Soviet-style healthcare for thee but not for me

Here is absolutely everything you need to know about the proposed Obama/Democratic health care plan:

The president is barnstorming the nation, urging swift approval of legislation that is taking shape in Congress. This legislation — the Affordable Health Choices Act that’s being drafted by Sen. Edward Kennedy’s staff and the Health, Education, Labor and Pensions Committee — will push Americans into stingy insurance plans with tight, HMO-style controls. It specifically exempts members of Congress (along with federal employees; the exemptions are in section 3116).

I think that one bit of information should tip off Americans to the real nature of this plan.

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  • suek

    Sgt Dave….

    Are you out there??

    Here’s a quote for your collection:

    ” Wherever standing armies are kept up, and the right of the people to keep and bear arms is, under any colour or pretext whatsoever, prohibited, liberty, if not already annihilated, is on the brink of destruction.”

    Sir George Tucker, Blackstone’s Commentaries, 1803

    I know this is off topic, but having passed on Book’s quote above (Book…do you have a source for that quote?), I thought I’d plant one here. This was on Wolf Howling’s page, in reference to the Iran uprising, but it still pertains, I think. It should be right up there with the quote on sheep, wolves and vegetarianism that headlines his blog…

    I’m starting a “quotes” file…starting with this one.

  • BrianE

    We know that one of the reasons medical costs for those with private insurance are rising so dramatically is the cost-shifting caused by Medicare and Medicaid.
    I’m not sure how rolling these groups into one plan are going to reduce costs enough, even conceding that more efficient billing procedures would provide some cost savings.
    What the government is hoping to capture, in part, are the premiums from young healthy Americans that have foregone any insurance coverage (part of those uninsureds) who don’t use the system. The beauty of this is they will now be forced to pay for coverage they won’t use.
    These folks do currently pay into the Medicare system through payroll taxes, which demonstrates that at the heart of Medicares problems– premiums are too low for the level of coverage.
    Bottom line, premiums are going to go up, and there are only limited ways of controlling those costs– the most obvious of which will be rationing.

    I do think we should consider some sort of “healthy American” rebates to insurance coverage. Coupled to an annual physical, we should either receive a rebate or be charged more for the state of our physical health. Shouldn’t folks who smoke, drink excessively, or engage in other risky behavior including “supersizing” every meal they consume pay more for their health care?

    An aside. I don’t know if taxing company benefits is in the current bill, but the idea of taxing company health care benefits has been floated, with the kicker of exempting union health care benefits which would be grandfathered if in existence by 2013. This would have the benefit of encouraging unionization, the effect of which Democrats must be privately salivating over.

  • suek
  • BrianE

    Good article Suek,

    Obama was booed at the AMA meeting for explicitly stating that medical malpractice caps weren’t part of his health care plan.
    http://www.realclearpolitics.com/video/2009/06/15/obama_booed_at_ama_over_malpractice_remarks.html

  • BrianE

    Imagine,
    Barack, a lawyer, siding with lawyers on this issue.
    Is the transparency Barack was touting for his administration?
    This is certainly transparent.

  • suek

    >>Shouldn’t folks who smoke, drink excessively, or engage in other risky behavior including “supersizing” every meal they consume pay more for their health care?>>

    Are you talking about “health care” or “health insurance”?

    There’s a difference. People choose to pay for health care when they engage in risky behavior. They have _always_ paid – one way or another. They either suffer from poor health or they pay more for medical help, or they die young. Are you going to include homosexual behavior in that “risky” behavior, by the way? Or sexual promiscuity? I suspect you’ll find those off limits…wonder why? I do.

    Now insurance…that’s a different kettle of fish. Insurance is a kind of legalized gambling. You say “I’m going to have an (episode – whatever) and I’ll bet xxx dollars on it.” The insurance company says “I bet you won’t, but if you do, I’ll pay xxx to fix it”. The problem we have is that some things are truly random, some are the result of risky behavior, and some are guaranteed. So if you live in certain areas and drive an inordinate amount of miles to work each week, and have had multiple tickets for various types of faulty driving, the insurance company will either refuse to insure you or charge you up the wazoo. If you live in certain other areas, drive to church on Sundays to the church that’s about 2 miles from home, and haven’t had a ticket for driving for the last 10 years, you get a completely different rate – even though you may have exactly the same car – year and model – as the up the wazoo guy. The reality is that it’s entirely possible for the Sundays only guy to have just as costly an accident as the up the wazoo guy. That’s the gambling part.
    Then there’s the guaranteed part. After 500,000 miles, you _will_ need a new car. If you don’t die before age 70 +/-, you will suffer the debilitation of age. Is it reasonable to expect a form of insurance that will pay for your new car? I don’t think so. Most of the expense of insurance probably goes to build up a cash reserve to pay for the vicissitudes of old age. Do they really belong in the same pot? If you really want to cut the expense of insurance – assuming you’re expecting to pay for those inevitable vicissitudes – isn’t it probable that those oldersters are the ones causing a problem who are going to get cut? Betchya.

    When you buy insurance, do you expect to have your oil changes, your tune-ups and new tires covered? I doubt it. So why shouldn’t people expect to pay for routine medical care, with insurance limited to disastrous illnesses or accidents?

  • suek

    Another by the way…

    I read – either on a blog, or in the comments, I forgotten which (might even have been here!) – that if you want some interesting reading, do a search on “AARP ACORN”. Apparently there’s some significant linkage.

    As you know, it’s common practice for leftists to involve themselves in virtually _any_ kind of political activism, and eventually ensconce themselves as leaders in order to divert the original activism to their goals. I hadn’t thought of this in connection with the AARP, but it doesn’t surprise me either.

  • BrianE

    Suek, I think they used to be called risk pools, and your premiums were based on which pool you were in.
    I think the government has done away with that– and limited pre-existing conditions.
    It seems only prudent though, to allow an insurance company to reward behavior that produces the likelihood of less utilization later in life.
    Obviously the unexpected happens. That’s the purpose of insurance. We allow riskier drivers to be penalized with higher premiums, why is it wrong when applied to health insurance?

  • suek

    >>why is it wrong when applied to health insurance>>

    I wouldn’t call it “wrong”…but I suspect that old age is a greater “risk”, and unless you’re going to euthanize all citizens when they reach the age of no return, it shouldn’t be in a “risk pool”. It should be expected that the majority will need expensive care in the last years. That means that we either deny the care or make provision for it. Right now, the “provision” being made is that the burden is carried by all those who pay for low risk care.
    You’re also talking about making health insurance mandatory. If you make insurance mandatory, then place behavior limits on the individual, aren’t you mandating behavior? Doesn’t that strike you as anathema in a country that proclaims to have “freedom”?

    Personally, I’d be in favor of legalizing drug use – and also of not giving medical care to those who choose to OD. In other words, I’m much more libertarian in this respect, but as with the other behaviors, people should also be allowed to suffer the results of their risky behavior.

    Auto insurance is required so that damage done to others is paid for. Others aren’t affected by your overweight and other health risky behavior. It isn’t the same risk pool.

  • http://ymarsakar.wordpress.com/ Ymarsakar

    The party leaders of the Communist Party lived high off the exploitation of the masses. The masses lived like pigs in the eternal slums, however.

    That’s the very definition of what a Leftist utopia would be.

  • Mike Devx

    If we went with risk levels, so that higher-risk people simply payed higher premiums, then Congress would pay the highest of all, wouldn’t they?

    They’re at constant risk of a complete collapse of the moral cavity.

    Some of them exude the stench of corruption. Second-hand corruption must then be breathed by all others – if there are any not exuding. The risks of second-hand corruption cannot be overemphasized.

    A lack of spine and moral fiber ensures that muscles and ligaments are under constant strain.

    High money pressure – “Where can I hide these illegal contributions?” – leads to extreme hypertension. In extreme cases, eye strain could cause blindness due to the constant darting of eye muscles, while trying to ensure that no one is watching as the illegal deals go down.

    And on. Clearly they would suffer from the highest-risk premiums.

  • http://home.earthlink.net/~nooriginalthought/ Charles

    . . It specifically exempts members of Congress . . .

    This really isn’t surprising. When it comes to governing healthcare, workplace issues, etc. Congress is almost always “exempt” from their own laws that they force on the rest of us.

  • suek

    >>The party leaders of the Communist Party lived high off the exploitation of the masses.>>

    Repeat.

    Repeat.

    Washington was an extraordinary leader – he gave it up. He showed us that what we need is leaders with character and honor. We’ve lost that ideal, it seems. And we’re going to pay for it.

  • BrianE

    >>Shouldn’t folks who smoke, drink excessively, or engage in other risky behavior including “supersizing” every meal they consume pay more for their health care?>>

    Are you talking about “health care” or “health insurance”?

    I don’t see a practical difference. Unless you’re uninsured, what you pay for your health care is your premium + copay + deductibles. Your premium should be based on risk.

    “You’re also talking about making health insurance mandatory. If you make insurance mandatory, then place behavior limits on the individual, aren’t you mandating behavior? Doesn’t that strike you as anathema in a country that proclaims to have “freedom”?”

    No, the government is talking about making health insurance mandatory. We can address this two ways- allow insurance companies to charge based on risk, which you don’t like (I don’t particularly like either), or come up with incentives to encourage healthy behavior- which still leaves the choice up to the individual.

    I would allow insurance companies to charge based on risk, and incentivise by tax credits for healthy behavior.

    The question is, who should subsidize whom? If we require insurance companies to completely ignore risk, we’re distorting the system and forcing the low risk to subsidize high risk individuals.
    Any tax credit directed to low risk individuals is just saying, the low risk group is being rewarded by the high risk group. In my mind, this at least attempts to encourage healthy behavior.
    I don’t see this as “the” answer, but a part.

    Do you have a problem with this:

    Prior to the development of computers, actuaries had to use long formulas and pages of tables to calculate the likelihood of any single event happening to a specific group of people. While it was not possible to pinpoint a particular person for an event—such as death or catastrophic illness, the 20th century brought the study of probability, statistics, economics, and financial theory together to form a precise and accurate actuarial science.

    The calculations of the actuaries thus allow an insurance company to predict, with surprising accuracy, the likelihood of the occurrence heart disease, diabetes, stroke, cancer, Alzheimer’s Disease, and many other chronic ailments among a particular group of people who have something in common—such as living in a certain area, or having a family history of illness.

    Today’s actuaries have an even more challenging job than those of the 19th and 20th centuries due to cultural changes, a global interaction among people who at one time would have had no chance of contact, and the extreme variation in life styles. Fortunately for them, calculations that once would have taken months to work out can now be accomplished in seconds with the aid of computers and calculators.

    The work of an actuary is beneficial to both the consumer and the company, although it may seem to be more for the protection of a company. The ability to accurately predict the likelihood of a particular health event occurring within a certain group (called cohort) of people is supposed to ensure that premiums will be assessed fairly based on the risk to the company. Companies do, however, have the ability to select their own target groups and establish premiums based on the actuarial tables specific to that group. Thus, a group of seniors in a particular geographic area will be more likely to have heart disease than a similar age group in a different geographic area. These differences lead to widely differing premiums in different parts of the country. If they chose a different grouping method—such as economic status or education without regard to age, for example—the necessary premiums would be radically different.

    Modern companies use the finely tuned actuarial calculations to both avoid undesirable risk, determine the amount of money they must keep available for paying claims, and to estimate the profits that will be available to share holders. Consequently, fewer health insurance companies go bankrupt today, and few actuaries have to worry about being out of work.

    To the extent government mandate distorts this, costs will be shifted onto someone. The question is still, who the someone will be.

    Of course, if risk pools were the answer, using the US population as the pool, and requiring everyone to buy health insurance would solve the problem. I assume nobody would like what the premiums would be though.

    Medicare will be bankrupt by 2017. Everyone pays into the system, and in retirement everyone pays a premium that joins. What would the premiums be to make the system solvent?

  • suek

    >>What would the premiums be to make the system solvent?>>

    What would the “premiums” be to ensure that each person saved enough to pay his/her own health expenses?

    The usual cry is that “xx number of people declared bankruptcy – all because of health care costs”. So how about a tax free savings account for health expenses? You can accumulate it till you die, then pass it on to your heirs – or pay it all out beforehand – however it works out. Or you can use it to choose some form of health insurance.

    None of the insurance plans are going to work unless there’s also tort reform.

    Amazing that people lived completely without health insurance until about 50 years ago, isn’t it! How _do_ you suppose they managed? They also didn’t make near as much money as we do these days. Hmmm.

  • Zhombre

    Just a note: all federal retirees are shuffled into Medicare at age 65. Or so they tell me at the pre-retirement seminars.

  • BrianE

    http://maggiesfarm.anotherdotcom.com/archives/10836-Top-Ten-Reasons-For-ObamaCare-Are-Based-On-False-Information.html

    This does a good job refuting Barack’s distorts surrounding the health care debate.

  • BrianE

    “…how about a tax free savings account for health expenses? You can accumulate it till you die, then pass it on to your heirs – or pay it all out beforehand – however it works out.” – Suek
    You’re describing Health Savings Accounts.

    Health Savings Accounts (HSA) coupled with a high deductable insurance plan are a good alternative to the traditional health care plan.

    http://www.kiplinger.com/features/archives/2004/02/hsa.html

    I don’t think the benefits have been explained to most Americans.

  • suek

    What do you think will happen to that HSA if the Obama care plan goes through?

  • BrianE

    Politicians and have Medicare and Social Security revenue gaps down the road for years. The Medicare can is firmly lodged against the barricade at the end of the road.
    Defeating the Barack plan, or any plan leading to single payer isn’t enough.
    The opponents of Barack’s plan must come up with a credible alternative.
    I don’t believe doing nothing is an option.

    Health Savings Accounts, initiated in 2003, could be a piece of the solution.

    If I understand it correctly, Medicare spending is 3% of GDP currently, will rise to 6.3% by 2030 and 10% of GDP in 75 years.

    Here’s one proposal:
    http://www.kiplinger.com/businessresource/recommend/archive/2008/medicare_reform.ncpa.html

    In the 1990’s a bipartisan commission was formed to reform Medicare chaired by John Breaux and Bill Thomas. The commission disolved without a recommendation, but a proposal by Breaux and Thomas (two unlikely allies) was submitted to the senate.
    Here’s an article about Bill Clinton’s alternative and the debate surrounding it:
    http://www.cagw.org/site/PageServer?pagename=reports_trojanhorse

    The politics of this eventually led to the 2003 prescription drug coverage under Medicare (part D), but none of the structural reform Bush was seeking.
    http://web.mit.edu/polisci/research/Campbell/Shifting%20Line.pdf

  • suek

    Brian…

    This link is specially for you:

    http://directorblue.blogspot.com/2009/06/cold-chills-why-every-senior-should.html

    I also want to ask…are there any private alternatives to Medicare and Medicaid?

    If not, why do you think that is?

  • suek
  • BrianE

    For the bulk of its history, Medicare has operated as a single insurance pool, spreading the costs of any individual’s illness across the full population. By contrast, a system of competing health plans threatens to fragment the pool, separating the healthy from the sick. The easiest way for insurers to keep premiums low, and thereby win more enrollees, is to attract the healthy and avoid people who are sick and will run up heavy claims. Not only insurance plans, but also healthy beneficiaries have a short-term stake in this separation since they pay less until they need health care. But this fragmentation or risk selection undermines the pooling of risk that insurance is supposed to provide. It leaves sick people in a smaller pool with higher costs.- From The American Prospect, 1999

    I’m coming to the conclusion that the mantra of insuring the uninsured is a diversion to protect the second jewel of the progressive utopian vision- Medicare.

    It isn’t rocket science to understand that if the risk pool is the elderly, premiums either need to reflect that or subsidies from the treasury need to increase geometrically with an aging population.

    The left continues to hang their hopes of Medicare’s survival on a single payer plan (the government) with the American population as its pool. That alone won’t solve the problem though, since even adding those who can afford insurance but avoid coverage won’t make up the shortfall.

    From the liberal The American Prospect:

    …Despite budget pressures, President Obama to his credit has not backed off his commitment to universal health reform. But the devil is in the details. And if he is not careful he could end up with a reform that is worse than nothing.
    A crucial question is whether the law will include a public, Medicare-style plan. This public plan could be used by people who otherwise lack good insurance, or by employers who conclude that the public plan is a better deal for themselves and their workers.

    The public plan would be the gold standard of both good coverage and cost-containment. Without the public option, a system to cover everyone by relying on the existing private insurance industry will realize few cost savings. The result would be increased pressures over time to cut care and shift out-of-pocket costs from insurers to consumers.

    The administration’s projections have relied heavily on the supposed savings of better use of computerized medical records and an end to the extreme variation on treatment patterns and costs. However, absent a single unified system, or a strong public option, neither better computerization nor voluntary pledges to cuts costs will realize major savings.

    In a meeting with Democratic senators midweek, Obama pledged his support for the public option. But given his desire to work with the insurance companies and get some Republican support as well, the real question is whether he will put his prestige on the line to keep the public option in the bill. He pointedly did not say that he’d veto a bill without a public option…

    …Obama’s plan is a variant of an astute strategy first proposed by the political scientist Jacob Hacker as solution to two political obstacles to health reform. First, how to enlist the uninsured and the anxious insured in the same coalition? Second, how to build momentum for a single-payer system recognizing that there are not the votes to legislate it all at once?

    Hacker’s insight was that if the government offered a public insurance option, people who liked their present private insurance could keep it, while others could elect the public plan. Coalition problem solved. And the superior efficiencies of the public plan would gradually and inexorably overtake the rival private plans over time. Momentum problem solved.- The American Prospect, June 5, 2009

    The left realizes that any plan including a public alternative will drive the private sector from the market, and their goals of single pay universal health care hinge on that component, despite protestations from Barack himself.

    CBO estimates of a ten year cost of $1 trillion dollars will only cover 16 million uninsured (which is probably a total closer to the actual number), leaving 36 million still uninsured (if you believe the figures). Which I think, exposes the true motive behind all this– salvaging some form of public health care insurance–Medicare, even if the plan never was and never will be sustainable.

    The left also hangs its hat on cost savings because of Medicare billing efficiences, but those savings my be illusion due to the fact that most of the accounting costs are born by the private sector. Of the supposed 25% cost savings to be wrung from the switch from private to public financing, almost half of that may represent salaries of bookkeepers, billers, etc. What would happen to those newly unemployed workers?
    Well I guess they would have a government health care plan to enjoy along with their unemployment check.

  • suek

    What is the constitutional authorization for health care of any sort? Actually, ditto social security…

  • BrianE

    Found this in the comments section here:
    http://www.john-goodman-blog.com/why-health-reform-is-bound-to-fail/#more-3978
    I think he’s on to something, and the Republican plan moving away from company based health care plans is worth looking at.

    Chris Ewin, MD Says:

    June 22nd, 2009 at 6:07 pm
    Simple solution:

    Patients need:
    1. High Deductible Health plan (like car insurance)
    2. Health Savings Account (Medical IRA)
    3. Accident Insurance
    4. Primary Care Physician with a direct practice model
    (we take care of 85% of your needs and function like a gas station with unlimited
    gas, tire changes, tune-ups…etc)

    Primary care physicians need:
    1. Change their business model to a direct practice
    2. Pass the Ryan/Coburn bill (Patient Choice Act)

    If passed, it will allow pre-paid physician fees to be included in the definition of “medical care” under the IRS Code of 1986. This will allow Direct Practice fees to be qualified medical expenses on Health Savings Accounts. One fee, once a year for unlimited access to primary care.

    The only way we can resuscitate primary care is to change the business model.

    News article about the Patient Choice Act:

    Wall Street Journal –
    May 21, 2009

    Republicans Offer Health-Care Plan
    By JANET ADAMY
    WASHINGTON — Republican lawmakers stepped up their opposition to Democrats’ plans for overhauling the nation’s health-care system, introducing legislation on Wednesday that would give Americans tax credits to pay for health insurance.

    The plan, backed by some Republicans in the House and Senate, offers a glimpse into how the GOP is mobilizing against Democrats’ effort to create a public insurance plan and to require companies to provide or otherwise pay for health-insurance coverage for workers. Republican lawmakers say such measures would bureaucratize the nation’s health system and stifle job creation.

    Given the Democrats’ control of Congress, the Republican plan has little chance of passage. But it reflects some Republican lawmakers’ growing dissatisfaction with a bipartisan effort to fix the health-care system. Congressional leaders hope to pass a health-care overhaul this summer.

    The government would run a health plan “with the compassion of the IRS, the efficiency of the post office, and the incompetence of Katrina,” according to a summary of the Republicans’ plan unveiled on Wednesday. Called the Patients’ Choice Act, it would eliminate the tax break that employers receive for providing health-insurance benefits to their workers. Instead, it would give an annual tax credit of $2,300 to each individual and $5,700 to each family that they could use to offset the cost of their health insurance. Low-income families would get extra money to buy into private insurance plans.

    Rep. Paul Ryan (R., Wis.) said the system of employer-based coverage is becoming “a 21st century relic” as companies become less generous with benefits.

    President Barack Obama has tasked Congress with drawing up legislation to reduce health-care costs and expand health-insurance coverage. He and many Democrats want to create a new public insurance plan to help cover the uninsured and create competition for private insurers.

    The Republican plan introduced Wednesday shares some things in common with measures Democrats are pushing. Both parties want to create insurance exchanges that make it easier to comparison-shop for health-care plans. They also want to shift health-care dollars toward preventing chronic diseases like heart disease and diabetes, not just because it will make Americans healthier, but because prevention is cheaper than treating people once they get really sick.

    Senate Finance Committee Chairman Max Baucus (D., Mont.), who is leading the effort to draft a health overhaul, said that while this Republican measure meets many of his goals, eliminating the tax incentives for employer-provided health benefits “would destroy the employer-based health-care system we have today.”

    Karen Davenport, director of health policy at the liberal-leaning Center for American Progress Action Fund, said the Republican plan’s tax subsidy wouldn’t cover half of the cost of the average family’s health-care premiums.

    Rep. Ryan introduced the legislation with Sens. Tom Coburn (R., Okla.) and Richard Burr (R., N.C.), and Rep. Devin Nunes (R., Calif.).

    Many Democrats are backing the idea of curbing the health-care tax exclusion, which exempts employer health-care benefits from taxation. Under proposed changes, wealthy individuals and people with particularly generous benefits could pay some taxes on their benefits. But most Democrats don’t want the exemption eliminated altogether, as called for under the Republican plan.

  • suek

    Brian…

    We may yet come to the same point! I haven’t had time to read your last comment with any real thought, but I will. In the meantime…

    http://directorblue.blogspot.com/2009/06/calling-democrat-socialized-medicine.html

    Heh!

  • BrianE

    Here’s an article where Tom Coburn, sponsor of The Patient Choice Act describes his plan:

    http://www.huffingtonpost.com/sen-tom-coburn/a-better-way-to-reform-he_b_213109.html?page=6

  • BrianE

    All progressive roads leading to Universal Health Care ultimately end at a single-payer system.

    Here is a short video from proponents of single payer revealing a core contempt for the principal of profit– imagine removing profit from 20% of the economy!

    The left is salivating and fortunately their arrogance may be their downfall.

    http://www.letfreedomringblog.com/?p=4905