Doomed bill HR 2 passes the House
January 19, 2011 4:50 PM Subscribe

HR 2, officially the "Repealing the Job-Killing Health Care Law Act", has passed in the U.S. House of Representatives with a vote of 245 to 189. 3 Democrats (Reps. Boren (OK), McIntyre (NC), and Ross (AR)) joined all 242 Republicans voting Aye. The bill will not be brought for a vote in the Senate, nor would it escape veto by President Obama.

Previously: HCR passes the house

posted by 0xFCAF (174 comments total) 5 users marked this as a favorite

In some alternate universe the Healthcare Law Act is Jobs-Killing and the new congress is just trying to save the life of America's most loved/hated CEO.
posted by twjordan at 4:53 PM on January 19, 2011 [2 favorites]

I would like to enact the "Stop Wasting Our Time and Money on Empty Symbolic Gestures Act."
posted by Cool Papa Bell at 4:56 PM on January 19, 2011 [97 favorites]

It's gonna be a long 2 years.
posted by Max Power at 4:56 PM on January 19, 2011 [10 favorites]

To paraphrase the immortal words of a decided non-fan, they've had their fun and now it's time to serve.
posted by kittens for breakfast at 4:56 PM on January 19, 2011

With a Democratic Senate and president standing in the way, this is little more than grandstanding. I'd be more concerned about refusal to fund key parts of the bill in the upcoming budget, followed by the legal challenges percolating through the courts.

But even if this exercise turns out to be toothless, there's a real potential for things to go very badly next year. Since the vast majority of Senate seats up for election next year are held by Democrats (and the few Republican ones are in deeply conservative states), the chamber has a very good chance of changing hands next election. And with the Republican sweep of state houses and governorships this past midterm, they're in an excellent position to gerrymander their way to privileged status in the House. If the political environment sours on Obama, it's entirely possible for the GOP to take both houses of Congress and the White House in 2012.
posted by Rhaomi at 4:57 PM on January 19, 2011 [1 favorite]

That's seriously what they named it? Could they sound a little LESS twelve years old?
posted by Tknophobia at 4:58 PM on January 19, 2011 [44 favorites]

Since the vast majority of Senate seats up for election next year are held by Democrats...

McCain deeply regrets Lieberman decision to retire

posted by Joe Beese at 5:00 PM on January 19, 2011 [1 favorite]

So basically the House of Representatives are a bunch of trolls.
posted by exogenous at 5:01 PM on January 19, 2011 [12 favorites]

Yes, that is the name of the bill. There was some speculation that the bill might be renamed in the wake of the Tuscon shootings.
posted by fixedgear at 5:02 PM on January 19, 2011

After a brief period of thinking maybe you Americans were finally getting things right, I'm back to feeling pity and a touch of schadenfreude. It's like wrapping up in a comfortable old bathrobe that has a big hole over the butt -- I'm not proud, but at least it's familiar.
posted by stavrosthewonderchicken at 5:02 PM on January 19, 2011 [4 favorites]

Is Waaaambulance service covered under the Act?
posted by The Card Cheat at 5:02 PM on January 19, 2011 [13 favorites]

Probably not coming any time soon, unfortunately: "The Actually Doing Something About the Republican Party's Continuous Flow of Slander Act"
posted by Sys Rq at 5:02 PM on January 19, 2011 [9 favorites]

I think they're working on the "Democrats Hate America Jobs Act" next.
posted by saul wright at 5:03 PM on January 19, 2011

Here is the difference between the GOP and the Tea Party: The GOP says stupid shit it knows its gullible supporters will believe. The Tea Party says stupid shit it actually believes.
posted by Legomancer at 5:04 PM on January 19, 2011 [25 favorites]

That's seriously what they named it? Could they sound a little LESS twelve years old?

My thoughts as well. I look forward to the "No Obamas Club" that will surely be founded in the coming days, along with the "Democrats are gross and have cooties" faction.
posted by chalkbored at 5:04 PM on January 19, 2011 [7 favorites]

"No Obamas Club"

There's no shortage of conservative organizations that'll exclude anyone with a single drop.
posted by kafziel at 5:05 PM on January 19, 2011 [3 favorites]

This reminds me of the time Lincoln signed the "Outlawing of the African-oppressing Slavery Practice Proclamation"
posted by America at 5:09 PM on January 19, 2011 [7 favorites]

> "This legislation we seek to repeal is rooted in having federal bureaucrats come between patients and their doctors," Cantor said.

Private sector bureaucrats coming between patients and their doctors is totally cool, though.
posted by The Card Cheat at 5:09 PM on January 19, 2011 [27 favorites]

My earlier twitter commentary, The House has passed the "Repealing the Job-Killing Health Care Law Act." In other news, "Dog and Pony Show Bill" also passes.

I don't have a lot to add to that.

Any kind of political analysis is wasted here. This was a vote for little reason that does nothing and was a waste of time. Either you agree with HCR or it's too late to disagree.

I remember getting mad that the GOP wasn't floating their own HCR ideas. I kept asking, "Where's their plan?" But the GOP didn't want to float a plan, they wanted to score points as the "party of no." Next week they are coming out with their plan. I am not asking for it anymore. I would have loved for them to float a better plan that the Democrats. They could have. They had a chance to. They didn't.
posted by cjorgensen at 5:09 PM on January 19, 2011 [2 favorites]

Call it childish if you want, but at least the Rs do what their base demands.
posted by DU at 5:10 PM on January 19, 2011 [5 favorites]

QOTD from Rep. Anthony Weiner (D-NY):

" “For all of you sitting and watching at home, playing the drinking game where you take a shot every time a Republican lies; you better get a designated driver.”
posted by briank at 5:11 PM on January 19, 2011 [74 favorites]

Call it childish if you want, but at least the Rs do what their base demands.

Which is what the media arms of the Republican party tell their base they should demand. Funny how that works.
posted by stavrosthewonderchicken at 5:12 PM on January 19, 2011 [25 favorites]

Apparently the R have succeeded in drumming up support for legislation that had very little public support to begin with:

On the eve of the Republican move, a new poll shows public support for repealing the healthcare law has plunged over the past week ... According to the Associated Press, just 30 percent of Americans say they strongly oppose the healthcare law, and only one in four back a full repeal. A poll earlier this month showed that a majority supported repealing Obama’s healthcare by a margin of 46 to 40 percent.

Too bad the rest of his party won't stick to principles as much as Dennis Kucinich, who is essentially ignored instead, even if his proposals are much more in line with public desires (and by huge margins when terms like "single payer" are actually explained).

Both D and R have dug themselves such huge holes wrt public opinion. Between that and the now-unlimited amount of corporate spending (read: horrible advertisements) involved, the 2012 election cycle is shaping up to be possibly one of the ugliest and least promising in history.
posted by anarch at 5:12 PM on January 19, 2011 [4 favorites]

What's that, DU - pointless, empty rhetoric and political grandstanding? That's what the Repub base wants?
posted by caution live frogs at 5:14 PM on January 19, 2011

err, that was supposed to be Kucinich.
posted by anarch at 5:15 PM on January 19, 2011 [1 favorite]

I look forward to HR 3, the Democrats Are Poopyheads And They Smell Like Poop And They Like To Smell Their Own Poop Act.
posted by Flunkie at 5:17 PM on January 19, 2011 [23 favorites]

Rather than call GOP names, rather than deal with abstractions, let me get personal:
Since the passage of the bill my son, taken off my family health insurance, has been able to be put back on it. Now they want him off and without coverage?
posted by Postroad at 5:17 PM on January 19, 2011 [29 favorites]

nor would it escape veto by President Obama.

A president vetoing? Now that's change I can believe in!
posted by rough ashlar at 5:19 PM on January 19, 2011

Call it childish if you want, but at least the Rs do what their base demands.

If by their base, you mean the bankers and lobbyists who pay their wages, then I agree.

If, on the otherhand, you mean the poor dimwits who actually elect them into office -- are you having a laugh?
posted by PeterMcDermott at 5:22 PM on January 19, 2011 [1 favorite]

Next time you hear a left-leaning person moan about how Obama compromised his/our principles over the past couple years in order to pass watered down reform, gently remind them that THIS IS THE FUCKING ALTERNATIVE.

Pelosi could have got the votes for every liberal, progressive dream legislation you could imagine. But even with 59 or 60 "Democrat" senators, it all would have died in the upper house.

Imagine if the last House had tried to pass...
Single payer health care? "Senate declines to consider the bill"
Increase taxes on the rich? "Senate declines to consider the bill"
Send Bush to Gitmo? ...You get the idea.

Obama and Pelosi decided it was better to pass imperfect bills, than waste time on useless gestures like this one. And good on them for it.
posted by auto-correct at 5:23 PM on January 19, 2011 [34 favorites]

I think they're working on the "Democrats Hate America Jobs Act" next.

on the other hand, Obama's current "message: i care" is streamlining those job killing federal regulations.
posted by ennui.bz at 5:24 PM on January 19, 2011 [2 favorites]

It would take very little to make this a single issue PR campaign. Get a dozen folks like Postroad and profile one every day in a press conference. Any one of the basic changes, if personified in a similar way in the public forum, would make the Republican repeal effort look like the venal bullshit grandstanding stunt it is.
posted by docpops at 5:25 PM on January 19, 2011 [9 favorites]

The newest dishonest tactic by the incoming GOP is "CutGo" which is designed to reduce the deficit by requiring budget cuts to make room for new programs instead of introducing new taxes. There are several exceptions to this rule:

1) Health Care Repeal (since repeal would increase the deficit)
2) Estate Tax
3) Bush Tax Cuts

So, basically, only the GOP is allowed to increase the deficit if it's something they like. They remain blissfully unaware of what the word "principle" means.

As Jon Stewart noted (start at 6:00): "Apparently the only budget items not to fall under the GOP's new deficit reduction rules are the ones that created 25% of our actual deficit."
posted by notion at 5:25 PM on January 19, 2011 [8 favorites]

Since the passage of the bill my son, taken off my family health insurance, has been able to be put back on it. Now they want him off and without coverage?

Absolutely. So the only way he can get health insurance will be to get a job that provides it. THAT's what made the HCR bill "job-killing". Duh.
posted by oneswellfoop at 5:26 PM on January 19, 2011 [1 favorite]

Are we talking about the "Repeal the Jobs, Kill health care" bill?
posted by notsnot at 5:29 PM on January 19, 2011 [2 favorites]

Obama and Pelosi decided it was better to pass imperfect bills, than waste time on useless gestures like this one. And good on them for it.

Unfortunately they decided to start from a position of "compromise", instantly back down on everything but the most-mildly progressive items, and deploy almost zero PR strategy in favor of their watered-down plans. D are either absolutely clueless compared to R when it comes to manipulation of media, or they are only pretending to be for real progressive change while promising corporate backers not to rock the boat too much. Presenting Obama and Pelosi on one side and the R on the other is a false dichotomy. There were plenty of other possibilities, had the D been willing to pursue them.
posted by anarch at 5:29 PM on January 19, 2011 [10 favorites]

Dear House of Representatives,
Global climate change is happening right now. Really, right this instant, it's happening. As a person you are representing, I would appreciate it if you could turn your attention to prioritizing.
posted by so_gracefully at 5:32 PM on January 19, 2011 [4 favorites]

Oooh, ooh, I like this game, can I play?

But Rep. Mike Pence, a leading GOP conservative, dismissed Democratic criticism that Wednesday's vote was a "gimmick."

"We have another term for it on our side of the aisle: It's a promise kept,"

The "Pointless Grandstandy Gestures Perpetuation Act"

House Speaker John Boehner said Republicans will ask congressional committees to come up with "common-sense reforms" that will widen coverage while bringing down costs, but told reporters no "artificial deadlines" were needed.

The "We're Going To Bitch About Things For A While But Not Offer Constructive Solutions Act"

...many of them, including House Majority Leader Eric Cantor, argued the law harms American freedoms.

The "Freedom To Die Without Access To Healthcare Act"

The Department of Health and Human Services released an analysis Tuesday morning warning that almost 130 million nonelderly Americans with pre-existing conditions would be at risk of losing their insurance without the guarantees provided by the legislation.

The "Fuck The Old, They're Going To Die Before The Next Election Anyway Act"
posted by djgh at 5:32 PM on January 19, 2011 [4 favorites]

It's not a pointless act. It's purpose is to inform us that any health care reform will be repealed as soon as they're in power again and there will be no more talk of it ever again. As for me, I have health insurance this year until my birthday thanks to my mom and this bill, so just don't repeal it before then kthx.
posted by amethysts at 5:33 PM on January 19, 2011 [1 favorite]

HR 3 Proclamation that Some People in the House of Representatives Are Dicks

Then we put their names under it.

I haven't thought of what else we do with it.
posted by anniecat at 5:34 PM on January 19, 2011 [1 favorite]

That's seriously what they named it? Could they sound a little LESS twelve years old?

I know, right? That doesn't even make a wacky acronym.

How about the "Health Insurance Providers' Freedom And Kindness Encouragement" act?

Or the "Get Over Totalitarian, Communistic Healthcare, America!" act?

Don't these guys know anything?
posted by steambadger at 5:34 PM on January 19, 2011

Last night a friend of mine made the point that he likes the term "Obamacare," not because he's a fan of Fox News, but because it's not going anywhere and once people come around to relying on it and seeing it as a much-needed good thing, that's where the credit's going to go, and the partisan rancor over it will be enshrined n history.
posted by Navelgazer at 5:44 PM on January 19, 2011 [14 favorites]

> but because it's not going anywhere and once people come around to relying on it and seeing it as a much-needed good thing,

I wish I could share your optimism. My assumption is that the Republicans will find some way to break it and the Democrats will just sit there and explain to us why they cannot fight against it.
posted by lupus_yonderboy at 5:55 PM on January 19, 2011 [3 favorites]

Either I, or this country, have fallen to the point where reading about politics is very harmful to my psychological well-being.

I don't even understand. Crazy. It gone crazy. I lost my grammar -- just so crazy.
posted by meese at 6:00 PM on January 19, 2011 [3 favorites]

I would like to enact the "Stop Wasting Our Time and Money on Empty Symbolic Gestures Act."

The democratic house passed all kinds of things that didn't have a chance in the Senate. Like greenhouse gas restrictions...
posted by delmoi at 6:04 PM on January 19, 2011 [1 favorite]

Ugh.
posted by agregoli at 6:04 PM on January 19, 2011

Housturbation.
posted by ryoshu at 6:06 PM on January 19, 2011 [1 favorite]

Navelgazer writes "Last night a friend of mine made the point that he likes the term 'Obamacare,' not because he's a fan of Fox News, but because it's not going anywhere and once people come around to relying on it and seeing it as a much-needed good thing, that's where the credit's going to go, and the partisan rancor over it will be enshrined n history."

That's my thought too.
posted by Mitheral at 6:12 PM on January 19, 2011 [1 favorite]

Next time you hear a left-leaning person moan about how Obama compromised his/our principles over the past couple years in order to pass watered down reform, gently remind them that THIS IS THE FUCKING ALTERNATIVE.

Pelosi could have got the votes for every liberal, progressive dream legislation you could imagine. But even with 59 or 60 "Democrat" senators, it all would have died in the upper house.

First of all, like I said the democratic congress actually did pass a bunch of good (from a liberal perspective) stuff that didn't pass the senate.

Secondly this is mindless grandstanding. It's unlikely that republicans would actually repeal HCR if they had control of the house and senate. They would probably just tweak it to give even more money to insurance companies, or something obnoxious like that.

Finally, there are (or were) ways to pass things in the senate without 60 votes (like using reconciliation), but they weren't used enough. And now the rules have been changed to make filibusters harder.

Honestly fear-mongering about how horrible the republicans are and that's why people need to always support the democrats doesn't make all that much sense for the president to talk about how great they are and how we need to "reach across the isle". If the republicans were actually that terrible, wouldn't it make more sense to fight them tooth and nail?

These symbolic gestures can be annoying if you're on the other side, but ultimately their meaningless. The republican base is probably going to be just as disappointed as the left-wing base is with the democrats. Meanwhile both sides will go out of their way to serve wall street and the CEO class, at the expense of middle class Americans on both sides, who are kept divided by people fearmongering the other side.
posted by delmoi at 6:13 PM on January 19, 2011 [2 favorites]

I honestly think they should think twice about calling it obamacare. 20 years from now we will be seeing signs with "government hands off obamacare". They should probably associate it with one of their own, maybe get a jump on "Palincare"
posted by Ad hominem at 6:17 PM on January 19, 2011

DU: Call it childish if you want, but at least the Rs do what their base demands.

...and subsequently fail to pass something that will actually be enacted! Yay for no compromise, since it prevents anything from getting done!
posted by Joey Michaels at 6:21 PM on January 19, 2011

I think that the most prominent, though infrequently discussed, force driving political winds is demographics. The baby boom is getting old and starting to retire, losing their employer subsidized insurance. I expect health care will become increasingly affordable, at least for retirees, via one mechanism or another.

From a strictly strategic perspective the repubs are going to have to do some artful repositioning over the next 20 years to not come out on the wrong side of this debate.
posted by vapidave at 6:32 PM on January 19, 2011 [1 favorite]

The problem with ~~Romney~~ObamaCare is that expanding coverage is based on subsidizing the insurance of those who can't afford it. As the price of insurance infaltes (by ~15%/yr) eventually richer and richer ameriancs will be able to afford less and less health insurance, but the only way to expand ObamaCare will be to expand those subsidies i.e. give your tax-money so that poor people (people poorer than you) can buy health insurance you can't afford. This is why the REPUBLICANS designed ObamaCare the way they did.It has a built in political short-circuit to obtaining true universal coverage ala Europe and the rest of the developed world.

This would be all well and good except that the explosion in the cost of health care in the US is a huge crisis, both for people and for business. Passing something which doesn't really address the scale of the crisis and has built in political traps to expansion isn't anything to crow about. Yet, Obama and the Democrats want to hang their legacy on it. It's whistling past the graveyard and like Obama's response to the financial crisis seems to be based on a inability to fathom that our society, economically and politically, is in genuine crisis and has problems which can't be solved and sausage-making and hopeful rhetoric.
posted by ennui.bz at 6:37 PM on January 19, 2011 [5 favorites]

They should have explicitly voted out Dick Cheney's health coverage as part of this. I'm sure he can afford his $500K heart transplant on his own, as well as the artificial assist device keeping him alive.
posted by humanfont at 6:45 PM on January 19, 2011 [1 favorite]

The democratic house passed all kinds of things that didn't have a chance in the Senate. Like greenhouse gas restrictions...

And that was bullshit, too. Not that I'm all rah-rah greenhouse gas. But bills that are designed not to pass, to be full of sound and fury, signifying nothing, are as useless as tits on a bull.

Here's an idea. We have committees. Let's, you know, use them as they're intended.
posted by Cool Papa Bell at 6:47 PM on January 19, 2011 [1 favorite]

> But even with 59 or 60 "Democrat" senators, it all would have died in the upper house.

I'm sorry - perhaps I missed something, but I thought the Democrats had a majority in both House and Senate at that point? Filibuster, etc, but such filibuster does never seem to happen... and in the event, no Republicans voted for the bill, now did they? So, the Democrats voted, and they got a bill.

Mr. Obama asked for very little and got a little less than that. If he'd started asking for a lot, he'd have been able to dial it quite a bit back and still get a whole lot more than he got by completely copping out.

If Mr. Obama had started punching strongly, making the undeniable case for single payer, not only the most extreme system but also the one that has the most evidence for its effectiveness (look North, look to Europe...) and the one that saves the most money because it cuts out much of the the useless middlemen, then he could easily have given that up and still had a strong health bill.
posted by lupus_yonderboy at 6:52 PM on January 19, 2011 [4 favorites]

This is why we can't have nice things. Literally.
posted by y6y6y6 at 7:02 PM on January 19, 2011 [4 favorites]

...as well as the artificial assist device keeping him alive.

"Artificial assist device" sounds so clinical. Why not just call it what it is -- a vile abomination spawed in the fecund belly of Ubbo-Sathla in it's castle in gray-litten Y'qaa at the dawn of time, and harnessed to the dark and corrupted heart of the vice-president by the spilling of innocent blood and the chanting of eldritch curses that scorch the ears of mankind?

It's more friendly-like!
posted by steambadger at 7:04 PM on January 19, 2011 [1 favorite]

So basically the House of Representatives are a bunch of trolls.

Ummmm. Yeah. Are you new here?

Since the passage of the bill my son, taken off my family health insurance, has been able to be put back on it. Now they want him off and without coverage?

Hey me too! FUCK YEAH OBAMACARE.
posted by thsmchnekllsfascists at 7:11 PM on January 19, 2011

"Artificial assist device" sounds so clinical. Why not just call it what it is -- a vile abomination spawed in the fecund belly of Ubbo-Sathla in it's castle in gray-litten Y'qaa at the dawn of time, and harnessed to the dark and corrupted heart of the vice-president by the spilling of innocent blood and the chanting of eldritch curses that scorch the ears of mankind?

Or you could call it an artificial blood pump.
posted by thsmchnekllsfascists at 7:12 PM on January 19, 2011

Besides, a name like that doesn't make a good acronym.
posted by maryr at 7:14 PM on January 19, 2011 [3 favorites]

"For all of you sitting and watching at home, playing the drinking game where you take a shot every time a Republican lies; you better get a designated driver.”

You better get a ride to the emergency room if you're doing that. I mean, if you have some way of paying for it. Otherwise, I guess you can just die.
posted by marxchivist at 7:28 PM on January 19, 2011 [4 favorites]

marxchivist: "You better get a ride to the emergency room if you're doing that. "

I read the original quote as designated LIVER. A propos.
posted by notsnot at 7:34 PM on January 19, 2011 [1 favorite]

Or you could call it an artificial blood pump.

That's one way to describ "kept alive by the beating of hearts stolen from innocent interns in a satanic ceremony deep beneath the Pentagon."

In other news, Republican rep Andy Harris only has less than two weeks till he FINALLY gets his sweeeet government healthcare.
posted by emjaybee at 7:47 PM on January 19, 2011

I'm sorry - perhaps I missed something, but I thought the Democrats had a majority in both House and Senate at that point?

Hence why he put "Democrats" in quotes. In reality, only about 30 or so Dems are actually very liberal at all. Maybe another 15 or so could be convinced to vote for a real left-leaning idea on their own pet issues, but the final 12 or so are really Republicans from Republican states who just happen to have a D next to their name.
posted by T.D. Strange at 7:54 PM on January 19, 2011 [3 favorites]

Christ, what assholes.
posted by Danf at 7:59 PM on January 19, 2011 [1 favorite]

subsidizing the insurance of those who can't afford it.

We were already doing this (and still are), but in a really haphazard and unsustainable way.
posted by rtha at 8:04 PM on January 19, 2011 [2 favorites]

If the political environment sours on Obama, it's entirely possible for the GOP to take both houses of Congress and the White House in 2012.

Doesn't a particular calender end an epoch in 2012? I'm not saying that if this happens it will be the end of the world. But, an epoch, man.
posted by chemoboy at 8:07 PM on January 19, 2011

I have really been struggling to better understand the Health Care debate in the States. My wife and I remain mystified by it, up here in the frozen wastes of socialist Canuckistan, especially after our recent experience - our five year old son spent two weeks in the hospital (6 of them in intensive care), had one surgery, was on several different antibiotics, painkillers, etc, etc. You get the idea. He had Group A Strep pneumonia, which developed out of nowhere and came on suddenly...the type of thing that there was no way to foresee or prepare for.

When all was said and done, I walked out of the hospital with him and the only thing I had to pay for was the dispensing fee for the antibiotics he was still on (the drug itself was paid for by my health plan, and I was able to claim the dispensing fee on my HSA) and then for parking. In other words, we only paid for discretionary expenses (parking and food) during that two week period, we owe nothing, and we were able to pick up our lives pretty much where we left off.

The other night my wife asked me how much all of that care would've cost if we lived in the States, for which I have no answer. I suspect, though, that even with a health plan through work, we would've been piling on major debt getting through this experience...or have had to try to manage more of the illness at home, on our own. I am really glad that in all the decisions we had to make during that time, considering the costs of various procedures was never something that even entered our minds.

So how is it that people can think that a system that would have left a reasonably ok lower middle class family deeper in debt after this experience is preferable to trying to ensure that everyone has coverage? I can only see downsides - for everyone except the very rich - in such a system, when an unexpected illness can wipe out savings, housing, and pile on a burden of unpaid bills and debt or leave people with some horrible choices about whether or not to seek treatment. Isn't that more devastating to the economy than the alternative?
posted by never used baby shoes at 8:08 PM on January 19, 2011 [19 favorites]

"Why Are Republicans Such America-Hating Traitors Act"?

Bleah, I can't even do it. You just can't out-crazy the crazies.
posted by freecellwizard at 8:08 PM on January 19, 2011

I'm sorry - perhaps I missed something, but I thought the Democrats had a majority in both House and Senate at that point? Filibuster, etc, but such filibuster does never seem to happen... and in the event, no Republicans voted for the bill, now did they? So, the Democrats voted, and they got a bill.

Lupus you should really go and learn something about the legislative process and the rules of the Senate and House. You seem lack a basic understanding of committees, the rights of the minority, reconciliation, the filibuster, not to mention the the various coalitions within the political parties. This isn't an Aaron Sorkin TV show. For example Olympia Snowe (R-ME) provided a key vote on the Baccuus bill that enabled HCR exit the finance committee, even though she voted against the final HCR bill.
posted by humanfont at 8:08 PM on January 19, 2011 [4 favorites]

err, that should be 6 days in intensive care.
posted by never used baby shoes at 8:09 PM on January 19, 2011

So how is it that people can think that a system that would have left a reasonably ok lower middle class family deeper in debt after this experience is preferable to trying to ensure that everyone has coverage? I can only see downsides - for everyone except the very rich - in such a system, when an unexpected illness can wipe out savings, housing, and pile on a burden of unpaid bills and debt or leave people with some horrible choices about whether or not to seek treatment. Isn't that more devastating to the economy than the alternative?

More than once this year, I have been presented with the following argument from people who otherwise appear to have functioning brains:

If people had to pay for their own care, out of pocket, and could comparison shop, health care costs would come down, because doctors would have to lower their rates and stop overtreating patients.

Believing this piffle is only possible if you are massively ignorant of the history of disease and the effectiveness of government efforts in fighting it, how preventative care would be abandoned, and that no one doctor-shops while having a heart attack.

But it's insidious piffle, because it makes a complex situation (health care costs + government bureaucracy + deciding as a society how to ration care) into a simple one (healthcare is just like buying a refrigerator). And people have a hard time letting go of their insidious piffle. And those who know it's piffle have a hard time unpacking it, because the density of its wrongness is such that it seems to require an entire college semester to explain all the many ways in which it is wrong. Easier to just beat your head against the wall.
posted by emjaybee at 8:22 PM on January 19, 2011 [11 favorites]

in such a system, when an unexpected illness can wipe out savings, housing, and pile on a burden of unpaid bills and debt or leave people with some horrible choices about whether or not to seek treatment. Isn't that more devastating to the economy than the alternative?

They're just committing terribly typical human mistakes where a person sees something bad and thinks a) that can't happen to me and/or b) that other person must have done something to deserve it. Like seeing a commercial warning about the dangers of drunk driving -- "I'm smart. I know my limits. Besides, I'm not driving very far. It's a risk I can take safely for myself."

As if every drunk driver doesn't think exactly this, and only runs into trees and not cars full of disabled children.

This is why a book like Nudge was very, very interesting -- "The human brain is amazing, but it evolved for specific purposes, such as avoiding predators and finding food. Those purposes do not include choosing good credit card plans, reducing harmful pollution, avoiding fatty foods, and planning for a decade or so from now. Fortunately, a few nudges can help a lot."
posted by Cool Papa Bell at 8:36 PM on January 19, 2011 [1 favorite]

Ezra Klein on why Republicans don't care.
posted by crunchland at 8:41 PM on January 19, 2011

never used baby shoes: "So how is it that people can think that a system that would have left a reasonably ok lower middle class family deeper in debt after this experience is preferable to trying to ensure that everyone has coverage? "

Thanks to the deluge of anti-reform advertising that saturated the airwaves, a lot of Americans know the Canadian system only as a bureaucratic nightmare that almost killed the nice lady in this ad. Or in the case of Britain's NHS, they see only the Orwellian cabal from this ad that will remove all your healthcare choices.

(Oh, and the bald spokesman in that second video? That's Rick Scott. He's the governor of Florida now.)
posted by Rhaomi at 8:43 PM on January 19, 2011

> Lupus you should really go and learn something about the legislative process and the rules of the Senate and House. You seem lack a basic understanding of committees, the rights of the minority, reconciliation, the filibuster, not to mention the the various coalitions within the political parties.

Please do not condescend to me - I know far, far too much about these. It seems to me as if you're simply throwing out buzzwords. What, exactly, is your point here? It seems as if you're implying that the present bill was only passed through cooperation with the Republicans - do you have the slightest evidence of this aside from a single vote on an intermediate bill?
posted by lupus_yonderboy at 9:00 PM on January 19, 2011 [1 favorite]

And that's completely irrelevant anyway to my central point - that by starting off asking for something extremely modest, in fact exactly what the Republicans were asking for a decade or so before, Mr. Obama immediately guaranteed that we were going to get at best a tiny score.

I always get excoriated here for this - "tiny progress is better than none at all". That would be true - except since we keep alternating R and D, we get tiny progress and then huge losses, and the net result is a huge loss.
posted by lupus_yonderboy at 9:04 PM on January 19, 2011 [7 favorites]

subsidizing the insurance of those who can't afford it.
We were already doing this (and still are), but in a really haphazard and unsustainable way.

if you want to build a government entitlement program i.e. every person in the US is entitled to health care, you can't do it by explicitly framing it as giving your money to someone else. you have to build a program that benefits everyone: everyone gets medicare and as a government expenditure it probably benefits the middle classes the most (who coincidentally pay the largest share of the total income tax revenue.) how is it that the republicans actually ran in the last election on democrats taking away your medicare (for tinkering with the rules, which ObamaCare does do)?

on the other hand, if you desperately don't want health care to become an entitlement you can create a policy which explicitly subsidizes some lower class of people while everyone else is tied to a health care insurance market which is eating the economy (and people with it alive): if your premiums are constantly going up how is someone going to sell giving even more money to other people? you've helped some people out, you can call yourself a compassionate conservative or a pragmatic progressive, but the reality is that the program isn't going anywhere politically.

look at massachusetts, the birthplace of ~~Romney~~ObamaCare. on the surface, you have a higher percentage of people covered by insurance than other states. but what is happening is that the relentless increase in costs is breaking the state budget. instead of expanding access to insurance, you have cuts to dental coverage from the lowest segment of the subsidized population while even subsidized rates are going up, mine went up by 50% already. Meanwhile, "health insurance connectors" are a joke and the cost of care is not going down appreciably with expanded coverage and access to care.

ObamaCare isn't the beginning of health care reform in the US, it's the end of it, politically, until the whole system collapses. There were ways of doing universal health care that don't involve single-payer. The German model is a good example of this, but it involves implicit price controls and willingness to make hard requirements that every insurance policy must follow. The fact is that the Obama Democrats don't want health care as an entitlement for everyone, plain and simple. They, more than anyone, believe in the free market and think that if you just tinker with it a bit then everything will work out.
posted by ennui.bz at 9:10 PM on January 19, 2011 [3 favorites]

The "I've Got Mine So To Hell With Everybody Else Act"

aka the "Someday I Think I'll Have Mine So I'll Start Acting As If I Do Even If It's Against My Current Interests Act".
posted by joshwa at 9:12 PM on January 19, 2011 [7 favorites]

The other night my wife asked me how much all of that care would've cost if we lived in the States, for which I have no answer. I suspect, though, that even with a health plan through work, we would've been piling on major debt getting through this experience...or have had to try to manage more of the illness at home, on our own. I am really glad that in all the decisions we had to make during that time, considering the costs of various procedures was never something that even entered our minds.

the thing is, with most plans, you really wouldn't know. six months afterwards you'd have a giant stack of medical bills, some from individual doctors, some from the hospital, some from your insurance company, many of them contradictory.
posted by ennui.bz at 9:16 PM on January 19, 2011

that no one doctor-shops while having a heart attack.

Very true. All we wanted was the best possible treatment at each step of our unfortunate journey - you aren't bargain hunting, you are trying to make decisions that lead to the best outcomes. Much more emotion involved than shopping for an appliance or a car.

They're just committing terribly typical human mistakes where a person sees something bad and thinks a) that can't happen to me and/or b) that other person must have done something to deserve it.

To me, that is what made our experience so scary - nobody did anything to deserve it (and if anyone wants to say my five year old deserved that experience, they better have a health care plan of their own), and it showed just how easy it could happen to anybody - a normal, healthy, amazingly energetic boy went from his usual self to needing to be hospitalized in a matter of hours.

Americans know the Canadian system only as a bureaucratic nightmare

We can be; I won't defend the horrid things that still happen in our system, especially given the province I live in. No human system will ever be perfect. But are we more or less bureaucratic than the US system?
posted by never used baby shoes at 9:20 PM on January 19, 2011

The fact is that the Obama Democrats don't want health care as an entitlement for everyone, plain and simple. They, more than anyone, believe in the free market and think that if you just tinker with it a bit then everything will work out.

The worst part is, without the public option, with such a meagre program put in place, we're basically back to square one as soon as the Republicans/Tea Party get put back in charge of the rest of Congress and Presidency. The gig was up when Obama compromised before his opponents even asked for concessions.
posted by Blazecock Pileon at 9:35 PM on January 19, 2011 [5 favorites]

They needed to do what they wanted to do. Now they have to actually accomplish something.
posted by john wilkins at 9:42 PM on January 19, 2011

So how is it that people can think that a system that would have left a reasonably ok lower middle class family deeper in debt after this experience is preferable to trying to ensure that everyone has coverage?

The genius is in
a) tying a moral code to certain behaviors. (You must obey the moral code)
b) convincing people that a belief in that moral code constitutes an adherence to that moral code no matter their behaviors

They don't think, they believe. (That's fine for some things though.)
Corporations are making people believe that their beliefs constitute thinking even when it is contrary to their interest.

I'm sleepy and I realize the above sounds a bit woo but, and I've argued this even less effectively before, corporate structures have existed in, for example, ant colonies and slime molds for millions of years. Evolution favors it sometimes. We are undergoing it now.
posted by vapidave at 9:50 PM on January 19, 2011 [4 favorites]

Why is this even news? It has no chance of getting past the Senate. If it did it would be vetoed. So why does this even get a headline in the press? If anything it should show up on page 18 of section B of the newspaper, right under the listing for what plays the local elementary schools are performing next week.
posted by Xoc at 9:58 PM on January 19, 2011 [1 favorite]

But are we more or less bureaucratic than the US system?

As a Canadian, I'd guess considerably less. I show my OHIP card, maybe my Blue Cross card, and that's that. I've never heard of a Canadian being denied vitally necessary treatment for any reason, let alone because of red tape, and certainly not because they were deliberately cheated out of coverage they do have, like private insurers seem to do all the time in the US.

Waiting times, schmaiting times; yes, you have to be patient (heh) if your life isn't on the line. Emergency? You're in. Emergency Lite^®? You're next in line. Everyone else? Enjoy the meagre selection of two-year-old, snot-stiffened issues of Macleans* and wait your turn.

* While they do in fact exist, these are for the most part metaphorical periodicals, since waits for specialists can last months if there's no reason to rush.
posted by Sys Rq at 10:01 PM on January 19, 2011

I always get excoriated here for this - "tiny progress is better than none at all". That would be true - except since we keep alternating R and D, we get tiny progress and then huge losses, and the net result is a huge loss.

Where's the loss? This plan is here to stay. Everyone knows it.

This is the problem--people watched way too much The West Wing and they started to think that the President has a mind-control ray or something.

Repeat after me the President may only persuade, the President may only persuade.

You need the votes to pass things and you need 60 to overcome the filibuster. All of the ranting about "dems had 60 votes" obscures the fact that not every Dem senator agrees with single payer. So how do you get Liberman to go along with you? I've seen suggesting threatening to take him off committees, etc. A hollow threat. He says one word and he's a Republican, permanently. And he won't vote for anything the Dems want then.

Where are your sixty senators willing to vote for single-payer? Please name them all. Oh-oh--no cheating--you have to totally fucking prove that Obama just goes on the road and convinces 70% of the American people to be on board for that. Because that's what's needed. And if you can't be 100% certain, then you have to weigh risks of getting nothing and that includes the number of dead uninsured people who didn't get coverage if you fail to get your sparkly little pony, because that is the risk you are taking.

People who think it would be simple don't know shit about the Senate. One or two senators can gum up the works for months with holds on procedural motions, etc.

Here's the main thing--where are your votes? Where are they, by name? You couldn't get sixty for the public option, let alone single payer. If you are gonna get serious and convince them, provide a list of 60 senators willing to vote in single payer. Webb? Nelson? Blanche Lincoln? Liberman? How you gonna get oit done? Because this game is about specifics.
posted by Ironmouth at 11:26 PM on January 19, 2011 [9 favorites]

maryr just got added as a contact for the Dar Williams reference I was thinking of but didn't express.
posted by Navelgazer at 11:46 PM on January 19, 2011

Can we please not refer to Democrats as "The D"?
We all know they don't even come close to The D.

There can be only one!
posted by XhaustedProphet at 2:17 AM on January 20, 2011

It always seemed to me that what Obama was attempting was divisive and confrontational, not to mention way too expensive. (We're $14 tril in debt, got $2 tril coming in each year - now's not the time to take on an extra $100-300 billion in annual debt.)

It would have been a lot cheaper, as well as targeted, to give everyone on welfare/unemployment (and their dependents) a "GovCare" debit card preloaded with $1000. (Family of 5 - $5k total) Set restrictions on the card so it could only be used for doctor visits and pharmacy needs. Each year, refill the card (if needed) back up to $1000. When you get a job with medical benefits, the card doesn't get refilled. (Employer reports medical benefits to the IRS, IRS communicates w/GovCare, GovCare cuts the renewal.)

Allow folks to go to the various Doc-in-a-box places in Walgreens, CVS and the like. DON'T allow the card to be used for food, drink, other crap - just medical necessities.

Hospitals already provide critical emergency care, so no change there. If you get more than $1000 medical costs in a year, from authorized providers, then your dependents (if you've got 'em) get their accounts drawn down. When the account hits zero, a review is made, and if the reasons are justified (say, you dropped an air conditioner on your foot and needed stitches, smashed your hand in a door and needed stitches and a cast, stood up in your attic and found some roofing nails you weren't expecting with your head and needed stitches, or were generally accident prone) then you're refilled and all outstanding charges paid.

If it's not needed, at the end of the year your $1k just rolls over.

To take care of the supposded 20 million uninsured would have cost about $25 billion ($5 bil admin and setup) the first year, and less thereafter. Not everyone will need their full amount each year (I'm thinking less than 50%) and at a rough (VERY rough) estimate only about 15% will need more than the card allows - so after the first year the costs would likely go DOWN.

Instead, the folks inside the Beltway decided to revamp the entire system - to something big, glitzy, hideously expensive, doesn't seem to effectively (as in maximal results for minimal expenditures) address the problem, and is quite less than popular and getting more so the more people look at it. (You can only blind 'em with shine for so long...)

Obama missed a golden chance - by going for it all, he may have made it impossible to get much of anything.
posted by JB71 at 4:28 AM on January 20, 2011

We all know they don't even come close to The D.

My D beats your D.
posted by griphus at 5:14 AM on January 20, 2011

It would have been a lot cheaper, as well as targeted, to give everyone on welfare/unemployment (and their dependents) a "GovCare" debit card preloaded with $1000.

Ha! No, that's not how health care works. A $1000/yr. cap is ludicrous and covers nothing serious.
posted by krinklyfig at 5:25 AM on January 20, 2011 [1 favorite]

It always seemed to me that what Obama was attempting was divisive and confrontational, not to mention way too expensive. (We're $14 tril in debt, got $2 tril coming in each year - now's not the time to take on an extra $100-300 billion in annual debt.)
... Obama missed a golden chance - by going for it all, he may have made it impossible to get much of anything.

Well trolled, sir. Well trolled.

I particularly like the idea that Obama is "divisive and confrontational". That's delightful.
posted by lucien_reeve at 5:28 AM on January 20, 2011 [4 favorites]

A $1000/yr. cap is ludicrous and covers nothing serious.

Just to expand on this point, because several people in this thread have implied they don't really know how much healthcare costs in the US:

A few years ago, I got a really bad case of pneumonia and valley fever. I was a college student, and the doctor at my school's health center told me that he was terribly concerned, that I needed more tests, and that I was in very, very bad shape. (I was!) So, he sent me to the emergency room. (Note: I had health insurance, but this is how it was set up to work. Any small stuff was dealt with at the health center. Anything more serious? To the most expensive type of health care, the emergency room!)

There, they ran some tests. There was a spot on my lung. But because it was already midnight by that point, there was no one around qualified to tell me what the spot was. I was told, it could just be valley fever, or it could be cancer or any number of bad things. I was given this choice: either I could go home and make an appointment with a pulminologist, or I could stay at the hospital overnight. If I went home, I likely wouldn't be able to get an appointment for a month or longer. If I stayed overnight, a pulminologist would see me the next day. So, imagine, you're exhausted because it's so late, you're lightheaded and barely able to think or walk because you can't breathe, and you've just heard the word, "cancer." What would you have chosen?

So I stayed the night. So someone could look at a scan and tell me I had valley fever.

And that one night's stay... ONE NIGHT. It was $8500.

In the end, I was seriously lucky. I mean, I had health insurance, and in the end, I only needed to stay there for one night. And this was the year when Bush decided to give everyone a bunch of money, so I was able to pay off the hundreds of dollars in copays I accrued. At the time, my significant other didn't have health insurance. Had he been the one to get sick, rather than me, it would have bankrupted us. I mean, it just flabbergasts me: ONE NIGHT WAS EIGHT THOUSAND DOLLARS.

In the end, I honestly do not know how much my illness cost, overall. Literally, have no clue. Nor do I know how much I, personally, paid, compared to my insurance. Like someone above said, there are so many different bills, and so many confusing codes, and so many contradict each other..... No idea. But, I know that it was at least $12000. And all I really needed, in the end, was antibiotics and anti-fungal medication. If this isn't a story about a fundamentally broken system, I don't know what is.
posted by meese at 5:40 AM on January 20, 2011 [11 favorites]

Responding to a few folks.

It would have been a lot cheaper, as well as targeted, to give everyone on welfare/unemployment (and their dependents) a "GovCare" debit card preloaded with $1000. (Family of 5 - $5k total) Set restrictions on the card so it could only be used for doctor visits and pharmacy needs. Each year, refill the card (if needed) back up to $1000. When you get a job with medical benefits, the card doesn't get refilled. (Employer reports medical benefits to the IRS, IRS communicates w/GovCare, GovCare cuts the renewal.)

Yes but this would be totally useless for everything that you will get when you get older than your twenties. Have a baby end up with a c-section that's like $20K right there. Annual shots, physicals, glasses, dental, medications; that's easily going to go over that. Right now my employer has a FSA program where you can put aside dollars on a medical debit card as described above. I put a couple thousand on it each year and it ends up being all spent by the end of the year, and that is just with co-pays, deductibles and out of pocket expenses (like meds they won't cover). That's a family of four that is mostly healthy.

The German model is a good example of this, but it involves implicit price controls and willingness to make hard requirements that every insurance policy must follow.

The US HCR bill included price controls (85% of revenues must go to benefits, state insurance commissioners have new power over premium increases) and requirements for minimum policies to be used in cooperatives and exchanges. There have been a few waivers granted for some companies as the bill rolls out, but those just let companies buy time to get things sorted out.

Please do not condescend to me - I know far, far too much about these. It seems to me as if you're simply throwing out buzzwords.

Lupus if you know so much about these things then why don't you understand the role Olympia Snowe played in getting the Baccuus bill out of the senate finance committee, which was a pre-requisite to getting the bill passed. If you are such an expert, why would you seem to fail to understand the workings of the modern filibuster as you did in your post above. I'm confused as to why you think terms that are embedded in the legislative process and rules of both chambers would be mere "buzzwords"

Your proposed strategy is that the President should stand up and use the bully pulpit to push single payer or perhaps full blown socialized medicine out the door. A number of democratic presidents have actually tried this as a strategy and it resulted in no action.

I'm not trying to be condescending here, I'm simply challenging your grasp of the situation. You assertions and protests to the contrary simply display a further lack of understanding of the process by which a complex piece of legislation like HCR is enacted.

Furthermore you and others seem to be unaware of what the actual reform rollout process will be, or the ongoing legislative fights that will ultimately shape HCR's final impact as it rolls out over the next decade. The government is going to play an enormous role in the health care market.
posted by humanfont at 5:52 AM on January 20, 2011 [1 favorite]

perhaps i'm wrong but i don't think i've seen anybody working the "health care is a basic human right" angle in the US. why is this? people have the right not to be left to die if they are unable to pay expensive medical bills. the debate always seems to be framed as "what's it going to cost us" rather than "what is the correct and human thing to do".
posted by canned polar bear at 6:40 AM on January 20, 2011 [1 favorite]

But are we more or less bureaucratic than the US system?

Well, I don't know, having never experienced the Canadian system personally, but what I can tell you about one of the best hospitals in the US is that even their billing system is beyond suck. I had a number of blood tests done in October. I have health insurance (thanks to my boyfriend's delightful company, which allows for domestic partner coverage).

It took them over 2 months to get any kind of bill to me. When they did, they were split into two different bills, despite all being the same thing (blood tests), run by the same lab at the same hospital on the same day. The amounts not covered by my (good!) insurance were outrageous! It was Christmas, so I gave up on calling in to ask about the bill just then. Voila. ANOTHER bill arrives. Different amounts on the same things again. (And no, this was not the insurance-adjusted bill, I'd already gotten that one).

So I call, and I'm told the amount owed has changed yet again for some mysterious reason that even the lab's billing department doesn't understand. It's now nearly the end of January and I've had to write a letter to figure out what the hell is going on and what amount they actually think I'm supposed to pay because I'm not about to send off some HUGE check and then get yet another bill for the same thing with a different amount on it.

This is at the Cleveland Clinic, one of the world's top hospitals, and one of the most efficient, supposedly, when it comes to electronic patient record systems and billing. Are we less bureaucratic, more efficient, etc? I'd say hell no.

If we had a real healthcare system in place here, I wouldn't have doctors tacking on extra tests that aren't covered by insurance to pad the bill ($170, none of it covered by insurance, to tell me I have a slight vitamin D deficiency? I am so pale I am translucent, and I live in CLEVELAND, of COURSE I have a vitamin D deficiency!), and I wouldn't be getting speculative "let's see if we can get you to pay this huge amount now, and if not, we'll start changing up the bill until you do pay" nonsense.
posted by bitter-girl.com at 7:04 AM on January 20, 2011 [2 favorites]

Ahh, American Health Care. It's a continuing source of mirth for we who are not American. Much like tipping and wearing a gun in public, we see it in movies, we read about it on the internet, and we feel excited every time we realise we don't have to deal with it.

I hope one day, you will get healthcare that will not bankrupt the sick, abolish tip based income for minimum wage earners, and stop mentally damaged people from walking around with a gun on their hip waiting with baited breath for their hero moment.

Until then, keep the hilarity coming. If I stop laughing, I may cry.
posted by Jerub at 7:13 AM on January 20, 2011 [2 favorites]

I'm looking forward to HR3: "I know you are, but what am I?"
posted by dgran at 7:21 AM on January 20, 2011

Just to expand on this point, because several people in this thread have implied they don't really know how much healthcare costs in the US:

... ONE NIGHT. It was $8500.

Last March I had back surgery for a herniated thoracic disc. It definitely wasn't an elective procedure, considering I couldn't walk upright without blinding, breath-taking pain. Anyway, when it was all over, we kept a rolling total of the billed charges (thanks to the EOBs that our insurer sends) The total for that fun four days in the hospital? Right about $40,000.

Thankfully, we had insurance (we buy it ourselves, unfortunately) As it is, we're still paying-off the deductible.
posted by Thorzdad at 7:37 AM on January 20, 2011 [1 favorite]

"A $1000/yr. cap is ludicrous and covers nothing serious."

It'll cover 10 visits to a Doc-in-a-box @ (by our local prices) about $70 each - or several minor accidents (say, stitches and a cast) @ about $300 each. It'll also cover (@ $10 for three months supply of various generics, which seems to be prevalent) a fair number of prescriptions.

That's what it's designed for. It'll get people out of the ERs who go in for the sniffles. It'll reduce the ER load, it'll reduce ER costs from people who come in for the 'free' care. It's not designed to take care of major trauma, cancer, heart disease, eye exams or whatever - it's for low-level medical care which people would either do without or load up an ER with.

Stuff that NEEDS an ER will still GET ER treatment. Meese's example - he would have still been hospitalized - the difference is, if he were unemployed with the card, he'd have put the card in, had $1000 deducted from it for costs, a caseworker would have looked at the case, then paid the rest and refilled the card because it was justified by his sickness. No copays, no hassle.

But he had insurance. (And copays suck.)

I repeat - this isn't an 'everything' card idea - it's a low-level care card to get people something they don't have now at a price that's affordable. We're at $14 trillion debt, $2 trillion income, with a deficit between $1 and $1.3 trillion estimated for this year, so unless they raise the debt ceiling something's going to go bust somewhere.

And in my estimation, it's be a lot better to have something than nothing - which is what the prospects for Obamacare's starting to look like.
posted by JB71 at 7:45 AM on January 20, 2011

Why don't people in the USA make this a much more personal thing?
As a Canadian observer, I have not seen a single message about how this is improving people's lives, changing their access to health care, or making a lick of difference.
Is there some place where people are talking about how they are being effected by this, besides those that have obviously lost their liberties in the continued secret government takeover of their once glorious freedoms that they knew back in 2008?

It is the true human stories that need to come out. Make it look like the representatives are kicking people out of chemo treatments and unplugging the morphine drips.
posted by Theta States at 7:55 AM on January 20, 2011

To take care of the supposded 20 million uninsured would have cost about $25 billion ($5 bil admin and setup) the first year, and less thereafter. Not everyone will need their full amount each year (I'm thinking less than 50%) and at a rough (VERY rough) estimate only about 15% will need more than the card allows - so after the first year the costs would likely go DOWN.

You are adorable.
posted by TypographicalError at 7:58 AM on January 20, 2011 [1 favorite]

But are we more or less bureaucratic than the US system?

No medical system in the worl is more buraeucratic than the American one. Every single person employed by a medical insurance company in the United States? A bureaucrat. And most of them have fuck all to do with helping with medical care. (You need some bureaucrats - or you can make the doctors do their own paperwork rather than treat patients and thereby spend a mint on bureaucracy). Every hour spent going over the different provisions of the different insurance companies is a bureaucratic overhead most countries simply don't have. Line item billing to patients? Why bother under a sane system. Which means fewer arguments - and fewer people working out how to mark it up. Fewer arguments -> less bureacuracy. It all comes out in the wash anyway over large scales.

And worse than the bureaucracy is the bureaucracy that US patients have to see. The time before last I was in hospital, they needed to check my address was right. They needed to record I'd consented to a minor but obnoxious scope. But that was pretty much all the paperwork I saw. Last time? I had one form to fill in. And a collection of physio excercises that they printed out for me, which I suppose counts as paperwork. The entire billing process for the scope will have taken the clinical coders a matter of minutes - and for the physio it will have been completely automatic from the booking system. No one will have argued. You can't even scan through an insurance policy to check if the treatment's offered in that time. And for that matter it's only slightly longer than I personally would have spent opening the envelope from the insurance company to read and check the bill.
posted by Francis at 8:00 AM on January 20, 2011 [1 favorite]

...took them over 2 months to get any kind of bill to me. When they did, they were split into two different bills, despite all being the same thing (blood tests), run by the same lab at the same hospital on the same day. The amounts not covered by my (good!) insurance were outrageous! It was Christmas, so I gave up on calling in to ask about the bill just then. Voila. ANOTHER bill arrives. Different amounts on the same things again. (And no, this was not the insurance-adjusted bill, I'd already gotten that one).

So I call, and I'm told the amount owed has changed yet again for some mysterious reason that even the lab's billing department doesn't understand.

With this (and the other stories about billing confusion in this thread), I am left to wonder how anyone could think that the system would increase competition and drive down costs. It sounds like no one - even the billing department - knows what they are charging for the care people are receiving, so how on earth could anyone comparison shop?
posted by never used baby shoes at 8:01 AM on January 20, 2011 [1 favorite]

It'll cover 10 visits to a Doc-in-a-box @ (by our local prices) about $70 each - or several minor accidents (say, stitches and a cast) @ about $300 each.

When was the last time had to get stitches or a cast? Your concept of what those procedures cost does not match my personal experience.
posted by humanfont at 8:01 AM on January 20, 2011

Oh, and the card will only go to folks who are unemployed or not covered under an employer's health plan. If there IS a health plan where you work, and you choose not to partake of it - you don't get the card as a backup.

So -

1. $1000/year, x family members. (Family of 4, $4000.)
2. Only for low-level care and prescriptions and limited immunizations. No dental, glasses.
3. Eligible if unemployed or no health plan at work.
4. More money allotted if needed - if not, it rolls over at EOY.
5. Designed to get people out of ER for non-critical needs, dropping hospital ER costs.

Everybody's got their own ideas as to what should be included. Hell, I'd like to see chiropractors, accupunturists and opticians on it also, but... we're coming to a time where a lot of what we HAVE is simply going to be unaffordable. It'd be nice to get people who aren't covered at ANY level some coverage. Insisting on a platinum plan for everyone's a pretty good way to insure there won't be shit for anyone.
posted by JB71 at 8:03 AM on January 20, 2011

It'll cover 10 visits to a Doc-in-a-box @ (by our local prices) about $70 each - or several minor accidents (say, stitches and a cast) @ about $300 each. It'll also cover (@ $10 for three months supply of various generics, which seems to be prevalent) a fair number of prescriptions.

So you can choose to have several accidents or get sick several times. Free market in action! Causing people to make the tough choices between things they have no control over. And look at that, you can buy meds as long as they're generic. Hope poor people don't need antidepressants, AIDS medication, or any number of quite useful things.

Personally, I'd just rather give the poor vouchers for the medicine fairy. But only 20 per year. We don't want to inflate the national magic budget.
posted by TypographicalError at 8:06 AM on January 20, 2011 [3 favorites]

Humanfront - I cut my hand open and had some stitches a few years back. Saw the workman's comp bill on it - $650. Asked the doc - he said if I'd come in with no insurance it would have been about $250. Since I didn't have insurance at the time, that was interesting... and kind of reassuring. I did drop my dream of learning how to juggle running chainsaws, however.

If Workman's comp would pay $650, why shouldn't he charge that much?

TypographicalError - You are adorable.

You're pretty neat too. :)

Seriously though - regarding costs going down. I realize it's atypical of a government program, but if the money isn't spent off the card, it persists to the next fiscal year - so that's $1k that won't need to be renewed. There will be atypical cases (re Meese above) - but I think those would be more than offset by the folks who don't tap the card at all. And someone who is unemployed for a month would still get a card - but when he's covered by a company health insurance program the IRS would, in effect, have the card turned off and recover the $1000 that way.

Again - this isn't intended to replace conventional insurance policies or plans. This is strictly for those folk who haven't got insurance because of unemployment or no insurance available at work.
posted by JB71 at 8:18 AM on January 20, 2011

So you can choose to have several accidents or get sick several times.

If you're choosing to have accidents, TypographicalError, you're not someone I want to hang around no matter how adorable you think I am. ;)

Plus - when the card's tapped out - it gets refilled on a case-by-case basis. And when you get covered by an employer's health care plan, the remaining balance is scavenged. (Could simply be 'turned off' on future renewals, though - that'll give you some medical care to tide you over until your employer's health care kicks in.)
posted by JB71 at 8:24 AM on January 20, 2011

From Ezra's article, linked upthread:

In February 2007, Deamonte Driver died of an infected tooth. But he didn't really die of an infected tooth. He died because he didn't have consistent insurance. If he'd had an Aetna card, a dentist would've removed the tooth earlier, and the bacteria that filled the abscess would never have spread to his brain.

This is why it's called class warfare: people are dying. The wealthy have their needs taken care of, many times over. A tiny number of Americans have so much more than they could ever conceivably need, while millions suffer, and people like this poor child die from completely preventable ailments. We've allowed a social configuration to develop wherein basic and fundamental material inequality is celebrated and preached (albeit, frequently in coded language). This is like a whole-society form of Stockholm syndrome.

And what's to be done? It's not as though the millions without health care or those with access only to insanely expensive and restricted "care" actually like their precarious state. I think people feel disenfranchised, as they demonstrably are. The intent to repeal this act is an offensive, make no mistake, but one manifested as structural violence. The Republicans and their free-market masters want people to feel (and be) hopeless, scared, and defeated. They're so much easier to either manipulate or just push around that way. And it's sorta kinda been working.
posted by clockzero at 8:26 AM on January 20, 2011 [2 favorites]

Saw the workman's comp bill on it - $650. Asked the doc - he said if I'd come in with no insurance it would have been about $250.

Been there, done that. When boyfriend was working for a company without domestic partner coverage, I regularly negotiated cash prices at the doctor I was seeing then. "I don't have insurance. I'll pay you today for the visit. How much?" Surprisingly low, for the most part, because there's no rebilling nonsense involved, and he'd often thrown in samples from the drug companies if he had something appropriate on hand so I wouldn't have to go to the pharmacy, too.

However, this isn't going to help you if you have, say, cancer -- my best friend went through some truly absurd amounts of paperwork and nonsense during her cancer treatment last year. So many people were involved in her treatment, you'd never be able to sit down and, say, strike a deal with the anesthesiologist and radiology guy and surgeon and and and...
posted by bitter-girl.com at 8:27 AM on January 20, 2011

Oh, about the bureaucracy...

I get notices from my insurance, that have columns with numbers, and then a bolded item at the bottom. The notices, by the way, are not bills, but the bolded item is meant to be the amount that my doctor might bill me.

The notice has instructions, saying that Columns A + B + C + D + E + F = Bolded Item.

Every. single. time. The columns added together are different from the bolded item. Every time. And, I mean, I have a graduate degree -- I can do basic math. I can read English. Yet I have never once gotten a form from my insurance that I can understand.
posted by meese at 8:32 AM on January 20, 2011

Bitter-girl -

I know - had a friend come down with adenocarcinoma of the bladder. Nasty, fatal, and expensive until the fatal part.

But as I've said - this isn't designed to cover cancer, chemo, surgery or whatever. It's to simply get coverage for low-level medical issues for people who have none, without having them clog up ERs.
posted by JB71 at 8:34 AM on January 20, 2011

Meese -

10,000 years from now, when alien archeologists unearth our remains, they're going to be AMAZED at the sheer volume of red tape covering everything.
posted by JB71 at 8:37 AM on January 20, 2011

I cut my hand....Saw the workman's comp bill on it - $650. Asked the doc - he said if I'd come in with no insurance it would have been about $250.

I cut my finger (almost off) and had to see hand surgeon in order to avoid permanent disability. I saw the bill come through, it was over $10,000. I didn't ask the microsurgical specialist what the uninsured price would be, but given that I wanted to retain the use of my digits, I wasn't really thinking about it at the time.

Doctors are usually willing to cut you a break if you don't have insurance, but when they do that they are generally donating their time and even discounting materials. They know they can make it up later on insured patients. This is not the basis for a reliable public health system.
posted by humanfont at 8:44 AM on January 20, 2011 [1 favorite]

Oh, I wasn't talking about the $1000-card-bill, JB71, just the overall amount of bureaucracy and paperwork involved in delivering even minor things (see my first comment above re: my Fun Fights With The Lab Billing Department)...
posted by bitter-girl.com at 8:45 AM on January 20, 2011

Humanfront -

That sounds like an accident you'd normally go to the ER for, so I'll assume you did. And it sounds like you had insurance (or workman's comp) covering it.

The GovCard, once again, isn't for critical care beyond a point (which would be $1k, at which point other funding would kick in) - instead it's for the uninsured to make sure their minimal medical needs are met.

Emergency treatment falls outside that.

(I take it the finger's okay?)
posted by JB71 at 8:53 AM on January 20, 2011

bitter-girl.com -

It's funny how bureacratic systems tend towards maximum entropy (IE disorganization)

Computers were supposed to help with that - it's just made it worse.
posted by JB71 at 8:55 AM on January 20, 2011

The GovCard, once again, isn't for critical care beyond a point (which would be $1k, at which point other funding would kick in) - instead it's for the uninsured to make sure their minimal medical needs are met.

So what are minimal medical needs? An occasional sinus infection and a flu shot? Cholesterol/diabetes/blood pressure screening what about the medications required afterwards. Psychiatric medications for depression, etc? I spend over a thousand dollars a year just on copays, and I don't think my family is atypical.
posted by humanfont at 9:35 AM on January 20, 2011

So what are minimal medical needs? An occasional sinus infection and a flu shot? Cholesterol/diabetes/blood pressure screening what about the medications required afterwards.

I keep trying to point out this isn't a permanent card. Yes, it's for the cold, flu, sniffles, flu shots, generally feeling crappy that uninsured, unemployed folks would go to the ER for. As well as sprains, simple fractures, cholesterol tests, diabetes meds, blood pressure meds. (Mine cost roughly $50/year, generic, bought in 90-day increments.)

Psychiatic meds? Depends on the case, depends on the meds.

"... and I don't think my family is atypical."

We spend roughly $300. I go twice a year, the little guy once, my lovely bride twice to three times. Our copay runs about $50, which sucks, but... (shrug) we're employed and wouldn't be using the card in the first place. If we HAD the card, we'd have $3000 to cover medical expenses, (3 people x $1000 per person) since funds could be shifted between family members to cover.
posted by JB71 at 10:05 AM on January 20, 2011

It is my roommate's experience working in a pharmacy in East Texas that a major part of why the past couple of weeks have seen a huge upswing in anti-"ObamaCare" people is thatit is the beginning of a new year and now all their deductibles are due. Forget that this happens every year and is a part of their insurance policy and has literally nothing whatsoever to do with ObamaCare - last month they could get their prescriptions for free and now they have to pay cash money for it, it must be Obama's fault! She has come home with stories of people literally cursing Obama's name because they had to pay $1.10 for a prescription.

One dollar and ten cents.

I haven't had health coverage of any kind since I turned 18 and was no longer covered under my mom's insurance, so, like, if I'd been there I would've wanted to punch that guy for feeling so god damn entitled but anyway the point is, yeah, on ground level it sure does look like people suddenly hate ObamaCare and it's because they are stupid
posted by titus n. owl at 10:16 AM on January 20, 2011

She has come home with stories of people literally cursing Obama's name

I'd bet my eye teeth that when something similar happened under Bush, these same people either cursed "the government" or "[name of insurance company]". Now, they're blaming Obama.

I've seen Republican/conservative friends do the same thing. Some of them have opposed every form of so-called government bailout, but under Bush, they said "the government is bailing these companies out." Under Obama, they say, "Obama is bailing these companies out."

I wonder if it's just what they'd do for any Democratic president (e.g., "Clinton raised the price of my drugs") or if it's a cousin to the "a black guy cut me off in traffic" phenomenon.
posted by lord_wolf at 11:11 AM on January 20, 2011

Yes, it's for the cold, flu, sniffles, flu shots, generally feeling crappy that uninsured, unemployed folks would go to the ER for.

What uninsured, unemployed folks go to the ER for that stuff? In my experience, we just go without wherever possible.
posted by asperity at 11:13 AM on January 20, 2011

Lot of people do, Asperity - it's a chronic problem. They don't have money to go to the doctor, so they go to the ER instead.
posted by JB71 at 11:49 AM on January 20, 2011

We spend roughly $300. I go twice a year, the little guy once, my lovely bride twice to three times. Our copay runs about $50, which sucks, but... (shrug) we're employed and wouldn't be using the card in the first place. If we HAD the card, we'd have $3000 to cover medical expenses, (3 people x $1000 per person) since funds could be shifted between family members to cover.

This is for medical expenses when you are healthy. As mentioned above, if something worse happened, $3,000 won't cover a single visit to a hospital.
posted by Ironmouth at 11:57 AM on January 20, 2011

Lot of people do, Asperity - it's a chronic problem. They don't have money to go to the doctor, so they go to the ER instead

This is true--and it costs the government millions as ER visits are massively expensive. It is an incredibly inefficient way to deliver care.
posted by Ironmouth at 11:57 AM on January 20, 2011

It's funny how bureacratic systems tend towards maximum entropy (IE disorganization)

Computers were supposed to help with that - it's just made it worse.

I read that as 'Centaurs were supposed to help with that', and entered a rather confusing, but magical, land of insurance billing systems.
posted by FatherDagon at 12:46 PM on January 20, 2011 [2 favorites]

This is like a whole-society form of Stockholm syndrome.

And what's to be done? It's not as though the millions without health care or those with access only to insanely expensive and restricted "care" actually like their precarious state. I think people feel disenfranchised, as they demonstrably are. The intent to repeal this act is an offensive, make no mistake, but one manifested as structural violence. The Republicans and their free-market masters want people to feel (and be) hopeless, scared, and defeated. They're so much easier to either manipulate or just push around that way. And it's sorta kinda been working.

This is it right here. I don't understand why so many of us either feel we deserve this or refuse to admit just who is doing it to us.

Stockhold syndrome nothing; we're like a bunch of abused spouses thinking everything will be ok if we just get the house clean enough that we don't get beaten.
posted by emjaybee at 12:58 PM on January 20, 2011 [2 favorites]

Ironmouth:

"Except that Health Care reform reduces the debt, ace."

Sorry, I just don't see it. If you owe $14, earn $2, and borrow $1 to make it through the year (for example) - at the end of the year you end up with $15 debt. You don't end up with $13 owed.

Over the years I've come to regard the numbers coming out for any proposed program as coming from a world where they believe 2+2 really equals 5, you just have to 'redefine' 2. I'm looking at the numbers, I'm looking at the proposed tax increases under Obamacare, and thinking about their effects on the economy, and feeling that we're about to get royally screwed without any lube, due to 'unanticipated' financial side effects.

There's this from the CBO, saying there'd be a reduction of the deficit by $137 billion over 10 years. Forgive me, but I don't see $13, $14 billion a year reduction in the deficit as being a real 'win', and it won't do a thing to reduce the national debt.

"I read that as 'Centaurs were supposed to help with that', and entered a rather confusing, but magical, land of insurance billing systems."

LOL. I think that'll be about the only way this whole program will ever make sense.
posted by JB71 at 2:13 PM on January 20, 2011

There's this from the CBO, saying there'd be a reduction of the deficit by $137 billion over 10 years. Forgive me, but I don't see $13, $14 billion a year reduction in the deficit as being a real 'win', and it won't do a thing to reduce the national debt.

Your alternative is to do nothing and spend 13 or 14 billion more. Under your $1000 per family member gift card idea which you think would magically cost less because of the high costs of a 15 minute sniffles consult in the ER. Even though the thing that gets the ER is someone who has no insurance and needs 20k in medical treatment. In your fantasy world the 50 million people without health insurance would require that you find $50 billion dollars. And you arnt even covering their really expensive things. Guys with sniffles increase the wait time but they cost very little per time because thy spend maybe 10 minutes with the triage nurse and 8 minutes with a physician or CNP. Once or twice a day though some guy roles in with a serious health crisis. That's where the ER money goes. You need to go back to square one.
posted by humanfont at 2:25 PM on January 20, 2011

Ironmouth...

"They sure as hell aren't going to suggest a $1,000 card for people without health insurance. What's that supposed to cover, bandaids?"

I could point you further up the page so you could see just what I was suggesting on this, but briefly, it's designed to provide visits to things like a Doc-in-a-box at places like Walgreens and CVS and Rite-Aid, and cover prescriptions so folks w/o insurance will have some amount of care. It's not designed for covering cancer, chemotherapy, amputations, dental care, eye care or whatever - it's designed for relatively healthy folks who are temporarily unemployed who need some sort of primary care. Once you're employed again, you'll be covered by the employer's health plan - but if there isn't one you can still use it.

If you hit the $1000 limit, you'll be refilled on a case-by-case basis, looking at what's been going on to minimize fraud. If you get hit by a bus, or break a leg, or have something that requires an ER visit, the card is deducted to the limit of the card, and then the ER/hospital could get reimbursed for the rest by the government while the card is reset. If you're going to the ER for things that could be taken care of by a Doc-in-a-box, probably you'd be warned the first time and cut off the second. Make the ER for emergencies, which wouldn't cost you anything.

"...and it costs the government millions as ER visits are massively expensive. It is an incredibly inefficient way to deliver care."

Fully agree there - so what's the best way for the least cost to get the ERs cleared out for emergencies? Obamacare may clear them out, but at what cost overall?

"Also, concerned much about the debt? Just raise taxes on those making over $250,000 a year."

You'd better believe I'm concerned. How much do you think we could realistically raise them? We're at $14 tril debt, looking to add at least another trillion on this year. I think you could snag Bill Gate's entire fortune and that of the rest of the millionaires in this country, and we still wouldn't cover the deficit - much less touch the debt itself.

As far as tax rates go - the top 10% already pays about 70% of the taxes. Top 50% - about 97%.

We're broke. We can't afford what we've got now - but we must. Adding on more isn't going to help.
posted by JB71 at 2:38 PM on January 20, 2011

As far as tax rates go - the top 10% already pays about 70% of the taxes. Top 50% - about 97%.

In a world where the top 20% control 93% of the wealth, and 42% of that is controlled by the top 1%, that tax rate is not just understandable, but quite frankly NOT ENOUGH.

http://sociology.ucsc.edu/whorulesamerica/power/wealth.html
posted by FatherDagon at 2:55 PM on January 20, 2011 [2 favorites]

Humanfont -

The problem with the CBO estimates is that they're just that - estimates. And the CBO can ONLY give estimates covering the info that was presented to them. They can't take other information into account if it isn't in the original request.

I'll figure you understand the concept of 'Garbage in, garbage out'? Figure out a budget for yourself for the next five years that includes a 25% raise each year and no savings of any extra money. Now, impose that on yourself. If that raise fails to materialize you can't cut back your spending because you've committed to the budget. You don't have any extra income, but you've still got your programmed items. What's going to happen?

You're going to go into debt.

The CBO did what they could with the info they were given. With projections of tax revenue from increased and new taxes, and everything going just right - we might see the deficit lower by $13 bil a year. Maybe.

Re ER wait times and such - the difficulty is that they've got to build, prep, and staff for their current load. Reducing the load means they don't need as many doctors, nurses, spending for infrastructure can be less. That will lower costs overall.

I think a lot of people look on Obamacare as a magic thing that'll give everyone all the medical care anyone could want at no cost. But someone always pays, and you can hide a whole lot of 'unanticipated' costs and provisions in a 1900 pg bill.
posted by JB71 at 3:04 PM on January 20, 2011

In a world where the top 20% control 93% of the wealth, and 42% of that is controlled by the top 1%, that tax rate is not just understandable, but quite frankly NOT ENOUGH.

So what is, FatherDagon? Take Bill Gates - he's got a fortune of around $40 billion. Take it. Put it against the deficit. Congratulations - you've gone from a deficit of $1.3 trillion this year to $1.260 trillion. And you won't get a cent from him next year.

It's not that they're not being taxed enough - it's that government spending is way too high. Heck, the interest on the debt for the first three month of FY2011 alone is $148.2 billion. That's about three Bill Gates and a Warren Buffet.

Something's got to give, and there's no easy, painless answers. Anyone promising you everything you want from the government plus a bag of chips is lying to you.
posted by JB71 at 3:19 PM on January 20, 2011

here are some stats from Minnesota on the costs of various types of treatments. As you can see in an ER treating you costs $181, while critical interventions for things like abdominal pain, a bee sting, all run over 10x the cost. Basically people can show up at the ER with the sniffles day and night and it probably isn't going to break them because they can staff that with lower cost people.

JB71 your proposed solution of give everyone 5 visits per year like that. Furthermore you have yet to explain where you come up with $50 billion each year to pay for it. Let's assume it is cost savings. Are you suggesting that the average poor person uses the ER 5x /year for sniffles?

Furthermore current CBO estimates are for 230 billion over ten years in savings. That's 23 billion a year.

Finally you make the rather silly argument about spending money you don't have. Let's consider this like a family budget. Medical, Food and Housing tens to be pretty fixed. If you have to save money and balance the books, you can't practically zero out housing can you? Perhaps you find a cheaper place to live and that saves you $200/month. If you then are looking to balance the whole budget you'd say that saved $2400/year. You might cut back on food to 75/month but again you can't just zero it out, you need food. Medicine is the same way. The projected savings are in real dollars vs continuing to do what we are doing. You must provide a plan that can save as much. Right now your savings plan would be togs the family into the ritz Carlton to save on the house keeper.

You want to cut the deficit start with the half trillion dollar defense budget. Two programs could be cut and save 100billion/year Missile Defense and the nuclear modernization efforts (cause apparently we need iNukes by apple those old W-88s don't match our shoes). Get rid of te second engine for the JSF (pushed through by #2 republican Eric Cantor).

You might also consider returning tax rates to their Clinton or Reagan era levels. Wow loom budget problems solved.
posted by humanfont at 4:16 PM on January 20, 2011 [1 favorite]

JB71 writes "The GovCard, once again, isn't for critical care beyond a point (which would be $1k, at which point other funding would kick in) - instead it's for the uninsured to make sure their minimal medical needs are met."

If that other funding is in place why cause people stress by making them fill out yet another form and see yet another administator to get the funds. Just frickin' provide it all ready and cut out all the angst and fucking around. Oh right; SOCIALISM.
posted by Mitheral at 5:31 PM on January 20, 2011

JB71: Something's got to give, and there's no easy, painless answers.

Sure. But I will point out that from a Canadian perspective, the US as a whole--public and private sectors--is spending a larger amount, as a percentage of GDP, on health care, than Canada does, while getting worse results: the US spent 15% of GDP on health care in 2006, while Canada spent 10% (and insured everyone). So there's a ton of room for cost savings.

I'll also point out that expanding coverage isn't going to be very expensive. Most uninsured people are young. The really expensive patients--the elderly--are already covered by Medicare.

It's not that they're not being taxed enough - it's that government spending is way too high.

US voters really need to sit down and decide what the appropriate level of government spending is. Is it 30% of GDP? 40% of GDP? Somewhere in between? Then they need to set their taxes to the same level (or a little higher, to pay for past deficits). Prior to the economic crisis, total US government spending (all levels) was about 36-39% of GDP, which is not that different from Canada, at about 40%. But while Canada balanced its budgets back in the mid-1990s, with government revenue at 40% or higher, total US government revenue (all levels) was only about 31-33%. This isn't sustainable. (Figures from the OECD.)

There appears to be a line of magical thinking among Republicans and groups like the American Enterprise Institute, summed up by former Vice President Cheney: "Reagan proved that deficits don't matter." Unfortunately this isn't true.
posted by russilwvong at 5:33 PM on January 20, 2011 [1 favorite]

Humanfont -

Good research. You're starting to see the problem - but you're not accepting the answers you're seeing. Go a further step and apply your similes to the federal budget.

Cut defense? Ask yourself - how much is LA worth, if NK's peerless leader decides to show just what a big dick he has by firing a missile this way? Would he do it if he thought it would be intercepted - or would he continue his bluster? Or Europe - if Iran's research provides something that can be missile-mounted, I'm sure the EU would understand if we cut missile defense to provide medical care. They'll bitch because the world's policeman (much as they bitch about us, they still need us) went off duty for the duration. Especially if Iran lobs a nuke. I'd like to think that they wouldn't - but I don't trust them to be rational enough not to.

Where's the $50 bil come from?

Department of Energy budget - cut it in half, you'll get $14 bil.
Department of Education - cut it in half, you'll get $23 bil.
Cut farm subsidies and gut Agriculture - that'd be about $14 billion.
Cut Amtrak and NASA in half - that'd be about $1.5 and about $9 bil respectively.

There you go - over $60 bil there. (Damn shame - I'm gonna miss Amtrak...)

Department of Defense? 10% cut. Department of Homeland Security? Gut the TSA, put security back in the hands of the airlines. That's $5-6 bil there. Yes, airline tickets will rise, possibly as much as, oh, $10 a head? Social Security? Tough titty, granny, but if you've got assets of $250k or more you don't get the stipend. IRS tells us you're worth less than that, and you're golden. Medicare? Medicaid? Those are tough calls - but since there's supposedly (at one point, when they were arguing for Obamacare) something like $500 billion/year fraud and abuse - increase oversight on that and crack down hard on all fraud.

Of course, that doesn't do much for the income stream. Government can only spend what the private sector supplies, and you can figure the IRS sucks about $12 bil off the top of whatever's collected. Add in 'friction' from various bureaucracies - and you'll lose probably about 5-10% of income in admin costs. (Just think of it as burning $5 out of every $100...)

Thoughts on income in a bit... but I don't think you're going to like them, either.
posted by JB71 at 6:55 PM on January 20, 2011

Okay - the money's got to come from somewhere, right? All that tax revenue isn't just hanging on the money tree in the back yard waiting to be plucked... so that means they come from you and me.

Businesses pay taxes - but they get that money from the businesses or people who buy their services or products. So the cost of them doing business is passed on - to the end consumer. I buy a gallon of milk, the store gets a cut of the profit, the distributor and the dairy all share. But they all pay taxes - so I'm paying a share of their taxes, right? And the money goes to Washington, the IRS gets their share and passes it all around... That's the way it works, like it or loathe it. You get businesses to pay more, and you'll pay more for the products.

At this point, it's pretty fair to assume that any increase in the tax rates in the US aren't going to do the economy any good. (Look at Illinois for an example there. They just raised their rates, and the surrounding states are courting Illinois businesses with lower taxes. Figure by raising the taxes they've just slashed both the job base in their state and their revenue. I'd move, if I lived in that state...) (Plus, look at the economic fallout from the 'Luxury Tax' of the early 90s. People decided they didn't need luxuries like new boats and small aircraft, so they didn't buy them. It ended up as a very revenue-negative tax, and hurt a lot of small businesses like Cessna, Beechcraft, Piper and various boat builders... who had to lay off workers and almost shut down. Woops.)

Conversely, we can't really cut taxes much. We NEED what's coming in (and more besides) and a tax cut would take about 2, 3 years to grow the economy.

So what else can we do? How about... looking at California? The Golden State. The fertile valleys, beautiful forests, towering redwoods... the high electricity prices, high gas prices... surrounded by resources, they're about to go bust. Why? Because by law they can't do anything that shows a profit. (Except for Disneyland, of course. Slight exaggeration, but only slight.) They've cut off water to agriculture, they've prohibited new power plants, with loads of oil off the coasts they've decided they'd rather sit in the metaphorical dark and metaphorically starve. The government will save them, of course - they're 'too big to fail'.

Except the government's broke, too.

How much revenue could California generate - as well as jobs and needed electricity - if they opened up the oil fields off their coastline? (Much shallower drilling, easier and safer than Deepwater Horizon.) Charge a state tax of $2 a barrel, and that'd help quite a bit. Build long-overdue power plants (including 3rd Gen nuclear - if it's good enough for France, it's good enough for us...) which would ALSO increase their revenue base and provide jobs.

We need to shift to an all-electric economy. Solar and windmills will help, but you're not going to be running large-scale manufacturing or processing on them easily - you need 24/7 high capacity power. That leaves hydro (pretty well tapped out), gas, oil, coal and nuclear. (Geothermal? Microquakes in the local area. Sorry.) And I'd rather see petrochemicals kept for chemical feedstocks than burned.

They could also consider diverting water from the Colorado in wet years (which it looks like this one's going to be) into the Salton Sea area. Drop the salinity, and maybe re-establish the ecosystem there. Wouldn't be fast, wouldn't be sure, but it'd provide some jobs and do good for the wildlife habitats there. And maybe reestablish tourism.

Like I said - no easy, painless answers.

Think that'll do for tonight...
posted by JB71 at 7:31 PM on January 20, 2011

JB71 writes "So what else can we do? How about... looking at California? The Golden State. The fertile valleys, beautiful forests, towering redwoods... the high electricity prices, high gas prices... surrounded by resources, they're about to go bust. Why? Because by law they can't do anything that shows a profit. (Except for Disneyland, of course. Slight exaggeration, but only slight.) They've cut off water to agriculture, they've prohibited new power plants, with loads of oil off the coasts they've decided they'd rather sit in the metaphorical dark and metaphorically starve. The government will save them, of course - they're 'too big to fail'.

"Except the government's broke, too.

"How much revenue could California generate - as well as jobs and needed electricity - if they opened up the oil fields off their coastline? (Much shallower drilling, easier and safer than Deepwater Horizon.) Charge a state tax of $2 a barrel, and that'd help quite a bit. Build long-overdue power plants (including 3rd Gen nuclear - if it's good enough for France, it's good enough for us...) which would ALSO increase their revenue base and provide jobs."

California's fiscal problem is almost wholly the fact that you need a super majority to raise taxes and only a 50+1 to raise spending. Sheesh just suspending the property tax freeze would make a huge difference to their bottom line.
posted by Mitheral at 9:00 PM on January 20, 2011

JB71:
$50 billion dollars a year is to provide $1000 health care cards to the 50 million uninsured people today. If we just focus on the 18 million unemployed persons (ignoring their families), you have an 18 billion dollar annual mandate.

We have an overwhelming nuclear and military deterrent. North Korea and Iran will not going to Nuke Los Angles, and if they did Missile Defense isn't like to make much of a difference, since they could stash it in a cargo ship.

As noted above California is one of the richest economies in the world. You have Apple, Oracle, Facebook, Google, etc. The Milk Exports alone are $47 billion dollars. Your fiscal problems are best described by Mithreal. You don't need to drill more oil to solve your problems.
posted by humanfont at 9:22 PM on January 20, 2011

Cut defense? Ask yourself - how much is LA worth, if NK's peerless leader decides to show just what a big dick he has by firing a missile this way? Would he do it if he thought it would be intercepted - or would he continue his bluster? Or Europe - if Iran's research provides something that can be missile-mounted, I'm sure the EU would understand if we cut missile defense to provide medical care. They'll bitch because the world's policeman (much as they bitch about us, they still need us) went off duty for the duration. Especially if Iran lobs a nuke. I'd like to think that they wouldn't - but I don't trust them to be rational enough not to.

So I guess what you're saying is... 100% of GDP to military?

Fuck, I don't even know anymore.
posted by TypographicalError at 11:30 PM on January 20, 2011

TypographicalError:

Dang. And last night went so well, too...

Seriously, people keep (I think) trying to figure out what the nutcases will do based on THEIR PARTICULAR models of rational behavior. But (as was pointed out with Loughner) what you or I may think is rational behavior doesn't fit the mind of the crazy. And the crazy may be doing irrational things, but they're acting (by THEIR standards) consistently and well backed up by their internal logic. That WE think they're nuts doesn't matter - what matters is what THEY think. And if they think attacking the US fits their logic, then it's a matter of method...

And didn't you catch the 10% cut to the DOD?

Humanfont:

Lot of companies are moving out. Why stay in CA, when the business climate is better elsewhere? And the more businesses move out, the higher the taxes are going to be on the rest. Google up "California Businesses Leaving"...

Re how much is needed - there's the rub, right? Now the number being touted as 'potentially needing insurance' is up around 130 million or so. If we were looking to save money, you'd think it'd be possible to make a program that would cover 12 million and not require government-mandated overhaul of the entire health system. (Which I'll admit to being skeptical about - look how well they figured out and funded the Cash for Clunkers program. Frankly, financial planning doesn't seem to be this (or any) administration's strong point.) It's pretty difficult to design any sort of program if you're not sure what to design for.

"We have an overwhelming nuclear and military deterrent." Yet North Korea still is ruled by a nutcase. As is Iran. Nutcases look at that and go "They'll use it on me, so I've got to hit them first - or at least act like I can." That's why they're nutcases.

Mitheral -

"California's fiscal problem is almost wholly the fact that you need a super majority to raise taxes and only a 50+1 to raise spending. Sheesh just suspending the property tax freeze would make a huge difference to their bottom line."

Yep - it'll cause more businesses to move out, I think. Look at Illinois. Seriously, there's nothing magic about California any more. Transportation for product? Hello, interstate highways and FedEx/UPS. If you're a manufacturer, you could set up in Kansas. They'll be glad of the jobs, if you don't mind the occasional tornado. For people? It is to laugh, especially around LA. Climate? That's about all that's left - but is it enough? What keeps people in CA, aside from inertia? And traffic jams?
posted by JB71 at 2:38 AM on January 21, 2011

Yet North Korea still is ruled by a nutcase. As is Iran. Nutcases look at that and go "They'll use it on me, so I've got to hit them first - or at least act like I can." That's why they're nutcases.

They are opportunistic thugs looking to make a quick buck. They only play crazy. In anycase they are contained. Shit even Hamas has stopped the rockets on Israel recently because it just isn't worth the blowback.

Yep - it'll cause more businesses to move out, I think. Look at Illinois. Seriously, there's nothing magic about California any more.

You gotta be kidding me. Silicon Valley ain't moving to east bumblefuck. You going to relocate Stanford, CalTech, Etc. Manufacturing? That's going to China, Vietnam, or Germany if there is a high skill requirement. Illinois is going to be fine because they balanced their books. No gimics, just good old revenue to cover spending.

Speaking of which have you explained how you will pay for your $50 billion dollar health I insurance gift card yet? Or explained the source of revenue for all the non covered procedures that may occur?
posted by humanfont at 3:20 AM on January 21, 2011

Humanfont -

Already explained it - here. (I write long enough posts already, no sense repeating it.)

"They are opportunistic thugs looking to make a quick buck." Doesn't stop them from being crazy. How many times have you watched a program where the villian goes "SEE WHAT YOU MADE ME DO?!?!?" as they go around doing their villany. Standard trope, to be sure and lousy writing - but it plays out in real life way too often.

They use everything as a justification. And as far as Hamas pausing - that's a good sign but if you look at their record the likelyhood is that they're rearming. Give 20 years w/o any missile attacks or suicide bombers, and I'll consider the Palestinians have broken their cycle and have figured out how to live peacefully with their neighbors. But I doubt we'll see that.

Re CA - the universities aren't going to move, of course. Silicon Valley is made up of individual businesses, and if they decide the business climate is better elsewhere then they're going to be pulling up stakes and going.

List names 100 companies leaving California - Jan Norman on Small Business : The Orange County Register

And then there's this...

Cost of Living Sucks; Everyone Leaving California | NBC Bay Area

Getty Images LOS ANGELES -- Mike Reilly spent his lifetime chasing the California dream. This year he's going to look for it in Colorado.

With a house purchase near Denver in the works, the 38-year-old engineering contractor plans to restart his family's future 1,200 miles away from his home state's lemon groves, sunshine and beaches. For him, years of rising taxes, dead-end schools, unchecked illegal immigration and clogged traffic have sapped the allure of the place writer Wallace Stegner once described as "America only more so."The number of people leaving California for another state outstripped the number moving in from another state during the year ending on July 1, 2008. California lost a net total of 144,000 people during that period -- more than any other state, according to census estimates. That is about equal to the population of Syracuse, N.Y.

...

The number of people leaving California for another state outstripped the number moving in from another state during the year ending on July 1, 2008. California lost a net total of 144,000 people during that period -- more than any other state, according to census estimates. That is about equal to the population of Syracuse, N.Y.

And...

Companies Fleeing California For Utah Over Confiscatory Tax Rate | Nevada News and Views

Here is a partial list of the large and medium-sized companies that have either moved parts of their business or have left the “land of milk and honey” for brighter prospects altogether:

Abraxis Health, Adobr Systems, Inc. Alza Corp., American AVK, American Racing, Apple Computer Audix Corporation, Apria Healthcare Group, Assurant Inc., Barefoot Motors Bazz Houston Co., Beckman Coulter, Bild Industries Inc., Bill Miller Engineering, Ltd. BMC Select , BPI Labs, Buck Knives, CalPortland Cement California Casualty Group, CalStar Products Inc., Checks To-Go, Chivaroli & Associates CoreSite, A Carlyle Company, Creel Printing , Dassault Falcon DaVita Inc. , Denny’s Corp., Digital Domain, Ditech DuPont Fabros Technology, ebay, Inc., EDMO Distributors, Inc. Edwards Lifesciences, Electronic Arts, Inc., EMRISE Corp., Facebook FallLine Corporation, Fidelity National Financial, First American Corp., Fluor Corp. Foxconn Electronics, Fuel System Solutions, Gregg Industries, Hewlett-Packard Hilton Hotels Corp., Hino Motor Manufacturing USA, Intel Corporation, Intuit of Mountain View J.C. Penney , Kimmie Candy Co., Klaussner Home Furnishings, Knight Protective Industries Kulicke & Soffa Industries Inc., LCF Enterprises, Lennox Hearth Products Inc., Lyn-Tron, Inc. Mariah Power, Maxwell America, Miasolé, MotorVac Technologies Nissan North America, Northrop Grumman, One2Believe, Patmont Motor Werks, Inc. Paragon Relocation Resources, Pixel Magic, Plastic Model Engineering, Inc. Precor, Premier Inc., Pro Cal of South Gate, Race Track Chaplaincy of Amer., Red Truck Fire & Safety Co. SAIC, Scale Computing, Schott Solar Inc., SimpleTech Smiley Industries, Solaicx, SolarWorld, Special Devices Inc. StarKist , Stasis Engineering, Stata Corp., Tapmatic Teledesic, Telmar Network Technology Inc., Terremark, Terumo Cardiovascular Systems Toyota, True Games Interactive Inc., TTM Technologies, Understand.com US Press shifted, USAA Insurance, Yahoo.

Add Adobe and Ebay to that list. They may not leave completely - but there's no law (at present) that forces them to stay. (Hell, even STARKIST moving out? WTF?)

California's no longer the magic land. And as far as Illinois goes - they balanced their books? No - they passed an increase in the state income tax. Which may or may not (and I'd bet you a beer it's going to be 'not') end their funding woes. But they're 'balanced' on paper at least.

But we'll see.
posted by JB71 at 4:14 AM on January 21, 2011

Wait, are we still spending $5b a week in the Middle East?

Yeah, you're right, the obvious answer is cutting farm subsidies and Amtrak *facepalm*
posted by Uther Bentrazor at 6:56 AM on January 21, 2011

Comrade_Robot -

You can look at NK and think that they're rational? At least, rational as the rest of the world would define it?

Let's see... they've been at 'war' with SK for about 60 years now. The people are undernourished, their infrastructure ain't worth shit, they've got serial cult-of-personality dictators leading the country, they have regular famines, they have no intertubes, outside radio, all outside influences are banned, and did I mention the spending on the military's at a point where it pretty much consumes their entire GDP?

Of course, most McDonalds have a higher GDP than NK...

I'd call the leadership 'batshit crazy', but I'd worry about offending bats. China has something of a handle on them, as in "Stop the crazy or you'll get no food and fuel." - but I don't trust them to NOT throw a 'break everything even though I know Mommy will spank' tantrum, just because they can.

They ARE rational actors... by their own standards. And if that rationality demands that in order to save the Worker's Paradise they nuke the Great Devil US, then they will, logically, do so. I'm hoping they don't - but pile all your hopes in one hand and piss in the other and see which fills up first...

Re missile defense - we made it through the MAD years because the USSR was sure that if they launched, we would launch. We cut back the Spartan/Sprint ABM systems for SALT 1, and then deactivated the whole system back in '75. The USSR leadership, in wanting to survive as a functioning country, eventually cut back on the rhetoric and (thanks to their own internal problems) collapsed, pretty much ending the threat.

Now we've got additional threats. The leadership of Iran and NK, as I've said before, don't strike me as the most rational of actors.

"The thing about nuclear war is that only one nuclear warhead needs to get through, and no system is 100% effective."

If you've got 10 missiles, shooting into or through a target area where you've got interceptors, and there's 100 interceptors, each with a 90% chance of lock-on and destruction, how many missiles are going to get through?

Alternatively, would YOU like to be the President who, after the US is hit with a nuke, is asked "Why did you cancel missile defense back in whenever?"
posted by JB71 at 8:14 AM on January 21, 2011

Wait, are we still spending $5b a week in the Middle East?

Yeah, you're right, the obvious answer is cutting farm subsidies and Amtrak *facepalm*

Wait - we're spending $500 billion a year buying oil from folks who hate our guts? While we're sitting on more than enough to make the country energy independent until we can build a shitpile of nuclear power plants and switch to electric vehicles?

Yeah, you're right - the obvious answer is to cut off all drilling here stateside and keep sending that money overseas!

*facepalm*
posted by JB71 at 8:18 AM on January 21, 2011

Here is a partial list of the large and medium-sized companies that have either moved parts of their business or have left the “land of milk and honey” for brighter prospects altogether:
[long list]

Nevada Business Journal touting all the companies that are "leaving California. That's not evidence that's marketing copy from the local chamber of commerce. Many of the companies you list are currently hiring people for positions in California.

Yeah, you're right - the obvious answer is to cut off all drilling here stateside and keep sending that money oversea

How about instead we reduce per capita carbon emissions by 30% since 1974, lead the world in fuel efficiency and prepare for the green economy to come. Also oil is still cheap, why not wait for $200/barrel and then turn it back on. If peak oil is here what's my incentive to drill it now when in 3-4 years it will be worth 2-3x the price.

Now we've got additional threats. The leadership of Iran and NK, as I've said before, don't strike me as the most rational of actors. Alternatively, would YOU like to be the President who, after the US is hit with a nuke, is asked "Why did you cancel missile defense back in whenever?"

If you honestly believe that Iran / NK are hell bent on nuking us and are so irrational as to ignore our enormous deterrent, then real politick demands only one response. We must constrain those countries by force while we have the advantage.

Looking are your evidence:
Let's see... they've been at 'war' with SK for about 60 years now.

And this has been very profitable. The leadership is able to maintain its authority by outside threats, and checks and technical assistance from the Soviets (now russians) and the Chinese

The people are undernourished, their infrastructure ain't worth shit, they've got serial cult-of-personality dictators leading the country, they have regular famines, they have no intertubes, outside radio, all outside influences are banned, and did I mention the spending on the military's at a point where it pretty much consumes their entire GDP?

And as a members of the leadership of North Korea this affects you how exactly. Starving people are easy to control especially when there are outside threats. The lack of a burgeoning middle class means there is never any traffic while your merc goes roaring down the road. Oh and you have a nukes so anytime you need some more cash to keep the peasants from rioting or just want that new iPhone; you can shake down your brothers to the South, or Uncle Sam. You've got piles of money sitting in Swiss and other offshore secret accounts. It probably will collapse at some point, but then the mid-level leadership just disappears into South Korea, while the high ranking party officials go into exile. It's not irrational, amoral, but not irrational.
posted by humanfont at 9:46 AM on January 21, 2011

There's this from the CBO, saying there'd be a reduction of the deficit by $137 billion over 10 years. Forgive me, but I don't see $13, $14 billion a year reduction in the deficit as being a real 'win', and it won't do a thing to reduce the national debt.

Except you said it would increase the debt. So you now agree that the estimate you gave earlier was wrong? So if it doesn't increase the debt and actually decreases it, why not do it?

Our overseas competitors are kicking our asses because they don't have this expense. They have healthier workforces too. This is a matter of national security, and your fear for your wallet should be tempered by that knowledge.
posted by Ironmouth at 10:16 AM on January 21, 2011

If you've got 10 missiles, shooting into or through a target area where you've got interceptors, and there's 100 interceptors, each with a 90% chance of lock-on and destruction, how many missiles are going to get through?

Except one of these premises isn't backed up with facts. Wonder which one?

I love how the country is supposed to spend billions on a very attenuated potential threat from NK, which we would destroy in 10 minutes if they launched on us, but we can't save billions by saving more lives at home? How is that logical thinking?
posted by Ironmouth at 10:22 AM on January 21, 2011 [1 favorite]

"Many of the companies you list are currently hiring people for positions in California."

At one point I was the sole employee in the state for a company out of South Carolina. They needed a tech here to service some computers - I needed a job. Felt a lot like the Maytag repairman. Eventually found a different job - needed to feel like I was doing something useful. Maintaining a presence doesn't take much. Move 500 people out, hire 5 to keep the office open - net loss 495 jobs. The company's still 'there', for a limited definition - but the state won't be getting much from 'em.

http://articles.latimes.com/2008/dec/18/business/fi-leaving-california18

84 companies added to ‘leaving California’ list - Jan Norman on Small Business : The Orange County Register

Guess we'll see.

Re NK - didn't think we were talking about that, I was replying to Comrade_Robot. Sorry you disagree with my assessment, but any day without them doing crazy shit is a good day in my opinion.

"If you honestly believe that Iran / NK are hell bent on nuking us and are so irrational as to ignore our enormous deterrent, then real politick demands only one response."

Nah, let's just keep on doing what we've been doing, and kick the can down the road a bit further, maybe Israel or China will deal with them, eh? You leave the crazies alone as much as possible, and keep a watch on them. They may just be spouting off, or they may be serious. Best to treat them as if they were serious, I think.

"How about instead we reduce per capita carbon emissions by 30% since 1974, lead the world in fuel efficiency and prepare for the green economy to come. Also oil is still cheap, why not wait for $200/barrel and then turn it back on. If peak oil is here what's my incentive to drill it now when in 3-4 years it will be worth 2-3x the price.

Tell me how we can do that without crashing the economy. Practially, that is - not theoretically. At $150/bbl the economy nearly crashed - and it was in better shape two years back than it is now. I don't want to see $5/gallon gas again.

Going green? So far the efforts to go green haven't produced much - solar installtions in the Mojave being blocked, wind installations being blocked... though we did have to replace our furnace this year, from a 30 yr old system to something very nice and efficient. Civilization runs on energy. LOTS of energy. Easily transportable energy, whether by wire or pipeline. No energy - no civilization. And I likes me my hot showers and intertubes and xbox.

Personally, I'd rather see us building nuclear power plants. 3rd gen plants are decidedly fail-safe, but the problem is time frame in that it'll take about 10 years just to deal with the eco-group delays. Oil would take a lot less time to drill and get into the system. So we need to be doing both, until we can flip the switch on one and shut the tap on the other.

As far as carbon goes... Seriously, I realize this may sound heretical to you but I think we're about to hit a severe cold spell, akin to the Maunder Minimum. Solar output is dropping, sunspot numbers are akin to the lead-in for the Maunder Minimum time, and you know that trouble the South has had with snow and ice and the North has had with snow and ice and record cold temperatures? That's going to be more the norm. CO2 isn't the forcing agent it was thought to be - there's a lot more complexity in the climatological cycle than that.

Might want to look at these videos - especially the long-range forecasts by Bastardi. We haven't needed a snow shovel where I am in the last 20 years until this last snow - I'll be getting one as soon as Home Depot gets them back in stock.

Anyway, gotta go - yak at you later...
posted by JB71 at 10:46 AM on January 21, 2011

Ironmouth -

I'm sure you're aware of the difference between the national debt and the deficit? That each year, the deficit ADDS to the debt? So woo-hoo, we manage to save $13 bil a year, while still running up the debt a trillion or so each year. My children's great-grandkids thank you for the 'savings'.

"Except one of these premises isn't backed up with facts. Wonder which one?"

You trust in their essential rationality and peaceful intent. Good on you - but I'm thinking you're making a lousy bet. Same thing with Obama's 'health care' plan. 1900+ pages, that nobody read, nobody took the time to analyze to see what might go wrong - just buy it and swallow it. So here's some of it, formatted really badly since it's a cut&paste from here... (It's an anti-tax site, so it's partisan, but I believe the list is accurate. Google up "List of obama health tax hikes" and check for yourself.

Individual Mandate Excise Tax(Jan 2014): Starting in 2014, anyone not buying “qualifying” health insurance must pay an income surtax according to the higher of the following

1 Adult
2 Adults
3+ Adults

2014
1% AGI/$95
1% AGI/$190
1% AGI/$285

2015
2% AGI/$325
2% AGI/$650
2% AGI/$975

2016 +
2.5% AGI/$695
2.5% AGI/$1390
2.5% AGI/$2085

Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS)

Employer Mandate Tax(Jan 2014): If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees. This provision applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).

Combined score of individual and employer mandate tax penalty: $65 billion/10 years

Surtax on Investment Income ($123 billion/Jan. 2013): This increase involves the creation of a new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single). This would result in the following top tax rates on investment income

Capital Gains
Dividends
Other*

2010-2012
15%
15%
35%

2013+ (current law)
23.8%
43.4%
43.4%

2013+ (Obama budget)
23.8%
23.8%
43.4%

*Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations. It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income. It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans. The 3.8% surtax does not apply to non-resident aliens.
Excise Tax on Comprehensive Health Insurance Plans($32 bil/Jan 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). For early retirees and high-risk professions exists a higher threshold ($11,500 single/$29,450 family). CPI +1 percentage point indexed.

Hike in Medicare Payroll Tax($86.8 bil/Jan 2013): Current law and changes:

First $200,000
($250,000 Married)
Employer/Employee
All Remaining Wages
Employer/Employee

Current Law
1.45%/1.45%
2.9% self-employed
1.45%/1.45%
2.9% self-employed

Obamacare Tax Hike
1.45%/1.45%
2.9% self-employed
1.45%/2.35%
3.8% self-employed

Medicine Cabinet Tax($5 bil/Jan 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin)

HSA Withdrawal Tax Hike($1.4 bil/Jan 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent.

Flexible Spending Account Cap – aka“Special Needs Kids Tax”($13 bil/Jan 2013): Imposes cap of $2500 (Indexed to inflation after 2013) on FSAs (now unlimited). . There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education.

Tax on Medical Device Manufacturers($20 bil/Jan 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax. Exemptions include items retailing for less than $100.

Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI($15.2 bil/Jan 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). The new provision imposes a threshold of 10 percent of AGI; it is waived for 65+ taxpayers in 2013-2016 only.

Tax on Indoor Tanning Services($2.7 billion/July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons

Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D($4.5 bil/Jan 2013)

Blue Cross/Blue Shield Tax Hike($0.4 bil/Jan 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services

Excise Tax on Charitable Hospitals(Min$/immediate): $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS

Tax on Innovator Drug Companies($22.2 bil/Jan 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year.

Tax on Health Insurers($60.1 bil/Jan 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year. The stipulation phases in gradually until 2018, and is fully-imposed on firms with $50 million in profits.

$500,000 Annual Executive Compensation Limit for Health Insurance Executives($0.6 bil/Jan 2013)

Employer Reporting of Insurance on W-2(Min$/Jan 2011): Preamble to taxing health benefits on individual tax returns.

Corporate 1099-MISC Information Reporting($17.1 bil/Jan 2012): Requires businesses to send 1099-MISC information tax forms to corporations (currently limited to individuals), a huge compliance burden for small employers

“Black liquor” tax hike(Tax hike of $23.6 billion). This is a tax increase on a type of bio-fuel.

Codification of the “economic substance doctrine”(Tax hike of $4.5 billion). This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed.

----------------------

Hard to tell if this is a complete list. I'm sure the tanning salon tax will bring in a good bit, don't you? The whole thing just smells like it's going to be a textbook example of the Law of Unanticipated Consequences...

Well, gotta go. Chat at ya later!
posted by JB71 at 11:07 AM on January 21, 2011

BTW, I REALLY like this one...

"Excise Tax on Comprehensive Health Insurance Plans($32 bil/Jan 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). "

So you get taxed for not having insurance, and taxed for having 'too much'. Got you coming and going, don't they?
posted by JB71 at 11:13 AM on January 21, 2011

Comrade-Robot -

Very good points, you've thought about this too I see.

Re NK and missiles - I can see them fielding 1 ICBM. MAYBE 3 at most. 20? No. Besides - missile defense at this point isn't designed to stop a strategic attack, but more to stop the ones and twos from nutcases. A 10-1 ratio works pretty well for that.

Re Boomer time... I'm a late boomer - but I don't think I'm going to see much in the way of Social Security.

Gotta run - later!
posted by JB71 at 11:19 AM on January 21, 2011

JB71 I've given you several thoughtful answers to your points, but you seem uninterested in engaging in conversation, and instead posted long screeds copied from right wing websites. You proposed a $50 billion dollar a year program to "deal" with the health care system. I've asked a straightforward question, how is this cheaper than Obamacare, and how do you plan to pay for it. You've indicated that the plan doesn't cover the most expensive things in ER's today; so how do you keep emergency rooms open, which must treat injured patients when they come in?

You have also proposed a trillion dollar defense shield against Iran and North Korea, how will you pay for this? Future savings against some fantasy nuclear attack?
posted by humanfont at 12:54 PM on January 21, 2011

"Except one of these premises isn't backed up with facts. Wonder which one?"

You trust in their essential rationality and peaceful intent.

Wrong premise. The one where you think that we can hit the missile.
posted by Ironmouth at 3:10 PM on January 21, 2011

This is a national security matter. Without a healthy population, where are we going to get soldiers?

Afghanistan.
posted by Sys Rq at 3:35 PM on January 21, 2011

Humanfont -

My apologies for the crappy formatting - I was rushed. I only have so much time to spend a day doing this, so I apologize also for not getting back to you quickly. As far as it being right-wing... sigh.

When I'm looking for info, I try to find stuff that's factually accurate. I woulnd't have cared if it were from HuffPo, Democratic Underground, or wherever - what I was looking for is an accurate list of the anticipated taxes that'll be raised to fund Obamacare. Not articles touting the wonders of it, just a list of the taxes.

Is Kiplinger's okay for that?

I've specified above what I was intending to do with the GovCare idea, namely get the temporarily uninsured unemployed a minimal level of care for the supposed most pressing needs - namely doctor visits for minor illnesses and prescriptions, until they get jobs again and get on a business's insurance. It wasn't designed to provide more than that.

I'm not a lawyer, a tax accountant, politician, a CPA or a doctor - I'm a technician, who looks at a problem as stated and attempts to find some sort of fix. Change the parameters, and the fix gets much more complex and costly.

Trying to configure that fix so it (a) provides help to the people who most need it at (b) the specified level for (c) minimal cost long term. It's like the old joke - you can have something fixed fast, cheap, or right. Fast and cheap won't be right. Fast and right won't be cheap. Cheap and right won't be fast.

I think Obamacare is a mess, they tried for a 'fast, right, and cheap' fix and I believe it's going to seriously inflate the deficit if it ever gets enabled, not to mention having a lot of 'unanticipated' side effects that were unobserved in the surge to get this thing out fast.

But that's as may be. Lot of other things got thrown into the conversation - and it wandered way too far afield, I think. I seem to have hit on spots you find pretty sore, for which I again apologize, it was not my intent to offend.

Health care reform will happen as it will - neither my opinion or yours can affect the trajectory at this point. I sincerely hope that, if this does get fully implemented, that I'm wrong and it does turn out to be as good as you think it will be, with as little impact. But... after watching what Washington says, and what Washington does, and what the side effects are for their efforts the last 30 years or so, I'm very, very doubtful.

And so, I wish you a good night. Take care, and good luck to you.
posted by JB71 at 6:47 PM on January 21, 2011

Ironmouth -

"If Health Care Reform reduces the deficit by $13 billion a year dude, then the national debt is also not built up by that $13 billion every year. So why isn't this a good thing?"

Based on what I've seen of Congress the last 30 years, they'll use that savings to justify more spending. It's a never ending cycle - save 30 bil, spend 60. Point at the 30 bil saved and praise your efforts loudly, and just... ignore the 60. We've got to cut back. From where the money will come is the sticking point... but I've got to unstick myself from this thread at this point.

See my note above to Humanfont, and go over the last two paragraphs. I apologize if I offended, and sincerely hope that if Obamacare does get implemented that I'm wrong and it does turn out to be all it says on the box.

And so, I wish you a good night. Take care, and good luck to you.
posted by JB71 at 6:53 PM on January 21, 2011

'm not a lawyer, a tax accountant, politician, a CPA or a doctor - I'm a technician, who looks at a problem as stated and attempts to find some sort of fix. Change the parameters, and the fix gets much more complex and costly.

Trying to configure that fix so it (a) provides help to the people who most need it at (b) the specified level for (c) minimal cost long term. It's like the old joke - you can have something fixed fast, cheap, or right. Fast and cheap won't be right. Fast and right won't be cheap. Cheap and right won't be fast.

Yet you propose a simplistic $1000 GovCard concept that costs $50 billion dollars per year to implement (50 million uninsured * $1000 each).

Ithink Obamacare is a mess, they tried for a 'fast, right, and cheap' fix and I believe it's going to seriously inflate the deficit if it ever gets enabled, not to mention having a lot of 'unanticipated' side effects that were unobserved in the surge to get this thing out fast.

Fast and Easy? The reform package rolls out over 6 years. There is ample opportunity for correction and improvement. Fast and easy is inventing a $50 billion dollar entitlement program with no plan to pay for it.

You think reforming a huge chunk of our economy is going to be straight forward? Of course it will be complex, in medicine we are actually talking about matters of life and death here.
posted by humanfont at 8:06 PM on January 21, 2011

Big difference between speed of rollout and speed of design, Humanfont. Health care reform looks like it was thrown together by stacking a whole lof of 'good ideas' in a pile with little regard to how it all comes together and what affects what later on. That they wouldn't stop and let the bill be examined (as Pelosi said - "We have to pass it to find out what's in it.") should have caused people to put on the brakes and go "WTF? Let's examine this turkey before we buy it."

Think of used car salesmen, and how they'd screw you in a heartbeat to get their sales (approval) numbers up. "Doesn't that car look nice? Sign here.... what do you mean, you want take it for a test drive and read the fine print? It's all okay, you don't need to do that!"

And in the beginning, my back-of-the-envelope plan was only supposed to cover maybe 20 mil. Or less. The temporarily unemployed. (The numbers I've seen re unemployed/uninsured have ranged in the 12-20 mil mark.) IE - not a permanent plan, or a long-term plan, it's a stopgap plan to make sure folks have minimal insurance (have you priced COBRA coverage? Crazy expensive...) while they're looking for work.

See? When you can't even solidly define the numbers needed, how can you come up with anything resembing a plan? Much less figure out the funding?

It has no chance in hell of getting passed, or even seriously considered by the powers that be. I appreciate your examination and critique of it though, and wonder if you've given what's passed the same sort of thought and criticism.

I don't think reforming health care is going to be cheap, easy, or fast. I also think that majority of the folks inside the Beltway are in way over their heads attempting it - that they've figured out how to do one thing well and that's get elected to office. All else is subordinate to that.

Anyway - hope you have a good weekend!
posted by JB71 at 7:01 AM on January 22, 2011

And in the beginning, my back-of-the-envelope plan was only supposed to cover maybe 20 mil. Or less. The temporarily unemployed. (The numbers I've seen re unemployed/uninsured have ranged in the 12-20 mil mark.) IE - not a permanent plan, or a long-term plan, it's a stopgap plan to make sure folks have minimal insurance (have you priced COBRA coverage? Crazy expensive...) while they're looking for work.

All of the following from Five Facts About the Uninsured:

The number of uninsured rose sharply in 2009, reaching 50 million people.

Uninsured adults are about twice as likely as privately insured adults to have no education beyond high school (61% vs. 31%).1

About three-quarters of the uninsured are uninsured for more than one year.2 The uninsured often remain without coverage because they do not have access to employer-sponsored insurance. The recession may increase the number of long- term uninsured as more individuals are unemployed for long periods of time.

Some 77% of the 50 million uninsured in the U.S. come from working families (Figure 2). Most uninsured workers are self-employed or work for small firms where health benefits are less likely to be offered.3 Almost three-quarters of uninsured employees in 2005 were not offered employer-sponsored insurance, either through their own employer or that of a family member—and the share is likely to be higher today given the recession and the continued growth in the cost of health premiums.4

Workers usually enroll in employer-sponsored health insurance if they are eligible.5 However, it has become increasingly difficult for many workers to afford coverage. The average annual total cost of employer-sponsored family coverage is $13,770 in 2010, and the share of the premium paid by workers increased to 30% this year. Since 2005, workers’ share of premiums has gone up 47%, while overall premiums rose 27% and wages increased 18%.6

"Temporarily unemployed" has meant more than two years for a lot of people, and as you can see in the report I linked to, many of the uninsured already have jobs. Lack of jobs is not the problem for a lot of people. Lack of insurance is.
posted by rtha at 7:32 AM on January 22, 2011

And in the beginning, my back-of-the-envelope plan was only supposed to cover maybe 20 mil. Or less.

So that's $20 billion dollars / year of additional spending for GovCard. This of course presumes no administrative costs, let's assume 15% overhead costs, so that $3 billion dollars of new contractors or government workers, office space, stopping fraud, program abuse, etc. So let's call your program $23 billion dollars / year. How do you pay for it?

I don't think reforming health care is going to be cheap, easy, or fast. I also think that majority of the folks inside the Beltway are in way over their heads attempting it - that they've figured out how to do one thing well and that's get elected to office. All else is subordinate to that.

Members of congress are often quite bright and articulate. They are supported by hard working, smart staffers who have a great deal of expertise. Your position portending to be common sense folk wisdom is in fact difficult to support with actual facts. Members of congress, staffers and policy folks worked on multiple components of the legislation for many years. The ideas and impacts were debated, weighed and scored by accountants, lawyers, and health care professionals. The impact is a savings of 20 billion dollars a year against doing nothing. In addition to saving 20 billion / year, the bill will also expand coverage by 30-40 million poeple. So it covers more people at lower total cost. Your plan by contrast simply adds 20 billion dollars to the deficit and expands "covereage" by a mere 12-20 million poeople. Thus the net of your plan vs. Obamacare is a $40 billion dollar swing to the red under your plan and a net loss of coverage of 18-20 million people.
posted by humanfont at 9:03 AM on January 22, 2011 [1 favorite]

billions in medicare fraud recovered. Thank you Obamacare the savings keep growing. Soon you'll be the most popular government program in America.
posted by humanfont at 8:54 PM on January 24, 2011

$2.5 billion out of 90 billion is a start. Hopefully they can make an even greater impact over the coming year as Republicans work to defund the bill.
posted by Theta States at 6:12 AM on January 25, 2011

Why Almost Everything You Hear About Medicine Is Wrong
posted by homunculus at 11:27 AM on January 27, 2011

Republicans Vote To Repeal Obama-Backed Bill That Would Destroy Asteroid Headed For Earth
posted by Blazecock Pileon at 1:42 PM on February 3, 2011

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