bronze level, and for the chronically ill at the silver level, Obamacare is going to amount to getting catastrophic healthcare coverage, but at the price you used to pay for *good* healthcare coverage.

An no, this was not the prelude to single payer either - that was supposed to be the "public option" that got ignored by Obama. In actuality, Obamacare was a giant bailout of the health insurance industry. How the hell can they make any money on the float of premium payments in a zero interest rate environment? Did you hear any of the big health insurance companies objecting during Obamacare deliberations? That was the dog that did not bark. They are getting out the insurance business, and getting into the benefits administration business, with the feds on the risk for all the big financial downsides.

You don't believe me? Folllow the money. It's not going to pay for "healthcare" - every penny of it is going to subsidize "health insurance". Their insurance products are now subsidized by the government, and the purchase of their products is now mandated by the penalty/tax.

We can thank Keyser Soze for our health reform :)

Anonymous Huckleberry - est. 1977 October 03, 2013 10:19 AM  

The most hilarious part is that none of the current issues/meltdown have anything to do with what has been currently implemented.
By October 1, all they had to do was have a website with relatively basic e-commerce functionality up and running, and they couldn't do it with three years and tens of millions of dollars.
But as others have said, this is structured chaos; everything is proceeding as planned.
One funny thing to note: In a poll conducted on Launch Day, a majority of respondents hated Obamacare but loved the Affordable Care Act, not realizing they're the same thing.
This is how they win.

Anonymous The other skeptic October 03, 2013 10:22 AM  

And two decades later all the history books will record that markets didn't work in healthcare and after years of reluctance the government finally stepped in and made things better by dictating who gets what and paying for it all out of the public funds.

Your optimism that the system will still be around by then is interesting.

Anonymous Porky October 03, 2013 10:22 AM  

Some of you young bucks need to get off the bench and take an interest in the game before it is completely lost.

That game has been lost for some time. We're just moving our king around hoping for a stalemate.

Anonymous Gaffe Pro October 03, 2013 10:24 AM  

I am lobbying for an individual mandate for Richard Dawkins books. If everyone in America was mandated to buy Richard's books, it would really turn things around.

Anonymous Mr. Logic October 03, 2013 10:25 AM  

ObamaCare will collapse just like the New Deal and Great Society reforms collapsed.

Anonymous Porky October 03, 2013 10:26 AM  

This posting is referring a BS post that has gone viral on Facebook.

Thought so. It's not the way progressives work. They lure you into the van with candy first.

Anonymous Mr. Logic October 03, 2013 10:29 AM  

"I actually made it through this morning at 8:00 A.M."

I call BS. Like was widely reported, the system is way to popular to let anyone in.

Anonymous DonReynolds October 03, 2013 10:30 AM  

Some of you young bucks need to get off the bench and take an interest in the game before it is completely lost.

"That game has been lost for some time. We're just moving our king around hoping for a stalemate."

Stuff it up your a$$, Porky. A stalemate is better than a loss, especially when playing in the dark with people who lie and cheat and steal.

Anonymous Jack Amok October 03, 2013 10:31 AM  

See how much simpler a single-payer system would have been?

Certainly there are simpler ways to fail, yes. OTOH, nothing is simple enough that the fools in D.C.wouldn't make a hash of it. They have a knack for tragedy and farce at the same time.

Anonymous Josh October 03, 2013 10:32 AM  

The healthcare.gov exchange for Tennessee is down today.

Anonymous The other skeptic October 03, 2013 10:32 AM  

ObamaCare will collapse just like the New Deal and Great Society reforms collapsed.

With luck, much more quickly. Unfortunately, the recession will be bad, and the war after that will be worse.

Anonymous Dr. Doom October 03, 2013 10:33 AM  

Do not underestimate the anger of the Middle Class! They have been screwed by BOTH the Republicans and Democrats for most of their lives. First, the outsourcing that sent jobs overseas, and then the invasion of peons to take the jobs that are still left.
Considering the Financial System has ALREADY COLLAPSED and is merely being kept from decomposing by steady infusions of Funny Money by Timmy at the Federal Reserve, the Federal Government cannot really afford a serious revolt by taxpayers.
Obamascare is obviously a ploy to get people to run towards deplorable Socialized Medicine. However, these clowns are ALL OUT of Bread and Circuses to keep the plebeians happy while they play these games of Smoke and Mirrors.
The American People are MAD AS HELL. These people are pouring gas onto the FIRE!

Anonymous Stirner October 03, 2013 10:36 AM  

I highly recommend giving "Open Wide and Say Moo" which has some very keen insights into Obamacare and the problems in our healthcare system.

A draft of the book is available online:
http://bit.ly/1dXOIT0

Blogger Ephrem Antony Gray October 03, 2013 10:44 AM  

Infowars? The site that uses information as a weapon? They also let us know that the USG was using Russian troops to provide security at certain public events in the USA!

When some other actual news outlet picks it up, I'll give it the time of day.

Anonymous Gaffe Pro October 03, 2013 10:45 AM  

My bet for next stage of Shutdown Theater:

The Return of OWS!

Yup, the "anti-establishment" Occupy movement will be there as shock troops, marching against those evil Tea Party anarchists who shut down the government...

After all, what's the point of having guys like Van Jones build a Sturmabteilung for Barry, unless he gets to use them?

Anonymous Jake October 03, 2013 10:45 AM  

Your optimism that the system will still be around by then is interesting.

"optimism" would not be the word I would use.

Anonymous Stilicho October 03, 2013 10:50 AM  

Yes they will deduct the fines from your tax returns but:

Patient Protection and Affordable Care Act: The Secretary [of Health and Human Services] shall not file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section … or levy on any such property with respect to such failure.

So I'm wondering if this is a hoax post on FB.


No need for HHS to file a lien. That's a prohibition without any teeth or any particular purpose. HHS was never meant to be the enforcer of Obamacare. Once the penalty is assessed via the tax return, the IRS can and will file such liens if the taxpayer has not already paid in sufficient money to cover the penalty. And it will be such a nice, super-priority, non-dischargeable lien as well.

Anonymous Orlok October 03, 2013 10:52 AM  

Hey Vox, I appreciate the info , but if anyone has a back up that isn't INFO WARS based , i would surely appreciate it.
Credibility is an issue, and i am sure we can all agree while i don't doubt the veracity of the info provided , it is hard to prove with only one source.

Anonymous Stilicho October 03, 2013 10:54 AM  

Infowars? The site that uses information as a weapon? They also let us know that the USG was using Russian troops to provide security at certain public events in the USA!

When some other actual news outlet picks it up, I'll give it the time of day.


Perhaps, but you can't simply dismiss such outlets in this day and age: after all, the National Enquirer has been known to accurately report and break stories the state-controlled media did not want to report because they were trying to protect the politician involved (Clinton, Edwards, etc.). Ultimately, the reports will stand or fall on the truth of the matter.

Blogger CarpeOro October 03, 2013 10:54 AM  

"Do not underestimate the anger of the Middle Class! "

Why bother under estimate it when it is currently irrelevant? TPTB and their Demican/Republicrat minions have worked for decades to undermine and destroy the middle class, causing people to slide from it at a growing rate a their wealth is stolen. When voices of reason or leadership arise that support them they are omitted from new coverage, vilified, or dismissed as unpractical. Look how many bought the McCain pablum last time. Add that to the Obama supporters the number of remaining members of the middle class that show signs of independent thought is getting vanishingly few.

Blogger Dystopic October 03, 2013 10:56 AM  

I more envision the rise and enforcement of the cashless society.

During an interview with some of the MIDI Fight Club DJs, this little gem came up:

Q: "What do you think the future of DJing will be like? Will we go more digital?"

A: "The way things are degenerating these days, the future of DJing is just as likely to be a couple of tribal barbarians banking on rocks as anything else. We'll probably get paid in slabs of animal meat, too."

Anonymous YIH October 03, 2013 10:56 AM  

@River Cocytus:
I didn't see the 'infowars' until I moused over the link.
Like you I'd give this 'rumor' status until verified.
Think 'debkafile' or yes, 'newsmax'
All three have about the same track record.

Anonymous Dr. Doom October 03, 2013 10:58 AM  

CarpeOro, you are assuming that this anger will be channeled through normal systematic ways through the rigged two-party kleptocracy that clearly ignores them. I doubt that Americans have any faith in this system after the CLEARLY IMPLAUSIBLE RESULT of the 2012 election in which an EXTREMELY UNPOPULAR President was re-elected during a terrible economy.
I would say that the jig is up for these phonies in Washington!

Anonymous Huckleberry - est. 1977 October 03, 2013 10:59 AM  

Once the penalty is assessed via the tax return, the IRS can and will file such liens if the taxpayer has not already paid in sufficient money to cover the penalty

Pretty much.
At that point, it just becomes an issue of unpaid tax debt, lumped in with everything else you owe to the IRS, not a specific Obamacare non-compliance penalty.
At that point, they can engage in any collections activities that they are allowed to, including the aforementioned leins, wage garnishments, bank seizures, and if the overall penalty is high enough, arrest and prosecution.
Kind of like how legal escorts skirt the law by charging for the conversation over dinner; the sex is free.
Semantics.

Anonymous Stirner October 03, 2013 11:00 AM  

I agree with Stillicho.

Basically, Obamacare raised everyone's income taxes across the board, but then gave everyone with insurance a deduction to pay at the old rates. This was the basic logic that allowed Roberts to view it as a legit tax. The mortgage interest deduction doesn't "force" renters to buy a house, does it? No, it just incentivizes it.

HHS doesn't come into the process at all. The IRS won't come after you for paying your "Obamacare tax" - they are going to come after you for not paying your full amount of taxes, just like before. Except now, the Obamacare tax is hidden away in all your tax obligations.

You can either pay higher income taxes, or claim the healthcare insurance deduction. Or you have the IRS throw the book at you just like before Obamacare.

Anonymous Josh October 03, 2013 11:00 AM  

Infowars? The site that uses information as a weapon? They also let us know that the USG was using Russian troops to provide security at certain public events in the USA!

Well, it's not like he's referencing veterans today...

Anonymous dh October 03, 2013 11:02 AM  

And using the banking system as an enforcement device for the sake of compliance is more likely to break the banking system than it is to allow this expansion of the tax system to function as envisioned.

There is no evidence of this. The IRS seizes over a million bank accounts a year already, and levy's the pay of another half-a-million workers on top of regular payroll deductions. It's practically entirely automated. With an extra 16k agents, they can easily

Regarding the original claim of a $4,000 fine. It's true. The fine right now is 1% of AGI, so the guy's top line is probably $55k, AGI is probably $40k, 1% of 40k = $4k fine. In a few more years, his fine could be 2.5%, which is more than $12k.

The only piece of his claim that's not accurate is his yearly deductible. His yearly maximum out of pocket for an individual is $6,350 or $12,700 for a family plan. I am fairly certain he took the sum of his premiums $7,164, added to his maximum out of pocket and came out with his number, which is close to my calculation of $13,514. So basically, his range of costs for 1 year of health care is a minimum of $7,164 to a maximum of $13,514, or $597 a month to $1,126 a month.

This strikes me from actuarial standpoint as probably accurate. Type 1 diabetes means long-term he will have major complications. He probably has some ongoing maintenance costs.

This guy smells to me like a classic freeloader. When he goes into diabetic coma we will be expected to pay his medical bills, instead of dumping him into the street.

Americans have to start making big boy decisions. Either sick people with no money die in charity care wards at hospitals and church's, beg for treatment/care, or get dumped off at bus stops by hospitals, or everyone pays a tax to have insurance.

He doesn't say, but chances are he's uninsured because previously he couldn't get any coverage, at any cost, on the private market. He is an actuarial time bomb.

Anonymous Josh October 03, 2013 11:03 AM  

Once the penalty is assessed via the tax return, the IRS can and will file such liens if the taxpayer has not already paid in sufficient money to cover the penalty. And it will be such a nice, super-priority, non-dischargeable lien as well.

Yipee.

Hey, remember in 2008 when all the Republican frontrunners were in favor of insurance mandates?

Anonymous Stoner Cat October 03, 2013 11:04 AM  

The fine right now is 1% of AGI, so the guy's top line is probably $55k, AGI is probably $40k, 1% of 40k = $4k fine.

Wait...what?

Anonymous Josh October 03, 2013 11:05 AM  

Regarding the original claim of a $4,000 fine. It's true. The fine right now is 1% of AGI, so the guy's top line is probably $55k, AGI is probably $40k, 1% of 40k = $4k fine. In a few more years, his fine could be 2.5%, which is more than $12k.

You've misplaced a decimal.

1% of 40k is 400.

10% of 40k is 4k

And 2.5% of 40k is 1k

Anonymous ZhukovG October 03, 2013 11:06 AM  

Dh, double check your math. I think his fine is only $400.00 if it's 1%.

Anonymous Josh October 03, 2013 11:07 AM  

Americans have to start making big boy decisions. Either sick people with no money die in charity care wards at hospitals and church's, beg for treatment/care, or get dumped off at bus stops by hospitals, or everyone pays a tax to have insurance.

I prefer the first choice, as I assume most of the people here do.

Anonymous dh October 03, 2013 11:13 AM  

ZhukovG, Josh, you are right. Sorry. The miscalculated numbers seemed to line up well my expectations, so I didn't double check them. Back in the box!

So I guess the guy is just lying. I can't see how his numbers are not fabricated.

Anonymous liljoe October 03, 2013 11:17 AM  

Cloward-Piven to a 'T'. Single payer will be the end result, provided we make it that far

Anonymous Huckleberry - est. 1977 October 03, 2013 11:18 AM  

I can't see how his numbers are not fabricated

Its always possible that the website made the same mathematical error -- carried the decimal point one place too far to return an erroneous yet scary number.
Could also be a lie.
There's also the story of a 30-year-old man who was eventually able to sign up through the website, and he's not sure if it was a glitch, but was able to enroll in Medicare (possibly Medicaid, the report may have confused the two).

Anonymous Josh October 03, 2013 11:21 AM  

So I guess the guy is just lying. I can't see how his numbers are not fabricated.
But see, it was on the internets! No one can lie on the internets!

Anonymous dh October 03, 2013 11:22 AM  

I prefer the first choice, as I assume most of the people here do.

I have an honest disagreement with most people on this one. I don't see it that way, not at all. But I understand 1) the Ilk consensus is historically in line with American values; 2) the alternative may not be Constitutional by any measure, and was not envisioned in the Constitution as drafted and 3) that the alternative is socialism, will lead to shortages, mismanagement, fraud/waste, bad care, and all the things that come with socialized healthcare.

I've been to Bangladesh, I've been to Bangalore, I've been to Karachi. In India , for example, where they spend 2.1 per cent of GDP on health care, (the US spends about 18% of GDP on health care), despite having universal health care mandates, people die on the streets frequently. Or in large hospice units run by religious charities. It's fairly sad, and it's fairly tragic. The Indian native response is often "karma" when asked why they do palliative care at least in the face of wide-scale human suffering.

I think that, unlike India, the Christian values of the US would avoid widespread unattended death and disease. But I am not hoping to have to find out!

Anonymous Daniel October 03, 2013 11:23 AM  

Type 1 diabetes means long-term he will have major complications.

dh - actuarially, this is not as true as it once was, except in a certain subset, which skews things badly. The other things you mention are spot on (and I'm not saying the above is inaccurate either - I'm just adding an important detail).

The fact is that health insurance is not necessary financially to successfully manage Type 1 diabetes for life. Without the inflationary effects of mandatory insurance system/medicare/medicaid, the technological costs for the development of meters, pumps and insulin would drop significantly. There is no reason at all why Type 1 diabetes should these days cost more than a basic cell phone plan - with the rare visit to urgent care, and slightly elevated risk of hospitalization over the typical person. Life expectancy and complications for Type 1 diabetics under sound lifelong control are nearly identical to those of non-type 1s.

In other words, even without a massive boondoggle plan (not just Obamacare - that's just a rider on the social medicine contract that has been in place since the 1960s), even the chronic illnesses (at least the majority of the biggies - heart and diabetes) would be an individual living expense that would be entirely manageable. The cost is not in the proper maintenance and occasional treatment - but in the government malinvestment policies and the catastrophic costs of those not self-managed.

After all, when you can, with government blessing hide your sliding scale charges for a $0.005 piece of medical equipment in the variable range of $0.25-1.75(!) you'd be a terrible business person to charge normal competitive market mark-ups. You'd make so much less money at the margin...and you'd be locked out of the health care system customer chain.

Anonymous Roundtine October 03, 2013 11:24 AM  

The guy said the fine was for 24 months of non-payment. If they tack on penalties like the IRS does for everything else, $4k for 2 years non payment isn't a crazy number.

So I'm wondering if this is a hoax post on FB.

It's called propaganda. Remember, if it fits the narrative, it's true, even if it's not. At a certain point, they can't put out all the fires. The great thing is all you need is one or two real stories and then you can get tons of fake ones going.

Anonymous dh October 03, 2013 11:29 AM  

There's also the story of a 30-year-old man who was eventually able to sign up through the website, and he's not sure if it was a glitch, but was able to enroll in Medicare (possibly Medicaid, the report may have confused the two).

Lots of confusion about this. Many states have expanded Medicaid as part of Obamacare, and you can enroll in Medicaid from the portal if you qualify in your state and the portal is the federal one. There's probably a dozen states that have done that. There are also edge cases where young people can enroll in Medicare. If the guy has reached lifetime maximums under old commercial policies, he could be eligible for Medicare, as well as if he has certain diseases related to heavy industry.

A lot of the complaining from people about affordability is because of the gaps in the system created by the SCOTUS decision on Medicaid. There are many millions of people who were supposed to be covered under Medicaid, but won't be. Like, for example, Texas, the design of the law was that the Federal government would enroll about 1 million of the uninsured in Medicaid. But now they have to buy insurance they can't afford on the private market. So that's messy.

If ACA/Obamacare takes hold, it will be because the business lobby cracks. States like California are going to get a huge slice of Federal money for thier Medicaid expansion. Businesses with less than 50 employees paying wages up to around minimum wage will be able to have their employees enrolled in Medicaid. Their employees will get free health insurance, and they won't have to pay it. Meanwhile, the same business in Texas will be forced to offer insurance or pay a per employee fine. And their employees will also be subject to a fine.

The first time a business moves from a reds tate to a blue state because of the disparity in Federal benefits, it's over. No matter how ideological, the Republican governor will cave. It's going to happen, probably in Texas or Florida, right after the next election.

Anonymous Roundtine October 03, 2013 11:29 AM  

Remember too you can lie about your AGI when you apply for Obamacare subsidies. How many people are going to think they also need to lie on their taxes to match it up? Vox is not joking, this could lead to tax cheating and closing of bank accounts.

Anonymous Roundtine October 03, 2013 11:31 AM  

The first time a business moves from a reds tate to a blue state because of the disparity in Federal benefits, it's over. No matter how ideological, the Republican governor will cave. It's going to happen, probably in Texas or Florida, right after the next election.

And then it's game over time for the U.S. government and U.S. economy. It's going to be epic.

Anonymous MacGhil October 03, 2013 11:31 AM  

If the man in question is married, he could save thousands if he got a divorce: http://www.thefiscaltimes.com/Articles/2013/10/02/Why-Divorce-Attorneys-Will-Love-Obamacare

I'm sure everyone is shocked that the progs would incentivize divorce.

I'm a big fan of Dr. Rich, Stirner, and his snark is delightful! I especially like his suggestions for black market medical care: http://covertrationingblog.com/general-rationing-issues/black-market-healthcare-a-few-concrete-suggestions

He's a big proponent of direct-pay practices and is frustrated over the fact that no one is working to protect them, and while everyone is busy fighting the last (lost) battle, the real war is yet to come, which is being prohibited from spending our own money on the medical care we want: http://covertrationingblog.com/rebuilding/limiting-individual-prerogatives-in-healthcare

Anonymous Gaffe Pro October 03, 2013 11:32 AM  

"This was the basic logic that allowed Roberts to view it as a legit tax. The mortgage interest deduction doesn't "force" renters to buy a house, does it? No, it just incentivizes it. "

I WANT MY FREE HOUSE.

Anonymous McDonalds PR Rep October 03, 2013 11:34 AM  

"Americans have to start making big boy decisions."

INDIVIDUAL MANDATE FOR FOOD AND CLOTHING!

Anonymous Gaffe Pro October 03, 2013 11:36 AM  

"The first time a business moves from a reds tate to a blue state because of the disparity in Federal benefits, it's over."

Unless they are gun manufacturer.

Anonymous Roundtine October 03, 2013 11:40 AM  

Americans have to start making big boy decisions. Either sick people with no money die in charity care wards at hospitals and church's, beg for treatment/care, or get dumped off at bus stops by hospitals, or everyone pays a tax to have insurance.

No. Everyone pays for catastrophic insurance with very high deductibles and then pays cash for everything else. Prices will crash and some healthcare will shut down. Healthcare spending as a percentage of GDP will fall 50%, Many women will become unemployed from the HC sector. The economy will go into recession due to the contraction in healthcare. Moving forward, HC spending will only be slightly higher than Europe (Americans like healthcare), but the bubble will be popped. Medicare will be able to buy insurance for the poor and there will be tax deductions if you get seriously ill and get hit on the deductible.

Anonymous Eric C October 03, 2013 11:43 AM  

Americans have to start making big boy decisions. Either sick people with no money die in charity care wards at hospitals and church's, beg for treatment/care, or get dumped off at bus stops by hospitals, or everyone pays a tax to have insurance.

Sadly, either "choice" is going to ultimately end in the first choice.

Anonymous Roundtine October 03, 2013 11:46 AM  

Oh man. Someone figured out what the numbers in the Obamacare Hotline spell.

1-800-FUCKYO

Anonymous Mr. Logic October 03, 2013 11:49 AM  

"No. Everyone pays for catastrophic insurance with very high deductibles and then pays cash for everything else. Prices will crash and some healthcare will shut down. "

Unless they keep raising the ObamaCare tax as a penalty for this behavior...

Anonymous Sigyn October 03, 2013 11:51 AM  

Either sick people with no money die in charity care wards at hospitals and church's

It's funny you bring that up. I was just reading yesterday about one of the first NICU's...in the 19th century. And it was a charity.

Anonymous Josh October 03, 2013 11:51 AM  

Everyone pays for catastrophic insurance with very high deductibles and then pays cash for everything else. Prices will crash and some healthcare will shut down. Healthcare spending as a percentage of GDP will fall 50%, Many women will become unemployed from the HC sector. The economy will go into recession due to the contraction in healthcare.

This is what should happen, but it won't until the system collapses completely. Americans tend to be stupid about healthcare and somehow don't view it like a market commodity. That's why you have people with $100 cable bills and $100 smart phone bills bitching about an increase in their copay from $10 to $25.

Anonymous FUBAR Nation Ben October 03, 2013 11:53 AM  

If I were the republicans, I would agree with the democrats and amplify. I would propose massive spending and tax increases as well as letting in 200 million immigrants/year. This ship needs to be sunk. F it.

Blogger TontoBubbaGoldstein October 03, 2013 12:01 PM  

This is what should happen, but it won't until the system collapses completely. Americans tend to be stupid about healthcare and somehow don't view it like a market commodity. That's why you have people with $100 cable bills and $100 smart phone bills bitching about an increase in their copay from $10 to $25.

*Shakes head. Poundz fist*

Josh, you just DON'T GET IT! Healthcare is a RIGHT.

For that matter so are smartphones and cable. They'll get around to fixing this oversight soon enough...

Anonymous Storm Saxon's Gall Bladder October 03, 2013 12:02 PM  

This is not failure. This is meant to happen. When enough people are desperate and helpless they will beg their Federal Masters to nationalize the medical care system. This has always been the plan. This is the smell of success.

Anonymous zen0 October 03, 2013 12:02 PM  

Canadian Health Care : (just for camparison)

From January 1, 2012, to December 31, 2012 monthly rates are $64.00 for one person, $116.00 for a family of two and $128.00 for a family of three or more. Effective January 1, 2013, monthly rates are $66.50 for one person, $120.50 for a family of two and $133.00 for a family of three or more.

That just covers the basics. You need private coverage of some kind for drugs and dental & other things.

Anonymous dh October 03, 2013 12:02 PM  

dh - actuarially, this is not as true as it once was, except in a certain subset, which skews things badly. The other things you mention are spot on (and I'm not saying the above is inaccurate either - I'm just adding an important detail).

Yeah, I mean, on the one hand, a person can manage Type 1 and do okay. On the other hand, a few people can't manage it for real medical reasons, and it becomes a life long medical cost explosion. And then, because a lot Americans are fat and stupid and ignorant, at lot of manageable Type 1 ends up in amputations, then prosthetic, mobility problems, stroke, nerve problems, wound care, etc. All of which obviously are an actuarial disaster.

I have no direct knowledge of it other than casual experience, so I would leave the details up to you. The interesting thing about the FB post was that the numbers were wrong, that he chose a plan that was not as inexpensive as he could have, and that he didn't really explain the circumstances as well as he could. I tend to give people the benefit of the doubt, but in this case maybe he's just spouting lies?

Anonymous Gaffe Pro October 03, 2013 12:06 PM  

"but in this case maybe he's just spouting lies?"

He's a dirty Tea Partier anarchist. Could the answer be anything less than TOTAL LIAR?

Anonymous RINO October 03, 2013 12:07 PM  

Oh, InfoWars, now you're running entire stories based on 1 facebook comment.

Anonymous VD October 03, 2013 12:07 PM  

Patient Protection and Affordable Care Act: The Secretary [of Health and Human Services] shall not file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section … or levy on any such property with respect to such failure.

I doubt the Secretary was planning to file any liens, or notices of liens. You'll notice that language doesn't bar anyone else from doing so. As for whether the report is fake or not, well, we'll find out soon enough how strictly they are enforcing the fines.

Anonymous dh October 03, 2013 12:17 PM  

No. Everyone pays for catastrophic insurance with very high deductibles and then pays cash for everything else. Prices will crash and some healthcare will shut down. Healthcare spending as a percentage of GDP will fall 50%, Many women will become unemployed from the HC sector. The economy will go into recession due to the contraction in healthcare. Moving forward, HC spending will only be slightly higher than Europe (Americans like healthcare), but the bubble will be popped. Medicare will be able to buy insurance for the poor and there will be tax deductions if you get seriously ill and get hit on the deductible.

1. Everyone pays = individual mandate? Catastrophic coverage was only cheap prior to Oct 1st. because it was selective. If you had risk factors for "catastrophic" disease or conditions, you couldn't get it. This exact plan is an option for those under 30 right now with ACA, and because of guaranteed issue, those are the plans that are exploding in cost. (That's only half the story, because those plans still cover preventative services, which for an under 30 person is basically an annual physical and a gyn exam for a woman). Also, once you get passed a certain age, you can't get catastrophic coverage at any cost. A 65 year old smoker, absent the mandate plus guaranteed issue, could not get such a policy at any cost lower than face value.

2. What you are describing is done all over the place, for example, it's exactly like you describe in Equador. Your local hospital will sell you a high-deductible plan, all other services are paid for in cash. There is charity care and government coverage for low income earners. It's not a bad system, it's relatively fair, and it's dirt cheap. But honestly, I don't think Americans are ready to have doctors who are borderline professionals. We are idiots when it comes to this stuff. We like our doctors chubby, tan, and with expensive cars. In Ecuador, it's basically 1950's medicine. A doctor makes about $60k, doesn't have a nurse, doesn't have a lot of staff. Major procedures cost 10% of what they do in the US. They get new drugs developed in Europe and the US about 20-25 years after they get off the ground. They get new procedures infrequently. For many diseases that are curable in the US, they get management. For many serious conditions, you just die young. In the US, we go all out to save people who suffer heart attacks - life flights, cardiac specialist hospitals and trauma teams, emergency surgery, stents, valves, replacements, transplants, therapy. Americans spend 18% of GDP of health care, Ecuador 7%. That percentage difference is trillions of dollars.

3. I agree that the bubble must be deflated. This is what politicians talk about with "cost curve must be bent". Meaning, we need many years of flat spending growth, while the rest of the economy grows, to avoid a recession and to bring our spending in line with the rest of the world. It's really that simple, everyone know's it must happen. Ironically, for those that call Obamacare socialism, I think it's the last stop before full socialism. This is the last gasp chance for insurance to be workable. Insurance industry signed onto the ACA because they've been in a membership selection death-spiral for 15 years. There is no winning endgame for insurers in those conditions. Change, or die. And even with change, you may still die.

Blogger JartStar October 03, 2013 12:18 PM  

And then it's game over time for the U.S. government and U.S. economy. It's going to be epic.

I like how every time there's a large program which the right doesn't like, it always ends in the collapse of the country.

You realize that if the country doesn't collapse then you have shot your credibility?

Anonymous dh October 03, 2013 12:20 PM  

Remember too you can lie about your AGI when you apply for Obamacare subsidies. How many people are going to think they also need to lie on their taxes to match it up? Vox is not joking, this could lead to tax cheating and closing of bank accounts.

It's way more sinister than that. They just get the data from the IRS. So you only have to lie once.

The biggest problem is on self-employed persons. But, they are tightening down the hatches. Credit card processors have to file interchange tax forms with the IRS, so now the IRS knows how much plastic revenue you receive and can match up your entries on that to your return. They get almost all other payroll data as well.

Anonymous dh October 03, 2013 12:21 PM  

He's a dirty Tea Partier anarchist. Could the answer be anything less than TOTAL LIAR?

I am inclined to belive the system gave him bad information.

Anonymous Salt October 03, 2013 12:22 PM  

This is way to good -


Need health insurance? The Obama administration has you covered. Simply dial 1-800-FUCKYO to reach the next available health-care provider.

Far from being a mistype, that’s the official number that Health and Human Services wants Americans to dial when seeking health care. Obamacare’s national call center really did list its number as 1-800-318-2596, helpfully spelling out President Barack Obama’s tendency to blatantly flip the bird in plain view.

After allowing for the lack of letters attached to 1 on a traditional American telephone keypad, the number spells out a clear message. For every duped voter, every young invincible weighing the cost of a penalty versus a newly tripled yearly deductible, every ailing old granny in a wheelchair (whom, remember, Paul Ryan wants to push off a cliff) who needs adequate and affordable health care, Obama’s message is:

Anonymous FUBAR Nation Ben October 03, 2013 12:25 PM  

dh, this will lead to an officially nationalized healthcare system. When the new healthcare continues to fail, there will be loud calls for nationalization.

Anonymous Golf Pro October 03, 2013 12:29 PM  

"If I were the republicans, I would agree with the democrats and amplify. I would propose massive spending and tax increases as well as letting in 200 million immigrants/year. This ship needs to be sunk. F it."

Problem is, following this shutdown and followning the coming contrived debt crisis that the GOP will manufacture in a couple weeks, the party will be so debased and so properly blamed for all the fall out, they won't even be able to harm the economy any more as they will have ceded all pretense of responsibility to the Democratic Party.

I keep wondering how long the GOP will be around or if the hardline conservatives in that party really have initiated a Whig-liked demise and discrediting of the conservative ideology.

Anonymous dh October 03, 2013 12:31 PM  

dh, this will lead to an officially nationalized healthcare system. When the new healthcare continues to fail, there will be loud calls for nationalization

Agreed. This is the last stop for a partially private healthcare system. That's why the GOP is so stupid. If they had any brains, they would have realized that the alternative to Obamacare isn't a Singapore style totally open free market, it's the NHS. They would have used the opportunity to drastically lower what is covered under insurance plans, to make it more insurance like, and then they would have passed a large number of economic freedom laws as riders.

But instead they are blinded by impotent Obama rage, they got nothing. In a few more days, they'll cave on the shutdown, Obamacare will still be the law, and that will be the end of it. They will have gotten nothing.

Anonymous FUBAR Nation Ben October 03, 2013 12:34 PM  

dh, you really believe the Republican are for a totally free open market? When's the last time they ever cut government spending?

Anonymous Roundtine October 03, 2013 12:35 PM  

What you are describing is done all over the place, for example, it's exactly like you describe in Equador.

dh, I would argue that what you see as bad in Ecuador is a result of them being poor. Just as France's state run healthcare is much better than Cuba's.

Anonymous FUBAR Nation Ben October 03, 2013 12:36 PM  

Hey Golf Pro. The debt crisis isn't contrived. You really think the government is going to be able to run trillion dollar deficits forever without interest rates being jacked up because, you know, the creditors actually want to get paid back?

There's more proof you failed algebra back in the wonderful government schools.

Anonymous Josh October 03, 2013 12:38 PM  

But instead they are blinded by impotent Obama rage, they got nothing. In a few more days, they'll cave on the shutdown, Obamacare will still be the law, and that will be the end of it. They will have gotten nothing.

They always do this. Always.

Anonymous Roundtine October 03, 2013 12:41 PM  

I like how every time there's a large program which the right doesn't like, it always ends in the collapse of the country.

You realize that if the country doesn't collapse then you have shot your credibility?


I agree. But in this case, the country is already toast based on the numbers. The left is deluding itself about single-payer and putting people on Medicaid. America is not homogenous like a European country. There are way more holes and inconsistencies that get papered over with U.S. dollars. All I'm saying is this will speed up an already mathematically doomed system. Obamacare will also increase spending. No matter what the government does, it will increase spending.

Anonymous RINO October 03, 2013 12:42 PM  

You really think the government is going to be able to run trillion dollar deficits forever

Paul Krugman said so.

Blogger Guitar Man October 03, 2013 12:43 PM  

OT, but a huge prayer request, please pray for my friend's husband (a doctor in Mexico), who has been missing since October 1st. He was scheduled to fly from Villahermosa back to Mexico City and the plane he was on has gone missing.

https://www.facebook.com/photo.php?fbid=10151882890782969&set=a.425105172968.185049.679947968&type=1&theater

Blogger foxmarks October 03, 2013 12:43 PM  

A la Roundtine, imagine Ecuador with double or triple the average real personal income. Make adjustments to patent law, medical liability law and drug regulation. imagine further a federal model, where the USA has 50 variations on Ecuador, some a little poorer and with more social guarantees, and some a little richer to incent new treatments.

That sounds awesome to me.

Anonymous Josh October 03, 2013 12:44 PM  

Praying dude

Anonymous Roundtine October 03, 2013 12:44 PM  

They will have gotten nothing.

Did you notice the Republicans wanted to put back defense spending cuts from the sequester? Both sides want to spend more. Obamacare is a sideshow because the Tea Party will primary all the RINOs in 2014.

Anonymous Jake October 03, 2013 12:45 PM  

But instead they are blinded by impotent Obama rage, they got nothing. In a few more days, they'll cave on the shutdown, Obamacare will still be the law, and that will be the end of it. They will have gotten nothing.

Most people around here would suspect that was the plan all along. That the Republican party has never had any intention of effectively resisting Obamacare, they just need to make a good show to maintain the illusion of two adversarial parties, lest millions of small-gov. conservative types realize they're wasting their time supporting the R's and voting out the D's.

Anonymous FUBAR Nation Ben October 03, 2013 12:46 PM  

RINO, the republicans should insist on making Paul Krugman czar (don't they love that word?) over the economy.

Anonymous dh October 03, 2013 12:51 PM  

A la Roundtine, imagine Ecuador with double or triple the average real personal income. Make adjustments to patent law, medical liability law and drug regulation. imagine further a federal model, where the USA has 50 variations on Ecuador, some a little poorer and with more social guarantees, and some a little richer to incent new treatments.

That sounds awesome to me.


Yeah, you are basically back to the 1950's in the US healthcare system. Certainly not bad.

Anonymous Jack Amok October 03, 2013 12:52 PM  

... or everyone pays a tax to have insurance and the other stuff happens anyway.

Honestly, these clowns can't build a website. That idiot Progs continue to believe giving money to the Government will solve any real problem is a sad commentary on the human race. Gamma-Fem thinking at it's finest, assuming that just saying someone else is in charge of solving a problem is the same as solving it. Like the claims over at Alpha Game that the mother screaming when her child fell onto the train tracks helped save the child by alerting everyone else to the problem.

Anonymous Fisk Ellington Rutledge III October 03, 2013 12:53 PM  

ObamaCare is the most disgusting, destructive, dishonest con job ever foisted on the U.S. The goal of ObamaCare is to destroy the private health care system utterly, and replace it with a government-run system that will be a disaster; a system that will have complete contempt for the patients while serving as a patronage system for affirmative-action scum.

Obama is a liar, cheat, thief and affirmative action parasite himself, and his health care bill has nothing AT ALL to do with health care. It is a cynical, evil power and money grab; a typical Leftist crime that must be overturned.

ObamaCare must be stopped right now, by the most drastic, draconian measures.

Leftists are, typically, idiots to say that partisanship should cease. That is a typical Leftist euphemism for surrender to the evil of the Left.

Now is the time when open, hostile partisanship should become our refuge from a traitorous Democratic Party as well as the cowardly Republican leadership. Open hostility is entirely appropriate when contemplating an administration and a Senate that are literally the enemies of their own country.

Now is the time when decent Americans need to draw the line at their dispossession by an alliance of Leftist liars and traitors and affirmative-action parasites.

SHUT THE GOVERNMENT DOWN OR DEFUND OBAMACARE FOR GOOD. At least a shut-down government can't continue its project to destroy its own country.

Of course while all this is going on the traitorous Republican leadership is trying to slip amnesty for millions of illegal third-world savages under our noses. They are also keen on the evil idea of importing millions more legally and it doesn't matter a whit HOW third-world savages are entering the country. All that matters is that they ARE and that WE NEED TO REVERSE THIS HOSTILE INVASION THAT IS BEING FACILITATED BY THE COWARDS AND TRAITORS IN GOVERNMENT.

And don't forget that that RINO Cruz is front and center for amnesty and increased immigration. Cruz is our enemy. He is not our friend regardless of what happens with ObamaCare.

Blogger JartStar October 03, 2013 12:56 PM  

But instead they are blinded by impotent Obama rage

The talk radio circuit was mocking the exchange failures which is of course petty and worthless beyond making the enraged feel good.

Anyone with half a brain saw that this is whole thing was passed to get us on the way to a single payer system. The system looks like it break first, then it will come.

Anonymous Huckleberry - est. 1977 October 03, 2013 12:57 PM  

And don't forget that that RINO Cruz is front and center for amnesty and increased immigration

You're thinking of Rubio, not Cruz.

Anonymous dh October 03, 2013 12:58 PM  

I agree. But in this case, the country is already toast based on the numbers. The left is deluding itself about single-payer and putting people on Medicaid. America is not homogenous like a European country. There are way more holes and inconsistencies that get papered over with U.S. dollars. All I'm saying is this will speed up an already mathematically doomed system. Obamacare will also increase spending. No matter what the government does, it will increase spending.

It depends on how long things last. In the macro level, the spending is the biggest problem. We can spend close to 1 out of 5 dollars on health care and insurance. It's mal-investment. The basic plan under the ACA is not horrible. If you ignore for a minute who is doing the spending, the plan is to put more cost onto the backs of consumers up front, before it's catastrophic. You pay into insurance your whole life in case you need it later. That's basic cost shifting. The next piece is that everyone has to pay into the system. That's the essence of a capititated tax. The last leg of the change is that you regulate those entities that do not provide any value. Insurance companies, hospitals, etc are restricted in how much economic extortion they can extract from the market. It would better to eliminate the extortion, but still.. it's an improvement to cut back how much you are extorted.

It is likely that the medical cost inflation rate will trend down for a bit. There has been some evidence of it. It's also to the point where there isn't much more that can paid into healthcare. Most hospitals already look like SPA's. Doctors are already vastly overpaid for what they do. It's topping out.

Of course, there's so much bad in the ACA that it's hard to say what will happen more than short-term.

Anonymous Josh October 03, 2013 12:59 PM  

Fisk Ellington Rutledge III

Cool story bro

Anonymous dh October 03, 2013 1:00 PM  

Fisk Ellington Rutledge III

Unfortunately the morons in the Republican party are going to capitulate and fail. They have done a bad job with this all around.

Anonymous CLK October 03, 2013 1:01 PM  

I wonder what the real end game here is ... what are the republicans really afraid of and why are the democrats so hard over ?

It was explained in one article that if Obama care is successful it will mean the end of the republican party as it will add millions of low income, likely democrats to the system that have an interest in keeping the democrats in power.

I know its not because either party cares about the actual people ..

What is the real endgame here ???

Anonymous Noah B. October 03, 2013 1:03 PM  

Welcome to the suck.

Anonymous FUBAR Nation Ben October 03, 2013 1:06 PM  

There is no end game. It's basically about money and power. There's no conspiracy.

Anonymous Jack Amok October 03, 2013 1:08 PM  

Less than one out of every five Americans currently consider our government "legitmate." Different people have different reasons for considering it illegitimate and there's no coherent block of support to replace it with something else. The status quo will continue as long as there is no compelling alternative. Prudence, indeed, will dictate that governments long established should not be changed for light and transient causes; and accordingly all experience hath shown that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed.. But the situation is unstable, a giant boulder stitting on top of a hill that's crumbling away. A long train of not just abuses and usurpations, but fiascos and failures, is going to pull into a station sooner or later, and the legitimacy gap is going to be closed one way or another.

Anonymous Roundtine October 03, 2013 1:11 PM  

The next piece is that everyone has to pay into the system.

dh, are you familiar with the Rand Health Insurance Experiment? Right now, today, too many people are paying into the health insurance system and they are paying too much. When Massachusetts forced everyone to buy insurance, medical spending increased because people with insurance will use it. We don't want more people paying in, we want more people to opt out of getting medical care. It is being over consumed.

Anonymous E. PERLINE October 03, 2013 1:15 PM  

Reading all these erudite postings, I had a vision in movie script.

Mysterious masked character holds an Obama-like figiure on his lap.

Obama-like figure: I fine mess you got me in.

Anonymous paradox October 03, 2013 1:17 PM  

The more you tighten your grip...

Anonymous What Would Lodi Do? October 03, 2013 1:20 PM  

Looks like California is taking a page from McRapey's playbook:

California exchange overstated its Web traffic for Obamacare launch

Anonymous Porky October 03, 2013 1:26 PM  

dh: "Unfortunately the morons in the Republican party are going to capitulate and fail. They have done a bad job with this all around."

Dh, I have no doubt that you will someday volunteer for the "Dept. of Human Experimentation".

And as you help inject Windex into the veins of young identical twins you will blame the Republicans for all the horror you have wrought.

Anonymous dh October 03, 2013 1:33 PM  

dh, are you familiar with the Rand Health Insurance Experiment? Right now, today, too many people are paying into the health insurance system and they are paying too much. When Massachusetts forced everyone to buy insurance, medical spending increased because people with insurance will use it. We don't want more people paying in, we want more people to opt out of getting medical care. It is being over consumed.

Yes, I am aware of it. It's pretty well known. Another way of stating what you are saying is that previously people self-rationed care because they could not afford it, or did not want to pay for it. Now that they can afford it, through cost sharing and cost shifting, they are more likely to use it.

This is feature to leftists. The selling point is that over time, it is less expensive to be healthy. Though, there is no a lot of evidence that Americans are smart enough to realize this. There are a lot of sickly people who are so for no good reason.

Anonymous dh October 03, 2013 1:43 PM  

And as you help inject Windex into the veins of young identical twins you will blame the Republicans for all the horror you have wrought.

Well I think I hear your point, which is that the ACA is the Democrats/leftists fault. And I agree with that.

However, I will say that there is something else on this topic. In a proper functioning system, you have regular order. Bills get proposed in committee, they are debated, amended, hearings are held, and then voted out of committee. Then the bill is opened up for debate, amendments, revisions, and then voted upon for passage to the other chamber. From there the same process repeats. Then the bill is reconciled, negotiated between the chambers, and then finally passed and signed into law.

None of that happened with the ACA. The GOP went all in on just blocking it, because people like Sen. Cruz (and many others) convinced them that it could be done. Before that, they were sure the SCOTUS would turn it over. This is a fine strategy if you want to lose. Part of it is that you have a lot of new people in Congress who don't really know how powerless the minority party is.

So I do put a lot of blame on the GOP for fighting this the way they did. It would have been better to amend the bill, to make it better. Just a simple example. There are literally dozens of drafting errors in this thing. Just gaps in the language, problems with terms, oversights, etc. These are normal, but normally, the adversarial and amendment process strips them out. That didn't happen. So we get a one-party boondoggle. And of course the GOP failed to repeal it, and now it's much more difficult to undo.

Blogger foxmarks October 03, 2013 1:47 PM  

“basically back to the 1950's in the US healthcare system”

An important bit of that is the word “system”. We don’t have to go back to the 50s level of medical knowledge and technique. Just the structure of payments and responsibilities.

For ordinary care, much of what people need is now dramatically less costly thanks to technological progress. A 15-minute in-office blood panel for a couple dozen common things can be had for around $20-$30. Less-invasive surgical techniques, a half-century of pharmaceuticals now priced near the marginal cost of production. Poor people could afford the dignity that comes with paying for their own basic care. And imagine the reach of charity hospitals and free clinics with modern tools at modern costs!

There would still be need for insurance against catastrophes. And only richer people will get the newest technology going forward. It isn’t utopia, but seems a much better trade-off than either the current corporatist model or the statist single-payer model.

Anonymous Anonymous October 03, 2013 1:57 PM  

Remember too you can lie about your AGI when you apply for Obamacare subsidies. How many people are going to think they also need to lie on their taxes to match it up? Vox is not joking, this could lead to tax cheating and closing of bank accounts.

Unless you work for yourself, it's pretty hard to cheat your AGI down and people who get paid under the table, probably aren't being truthful in the first place.

Anonymous dh October 03, 2013 1:57 PM  

There would still be need for insurance against catastrophes. And only richer people will get the newest technology going forward. It isn’t utopia, but seems a much better trade-off than either the current corporatist model or the statist single-payer model.

Agree with that - it's a great point. There is nothing wrong with 1950's system, with today's knowledge. We had a good standard of living in the 1950's. It wasn't perfect. But it was good.

Anonymous Porky October 03, 2013 2:15 PM  

None of that happened with the ACA. The GOP went all in on just blocking it, because people like Sen. Cruz (and many others) convinced them that it could be done.

None of that happened because the Dems already had a 60 vote filibuster proof majority on the bill in the senate and weren't about to give that up.

Man you're a disingenuous little leftist bitch.

Blogger IM2L844 October 03, 2013 2:38 PM  

I keep wondering how long the GOP will be around or if the hardline conservatives in that party really have initiated a Whig-liked demise and discrediting of the conservative ideology.

Far right GOP will have a banner year in 2016 if ObamaCare is fully implemented as is. The leftist's only salvation would be a successful "It's finally time for a woman president" campaign. I believe those Idiotic PC oriented conformists are fully primed to get absolutely giddy about jumping on that spine tingling bandwagon.

Anonymous Salt October 03, 2013 2:49 PM  

Being reported -

WASHINGTON (AP) — Police say the U.S. Capitol has been put on a security lockdown amid reports of possible shots fired outside the building.

People standing outside the Supreme Court across the street from Congress were hurried into the court building by authorities.

In a notice distributed by email, the U.S. Capitol Police advised everyone to "close, lock and stay away from external doors and windows.The notice said gunshots have been reported on Capitol Hill. There are unconfirmed reports of an officer injured.

Anonymous 5trych9 October 03, 2013 2:53 PM  

"WASHINGTON (AP) — Police say the U.S. Capitol has been put on a security lockdown amid reports of possible shots fired outside the building."

I suppose we will now see how far the cops will go in obeying orders. What do do when asked to open fire on a group of WWII vets who are exercising their rights of protest?

Anonymous lozozlo October 03, 2013 3:00 PM  

@Guitar Man

Prayers spoken and shipped out!

Anonymous Rabid Pathners Fanboi October 03, 2013 3:32 PM  

Vikings play the Panthers on Oct. 13

Unfortunately the morons on the Vikings are going to capitulate and fail.

That's just the unbiased nonpartisan facts.

Anonymous Gaffe Pro October 03, 2013 3:34 PM  

"party will be so debased and so properly blamed for all the fall out, they won't even be able to harm the economy any more as they will have ceded all pretense of responsibility to the Democratic Party."

This is a real comment.

Anonymous dh October 03, 2013 3:43 PM  

My porcine friend, you are just denying history. There were three separate attempts to find a bi-partisan - regular order - solution:

1. The Senate Finance Committee members - Baucus, Bingaman, Conrad, Enzi, Grassley, and Snowe met for 5 months to develop a bi-partisan plan. This was BEFORE the Democrats had a 60-seat majority - at the time, they held only 58 seats.

2. Before that, the House went through a similar process with members, immediately following Obama's inaguration. The Ways and Means and Commerce committees all worked on a different bill than what became law - the Affordable Health Care for America Act.

3. Pres. Obama invited all parties to the White House in early 2009 for a series of meetings, one of which was televised.

But three things happened:

1. Mitch McConnell was assigned to the lead the charge against any reform.

2. Republican leadership put out the word that this was 100% party line. Even Senator Snowe who literally wrote a good chunk of the ACA was forced into line by leadership, voting against her own bill.

3. The Republicans promised to vote against any bill en masse, and to try to obstruct passing it as long as possible.

Once this happened, there is no reason to negotiate. You don't negotiate against yourself when there is nothing to gain. The thing you compromise on is to gain wider support. If the other side says they won't play ball, no matter what, well than fine, but you don't give them your ball.

And that's why the GOP is stupid. They never had the votes to block the bill. Never. They went all in on making Obama a 1 term President, and the top of their ticket was a Liberal Republican Governor whose healthcare experts literally wrote the ACA. And so now, here we are, and they are going to cave on the shutdown as well.

And all along the way, they go nothing. They have achieved nothing in 5 years. Stupid.

Anonymous Porky October 03, 2013 4:05 PM  

And that's why the GOP is stupid. They never had the votes to block the bill. Never.

Yet you accuse them of blocking the bill.

You also said that regular order didn't happen but now you admit that Republicans attempted to negotiate three separate times and even helped write the damn thing.

Yet we all know what really happened in the end. The final bill was rammed through before anyone had a chance to read it, a disingenuous amendment was added to appease pro-life democrats and it never made it back to the Senate because Teddy Kennedy croaked and they knew they'd be forced to debate the bill without a 60 vote majority.

This is symptomatic of leftists. You simply are incapable of being truthful when talking about politics.

Anonymous Vladdy Lennin October 03, 2013 4:05 PM  

You guys realize that if the Kulaks had given up 47% of their land 20% faster to the Bolsheviks, then 67% of them would have been shot 26% less fast. Stupid.

Anonymous civilServant October 03, 2013 4:15 PM  

The system is breaking down

It is being broken down.

Once people stop paying their Obamacare fines, how long will it be before they stop paying other taxes?

When they must choose between taxes and survival.

I wonder how far overseas their paws will reach.

As far as the dollar.

Anonymous Frederick 303 October 03, 2013 4:27 PM  

Dh

you do seem to dishonest in this discussion. At no time have you blamed the democrats for any of this mess, yet you are doign every thing you can to blame the republicans.

I recall the debate post electionj 2008 to fall of 2009. The republicans had several proposals, non of which were given any chance. The fact is the democrats shut them out of the bill writing and voted down all of theattempted republican amendments.

The democrats own this mess, lock stock and barrel.

Anonymous Blume October 03, 2013 4:33 PM  

Your confused about who makes minimum wages. Minimum wage jobs only exist in businesses which cant move. You cant move a papa johns, or a walmart.

Anonymous dh October 03, 2013 4:39 PM  

You also said that regular order didn't happen but now you admit that Republicans attempted to negotiate three separate times and even helped write the damn thing.

Regular order didn't happen. It was suspended. It went through part of a committee process, but once the Republicans said they will never vote yes on anything, it was over. That was a huge mistake.

Yet we all know what really happened in the end. The final bill was rammed through before anyone had a chance to read it, a disingenuous amendment was added to appease pro-life democrats and it never made it back to the Senate because Teddy Kennedy croaked and they knew they'd be forced to debate the bill without a 60 vote majority.

The "read it" part is a lie. But still the point is - it was rammed through. Because there was no reason not to ram it through. Once the Republicans said they would never vote for any bill on principle, why should you accept amendments from them? So they can vote against their own bill?

That's why it there are so stupid. The actual bill didn't matter. The Democrats *had* to pass either an inferior bill, which had already been passed by the Senate, or start over and pass nothing. Given that, they choose to pass the inferior bill. Which, given the circumstances, was the only option they had other than to do nothing.

This is symptomatic of leftists. You simply are incapable of being truthful when talking about politics.

I've said nothing that is dishonest. I just think you don't really know how bills become law, or how badly the GOP screwed up their position.

Yet you accuse them of blocking the bill.

No, I didn't. I said they went "all in" on blocking the bill, because people like Sen. Cruz told them it was possible. But in fact, it's not. That's why the coming capitulation will hurt so much. The base has been led to believe it was possible to block the bill, and even if the government shuts down and the Treasury defaults on it's debts it still won't happen.

Anonymous Gaffe Pro October 03, 2013 4:49 PM  

Nichole Brown Simpson was stupid in how she handled OJ.

Anonymous Anonymous October 03, 2013 4:51 PM  

So, they're telling me I should not own property or invest in any businesses, barter and work for cash as much as possible, keep no money in the bank, and keep my reported income low enough that I qualify for government health care.

Consider the lesson learned.

Anonymous dh October 03, 2013 4:53 PM  

you do seem to dishonest in this discussion. At no time have you blamed the democrats for any of this mess, yet you are doign every thing you can to blame the republicans.

You assume that I don't support the ACA/Obamacare. That's your first problem.

I recall the debate post electionj 2008 to fall of 2009. The republicans had several proposals, non of which were given any chance. The fact is the democrats shut them out of the bill writing and voted down all of theattempted republican amendments.
That is simply untrue. The current ACA was drafted in large part by the three Republican members of the Senate Finance Committee. The problem is that after the Tea Party was born in August of 2008, the Republicans rightly listened to their base, and the Republican strategy became that the GOP would vote against *any reform*. This was courageous to do, but stupid. Courage and brains are not necessarily the same thing.

This is basic negotiation. You work with the other side in order to secure their vote on the bill. That's how Representative government works. The side with the most votes has the best position, but it's not the only position. However, once the GOP publicly declared that this was a party line vote, why would anyone in their right mind negotiate with them?

The democrats own this mess, lock stock and barrel.

Yes, Agreed. I don't disagree with that. What I am suggesting is that instead of a bill with quite a few flaws, including the every day type that are normally found doing regular order, as well as some structural ones, we could have ended up with a bill that was superior, the GOP could have still gone all in repealing and replacing it in the 2012 election, and the result would be a lot better policy.

Instead, what we have now is:

1. The GOP has accomplished nothing from it's time in power, so far. They have simply engaged their bases taste for showing Obama how much they hate him. That is certainly a fine passtime, but a better goal would be to restrain and move your ball closer to your endgame. They lost 2012 handily.

2. The GOP is about to cave on things it said it wouldn't do - the government shut down is going to fail; the GOP is looking for a fig leaf to call a win. It's not even clear Pres. Obama is going to give them that.

3. The GOP is about to cave again on spending. On this last CR, all they got was a $200 billion dollar cut. Out of 3500 billion. The Senate wanted 3700 billion. The House wanted 3500 billion. That's it. They have once again been exposed for saying they wanted to balance the budget, yet failed to deliver a single proposal to do so. The closest - the Ryan budget - took 10 years to balance, and even then, only balanced because of keeping the ACA taxes on the books and repealing the ACA.

And on the Democratic side, without having the House, they have gotten:

1. A new entitlement (ACA/Obamacare). Once 2008 election happened, there was no stopping this. So that one is done for, and has nothing to show for it.

2. A roughly $100B a year cut in military spending - part of the Democratic plank for many years.

3. The future ability to act the same way the Republicans are now and not suffer politically for it.

4. Complete control of the Executive branch, with minimal oversight.

5. Permission to spend $800B-$1000B more than they tax in any given fiscal year, indefinitely.

Look, we're leftists. We are going to tax and spend. We are going deficit spend. You are the ones saying we have to control spending, get fiscal policy in order, fix monetary policy. Yet you get control of the only organ of government who can spend money and tax, and you don't even come close.

Anonymous VD October 03, 2013 5:31 PM  

So, they're telling me I should not own property or invest in any businesses, barter and work for cash as much as possible, keep no money in the bank, and keep my reported income low enough that I qualify for government health care.

Precisely.

Anonymous Porky October 03, 2013 5:32 PM  

I've said nothing that is dishonest.
Of course you have.

Lie #1
Regular order didn't happen.

Sure it did. There were committees, bills proposed, bipartisan negotiations etc.

Lie #2
None of that (regular order procedures) happened with the ACA.

Same lie, different post. See above.

Lie #3

...but once the Republicans said they will never vote yes on anything, it was over...Once the Republicans said they would never vote for any bill on principle, why should you accept amendments from them?

Blatant lie. They didn't say they wouldn't vote for "any bill on principle". The impasse was over the Individual Mandate provision.

There's more of course, but why go on?

I know you think of yourself as an honest person, dh. But you are far too invested in politics to be objectively honest about it. You, like all leftists, lie without even realizing that you are lying. It's just who you are. Probably a nice enough guy, but you will never be able to be objectively honest about politics. Ever.

Anonymous Outlaw X October 03, 2013 5:34 PM  

Government and Media.

Always a crisis. Now we got a women on drugs trying to get to the Whitehouse with her little girl suddenly turns into a crisis. Jeeze!

The media has about three brain cells. This is why the AHA got passed in the first place.

Anonymous a_peraspera October 03, 2013 5:35 PM  

Yes, you can accomplish a lot when you abolish all constitution and law, and simply rule by decree....

Anonymous Dr. J October 03, 2013 6:21 PM  

Doctors are already vastly overpaid for what they do.

I've often suspected you have no idea what you're talking about. This statement proves it. Prove this assertion or retract. And no, citing 3rd world practitioners and pay scales in South America is not a sufficient refutation.

Oh, and f**k you.

Anonymous Outlaw X October 03, 2013 6:44 PM  

@ Dr J

I had a long conversation with my surgeon one day by a fluke. I asked him about if he would retire because of Obamacare. He said we will have to see, then he went on to tell me about the IRS always harassing doctors over a coding system that no one can understand.

I was surprised how he had time to ever doctor with the bureaucracy breathing down his neck. I suspect it will get worse and frustrations will mount.

Anonymous Dr. J October 03, 2013 6:52 PM  

@Outlaw X

I can't claim to speak for all surgeons, but it's becoming increasingly difficult to practice. The hurdles are becoming impossible to jump. The ACA is doubling down on the worst aspects of medicine. You have no idea how bad the bureaucracy is, and how much revenue the parasitic administrators, who contribute nothing to patient care, are skimming off the top.

To put things in perspective, a colleague decided to go to a cash only business before choosing retirement. He charged his patient's a fraction of what their insurance billed, worked half as many hours and doubled his income. We're experimenting with cash only surgery, as are others.

Anonymous dh October 03, 2013 7:02 PM  

Porky--

You can have your opinion, but not your own facts: This is Sen. McConnell:

“We worked very hard to keep our fingerprints off of these proposals,” he told The Atlantic soon after the 2010 election. “Because we thought — correctly, I think — that the only way the American people would know that a great debate was going on was if the measures were not bipartisan. When you hang the ‘bipartisan’ tag on something, the perception is that differences have been worked out, and there’s a broad agreement that that’s the way forward.”

McConnell was enforcing against ACA in August 2009, six months before it was signed into law. It wasn't even written yet.

But, I am actually pretty much ready to agree with you. The principle was that the GOP decided to vote against any bill that had a mandate and any bill that expanded Medicaid. They also wanted a few other things, but I don't think it was as important (tort reform, an example).

And it goes back to the original point. Once they declared that they wouldn't vote for any bill with a mandate, what incentive does anyone have to consult them at all? That was in Obama's plan since the late days of his campaign.

See? It's stupid. Bad tactics.

Sure it did. There were committees, bills proposed, bipartisan negotiations etc.

No, it didn't. Regular order means something. The bill was passed through reconciliation. A different process. The Senate Finance Committee started held markup, committee meetings, and that was the end of it. It was voted out of the committee 14-9, and that was the last Republican vote on the health reform except for 1 in the house.

None of that (regular order procedures) happened with the ACA.

You don't know what you are talking about because you are an idiot. The PPACA, the bill that is law, did not go through committee. An old House bill was gutted, amended, and that's how the PPACA was born. Through budget reconcilation process. The text of law that was signed into effect in March 2013 did not go through regular order.

I am sure that all the bacon on the brain clouds your view of what is true and is not true. The GOP, like you, have overplayed their hand dramatically, mostly because they use their base as money extraction devices. They have not honestly informed that they lost the fight in 2010. That's why the rage.

Anonymous dh October 03, 2013 7:10 PM  

I've often suspected you have no idea what you're talking about. This statement proves it. Prove this assertion or retract. And no, citing 3rd world practitioners and pay scales in South America is not a sufficient refutation.

Well of course this is an opinion, but the primary pieces of evidence are how doctors behave.

1. They use a cartel to limit competition. The AMA/Medical School system successfully keeps the supply of doctors constrained. See here for examples. They also use authority to restrict the roles of alternative practitioners, for example, see here here.

2. Compared to their counterparts in other countries they make as much or more. Doctors in the US on average make about double what their counterparts in other first world country make. See: here. Probably because of the cartel.

3. They are fighting attempts to link pay to quality. To keep prices inflated. See here.

Anonymous dh October 03, 2013 7:14 PM  

To put things in perspective, a colleague decided to go to a cash only business before choosing retirement. He charged his patient's a fraction of what their insurance billed, worked half as many hours and doubled his income. We're experimenting with cash only surgery, as are others.

This is a good option. Why do you suppose that so few doctors have done it? Concierge/cash only practices are rare. Why?

Doctors want to take government money, and then complain about the government. You cannot have it both ways. They need to remember who is keeping foreign and inexperienced doctors out, and preventing them from snapping up their patients.

EVERY OTHER industry has faced significant price pressure from technology. Doctors are just getting the tip, and they are whining endlessly about it. Lawyers are facing a huge decrease in demand because of technology. Programmers have to compete with Indians willing to work for 18% of US salaries.

There are so many problems with US healthcare. Not the least of which is that doctors feel entitled to make salaries far, far, far above average for people who work a similar load, and take on a similar risk.

Anonymous Sigyn October 03, 2013 7:32 PM  

Not the least of which is that doctors feel entitled to make salaries far, far, far above average for people who work a similar load, and take on a similar risk.

Maybe that's partly because they have such huge student-loan debt and malpractice insurance costs.

Hey, we just tied it back into the other thread!

Anonymous Porky October 03, 2013 7:40 PM  

Once they declared that they wouldn't vote for any bill with a mandate, what incentive does anyone have to consult them at all?

Moving goalposts now? Lol! What a surprise from the lying leftist.

The Senate Finance Committee started held markup, committee meetings, and that was the end of it. It was voted out of the committee 14-9, and that was the last Republican vote on the health reform except for 1 in the house.

Hmmm....this is all stuff you said never happened. "None of that happened" I think was what you said exactly. Which is a lie, of course.

No, it didn't. Regular order means something. The bill was passed through reconciliation. A different process.

Different bill. The reconciliation bill was called, oddly enough, the Health Care and Education Reconciliation Act. Different bill. Different goalpost. More lies. Yawn.

You see what I mean? You are quite literally incapable of honesty when it comes to politics. You may very well be able to converse honestly about some topics but not politics. You are simply not wired for it and this will likely never, ever change. Ever.







Blogger Serge_Tomiko October 03, 2013 7:57 PM  

Still living in that fantasy world where the world's most powerful empire has to collect taxes from the American peons in order to survive.

Taxes. Are. Not. About. Raising. Revenue.

Anonymous a_peraspera October 03, 2013 7:58 PM  

"Once they declared that they wouldn't vote for any bill with a mandate, what incentive does anyone have to consult them at all?"



If the Republicans believed that socialized medicine would harm the country, why should they vote for the bill?

You seem to be saying that because the Pubs wouldn't vote for Obamacare they were acting in bad faith...?

Anonymous Menuka October 03, 2013 7:59 PM  

So, I thought I'd add a case study example.

I'm a well educated, poorly skilled worker with a family of 4; me, wife, two kids. Our household income is low, but there is fair upside potential. We were not able to afford insurance with our employer and therefore opted to enrol with Metashare, a Christian healthcare sharing service (not insurance, poperly speaking). We pay $300 a month for this service and it has provided us acceptible health coverage. We've had a baby, been to the ER, and visited a few doctors; there has been no problem. Best I can tell, Obamacare will force us into our employer's plan with rich subsidies. For simimilar coverage, we will pay $500/year versus $300/month. As much as I'd like to stay with a private ulternative and stay of the GommitCheese, the savings (260/month) seem too good to pass up.

Anonymous Jack Amok October 03, 2013 8:30 PM  

This is a good option. Why do you suppose that so few doctors have done it? Concierge/cash only practices are rare. Why?

Because most people are already paying several thousand a year (either directly or in lower wages when their employer pays the premium) for health insurance. For many people, it's not even an option to not pay it (er, and possibly this idiot Obamacare legislation says it's illegal not to, but I think you probalby have to violate the law to see what's in it).

What do you suppose would happen if the IRS decided to give employers a tax write-off for buying their employees 80% discout cards at Target? How many competitors to Target would prosper?

Anonymous dh October 03, 2013 8:35 PM  

Porky---

You must have swine flu. What I actually wrote was:

None of that happened with the ACA.

How hard is for you to understand: once the GOP went all in with obstruction, why would anyone in their right mind negotiate with them? The thing the Democrats are negogiating for are Republican votes. If there are no votes, there are no negotiations.

The problem here is that you, and the GOP base, are low information idiots. When people like Sen. Cruz, or Rand Paul, or others fancifully make up scenarios where the ACA is repealed between when it was signed into law in 2010 and now, it was simply wishful thinking. After Obama was re-elected, it was over. There is no way to extract a signature from him. None.

A better course would have been for the GOP to get whatever concessions they could out of the law, as separate bills - tort reform, conscience protections, economic liberty, etc. And then work like hell to elect a candidate who was not Mitt Romney. But of course they are too stupid to nominate a candidate who could win, and so they, lost. Again.

They doubled down on defeating Obama, and they lost. Badly.

Different bill. The reconciliation bill was called, oddly enough, the Health Care and Education Reconciliation Act. Different bill. Different goalpost. More lies. Yawn.

What is your point? What said is and remains 100% true. The GOP did not participate at all in either bill. They voted against both en masses. They have tried to block it from the day it came up for a vote. And they have lost all along the way.

Because they are stupid.

You see what I mean? You are quite literally incapable of honesty when it comes to politics. You may very well be able to converse honestly about some topics but not politics. You are simply not wired for it and this will likely never, ever change. Ever.

Porky, I just don't think you are up to snuff to talk about this stuff. You try, but you are blinded by low-information and the inherent inability to accept that someone other than yourself is acting in good faith. If you want to fight and die on the hill of the GOP being smart and handling the health reform debacle as wisely as possible, go knock yourself out. But I have seen no evidence to suggest anything other than the most cynical GOP wags using an intense dislike of the people involved (esp. Pres. Obama) to propel themselves to greater individual popularity, at the expense of actually preventing bad things from happening. Doubling down on pure obstruction meant that GOP waived any ability to offset the most destructive pieces of the law. In their only legitimate role as a minority party, as opposition, they failed. Badly. And when Boehner caves, and allows the shutdown and debt ceiling to be raised with a handful of Republican votes and all Democrat votes, and is removed from his job and replaced with Cantor or someone else, you will know I was right.

Anonymous Menuka October 03, 2013 8:37 PM  

Though it's likely already been mentioned, 1) infowars' source is nothing more than facebook. 2) The ACA, as the article admits already stipulates that leans may NOT be placed against homeowners, therefore, either the government is wandering into a blatant affirmation of conspiracy theorists, or the facebook poster was BSing. Seeing that the Democratically controlled government is winning the ball game at this juncture, I suspect the latter.

Anonymous bluto October 03, 2013 8:46 PM  

DH,
I agree with you, the shutdown isn't D vs R, it's a subset of R vs D, and it's a fight of principle that's why neither side has any negotiating points. The R side's only possible goal is a hail mary, it's to show the electorate that discretionary government isn't required (each day something bad doesn't happen they get a bit closer to winning). If they win, they may get a chance to roll back some of FDR's stuff, if they lose, the Republican party will go Whig and be replaced with what I expect will be a populist party.

Anonymous dh October 03, 2013 8:50 PM  

If the Republicans believed that socialized medicine would harm the country, why should they vote for the bill?

You seem to be saying that because the Pubs wouldn't vote for Obamacare they were acting in bad faith...?


No, it's not bad faith. It's perfectly fine for them to not vote for it. But, coming two or three years after the fact, to hear whining about how they weren't consulted, and all that, it's disengious. You don't get to participate if you don't deliver any votes.

It is extremely interesting that anyone would call ACA/Obamacare socialized medicine. In fact it's quite literally the farthermost option that was proposed from it. There are very few provisions of the law that actually deal with the delivery of care - and most all of them are expansions of things that have been done for a while. The vast majority of the law affects only how care is paid for. One of the explicit stated goal of the plan is to get more people into the private market, and out of charity care, Medicaid, or Medicare.

Regardless, the GOP is stupid. I stand by this:

But instead they are blinded by impotent Obama rage, they got nothing. In a few more days, they'll cave on the shutdown, Obamacare will still be the law, and that will be the end of it. They will have gotten nothing.

Once it became clear that the Democrats had the votes to pass a bill, the GOP should have caved then, and negotiated for whatever concessions they could get. This is how Democrats win, even when they appear to be losing.

For example, in 2006, a majority of Democrats voted against the Iraqi war re-authorization/surge. It passed with almost uniamious Republican votes, and less than half of Democratic votes. It was going to be an entirely partisan event, which Pres. Bush did not want. So all sides negogiated, and the Democrats got a number of concessions which later helped them, both electorally and policy wise. In return for not passing a law blocking the surge (which the House had passed), the Bush administration promised to replace the Joint Chief and the DNI, which he did a few days later. The House and Senate held a non-binding vote, which was filibustered in the Senate, and that was the end of it. The Democrats were able to claim to be anti-war, and the Republicans got their blood.

And that is how minority parties exercise power. The Democrats wanted Gen. Casey gone for 6 months and could not do it. It required Pres. Bush's help to get rid of him, and they found something Bush wanted, and delivered it. For a price.

Anonymous dh October 03, 2013 8:52 PM  

If they win, they may get a chance to roll back some of FDR's stuff, if they lose, the Republican party will go Whig and be replaced with what I expect will be a populist party.

Yeah, agree that this point it time it's the only option. But the pressure is already ratcheting and the weasels are out to find an escape hatch. Boehner will find some fig leaf to try to cover himself - a partial repeal of a tax that is already unpopular, cancer funding, future reform of the tax code, something. And then he will cave.

Anonymous dh October 03, 2013 8:53 PM  

Sorry, one more though. Right now, the government is backing 90% of mortgage's in the country. The FHA hasn't assigned a new case number in 3 days. Within a few weeks, the entire mortgage market will grind to a halt. An industry that supports a few million workers.

When business turns against the GOP, it's over.

Anonymous zen0 October 03, 2013 8:55 PM  

dh challenges:

And when Boehner caves, and allows the shutdown and debt ceiling to be raised with a handful of Republican votes and all Democrat votes, and is removed from his job and replaced with Cantor or someone else, you will know I was right.

That's a lot of variables. It reminds me of the time I predicted SF would lose the first 2 games and Harbaugh's head would explode on national TV.

They went 1-1 and he just got slapped on the ass when he wasn't expecting it.

Is that a partial win for me, oh serpentine one?

Anonymous Dr. J October 03, 2013 8:57 PM  

This is a good option. Why do you suppose that so few doctors have done it? Concierge/cash only practices are rare. Why?

The fact that the majority of people who seek care are already insured for one, but the dramatic increase in deductibles will likely create opportunities. For surgery in particular, though, it's the need for a facility. A cash only facility can not take insurance of any kind and give different bargain prices to cash payers. Therefore, physicians would have to invest capital in a surgery facility that takes no insurance at all, like this one. Despite their fabulous wealth (/sarcasm), very few would have the capital to build a hospital, even if permitting were possible.

They need to remember who is keeping foreign and inexperienced doctors out, and preventing them from snapping up their patients.

No one is. Have you been to a general practitioner recently? The country is flooded with piss poor immigrant doctors who don't know which end of the stethoscope to use. All the most intelligent US trained docs have gravitated into specialties. And they're not snapping up anything - patients don't want a doc who got his MD in Pakistan.

American medicine does function like a guild, and supply is intentionally limited, but even with the residency bottleneck, fewer and fewer intelligent people are drawn to the field. The next generation of docs coming out of training are going to be a huge problem, and they are not interested in making sacrifices for their patients. Did you know the oral board fail rate for general surgeons is north of 30%?

There are so many problems with US healthcare. Not the least of which is that doctors feel entitled to make salaries far, far, far above average for people who work a similar load, and take on a similar risk.

I would venture to say you have no idea of the risk docs take on. I'm not a UK MD, who can just stop my day at 3 PM. Nor a Canadian MD who really faces no risk of litigation - ever. I see more patient's than my international counterparts, work longer hours, have 10-fold their debt-load and take on significantly more risk. Lastly, I would wager that most US professions are making more than their international counterparts, from electricians to mechanics. And physician pay has been in a steady decline in real, not inflation-adjusted dollars, for 20 years.

Let me ask you this - how much do you want the guy operating next to your spinal cord to make?

You're right about one thing - we never should have taken government money. I loathe the generation of docs that preceded me and surrendered the profession to the Feds, especially letting go of medical training, now funded through Medicare.

I am curious though: What technology would you use to replace a surgeon, exactly?

Anonymous Dr. No October 03, 2013 9:18 PM  

"The country is flooded with piss poor immigrant doctors who don't know which end of the stethoscope to use."

In reality, in order to even be eligible to apply for residency training in the U.S., international medical graduates must demonstrate their qualifications are equivalent to American medical graduates by passing three sections of the U.S. Medical Licensing Exam.

In 2008, only 42.6 percent of international medical graduates passed all three components of the test on their first try, and only 73 percent of those who passed all three exams eventually found a residency -- and getting a residency match is effectively an additional level of quality screening. Post-licensure, there are few differences between U.S. and international medical graduates in patient health outcomes, or in the frequency of disciplinary actions by state medical boards.

Try harder next time.

Anonymous A is A October 03, 2013 9:21 PM  

"When business turns against the GOP, it's over."

...prays the boring Democrat hack.

You'd be a better Concern Troll.

Anonymous zen0 October 03, 2013 9:28 PM  

Dr.J points out:

You're right about one thing - we never should have taken government money. I loathe the generation of docs that preceded me and surrendered the profession to the Feds, especially letting go of medical training, now funded through Medicare.

Mrs. zen0's father was a doctor in Saskatchewan before medicare was introduced. He used to get paid in chickens and other farm produce. He was against medicare originally, but did ok once it was introduced.

Now, all I am saying is, there is a reason why things develop how they do, and it did not all start last week.

Anonymous Dr. J October 03, 2013 9:42 PM  

Try harder next time.

How many have you worked with?

You're referencing the USMLE boards, which no one who's made it through med school should fail, even once. The fail rate of international students you cite should give one pause, or are those 42.6% rocking the exams? US students pass rates are above 95%.

Getting a residency in internal medicine or some other equally non-competitive field does not equate to equivalency with US trained MDs, particularly when many of those residency slots remain unfilled.

International grads have lower average scores and need more attempts to pass. Your argument is disingenuous at best, and more likely a blatant misrepresentation. Show me your data on comparison of outcomes.

Anonymous Porky October 03, 2013 9:56 PM  

You must have swine flu. What I actually wrote was:

None of that happened with the ACA.


Which is a lie. Derp.

The problem here is that you, and the GOP base, are low information idiots.

Even if true you are still a liar.

When people like Sen. Cruz, or Rand Paul, or others fancifully make up scenarios where the ACA is repealed between when it was signed into law in 2010 and now, it was simply wishful thinking.

No, it's called politics. You know, that thing that apparently turns the rational part of your brain to sticky goo and causes you to tell one obvious lie after another?

The GOP did not participate at all in either bill.

Gee you say this as if you believe it is true... but then even a low information idiot can look earlier in the thread where you claimed that "Even Senator Snowe who literally wrote a good chunk of the ACA"

It's funny to watch you contort and writhe around because you can't even keep track of your own lies. :)

Porky, I just don't think you are up to snuff to talk about this stuff. You try, but you are blinded by low-information and the inherent inability to accept that someone other than yourself is acting in good faith.

Well, the first step toward acting in good faith might be to STOP LYING!

Just kidding. I know you couldn't stop if you tried.

If you want to fight and die on the hill of the GOP being smart and handling the health reform debacle as wisely as possible, go knock yourself out.

No thanks. I'm an anarchist and couldn't care less about your petty partisan bullshit. I just felt like showing everyone what an unrepentant lying leftist looks like.

Later, bro!



Anonymous Gen. Kong October 03, 2013 10:11 PM  

dh:
And when Boehner caves, and allows the shutdown and debt ceiling to be raised with a handful of Republican votes and all Democrat votes, and is removed from his job and replaced with Cantor or someone else, you will know I was right.

Can't really argue with dh here. Weepin' Johnny and the Brokeback Boyz can't wait to assume their customary supine position. It's what makes them Repukes, after all.

Anonymous Anonymous October 03, 2013 11:15 PM  

The Obama voters I know, as well as the people who consider themselves "moderates" who are above the ugly political fray, just seem sort of puzzled. They have enough sense to realize that you can't get fined thousands of dollars for "opting out" of something that's truly voluntary, but they're naive enough to think something like that couldn't really happen in America. It's like they're waiting for someone to tell them it's just a myth and none of this stuff is in there, or for someone to amend it at the last minute to take these unpleasant bits out. After all, they just wanted to help poor people who were falling through the cracks; that's not so bad, right? And sure, Rush Limbaugh said this would happen, but he was just making that up to scare people into voting Republican, right? Right?

Anonymous The other skeptic October 03, 2013 11:44 PM  

When the media would not tell us the race of the woman killed in DC when shots were fired, it was clear what her race was.

I guess they want to whittle down the Obamacare recipients.

Anonymous Bran October 03, 2013 11:57 PM  

And then if the fu@$ers can save us from obumbocare, the republicans will be selling us out to the stupid illegals ruining and burying our country under third world losers. The only hope is to find a place where like minded folks are in an area we can't be reached

Anonymous Dr. No October 04, 2013 12:11 AM  

"The fail rate of international students you cite should give one pause, or are those 42.6% rocking the exams? US students pass rates are above 95%."

No shit, sherlock. When it comes to USMLE pass rates, not all medical schools are created equal. Training on medico-cultural differences, for example, must be taken into account. Nonetheless, the "vibrants" do not lack the credentials once they pass the boards. Keep in mind the American University of the Caribbean reported and overall pass rate of 96% in 2012.


"Your argument is disingenuous at best, and more likely a blatant misrepresentation."

Try again.

http://usatoday30.usatoday.com/news/health/2010-08-08-doctors-foreign-training_N.htm


"How many have you worked with?"

More than you. They are solid, just like their American counterparts.

Why are you mad, bro?

Anonymous dh October 04, 2013 12:28 AM  

I'm not a UK MD, who can just stop my day at 3 PM. Nor a Canadian MD who really faces no risk of litigation - ever. I see more patient's than my international counterparts, work longer hours, have 10-fold their debt-load and take on significantly more risk.
More risk than a foreign doctor? Absolutely. That, by the way, is not a selling point of the US healthcare system. More risk than other small business men and women? More liability than most (but not all). But especially for specialists, you make more than comparable business people with comparable risk. I would never begrude anyone whatever living they can make. But at the same time, you want to whine about all your problems that are all virtually all caused by your cartel and legal protection rackets. You can have one or the other. The strong chance of an above median income for your entire career, social prestige, and unearned political clout, or a 9-5 work day with no chance of being sued.

Lastly, I would wager that most US professions are making more than their international counterparts, from electricians to mechanics. And physician pay has been in a steady decline in real, not inflation-adjusted dollars, for 20 years.
If this is true, that's interesting to know. Do you have a source for the non-inflation adjusted dollars claim? For purchasing power parity, a doctor making $100k in 1993 would have to be making about $163k in 2013 money. What you are claiming is not are they not making $163k, but they are making less than
$100k?

Let me ask you this - how much do you want the guy operating next to your spinal cord to make?

I want him to make whatever the free market will bear. This often sounds trite, but look, we are paying you folks (doctors and surgeons) a vast premium in this country. A huge slice of our health spending going to administration. That's the premium we all pay so that you folks are not directly employed by the government, or only by hospitals. That's what it costs to run parallel claims processing, payment, accounting, review, appeals, regulatory, and medical review all the private insurers in the country. This is what it costs not to have a single payer system. And there is very little incentive for the doctors to step up and demand changes to the overheard structure, because both you and the insurers are essentially, economically speaking, cost plus arrangements.

Doctors in the US make in the ball park of double their developed country counterparts. If you deserve it, fine. Fine by all means, make it. But, for that, we expect:

1. You to at least be as productive and have at least as good results. While the extremes are far superior to the rest of the world, the median is not. Why?

2. You to work at least as hard as the rest of the small businessmen and women in this country. And to be at least as innovative.

3. To resist forming anti-competitive cartels, and to not abuse your social prestige to keep your own status artificial elevated. Namely, the expansion of common medical practices to non-MD practitioners.

4. End of the "Art of medicine" garbage. Most medicine should be engineering, but instead it's treated like it's making breast shape pottery and selling it to tourists. Everything you do should be checklist driven. Everything you do should be logged. Everything you rule out or in is an auditable analyzable event. We aren't going to trust your gut, we aren't going to listen to experience. We expect decisions to be coldly made in a calculating way.

I am curious though: What technology would you use to replace a surgeon, exactly?
The bottom line is that we are not willing, as a society, to pay for the level of surgical care being delivered. It's too expensive.

Anonymous dh October 04, 2013 12:35 AM  

Gee you say this as if you believe it is true... but then even a low information idiot can look earlier in the thread where you claimed that "Even Senator Snowe who literally wrote a good chunk of the ACA"

It's funny to watch you contort and writhe around because you can't even keep track of your own lies. :)


Porky, you are incapable of assessing a lie from not a lie. The GOP delivered 1 vote to the ACA. They have delivered roughly individual votes 14,000 against. Are you hanging your hate on the single 1 vote in favor?

You know that what I am saying is exactly true. The GOP made a wholesale move to disengage from the bill, after working on it intently for months.

No, it's called politics. You know, that thing that apparently turns the rational part of your brain to sticky goo and causes you to tell one obvious lie after another?

I invite you to spend some time with these people. You know that they think any minute now Obama is going to cave, and sign a repeal of his own signature law - the one called "Obamacare"? These people don't think it's just politics. Their side has lead them to believe this was possible. And everytime, when the football gets moved and they land flat on their back, they think - "next time I am going to get that ball, Lucy!"

This is the their last play. The desperation to stick it to Obama is so strong you can smell it. Go over and read Erick Erickson at Redstate. The guy is convinced if they just hold tough Obama is going to cave. Rand Paul and Mitch McConnell are convinced that it sounds horrible to say "we aren't going to negotiate". These idiots are making Obama, the weakest President in the history of the executive, look strong.

Everyone forgot to tell them that they lost in 2010. Their own representatives don't have the guts to tell them the truth. It was over as soon Pres. Obama was re-elected.

Anonymous Dr. J October 04, 2013 12:38 AM  

Why are you mad, bro?

Because my patients have suffered repeatedly from their incompetent level of care, at multiple institutions - from Harvard, to Milwaukee, to Atlanta. You're going to cite some study from a garbage journal like Health Affairs, and regurgitated in USA today, as your proof? And on top of that spout non-sense about medico-cultural differences. I'm sure that makes a huge difference in the tenets of Biochemistry tested on Step 1. And the students from the Caribbean schools are largely Americans, not foreigners, which again shows that you like to misrepresent data to support your position.

Quite clearly your final assertion has no basis in fact. Our entire hospitalist service reads like the CIA's mid-east target list, and that's tiny compared to the larger institutions I've been at. I and my colleagues do our best to avoid consulting these guys, if we want our patients to live, that is.

Anonymous The other skeptic October 04, 2013 12:46 AM  

Peter Turchin in The Road to Disunion says:


The disquieting conclusion from this more recent analysis is that we are still firmly on track to some kind of a social and political upheaval during the coming decade or so. The worsening structural-demographic trends argue that things will be quite a lot more violent than the 1960s. How much worse – I don’t want even think about it.

But as I read the today’s news, I am struck by how many parallels there are between the 2010s and the 1850s, especially on the political front.

Anonymous Dr. J October 04, 2013 12:53 AM  

What you are claiming is not are they not making $163k, but they are making less than
$100k?




Not the exact numbers you list, but in principle, yes. For instance, reimbursement for a knee arthroplasty 20 years ago was $3000, now the average is $1200. While some have been able to increase volume, it hasn't been more than double.

You to at least be as productive and have at least as good results. While the extremes are far superior to the rest of the world, the median is not. Why?

Firstly, the measures are not comparable. For example. the UK registers many neonatal deaths as stillborn, while they are measured as infant mortality in the US. Then we see reports of an unacceptably high rate of US infant mortality. That's the most oft-cited example.

Most medicine should be engineering

My background is engineering. The fields are not even close to comparable. The number of variables for any given patient undergoing a procedure make prediction nearly impossible. If you bother to read any medical literature, you'll learn that it's mostly complete garbage. The number of patients available to answer any question is never large enough, and the variables too numerous so simply plug into an algorithm. Check box medicine will lead to more deaths and complications, particularly in the hands of the brutes who are coming up through the training programs.

Namely, the expansion of common medical practices to non-MD practitioners.
You're going to get this, and by the bucket load. Nurse practitioners and physician assistants are already filling the family practitioner roles that no one wants anymore, except from your friendly Bangladeshi that Dr. No wants to manage his hypertension and diabetes. Americans are not going to be pleased with this, and you're certainly welcome to let them cut you open, if you so desire.

Anonymous Anonymous October 04, 2013 1:50 AM  

If foreign-trained doctors are anything like the foreign-trained programmers that I see everyday in programming forums online -- who we're assured are head-and-shoulders above lazy, stupid American programmers -- I wouldn't hire one to wash my car, let alone cut into me.

And oh, those foreign programmers all have "degrees" from "colleges" too.

Anonymous Anti-Democracy Activist October 04, 2013 2:48 AM  

Welp, here's some genuine, bona fide news on Obamacare. It turns out someone did the alphanumerics on the Obamacare help support line, and it works out to 1-800-F1UCKYO

Story at Zerohedge: http://www.zerohedge.com/news/2013-10-03/have-questions-obamacare-call-1-800-f-u-ckyo

Anonymous Ain October 04, 2013 3:06 AM  

bluto: "I love that someone who is getting a very good deal, (I was looking at plans for a friend and mr type 1 diabetes will probably receive many times his premium in benefits based on some pretty low estimates) is complaining about how unaffordable his options for insurance are. If the potential winners aren't liking Obama care, the program is in deep, deep trouble."

Getting screwed less than some people is not "getting a good deal."

Anonymous Carlotta October 04, 2013 8:15 AM  

I think that, unlike India, the Christian values of the US would avoid widespread unattended death and disease. But I am not hoping to have to find out!

Parasitic morals. So you see what happens when Christian morals are not the norm and it is scary and sad. What religion are you again?

Anonymous Obvious October 04, 2013 10:12 AM  

Really? You're now mining Facebook propaganda click bait for blog posts?

You do know that you have access to the internet, right? That it's not that hard to fact check things? I see even super geniuses are gullible.

Anonymous dh October 04, 2013 10:51 AM  

Not the exact numbers you list, but in principle, yes. For instance, reimbursement for a knee arthroplasty 20 years ago was $3000, now the average is $1200. While some have been able to increase volume, it hasn't been more than double.

I don't think that's right. According to CMS, for 27438 the simplest version you can bill, the reimbursement for the non-facility portion is $2,497.09, subject to your adjustment for reasonable and customary in your area. Adjusted for Ohio, for random example, which is 0.91 adjustment, reimbursement would be $2,272.35.

Firstly, the measures are not comparable. For example. the UK registers many neonatal deaths as stillborn, while they are measured as infant mortality in the US. Then we see reports of an unacceptably high rate of US infant mortality. That's the most oft-cited example.

For the amount of GDP we are spending, the results should be, apples to apples, far above the rest of the world. Is your claim that this is being delivered? This is generally, across the board. Comparing any procedure, NHS vs. US vs Canadian Medicare, for often 2, 3, 4 or more times the cost, the US system should be delivering results at least equal. Do you think this is happening? The high-end of the system I think is second to none. But what about the average?

. Check box medicine will lead to more deaths and complications, particularly in the hands of the brutes who are coming up through the training programs.

Sorry, but the data doesn't support your thinking. Data suggests that even in places with "brutes" - New Delhi, India; Amman, Jordan; Manila, Philippines; Ifakara, Tanzania; London, England - that checklist medicine substantially saved lives and reduced morbidity.

Link: New England Journal of Medicine

Of course, there is a huge resistance to this from practitioners. Because it would allow one doctor to supervise 50 medical technicians going through the checklist quickly and inexpensively. And if that happened, the art of medicine would be dead, and it would instead be an assembly line. And assembly line workers are expected to be cheap and disposable.

Put it this way - given the enhancements of modern IT, education, and methods there is no reason why for those without substantial means shouldn't be processed through a medical system in a factory like way.

Anonymous dh October 04, 2013 10:52 AM  

Parasitic morals. So you see what happens when Christian morals are not the norm and it is scary and sad. What religion are you again?

I am being baptized at Easter. Roman Catholic.

Anonymous dh October 04, 2013 10:53 AM  

And oh, those foreign programmers all have "degrees" from "colleges" too.

I agree foreign programmers suck. I make a great living by undoing their work. But guess what - they sure have depressed wages in IT over the last 20 years.

Anonymous Dr. J October 04, 2013 12:16 PM  

According to CMS, for 27438 the simplest version you can bill

27447 is the relevant code. The AMA website (which publish the codes) lists reimbursement at $1552.81 as the national average. I don't know how you got CMS info because the AMA holds copyright to these codes and sets rates in conjunction with CMS. You can't access the actual numbers from the CMS website. By the way, I am in no way a supporter of this system or the AMA.

I'm aware of the paper you linked. There was substantial enthusiasm for that checklist. It's a pre-operative role call that occurs before the operation. It's since been dropped at most institutions for a more streamlined time-out, as on a large scale it made no difference in outcomes, and actually lengthened anesthesia times. I hope you understand that this verbal melange has no bearing on the execution of the surgery. The checklist isn't the treatment.

Anonymous civilServant October 04, 2013 12:36 PM  

I am being baptized at Easter.

Why not now?

Blogger IM2L844 October 04, 2013 12:37 PM  

I am being baptized at Easter. Roman Catholic.

Too bad you couldn't get Tom Woods as your sponsor.

Blogger IM2L844 October 04, 2013 12:43 PM  

...Or Anthony Flood.

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