SCOTUS Upholds Affordable Care Act!
Comments
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Part of the problem is American ideal of the completely self-reliable person - the pilgrims who settled this country, the pioneers who traveled west and homesteaded their way to the American dream etc. But that idea does not fit into modern society. WE cannot simply rely on ourselves. Life is too complicated. Banking, communications, health - all of those require joint action. Those who try to impose the model of the unregulated industry upon the modern world should look at what companies did in the late 19th and early 20th century.
We are, like it or not, in a complicated post-industrial world. We cannot go back to the self- reliable model of the 18th century. Health care is complicated and expensive, which is why we need insurance. Businesses will act in their own self-interest in deciding whether or not to offer insurance, which is why we need some government intervention, either in the form (imperfect though it may be) of the ACA or single payer.
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But that "ideal" of the totally self-reliable person is a falsehood. Settlers depended on each other in a primarily physical way out of necessity, and they built small communities. When a barn needed to be raised, everyone helped. When the crops needed harvesting, everyone helped. When industrialization began, the "communities" evolved into unions.North America (both the U.S. and Canada) have a long and proud history of people working together for the benefit of all. The "self-reliability" idea is a modern-day myth of what yesteryear was like, IMHO!
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It is not socialist to believe that the weakest members of society should be protected from the vicissitudes of life, be that ill health, lack of access to clean water, food, and shelter. The American way is to look after their own. The poor and the working poor are your own, children, parents, neighbours....
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Kay, besides you can have problems getting or paying for insurance even if you are completely middle class.
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Interesting historical vignette about the founding of the first hospital in the U.S. -- Pennsylvania Hospital in Philadelphia, supported by matching private funds with public funds (from the colonial-era Pennsylvania Assembly) -- by Benjamin Franklin, among others:
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And the local successful businessman and even the rockefeller types considered it their duty to invest in their communities.......hospitals, libraries, school facilities or anything they could put their name on. There was still a sense of obligation to your neighbors, especially if you wanted to sit in the front pew at church.
To those whom much is given, much is expected. Not "what's in it for me"
Remember the bumper sticker. "He who dies with the most toys, wins". Boy I always disliked that one. -
kay -- Do U.S. doctors post their fees? If you "shopped around" by using the phone, would the receptionist answer your "how much" query? Do hospitals post their fees?
The vast majority of patients (or customers, as some would have it) aren't looking for the cheapest -- they're looking for the best. Buying healthcare is quite a bit different from buying a car. Smart people understand this.
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I shopped for my son's surgeon. He fell in a major metropolitan area but had his surgery in our much smaller city for a much reduced price. That was fairly straghtforward because of his lack of insurance. I think it is hard to get pricing with insurance, there is a varience in negotiated pricing with every company.
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U.S. doctors do not post their fees. The receptionist would not be able to answer the "how much" query in most circumstances, as fees are different in so many cases. Do you have insurance or not, what insurance company are you with, what insurance plan in that company are you on? Is the doctor in-network or out? If out of network, what does your insurance company consider "reasonable and normal" - and the list goes on.
Of course, the majority of patients ARE looking for "the best", not the cheapest, but (just like with anything) paying more does not necessarily mean you are getting better care. And of course, paying less doesn't necessarily mean worse - but the fact is that most of the time you simply cannot figure out what you will be paying at any particular place. Then add in the fact that once you are under a doctor's care, if he orders tests, then there is NO way you can control those costs or even find out what they will be. Some places will charge $2000 for something that another place will charge $800. But even if you happen to know that (and who would when you've just found out that you might have something BAD - oh like - cancer....) you cannot tell the doctor to send your "stuff" to the less expensive lab, as they have a contract with the other lab.
It's far too confusing.
That said - we have on a couple of occasions opted out of using our insurance, as we were able to negotiate a better deal with the doctor when we simply paid cash. But to bring that up, you've usually already got to have a good relationship with the doctor, else why would he trust you to pay - and why would you trust the doctor to do a good enough job to pre-pay.
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Notself - Why not at least try allowing people to buy insurance across state lines? Here's more on that idea:
Who do you know "loves" Medicare? Every retired person I know buys a second insurance policy on top of the Medicare because they hate Medicare.
I guess I should've realized that the "up to age 26" part of the ACA plan would require more funding. If that's true, then I oppose it. (Btw, 21 years ago, I was one of those uninsured 26-year-olds.)
Corgi - I'm sorry about your sister.
I have children who've had their share of injuries, including one with a broken bone, so I know those bills are high. I spent the whole afternoon yesterday talking with bill collectors, btw, about medical bills - one of them an old dental bill (long story). Sometimes people have emergencies and have to go directly to the ER. Otherwise, it would be nice if we could shop around for the best price. (A higher price doesn't mean that a doctor is better. I switched from a young onc, who was over-charging me and is now collecting from me, to a top oncologist who's far more reasonable.)
More than 15 years ago, I was facing a hospital bill that would've ranged between $8,000 - $10,000 because I had a pre-existing condition. At the local clinic and the public assistance office, I was advised: "Everyone has bills to pay. No one will turn you away at the ER." And that's true. All I wanted, though, was some advice/direction. They were full of advice for the people who qualified for assistance, but they couldn't provide information to those of us who didn't. In shopping around on my own, it was very difficult to find other options. I'm so lucky that finally, after three months, one of the numbers I called was a private organization that referred me to a hospital; I ended up paying only $2,000. (Thank you, Catholic Church.)
Alexandria - No, it is not clear that people are dying because they have no money and no insurance. In my state, where I am treated, if you are uninsured, you can apply for public assistance. If you are "under-insured", you can apply for a reduction in your bill. When I use the term charity, I'm not referring only to private charities - there are state-run programs that are helpful, too.
And, btw, I'm focusing on the one story because other stories presented are personal stories shared here. I am sorry for everyone's losses, as I'm sure they are sorry for mine. Maybe, Alexandria, you'd like to find another story being used by the news media to further the ACA agenda.
As for fear, why are so many of you afraid of the free market?
AnneW - I have personal experience with a massive infection, and I did have to administer IV antibiotics myself at home. But, we were referring specifically to the story of a man with a tooth infection - one of the stories being used in the media to further the ACA agenda. He was sent home with two prescriptions - not IV antibiotics. He could not have known how serious a tooth infection could become. Most people don't know. And we really don't know the reason he didn't buy the antibiotics.
Kayb - In response to your post, please read my comments above.
PatMom - Good question! Many people keep mentioning the other countries with single-payer systems. I posted earlier that England, with the "largest and oldest single-payer system in the world," does not cover dental care for everyone. In fact, there are articles out there about England having the highest dental costs in Europe. Once again, if anyone out there knows more about England's system, let me know. When I was uninsured, btw, when I couldn't make it to a dentist who charged a reasonable price but was located farther away, I went to the local dental school - not the greatest option, but an option nonetheless. Today, I know many uninsured people who go to a local dentist who is very reasonable and a good doctor - many insured people go to him, too.
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I was asked a question that I suspected was more an excuse to pick apart my answer than a true quest for information. The responses I got proved me right.
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Life, one group of people who love Medicare are those who can't afford to buy insurance. Yes, it's great if one can get additional coverage, as my husband did and I will, but not everybody is as lucky as we.
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Yorkiemom - No one has suggested that we get rid of Medicare. Many people have no choice. But, obviously, you must see Medicare as limited, too, if you bought additional coverage.
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lifeiswonderful - I know a LOT of people who LOVE Medicare. The reason they also buy private insurance isn't due to a dislike of Medicare, but to fill in the gaps. It's a reasonable option.
As for the "free market"
that you think we are "afraid of". We've had the free market running our health coverage for lo these many years. It hasn't worked. I'm not at all afraid of the free market - for many things it works wonderfully well, but it doesn't work for ALL things - and health care is one of the things where it hasn't worked. If it was working we would be first in the world life expectancy - we aren't. Our health care is the most expensive, and we the people are decidedly less healthy than many other countries in the world.As for receiving public assistance if you are uninsured or price reduction if you are underinsured - the key word in your statement is "apply". Just because you apply for something, certainly doesn't mean you will get it. Also, what you will get or be eligible for or whatever varies drastically from state to state - so you find that people who do want to "game the system" moving to states where benefits are better, and draining the coffers of the states where they actually are attempting to take care of their citizens - then there are the other states that pretty much say - well, you're on your own guys....
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Life, you said that "In my state, where I am treated, if you are uninsured, you can apply for public assistance."
Does that mean that anyone can qualify for public assistance merely by virtue of being uninsured, or do you have to be below the poverty line or some multiple of same to qualify?
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Please, All, keep this civil, and refrain from attacks, and perhaps not get on this thread if you can't.
Thank you.
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Lifeiswonderful: Actually, the newspapers did report why he didn't buy the antibiotic. He was unemployed and couldn't pay for it. That was one of three anecdotal incidents that I reported, quite apart from the Harvard study on the uninsured.
You ask if I'm scared of the free market in health care? Yup. You got it. That's what we've had, and it scares me no end. Under free market rules, no one would give me insurance if I had to buy it on the open market, because I have a pre-existing condition, I am 60, and I am female. Under the pure Ayn Rand philosophy, which I refer to because it's the form of capitalism adored by people like Paul Ryan, those who have illnesses and can't take care of themselves, need to die. Survival of the fittest.
By the way, people don't buy secondary insurance because they "hate" Medicare. They buy it because Medicare only covers 80 percent of costs, but since it's supplemental, it's substantially cheaper than buying a private policy to cover everything - if an older person could even get such a policy. The angriest people about the ACA were those who thought that their Medicare would have to be cut to provide for it.
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PatMom - if you are referring to the question I asked - I did not ask it to "pick apart your reply", but rather to understand what you dislike about ACA, and what you feel would be a better way to handle the health care problems in this country. Asking a question, however, does not mean that I will not, or should not, disagree with and attempt to have discourse in regards to your answer.
I'm fairly certain that you do not agree with my opinion(s) in a variety of subjects. I'm used to that, as I work with a number of people who also do not. We end up having some very interesting and productive discussions because of our disagreement. We have learned to disagree without being disagreeable.
I would hope to be able to have that same type of relationship on this board. -
Gardengumby - We have been debating the merits of a single-payer system. Thank you for making my argument for me. Indeed, Medicare, a government-funded insurance program, requires that gaps be filled.
The topic of "fear" was brought up by another person - as if we simply fear something new (the ACA). So, I am asking why the rest of you fear the free market.
No, insurance coverage is not sold on the free market and hasn't been for a long time. We've discussed this earlier - there are state restrictions, and we cannot buy across state lines, and so on.
As for the health of Americans, just because A and B exist does not mean A causes B. Many other factors, such as diet and exercise, contribute to life expectancy.
As for charity and assistance, I already shared again and again my own experience as someone who had a pre-existing condition but did not qualify for assistance. So I fully realize that not everyone who applies is accepted. As someone who has been in that position, I am telling you what I wanted: advice and direction. Information is powerful and can be very helpful.
But, as I said, if the rest of you keep insisting on paying my bills, who am I to argue?
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Interesting how the word socialism comes up as a sort of conversation stopper.
In addition to what Lindasa et. al. have said about our history as a cooperative society, it is well known that there is no such thing as a purely capitalist economy. I alluded to this before, we have a mixed economy in the US (as exists in Canada and the EU), with features of a market economy but with state intervention.
Socialism is GOOD and NECESSARY.
UNFORTUNATELY, there is very little of it in ACA with the exception of the Medicaid expansion, which states will probably acceed to despite some political kicking and screaming by certain southern governors. But the absence of a public option makes the ACA something of a capitalist grab bag.
(Had to interrupt half way to go to a meeting - apologies if we've moved on in the interim. :-) )
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The topic of "fear" was brought up by another person - as if we simply fear something new (the ACA). So, I am asking why the rest of you fear the free market.
I don't think anyone fears the free market - but that's never what we've had in health insurance. Did you know that health insurance companies have long been specifically exempt from anti-monopoly laws. That's right. There are things banks, media companies and even big oil cannot do that big insurance can. They can monopolize entire regions and stifle competition - that is anti-free market and it is part of what has made insurance premiums so expensive.
I just think there's an information gap amongst some of you who oppose the ACA. There are many fact-based reasons to find fault with the law. But a defense of free market ain't one of them!
Nor is the contention that it will curb access to care. That is a lie. It will improve access for many millions. If you have insurance, nothing will change for you. And by most estimates, about 20 million Americans will remain uninsured, so it is hardly a universal coverage panacea.
Lifeiswonderful - I'm happy to keep paying your bills. And I thank you for paying mine. Because that is what you and I have done every time we have a phone line, put gasoline in a car or pay federal income taxes. If you and I did not help each other, we wouldn't have an army to protect us.
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Many of the rugged individualism ideas come from Ayn Rand. She preached Objectivism and in her book "Atlas Shrugged" she said: I swear-by my life and my love of it-that I will never live for the sake of another man, nor ask another man to live for mine. It could be the motto of the Republican Party as it is today. Of course when the going got tough, she signed up for Social Security and Medicare.
When it comes to social philosophy I prefer that of John Donne (1572-1631) No man is an island, entire of itself...any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee."
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I tend to think that Ayn Rands books just gave some people the permission they needed to be openly selfish.
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Notself, nice juxtaposition. Donne is one of my favorites, and he was also, by the way, a deeply religious man.
Greenspan was an ardent "randist," yet had to admit in front of congress that his philosophy was flawed. Rand's writings always struck me as the kind of stuff that appeals to clever teens, but if they really are clever they grow out of it. I guess Greenspan was a late bloomer. -
Lol - VERY late Momine, fancy having to go before Congress after your tenure is over and admit, amidst a near economic crash, that you were wrong to support the Bush tax cuts. Kudos to him, late as it was.
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Athena, yeah, better late than never.
Kay, yes, Greenspan was part of Rand's "salon," where she read her latest scribblings to her acolytes, as she developed her "brilliant" philosophy. -
She was also at his swearing in. I guess she thought she was about to control the world.
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kayb,
feel free to copy my post.
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Life, we like to have as much coverage as allowed. I do not see Medicare as limited, but if one can have more why not? We also have several life insurance policies. Just because one would be sufficient, why shouldn't we buy more, since we can? I also have (many) more than one pair of shoes.
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For the record, I am not a Rand-ian. Also, Athena, I'm well-aware that our economy is a mixed economy. That's why I keep pointing out that health care in the U.S. is not being sold on the free market now, so, if you believe our current health care system has failed, the free market can't be to blame. Why not try the free market for once?
Kayb - The ACA supposedly will take some time to have impact, so we're told, and there still will be uninsured people under that plan. The main difference is that, under the ACA, certain people who don't buy insurance will have to pay fines which are scheduled to increase annually. If I understand the ACA correctly - Even if you had a healthy year and/or were willing to pay out-of-pocket for your medical expenses, you will be penalized for not buying insurance with a fine up to $295 per family in 2014, $975 for a family in 2015, $2085 for a family in 2016, and so on:
http://www.cleveland.com/healthfit/index.ssf/2012/06/affordable_care_acts_mandate_d.html
Those of you who favor the ACA point out - and rightly so - that people are showing up at the hospital now to be treated, and you are paying their bills, anyway. But you know the ACA doesn't cover everyone in this country - such as the 12 million "undocumented" immigrants living here - so what do you think should be done when they show up at the hospital? I'll answer for you: You'll still have to pay those bills, and eventually there will be a push to add "undocumented" immigrants to the coverage, too. Meanwhile, people who aren't even visiting doctor's offices will have to pay large penalties for medical care they don't receive, anyway.
The ACA is not about helping people. It's all about control. Remember, insuring a person still does not mean they will receive medical care... unless you want the gov't to force people to go to the doctor.
Ladies, it's been interesting. This discussion has taken our minds off breast cancer for awhile... I hope. But I think we've beaten this horse to death.
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