by Tia Will
I believe in the value of the Constitution of the United States of America. I believe in the value of the Bill of Rights and specifically in our First Amendment .
“Congress shall make no law respecting an establishment of religion… “
While the recent Supreme Court decision in Burell vs Hobby Lobby may not abridge the technical wording of this amendment, it certainly contradicts its spirit.
Quoting from the majority decision;
“The Religious Freedom Restoration Act of 1993 (RFRA) prohibits the “Government [from] substantially burden[ing] a person’s exercise of religion even if the burden results from a rule of general applicability” unless the Government “demonstrates that application of the burden to the person—(1) is in furtherance of a compelling governmental interest; and (2) is the least restrictive means of furthering that compelling governmental interest.”
Quoting from the majority opinion by Justice Alito: “The owners of the businesses have religious objections to abortion, and according to their religious beliefs the four contraceptive methods at issue are abortifacients.”
People are certainly entitled to their own religious beliefs. However, they are not entitled to their own facts. Of the two IUDs cited as abortifacients, only one, the Paraguard could by any stretch of the imagination be considered an abortifacient since it can be used as emergency contraception. This is also true for the preparation known as Plan B. The other IUD, the Mirena has no known abortifacient action and so is not approved for emergency contraception. So what the Supreme Court has actually decided is that that the religious objection to abortion of the owners can be extrapolated to their erroneous beliefs about the mechanisms of action and therefore should take precedence over the demonstrated biological facts. Would the Supreme Court have taken the same stance if the employer were a company founded by Jehovah’s Witnesses and the procedure that they were refusing to insure was a blood transfusion, as suggested by Justice Ginsburg in her dissent. The majority states this would not necessarily apply. But why not ? What would make one genuinely held religious belief superior to another? This seems to me to be skating extremely close to interpreting law so as to respect the establishment of a certain type of religion, namely the Christian faith. Would the court have upheld the genuinely held beliefs of other religious groups, such as Muslims who legitimately practice Sharia law as part of their religious doctrine?
Justice Alito continues: “Nor do we hold, as the dissent implies, that such corporations have free rein to take steps that impose “disadvantages . . . on others” or that require “the general public [to] pick up the tab.”
This statement is clearly contradicted by the portion of the decision that states the HHS has the less restrictive option of providing direct coverage for women who are unable to obtain contraception through their employer’s health plan. If the government is providing the coverage, who other than the general public through their tax dollars does Justice Alito believe is “picking up the tab?”
And if neither their employer nor the general public are to “pick up the tab”, then most certainly these women are disadvantaged both by comparison to other women and to their male counterparts working at the same company, having the same insurance, but without the same religious restrictions imposed on their personal medical options by their employer.
Justice Ginsburg continued: “Approving some religious claims while deeming others unworthy of accommodation could be ‘perceived as favoring one religion over another,’ the very risk the [Constitution’s] Establishment Clause was designed to preclude.”
In my opinion Justice Ginsburg has this exactly right. I also believe that the five Justices in the majority in this case were unable to see past their own religious and ideological biases. I agree with Justice Alito’s suggestion that had this case been about blood transfusion, or pork containing products that it would have been decided in favor of the HHS. I believe that this would have occurred because the majority justices would not have connected so fundamentally with the religious beliefs being expressed. While each of the justices is entitled to their own religious beliefs, these should not be allowed to color their views of the issues before them thus leading to a de facto respect for a very specific religious establishment, namely a specific belief of the Christian faith.
I believe our First Amendment clearly forbids the making of laws respecting an establishment of religion. Since this is clear, should it then not follow that the Supreme Court should not interpret existing law so as to respect an establishment of religion? It would seem clear to me that this is the effect of the current majority decision and that this decision should itself be considered unconstitutional. My appreciation to Judge Ginsburg for her clear and well reasoned opposition to this majority decision.
….and my appreciation to you Tia for the article. I do agree with all you and what you quote from Justice Ginsburg…..only point is that to my knowledge issues of blood transfusions and pork, etc have never come before the Court? Easy for the majority to say what might happen if it hasn’t.
I remember being involved in a case early in my career of a Jehovah’s Witness with a bleeding ulcer. The controversy and angst on both sides. Then years later I read Anne Fadiman’s “When the Spirit Catches you then You Fall” which had a profound affect on me and brought multicultural issues front and center in a powerful way.
You didn’t mention the fact (I think true?) that the company’s insurance does cover vasectomies and erectile dysfunction meds? Is that true?
Thanks Tia!
Hi Soda,
My understanding is that their insurance does cover medications for erectile dysfunction. I do not know about their policy regarding vasectomy.
….and my appreciation to you Tia for the article. I do agree with all you and what you quote from Justice Ginsburg…..only point is that to my knowledge issues of blood transfusions and pork, etc have never come before the Court? Easy for the majority to say what might happen if it hasn’t.
I remember being involved in a case early in my career of a Jehovah’s Witness with a bleeding ulcer. The controversy and angst on both sides. Then years later I read Anne Fadiman’s “When the Spirit Catches you then You Fall” which had a profound affect on me and brought multicultural issues front and center in a powerful way.
You didn’t mention the fact (I think true?) that the company’s insurance does cover vasectomies and erectile dysfunction meds? Is that true?
Thanks Tia!
Hi Soda,
My understanding is that their insurance does cover medications for erectile dysfunction. I do not know about their policy regarding vasectomy.
Hobby Lobby covers something like 16 of the 20 birth control options. This is just antoher hyped up non controversy for the War on Women Democrats to try and stir up their base.
for a non-controvery, it sure seems to have struck a nerve. and no, i don’t believe you can randomly drum up controversies to stire up the base – if you could, everyone would stir their base every election cycle and that simply doesn’t happen.
Yup. But this is how the Progressives gin up votes.
I mean, do you think they’ll have a serious discussion of how Hillary Clinton defended the brutal rapist of a 12-year-old girl, and later cackled about it? Do you think they’ll discuss the Motion she filed in court that is filled with blatant lies, used to get her rapist-client free with a few months served in prison? Sure, Hillary was young, it was Arkansas, and there weren’t rape shield laws then … but doesn’t this tell us a whole lot more about power-hungry Mrs. Clinton?
Off topic. Please stick to the topic of Hobby Lobby and related issues.
BP
Actually, this is not “trumped up”. Holly Hobby’s policy excludes from coverage both of the IUDs. The Paraguard IUD is the only non hormonal means of contraception that comes even close to the < 1% effectiveness and so is the only statistically effective alternative for many women with serious medical conditions who cannot use a hormonal contraceptive.
Meanwhile, Obama pays women in the White House less than the men; raises in the WH were larger for the men than the women; and he plays golf predominantly with white Jewish men.
Hypocrisy?
TBD
Relevance to the Hobby Lobby decision ?
Hobby Lobby covers something like 16 of the 20 birth control options. This is just antoher hyped up non controversy for the War on Women Democrats to try and stir up their base.
for a non-controvery, it sure seems to have struck a nerve. and no, i don’t believe you can randomly drum up controversies to stire up the base – if you could, everyone would stir their base every election cycle and that simply doesn’t happen.
Yup. But this is how the Progressives gin up votes.
I mean, do you think they’ll have a serious discussion of how Hillary Clinton defended the brutal rapist of a 12-year-old girl, and later cackled about it? Do you think they’ll discuss the Motion she filed in court that is filled with blatant lies, used to get her rapist-client free with a few months served in prison? Sure, Hillary was young, it was Arkansas, and there weren’t rape shield laws then … but doesn’t this tell us a whole lot more about power-hungry Mrs. Clinton?
Off topic. Please stick to the topic of Hobby Lobby and related issues.
BP
Actually, this is not “trumped up”. Holly Hobby’s policy excludes from coverage both of the IUDs. The Paraguard IUD is the only non hormonal means of contraception that comes even close to the < 1% effectiveness and so is the only statistically effective alternative for many women with serious medical conditions who cannot use a hormonal contraceptive.
Meanwhile, Obama pays women in the White House less than the men; raises in the WH were larger for the men than the women; and he plays golf predominantly with white Jewish men.
Hypocrisy?
TBD
Relevance to the Hobby Lobby decision ?
“We should be afraid of this court, that five guys [are] determining what contraceptives are legal or not.
That court decision was a frightening one that five men should get down to the specifics of whether a woman should use a diaphragm and she should pay for it herself or her boss. It’s not her boss’s business.”
This from a liberal-loved California Democrat politician that was just recently 2 steps away from the job of President.
So male supreme court justices cannot help but be sexist in their decisions. From Megyn Kelly: When Roe v. Wade was decided it was all men in the majority. Does Miss Pelosi think those justices were ill-equipped to fairly decide that case?”
Nancy Pelosi is a sexist, lying, hypocrite, partisan, ignorant fool that somehow gets re-elected by the people of this once great state.
Maybe SCOTUS just needed to vote on the case so we could read it and see what was inside.
“So male supreme court justices cannot help but be sexist in their decisions. ”
i do think ideology rather than gender was the biggest factor. it so happens that the five male justices were also the politically most conservative on the court.
with that said, from a political stand point, they couldn’t have picked a worse time to stir up women voters. look at the voting difference from 2008 to 2010 to 2012 among women and how that impacted electoral outcomes.
“stir up women voters?”
Right DP, because those women are just so emotional and cannot think well enough for themselves to understand the facts and the truth. Let’s keep playing that play.
Do those on the left every get how denigrating and demeaning their constant gender, race and sexual class-ism arguments are?
Those little black and brown people, and those little poor people, and those little women and those little gays… they need constant defense from those big, bad conservative (white?) males. That is your party message over and over and over again.
It seems you are excusing Nancy Pelosi on this as just being political. That is similar to what we are hearing from the left about all of Obama’s lies and misdeeds. So the end justifies the means? No wonder we are at the highest levels of partisanship ever.
Let’s keep ginning up the war… class war, race war, gender war… you name it victim’s group wars. I wonder if women really like being put into a victim category? The ones I know don’t. But then maybe there are more Janeane Garofalo types than we know about.
“Right DP, because those women are just so emotional and cannot think well enough for themselves to understand the facts and the truth.”
i’m wondering if you didn’t misunderstand my point. women were angered by the outcome, women have been angry at the rhetoric on sexual assaults and other issues as well for some time. from a conservative stand point, this didn’t seem like an opportune time to anger a large constituency.
women are just so emotional? no more than the white males who go ballistic every time the gun issue comes up.
Hi Davis Progressive, I am a woman and am not angered by the outcome. In fact, I think it was the proper decision, based on the Constitution.
This whole Obamacare thing is a mess–telling employers that they have to provide insurance and that they have to cover certain products or procedures as part of that insurance. Why not let the free market take over? If people don’t like the insurance policy that one company has, they can work elsewhere. Why isn’t that OK anymore?
Because the “free market” was excluding millions of us from health coverage.
as don said, we tried the free market and it wasn’t working. i saw an article yesterday that the number of uninsured california’s has been cut in half in a less than a year.
8 – 10 million previously uninsured are now covered nationwide.
Dorte wrote:
> I am a woman and am not angered by the outcome.
> In fact, I think it was the proper decision, based on
> the Constitution.
I get why the press (both left and right) is all excited about this (a classic “wedge issue” that not only distracts the masses but aids in fundraising (donate to the blue team to protect women, and donate to the red team to protect the unborn).
I’m all for “freedom of religion” (and “freedom from religion”), but I don’t get why there is a big fuss about a company insurance policy paying for plan B (that is probably easier for most people to buy for $50 at Wal-Mart or Walgreens than take an hour to fill out a bunch of forms and hope you get your “insurance” to cover it).
Why is it OK to pay for condoms that a gay employee could “sin” with here in America or a straight employee could take to “sin” with on an underage sex trip to Thailand (pissing off most devout Christians “and” Progressive Atheists)?
If it is OK to stop paying for emergency contraception since someone “might” use it to have “what some call” an abortion it seems like it should be OK to stop paying all “non-believers” since they “might” take $50 of their pay and buy plan B for a niece who “might” use it after she is not sure what happened after she blacked out at the fraternity party…
“8 – 10 million previously uninsured are now covered nationwide.”
That’s flat out totally untrue.
Flat out completely provably true. Here’s just one of several articles on the topic, citing three different analyses that come to the same conclusion. http://www.latimes.com/business/la-fi-obamacare-uninsured-20140711-story.html You can find more.
Flat out lie.
I can find many article that prove the 8-10 million figure is a lie.
Here’s one:
http://dailysignal.com/2014/06/24/obamacare-exchanges-disappointing/
Shall I keep posting Don Shor, I can go on a long time.
Great link, since it proves what I said. I said ““8 – 10 million previously uninsured are now covered nationwide.”
You said it was “flat out totally untrue.”
You then posted a link that says:
So, the number of uninsured has dropped substantially because people are buying health insurance through the exchanges, and because of the expansion of Medicaid. Those were the main provisions of the Affordable Care Act.
My statement was true.
“The Daily Signal is supported by the resources and intellectual firepower of The Heritage Foundation”
can you find one not written by a publication that is backed by a right-wing think-tank?
Hi Don,
I was one of the millions that was excluded, and I haven’t signed up for Obamacare, so I am still excluded. Let me tell you how my thinking on this issue has evolved.
Before Obamacare, I looked at the problem theoretically. The available data I had (and I was less discerning then) was that other countries with national health care had in general lower medical costs and greater population health, or some such thing. From this I decided that a national health care system in this country would benefit me and all citizens. (I did not vote for President Obama, however.)
When Obamacare was passed with its special deals (such as exempting or subsidizing Congress and Congressional aides, whichever one it is), I realized what a mess we were going to be in. The President’s oft-repeated pledge, “If you like your health plan you can keep it, period,” is an example of a lie proffered to keep a politician and political party (the Democrats were only those who voted for it, as I remember) in power.
Now that Obamacare is up and (sort of) running, I don’t want to apply for it because I don’t want to be part of a big governmental system, especially one tied to/associated with others (like the IRS and the VA, respectively) in the midst of scandal.
However, as they say on the late-night commercials, “But wait; there’s more!”
When I expressed the above concerns to an assistant in John Garamendi’s office, she replied, “Don’t worry. That will be fixed when we get single-payer.” As it turns out, there is a provision in Obamacare (on one of however many thousands of pages) which states that a state can opt out if it comes up with a system which is as good.
On July 22, a group will be meeting in Winters to discuss the single-payer option. For information about that meeting, click on the following link:
http://www.davisenterprise.com/local-news/meeting-examines-single-payer-health-care-system/
I have spoken with the representatives of that group, who answered my questions and welcomed my participation. Whether or not single-payer would be better than Obamacare is beside the point. It should not have been hidden in Obamacare to begin with.
What I’m trying to say is that the United States may be a special case. Perhaps national health care works in other countries but would not work here. My immediate goal would be to get prices of medical care down–through the free market–so that people could better afford to pay for what they want.
Many factors complicate this. In the free market, we have insurance companies whose red tape makes the price of services go up, and we have lawyers whose threats of massive lawsuits make doctors want to perform every test (which makes patients think that they need them, which makes insurance rates go up, which also makes insurers want to drop clients costing them money). Government programs also complicate the picture, since Medicare and Medicaid compensate doctors less, so doctors have to charge uninsured people–like myself–more.
In other words, our health care system before Obamacare was a hybrid of the free market and the government, but after Obamacare it is much closer to the latter. Now that I see the problems there, I would like to reverse direction and move towards the free market again with the goal of correcting conditions which prompted the change to begin with.
Simply put, I don’t have an answer, but I don’t think that Obamacare is it.
Finally, to lead this comment back to the article in question, I don’t think that Obamacare mandates, when they infringe on religious liberty, are “it” either, and that’s what the Supreme Court ruled. Forgive me if my phrasing here (use of “it”) is a little vague, but this post is long, and I don’t have the time/energy to expound. If anyone is interested, let me know, and I’ll give it a crack later.
I’ll keep my reply simple. Before the ACA, I couldn’t get health insurance. Now I can. It’s a reasonable cost, and it covers what I need. The only reason I can get it now, and couldn’t before, is the ACA.
I don’t support single-payer, and certainly don’t expect to see it implemented in the United States in my lifetime.
The health insurance I purchased through the California health exchange is with a private insurer. The doctors that I go to are in a private health care group. There is no aspect of my coverage that is part of a “big governmental system,” except that the state of California set up and runs the health exchange I used. It was very easy to navigate. I suggest you check it out.
We have Kaiser through Covered California. Not Government in the least. In fact, ACA has allowed us to go from a government plan to Kaiser. The level of treatment is far superior.
Republicans Who Signed Up For Obamacare This Year Are Pretty Happy
Hi South of Davis,
Thanks for your response. The full text of the Hobby Lobby decision is here:
http://www.supremecourt.gov/opinions/13pdf/13-354_olp1.pdf
I have not read much of it, but I doubt that it is about “sin”, “emergency contraception”, or “abortion”. I believe it is about birth control, specifically the kind which the majority decribes as that which “may have the effect of preventing an already fertilized egg from developing any further by inhibiting its attachment to the uterus” (p. 2 in above link).
Discussion of this issue is difficult in part because people are unfamiliar with the meaning of terms. For reference, consider these definitions from the American Heritage Dictionary:
–contraception: prevention of conception, as by use of a device, drug, or chemical agent
–conception: formation of a viable zygote by the union of the male sperm and the female ovum; fertilization
–abortion: induced termination of pregnancy and expulsion of an embryo or fetus before it is viable
–pregnant: carrying developing offspring within the body
–embryo: an organism in its early stages of development, esp. before it has reached a distinctively recognizable form
Based on these definitions, the type of birth control Hobby Lobby objected to was not a contraceptive (since it did not prevent fertilization) and not an abortifacient (since that concerns an embryo, which I understand is what a fertilized egg is called after implantation). What this type of birth control is called I don’t know. Perhaps Tia does.
The fuzziness may come in part in the definition of pregnancy, which concerns “developing offspring”. Since the fertilized egg is developing but won’t develop further if it does not implant, I guess this is an example of someone being “somewhat pregnant” (which is something people laugh about and say can never occur).
The bottom line is that Hobby Lobby did not want to pay for any form of birth control which would (or might) prevent this implantation, since they believe that a fertilized egg is on the way to becoming a human being. Preventing implantation would arrest that course, so it would destroy the earliest form of human life, which is the fertilized egg.
I hope this helps!
wdf1 wrote:
> Republicans Who Signed Up For Obamacare This Year Are Pretty Happy
Like most changes the people who come out ahead are “pretty happy”. I have a Republican friend with failed kidneys (he goes to dialysis) and as a self employed software engineer with a big giant “pre-existing condition” he is VERY happy with Obamacare (despite the fact that he hates Obama). I have another healthy (vegan health nut) friend who is a proud Democrat (and left of Tia) but since his HSA with a $10K deductible is not allowed under Obamacare he is not happy that he is paying more, but he still (really) has the HOPE sticker on his Prius…
The Dems have to run on gender and other victim issues, as they can’t turn around our economy, VA, border, Benghazi, or IRS.
Pelosi recently had to recant all her lies she had said about the Hobby Lobby decision.
You also have the fool Harry Reid saying it was 5 white men who made the decision. It’s hard to believe that thse two fools actually have high position in running this country.
Agreed. They are the face of the Democrats these days. Sad that they appeal to anyone with a brain.
i just reading this morning an article in the wash post about elizabeth warren becoming the champion of progressive democrats. i read your comments and bp’s and don’t think you really understand the political landscape.
Harry Reid played the Race Card? No! Next you’ll tell me Eric Holder played it, too… opps, he did and does.
the funny thing is only conservatives care about harry reid.
It’s not that Harry Reid played the race card 9which he did) , it’s that it’s a lie that five old white men made the decision.
He’s enriched one of his sons, a lawyer who is now representing energy companies, as well as spending campaign monies on his granddaughter’s new jewelry line.
BP
“it’s a lie that five old white men made the decision.”
I am not understanding your comment. Who do you think made the majority decision ?
Think about it Tia Will, five old “white” men? It shows how out of touch Harry Reid is.
BP
Well now that depends on who is counted as “white” doesn’t it ? My ex -husband
was darker than most Hispanics I have met in skin tone, and yet considered himself
“white”. This is basically why forms allow self identification of racial make up.
Skin tone doesn’t tell the whole story.
And, besides, what exactly does Harry Reids ability to accurately discern racial composition have to do with this Supreme Court case. It was the decision of the
5 majority justices that I was commenting on , not Harry Reid’s opinion about which I care not at all.
Earth to Tia, Clarence Thomas is black. There’s no defending Harry Reid’s stupid comment.
I’m sure this is where Tia will probably come back and tell me that Clarence Thomas is white because in the liberal world up is down and black is white.
Barack Palin: no, Justice Thomas is clearly white because he enjoys driving his RV across our country.
Side note: Justice Thomas lived for a while, I believe, with womenfolk in his family, and was a bit coddled. He then went to live with his super-independent grandfather who was determined that no man own or control anything that impacted his existence. His first words to a young Clarence? “Vacations over, son.” I love that!
It’s who we identify with, also. It was difficult when I worked for W.I.C. because many do not want to self identify at all, & want to put R for refused when asked the race and ethnicity questions.
“We should be afraid of this court, that five guys [are] determining what contraceptives are legal or not.
That court decision was a frightening one that five men should get down to the specifics of whether a woman should use a diaphragm and she should pay for it herself or her boss. It’s not her boss’s business.”
This from a liberal-loved California Democrat politician that was just recently 2 steps away from the job of President.
So male supreme court justices cannot help but be sexist in their decisions. From Megyn Kelly: When Roe v. Wade was decided it was all men in the majority. Does Miss Pelosi think those justices were ill-equipped to fairly decide that case?”
Nancy Pelosi is a sexist, lying, hypocrite, partisan, ignorant fool that somehow gets re-elected by the people of this once great state.
Maybe SCOTUS just needed to vote on the case so we could read it and see what was inside.
“So male supreme court justices cannot help but be sexist in their decisions. ”
i do think ideology rather than gender was the biggest factor. it so happens that the five male justices were also the politically most conservative on the court.
with that said, from a political stand point, they couldn’t have picked a worse time to stir up women voters. look at the voting difference from 2008 to 2010 to 2012 among women and how that impacted electoral outcomes.
“stir up women voters?”
Right DP, because those women are just so emotional and cannot think well enough for themselves to understand the facts and the truth. Let’s keep playing that play.
Do those on the left every get how denigrating and demeaning their constant gender, race and sexual class-ism arguments are?
Those little black and brown people, and those little poor people, and those little women and those little gays… they need constant defense from those big, bad conservative (white?) males. That is your party message over and over and over again.
It seems you are excusing Nancy Pelosi on this as just being political. That is similar to what we are hearing from the left about all of Obama’s lies and misdeeds. So the end justifies the means? No wonder we are at the highest levels of partisanship ever.
Let’s keep ginning up the war… class war, race war, gender war… you name it victim’s group wars. I wonder if women really like being put into a victim category? The ones I know don’t. But then maybe there are more Janeane Garofalo types than we know about.
“Right DP, because those women are just so emotional and cannot think well enough for themselves to understand the facts and the truth.”
i’m wondering if you didn’t misunderstand my point. women were angered by the outcome, women have been angry at the rhetoric on sexual assaults and other issues as well for some time. from a conservative stand point, this didn’t seem like an opportune time to anger a large constituency.
women are just so emotional? no more than the white males who go ballistic every time the gun issue comes up.
Hi Davis Progressive, I am a woman and am not angered by the outcome. In fact, I think it was the proper decision, based on the Constitution.
This whole Obamacare thing is a mess–telling employers that they have to provide insurance and that they have to cover certain products or procedures as part of that insurance. Why not let the free market take over? If people don’t like the insurance policy that one company has, they can work elsewhere. Why isn’t that OK anymore?
Because the “free market” was excluding millions of us from health coverage.
as don said, we tried the free market and it wasn’t working. i saw an article yesterday that the number of uninsured california’s has been cut in half in a less than a year.
8 – 10 million previously uninsured are now covered nationwide.
Dorte wrote:
> I am a woman and am not angered by the outcome.
> In fact, I think it was the proper decision, based on
> the Constitution.
I get why the press (both left and right) is all excited about this (a classic “wedge issue” that not only distracts the masses but aids in fundraising (donate to the blue team to protect women, and donate to the red team to protect the unborn).
I’m all for “freedom of religion” (and “freedom from religion”), but I don’t get why there is a big fuss about a company insurance policy paying for plan B (that is probably easier for most people to buy for $50 at Wal-Mart or Walgreens than take an hour to fill out a bunch of forms and hope you get your “insurance” to cover it).
Why is it OK to pay for condoms that a gay employee could “sin” with here in America or a straight employee could take to “sin” with on an underage sex trip to Thailand (pissing off most devout Christians “and” Progressive Atheists)?
If it is OK to stop paying for emergency contraception since someone “might” use it to have “what some call” an abortion it seems like it should be OK to stop paying all “non-believers” since they “might” take $50 of their pay and buy plan B for a niece who “might” use it after she is not sure what happened after she blacked out at the fraternity party…
“8 – 10 million previously uninsured are now covered nationwide.”
That’s flat out totally untrue.
Flat out completely provably true. Here’s just one of several articles on the topic, citing three different analyses that come to the same conclusion. http://www.latimes.com/business/la-fi-obamacare-uninsured-20140711-story.html You can find more.
Flat out lie.
I can find many article that prove the 8-10 million figure is a lie.
Here’s one:
http://dailysignal.com/2014/06/24/obamacare-exchanges-disappointing/
Shall I keep posting Don Shor, I can go on a long time.
Great link, since it proves what I said. I said ““8 – 10 million previously uninsured are now covered nationwide.”
You said it was “flat out totally untrue.”
You then posted a link that says:
So, the number of uninsured has dropped substantially because people are buying health insurance through the exchanges, and because of the expansion of Medicaid. Those were the main provisions of the Affordable Care Act.
My statement was true.
“The Daily Signal is supported by the resources and intellectual firepower of The Heritage Foundation”
can you find one not written by a publication that is backed by a right-wing think-tank?
Hi Don,
I was one of the millions that was excluded, and I haven’t signed up for Obamacare, so I am still excluded. Let me tell you how my thinking on this issue has evolved.
Before Obamacare, I looked at the problem theoretically. The available data I had (and I was less discerning then) was that other countries with national health care had in general lower medical costs and greater population health, or some such thing. From this I decided that a national health care system in this country would benefit me and all citizens. (I did not vote for President Obama, however.)
When Obamacare was passed with its special deals (such as exempting or subsidizing Congress and Congressional aides, whichever one it is), I realized what a mess we were going to be in. The President’s oft-repeated pledge, “If you like your health plan you can keep it, period,” is an example of a lie proffered to keep a politician and political party (the Democrats were only those who voted for it, as I remember) in power.
Now that Obamacare is up and (sort of) running, I don’t want to apply for it because I don’t want to be part of a big governmental system, especially one tied to/associated with others (like the IRS and the VA, respectively) in the midst of scandal.
However, as they say on the late-night commercials, “But wait; there’s more!”
When I expressed the above concerns to an assistant in John Garamendi’s office, she replied, “Don’t worry. That will be fixed when we get single-payer.” As it turns out, there is a provision in Obamacare (on one of however many thousands of pages) which states that a state can opt out if it comes up with a system which is as good.
On July 22, a group will be meeting in Winters to discuss the single-payer option. For information about that meeting, click on the following link:
http://www.davisenterprise.com/local-news/meeting-examines-single-payer-health-care-system/
I have spoken with the representatives of that group, who answered my questions and welcomed my participation. Whether or not single-payer would be better than Obamacare is beside the point. It should not have been hidden in Obamacare to begin with.
What I’m trying to say is that the United States may be a special case. Perhaps national health care works in other countries but would not work here. My immediate goal would be to get prices of medical care down–through the free market–so that people could better afford to pay for what they want.
Many factors complicate this. In the free market, we have insurance companies whose red tape makes the price of services go up, and we have lawyers whose threats of massive lawsuits make doctors want to perform every test (which makes patients think that they need them, which makes insurance rates go up, which also makes insurers want to drop clients costing them money). Government programs also complicate the picture, since Medicare and Medicaid compensate doctors less, so doctors have to charge uninsured people–like myself–more.
In other words, our health care system before Obamacare was a hybrid of the free market and the government, but after Obamacare it is much closer to the latter. Now that I see the problems there, I would like to reverse direction and move towards the free market again with the goal of correcting conditions which prompted the change to begin with.
Simply put, I don’t have an answer, but I don’t think that Obamacare is it.
Finally, to lead this comment back to the article in question, I don’t think that Obamacare mandates, when they infringe on religious liberty, are “it” either, and that’s what the Supreme Court ruled. Forgive me if my phrasing here (use of “it”) is a little vague, but this post is long, and I don’t have the time/energy to expound. If anyone is interested, let me know, and I’ll give it a crack later.
I’ll keep my reply simple. Before the ACA, I couldn’t get health insurance. Now I can. It’s a reasonable cost, and it covers what I need. The only reason I can get it now, and couldn’t before, is the ACA.
I don’t support single-payer, and certainly don’t expect to see it implemented in the United States in my lifetime.
The health insurance I purchased through the California health exchange is with a private insurer. The doctors that I go to are in a private health care group. There is no aspect of my coverage that is part of a “big governmental system,” except that the state of California set up and runs the health exchange I used. It was very easy to navigate. I suggest you check it out.
We have Kaiser through Covered California. Not Government in the least. In fact, ACA has allowed us to go from a government plan to Kaiser. The level of treatment is far superior.
Republicans Who Signed Up For Obamacare This Year Are Pretty Happy
Hi South of Davis,
Thanks for your response. The full text of the Hobby Lobby decision is here:
http://www.supremecourt.gov/opinions/13pdf/13-354_olp1.pdf
I have not read much of it, but I doubt that it is about “sin”, “emergency contraception”, or “abortion”. I believe it is about birth control, specifically the kind which the majority decribes as that which “may have the effect of preventing an already fertilized egg from developing any further by inhibiting its attachment to the uterus” (p. 2 in above link).
Discussion of this issue is difficult in part because people are unfamiliar with the meaning of terms. For reference, consider these definitions from the American Heritage Dictionary:
–contraception: prevention of conception, as by use of a device, drug, or chemical agent
–conception: formation of a viable zygote by the union of the male sperm and the female ovum; fertilization
–abortion: induced termination of pregnancy and expulsion of an embryo or fetus before it is viable
–pregnant: carrying developing offspring within the body
–embryo: an organism in its early stages of development, esp. before it has reached a distinctively recognizable form
Based on these definitions, the type of birth control Hobby Lobby objected to was not a contraceptive (since it did not prevent fertilization) and not an abortifacient (since that concerns an embryo, which I understand is what a fertilized egg is called after implantation). What this type of birth control is called I don’t know. Perhaps Tia does.
The fuzziness may come in part in the definition of pregnancy, which concerns “developing offspring”. Since the fertilized egg is developing but won’t develop further if it does not implant, I guess this is an example of someone being “somewhat pregnant” (which is something people laugh about and say can never occur).
The bottom line is that Hobby Lobby did not want to pay for any form of birth control which would (or might) prevent this implantation, since they believe that a fertilized egg is on the way to becoming a human being. Preventing implantation would arrest that course, so it would destroy the earliest form of human life, which is the fertilized egg.
I hope this helps!
wdf1 wrote:
> Republicans Who Signed Up For Obamacare This Year Are Pretty Happy
Like most changes the people who come out ahead are “pretty happy”. I have a Republican friend with failed kidneys (he goes to dialysis) and as a self employed software engineer with a big giant “pre-existing condition” he is VERY happy with Obamacare (despite the fact that he hates Obama). I have another healthy (vegan health nut) friend who is a proud Democrat (and left of Tia) but since his HSA with a $10K deductible is not allowed under Obamacare he is not happy that he is paying more, but he still (really) has the HOPE sticker on his Prius…
The Dems have to run on gender and other victim issues, as they can’t turn around our economy, VA, border, Benghazi, or IRS.
Pelosi recently had to recant all her lies she had said about the Hobby Lobby decision.
You also have the fool Harry Reid saying it was 5 white men who made the decision. It’s hard to believe that thse two fools actually have high position in running this country.
Agreed. They are the face of the Democrats these days. Sad that they appeal to anyone with a brain.
i just reading this morning an article in the wash post about elizabeth warren becoming the champion of progressive democrats. i read your comments and bp’s and don’t think you really understand the political landscape.
Harry Reid played the Race Card? No! Next you’ll tell me Eric Holder played it, too… opps, he did and does.
the funny thing is only conservatives care about harry reid.
It’s not that Harry Reid played the race card 9which he did) , it’s that it’s a lie that five old white men made the decision.
He’s enriched one of his sons, a lawyer who is now representing energy companies, as well as spending campaign monies on his granddaughter’s new jewelry line.
BP
“it’s a lie that five old white men made the decision.”
I am not understanding your comment. Who do you think made the majority decision ?
Think about it Tia Will, five old “white” men? It shows how out of touch Harry Reid is.
BP
Well now that depends on who is counted as “white” doesn’t it ? My ex -husband
was darker than most Hispanics I have met in skin tone, and yet considered himself
“white”. This is basically why forms allow self identification of racial make up.
Skin tone doesn’t tell the whole story.
And, besides, what exactly does Harry Reids ability to accurately discern racial composition have to do with this Supreme Court case. It was the decision of the
5 majority justices that I was commenting on , not Harry Reid’s opinion about which I care not at all.
Earth to Tia, Clarence Thomas is black. There’s no defending Harry Reid’s stupid comment.
I’m sure this is where Tia will probably come back and tell me that Clarence Thomas is white because in the liberal world up is down and black is white.
Barack Palin: no, Justice Thomas is clearly white because he enjoys driving his RV across our country.
Side note: Justice Thomas lived for a while, I believe, with womenfolk in his family, and was a bit coddled. He then went to live with his super-independent grandfather who was determined that no man own or control anything that impacted his existence. His first words to a young Clarence? “Vacations over, son.” I love that!
It’s who we identify with, also. It was difficult when I worked for W.I.C. because many do not want to self identify at all, & want to put R for refused when asked the race and ethnicity questions.
Women are not served well by political conservatives. It is about control and domination of women. Women, thank goodness, are becoming wiser and more independent in how they vote.
Ryan you drink the Kool Aide well. I think you might actually own a lot of stock in the company that makes it.
Women are not served well by Democrats. Just like they are not served well by NOW. They are exploited by both for political power. And the left media exploits the gender conflict for money.
Survey after survey has confirmed that conservative women are much happier than are those that those on the left. Why do you think that is?
I question the validity of these surveys & also wonder how a person’s feelings can be quantified in a survey. Do they ask the woman to sign her name to the survey? How large was the survey? Where was the survey taken?
Sorry about the Kool aid comment. But please don’t just mouth partisan talking points without any thought behind it.
The issue of abortion and woman’s rights is a convoluted ginned up topic stuck in a political war but that deserves greater social dialogue. There are valid moral arguments on both sides. Democrats that exploit it as a political conflict should be ashamed.
it’s funny. above you said, “because those women are just so emotional and cannot think well enough for themselves” but you’re comment, “The issue of abortion and woman’s rights is a convoluted ginned up topic.” seems like you believe that yourself.
DP – you need to take a class on sarcasm.
I was reflecting the Democrat position on women.
sarcasm relies on non-verbal indicators and therefore doesn’t translate well to the written format.
that said, i think the republicans have to re-think their strategy, white males are no longer a majority of voters in this country.
But they won’t give it up, because they have no idea how to run an economy … which is to get out of the way of the Free Market wherever possible.
Frankly
“Democrats that exploit it as a political conflict should be ashamed.”
But Republicans who exploit it as a optical conflict should not be ?”
Please correct me if I am misunderstanding you.
Women are not served well by political conservatives. It is about control and domination of women. Women, thank goodness, are becoming wiser and more independent in how they vote.
Ryan you drink the Kool Aide well. I think you might actually own a lot of stock in the company that makes it.
Women are not served well by Democrats. Just like they are not served well by NOW. They are exploited by both for political power. And the left media exploits the gender conflict for money.
Survey after survey has confirmed that conservative women are much happier than are those that those on the left. Why do you think that is?
I question the validity of these surveys & also wonder how a person’s feelings can be quantified in a survey. Do they ask the woman to sign her name to the survey? How large was the survey? Where was the survey taken?
Sorry about the Kool aid comment. But please don’t just mouth partisan talking points without any thought behind it.
The issue of abortion and woman’s rights is a convoluted ginned up topic stuck in a political war but that deserves greater social dialogue. There are valid moral arguments on both sides. Democrats that exploit it as a political conflict should be ashamed.
it’s funny. above you said, “because those women are just so emotional and cannot think well enough for themselves” but you’re comment, “The issue of abortion and woman’s rights is a convoluted ginned up topic.” seems like you believe that yourself.
DP – you need to take a class on sarcasm.
I was reflecting the Democrat position on women.
sarcasm relies on non-verbal indicators and therefore doesn’t translate well to the written format.
that said, i think the republicans have to re-think their strategy, white males are no longer a majority of voters in this country.
But they won’t give it up, because they have no idea how to run an economy … which is to get out of the way of the Free Market wherever possible.
Frankly
“Democrats that exploit it as a political conflict should be ashamed.”
But Republicans who exploit it as a optical conflict should not be ?”
Please correct me if I am misunderstanding you.
I don’t believe that independent women who do not subscribe to roles dictated by their religious beliefs want others to make medical choices for them. Maybe conservative women survey better because the population is smaller than that of women on the left which encompasses greater diversity and life experience. Don’t believe for an instant that forcing the religious beliefs on others will result in their happiness. This argument is offensive and typical of the religious right.
http://nypost.com/2013/12/27/conservative-women-hold-secret-to-happiness/
Women in the United States have long reported greater levels of happiness than men. Their advantage has, however, been shrinking, and for an unhappy reason: falling happiness among women.
Yes, at the same time that NOW has succeeded in getting women everything that NOW says they want.
Over the last 40 years, women who describe themselves as “conservative” have been more likely than women to their left to say they are “very happy,” and those who say they are “extremely conservative” have been happier still. Over the same period, conservatives in general have held the same pattern: Righty men, too, have been happier than their more liberal counterparts. So maybe the last two presidential elections should be seen as a victory for the redistribution of happiness as well as income.
And then this raises the obvious questions: Are people more likely to be unhappy because they are liberal, or does the ideology of liberalism attract more unhappy people?
And somewhat related to this, if we could somehow change the thinking of some liberals to be more conservative, maybe the world would be a happier place.
Really, how happy does W seem compared to Obama? Obama only seems happy on the golf course and away from Michele. What about Mr. grumpy Harry Reid? And Nancy Pelosi (Pelosi has a perpetual smile from Botox… but her words are anything but happy most of the time).
In the 70’s I imagined a world where men & women would share housework evenly. I think many members of N.O.W. imagined that would happen in their future.
Frankly
” how happy does W seem compared to Obama? Obama only seems happy on the golf course and away from Michele. What about Mr. grumpy Harry Reid? And Nancy Pelosi (Pelosi has a perpetual smile from Botox… but her words are anything but happy most of the time).
I am really having a hard time seeing how this has any relevance to the topic of my article.
Perhaps you can tie the two together ?
Sometimes, not always, conservative women can get out and vote with more ease because they can have someone else watch their children for a while, to wait in line to vote. I wonder how the voting has turned out in areas where people can vote on Saturday. I also wonder what will happen when people can vote olline, using their cell phones.
Maybe a certain percentage of wealthy conservative women don’t have as many accidental pregnancies because their hubbies work extremely long hours to provide a lavish lifestyle, the women can afford their expensive private OB/GYN’s, and they can afford to tell their very well providing hubbies they “have a headache” and practice abstinence during their fertile months. Maybe some of them enjoy pilates, shopping @ Nordy’s, cocktails at the club with their girlfriends, book club wine parties, and other activities as much as they enjoy sex. So maybe they are a little more content, after their dip in the spa, and mani & pedi appointment. Maybe a few of ther hubbies don’t mind because they have a younger, prettier make & model of the same trophy wife and that younger woman is the hubby’s mistress.
Maybe.
Maybe not.
D.D.–there are plenty of liberal guys who lead such a lifestyle as well, as played out by the Hollywood crowd! The difference is that the conservatives will put the guilty-dog mantle on their face before going to sex-addict rehab; whereas the liberals will first go to counseling to excorcise their guilty feelings (whether fake or real) before going to sex-addict rehab (where they might meet some babes!)
Wow, D.D.! That’s a lot of fantasizing there.
I don’t believe that independent women who do not subscribe to roles dictated by their religious beliefs want others to make medical choices for them. Maybe conservative women survey better because the population is smaller than that of women on the left which encompasses greater diversity and life experience. Don’t believe for an instant that forcing the religious beliefs on others will result in their happiness. This argument is offensive and typical of the religious right.
http://nypost.com/2013/12/27/conservative-women-hold-secret-to-happiness/
Women in the United States have long reported greater levels of happiness than men. Their advantage has, however, been shrinking, and for an unhappy reason: falling happiness among women.
Yes, at the same time that NOW has succeeded in getting women everything that NOW says they want.
Over the last 40 years, women who describe themselves as “conservative” have been more likely than women to their left to say they are “very happy,” and those who say they are “extremely conservative” have been happier still. Over the same period, conservatives in general have held the same pattern: Righty men, too, have been happier than their more liberal counterparts. So maybe the last two presidential elections should be seen as a victory for the redistribution of happiness as well as income.
And then this raises the obvious questions: Are people more likely to be unhappy because they are liberal, or does the ideology of liberalism attract more unhappy people?
And somewhat related to this, if we could somehow change the thinking of some liberals to be more conservative, maybe the world would be a happier place.
Really, how happy does W seem compared to Obama? Obama only seems happy on the golf course and away from Michele. What about Mr. grumpy Harry Reid? And Nancy Pelosi (Pelosi has a perpetual smile from Botox… but her words are anything but happy most of the time).
In the 70’s I imagined a world where men & women would share housework evenly. I think many members of N.O.W. imagined that would happen in their future.
Frankly
” how happy does W seem compared to Obama? Obama only seems happy on the golf course and away from Michele. What about Mr. grumpy Harry Reid? And Nancy Pelosi (Pelosi has a perpetual smile from Botox… but her words are anything but happy most of the time).
I am really having a hard time seeing how this has any relevance to the topic of my article.
Perhaps you can tie the two together ?
Sometimes, not always, conservative women can get out and vote with more ease because they can have someone else watch their children for a while, to wait in line to vote. I wonder how the voting has turned out in areas where people can vote on Saturday. I also wonder what will happen when people can vote olline, using their cell phones.
Maybe a certain percentage of wealthy conservative women don’t have as many accidental pregnancies because their hubbies work extremely long hours to provide a lavish lifestyle, the women can afford their expensive private OB/GYN’s, and they can afford to tell their very well providing hubbies they “have a headache” and practice abstinence during their fertile months. Maybe some of them enjoy pilates, shopping @ Nordy’s, cocktails at the club with their girlfriends, book club wine parties, and other activities as much as they enjoy sex. So maybe they are a little more content, after their dip in the spa, and mani & pedi appointment. Maybe a few of ther hubbies don’t mind because they have a younger, prettier make & model of the same trophy wife and that younger woman is the hubby’s mistress.
Maybe.
Maybe not.
D.D.–there are plenty of liberal guys who lead such a lifestyle as well, as played out by the Hollywood crowd! The difference is that the conservatives will put the guilty-dog mantle on their face before going to sex-addict rehab; whereas the liberals will first go to counseling to excorcise their guilty feelings (whether fake or real) before going to sex-addict rehab (where they might meet some babes!)
Wow, D.D.! That’s a lot of fantasizing there.
This ruling is extremely broad in its potential effects and could be a major political liability for Republicans.
Dozens of other companies are already ready to stop covering contraception. The Supreme Court clarified that the ruling applies to all contraception, not just the supposed “abortifacients.”
It could extend to any number of other discriminations employers choose to apply based on ‘religious beliefs’.
As a work-around, it increases the likelihood that taxpayers will end up funding contraception. It isn’t clear to me why that is morally acceptable to these plaintiffs.
Why is this perceived as especially targeted at women? Well, they are the major consumers of contraception products. Contraceptive health services are basic health care for women. Health insurance that doesn’t cover contraception doesn’t cover the most common health care that women seek.
Here’s the context of the ‘war on women’ narrative.
There has been, in the last 3 to 4 years, a major increase in the number of state laws seeking to restrict access to abortion. By one source: 22 states, 70 different restrictions in three years. There are some states where you would have to go hundreds of miles to attain an abortion, even within the legal timeframe established by Roe v Wade.
The Supreme Court has eliminated the buffer zones around abortion clinics, allowing harassment of women seeking a legal abortion.
States have tried to restrict access to emergency contraception. Oklahoma’s latest attempt was just blocked by a state judge. I’m guessing the Supreme Court will have to rule on this issue several more times.
Some states have tried to exclude emergency contraception from their Medicaid coverage.
Some states allow pharmacists to refuse to dispense them.
It is an unrelenting pattern of seeking to put up roadblocks to women who are seeking contraception and abortion services.
And now, refusing to fund them at the place of work, based on nebulous religious beliefs. Some contraceptives, but not others? Hobby Lobby was objecting to copper IUD’s, to Plan B pills, to ella pills, to hormonal IUD’s. None of those are abortion pills. RU-486 is the abortion pill.
They are objecting to highly effective birth control methods that do not, repeat do NOT, cause abortion. If there is something in their religion that says altering the body’s hormones or changing the lining of the uterus violates their religious principles, I’d be very curious what it is. They’re Assemblies of God, which I guess is biblical literalist. I don’t recall that much about hormones and uteruses in the Bible. More to the point: it’s none of their business. And it has created a fearsome precedent that will be tested over and over again.
“Perceived at targeting at women”
Because folks like you and Nancy Pelosi are well served politically ginning up this false war on women.
“Nebulous religious beliefs”
Yup, just like banning plastic bags.
I don’t understand your plastic bag reference.
‘War on women’ may be inflated rhetoric (gee, how unusual is that? Is there a “war on Christmas?”). But the disproportional impact of these decisions and laws is adverse to women’s health care and their freedom to control their own reproduction. You simply cannot deny that.
It’s not false.
“War on Christmas” Christmas is a benign non-voting entity. And it is true.
“War on women” is a political wedge from the left. And it is not true.
I also don’t understand why conservatives get so unhinged about Nancy Pelosi. What bothers them about her, as compared to strongly ideological politicians elsewhere in the House and Senate, I do not understand. She’s a liberal from the Bay Area. Surprise! There are lots of them. And lots of off-the-wall conservatives from some states. There seems to be a special venom reserved just for Pelosi. It almost seems, I dunno, emotional or something.
Are you kidding. “We need to vote for Obamacare so we can see what is in it.”
“The Tea Party people are Nazis.”
“Right wing extremists shot Gabby Gifford.”
“Five guys on SCOTUS are sexist and wage war on women.”
All those quotes are reasonable approximations of what she said. And there is tons more.
What is absurd to me that so many smart people from any political stripe actually support her. She epitomizes what is wrong with Washington.
She is supported by a small congressional district in San Francisco. She has worked her way up the ladder of seniority to her position in the House, just as John Boehner did. I could find any number of absurd quotations from members of Congress across the political spectrum. I don’t think any of the current congressional leaders — Boehner or Pelosi, Reid or McConnell — are particularly astute or articulate or effective leaders. She no more “epitomizes what is wrong with Washington” than do any of the others. Perhaps if your hostility was more broadly directed to congressional leaders of both parties, I’d find it more reasonable.
Maybe Nancy P. reminds them of a classy older woman who tried to teach them proper manners and who was extremely intelligent & patient. She reminds them of a school teacher who tried to help them by teaching them how to be articulate, to “use their words”…proper debating skills. That’s my guess.
Maybe a tiny percentage don’t perceive her as having the right “looks” to be in front of the camera, but they are probably embarrassed to admit that.
Don
Thank you for your clear and concise summary of the legal attempts to block women’s exercise of their right to choose the best medical preventive services available to them.
What is being missed is that all health care providers and all pro life individuals want the same thing. We want there to be as few abortions as possible. What the “pro lifers” are over looking is that the single best way to prevent an abortion is to prevent the pregnancy. By limiting or making more difficulty pregnancy prevention, they are actually contributing to the number of abortions. How ironic !
Tia.
Very much in agreement. Ironic indeed.
This ruling is extremely broad in its potential effects and could be a major political liability for Republicans.
Dozens of other companies are already ready to stop covering contraception. The Supreme Court clarified that the ruling applies to all contraception, not just the supposed “abortifacients.”
It could extend to any number of other discriminations employers choose to apply based on ‘religious beliefs’.
As a work-around, it increases the likelihood that taxpayers will end up funding contraception. It isn’t clear to me why that is morally acceptable to these plaintiffs.
Why is this perceived as especially targeted at women? Well, they are the major consumers of contraception products. Contraceptive health services are basic health care for women. Health insurance that doesn’t cover contraception doesn’t cover the most common health care that women seek.
Here’s the context of the ‘war on women’ narrative.
There has been, in the last 3 to 4 years, a major increase in the number of state laws seeking to restrict access to abortion. By one source: 22 states, 70 different restrictions in three years. There are some states where you would have to go hundreds of miles to attain an abortion, even within the legal timeframe established by Roe v Wade.
The Supreme Court has eliminated the buffer zones around abortion clinics, allowing harassment of women seeking a legal abortion.
States have tried to restrict access to emergency contraception. Oklahoma’s latest attempt was just blocked by a state judge. I’m guessing the Supreme Court will have to rule on this issue several more times.
Some states have tried to exclude emergency contraception from their Medicaid coverage.
Some states allow pharmacists to refuse to dispense them.
It is an unrelenting pattern of seeking to put up roadblocks to women who are seeking contraception and abortion services.
And now, refusing to fund them at the place of work, based on nebulous religious beliefs. Some contraceptives, but not others? Hobby Lobby was objecting to copper IUD’s, to Plan B pills, to ella pills, to hormonal IUD’s. None of those are abortion pills. RU-486 is the abortion pill.
They are objecting to highly effective birth control methods that do not, repeat do NOT, cause abortion. If there is something in their religion that says altering the body’s hormones or changing the lining of the uterus violates their religious principles, I’d be very curious what it is. They’re Assemblies of God, which I guess is biblical literalist. I don’t recall that much about hormones and uteruses in the Bible. More to the point: it’s none of their business. And it has created a fearsome precedent that will be tested over and over again.
“Perceived at targeting at women”
Because folks like you and Nancy Pelosi are well served politically ginning up this false war on women.
“Nebulous religious beliefs”
Yup, just like banning plastic bags.
I don’t understand your plastic bag reference.
‘War on women’ may be inflated rhetoric (gee, how unusual is that? Is there a “war on Christmas?”). But the disproportional impact of these decisions and laws is adverse to women’s health care and their freedom to control their own reproduction. You simply cannot deny that.
It’s not false.
“War on Christmas” Christmas is a benign non-voting entity. And it is true.
“War on women” is a political wedge from the left. And it is not true.
I also don’t understand why conservatives get so unhinged about Nancy Pelosi. What bothers them about her, as compared to strongly ideological politicians elsewhere in the House and Senate, I do not understand. She’s a liberal from the Bay Area. Surprise! There are lots of them. And lots of off-the-wall conservatives from some states. There seems to be a special venom reserved just for Pelosi. It almost seems, I dunno, emotional or something.
Are you kidding. “We need to vote for Obamacare so we can see what is in it.”
“The Tea Party people are Nazis.”
“Right wing extremists shot Gabby Gifford.”
“Five guys on SCOTUS are sexist and wage war on women.”
All those quotes are reasonable approximations of what she said. And there is tons more.
What is absurd to me that so many smart people from any political stripe actually support her. She epitomizes what is wrong with Washington.
She is supported by a small congressional district in San Francisco. She has worked her way up the ladder of seniority to her position in the House, just as John Boehner did. I could find any number of absurd quotations from members of Congress across the political spectrum. I don’t think any of the current congressional leaders — Boehner or Pelosi, Reid or McConnell — are particularly astute or articulate or effective leaders. She no more “epitomizes what is wrong with Washington” than do any of the others. Perhaps if your hostility was more broadly directed to congressional leaders of both parties, I’d find it more reasonable.
Maybe Nancy P. reminds them of a classy older woman who tried to teach them proper manners and who was extremely intelligent & patient. She reminds them of a school teacher who tried to help them by teaching them how to be articulate, to “use their words”…proper debating skills. That’s my guess.
Maybe a tiny percentage don’t perceive her as having the right “looks” to be in front of the camera, but they are probably embarrassed to admit that.
Don
Thank you for your clear and concise summary of the legal attempts to block women’s exercise of their right to choose the best medical preventive services available to them.
What is being missed is that all health care providers and all pro life individuals want the same thing. We want there to be as few abortions as possible. What the “pro lifers” are over looking is that the single best way to prevent an abortion is to prevent the pregnancy. By limiting or making more difficulty pregnancy prevention, they are actually contributing to the number of abortions. How ironic !
Tia.
Very much in agreement. Ironic indeed.
At the risk of being referred to as “ignorant” or a “fool” by certain individuals who eschew civil discourse in favor of name-calling, the Supreme Court’s Hobby Lobby decision is one that should be a cause of concern for anyone who values individual rights, including privacy rights and religious freedom. Despite protestations from the Court majority, the decision recognizes the right of corporations (and those who run them) to impose their religious beliefs on their employees. Corporations can determine to provide medical benefits only to the extent that those benefits are used in a manner consistent with ownership’s religious beliefs—thereby intruding into what should be the private and personal healthcare choices of its employees. The decision opens the door to other impositions of “corporate” religious beliefs on individuals—e.g., religious opposition to all means of birth control, to transfusions, to any medical intervention. I, for one, am very concerned with this step down the road to theocracy.
“the decision recognizes the right of corporations (and those who run them) to impose their religious beliefs on their employees.”
Nice way to frame the argument incorrectly.
Working for a corporation is not a right. Any employee can choose to not apply or quit and work somewhere else. A corporation is a separate taxed entity, but they are simply businesses started by and owned by individuals. And individuals have principles and beliefs that they have a right to hold. As long as there is no material harm done, we should celebrate and support the freedom to have and hold individual principles and beliefs, and the rights of free association.
And your use of the term “religion” in this context is quite disturbing and demonstrates some bias. What about a company owned by Godless liberals that demand that no employee can bring any plastic bags to work? I have a guess that you would fully support that erosion of rights.
“Step down the road to theocracy” LOL. Sure… we are heading toward a church-state if you consider liberalism a religion. I actually do think it fills a spiritual need for many atheists, and so maybe we should look it as a religion and stop the march toward a theocracy of liberalism.
What the Supreme Court has said, in effect, is that corporations can enact policies against one sub-set of their workers based on scientifically illiterate or inaccurate beliefs (they have a right to be ignorant) simply because they can claim a religious basis to those beliefs.
They can do this regardless of the burden that it may impose on their workers, because evidently (said Alito) the government can provide the necessary services or products. For some reason, he seemed to believe that this was a limited ruling, in spite of how obviously broad its application could be.
And they have extended the principle that a corporation has these human rights, even though a corporation can’t hold a specific set of beliefs if there is more than a single owner. Do you and your spouse or business partner agree on all theological principles and practices? The right of an individual to act on their beliefs is valid. But a corporation should have no such right. Unfortunately, the rights granted to corporations keep getting expanded by this Court.
Frankly
” As long as there is no material harm done”
But there is great chance of material harm in limiting a woman’s right to choose her form of contraception, or to make it effectively unavailable to her.
Let me give you a real life example from my clinic.
I have a young woman ( under 35) who has been diagnosed with breast cancer. She is in need of highly statistically effective contraception while she completes her chemotherapy.
If she goes into remission, she would be a candidate for pregnancy in the future.
The only highly statistically effective and non hormonal means of contraception available to her is the Paraguard IUD, which because some people’s religion, not scientific fact determines this to be an abortifacient, it would not be covered by her insurance.
I am very disturbed that the Supreme Court has decided that the religion of employers is of more relevance to the covered form of birth control than the religion of the woman herself.
My patient and I had a long conversation about the mechanism of action of the Paraguard IUD which is primarily to induce what is termed a hostile cervical mucous through which sperm cannot penetrate, far from inducing an abortion it prevent sperm and egg from getting together. She was very clear that this was acceptable to her and we agreed as doctor and patient that this was by far her best option.
How do you see preventing her from easily accessing this potentially life saving means of birth control as “no material harm” ?
Tia, there seem to be several missing points here.
1. Condoms. Condoms have worked for centuries. I believe the failure rate of condoms also includes those that decide to forgo them once in a while, or buy cheap versions. Let’s also just say that if the user “checks the method” before the conclusion, that also helps. (No tears, hasn’t broken.)
2. Making public healthy policy based on an “outlying” case seems like a bad move. To make police based on the .1 % of those insured doesn’t seem wise.
3. She can’t pay for this method herself?
4. Since you have repeatedly stated that you (and other doctors) and significantly overpaid, can’t you eliminate your profit with this patient? That would help her defray costs.
Thanks, that gave me a good laugh this morning. I hope you’re not relying on them, though. Tia can address this in more detail.
TBD
I am happy to address your points.
1) First with regard to condoms, they are a good means of prevention of sexually transmissible diseases. As contraceptives they are of low statistical efficacy. Of 100 couples between the ages of 18 and 35 ( woman’s age)
using condoms as their only means of contraception ( consistently and as recommended) 20 will have conceived within one year. That is 1/5.
What I tell my patient’s is that if that is an acceptable odds for them, that is fine. If they want more statistical efficacy, they need to choose another means.
2) When you add up all the woman for whom a pregnancy would be medially dangerous including those with cancer, those with diabetes, hypertension, bleeding disorders, severe asthma, clotting abnormalities,
seizure disorders, morbid obesity….we are no longer just talking about
“outliers”. One other thing that I neglected to mention in my article is that the Mirena IUD is frequently used for non contraceptive health purposes such as control of excessively heavy menstrual bleeding leading to anemia, disabling menstrual cramps ( think time lost from work),
and some forms of overgrowth conditions of the lining of the uterus.
So in effect, this erroneous religious view of what the Mirena IUD does and does not do could prevent women from obtaining it regardless of whether they are even sexually active. I find this kind of employer control over women’s medical decisions deeply disturbing.
3) The cost of the IUD itself is typically around $800.00. I am quite sure that is beyond the means of many woman who would be working for a store like Hobby Lobby.
4) No, unless one is working in fee for service medicine, which I am not, I get no profit from placing or not placing a patient’s IUD. Since I work for Kaiser, I am salaried. Since under Kaiser policy, an IUD is considered preventative, the vast majority of women will pay nothing but their copay which for my services is typically between 0 -$25.00. So the answer is no,
I honestly don’t see how I can affect the woman’s nominal payment of
$25.00 for 5 years worth of prevention and / or treatment.
At the risk of being referred to as “ignorant” or a “fool” by certain individuals who eschew civil discourse in favor of name-calling, the Supreme Court’s Hobby Lobby decision is one that should be a cause of concern for anyone who values individual rights, including privacy rights and religious freedom. Despite protestations from the Court majority, the decision recognizes the right of corporations (and those who run them) to impose their religious beliefs on their employees. Corporations can determine to provide medical benefits only to the extent that those benefits are used in a manner consistent with ownership’s religious beliefs—thereby intruding into what should be the private and personal healthcare choices of its employees. The decision opens the door to other impositions of “corporate” religious beliefs on individuals—e.g., religious opposition to all means of birth control, to transfusions, to any medical intervention. I, for one, am very concerned with this step down the road to theocracy.
“the decision recognizes the right of corporations (and those who run them) to impose their religious beliefs on their employees.”
Nice way to frame the argument incorrectly.
Working for a corporation is not a right. Any employee can choose to not apply or quit and work somewhere else. A corporation is a separate taxed entity, but they are simply businesses started by and owned by individuals. And individuals have principles and beliefs that they have a right to hold. As long as there is no material harm done, we should celebrate and support the freedom to have and hold individual principles and beliefs, and the rights of free association.
And your use of the term “religion” in this context is quite disturbing and demonstrates some bias. What about a company owned by Godless liberals that demand that no employee can bring any plastic bags to work? I have a guess that you would fully support that erosion of rights.
“Step down the road to theocracy” LOL. Sure… we are heading toward a church-state if you consider liberalism a religion. I actually do think it fills a spiritual need for many atheists, and so maybe we should look it as a religion and stop the march toward a theocracy of liberalism.
What the Supreme Court has said, in effect, is that corporations can enact policies against one sub-set of their workers based on scientifically illiterate or inaccurate beliefs (they have a right to be ignorant) simply because they can claim a religious basis to those beliefs.
They can do this regardless of the burden that it may impose on their workers, because evidently (said Alito) the government can provide the necessary services or products. For some reason, he seemed to believe that this was a limited ruling, in spite of how obviously broad its application could be.
And they have extended the principle that a corporation has these human rights, even though a corporation can’t hold a specific set of beliefs if there is more than a single owner. Do you and your spouse or business partner agree on all theological principles and practices? The right of an individual to act on their beliefs is valid. But a corporation should have no such right. Unfortunately, the rights granted to corporations keep getting expanded by this Court.
Frankly
” As long as there is no material harm done”
But there is great chance of material harm in limiting a woman’s right to choose her form of contraception, or to make it effectively unavailable to her.
Let me give you a real life example from my clinic.
I have a young woman ( under 35) who has been diagnosed with breast cancer. She is in need of highly statistically effective contraception while she completes her chemotherapy.
If she goes into remission, she would be a candidate for pregnancy in the future.
The only highly statistically effective and non hormonal means of contraception available to her is the Paraguard IUD, which because some people’s religion, not scientific fact determines this to be an abortifacient, it would not be covered by her insurance.
I am very disturbed that the Supreme Court has decided that the religion of employers is of more relevance to the covered form of birth control than the religion of the woman herself.
My patient and I had a long conversation about the mechanism of action of the Paraguard IUD which is primarily to induce what is termed a hostile cervical mucous through which sperm cannot penetrate, far from inducing an abortion it prevent sperm and egg from getting together. She was very clear that this was acceptable to her and we agreed as doctor and patient that this was by far her best option.
How do you see preventing her from easily accessing this potentially life saving means of birth control as “no material harm” ?
Tia, there seem to be several missing points here.
1. Condoms. Condoms have worked for centuries. I believe the failure rate of condoms also includes those that decide to forgo them once in a while, or buy cheap versions. Let’s also just say that if the user “checks the method” before the conclusion, that also helps. (No tears, hasn’t broken.)
2. Making public healthy policy based on an “outlying” case seems like a bad move. To make police based on the .1 % of those insured doesn’t seem wise.
3. She can’t pay for this method herself?
4. Since you have repeatedly stated that you (and other doctors) and significantly overpaid, can’t you eliminate your profit with this patient? That would help her defray costs.
Thanks, that gave me a good laugh this morning. I hope you’re not relying on them, though. Tia can address this in more detail.
TBD
I am happy to address your points.
1) First with regard to condoms, they are a good means of prevention of sexually transmissible diseases. As contraceptives they are of low statistical efficacy. Of 100 couples between the ages of 18 and 35 ( woman’s age)
using condoms as their only means of contraception ( consistently and as recommended) 20 will have conceived within one year. That is 1/5.
What I tell my patient’s is that if that is an acceptable odds for them, that is fine. If they want more statistical efficacy, they need to choose another means.
2) When you add up all the woman for whom a pregnancy would be medially dangerous including those with cancer, those with diabetes, hypertension, bleeding disorders, severe asthma, clotting abnormalities,
seizure disorders, morbid obesity….we are no longer just talking about
“outliers”. One other thing that I neglected to mention in my article is that the Mirena IUD is frequently used for non contraceptive health purposes such as control of excessively heavy menstrual bleeding leading to anemia, disabling menstrual cramps ( think time lost from work),
and some forms of overgrowth conditions of the lining of the uterus.
So in effect, this erroneous religious view of what the Mirena IUD does and does not do could prevent women from obtaining it regardless of whether they are even sexually active. I find this kind of employer control over women’s medical decisions deeply disturbing.
3) The cost of the IUD itself is typically around $800.00. I am quite sure that is beyond the means of many woman who would be working for a store like Hobby Lobby.
4) No, unless one is working in fee for service medicine, which I am not, I get no profit from placing or not placing a patient’s IUD. Since I work for Kaiser, I am salaried. Since under Kaiser policy, an IUD is considered preventative, the vast majority of women will pay nothing but their copay which for my services is typically between 0 -$25.00. So the answer is no,
I honestly don’t see how I can affect the woman’s nominal payment of
$25.00 for 5 years worth of prevention and / or treatment.
While I do not like the Supreme Courts’s decision in any way, I would prefer that we have the option of a single payer health system and leave business owners, corporations, insurance agents ( and the profits they make off us) out of the equation entirely. The cobbled together health coverage we have now is an inefficient mess. It’s a stupid way to provide health insurance.
That’s Obama’s plan, this is just the first step of dismantling the best medical system in the world. Google any comparison of our American medical system to the United Kingdom, and you’ll see how much better we perform… or should I say performed.
We’ll now get more of what the VA is experiencing… months long waits to see a doctor, or being purposefully dropped off waiting lists.
how do you have the best medical system where huge numbers of people do not have access to it?
Nothing in life is perfect, we could have had market-based solutions that would have helped far better, and then expanded Medicaid (as has already happened), instead of adding the monstrosity that is the ACA,
BTW, prices will continue to rise. I believe that insurance companies were given coverage and help by the federal government the first few years, but as that fades away, prices will continue to rise, and individuals will continue to lose coverage.
Don’t think the ACA travesty is over or stagnant.
seems more complicated than that:
http://online.wsj.com/articles/premiums-rise-at-big-insurers-fall-at-small-rivals-under-health-law-1403135040
Not a single proposal from the ‘other’ side would have expanded coverage as thoroughly as the ACA did.
The ACA is working. The dire predictions have fallen away, one by one.
Don: it doesn’t seem like you read the news much. Have you heard about the VA?
How will the ACA be better than the VA?
The only individuals I know who like the ACA are those who had a limited income, weren’t working, and / or had a pre-exisiting condition.
Our President lied about the ACA repeatedly, and that is one of many reasons why his approval ratings are in the toilet, and Hillary Clinton is running away from him.
The ACA is working. How is there any comparison with the VA? Through the ACA, via the state exchange, I have private insurance and see private doctors. Anyone who compares the ACA (private) and the VA (public) either doesn’t understand them, or is being intentionally dishonest.
The VA does happen to have a high patient satisfaction index. The scandals we are reading about are very serious. But they don’t, fortunately, affect the vast majority of VA patients.
Get it TrueBlue?
Flood the country with 50 million poor and uneducated people.
Destroy business and job growth by “save the environment” and hyper entitlement policies.
Then claim that our healthcare system outcomes are below average based on the stats.
See how these people work? It is the playbook of collectivists everywhere throughout history. Divide and conquer. Explode the population of moochers to justify the looter existence. Think about all the money earned by producers… all those hard working and risk taking people that eventually win a profit.
Those who can do, those that can’t stew.
And the stewies have done well to develop their backdoor strategy to getting a bigger piece of the shrinking pie. Just like for the histories of many Mid Eastern countries, they learned that looting others is much easier than producing themselves.
And if we turn healthcare over to government, the stewies win one of their biggest prizes ever. Think about all those public sector employees… the new millionaires.
Just like Governor Brown and RDA… let others build something up until the stewies can harvest it to consume. It is a scorched earth strategy… consume, consume, consume… don’t stop until it is all gone. They try to do it quick enough so they get the maximum benefits before they die. To hell with the kids, they are on their own to deal with that empty husk.
If you remove the flood of poor and uneducated illegal immigrants only, the US healthcare statistical outcomes match and exceed those with socialized healthcare.
And that still does not explain why so many people from these countries with socialized healthcare flock to the US for their specialized procedures.
This is a spectacular reply. One of your best. You managed to get Ayn Rand, Jerry Brown, health care, immigrants, the Mid East, public sector employees, and the RDA — all in one comment! You just forgot Benghazi and the IRS, and Obama.
I think he also didn’t manage a comment on crappy schools.
You two must really be Penn and Teller.
But thanks for the complement.
Frankly, you make interesting points. I heard a commentator put it another way: we have 10% of the population that is in the cart, who can’t work for various substantive, real, reasons, and 90% who pull the cart. And we accept that. We are a just society, and we want to help the 10% who can’t do for themselves.
But the Left wants to expand those in the cart being pulled to 15%, 20%, 30% … and many think we’ve reached a breaking point. The numbers don’t add up. This is why I still think they use the laughable “12 million illegal immigrant” number, because if they used a real number like 30 or 40 million, plus another 10-20-30 million family members brought over for “family reunification”, the political tide might stop.
Yes, wdf1 mentioned education. California was once number one in education, now we’re number 48 or 49? Libs only blame Prop 13, not the millions of non-native illegal immigrant children we now try to educate.
I spoke recently with a teacher from Wilmington, and I asked her if there are any African American students in her elementary school. She replied: “There is one black student … and I think maybe 1 white student, but I’m not sure… yes, we are an ‘underperforming’ school.”
DP wrote:
> how do you have the best medical system where huge numbers
> of people do not have access to it?
The same way we can have the best higher education system in the world where huge numbers of people do not have access to it (just because every kid that sneaks across the border can’t get in to a viniculture and enology department at UCD does not mean it is not the “best”). If EVERYONE has access to something it will not be the “best” for long (think of a restaurant, sports team or private school that had to let EVERYONE in, how long would it be the “best”)?
TBD: Ask the 10s of millions who now have healthcare coverage because of Obamacare if they think it is dismantling the best medical system in the world. Ask those who get medical care through the VA if they are happy with the quality of care they receive. I don’t think the answers will fit your premise.
How do you think the people feel who lost coverage because of Obamacare?
How do you think people feel (when Obama lied) who lost their doctor?
How do you think people feel who had their coverage costs skyrocket?
A big chunk of the people who now have health coverage simply have Medicaid, which already existed!
Talk to people who are covered through the VA? Have you read the news the past 2 months or 6 years?
How do you think people felt who could not get coverage before Obamacare?
How do you think people felt who had our coverage costs skyrocket, or had insurance cancelled, or had procedures denied, or had specific health issues excluded?
Why do you think Medicaid has ‘simply’ been expanded to millions of people who didn’t have it before? Why do you think that isn’t happening in some states?
Don’t confuse the current scheduling scandal with the quality of health care provided by the VA.
http://www.forbes.com/sites/harlankrumholz/2014/05/23/3-things-to-know-before-you-rush-to-judgment-about-va-health-system/
There were only TWO problems with our healthcare system that could have been easily remedied with a bipartisan plan.
1. Pre-existing conditions. Change health insurer regulations, like for auto insurance, were rate tier limits exist based on certain actuarial critera. Index the rate tiers for people with per-existing conditions for the number of months that they have been without insurance after a 12 month window of sing up. Provide exceptions for people out of work that can prove inability to pay for health insurance.
2. Reduce healthcare costs with tort reform, intra and extra-state competition, regulatory simplification. Encourage HSA high deductible plans, and require healthcare providers to clearly publish the cost of all procedures.
But instead the left manufactured a crisis and leveraged it to take over private industry on a march to pure collectivism where the looters can better pad their pockets.
#1 won’t work for a number of reasons, and #2 is just tinkering around the margins. Tort reform is fine, HSA’s are fine, but they don’t achieve providing health insurance to the uninsured.
It was a crisis, Frankly, for those of us who couldn’t get health insurance. You really, really don’t get that.
The VA scandal and the quality of care are perfect examples of what government-run single-payer health care will provide. Thanks Eric!
which doesn’t address the biggest problem – uninsured people. manufactured a crisis?
A nationwide audit by the Department of Veteran Affairs found that 57,000 veterans have been waiting more than 90 days for an appointment and that an additional 64,000 requested medical care but never made it onto VA waiting lists.
Eric, I just noticed that you might not get to this part of that article you linked.
The quality of care makes little difference if you cannot get an appointment.
“The VA scandal and the quality of care are perfect examples of what government-run single-payer health care will provide” …
Yes. When the GOP-controlled Senate repeatedly blocks funding requests, including $21 billion this February. At least you now acknowledge that government healthcare is of high quality. Thanks, Frankly!
By Republican-controlled, I mean through the use of fillibusters and other obstructionist measures, not majority membership.
Frankly, you make good suggestions, but I have a few more.
3. Allow for health savings accounts (HSA).
4. Allow individuals to transfer their monies from their HSA to family members or friends. This would help in times of large medical procedures.
5. Published pricing. This has always been a big one for me. How can we be educated consumers if we don’t know what something costs? I had a basic health test conducted, I called and told the billing specialist “Here is my plan, here is the test I’ll have at your office, what will it cost?” Her reply: “I don’t know.”
If I knew the price, and there was competition, I could go in at 5AM for the test, or Saturday, or go to Fairfield on a Saturday to save $400 … all of these options weren’t available to me as they don’t tell me what the costs are! Do they do this on purpose?
But even given these and many other options, we know that the number one way to reduce costs is the so-called death panels. Many of the seniors I know over 75, 80, have multiple health issues at play. They have survived cancer, strokes, diabetes, quadruple bipass, you name it … 4 senior men I know all have survived prostate cancer … it seems like we do an amazing job with many of these formerly fatal diseases. These are where the big dollars are, and where they will try to trim … as they also provide free health care to individuals from other countries.
TBD
“How do you think the people feel who lost coverage because of Obamacare?
How do you think people feel (when Obama lied) who lost their doctor?”
I can only answer for those who after losing their coverage chose Kaiser in the exchange, but this is not an insignificant number. Some are sad about leaving a trusted doctor. This usually resolves once they realize that I also can be a trusted doctor. When people who did not have Kaiser previously join, the typical ( although of course not universal reaction) is
“Wow, you mean that I can get all of that done here today !”
I can see a specialist in Sacramento or Vacaville tomorrow ? You will personally e-mail me or phone me with my lab results if they are not normal ? Or even more surprising to many who need a minor procedure….you mean that you can do that for me today ? I won’t have to come back later and pay another copay ? The typical patient that I meet who was uninformed about the Kaiser system is usually delighted because of our commitment to providing as much as possible that the patient needs on the same day as their first appointment. For the vast majority of patients, the advantages of an integrated plan far outweigh their initial disappointment and insecurity about changing providers and plans.
DavisBurns wrote: “The cobbled together health coverage we have now is an inefficient mess. It’s a stupid way to provide health insurance.”
Yes. We have a cobbled together mess of a system with lots of waste and inefficiency. I’ve seen figures that about 1/3 of the healthcare expenditure goes to administrative, insurance costs and pure waste. Lots of time and money is wasted by insurance companies and bureaucratic nonsense.
I don’t know what the answer is, but I do know that the system we have now is a mess.
The system we had before excluded tens of millions of people from health coverage. The ACA is working.
The argument was 50 million without.
How many have REALLY signed up through Obamacare?
the estimate after all that already had healthcare that signed up, all that signed up and haven’t actually paid, all that don’t qualify because they reported false income or personal stats, etc. actually comes out to 2 to 3 million now covered that weren’t covered before. How much did it cist to cover these 2 to 3 million?
Don wrote: “The system we had before excluded tens of millions of people from health coverage. The ACA is working.”
Yes, it is providing a chance for previously uninsured to get coverage. What I am concerned about is the waste and inefficiency of the overall healthcare system. As I stated before, I have seen figures that 1/3 of healthcare expenditure does not go to providing healthcare, but rather to insurance companies, bureaucracy, administration, and waste.
The Hobby Lobby debate is an example of the wastefulness in our system. I just don’t see why someone’s employer should have anything to do with the person’s healthcare.
My understanding is that is something of a post-war relic. But it’s the system we’ve got. I’ve read analyses, by people who seem to know about this topic, that the employer mandate is probably the least important part of the process of getting more people insured. The individual mandate, Medicaid expansion, and the subsidies are much more crucial. But the employer mandate provides funding that wouldn’t be there otherwise. So if there’s going to be a reform that removes that, and makes health insurance truly individual, portable, and economical, there would have to be a mix of taxes and incentives to provide that lost revenue.
Dorte
“This whole Obamacare thing is a mess”
This is clearly a matter of perspective and I do not share yours.
What I am seeing as a provider is a large number of woman coming in for care who were not able to obtain it before. In my area this includes women who are severely anemic from menstrual abnormalities, women who have breast cancer, women who have untreated diabetes, women who are in need of statistically effective contraception.
Many of these women previously had insurance which they lost their jobs and / or had their hours cut. They were then unable to get health insurance because of their pre existing conditions.
I have posted frequently on how I believe that one of the first two provisions of Obamacare enabling those not yet 26 to remain on their parents insurance. My daughter at age 23 was diagnosed with anorexia requiring several prolong hospitalizations and outpatient intensive therapy which would potentially have bankrupted me and still left her with a 1/5 chance of dying without adequate care when I became unable to pay.
Does anyone really believe that this is acceptable.
This succinctly explains why the suggestions Frankly has made about how to deal with pre-existing conditions would be ineffective and, in some ways, punitive. Many people have been without insurance for long intervals due to decisions made by insurance companies, not of their own volition. The only practical answer to the problem of pre-existing conditions is the method of the ACA: make it illegal to deny coverage, and deal with the cost by broadening the risk pool to include everybody.
Many of these women previously had insurance which they lost their jobs and / or had their hours cut. They were then unable to get health insurance because of their pre existing conditions.
This succinctly explains why the suggestions Frankly has made about how to deal with pre-existing conditions would be ineffective and, in some ways, punitive. Many people have been without insurance for long intervals due to decisions made by insurance companies, not of their own volition. The only practical answer to the problem of pre-existing conditions is the method of the ACA: make it illegal to deny coverage, and deal with the cost by broadening the risk pool to include everybody.
Read what I wrote again.
So Obama give time and keeps extending time for people to sign up, yet for some reason this won’t work for uninsured women? Sounds sexist to me.
You cannot simply say preexisting conditions are covered at the same rate. That will not work since many people will just wait until they are diagnosed and then get insurance. The best way to deal with it is to give people a deadline to sign up. And if Obama is still in power he can extend that date by executive order several times. But after the deadline, anyone acquiring insurance with preexisting conditions would pay a higher rate based on the number of months they had been without insurance. That premium on their premiums would be an incentive to get insurance as early as they could afford it. And also we should provide exceptions to this premium if the insured can prove inability to pay for insurance.
You know this would work Don. Don’t be so stubborn in love of Obamacare to reject all other valid ideas.
And here is the other ironic thing.
The reason that so many people are still out of work has a lot to do with the Obama administration putting healthcare reform toward the left dream of single payer over economic policy to grow the economy and create more jobs so more people could get or afford healthcare insurance.
Hi Tia,
I say that Obamacare is a mess for (at least) the following reasons. The way it was:
–passed (arm twisting, kickbacks, strict party-line vote)
–implemented (website failures, insecure data, unverified subsidies)
–upheld by a 5-4 Supreme Court vote (public intimidation by President of Supreme Court justices, a “penalty”–Obama’s term–became a “tax”–the majority’s term)
–changed 37 times (I believe) by the President, whose job is to execute the laws, not make them
–assigned to the IRS for enforcement, a government agency knee-deep in scandal
–billed as a final solution but allows states to replace it, probably by single-payer
Yes, none of these objections deal with the reality that you see, that some people now have insurance. They may be helped, but I fear that many more people will be hurt.
For example, the following may occur:
–Health care costs in general may rise
–Employers may opt out when the employer mandate kicks in (more uninsured pushed into Obamacare, but will healthy young people enroll in sufficient numbers to finance older, sicker ones?)
In other words, you are looking at a small piece of the present. (Granted, your experience is first-hand.) I am looking at the past and anticipating the future. (Granted, my experience is second-hand.) We will see who ends up being right. At some point, reality is no longer a question of perspective, or at least I hope not.
Dorte, you forgot that Congress, their staffers, and the President exempted themselves from the law!!!
Hi TrueBlueDevil,
I mentioned Congress and their staffers in my post of July 15, 3:05 p.m. (which starts “Hi Don” and is located about 1/5 down the entire comment page as measured by the orange cursor on the right-hand bar).
I did omit listing the President. Thanks for the correction!
Don, I agree that what we have now is better than what we had before however we still don’t cover everyone so it’s still a problem. Medicare works (been on for 8 months). The paper work could be better and sign up was a learning experience but the single payer crowd believed we just needed to expand Medicare over time until everyone was covered.
DavisBurns wrote: “Medicare works (been on for 8 months). The paper work could be better and sign up was a learning experience but the single payer crowd believed we just needed to expand Medicare over time until everyone was covered.”
Yes, that would have been a better solution than what we ended up with. What we have now is a patchwork system with tremendous inefficiency where a lot of our dollars go to insurance companies, administration and waste. I’ve seen estimates that about 1/3 of our health care dollars go for these things rather than actually providing healthcare. Imagine how much more healthcare we could provide for the same cost if we could just eliminate some of the inefficiency from the system.
DavisBurns
As a thirty year practitioner, I could not agree more with your views on a single party payer system delivered through a Kaiser like model as Frankly once suggested ( well the Kaiser part anyway).
While I do not like the Supreme Courts’s decision in any way, I would prefer that we have the option of a single payer health system and leave business owners, corporations, insurance agents ( and the profits they make off us) out of the equation entirely. The cobbled together health coverage we have now is an inefficient mess. It’s a stupid way to provide health insurance.
That’s Obama’s plan, this is just the first step of dismantling the best medical system in the world. Google any comparison of our American medical system to the United Kingdom, and you’ll see how much better we perform… or should I say performed.
We’ll now get more of what the VA is experiencing… months long waits to see a doctor, or being purposefully dropped off waiting lists.
how do you have the best medical system where huge numbers of people do not have access to it?
Nothing in life is perfect, we could have had market-based solutions that would have helped far better, and then expanded Medicaid (as has already happened), instead of adding the monstrosity that is the ACA,
BTW, prices will continue to rise. I believe that insurance companies were given coverage and help by the federal government the first few years, but as that fades away, prices will continue to rise, and individuals will continue to lose coverage.
Don’t think the ACA travesty is over or stagnant.
seems more complicated than that:
http://online.wsj.com/articles/premiums-rise-at-big-insurers-fall-at-small-rivals-under-health-law-1403135040
Not a single proposal from the ‘other’ side would have expanded coverage as thoroughly as the ACA did.
The ACA is working. The dire predictions have fallen away, one by one.
Don: it doesn’t seem like you read the news much. Have you heard about the VA?
How will the ACA be better than the VA?
The only individuals I know who like the ACA are those who had a limited income, weren’t working, and / or had a pre-exisiting condition.
Our President lied about the ACA repeatedly, and that is one of many reasons why his approval ratings are in the toilet, and Hillary Clinton is running away from him.
The ACA is working. How is there any comparison with the VA? Through the ACA, via the state exchange, I have private insurance and see private doctors. Anyone who compares the ACA (private) and the VA (public) either doesn’t understand them, or is being intentionally dishonest.
The VA does happen to have a high patient satisfaction index. The scandals we are reading about are very serious. But they don’t, fortunately, affect the vast majority of VA patients.
Get it TrueBlue?
Flood the country with 50 million poor and uneducated people.
Destroy business and job growth by “save the environment” and hyper entitlement policies.
Then claim that our healthcare system outcomes are below average based on the stats.
See how these people work? It is the playbook of collectivists everywhere throughout history. Divide and conquer. Explode the population of moochers to justify the looter existence. Think about all the money earned by producers… all those hard working and risk taking people that eventually win a profit.
Those who can do, those that can’t stew.
And the stewies have done well to develop their backdoor strategy to getting a bigger piece of the shrinking pie. Just like for the histories of many Mid Eastern countries, they learned that looting others is much easier than producing themselves.
And if we turn healthcare over to government, the stewies win one of their biggest prizes ever. Think about all those public sector employees… the new millionaires.
Just like Governor Brown and RDA… let others build something up until the stewies can harvest it to consume. It is a scorched earth strategy… consume, consume, consume… don’t stop until it is all gone. They try to do it quick enough so they get the maximum benefits before they die. To hell with the kids, they are on their own to deal with that empty husk.
If you remove the flood of poor and uneducated illegal immigrants only, the US healthcare statistical outcomes match and exceed those with socialized healthcare.
And that still does not explain why so many people from these countries with socialized healthcare flock to the US for their specialized procedures.
This is a spectacular reply. One of your best. You managed to get Ayn Rand, Jerry Brown, health care, immigrants, the Mid East, public sector employees, and the RDA — all in one comment! You just forgot Benghazi and the IRS, and Obama.
I think he also didn’t manage a comment on crappy schools.
You two must really be Penn and Teller.
But thanks for the complement.
Frankly, you make interesting points. I heard a commentator put it another way: we have 10% of the population that is in the cart, who can’t work for various substantive, real, reasons, and 90% who pull the cart. And we accept that. We are a just society, and we want to help the 10% who can’t do for themselves.
But the Left wants to expand those in the cart being pulled to 15%, 20%, 30% … and many think we’ve reached a breaking point. The numbers don’t add up. This is why I still think they use the laughable “12 million illegal immigrant” number, because if they used a real number like 30 or 40 million, plus another 10-20-30 million family members brought over for “family reunification”, the political tide might stop.
Yes, wdf1 mentioned education. California was once number one in education, now we’re number 48 or 49? Libs only blame Prop 13, not the millions of non-native illegal immigrant children we now try to educate.
I spoke recently with a teacher from Wilmington, and I asked her if there are any African American students in her elementary school. She replied: “There is one black student … and I think maybe 1 white student, but I’m not sure… yes, we are an ‘underperforming’ school.”
DP wrote:
> how do you have the best medical system where huge numbers
> of people do not have access to it?
The same way we can have the best higher education system in the world where huge numbers of people do not have access to it (just because every kid that sneaks across the border can’t get in to a viniculture and enology department at UCD does not mean it is not the “best”). If EVERYONE has access to something it will not be the “best” for long (think of a restaurant, sports team or private school that had to let EVERYONE in, how long would it be the “best”)?
TBD: Ask the 10s of millions who now have healthcare coverage because of Obamacare if they think it is dismantling the best medical system in the world. Ask those who get medical care through the VA if they are happy with the quality of care they receive. I don’t think the answers will fit your premise.
How do you think the people feel who lost coverage because of Obamacare?
How do you think people feel (when Obama lied) who lost their doctor?
How do you think people feel who had their coverage costs skyrocket?
A big chunk of the people who now have health coverage simply have Medicaid, which already existed!
Talk to people who are covered through the VA? Have you read the news the past 2 months or 6 years?
How do you think people felt who could not get coverage before Obamacare?
How do you think people felt who had our coverage costs skyrocket, or had insurance cancelled, or had procedures denied, or had specific health issues excluded?
Why do you think Medicaid has ‘simply’ been expanded to millions of people who didn’t have it before? Why do you think that isn’t happening in some states?
Don’t confuse the current scheduling scandal with the quality of health care provided by the VA.
http://www.forbes.com/sites/harlankrumholz/2014/05/23/3-things-to-know-before-you-rush-to-judgment-about-va-health-system/
There were only TWO problems with our healthcare system that could have been easily remedied with a bipartisan plan.
1. Pre-existing conditions. Change health insurer regulations, like for auto insurance, were rate tier limits exist based on certain actuarial critera. Index the rate tiers for people with per-existing conditions for the number of months that they have been without insurance after a 12 month window of sing up. Provide exceptions for people out of work that can prove inability to pay for health insurance.
2. Reduce healthcare costs with tort reform, intra and extra-state competition, regulatory simplification. Encourage HSA high deductible plans, and require healthcare providers to clearly publish the cost of all procedures.
But instead the left manufactured a crisis and leveraged it to take over private industry on a march to pure collectivism where the looters can better pad their pockets.
#1 won’t work for a number of reasons, and #2 is just tinkering around the margins. Tort reform is fine, HSA’s are fine, but they don’t achieve providing health insurance to the uninsured.
It was a crisis, Frankly, for those of us who couldn’t get health insurance. You really, really don’t get that.
The VA scandal and the quality of care are perfect examples of what government-run single-payer health care will provide. Thanks Eric!
which doesn’t address the biggest problem – uninsured people. manufactured a crisis?
A nationwide audit by the Department of Veteran Affairs found that 57,000 veterans have been waiting more than 90 days for an appointment and that an additional 64,000 requested medical care but never made it onto VA waiting lists.
Eric, I just noticed that you might not get to this part of that article you linked.
The quality of care makes little difference if you cannot get an appointment.
“The VA scandal and the quality of care are perfect examples of what government-run single-payer health care will provide” …
Yes. When the GOP-controlled Senate repeatedly blocks funding requests, including $21 billion this February. At least you now acknowledge that government healthcare is of high quality. Thanks, Frankly!
By Republican-controlled, I mean through the use of fillibusters and other obstructionist measures, not majority membership.
Frankly, you make good suggestions, but I have a few more.
3. Allow for health savings accounts (HSA).
4. Allow individuals to transfer their monies from their HSA to family members or friends. This would help in times of large medical procedures.
5. Published pricing. This has always been a big one for me. How can we be educated consumers if we don’t know what something costs? I had a basic health test conducted, I called and told the billing specialist “Here is my plan, here is the test I’ll have at your office, what will it cost?” Her reply: “I don’t know.”
If I knew the price, and there was competition, I could go in at 5AM for the test, or Saturday, or go to Fairfield on a Saturday to save $400 … all of these options weren’t available to me as they don’t tell me what the costs are! Do they do this on purpose?
But even given these and many other options, we know that the number one way to reduce costs is the so-called death panels. Many of the seniors I know over 75, 80, have multiple health issues at play. They have survived cancer, strokes, diabetes, quadruple bipass, you name it … 4 senior men I know all have survived prostate cancer … it seems like we do an amazing job with many of these formerly fatal diseases. These are where the big dollars are, and where they will try to trim … as they also provide free health care to individuals from other countries.
TBD
“How do you think the people feel who lost coverage because of Obamacare?
How do you think people feel (when Obama lied) who lost their doctor?”
I can only answer for those who after losing their coverage chose Kaiser in the exchange, but this is not an insignificant number. Some are sad about leaving a trusted doctor. This usually resolves once they realize that I also can be a trusted doctor. When people who did not have Kaiser previously join, the typical ( although of course not universal reaction) is
“Wow, you mean that I can get all of that done here today !”
I can see a specialist in Sacramento or Vacaville tomorrow ? You will personally e-mail me or phone me with my lab results if they are not normal ? Or even more surprising to many who need a minor procedure….you mean that you can do that for me today ? I won’t have to come back later and pay another copay ? The typical patient that I meet who was uninformed about the Kaiser system is usually delighted because of our commitment to providing as much as possible that the patient needs on the same day as their first appointment. For the vast majority of patients, the advantages of an integrated plan far outweigh their initial disappointment and insecurity about changing providers and plans.
DavisBurns wrote: “The cobbled together health coverage we have now is an inefficient mess. It’s a stupid way to provide health insurance.”
Yes. We have a cobbled together mess of a system with lots of waste and inefficiency. I’ve seen figures that about 1/3 of the healthcare expenditure goes to administrative, insurance costs and pure waste. Lots of time and money is wasted by insurance companies and bureaucratic nonsense.
I don’t know what the answer is, but I do know that the system we have now is a mess.
The system we had before excluded tens of millions of people from health coverage. The ACA is working.
The argument was 50 million without.
How many have REALLY signed up through Obamacare?
the estimate after all that already had healthcare that signed up, all that signed up and haven’t actually paid, all that don’t qualify because they reported false income or personal stats, etc. actually comes out to 2 to 3 million now covered that weren’t covered before. How much did it cist to cover these 2 to 3 million?
Don wrote: “The system we had before excluded tens of millions of people from health coverage. The ACA is working.”
Yes, it is providing a chance for previously uninsured to get coverage. What I am concerned about is the waste and inefficiency of the overall healthcare system. As I stated before, I have seen figures that 1/3 of healthcare expenditure does not go to providing healthcare, but rather to insurance companies, bureaucracy, administration, and waste.
The Hobby Lobby debate is an example of the wastefulness in our system. I just don’t see why someone’s employer should have anything to do with the person’s healthcare.
My understanding is that is something of a post-war relic. But it’s the system we’ve got. I’ve read analyses, by people who seem to know about this topic, that the employer mandate is probably the least important part of the process of getting more people insured. The individual mandate, Medicaid expansion, and the subsidies are much more crucial. But the employer mandate provides funding that wouldn’t be there otherwise. So if there’s going to be a reform that removes that, and makes health insurance truly individual, portable, and economical, there would have to be a mix of taxes and incentives to provide that lost revenue.
Dorte
“This whole Obamacare thing is a mess”
This is clearly a matter of perspective and I do not share yours.
What I am seeing as a provider is a large number of woman coming in for care who were not able to obtain it before. In my area this includes women who are severely anemic from menstrual abnormalities, women who have breast cancer, women who have untreated diabetes, women who are in need of statistically effective contraception.
Many of these women previously had insurance which they lost their jobs and / or had their hours cut. They were then unable to get health insurance because of their pre existing conditions.
I have posted frequently on how I believe that one of the first two provisions of Obamacare enabling those not yet 26 to remain on their parents insurance. My daughter at age 23 was diagnosed with anorexia requiring several prolong hospitalizations and outpatient intensive therapy which would potentially have bankrupted me and still left her with a 1/5 chance of dying without adequate care when I became unable to pay.
Does anyone really believe that this is acceptable.
This succinctly explains why the suggestions Frankly has made about how to deal with pre-existing conditions would be ineffective and, in some ways, punitive. Many people have been without insurance for long intervals due to decisions made by insurance companies, not of their own volition. The only practical answer to the problem of pre-existing conditions is the method of the ACA: make it illegal to deny coverage, and deal with the cost by broadening the risk pool to include everybody.
Many of these women previously had insurance which they lost their jobs and / or had their hours cut. They were then unable to get health insurance because of their pre existing conditions.
This succinctly explains why the suggestions Frankly has made about how to deal with pre-existing conditions would be ineffective and, in some ways, punitive. Many people have been without insurance for long intervals due to decisions made by insurance companies, not of their own volition. The only practical answer to the problem of pre-existing conditions is the method of the ACA: make it illegal to deny coverage, and deal with the cost by broadening the risk pool to include everybody.
Read what I wrote again.
So Obama give time and keeps extending time for people to sign up, yet for some reason this won’t work for uninsured women? Sounds sexist to me.
You cannot simply say preexisting conditions are covered at the same rate. That will not work since many people will just wait until they are diagnosed and then get insurance. The best way to deal with it is to give people a deadline to sign up. And if Obama is still in power he can extend that date by executive order several times. But after the deadline, anyone acquiring insurance with preexisting conditions would pay a higher rate based on the number of months they had been without insurance. That premium on their premiums would be an incentive to get insurance as early as they could afford it. And also we should provide exceptions to this premium if the insured can prove inability to pay for insurance.
You know this would work Don. Don’t be so stubborn in love of Obamacare to reject all other valid ideas.
And here is the other ironic thing.
The reason that so many people are still out of work has a lot to do with the Obama administration putting healthcare reform toward the left dream of single payer over economic policy to grow the economy and create more jobs so more people could get or afford healthcare insurance.
Hi Tia,
I say that Obamacare is a mess for (at least) the following reasons. The way it was:
–passed (arm twisting, kickbacks, strict party-line vote)
–implemented (website failures, insecure data, unverified subsidies)
–upheld by a 5-4 Supreme Court vote (public intimidation by President of Supreme Court justices, a “penalty”–Obama’s term–became a “tax”–the majority’s term)
–changed 37 times (I believe) by the President, whose job is to execute the laws, not make them
–assigned to the IRS for enforcement, a government agency knee-deep in scandal
–billed as a final solution but allows states to replace it, probably by single-payer
Yes, none of these objections deal with the reality that you see, that some people now have insurance. They may be helped, but I fear that many more people will be hurt.
For example, the following may occur:
–Health care costs in general may rise
–Employers may opt out when the employer mandate kicks in (more uninsured pushed into Obamacare, but will healthy young people enroll in sufficient numbers to finance older, sicker ones?)
In other words, you are looking at a small piece of the present. (Granted, your experience is first-hand.) I am looking at the past and anticipating the future. (Granted, my experience is second-hand.) We will see who ends up being right. At some point, reality is no longer a question of perspective, or at least I hope not.
Dorte, you forgot that Congress, their staffers, and the President exempted themselves from the law!!!
Hi TrueBlueDevil,
I mentioned Congress and their staffers in my post of July 15, 3:05 p.m. (which starts “Hi Don” and is located about 1/5 down the entire comment page as measured by the orange cursor on the right-hand bar).
I did omit listing the President. Thanks for the correction!
Don, I agree that what we have now is better than what we had before however we still don’t cover everyone so it’s still a problem. Medicare works (been on for 8 months). The paper work could be better and sign up was a learning experience but the single payer crowd believed we just needed to expand Medicare over time until everyone was covered.
DavisBurns wrote: “Medicare works (been on for 8 months). The paper work could be better and sign up was a learning experience but the single payer crowd believed we just needed to expand Medicare over time until everyone was covered.”
Yes, that would have been a better solution than what we ended up with. What we have now is a patchwork system with tremendous inefficiency where a lot of our dollars go to insurance companies, administration and waste. I’ve seen estimates that about 1/3 of our health care dollars go for these things rather than actually providing healthcare. Imagine how much more healthcare we could provide for the same cost if we could just eliminate some of the inefficiency from the system.
DavisBurns
As a thirty year practitioner, I could not agree more with your views on a single party payer system delivered through a Kaiser like model as Frankly once suggested ( well the Kaiser part anyway).
Frankly,
Your article about happy conservative women is from the American Enterprise Institute for Public Policy Research (AEI) is a private, conservative think tank. http://en.wikipedia.org/wiki/American_Enterprise_Institute
The report says that happiness is the result of 4 factors: Faith, Family, Friends and Work. Funny how political affiliation was never mentioned. It is complete bullshit to say that conservative women have a lock of these four factors and I suspect that non-conservative women are just as happy where these factors are strong.
How about this report: http://www.motherjones.com/politics/2014/07/biology-ideology-john-hibbing-negativity-bias , – “conservatism is positively associated with heightened epistemic concerns for order, structure, closure, certainty, consistency, simplicity, and familiarity, as well as existential concerns such as perceptions of danger, sensitivity to threat, and death anxiety.”
I think a reliance on simple religious codes or belief to explain everything, a desire for consistency and familiarity with regards to family, friends and work would lead to a sense of happiness. That is until someone wants to give healthcare access to everyone and changing the rules, or immigrant children come into town needing temporary housing while their families are located. Then the danger, threat, death anxiety alarms go off.
Note: duplicate comment removed. Posts that have links often have to await approval. Don
Here is a very good article on this “conservatives are happier” truths. I hope it does not make you less happy.
http://www.nytimes.com/2012/07/08/opinion/sunday/conservatives-are-happier-and-extremists-are-happiest-of-all.html?_r=0
I love this point:
So conservatives are ignorant, and ignorance is bliss, right? Not so fast, according to a study from the University of Florida psychologists Barry Schlenker and John Chambers and the University of Toronto psychologist Bonnie Le in the Journal of Research in Personality. These scholars note that liberals define fairness and an improved society in terms of greater economic equality. Liberals then condemn the happiness of conservatives, because conservatives are relatively untroubled by a problem that, it turns out, their political counterparts defined
And this point:
There is one other noteworthy political happiness gap that has gotten less scholarly attention than conservatives versus liberals: moderates versus extremists.
Political moderates must be happier than extremists, it always seemed to me. After all, extremists actually advertise their misery with strident bumper stickers that say things like, “If you’re not outraged, you’re not paying attention!”
But it turns out that’s wrong. People at the extremes are happier than political moderates. Correcting for income, education, age, race, family situation and religion, the happiest Americans are those who say they are either “extremely conservative” (48 percent very happy) or “extremely liberal” (35 percent). Everyone else is less happy, with the nadir at dead-center “moderate” (26 percent).
What explains this odd pattern? One possibility is that extremists have the whole world figured out, and sorted into good guys and bad guys. They have the security of knowing what’s wrong, and whom to fight. They are the happy warriors.
Which probably explains why I am so happy all the time when I am not pissed at all the unhappy people gumming up the works with so much absurdity. And related to this, I don’t think the apathetic can really be happy. So fire away!
What Makes Us Happy, Revisited; A new look at the famous Harvard study of what makes people thrive
Why do liberals make everything about sex? And why are they obsessed with older people having sex?
Frankly, I will more happy if I can just walk or drive myself to church and maybe play a little golf.
Frankly: Why do liberals make everything about sex? And why are they obsessed with older people having sex?
I’m amused at how obsessed you are with pigeonholing everyone here on the political spectrum. And nearly every other poster here seems to be at least a little less politically conservative than you, and hence, liberal.
If I’m going to make a step and self-identify as a liberal, then I might like to consider what all the possible consequences are. And if self-identifying as a liberal means an active sex life into my 80’s, I might like to take that into consideration.
For instance, in my octogenarian years, I might like to have some juicy stories to tell the priest during confession, and maybe also have a very credible excuse to not play golf if I don’t feel like it that day….
Frankly–I’m not an ordinary low-key moderate, but a fanatical moderate! It seems to me we need more moderates to get fanatical, to balance out the fanatical extremes, and perhaps act as moderators. I too am convinced my viewpoint is the best one, and am happy in expressing my moderation with fanatical enthusiasm and emphasis!!
tribeUSA, you are an extreme moderate, which, I think, explains your profound happiness.
Scientists Are Beginning to Figure Out Why Conservatives Are…Conservative
Frankly,
Your article about happy conservative women is from the American Enterprise Institute for Public Policy Research (AEI) is a private, conservative think tank. http://en.wikipedia.org/wiki/American_Enterprise_Institute
The report says that happiness is the result of 4 factors: Faith, Family, Friends and Work. Funny how political affiliation was never mentioned. It is complete bullshit to say that conservative women have a lock of these four factors and I suspect that non-conservative women are just as happy where these factors are strong.
How about this report: http://www.motherjones.com/politics/2014/07/biology-ideology-john-hibbing-negativity-bias , – “conservatism is positively associated with heightened epistemic concerns for order, structure, closure, certainty, consistency, simplicity, and familiarity, as well as existential concerns such as perceptions of danger, sensitivity to threat, and death anxiety.”
I think a reliance on simple religious codes or belief to explain everything, a desire for consistency and familiarity with regards to family, friends and work would lead to a sense of happiness. That is until someone wants to give healthcare access to everyone and changing the rules, or immigrant children come into town needing temporary housing while their families are located. Then the danger, threat, death anxiety alarms go off.
Note: duplicate comment removed. Posts that have links often have to await approval. Don
Here is a very good article on this “conservatives are happier” truths. I hope it does not make you less happy.
http://www.nytimes.com/2012/07/08/opinion/sunday/conservatives-are-happier-and-extremists-are-happiest-of-all.html?_r=0
I love this point:
So conservatives are ignorant, and ignorance is bliss, right? Not so fast, according to a study from the University of Florida psychologists Barry Schlenker and John Chambers and the University of Toronto psychologist Bonnie Le in the Journal of Research in Personality. These scholars note that liberals define fairness and an improved society in terms of greater economic equality. Liberals then condemn the happiness of conservatives, because conservatives are relatively untroubled by a problem that, it turns out, their political counterparts defined
And this point:
There is one other noteworthy political happiness gap that has gotten less scholarly attention than conservatives versus liberals: moderates versus extremists.
Political moderates must be happier than extremists, it always seemed to me. After all, extremists actually advertise their misery with strident bumper stickers that say things like, “If you’re not outraged, you’re not paying attention!”
But it turns out that’s wrong. People at the extremes are happier than political moderates. Correcting for income, education, age, race, family situation and religion, the happiest Americans are those who say they are either “extremely conservative” (48 percent very happy) or “extremely liberal” (35 percent). Everyone else is less happy, with the nadir at dead-center “moderate” (26 percent).
What explains this odd pattern? One possibility is that extremists have the whole world figured out, and sorted into good guys and bad guys. They have the security of knowing what’s wrong, and whom to fight. They are the happy warriors.
Which probably explains why I am so happy all the time when I am not pissed at all the unhappy people gumming up the works with so much absurdity. And related to this, I don’t think the apathetic can really be happy. So fire away!
What Makes Us Happy, Revisited; A new look at the famous Harvard study of what makes people thrive
Why do liberals make everything about sex? And why are they obsessed with older people having sex?
Frankly, I will more happy if I can just walk or drive myself to church and maybe play a little golf.
Frankly: Why do liberals make everything about sex? And why are they obsessed with older people having sex?
I’m amused at how obsessed you are with pigeonholing everyone here on the political spectrum. And nearly every other poster here seems to be at least a little less politically conservative than you, and hence, liberal.
If I’m going to make a step and self-identify as a liberal, then I might like to consider what all the possible consequences are. And if self-identifying as a liberal means an active sex life into my 80’s, I might like to take that into consideration.
For instance, in my octogenarian years, I might like to have some juicy stories to tell the priest during confession, and maybe also have a very credible excuse to not play golf if I don’t feel like it that day….
Frankly–I’m not an ordinary low-key moderate, but a fanatical moderate! It seems to me we need more moderates to get fanatical, to balance out the fanatical extremes, and perhaps act as moderators. I too am convinced my viewpoint is the best one, and am happy in expressing my moderation with fanatical enthusiasm and emphasis!!
tribeUSA, you are an extreme moderate, which, I think, explains your profound happiness.
Scientists Are Beginning to Figure Out Why Conservatives Are…Conservative
Your response only serves to further illustrate what I said. I think we actually agree.
Your response only serves to further illustrate what I said. I think we actually agree.
First observations: Why is it that people who post on this blog under their actual names tend to use fact-based and issue-oriented language while those posting under pseudonyms include more emotional language and rely more on their beliefs as opposed to science. So, I’d like to offer one more issue-oriented, fact-based observation aimed at establishing that the Supreme Court decision in the Hobby Lobby case was just plain wrong.
No pregnancy is terminated by these contraceptives. The Supreme Court majority does not understand the facts or science of human reproduction even in the context of their religious views. Here are some relevant facts regarding the human reproductive systems, especially as it pertains to women who are the only people who can get pregnant and therefore the only people whose healthcare needs are subject to the restrictions by the Supreme Court in this case:
Why scientific facts prove the US Supreme Court decision on Hobby Lobby is wrong:
1. Sperm and egg come in close proximity: not pregnant.
2. Sperm fertilizes egg => ovum in fallopian tube: not pregnant until implantation in uterus.
3. It takes the ovum about 72 hours to get from the fallopian tube to the uterus: not pregnant.
3. Fertilized egg implants itself in uterine wall: pregnant.
4. The I.U.D. and Morning-After pill prevent step (3) above,
Mr. Hart–I post under a psuedonym for several reasons
(1) Many of my viewpoints are non-pc; and I am still in the employment market
(2) I was a key witness to a serious crime that got a gang-banger jailed (pertinent when I post about crime-related issues)
(3) My psuedonym is a gestalt that pertains to an underlying philosophy on many issues presented in the Vanguard Forum.
I too respect and support science based arguments; but don’t mind emotional expressions (can help in figuring out where people are coming from); also remember only a small part of life and the universe is understood (or perhaps can ever be understood) by the scientific method; consciousness itself is a complete mystery to science.
Mr. Hart – I have to say that this was a very unhappy post.
But I really appreciate the science and largely agree with you on it.
Too bad that science does not dictate policy else we would still be getting our groceries in plastic bags.
First observations: Why is it that people who post on this blog under their actual names tend to use fact-based and issue-oriented language while those posting under pseudonyms include more emotional language and rely more on their beliefs as opposed to science. So, I’d like to offer one more issue-oriented, fact-based observation aimed at establishing that the Supreme Court decision in the Hobby Lobby case was just plain wrong.
No pregnancy is terminated by these contraceptives. The Supreme Court majority does not understand the facts or science of human reproduction even in the context of their religious views. Here are some relevant facts regarding the human reproductive systems, especially as it pertains to women who are the only people who can get pregnant and therefore the only people whose healthcare needs are subject to the restrictions by the Supreme Court in this case:
Why scientific facts prove the US Supreme Court decision on Hobby Lobby is wrong:
1. Sperm and egg come in close proximity: not pregnant.
2. Sperm fertilizes egg => ovum in fallopian tube: not pregnant until implantation in uterus.
3. It takes the ovum about 72 hours to get from the fallopian tube to the uterus: not pregnant.
3. Fertilized egg implants itself in uterine wall: pregnant.
4. The I.U.D. and Morning-After pill prevent step (3) above,
Mr. Hart–I post under a psuedonym for several reasons
(1) Many of my viewpoints are non-pc; and I am still in the employment market
(2) I was a key witness to a serious crime that got a gang-banger jailed (pertinent when I post about crime-related issues)
(3) My psuedonym is a gestalt that pertains to an underlying philosophy on many issues presented in the Vanguard Forum.
I too respect and support science based arguments; but don’t mind emotional expressions (can help in figuring out where people are coming from); also remember only a small part of life and the universe is understood (or perhaps can ever be understood) by the scientific method; consciousness itself is a complete mystery to science.
Mr. Hart – I have to say that this was a very unhappy post.
But I really appreciate the science and largely agree with you on it.
Too bad that science does not dictate policy else we would still be getting our groceries in plastic bags.
Mr. Hart–many religions (including the Catholic Church, I think) regard stage 2 (sperm fertilizes egg) the moment of conception, as the stage at which there should be no further interference to step 3 (you have listed two step 3s; the technical definition of pregnancy) and beyond. Perhaps many of the church spokespeople use the phrase ‘pregnancy termination’ in a technically incorrect manner; when they should really use the phrase ‘termination of the fertilized egg’; however the shorter phrase is used as a convenience to denote all stages from stage 2 thru birth; and is a phrase that is more familiar to the general public.
Mr. Hart–many religions (including the Catholic Church, I think) regard stage 2 (sperm fertilizes egg) the moment of conception, as the stage at which there should be no further interference to step 3 (you have listed two step 3s; the technical definition of pregnancy) and beyond. Perhaps many of the church spokespeople use the phrase ‘pregnancy termination’ in a technically incorrect manner; when they should really use the phrase ‘termination of the fertilized egg’; however the shorter phrase is used as a convenience to denote all stages from stage 2 thru birth; and is a phrase that is more familiar to the general public.
Why is it that people who post on this blog under their actual names tend to use fact-based and issue-oriented language while those posting under pseudonyms include more emotional language and rely more on their beliefs as opposed to science.
You want to back that statement up with any science, or are you just relying on your beliefs?
Why is it that people who post on this blog under their actual names tend to use fact-based and issue-oriented language while those posting under pseudonyms include more emotional language and rely more on their beliefs as opposed to science.
You want to back that statement up with any science, or are you just relying on your beliefs?
Frankly, I generalized, hence the word “most”. Re-using cloth bags for 10-15 years as we’ve been doing is less resource intensive and resource efficient than single use bags. But on the issue, the Supreme Court is wrong because they allow the religious belief of Hobby Lobby to allow that birth control pills are okay to include in insurance coverage which prevent sperm from fertilizing an egg while there is strong evidence that is how the IUD works. In nature, fertilized eggs don’t always implant in the uterus. They are flushed out of the uterus and murdered by Mother Nature herself. So they decided in a totally arbitrary way. The most galling of all, however, is that this only affects women. I don’t give a damn about women who agree with the idea of human life beginning at conception because they don’t have to do anything to live the way they want to live. This only affects women who want and NEED to have control over their lives. The decision is wrong on so many levels. It is an affront to the intelligence and humanity of people who want to take NORMAL advantage of simple and safe birth control but who are told somebody else’s crazy superstitious beliefs have more weight than your rational need for health care.
As Isaac Asimov said, “There is a cult of ignorance in the United States and there always has been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that my ignorance is just as good as your knowledge.” That’s what pisses me off.
I agree. Ignorance pisses me off too… but mostly stubborn ignorance. And there is a lot of that these days. People taking a position and digging in their heels and not really listening to others or really caring so much about the truth or fact rather than winning an argument.
I am pro-abortion… but only to an extent. And you pretty much hit on my scientific understanding of conception and gestation and where I currently draw the line at life of not life.
But there is too much pushing at the extremes from both sides. Anti-abortion activists and NOW demand that even late-term and partial birth abortions be kept legal and accessible. Some pro-life religious extremists demand that even condoms be banned from easy access.
Where the left and the pro-life argument loses me though is the Constitutional right for freedom of religion and freedom of association. I don’t have to agree with the opinions of a group to demand that they have a right to believe and express what they believe if. I bristle at the left constantly telling everyone else what they can or cannot believe in, and who the must associate with.
My litmus test is always material harm. If nobody is materially harmed by the beliefs and practice freedom of association, then there should be be any acceptance of any attempt to force some change through government or judicial tactics.
I use plastic bags as a reference because the science was clearly not in support of the claims of material harm, yet that has been forced upon us anyway.
And for Hobby Lobby, I don’t see enough material harm to any female employee to justify forcing them to violate their own beliefs… however stupid they may seem. And in the case where a woman employee just cannot tolerate the policy, she has the freedom to leave and go work somewhere else. There are a lot of things about a company policy that an employee might not like.
Let’s say, for a moment, that I believe cancer cells are God’s expression of Her desire to test a person’s faith and should in no way be interfered with. To make it a little more real, let’s say I only care about prostate cancer. I shouldn’t have to pay for PSA tests or any treatment in my medical plan. Affects just men. Whose beliefs are violated and how reasonable is it to insist that you, Frankly (I assume you are male) are free to go work for someone else and pay for your own life-saving treatment. Why can’t we as a society just say “All medical decisions are between you and your doctor and all health insurance should cover all and any medical condition?” What’s wrong with that simple idea and what is wrong with people that makes them feel like their beliefs should come between you and your doctor?
Frankly
“I don’t see enough material harm to any female employee to justify forcing them to violate their own beliefs”
I would like to provide you with two different examples of real material harm.
1) The actual case of my patient with breast cancer who needs chemotherapy and also needs statistically effective contraception. Her only statistically effective option is the non hormone containing IUD. I cannot imagine how you could not see this as material harm. And, if you are going to maintain that she can just leave and go get a job elsewhere, as a businessman, please tell me honestly how likely she is to be able to find a new job while on chemotherapy even if she is capable of working ?
2) Second case, also real. A woman has such heavy periods that she is constantly anemic ( missing work, unable to fully function ) so that there is no possibility that this does not represent material harm. She is not sexually active so there is no possibility that their religious beliefs could be abridged. We have tried other options and are down to a trial of the Mirena IUD. Now should her
Hobby Lobby cover her IUD ? Should she have to sign a form swearing that she will not engage in sexual activity ? What if her partner has had a vasectomy ? Can Hobby Lobby still deny coverage ? Where does her employers meddling in her health care decisions end ?
Hi Dave,
I disagree with your statement, “This only affects women who want and NEED to have control over their lives.” I believe that all of our lives are connected at some level. Therefore, it affects these women first, and then it affects other people, including those who own Hobby Lobby. If you think that my view is unscientific, consider the interface between Buddhism and quantum physics.
Frankly, I generalized, hence the word “most”. Re-using cloth bags for 10-15 years as we’ve been doing is less resource intensive and resource efficient than single use bags. But on the issue, the Supreme Court is wrong because they allow the religious belief of Hobby Lobby to allow that birth control pills are okay to include in insurance coverage which prevent sperm from fertilizing an egg while there is strong evidence that is how the IUD works. In nature, fertilized eggs don’t always implant in the uterus. They are flushed out of the uterus and murdered by Mother Nature herself. So they decided in a totally arbitrary way. The most galling of all, however, is that this only affects women. I don’t give a damn about women who agree with the idea of human life beginning at conception because they don’t have to do anything to live the way they want to live. This only affects women who want and NEED to have control over their lives. The decision is wrong on so many levels. It is an affront to the intelligence and humanity of people who want to take NORMAL advantage of simple and safe birth control but who are told somebody else’s crazy superstitious beliefs have more weight than your rational need for health care.
As Isaac Asimov said, “There is a cult of ignorance in the United States and there always has been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that my ignorance is just as good as your knowledge.” That’s what pisses me off.
I agree. Ignorance pisses me off too… but mostly stubborn ignorance. And there is a lot of that these days. People taking a position and digging in their heels and not really listening to others or really caring so much about the truth or fact rather than winning an argument.
I am pro-abortion… but only to an extent. And you pretty much hit on my scientific understanding of conception and gestation and where I currently draw the line at life of not life.
But there is too much pushing at the extremes from both sides. Anti-abortion activists and NOW demand that even late-term and partial birth abortions be kept legal and accessible. Some pro-life religious extremists demand that even condoms be banned from easy access.
Where the left and the pro-life argument loses me though is the Constitutional right for freedom of religion and freedom of association. I don’t have to agree with the opinions of a group to demand that they have a right to believe and express what they believe if. I bristle at the left constantly telling everyone else what they can or cannot believe in, and who the must associate with.
My litmus test is always material harm. If nobody is materially harmed by the beliefs and practice freedom of association, then there should be be any acceptance of any attempt to force some change through government or judicial tactics.
I use plastic bags as a reference because the science was clearly not in support of the claims of material harm, yet that has been forced upon us anyway.
And for Hobby Lobby, I don’t see enough material harm to any female employee to justify forcing them to violate their own beliefs… however stupid they may seem. And in the case where a woman employee just cannot tolerate the policy, she has the freedom to leave and go work somewhere else. There are a lot of things about a company policy that an employee might not like.
Let’s say, for a moment, that I believe cancer cells are God’s expression of Her desire to test a person’s faith and should in no way be interfered with. To make it a little more real, let’s say I only care about prostate cancer. I shouldn’t have to pay for PSA tests or any treatment in my medical plan. Affects just men. Whose beliefs are violated and how reasonable is it to insist that you, Frankly (I assume you are male) are free to go work for someone else and pay for your own life-saving treatment. Why can’t we as a society just say “All medical decisions are between you and your doctor and all health insurance should cover all and any medical condition?” What’s wrong with that simple idea and what is wrong with people that makes them feel like their beliefs should come between you and your doctor?
Frankly
“I don’t see enough material harm to any female employee to justify forcing them to violate their own beliefs”
I would like to provide you with two different examples of real material harm.
1) The actual case of my patient with breast cancer who needs chemotherapy and also needs statistically effective contraception. Her only statistically effective option is the non hormone containing IUD. I cannot imagine how you could not see this as material harm. And, if you are going to maintain that she can just leave and go get a job elsewhere, as a businessman, please tell me honestly how likely she is to be able to find a new job while on chemotherapy even if she is capable of working ?
2) Second case, also real. A woman has such heavy periods that she is constantly anemic ( missing work, unable to fully function ) so that there is no possibility that this does not represent material harm. She is not sexually active so there is no possibility that their religious beliefs could be abridged. We have tried other options and are down to a trial of the Mirena IUD. Now should her
Hobby Lobby cover her IUD ? Should she have to sign a form swearing that she will not engage in sexual activity ? What if her partner has had a vasectomy ? Can Hobby Lobby still deny coverage ? Where does her employers meddling in her health care decisions end ?
Hi Dave,
I disagree with your statement, “This only affects women who want and NEED to have control over their lives.” I believe that all of our lives are connected at some level. Therefore, it affects these women first, and then it affects other people, including those who own Hobby Lobby. If you think that my view is unscientific, consider the interface between Buddhism and quantum physics.
Dave Hart
Thanks for the Asimov quote.
A major frustration for those of us who work in science based fields, whether research or applied as in medicine, is the level of ignorance of basic functioning of the world demonstrated by those we encounter at work, but also by those who make and interpret our laws.
Tod Akins is my favorite recent example with his belief that women who are “legitimately raped” rarely get pregnant because their bodies have means to “shut that whole thing down”. The thought that people so ignorant of reproductive functioning could be involved in making any law having to do with reproduction in any way is
deeply disturbing to those of us who see the very real “material harm” done to women and families by not allowing women to freely choose the best means of pregnancy prevention available to them.
I agree with your condemnation of ignorance; does this extend to so-called leaders of women? There is a direct comparison here.
As a young lawyer in Arkansas, Hillary Clinton defended a brutal child rapist. She now claims she was required to do such, but the record from the time was that she “did it for a friend” (taking the case). There were no rape shield or victim protection laws at that time.
Hillary filed a Motion claiming that this 12-year-old girl had a history of cozying up to men, wasn’t stable, had a history of making up such stories, and had come from a “troubled” situation. These aren’t exact quotes, but the essence holds true. There was no evidence or substance for these blatant lies. You can Google it. This was a brutal rape of a 12-year-old child. Hillary – on audio tape – even notes that she knew the rapist was guilty, but he passed a polygraph test!
The rapist got a vastly reduced plea deal with limited jail time. The victim has gone on to have a very hard life. She has only commented on this case once before, but came out a second time when she was informed of what happened “behind the scenes”, and when she was informed that the young Mrs. Clinton was laughing about the case. She said that this case and crime devastated her life.
So Tia, who is worse, Tod Akin or Hillary Clinton?
This is getting way off topic. Please stick to health care and Hobby Lobby. Thanks.
Hi Tia,
Thanks for discussing this issue in terms of “pregnancy prevention” rather than “contraception”, since the matter in question is the fertilized egg. In case you didn’t notice, I included several relevant definitions in my post of July 15, 4:42 p.m. (which starts “Hi South of Davis” and is located about 1/5 down the entire comment page, as measured by the orange cursor in the right-hand bar).
Also, I hope you got to see my response to you (July 15, 11:33 p.m.) regarding why I call Obamacare a mess. (This post is located about 1/5 from the bottom of the entire page, as measured again by the orange cursor.)
Dave Hart
Thanks for the Asimov quote.
A major frustration for those of us who work in science based fields, whether research or applied as in medicine, is the level of ignorance of basic functioning of the world demonstrated by those we encounter at work, but also by those who make and interpret our laws.
Tod Akins is my favorite recent example with his belief that women who are “legitimately raped” rarely get pregnant because their bodies have means to “shut that whole thing down”. The thought that people so ignorant of reproductive functioning could be involved in making any law having to do with reproduction in any way is
deeply disturbing to those of us who see the very real “material harm” done to women and families by not allowing women to freely choose the best means of pregnancy prevention available to them.
I agree with your condemnation of ignorance; does this extend to so-called leaders of women? There is a direct comparison here.
As a young lawyer in Arkansas, Hillary Clinton defended a brutal child rapist. She now claims she was required to do such, but the record from the time was that she “did it for a friend” (taking the case). There were no rape shield or victim protection laws at that time.
Hillary filed a Motion claiming that this 12-year-old girl had a history of cozying up to men, wasn’t stable, had a history of making up such stories, and had come from a “troubled” situation. These aren’t exact quotes, but the essence holds true. There was no evidence or substance for these blatant lies. You can Google it. This was a brutal rape of a 12-year-old child. Hillary – on audio tape – even notes that she knew the rapist was guilty, but he passed a polygraph test!
The rapist got a vastly reduced plea deal with limited jail time. The victim has gone on to have a very hard life. She has only commented on this case once before, but came out a second time when she was informed of what happened “behind the scenes”, and when she was informed that the young Mrs. Clinton was laughing about the case. She said that this case and crime devastated her life.
So Tia, who is worse, Tod Akin or Hillary Clinton?
This is getting way off topic. Please stick to health care and Hobby Lobby. Thanks.
Hi Tia,
Thanks for discussing this issue in terms of “pregnancy prevention” rather than “contraception”, since the matter in question is the fertilized egg. In case you didn’t notice, I included several relevant definitions in my post of July 15, 4:42 p.m. (which starts “Hi South of Davis” and is located about 1/5 down the entire comment page, as measured by the orange cursor in the right-hand bar).
Also, I hope you got to see my response to you (July 15, 11:33 p.m.) regarding why I call Obamacare a mess. (This post is located about 1/5 from the bottom of the entire page, as measured again by the orange cursor.)
And the Senate Republican leadership is now on record supporting Hobby Lobby: http://talkingpointsmemo.com/dc/republicans-filibuster-bill-to-overturn-hobby-lobby
And the Senate Republican leadership is now on record supporting Hobby Lobby: http://talkingpointsmemo.com/dc/republicans-filibuster-bill-to-overturn-hobby-lobby
Dorte
“Yes, none of these objections deal with the reality that you see, that some people now have insurance. They may be helped, but I fear that many more people will be hurt.”
You are using the word “may” to describe things that are already reality ( people that I have already seen being helped) and to describe things that you fear may happen ( things that are speculative).
It is a fact that women who receive screening for cervical cancer rarely develop this form of cancer since we catch it and treat it when it is in a a precancerous form. I am typically screening 3-4 patients daily in my clinic who had not been screened within the past 3-5 years and are now able to get it because they signed up through Covered California. I know, because I ask my new patient’s what brought them to Kaiser.
It is a fact, not a “may” that I have seen women with treatable breast cancer who were not able to be treated before they were signed up. It is fact that I have helped women who could not get treatment for anemia and other readily treatable problems because they were not insured.
It is a fact that my daughter received life saving treatment which I would not have been able to afford for a prolonged period because of the provision of Obamacare that allowed her to be continued under my insurance policy until age 26.
These are facts, not speculation or my vision of what “may” happen.
I do not consider the ACA perfect. I wanted a single party payer system administered through systems like Kaiser.
I would happily do away with fee for service medicine altogether. It is fee for service medicine that makes it virtually impossible to determine what a procedure costs as one poster noted. It is true that “they” namely the insurance companies, hospitals , manufacturers of medical equipment and pharmaceuticals do not want you to know what each item actually costs. If the costs were transparent, people would not be driving up the cost of medicine by demanding completely unnecessary tests which I dissuade patients from doing on a regular basis. If I can determine the cause of a problem with a simple exam or office procedure, why would I order an MRI or CT ?
In fee for service medicine the answer is obvious. Its the money, although that is not what you will be told.
Hi Tia,
I use the word “may” in terms of the overall population of the presently insured who were previously uninsured. Yes, some of these people are helped now, such as those who have diseases which are caught or treated. However, if they never had a disease (such as cancer) and are screened now and still don’t have it, then knowing that may help psychologically, but it is not a help in the real sense, since they don’t have the disease to begin with.
In other words, I’m glad that some people are being helped, but I think that they and pretty much everyone else could have been helped by another approach. That would have been a net gain (in mathematical terms, a gain for the uninsured plus a gain for the country as a whole), rather than a net wash (some winners and some losers, the latter of which include people who had cancer, had their insurance cancelled due to Obamacare, and could not buy another policy at a comparable price) or a net loss (the whole medical and economic system comes crashing down or basically grinds to a halt). Of course, some of these events concern the future, but some of them have already occurred.
By the way, I commented to Don earlier on (in a very long post) that I was uninsured before Obamacare and am uninsured now. So at least I follow through with what I believe (at least in this case!). The IRS hasn’t come after me yet–I guess the individual mandate has been extended–so after that I will pay the fine as long as that is affordable, I suppose. I wish that Obamacare could be repealed and replaced, and I wish as before that I don’t get sick. To echo sentiments you often express, how is this situation acceptable?
You should get insurance. If you become sick with a chronic condition, you will become a major burden on the system unless you are very wealthy.
Don, I think that Obamacare is a major burden to the system, a much bigger burden than I could ever be.
And I think that the Affordable Care Act has provided people like you and me with the option of obtaining insurance — which is a personal responsibility — more affordably and more readily than before. It is based on private insurers providing coverage via private health care providers. But if don’t want to use the exchange, you can still buy insurance directly from companies like Anthem or Kaiser.
The major burden to the system was, among other things, uninsured people getting sick and using health care services, and being unable to pay for them.
Hi Don,
It took me a while to answer because I was thinking about what to say. Three points:
First, I don’t like health insurance in general, since companies drop customers when they start filing too many claims. That is when customers are sick and need insurance, and that is when they are dropped.
Second, I don’t like Obamacare, which is a means of getting insurance and a means of wealth distribution, since taxpayers subsidize the premiums of people with lower incomes. I have written on other posts why I think that it harms/will harm people and the country as a whole, so I won’t repeat myself here.
Finally, I don’t think that I have a responsibility to participate in something I find destructive. I do have a responsibility to pay medical bills which I incur, and I explained to Tia in my post of July 20, 2:53 a.m. that I would do so.
The ACA prohibits companies from dropping people from coverage when they get sick.
If you don’t wish to have taxpayers subsidize the premiums of people with lower incomes, how do you propose they get their medical care paid for if they cannot afford it? Do you think poor people have a right to health care?
You and your family would quickly be bankrupted by any medical issue of any duration or complexity. Moreover, you would be paying a much higher cost for services, because insured patients pay rates that are negotiated down by the insurers. You wouldn’t have that benefit.
You are taking a huge gamble by opting not to get insurance coverage.
Hi Don,
Oops. When I said, “a means of wealth distribution,” I meant wealth re-distribution.
Hi Don,
Some comments in response to yours:
–You write, “The ACA prohibits companies from dropping people from coverage when they get sick.” I am glad of this, since doing so after a person has paid into the system is basically fraud.
That said, I do wonder how these companies will stay in business, since they probably agreed to Obamacare thinking that they would get a lot of young/healthy people (so-called “invincibles”)who would make few claims for a long time. Data regarding the final percentage of this group (after the open-enrollment period closed) can be found here:
http://dailysignal.com/2014/05/02/details-missing-obamacare-headcount-final-report/
Here’s a quote from that article:
“[O]fficials promoted the 2.2 million young adult (ages 18 to 34) that made up 28 percent of the participant pool. Officials originally projected that, to be successful, Obamacare’s state and federal exchanges would need nearly 40 percent of new enrollees to be relatively healthy young adults — and thus spread out health care costs.”
As a result of this shortfall perhaps, a few months ago insurance companies wanted to raise premiums, and the President amended the ACA to provide taxpayer funds to prevent this increase (what critics have called a “bailout” of the insurance companies).
http://www.latimes.com/nation/la-na-insurance-bailout-20140521-story.html#page=1
(The fact that the President has changed the ACA–as I remember–37 times is a Constitutional problem, one that the Speaker of the House is addressing in his planned suit against the President for the delay of the employer mandate.)
As a result of this latest change, the people who have insurance without subsidies (who have as taxpayers the burden of paying for the subsidies of others) have the additional burden of paying insurance companies not to increase premiums. Obamacare just keeps getting more and more complicated, but a certain group keeps getting left holding the bag.
–You write, “If you don’t wish to have taxpayers subsidize the premiums of people with lower incomes, how do you propose they get their medical care paid for if they cannot afford it?” I thought that this was going to be taken care of by the invincibles (the funding source in the version of the ACA that was originally passed). If I am mistaken, please let me know.
–You ask, “Do you think poor people have a right to health care?” I don’t know if anyone has that right. Based on the Declaration of Independence (which is in the same spirit as the Constitution), we have the right to life, liberty, and the pursuit of happiness (which are human rights based on natural law). Here is a definition of human rights:
http://www.businessdictionary.com/definition/human-rights.html
The justification that the Supreme Court provided for Obamacare had nothing to do with human rights; it addressed the question of the individual mandate and responded that Congress has the power to tax (why logically it can tax people because they do not buy something now–health insurance–but will buy a related thing later–health care services–I do not know).
Since the Supreme Court has not weighed in on whether citizens have the right to health care, I hesitate to do so, since I’d say right off the bat that my thinking is less disciplined than theirs. If you really wish me to give it a crack, I could. (I think that I might start with the fact that human rights cannot be taken away, but health care is something that must be added.)
By the way, the Bill of Rights does not contain anything that would make me think that there should be universal health care. Perhaps that is because at that time doctors had little to offer in that regard. I mean, if you were sick you would probably die.
Here’s the Bill of Rights:
http://www.ratical.org/co-globalize/BillOfRights.html
–You write, “You and your family would quickly be bankrupted by any medical issue of any duration or complexity. Moreover, you would be paying a much higher cost for services, because insured patients pay rates that are negotiated down by the insurers. You wouldn’t have that benefit.” You are right. That’s why it’s important to get the cost of health care down. Government is known for its inefficiency, so that’s why I would look more to a free-market system.
–You conclude, “You are taking a huge gamble by opting not to get insurance coverage.” You are right. I wish I did not have to do so. However, I don’t want to take advantage of a system which takes advantage of my fellow citizens.
A partial solution would be for all of us (including myself) to be more charitable to one another. We tend to look to taxes and organizations to do this, but we ought to look at ourselves.
Before Obamacare, we could have helped pay for the medical bills of the less fortunate (a sibling, a neighbor) as individuals or as groups (fundraisers). In doing so, we would have had the incentive to find true solutions, since the money would have been coming directly and voluntarily out of our own pockets.
Now that Obamacare has passed, however, this approach may be harder to try, since many people seem to accept that the government is the best solution and that Obamacare is the best approach. I do not think that either of these is true, and I think that Obamacare is on life support, as shown by the many changes the President has made to it. If it ends up failing (or if another party gets control of the White House and Congress) it could be replaced with something better or changed so that it becomes better.
That is my hope. At that time I will join.
from the New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMhpr1405667
Dorte, I enjoy reading your posts and reasoning, thank you.
You example of charity starting at home (essentially) is a perfect one.
What if we all had medical savings accounts that started at birth? We could accumulate hundreds of thousands of dollars in this account, and then use it when we are in our twilight years. We could also transfer duns to a family or church member in need. Imagine a church group having 100 members each transferring $1,000 into a fellow member’s medical account!
This system would also give incentive to saving the medical account monies for future, larger needs – say, a pregnancy or major operation.
Hi Don,
Thanks for the article about the final enrollment numbers. I read it and found it to be informative but overly rosy. How else to account for recent polls, the first of which was taken April 23-27 and the second of which was taken June 1-3:
http://www.washingtonpost.com/blogs/post-politics/wp/2014/05/05/poll-obamacare-hits-new-low/
http://www.foxnews.com/politics/2014/06/10/fox-news-poll-voters-regret-obamacare-say-country-is-worse-off-under-new-law/
In both polls disapproval of Obamacare was at a new high of 55 percent.
More to the point of your post, however, the enrollment rate of the so-called invincibles must not have been high enough, since President Obama decided in late May of this year to change the ACA to give insurance companies tax money to keep their rates low:
http://www.latimes.com/nation/la-na-insurance-bailout-20140521-story.html#page=1
The article states, “Although more than 8 million people signed up for health coverage under the law, exceeding expectations, insurance companies in several states have been eyeing significant rate increases for next year amid concerns that their new customers are older and sicker than anticipated.”
Who knows whether Aetna (a major health insurance company) got any of this new tax money. As announced June 11, 2014, its rates will rise for the next year by less than 20%, which I think is a significant increase:
http://www.reuters.com/article/2014/06/11/aetna-insurance-idUSL2N0OS1CF20140611
In other words, you seem to think that the ACA is working. I think that we need to stay tuned.
Once in the 1990’s I had an 18% increase followed by a 20% increase the next year.
Did you know that polls have routinely shown that the public supports nearly every component of the ACA when asked about them individually? See Kaiser, for example: http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-march-2014/ The one exception is the individual mandate, which isn’t popular. Unfortunately, without the individual mandate the whole thing collapses. What we will really see affect rates is when the penalties for failing to get insurance kick in. Right now it’s a nominal penalty. Next year it goes up significantly, though it’s still less than the cost of insurance for most young people. The question is whether a $600+ fine (tax, per the Supreme Court) will be sufficient to persuade reluctant young adults to buy insurance.
Another view on 2015 rate increases: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf413410
Note that the CBO expects 7 million more people to enroll next year.
Hi TrueBlueDevil,
I’m glad that you and others are reading my posts. You gave me my first compliment, so thanks!
I researched Medical Savings Accounts, information about which can be found on the following link:
https://en.wikipedia.org/wiki/Medical_savings_account_(United_States)
I guess that the program would have to be modified to incorporate your features (establishment from birth and transfer of funds). However, these accounts would provide a nice incentive for saving and giving. (As I have mentioned before, incentives are much better than disincentives in modifying behavior.)
Thanks for the input. All of us need to share ideas about how to improve health care. The national conversation was started by Obamacare, but it need not be the last word.
Hi Don,
Thanks for the link to the Kaiser Health Tracking Poll. It was less recent than the ones I offered but much more comprehensive. I also found it to be more factual than the article in the New England Journal of Medicine which you brought to my attention. For example, in the latter the authors write:
“In advocating for the ACA before its passage, President Barack Obama promised that anyone who liked their insurance would be able to keep it under the new law. In hindsight, his assurances should have been more nuanced.”
Really? I don’t think that lying (he already knew what was in the law) for political purposes (up until the 2012 election) was a matter of nuance. If he had explained the true state of affairs (that millions of people would get letters in the mail come January 2013 that their insurance policies were cancelled), he most likely would have lost votes, which most likely would have cost him re-election. The balance of power in the Senate might have shifted as well.
I guess these authors don’t understand the meaning of fraud, which in the American Heritage Dictionary is “a deliberate deception for unfair or unlawful gain”. However, what the President did was political, so I guess that can be excused. I mean, things are such these days that the old adage should now be “All’s fair in love, war, and politics.”
However, the fact that two doctors writing in the New England Journal of Medicine pay so little attention to the meaning of words–the definition in said dictionary of “nuance” is “a subtle or slight degree of difference, as in meaning or feeling”–makes me want to gag. Not gag so much that I need to go to the doctor, however. Remember, I don’t have insurance.
I’d call these two doctors on their mistake, but that would cost me cell phone minutes, and they probably wouldn’t appreciate the correction. In other words, I’m finding that life is frustrating when you insist on the truth or a reasonable facsimile thereof.
Anyway, I wanted to draw your attention to one statement in the Kaiser Health Tracking poll, which was factual/fair enough not to raise my blood pressure. The article writes:
“[F]our in ten of the uninsured are still unaware of the law’s subsidies to help lower-income Americans purchase coverage.”
There are two big rulings about those subsidies today. See link:
http://money.cnn.com/2014/07/22/news/economy/obamacare-subsidies/
In one, the judges ruled that subsidies for customers on the federal exchange are unlawful. In another, the judges ruled the opposite. Since there are opposing rulings, the issue will need to be heard by the Supreme Court.
More details about the first ruling are here:
http://www.businessweek.com/articles/2014-07-22/obamacare-ruling-by-the-numbers-4-dot-7-million-could-lose-subsidies
Anyway, I thought you’d like to know!
By the way, Don, you keep mentioning that if Obamacare is repealed you will lose your insurance. Americans are a very forgiving sort (that includes Republicans) and don’t want to take away things that are already given. In fact, there is broad support for some parts of Obamacare (like that regarding pre-existing conditions and children up to the age of 26 on parents’ insurance plans). Therefore, I think that it is unlikely that the whole thing will be trashed. Here is a poll from yesterday:
http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/health_care_law
The article begins: “Voters still expect Republicans to repeal Obamacare if they take control of Congress in November, but they’re slightly more sympathetic now to a piece-by-piece approach to changing the law rather than a total overhaul.”
By the way, I don’t know how Republicans can repeal it, since the President wouldn’t sign it, but never mind. The main point is that you probably won’t lose your insurance, whatever happens. To put it more precisely (as I seem to insist with others) you will still be able to get insurance, but you may not have the policy that you have now.
Hi Don,
Thanks for the link to the article from the Robert Wood Johnson Foundation about 2015 insurance rates. The article was interesting and very detailed. The predictions may need to be changed in light of today’s rulings on subsidies for the federal exchange. I mean, business abhors uncertainty.
Today’s rulings will go to the full court of appeals, which is majority Democratic. Then the Supreme Court can decide if they want to review it, or just let it stand. Interesting to see court rulings following so closely along partisan lines.
From your previous comment:
I have zero confidence in that. The Tea Party controls the nominating process in the Republican Party. Tea Party folks are dead set against replacing the ACA, and only want to repeal it.
Hi Don,
Thanks for the correction. I just hope the plaintiffs win in the end. I mean, they are going up against the full force of the executive branch, the head of which has made I don’t know how many changes to that law. One count I heard was 37; today I heard 81. However many it is, that’s a lot of changes from someone who is supposed to administer the laws, not make them.
As for your certainty about the Tea Party, Ill look into that.
Why? If implemented, it would lead to huge premium increases for millions of people in several states. Not California, fortunately. Probably there would be a work-around by the administration, working with those states that don’t want their citizens adversely affected, to designate the federal exchange as a ‘state’ exchange.
But it’s clear that there are some state governors and legislators who will, for ideological reasons, choose to harm the health care of their citizens in their continued goal of blocking the ACA. They’re already doing so as they refuse the Medicare expansion. So it seems very likely that governors like Brownback of Kansas and Perry of Texas would refuse to allow any change, even if it meant thousands of their own citizens losing coverage or having to pay considerably more for it.
It is very clear that Republicans would act to destroy the ACA under any circumstances, that they consider the status quo ante preferable to the ACA. Just ask Frankly. This lawsuit is simply part of that ongoing strategy.
Hi Don,
I think that you may be constructing a false dilemma: either allow no changes to the ACA by President Obama or let the uninsured/poor die. I think that there is a middle ground, which is either to let Congress rework the law when problems come up (which is what should have happened all along) or to repeal and replace. I know that you do not believe that replacement would ever happen, so I’ll try to contact some Tea Party people, since you think they are the ones deciding that.
By the way, if my description of how to change the law is incorrect (return it to Congress; have them modify it), please let me know.
Dorte
“Of course, some of these events concern the future, but some of them have already occurred.”
Which of these events do your already think have happened ?
Hi Tia,
I found some references to help answer your question about events to which I referred.
Most of the events are in the “net wash” category. You have written about many women who are benefiting from the Obamacare, but here are stories about people who have been harmed by it.
–Michigan woman battling leukemia called “liar” by Senator Harry Reid:
http://www.mediaite.com/online/cancer-patient-who-lost-insurance-due-to-obamacare-demands-apology-from-harry-reid/
–Tom Coburn, Senator, will pay for his oncologist out-of-pocket:
http://www.politico.com/story/2014/01/obamacare-tom-coburn-cancer-doctor-102724.html
–San Diego woman losing oncologist mid-treatment for stage 4 cancer; new plans cost 40-50% more:
http://www.theblaze.com/stories/2013/11/04/woman-with-cancer-loses-world-class-insurance-plan-because-of-obamacare/
–Virginia woman with kidney cancer loses employer insurance; new plans more costly:
http://hotair.com/archives/2013/11/25/video-cancer-patient-loses-insurance-coverage-thanks-to-obamacare/
–Michigan woman battling cancer loses policy; other plans more expensive:
http://www.cnbc.com/id/101170381
As for the “net loss” category, it contains indicators that things are bad (but improving/possibly getting worse/getting worse) or very bad, getting worse.
Bad but improving:
–U3 unemployment rate higher under Obama than Bush:
http://portalseven.com/employment/unemployment_rate.jsp
–U6 unemployment rate much higher under Obama than Bush:
http://portalseven.com/employment/unemployment_rate_u6.jsp
–Applications for unemployment benefits same as pre-recession levels:
http://www.foxbusiness.com/markets/2014/07/10/applications-for-us-unemployment-aid-likely-were-unchanged-last-week-as-layoffs/
Bad, possibly getting worse:
–Gross Domestic Product Shrinks in Q1 of this year:
http://www.bloomberg.com/news/2014-05-29/u-s-economy-shrank-early-this-year-for-first-time-since-2011.html
Bad, getting worse:
–Consumer prices increased due to regulations?
http://www.foxnews.com/politics/2014/05/27/report-increased-regs-under-obama-have-hiked-consumer-prices-by-11k/
Very bad, getting worse:
The national debt:
http://www.justfacts.com/nationaldebt.asp
The “net loss” category also contains the employer mandate, which has been postponed until 2015, after 2014 elections:
http://www.bloomberg.com/news/2013-07-02/health-law-employer-mandate-said-to-be-delayed-to-2015.html
–Why postponed if a good or neutral thing?
–According to Wikipedia, “Most Americans with private health insurance receive it through an employer-sponsored program.”
https://en.wikipedia.org/wiki/Health_insurance_in_the_United_States
–Will most employers drop employee coverage? Yes, says Obamacare architect:
http://www.newsmax.com/Newsfront/Emanuel-employers-drop-health/2014/03/21/id/560906/
–Will new plans have higher prices?
That’s it for now! Let me know what you think.
Dorte
I read your examples, and I have some questions which are just that since we cannot obtain more information from the individuals involved.
First, I would want to know if, for each of these individuals, the plan that they chose was the only one available ? I would also want to know in the case of Tom Coburn, if his new plan did not cover his particular oncologist who he just prefers to continue to see, or if it did not offer any oncologist.
If there were a specialist of equal competency, I would not see this as in any way different from what we had previously since every year I saw new patients if their employer decided to provide Kaiser coverage and terminate their old plan and vice versa. Unlike what many people believe, most workers were already limited by their employers choice of health plan, not their personal choice of doctor.
This is one of the reasons that I would prefer single party payer which would stay with the individual for life regardless of employment. That way the decision about which doctor to see would always lie with the patient instead of with their insurer.
Also, what we do not know about these individuals who are sharing their stories is whether or not they live in states that full implemented the ACA and developed or allowed the Federal Government to develop robust exchanges. Like any system, if individuals act to thwart if, it will not work as effectively as if everyone accepts the changes as does their best to make the new system work.
Finally, unlike with my patient’s who I know are telling the truth because I can usually track their previous care, or lack thereof, on the system known as “Care Everywhere” that allows me to electronically get the health care records from previous providers, not to show any disrespect as they may all be telling the truth, however, without the ability to verify, it could also be true that some are not being entirely truthful and may have ideologic reasons for relating these stories. We simply do not have the means to verify.
I am not an economist, so I cannot respond meaningfully to the overall economic effects. However, I can speak to a couple of issues.
I am completely in favor of the abolition of the private medical insurance industry. This industry for the 30 + years in which I have seen the direct results has behaved consistently in a completely immoral fashion acting not in the best interest of patient but only with concern for the monetary bottom line of the company. Examples:
1) Dropping people from coverage once a serious diagnosis was made on such trumped up excuses as the patient forgetting to put down teenage acne, or child hood exercise induced asthma as previous diagnosis on their initial forms.
2) Not approving obviously needed care such as hysterectomies until a number of unnecessary tests such as ultrasounds had been done prior.
3) Delaying patient care which could easily be accomplished in one visit so that a planned procedure could be
“pre approved”. For anyone thinking that the government was going to run “death panels” you obviously do not understand that this was the defacto role of the insurance company employees who would not approve payment for care, sometimes until too late, thus saving themselves the expense.
4) Denying insurance for “pre existing conditions”.
For those of you , such as Frankly who believe that all of these issues could be dealt with “in better ways”, my question is, why weren’t they ? It was primarily the Republicans who blocked Hilary Clinton’s attempt at health care reform instead of attempting to work with her. There was plenty of opportunity for the years of the Bush administrations to take on these well known problems…..but they were not addressed. Mitt Romney was the initiator of the closest domestic policy to the ACA and yet because this was a proposal of Obama, the Republicans refused to attempt to work with this proposal in favor of constantly trying to block and repeal it.
So after years of ignoring and /or stonewalling the problem, Republicans and some Democrats are angry.
I believe that it is the American people who should be angry. Angry that in our very materially well off country we had decided that up until now we were going to ration care and that our form of rationing was going to be called
“ability to pay”.
Hi Tia,
Thanks for the response. Some thoughts:
Like me, you have thought critically about these accounts of people losing their plans. However, we differ in our conclusions.
–In my opinion, any difficulty is unacceptable, since these people (like all Americans) were promised, “If you like your health plan, you can keep it, period.” You seem to think that lying for political purposes is OK if the outcome is good. In other words, the ends justify the means. I disagree. We are all adults, so we can make choices if we get sufficient information.
–You question whether the people sharing their experiences are doing so for political reasons. I agree that they might be, but I give them credit for sticking their necks out, given the political climate. With increased government intrusion (NSA collection of data, wiretaps on journalists) and harassment (IRS targeting of conservative groups), it’s easier to go along with the powers that be than to express an opposing point of view.
–In line with that perhaps, you blame the situation these people may be in on state governors rather than on the President. You write, “Like any system, if individuals act to thwart if, it will not work as effectively as if everyone accepts the changes as does their best to make the new system work.” Since the governors were fully authorized by the ACA to set up their own exchanges, they are not thwarting the law, however well the exchanges end up working.
(By the way, the state v. federal exchange question is important, since there is a lawsuit right now about subsidies to each. See the following link:
http://www.forbes.com/sites/gracemarieturner/2014/07/10/awaiting-key-obamacare-court-decision/
This link concerns the fact that the ACA authorized subsidies specifically for the state exchanges, but they were also given on the federal exchange. The lawsuit contends that since subsidies for the latter were not mentioned in the ACA that they are unlawful, but if the plaintiffs prevail I guess that would not matter immediately, since the President could amend the law again (I think he’s done so 37 times) to specifically allow federal subsidies. If that happened or if the plaintiffs lost to begin with, they could appeal to the Supreme Court. If the Supremes agreed to hear the case, this would be another challenge to the ACA.)
In this post you also discuss the insurance companies. I am not a fan of them either. In this we agree. However, how to move from a basically failed system to a better one is another matter. The ACA tried to do it, and as you know I have many problems with its means and ends. Hillary Clinton wanted to do it, and people at the time had problems with that.
By the way, why do you think that Hillary Clinton would have been the one to lead the effort? She was not elected, did not have a background in medicine or economics, and was a lawyer. President Obama differs in these variables only on the first, so I guess that is how he got the ACA through, in addition to mounting national frustrations over health care.
As for your comments about George W. Bush and Mitt Romney, I have a different take from yours:
–I think that President Bush might have been overly consumed with foreign affairs (the war on terror), which prevented him from dealing with health care. Also, in general the Democrats are seen as the party of government, and the Republicans are seen as the party of the free market. Therefore, President Bush’s political orientation might have made him less inclined to impose a governmental solution on the problem.
–As to whether Mitt Romney’s health care plan was the same as Obamacare, the following article provides a very good analysis:
http://www.cato.org/policy-report/januaryfebruary-2008/lessons-fall-romneycare
Like Obamacare, Romneycare was enacted to cover all citizens and reduce cost. However, unlike the former we know how the latter turned out. In 2012, six years after it had been passed, Romneycare had achieved neither of these goals. That is one reason–a big reason–that Romney did not want to talk about national health care, and it is an example of why conservatives did not vote for him, which cost him in a close election.
Rather than dredging up old news, however, the important point is to learn from it. As the author of the previous article (written in 2012) concludes, “The answer to controlling health care costs and increasing access to care lies with giving consumers more control over their health care spending while increasing competition in the health care marketplace — not in mandates, subsidies, and regulation. That is the lesson we should be drawing from the failure of RomneyCare.”
That’s all! Thanks for corresponding with me. It takes a lot of time for both of us, but I think it is worth it.
Dorte wrote: “I wish that Obamacare could be repealed and replaced, and I wish as before that I don’t get sick.”
What would you suggest replacing it with and how would such a replacement be realistically paid for?
Hi Topcat,
Here is a new plan from Bobby Jindal, Governor of Louisiana. It is not a replacement but a modification. Perhaps that would be good enough (I haven’t studied the plan, so I don’t know):
http://www.businessweek.com/articles/2014-04-10/bobby-jindal-has-smart-ideas-to-improve-obamacare
Two aspects of this plan are as follows (quotes are from above article):
1) “[L]et nurse practitioners and other medical professionals practice to the full extent of their abilities.” (This would lower costs.)
2) Change the tax code so that health benefits from employers are no longer tax exempt. (This exemption leads to over-consumption of services, leading to a higher price of health care.) “Obamacare will tax high-cost plans starting in 2018; Jindal wants to scrap the exclusion altogether, replacing it with a tax deduction for all health insurance.” In other words, Obama approaches this problem with a disincentive, and Jindal approaches it with an incentive. As I have written in comments to a Vanguard article a few weeks ago, people learn better with reward (reinforcement) rather than with punishment, as shown by operant conditioning, the science of behavior modification.
As for how it is realistically paid for, I don’t know, but if prices are lower then they are more easily paid for. In any case, more plans will be coming down the pike, the article says, since Republican presidential hopefuls want to have something concrete to offer voters.
As for whether Obamacare is realistically paid for, that’s another can of worms, which I have discussed in my posts today to Tia (on this article) at 12:24 p.m. and 12:40 p.m.
Dorte
““[L]et nurse practitioners and other medical professionals practice to the full extent of their abilities.” (This would lower costs.)”
Mr. Jindal may not be aware since he is in a state where there is no Kaiser, but within our system this is already the case.
We employee Nurse Practitioners, Certified Nurse Midwives, Physicians Assistants, PharmDs manage many chronic stable conditions for patients in consultation with their physicians thus preventing the need for added expense. We use RNs, LVNs and medical assistants and engage in a constant process of training and retraining so that each job category is working to the top of their level of competency.
I am not informed enough to comment on Mr. Jindal’s second point.
Dr. Dean Edell has marveled at how quickly and efficiently the pharmacists at Costco do their vaccinations, and has wondered aloud why the government or a regular doctor’s office can’t do the same thing.
Dorte
“Yes, none of these objections deal with the reality that you see, that some people now have insurance. They may be helped, but I fear that many more people will be hurt.”
You are using the word “may” to describe things that are already reality ( people that I have already seen being helped) and to describe things that you fear may happen ( things that are speculative).
It is a fact that women who receive screening for cervical cancer rarely develop this form of cancer since we catch it and treat it when it is in a a precancerous form. I am typically screening 3-4 patients daily in my clinic who had not been screened within the past 3-5 years and are now able to get it because they signed up through Covered California. I know, because I ask my new patient’s what brought them to Kaiser.
It is a fact, not a “may” that I have seen women with treatable breast cancer who were not able to be treated before they were signed up. It is fact that I have helped women who could not get treatment for anemia and other readily treatable problems because they were not insured.
It is a fact that my daughter received life saving treatment which I would not have been able to afford for a prolonged period because of the provision of Obamacare that allowed her to be continued under my insurance policy until age 26.
These are facts, not speculation or my vision of what “may” happen.
I do not consider the ACA perfect. I wanted a single party payer system administered through systems like Kaiser.
I would happily do away with fee for service medicine altogether. It is fee for service medicine that makes it virtually impossible to determine what a procedure costs as one poster noted. It is true that “they” namely the insurance companies, hospitals , manufacturers of medical equipment and pharmaceuticals do not want you to know what each item actually costs. If the costs were transparent, people would not be driving up the cost of medicine by demanding completely unnecessary tests which I dissuade patients from doing on a regular basis. If I can determine the cause of a problem with a simple exam or office procedure, why would I order an MRI or CT ?
In fee for service medicine the answer is obvious. Its the money, although that is not what you will be told.
Hi Tia,
I use the word “may” in terms of the overall population of the presently insured who were previously uninsured. Yes, some of these people are helped now, such as those who have diseases which are caught or treated. However, if they never had a disease (such as cancer) and are screened now and still don’t have it, then knowing that may help psychologically, but it is not a help in the real sense, since they don’t have the disease to begin with.
In other words, I’m glad that some people are being helped, but I think that they and pretty much everyone else could have been helped by another approach. That would have been a net gain (in mathematical terms, a gain for the uninsured plus a gain for the country as a whole), rather than a net wash (some winners and some losers, the latter of which include people who had cancer, had their insurance cancelled due to Obamacare, and could not buy another policy at a comparable price) or a net loss (the whole medical and economic system comes crashing down or basically grinds to a halt). Of course, some of these events concern the future, but some of them have already occurred.
By the way, I commented to Don earlier on (in a very long post) that I was uninsured before Obamacare and am uninsured now. So at least I follow through with what I believe (at least in this case!). The IRS hasn’t come after me yet–I guess the individual mandate has been extended–so after that I will pay the fine as long as that is affordable, I suppose. I wish that Obamacare could be repealed and replaced, and I wish as before that I don’t get sick. To echo sentiments you often express, how is this situation acceptable?
You should get insurance. If you become sick with a chronic condition, you will become a major burden on the system unless you are very wealthy.
Don, I think that Obamacare is a major burden to the system, a much bigger burden than I could ever be.
And I think that the Affordable Care Act has provided people like you and me with the option of obtaining insurance — which is a personal responsibility — more affordably and more readily than before. It is based on private insurers providing coverage via private health care providers. But if don’t want to use the exchange, you can still buy insurance directly from companies like Anthem or Kaiser.
The major burden to the system was, among other things, uninsured people getting sick and using health care services, and being unable to pay for them.
Hi Don,
It took me a while to answer because I was thinking about what to say. Three points:
First, I don’t like health insurance in general, since companies drop customers when they start filing too many claims. That is when customers are sick and need insurance, and that is when they are dropped.
Second, I don’t like Obamacare, which is a means of getting insurance and a means of wealth distribution, since taxpayers subsidize the premiums of people with lower incomes. I have written on other posts why I think that it harms/will harm people and the country as a whole, so I won’t repeat myself here.
Finally, I don’t think that I have a responsibility to participate in something I find destructive. I do have a responsibility to pay medical bills which I incur, and I explained to Tia in my post of July 20, 2:53 a.m. that I would do so.
The ACA prohibits companies from dropping people from coverage when they get sick.
If you don’t wish to have taxpayers subsidize the premiums of people with lower incomes, how do you propose they get their medical care paid for if they cannot afford it? Do you think poor people have a right to health care?
You and your family would quickly be bankrupted by any medical issue of any duration or complexity. Moreover, you would be paying a much higher cost for services, because insured patients pay rates that are negotiated down by the insurers. You wouldn’t have that benefit.
You are taking a huge gamble by opting not to get insurance coverage.
Hi Don,
Oops. When I said, “a means of wealth distribution,” I meant wealth re-distribution.
Hi Don,
Some comments in response to yours:
–You write, “The ACA prohibits companies from dropping people from coverage when they get sick.” I am glad of this, since doing so after a person has paid into the system is basically fraud.
That said, I do wonder how these companies will stay in business, since they probably agreed to Obamacare thinking that they would get a lot of young/healthy people (so-called “invincibles”)who would make few claims for a long time. Data regarding the final percentage of this group (after the open-enrollment period closed) can be found here:
http://dailysignal.com/2014/05/02/details-missing-obamacare-headcount-final-report/
Here’s a quote from that article:
“[O]fficials promoted the 2.2 million young adult (ages 18 to 34) that made up 28 percent of the participant pool. Officials originally projected that, to be successful, Obamacare’s state and federal exchanges would need nearly 40 percent of new enrollees to be relatively healthy young adults — and thus spread out health care costs.”
As a result of this shortfall perhaps, a few months ago insurance companies wanted to raise premiums, and the President amended the ACA to provide taxpayer funds to prevent this increase (what critics have called a “bailout” of the insurance companies).
http://www.latimes.com/nation/la-na-insurance-bailout-20140521-story.html#page=1
(The fact that the President has changed the ACA–as I remember–37 times is a Constitutional problem, one that the Speaker of the House is addressing in his planned suit against the President for the delay of the employer mandate.)
As a result of this latest change, the people who have insurance without subsidies (who have as taxpayers the burden of paying for the subsidies of others) have the additional burden of paying insurance companies not to increase premiums. Obamacare just keeps getting more and more complicated, but a certain group keeps getting left holding the bag.
–You write, “If you don’t wish to have taxpayers subsidize the premiums of people with lower incomes, how do you propose they get their medical care paid for if they cannot afford it?” I thought that this was going to be taken care of by the invincibles (the funding source in the version of the ACA that was originally passed). If I am mistaken, please let me know.
–You ask, “Do you think poor people have a right to health care?” I don’t know if anyone has that right. Based on the Declaration of Independence (which is in the same spirit as the Constitution), we have the right to life, liberty, and the pursuit of happiness (which are human rights based on natural law). Here is a definition of human rights:
http://www.businessdictionary.com/definition/human-rights.html
The justification that the Supreme Court provided for Obamacare had nothing to do with human rights; it addressed the question of the individual mandate and responded that Congress has the power to tax (why logically it can tax people because they do not buy something now–health insurance–but will buy a related thing later–health care services–I do not know).
Since the Supreme Court has not weighed in on whether citizens have the right to health care, I hesitate to do so, since I’d say right off the bat that my thinking is less disciplined than theirs. If you really wish me to give it a crack, I could. (I think that I might start with the fact that human rights cannot be taken away, but health care is something that must be added.)
By the way, the Bill of Rights does not contain anything that would make me think that there should be universal health care. Perhaps that is because at that time doctors had little to offer in that regard. I mean, if you were sick you would probably die.
Here’s the Bill of Rights:
http://www.ratical.org/co-globalize/BillOfRights.html
–You write, “You and your family would quickly be bankrupted by any medical issue of any duration or complexity. Moreover, you would be paying a much higher cost for services, because insured patients pay rates that are negotiated down by the insurers. You wouldn’t have that benefit.” You are right. That’s why it’s important to get the cost of health care down. Government is known for its inefficiency, so that’s why I would look more to a free-market system.
–You conclude, “You are taking a huge gamble by opting not to get insurance coverage.” You are right. I wish I did not have to do so. However, I don’t want to take advantage of a system which takes advantage of my fellow citizens.
A partial solution would be for all of us (including myself) to be more charitable to one another. We tend to look to taxes and organizations to do this, but we ought to look at ourselves.
Before Obamacare, we could have helped pay for the medical bills of the less fortunate (a sibling, a neighbor) as individuals or as groups (fundraisers). In doing so, we would have had the incentive to find true solutions, since the money would have been coming directly and voluntarily out of our own pockets.
Now that Obamacare has passed, however, this approach may be harder to try, since many people seem to accept that the government is the best solution and that Obamacare is the best approach. I do not think that either of these is true, and I think that Obamacare is on life support, as shown by the many changes the President has made to it. If it ends up failing (or if another party gets control of the White House and Congress) it could be replaced with something better or changed so that it becomes better.
That is my hope. At that time I will join.
from the New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMhpr1405667
Dorte, I enjoy reading your posts and reasoning, thank you.
You example of charity starting at home (essentially) is a perfect one.
What if we all had medical savings accounts that started at birth? We could accumulate hundreds of thousands of dollars in this account, and then use it when we are in our twilight years. We could also transfer duns to a family or church member in need. Imagine a church group having 100 members each transferring $1,000 into a fellow member’s medical account!
This system would also give incentive to saving the medical account monies for future, larger needs – say, a pregnancy or major operation.
Hi Don,
Thanks for the article about the final enrollment numbers. I read it and found it to be informative but overly rosy. How else to account for recent polls, the first of which was taken April 23-27 and the second of which was taken June 1-3:
http://www.washingtonpost.com/blogs/post-politics/wp/2014/05/05/poll-obamacare-hits-new-low/
http://www.foxnews.com/politics/2014/06/10/fox-news-poll-voters-regret-obamacare-say-country-is-worse-off-under-new-law/
In both polls disapproval of Obamacare was at a new high of 55 percent.
More to the point of your post, however, the enrollment rate of the so-called invincibles must not have been high enough, since President Obama decided in late May of this year to change the ACA to give insurance companies tax money to keep their rates low:
http://www.latimes.com/nation/la-na-insurance-bailout-20140521-story.html#page=1
The article states, “Although more than 8 million people signed up for health coverage under the law, exceeding expectations, insurance companies in several states have been eyeing significant rate increases for next year amid concerns that their new customers are older and sicker than anticipated.”
Who knows whether Aetna (a major health insurance company) got any of this new tax money. As announced June 11, 2014, its rates will rise for the next year by less than 20%, which I think is a significant increase:
http://www.reuters.com/article/2014/06/11/aetna-insurance-idUSL2N0OS1CF20140611
In other words, you seem to think that the ACA is working. I think that we need to stay tuned.
Once in the 1990’s I had an 18% increase followed by a 20% increase the next year.
Did you know that polls have routinely shown that the public supports nearly every component of the ACA when asked about them individually? See Kaiser, for example: http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-march-2014/ The one exception is the individual mandate, which isn’t popular. Unfortunately, without the individual mandate the whole thing collapses. What we will really see affect rates is when the penalties for failing to get insurance kick in. Right now it’s a nominal penalty. Next year it goes up significantly, though it’s still less than the cost of insurance for most young people. The question is whether a $600+ fine (tax, per the Supreme Court) will be sufficient to persuade reluctant young adults to buy insurance.
Another view on 2015 rate increases: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf413410
Note that the CBO expects 7 million more people to enroll next year.
Hi TrueBlueDevil,
I’m glad that you and others are reading my posts. You gave me my first compliment, so thanks!
I researched Medical Savings Accounts, information about which can be found on the following link:
https://en.wikipedia.org/wiki/Medical_savings_account_(United_States)
I guess that the program would have to be modified to incorporate your features (establishment from birth and transfer of funds). However, these accounts would provide a nice incentive for saving and giving. (As I have mentioned before, incentives are much better than disincentives in modifying behavior.)
Thanks for the input. All of us need to share ideas about how to improve health care. The national conversation was started by Obamacare, but it need not be the last word.
Hi Don,
Thanks for the link to the Kaiser Health Tracking Poll. It was less recent than the ones I offered but much more comprehensive. I also found it to be more factual than the article in the New England Journal of Medicine which you brought to my attention. For example, in the latter the authors write:
“In advocating for the ACA before its passage, President Barack Obama promised that anyone who liked their insurance would be able to keep it under the new law. In hindsight, his assurances should have been more nuanced.”
Really? I don’t think that lying (he already knew what was in the law) for political purposes (up until the 2012 election) was a matter of nuance. If he had explained the true state of affairs (that millions of people would get letters in the mail come January 2013 that their insurance policies were cancelled), he most likely would have lost votes, which most likely would have cost him re-election. The balance of power in the Senate might have shifted as well.
I guess these authors don’t understand the meaning of fraud, which in the American Heritage Dictionary is “a deliberate deception for unfair or unlawful gain”. However, what the President did was political, so I guess that can be excused. I mean, things are such these days that the old adage should now be “All’s fair in love, war, and politics.”
However, the fact that two doctors writing in the New England Journal of Medicine pay so little attention to the meaning of words–the definition in said dictionary of “nuance” is “a subtle or slight degree of difference, as in meaning or feeling”–makes me want to gag. Not gag so much that I need to go to the doctor, however. Remember, I don’t have insurance.
I’d call these two doctors on their mistake, but that would cost me cell phone minutes, and they probably wouldn’t appreciate the correction. In other words, I’m finding that life is frustrating when you insist on the truth or a reasonable facsimile thereof.
Anyway, I wanted to draw your attention to one statement in the Kaiser Health Tracking poll, which was factual/fair enough not to raise my blood pressure. The article writes:
“[F]our in ten of the uninsured are still unaware of the law’s subsidies to help lower-income Americans purchase coverage.”
There are two big rulings about those subsidies today. See link:
http://money.cnn.com/2014/07/22/news/economy/obamacare-subsidies/
In one, the judges ruled that subsidies for customers on the federal exchange are unlawful. In another, the judges ruled the opposite. Since there are opposing rulings, the issue will need to be heard by the Supreme Court.
More details about the first ruling are here:
http://www.businessweek.com/articles/2014-07-22/obamacare-ruling-by-the-numbers-4-dot-7-million-could-lose-subsidies
Anyway, I thought you’d like to know!
By the way, Don, you keep mentioning that if Obamacare is repealed you will lose your insurance. Americans are a very forgiving sort (that includes Republicans) and don’t want to take away things that are already given. In fact, there is broad support for some parts of Obamacare (like that regarding pre-existing conditions and children up to the age of 26 on parents’ insurance plans). Therefore, I think that it is unlikely that the whole thing will be trashed. Here is a poll from yesterday:
http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/health_care_law
The article begins: “Voters still expect Republicans to repeal Obamacare if they take control of Congress in November, but they’re slightly more sympathetic now to a piece-by-piece approach to changing the law rather than a total overhaul.”
By the way, I don’t know how Republicans can repeal it, since the President wouldn’t sign it, but never mind. The main point is that you probably won’t lose your insurance, whatever happens. To put it more precisely (as I seem to insist with others) you will still be able to get insurance, but you may not have the policy that you have now.
Hi Don,
Thanks for the link to the article from the Robert Wood Johnson Foundation about 2015 insurance rates. The article was interesting and very detailed. The predictions may need to be changed in light of today’s rulings on subsidies for the federal exchange. I mean, business abhors uncertainty.
Today’s rulings will go to the full court of appeals, which is majority Democratic. Then the Supreme Court can decide if they want to review it, or just let it stand. Interesting to see court rulings following so closely along partisan lines.
From your previous comment:
I have zero confidence in that. The Tea Party controls the nominating process in the Republican Party. Tea Party folks are dead set against replacing the ACA, and only want to repeal it.
Hi Don,
Thanks for the correction. I just hope the plaintiffs win in the end. I mean, they are going up against the full force of the executive branch, the head of which has made I don’t know how many changes to that law. One count I heard was 37; today I heard 81. However many it is, that’s a lot of changes from someone who is supposed to administer the laws, not make them.
As for your certainty about the Tea Party, Ill look into that.
Why? If implemented, it would lead to huge premium increases for millions of people in several states. Not California, fortunately. Probably there would be a work-around by the administration, working with those states that don’t want their citizens adversely affected, to designate the federal exchange as a ‘state’ exchange.
But it’s clear that there are some state governors and legislators who will, for ideological reasons, choose to harm the health care of their citizens in their continued goal of blocking the ACA. They’re already doing so as they refuse the Medicare expansion. So it seems very likely that governors like Brownback of Kansas and Perry of Texas would refuse to allow any change, even if it meant thousands of their own citizens losing coverage or having to pay considerably more for it.
It is very clear that Republicans would act to destroy the ACA under any circumstances, that they consider the status quo ante preferable to the ACA. Just ask Frankly. This lawsuit is simply part of that ongoing strategy.
Hi Don,
I think that you may be constructing a false dilemma: either allow no changes to the ACA by President Obama or let the uninsured/poor die. I think that there is a middle ground, which is either to let Congress rework the law when problems come up (which is what should have happened all along) or to repeal and replace. I know that you do not believe that replacement would ever happen, so I’ll try to contact some Tea Party people, since you think they are the ones deciding that.
By the way, if my description of how to change the law is incorrect (return it to Congress; have them modify it), please let me know.
Dorte
“Of course, some of these events concern the future, but some of them have already occurred.”
Which of these events do your already think have happened ?
Hi Tia,
I found some references to help answer your question about events to which I referred.
Most of the events are in the “net wash” category. You have written about many women who are benefiting from the Obamacare, but here are stories about people who have been harmed by it.
–Michigan woman battling leukemia called “liar” by Senator Harry Reid:
http://www.mediaite.com/online/cancer-patient-who-lost-insurance-due-to-obamacare-demands-apology-from-harry-reid/
–Tom Coburn, Senator, will pay for his oncologist out-of-pocket:
http://www.politico.com/story/2014/01/obamacare-tom-coburn-cancer-doctor-102724.html
–San Diego woman losing oncologist mid-treatment for stage 4 cancer; new plans cost 40-50% more:
http://www.theblaze.com/stories/2013/11/04/woman-with-cancer-loses-world-class-insurance-plan-because-of-obamacare/
–Virginia woman with kidney cancer loses employer insurance; new plans more costly:
http://hotair.com/archives/2013/11/25/video-cancer-patient-loses-insurance-coverage-thanks-to-obamacare/
–Michigan woman battling cancer loses policy; other plans more expensive:
http://www.cnbc.com/id/101170381
As for the “net loss” category, it contains indicators that things are bad (but improving/possibly getting worse/getting worse) or very bad, getting worse.
Bad but improving:
–U3 unemployment rate higher under Obama than Bush:
http://portalseven.com/employment/unemployment_rate.jsp
–U6 unemployment rate much higher under Obama than Bush:
http://portalseven.com/employment/unemployment_rate_u6.jsp
–Applications for unemployment benefits same as pre-recession levels:
http://www.foxbusiness.com/markets/2014/07/10/applications-for-us-unemployment-aid-likely-were-unchanged-last-week-as-layoffs/
Bad, possibly getting worse:
–Gross Domestic Product Shrinks in Q1 of this year:
http://www.bloomberg.com/news/2014-05-29/u-s-economy-shrank-early-this-year-for-first-time-since-2011.html
Bad, getting worse:
–Consumer prices increased due to regulations?
http://www.foxnews.com/politics/2014/05/27/report-increased-regs-under-obama-have-hiked-consumer-prices-by-11k/
Very bad, getting worse:
The national debt:
http://www.justfacts.com/nationaldebt.asp
The “net loss” category also contains the employer mandate, which has been postponed until 2015, after 2014 elections:
http://www.bloomberg.com/news/2013-07-02/health-law-employer-mandate-said-to-be-delayed-to-2015.html
–Why postponed if a good or neutral thing?
–According to Wikipedia, “Most Americans with private health insurance receive it through an employer-sponsored program.”
https://en.wikipedia.org/wiki/Health_insurance_in_the_United_States
–Will most employers drop employee coverage? Yes, says Obamacare architect:
http://www.newsmax.com/Newsfront/Emanuel-employers-drop-health/2014/03/21/id/560906/
–Will new plans have higher prices?
That’s it for now! Let me know what you think.
Dorte
I read your examples, and I have some questions which are just that since we cannot obtain more information from the individuals involved.
First, I would want to know if, for each of these individuals, the plan that they chose was the only one available ? I would also want to know in the case of Tom Coburn, if his new plan did not cover his particular oncologist who he just prefers to continue to see, or if it did not offer any oncologist.
If there were a specialist of equal competency, I would not see this as in any way different from what we had previously since every year I saw new patients if their employer decided to provide Kaiser coverage and terminate their old plan and vice versa. Unlike what many people believe, most workers were already limited by their employers choice of health plan, not their personal choice of doctor.
This is one of the reasons that I would prefer single party payer which would stay with the individual for life regardless of employment. That way the decision about which doctor to see would always lie with the patient instead of with their insurer.
Also, what we do not know about these individuals who are sharing their stories is whether or not they live in states that full implemented the ACA and developed or allowed the Federal Government to develop robust exchanges. Like any system, if individuals act to thwart if, it will not work as effectively as if everyone accepts the changes as does their best to make the new system work.
Finally, unlike with my patient’s who I know are telling the truth because I can usually track their previous care, or lack thereof, on the system known as “Care Everywhere” that allows me to electronically get the health care records from previous providers, not to show any disrespect as they may all be telling the truth, however, without the ability to verify, it could also be true that some are not being entirely truthful and may have ideologic reasons for relating these stories. We simply do not have the means to verify.
I am not an economist, so I cannot respond meaningfully to the overall economic effects. However, I can speak to a couple of issues.
I am completely in favor of the abolition of the private medical insurance industry. This industry for the 30 + years in which I have seen the direct results has behaved consistently in a completely immoral fashion acting not in the best interest of patient but only with concern for the monetary bottom line of the company. Examples:
1) Dropping people from coverage once a serious diagnosis was made on such trumped up excuses as the patient forgetting to put down teenage acne, or child hood exercise induced asthma as previous diagnosis on their initial forms.
2) Not approving obviously needed care such as hysterectomies until a number of unnecessary tests such as ultrasounds had been done prior.
3) Delaying patient care which could easily be accomplished in one visit so that a planned procedure could be
“pre approved”. For anyone thinking that the government was going to run “death panels” you obviously do not understand that this was the defacto role of the insurance company employees who would not approve payment for care, sometimes until too late, thus saving themselves the expense.
4) Denying insurance for “pre existing conditions”.
For those of you , such as Frankly who believe that all of these issues could be dealt with “in better ways”, my question is, why weren’t they ? It was primarily the Republicans who blocked Hilary Clinton’s attempt at health care reform instead of attempting to work with her. There was plenty of opportunity for the years of the Bush administrations to take on these well known problems…..but they were not addressed. Mitt Romney was the initiator of the closest domestic policy to the ACA and yet because this was a proposal of Obama, the Republicans refused to attempt to work with this proposal in favor of constantly trying to block and repeal it.
So after years of ignoring and /or stonewalling the problem, Republicans and some Democrats are angry.
I believe that it is the American people who should be angry. Angry that in our very materially well off country we had decided that up until now we were going to ration care and that our form of rationing was going to be called
“ability to pay”.
Hi Tia,
Thanks for the response. Some thoughts:
Like me, you have thought critically about these accounts of people losing their plans. However, we differ in our conclusions.
–In my opinion, any difficulty is unacceptable, since these people (like all Americans) were promised, “If you like your health plan, you can keep it, period.” You seem to think that lying for political purposes is OK if the outcome is good. In other words, the ends justify the means. I disagree. We are all adults, so we can make choices if we get sufficient information.
–You question whether the people sharing their experiences are doing so for political reasons. I agree that they might be, but I give them credit for sticking their necks out, given the political climate. With increased government intrusion (NSA collection of data, wiretaps on journalists) and harassment (IRS targeting of conservative groups), it’s easier to go along with the powers that be than to express an opposing point of view.
–In line with that perhaps, you blame the situation these people may be in on state governors rather than on the President. You write, “Like any system, if individuals act to thwart if, it will not work as effectively as if everyone accepts the changes as does their best to make the new system work.” Since the governors were fully authorized by the ACA to set up their own exchanges, they are not thwarting the law, however well the exchanges end up working.
(By the way, the state v. federal exchange question is important, since there is a lawsuit right now about subsidies to each. See the following link:
http://www.forbes.com/sites/gracemarieturner/2014/07/10/awaiting-key-obamacare-court-decision/
This link concerns the fact that the ACA authorized subsidies specifically for the state exchanges, but they were also given on the federal exchange. The lawsuit contends that since subsidies for the latter were not mentioned in the ACA that they are unlawful, but if the plaintiffs prevail I guess that would not matter immediately, since the President could amend the law again (I think he’s done so 37 times) to specifically allow federal subsidies. If that happened or if the plaintiffs lost to begin with, they could appeal to the Supreme Court. If the Supremes agreed to hear the case, this would be another challenge to the ACA.)
In this post you also discuss the insurance companies. I am not a fan of them either. In this we agree. However, how to move from a basically failed system to a better one is another matter. The ACA tried to do it, and as you know I have many problems with its means and ends. Hillary Clinton wanted to do it, and people at the time had problems with that.
By the way, why do you think that Hillary Clinton would have been the one to lead the effort? She was not elected, did not have a background in medicine or economics, and was a lawyer. President Obama differs in these variables only on the first, so I guess that is how he got the ACA through, in addition to mounting national frustrations over health care.
As for your comments about George W. Bush and Mitt Romney, I have a different take from yours:
–I think that President Bush might have been overly consumed with foreign affairs (the war on terror), which prevented him from dealing with health care. Also, in general the Democrats are seen as the party of government, and the Republicans are seen as the party of the free market. Therefore, President Bush’s political orientation might have made him less inclined to impose a governmental solution on the problem.
–As to whether Mitt Romney’s health care plan was the same as Obamacare, the following article provides a very good analysis:
http://www.cato.org/policy-report/januaryfebruary-2008/lessons-fall-romneycare
Like Obamacare, Romneycare was enacted to cover all citizens and reduce cost. However, unlike the former we know how the latter turned out. In 2012, six years after it had been passed, Romneycare had achieved neither of these goals. That is one reason–a big reason–that Romney did not want to talk about national health care, and it is an example of why conservatives did not vote for him, which cost him in a close election.
Rather than dredging up old news, however, the important point is to learn from it. As the author of the previous article (written in 2012) concludes, “The answer to controlling health care costs and increasing access to care lies with giving consumers more control over their health care spending while increasing competition in the health care marketplace — not in mandates, subsidies, and regulation. That is the lesson we should be drawing from the failure of RomneyCare.”
That’s all! Thanks for corresponding with me. It takes a lot of time for both of us, but I think it is worth it.
Dorte wrote: “I wish that Obamacare could be repealed and replaced, and I wish as before that I don’t get sick.”
What would you suggest replacing it with and how would such a replacement be realistically paid for?
Hi Topcat,
Here is a new plan from Bobby Jindal, Governor of Louisiana. It is not a replacement but a modification. Perhaps that would be good enough (I haven’t studied the plan, so I don’t know):
http://www.businessweek.com/articles/2014-04-10/bobby-jindal-has-smart-ideas-to-improve-obamacare
Two aspects of this plan are as follows (quotes are from above article):
1) “[L]et nurse practitioners and other medical professionals practice to the full extent of their abilities.” (This would lower costs.)
2) Change the tax code so that health benefits from employers are no longer tax exempt. (This exemption leads to over-consumption of services, leading to a higher price of health care.) “Obamacare will tax high-cost plans starting in 2018; Jindal wants to scrap the exclusion altogether, replacing it with a tax deduction for all health insurance.” In other words, Obama approaches this problem with a disincentive, and Jindal approaches it with an incentive. As I have written in comments to a Vanguard article a few weeks ago, people learn better with reward (reinforcement) rather than with punishment, as shown by operant conditioning, the science of behavior modification.
As for how it is realistically paid for, I don’t know, but if prices are lower then they are more easily paid for. In any case, more plans will be coming down the pike, the article says, since Republican presidential hopefuls want to have something concrete to offer voters.
As for whether Obamacare is realistically paid for, that’s another can of worms, which I have discussed in my posts today to Tia (on this article) at 12:24 p.m. and 12:40 p.m.
Dorte
““[L]et nurse practitioners and other medical professionals practice to the full extent of their abilities.” (This would lower costs.)”
Mr. Jindal may not be aware since he is in a state where there is no Kaiser, but within our system this is already the case.
We employee Nurse Practitioners, Certified Nurse Midwives, Physicians Assistants, PharmDs manage many chronic stable conditions for patients in consultation with their physicians thus preventing the need for added expense. We use RNs, LVNs and medical assistants and engage in a constant process of training and retraining so that each job category is working to the top of their level of competency.
I am not informed enough to comment on Mr. Jindal’s second point.
Dr. Dean Edell has marveled at how quickly and efficiently the pharmacists at Costco do their vaccinations, and has wondered aloud why the government or a regular doctor’s office can’t do the same thing.
Dorte
I think it is far too soon to judge whether or not Obamacare is a positive or a burden to the system. I am wondering what actual evidence rather than fears is causing you to believe that it is overall a burden.
Hi Tia,
As I wrote in my post below, I think that a large portion of the proverbial ____ will hit the fan when the employer mandate kicks in (2015). That is after the 2014 elections. Some of that ____ hit the fan when the individual mandate kicked in (2013), which was after the 2012 elections. (You know, the President repeatedly said, “If you like your health plan, you can keep it, period,” even when he knew it was not true.)
Do you notice a pattern here? What do you think the outcome will be?
Dorte
I do not choose to judge a program by the way in which it has been promoted by a politician.
If I were that naive, I would believe that our intervention in Iraq was a stunning success because President Bush appeared in front of a banner saying Mission Accomplished.
The key for me is to assess the program itself. Is it being successful in providing a net benefit ? Is it achieving its stated goals ?
So far, the view from my own life and from my office is “yes”.
I am not as focused as you seem to be on what may go wrong. If things are not working, then it will be time to make adjustments. This president was elected, not once but twice because the majority of voters favored his positions over those of his opponent. My understanding of how our Democratic system is supposed to work is that those who are elected give it their best shot and should be supported to succeed to the extent possible.
That has not been the case with this president with the opposition stating that it was their chief goal to bring about his defeat even before he was sworn in. To me, this shows not only profound disrespect for the man himself, for the office of the Presidency, but also for the majority of voters who elected him.
Hi Tia,
You claim that the President made this statement to promote his program. However, he repeated it many times knowing that it was false.
I know this from these articles:
http://www.usatoday.com/story/news/politics/2013/11/11/fact-check-keeping-your-health-plan/3500187/
http://thehill.com/policy/healthcare/216223-cbo-millions-of-americans-could-lose-their-employer-coverage
By repeating it so many times (before the ACA was passed, after it was passed, and up to the 2012 elections) he encouraged voters to believe a falsehood before they knew the truth (and saw it in the form of cancellation letters in their mailboxes).
In other words, there is a difference between “promotion” and “fraud”. The President’s statement is the latter not the former.
You also write, “If things are not working, then it will be time to make adjustments.” Once entitlement programs are in place, they are very hard to remove. Do you know of one that has been cancelled?
You write, “This president was elected, not once but twice because the majority of voters favored his positions over those of his opponent.” Do you think that he would have been re-elected if voters knew that their policies might be cancelled?
You write, “My understanding of how our Democratic system is supposed to work is that those who are elected give it their best shot and should be supported to succeed to the extent possible.” The First Amendment guarantees us the right to free speech, which means that we can criticize someone with whom we disagree.
Consider your objections:
–“That has not been the case with this president with the opposition stating that it was their chief goal to bring about his defeat even before he was sworn in.” The President had associations with people who had non-mainstream beliefs (such as the Reverend Jeremiah Wright) and actions (such as William Ayers), so some people believed that the President might share these people’s convictions. Whether the President does or doesn’t, the First Amendment allows us to comment on him and to work in a lawful manner to block his goals, if that is what we would like to do. In fact, our tri-partite system of government was established so that there could be checks and balances, so that no branch could become too strong. This is how our democracy is supposed to work.
–“To me, this shows not only profound disrespect for the man himself, for the office of the Presidency, but also for the majority of voters who elected him.” To me, the highest respect for someone is to treat that person like an adult and express to him/her one’s point of view. That is sticking one’s neck out, showing one’s true colors, and facilitating an honest discussion of issues.
That is what I do with you and with other Vanguard readers.
Dorte
“Obamacare’s state and federal exchanges would need nearly 40 percent of new enrollees to be relatively healthy young adults — and thus spread out health care costs.”
I know I am really out of sync with my comments but I just received new information. Our enrollment of new members in the “relatively healthy young adult” demographic was within 5 percentage points of this target. Sorry that I am unable to provide the exact number.
Again, I am going to stress that there is a lot of speculation and fear about what may be going to happen. I like to keep in mind that when the word
“may” is used, one might just as well include the phrase “or may not”. We simply do not know how this is going to play out. Perhaps because I have had my career in medicine, I am trained to wait for the evidence before drawing a conclusion. That is the approach that I am taking to this bill.
We also seem to see another objection that you have made to the bill very differently. You have frequently made reference to the number of changes that Obama has made as though that were a negative. I see change when a better option is presented as a positive. Then in another paragraph, you mention that you want the bill to be modified. I am having difficulty seeing how you can both want change, but then criticize change when the need for it is perceived by President Obama. Could it be that you are so biased against the president that you will not see anything that he does as a step in the right direction ?
Dorte
“the highest respect for someone is to treat that person like an adult and express to him/her one’s point of view.”
On this point, we are in agreement. I see a difference in expressing one’s point of view so as to effect favorable change, and name calling, threats,
belittlement, and derision none of which I have ever found particularly helpful in trying to effect positive changes when working within a collaborative framework. However, these seem to be the principle MO of many who have constantly worked against the proposals of this administration.
Dorte
“Do you know of one that has been cancelled?”
Yes, I do. President Clinton fundamentally changed the nature of welfare which had been in place for many years.
Also your choice of words is illustrative of how differently we see the world. You chose to use the word “entitlement program”. Having been a beneficiary of Social Security after my father’s death when I was nine, I tend to see these programs as “freedom programs”. In my case, freedom from hunger.
It is interesting to me that in this country, we tend to view the word freedom as only having one aspect…. freedom to do something. I have a more balanced view of that word freedom. I see it also applying to freedom from ( freedom from hunger, from homelessness, from preventable and treatable illness). If we want the strongest society possible, it is my view that we should fully respect both aspects of the word “freedom” that we use so casually.
Hi Tia,
Per the Constitution, the role of the Congress is to make the laws, and the role of the President is to execute them. When a law is changed as many times as the ACA has been, that makes me think that it is being made. When that is being done by the President, that is a violation of the Constitution.
Also, we have a government of laws, not men, but this law (the ACA) is being changed by this man (President Obama). If you think this is OK because you like both of them, see how you feel when both are different (new man/new law).
For more information, see the following column by Jonathan Turley, a Constitutional law professor:
http://jonathanturley.org/2014/05/21/a-question-of-power-the-imperial-presidency/
You also write, “I am trained to wait for the evidence before drawing a conclusion.” As a doctor, you look for evidence of things present (such as the fact that the patient is breathing, which is good) and things absent (not breathing=bad). I know you’ve said that you don’t have much of a background in economics, and my knowledge is only basic, but consider the following about the U.S. economic recovery:
–It is the weakest in the world since 1970:
http://www.aei-ideas.org/2012/07/u-s-recovery-weakest-of-any-in-the-world-since-1970/
–It is the weakest in U.S. history since WWII:
http://www.huffingtonpost.com/2012/08/15/us-economic-recovery-weak_n_1783065.html
Unfortunately, these articles are somewhat outdated (I couldn’t find any which were more recent), but the question remains: Why would this recovery be so bad? What might have changed to make it so?
–The ACA was enacted, which changed the national health care system, which is 1/6 of the economy. Therefore, the economy changed as well.
–The many changes to this law lead to a climate of uncertainty, which leads to less economic investment, which leads to lower economic growth. As the last article points out: “And the deeply divided U.S. political system has delivered growth-chilling uncertainty.”
In other words, our economy is limping along probably because of the ACA. Why does the economy matter? All of its indices–such as jobs, unemployment, inflation–affect us on a daily basis because they involve money, and money is what we use as a means of exchange.
Of course, I don’t understand all of economics, but neither does anyone else, not even the pros. Economists are learning more all the time, and they continue to disagree. The point that I am making is this:
–The U.S. economy was weak to begin with (the recession ended in June 2009, according to the following link):
http://usgovinfo.about.com/od/moneymatters/a/When-Did-The-Great-Recession-End.htm
–The ACA was passed only six months later, which I believe was far too early for the recovering economy to adjust to.
You are a doctor, so think about the following scenario (in which I have arbitrarily assigned genders as masculine, since fewer words equal less confusion):
A patient is very ill, with several organs not functioning well. One of these is his heart, so his doctor gives him a heart transplant. He survives the operation but is still in poor health.
That is the situation of the U.S. economy. A massive change to it (the ACA) has been made, and the economy is still not doing well. You see the positive results for individual people. I look at the overall picture and am concerned, both on a Constitutional level (where the abstract becomes real over time) and on a concrete level (the overall economy as it is functioning now).
You conclude by asking, “Could it be that you are so biased against the president that you will not see anything that he does as a step in the right direction?” I admit that I do not like the President personally (from what I have seen of him) or politically (from what he has done especially in regards to the ACA). However, I will give him credit for doing what Republicans would not do (for philosophical or other reasons), which was to try to improve long-standing problems in national healthcare. That said, I fault him on his:
–manner of doing it (many revisions, which are most likely un-Constitutional)
–timing of it (during a nascent economic recovery)
I don’t know what will happen to this country, but I know that things will turn out better if people engage in honest and civil debate about the issues, the ACA being a crucial one. In another post, you write that you have not seen much of this so far. I am not responsible for the actions of others. I can only do my best and encourage others to do the same.
Dorte, is the law being changed or are the regulations that pertain to the law being adjusted? The IRS changes the tax code on a very regular basis, but that falls into the category of “regulatory change.” Why do you see the ACA changes as different from IRS changes?
Dorte, don’t these significant lies hit you the wrong way?
When our nation passed Social Security and Medicare, it was done in the light of day, with bi-partisan support. This monstrosity was passed with midnight votes, backdoor deals, significant lies and deceptions.
This thing has been a foul-smelling turkey since Day 1, and a chief reason why the Tea Party and nation revolved in the election which followed.
Dorte
I think it is far too soon to judge whether or not Obamacare is a positive or a burden to the system. I am wondering what actual evidence rather than fears is causing you to believe that it is overall a burden.
Hi Tia,
As I wrote in my post below, I think that a large portion of the proverbial ____ will hit the fan when the employer mandate kicks in (2015). That is after the 2014 elections. Some of that ____ hit the fan when the individual mandate kicked in (2013), which was after the 2012 elections. (You know, the President repeatedly said, “If you like your health plan, you can keep it, period,” even when he knew it was not true.)
Do you notice a pattern here? What do you think the outcome will be?
Dorte
I do not choose to judge a program by the way in which it has been promoted by a politician.
If I were that naive, I would believe that our intervention in Iraq was a stunning success because President Bush appeared in front of a banner saying Mission Accomplished.
The key for me is to assess the program itself. Is it being successful in providing a net benefit ? Is it achieving its stated goals ?
So far, the view from my own life and from my office is “yes”.
I am not as focused as you seem to be on what may go wrong. If things are not working, then it will be time to make adjustments. This president was elected, not once but twice because the majority of voters favored his positions over those of his opponent. My understanding of how our Democratic system is supposed to work is that those who are elected give it their best shot and should be supported to succeed to the extent possible.
That has not been the case with this president with the opposition stating that it was their chief goal to bring about his defeat even before he was sworn in. To me, this shows not only profound disrespect for the man himself, for the office of the Presidency, but also for the majority of voters who elected him.
Hi Tia,
You claim that the President made this statement to promote his program. However, he repeated it many times knowing that it was false.
I know this from these articles:
http://www.usatoday.com/story/news/politics/2013/11/11/fact-check-keeping-your-health-plan/3500187/
http://thehill.com/policy/healthcare/216223-cbo-millions-of-americans-could-lose-their-employer-coverage
By repeating it so many times (before the ACA was passed, after it was passed, and up to the 2012 elections) he encouraged voters to believe a falsehood before they knew the truth (and saw it in the form of cancellation letters in their mailboxes).
In other words, there is a difference between “promotion” and “fraud”. The President’s statement is the latter not the former.
You also write, “If things are not working, then it will be time to make adjustments.” Once entitlement programs are in place, they are very hard to remove. Do you know of one that has been cancelled?
You write, “This president was elected, not once but twice because the majority of voters favored his positions over those of his opponent.” Do you think that he would have been re-elected if voters knew that their policies might be cancelled?
You write, “My understanding of how our Democratic system is supposed to work is that those who are elected give it their best shot and should be supported to succeed to the extent possible.” The First Amendment guarantees us the right to free speech, which means that we can criticize someone with whom we disagree.
Consider your objections:
–“That has not been the case with this president with the opposition stating that it was their chief goal to bring about his defeat even before he was sworn in.” The President had associations with people who had non-mainstream beliefs (such as the Reverend Jeremiah Wright) and actions (such as William Ayers), so some people believed that the President might share these people’s convictions. Whether the President does or doesn’t, the First Amendment allows us to comment on him and to work in a lawful manner to block his goals, if that is what we would like to do. In fact, our tri-partite system of government was established so that there could be checks and balances, so that no branch could become too strong. This is how our democracy is supposed to work.
–“To me, this shows not only profound disrespect for the man himself, for the office of the Presidency, but also for the majority of voters who elected him.” To me, the highest respect for someone is to treat that person like an adult and express to him/her one’s point of view. That is sticking one’s neck out, showing one’s true colors, and facilitating an honest discussion of issues.
That is what I do with you and with other Vanguard readers.
Dorte
“Obamacare’s state and federal exchanges would need nearly 40 percent of new enrollees to be relatively healthy young adults — and thus spread out health care costs.”
I know I am really out of sync with my comments but I just received new information. Our enrollment of new members in the “relatively healthy young adult” demographic was within 5 percentage points of this target. Sorry that I am unable to provide the exact number.
Again, I am going to stress that there is a lot of speculation and fear about what may be going to happen. I like to keep in mind that when the word
“may” is used, one might just as well include the phrase “or may not”. We simply do not know how this is going to play out. Perhaps because I have had my career in medicine, I am trained to wait for the evidence before drawing a conclusion. That is the approach that I am taking to this bill.
We also seem to see another objection that you have made to the bill very differently. You have frequently made reference to the number of changes that Obama has made as though that were a negative. I see change when a better option is presented as a positive. Then in another paragraph, you mention that you want the bill to be modified. I am having difficulty seeing how you can both want change, but then criticize change when the need for it is perceived by President Obama. Could it be that you are so biased against the president that you will not see anything that he does as a step in the right direction ?
Dorte
“the highest respect for someone is to treat that person like an adult and express to him/her one’s point of view.”
On this point, we are in agreement. I see a difference in expressing one’s point of view so as to effect favorable change, and name calling, threats,
belittlement, and derision none of which I have ever found particularly helpful in trying to effect positive changes when working within a collaborative framework. However, these seem to be the principle MO of many who have constantly worked against the proposals of this administration.
Dorte
“Do you know of one that has been cancelled?”
Yes, I do. President Clinton fundamentally changed the nature of welfare which had been in place for many years.
Also your choice of words is illustrative of how differently we see the world. You chose to use the word “entitlement program”. Having been a beneficiary of Social Security after my father’s death when I was nine, I tend to see these programs as “freedom programs”. In my case, freedom from hunger.
It is interesting to me that in this country, we tend to view the word freedom as only having one aspect…. freedom to do something. I have a more balanced view of that word freedom. I see it also applying to freedom from ( freedom from hunger, from homelessness, from preventable and treatable illness). If we want the strongest society possible, it is my view that we should fully respect both aspects of the word “freedom” that we use so casually.
Hi Tia,
Per the Constitution, the role of the Congress is to make the laws, and the role of the President is to execute them. When a law is changed as many times as the ACA has been, that makes me think that it is being made. When that is being done by the President, that is a violation of the Constitution.
Also, we have a government of laws, not men, but this law (the ACA) is being changed by this man (President Obama). If you think this is OK because you like both of them, see how you feel when both are different (new man/new law).
For more information, see the following column by Jonathan Turley, a Constitutional law professor:
http://jonathanturley.org/2014/05/21/a-question-of-power-the-imperial-presidency/
You also write, “I am trained to wait for the evidence before drawing a conclusion.” As a doctor, you look for evidence of things present (such as the fact that the patient is breathing, which is good) and things absent (not breathing=bad). I know you’ve said that you don’t have much of a background in economics, and my knowledge is only basic, but consider the following about the U.S. economic recovery:
–It is the weakest in the world since 1970:
http://www.aei-ideas.org/2012/07/u-s-recovery-weakest-of-any-in-the-world-since-1970/
–It is the weakest in U.S. history since WWII:
http://www.huffingtonpost.com/2012/08/15/us-economic-recovery-weak_n_1783065.html
Unfortunately, these articles are somewhat outdated (I couldn’t find any which were more recent), but the question remains: Why would this recovery be so bad? What might have changed to make it so?
–The ACA was enacted, which changed the national health care system, which is 1/6 of the economy. Therefore, the economy changed as well.
–The many changes to this law lead to a climate of uncertainty, which leads to less economic investment, which leads to lower economic growth. As the last article points out: “And the deeply divided U.S. political system has delivered growth-chilling uncertainty.”
In other words, our economy is limping along probably because of the ACA. Why does the economy matter? All of its indices–such as jobs, unemployment, inflation–affect us on a daily basis because they involve money, and money is what we use as a means of exchange.
Of course, I don’t understand all of economics, but neither does anyone else, not even the pros. Economists are learning more all the time, and they continue to disagree. The point that I am making is this:
–The U.S. economy was weak to begin with (the recession ended in June 2009, according to the following link):
http://usgovinfo.about.com/od/moneymatters/a/When-Did-The-Great-Recession-End.htm
–The ACA was passed only six months later, which I believe was far too early for the recovering economy to adjust to.
You are a doctor, so think about the following scenario (in which I have arbitrarily assigned genders as masculine, since fewer words equal less confusion):
A patient is very ill, with several organs not functioning well. One of these is his heart, so his doctor gives him a heart transplant. He survives the operation but is still in poor health.
That is the situation of the U.S. economy. A massive change to it (the ACA) has been made, and the economy is still not doing well. You see the positive results for individual people. I look at the overall picture and am concerned, both on a Constitutional level (where the abstract becomes real over time) and on a concrete level (the overall economy as it is functioning now).
You conclude by asking, “Could it be that you are so biased against the president that you will not see anything that he does as a step in the right direction?” I admit that I do not like the President personally (from what I have seen of him) or politically (from what he has done especially in regards to the ACA). However, I will give him credit for doing what Republicans would not do (for philosophical or other reasons), which was to try to improve long-standing problems in national healthcare. That said, I fault him on his:
–manner of doing it (many revisions, which are most likely un-Constitutional)
–timing of it (during a nascent economic recovery)
I don’t know what will happen to this country, but I know that things will turn out better if people engage in honest and civil debate about the issues, the ACA being a crucial one. In another post, you write that you have not seen much of this so far. I am not responsible for the actions of others. I can only do my best and encourage others to do the same.
Dorte, is the law being changed or are the regulations that pertain to the law being adjusted? The IRS changes the tax code on a very regular basis, but that falls into the category of “regulatory change.” Why do you see the ACA changes as different from IRS changes?
Dorte, don’t these significant lies hit you the wrong way?
When our nation passed Social Security and Medicare, it was done in the light of day, with bi-partisan support. This monstrosity was passed with midnight votes, backdoor deals, significant lies and deceptions.
This thing has been a foul-smelling turkey since Day 1, and a chief reason why the Tea Party and nation revolved in the election which followed.
Dorte
“However, if they never had a disease (such as cancer) and are screened now and still don’t have it, then knowing that may help psychologically, but it is not a help in the real sense, since they don’t have the disease to begin with.”
With your post as my only indication, I think that you and I may have a fundamentally different view of the value of screening tests and preventive health care.
With screening tests for a given disease, there is a benefit not only to the individual, but also to the population as a whole. Many people who have not gone in to medicine perceive health care as a strictly private matter. Those of us who are in the business are keenly aware that there is a societal effect of the individual choices that we all make with regard to health care.
If we take cervical cancer screening as an example, when abnormal cells that have a high probability of progressing to cancer are found early, we are able to save the life of the individual woman. By preventing the more expensive to treat invasive cancer we also improve the health of the overall community since she will not be passing on HPV which can infect her partner(s) and their future partner(s) and because the money that would have been spent on cancer treatment is now available for research or management of other diseases. This effect is true for all sexually transmissible diseases. It is our policy ,for example ,to screen all sexually active women under the age of 24 for gonorrhea and chlamydia every year, both for her own protection and for the protection of other members of her age cohort.
Another benefit of preventive care can be seen with immunization. When an individual has insurance, they are more likely to take advantage of services such as immunization. This also has a community wide benefit as is seen in the current epidemic of pertussis. Staying up to date on pertussis immunization is quite literally life saving for infants under one year of age. While it is true that you would probably never know that you had saved a life, the reality is that this effect is real.
Hi Tia,
You write, “With your post as my only indication, I think that you and I may have a fundamentally different view of the value of screening tests and preventive health care.”
I don’t have a fundamentally different view of the value of these things, but I may have a different view of their cost. Before we get to the cost aspect, however, I’ll discuss the frequency of screenings, which relates to their cost.
In your next post, you describe recommended frequency of screenings for women, including those for breast cancer. You write that women should have a “mammography every one to two years starting around age 40 ( again for the average risk woman).” Suppose a patient and her provider are part of a state-funded program to cover mammography, and both of them need to choose how often to receive/provide one. Which would each choose? The patient is in a low-income group (not paying state income tax), so she will not pay anything, even indirectly, for the service. Therefore, she would probably choose to do it every year to be more safe. The doctor in question is in a higher-income group (presumably, so he/she would be paying state income tax for it indirectly), but the cost to him/her is small, so he/she would probably recommend to the patient to do it every year.
The point is that people tend to use things more when they perceive them to be free.
However, those who are taxed to provide the service are those who are paying the bill. You have said that you personally don’t mind paying more taxes to fund things you believe in, but taxes by nature are not a choice (since they are enforced). So all tax-payers end up paying for these screenings, whether they support them (like you do) or not.
So the question of free screenings come down not only to the problem of overuse but to the problem of income redistribution. To put it bluntly, why would a working couple trying to feed/clothe/send their own children to college want to pay extra so that someone else can have extra mammograms?
In other words, paying for preventive screening for poor people is a balancing act: Patients/doctors should not overuse funds, or sooner or later taxpayers will elect legislators who will not approve those programs.
As another example, consider the sign-ups for Obamacare on the federal marketplace. Nine out of every ten people who have signed up qualify for subsidies, and those subsidies reduce premium prices by 76%. The cost to taxpayers is $11 billion.
http://hotair.com/archives/2014/06/18/report-obama-admin-congratulates-itself-on-cutting-subsidy-eligible-enrollees-premiums-by-an-average-of-76-percent/
Do taxpayers want to fund this? They have no choice, since Obamacare is the law of the land. However, when the employer mandate kicks in (2015) and many employees probably lose their employer-provided insurance (I provided two relevant links in my above post of July 19, 12:35 a.m.), they will be forced onto the exchanges. Will they get a subsidy? Probably not. Will their premiums be higher. Probably so. You see, they (as taxpayers) are subsidizing Obamacare now, but soon there will be nobody to subsidize them.
Do you think that this scenario sounds good?
In any risk pool, those who aren’t currently using health care are ‘subsidizing’ those who are. The ACA expanded the risk pool to include all Americans, including the poor and those with pre-existing conditions. The more who sign up, the broader the risk pool and the less the burden on the others who are paying. All of us, as we age, use more health care. The majority of your expense comes in the last years of your life.
The grand bargain of the Affordable Care Act was that it handed the insurance companies an enormously larger risk pool over which to spread the cost of insuring more Americans. It will only work, cost-wise, if there is an individual mandate. The employer mandate is less crucial, but provides some important financing. So if we all want to get rid of the employer mandate, and have everyone responsible for his or her own insurance, some of the cost would probably have to be recouped–probably in the form of a tax on employers. I think that is politically unlikely.
Employer-based health coverage is the reality for most in America. The problems with that are becoming obvious, such as these religious exemptions. But since there isn’t likely to be any modification of the ACA, at least not within the next 2 – 3 years, then we will simply have to work with this patchwork of coverage that includes holes being created by court decisions such as Hobby Lobby.
Hi Don,
As I alluded to in my post of July 21, 12:09 a.m., the fact that subsidies are paid for by taxpayers means that the new risk pool is not a closed system.
In a closed system, participants would pay once (for premiums without subsidies) or in effect less than once (for premiums with subsidies). In the new insurance system (as a result of Obamacare), the former group’s taxes pay for the latter group’s subsidies, so the former group ends up paying in effect more than once. This is one of the main reasons why Obamacare is unfair, since it is not only an insurance system but a means of wealth redistribution.
Why is wealth redistribution unfair if it serves a social good? We do that for all kinds of things.
Why does it matter if the system is open or closed?
Why does it matter if the lower-income subsidies are paid for by the overall system, or by taxes, or by some combination of the two?
People who can’t afford health care, fully or partially, are either going to go without it (and get sick and die), or use the system and be unable to pay for it. Or they will be on a partially or fully subsidized health system. The money has to come from somewhere for that. The funds for the ACA came from expanding the pool (individual mandate), various fees, various taxes. It’s a combination of revenues.
Conservatives, over the last 5 – 6 years, have moved to a position of opposition to universal health coverage. As recently as 2007, conservatives and Republicans advocated for universal coverage and the individual mandate. Even Jim DeMint is on record for those things. Then there was a gradual shift to opposition to any expansion of the federal role in health insurance, complete opposition to raising taxes and fees, and governors refused to consider expansion of health services to their poorest citizens. So basically, conservatives and Republicans have abandoned the principle that all Americans have a right to basic health care. Do you hold that position? If you do, we have a fundamental difference of values.
If Obamacare is repealed, I will lose my health care. It’s that simple.
Wouldn’t you call it unfair to take 60% of someone else’s income? Why do we have a right to their money? Some people call that theft, Dr. Walter Williams being one of them.
The funds for the ACA didn’t come from expanding the pool; they are being put on our nation’s credit card, something Obama has become a master at.
As time goes on, no matter how grating she was, Sarah Palin was right – we will have Death Panels. I’m currently friends with several older Americans over 75 and 80, and the majority of them have battled at least 2 major illnesses; some have battled 4 or 5. There are enormous costs there, and rationing is the only way under the ACA to even come close to paying the tab.
So you complain about lies on one comment, and then repeat the most egregious, outlandish, ridiculous lie on another comment.
We will have rationing of services, which will lead to deaths; Palin simply gave it a memorable name that stuck with the public.
We will not have any more “rationing of services” than we had done by insurance companies. In fact, we’ll have less.
Don, on this you are either guessing or hoping.
You wrote: “The grand bargain of the Affordable Care Act was that it handed the insurance companies an enormously larger risk pool over which to spread the cost of insuring more Americans.”
The sign-up rate for youngsters for Obamacare hasn’t happened, so the system has added older, sicker people, but not the numbers of young healthy people needed. So rates will rise, possibly skyrocket, in the next go around.
You wrote: “. But since there isn’t likely to be any modification of the ACA, at least not within the next 2 – 3 years,…”
There have been over 40 changes to the ACA; Obama has made at least 24 unilaterally, which I thought was illegal under our Constitution.
http://www.galen.org/newsletters/changes-to-obamacare-so-far/
As noted on a previous reply, the signup rate for young people has been sufficient because it has met the expectations of the insurers as they established their rates.
Here is Kaiser’s analysis of what would happen to rates under various percentages of young adult signups: http://kff.org/health-reform/perspective/the-numbers-behind-young-invincibles-and-the-affordable-care-act/
Note that significant discrepancies are covered by the ‘risk corridor’ reimbursement from the federal government. Your assertion that rates will “possibly skyrocket” seems unfounded.
Most of the President’s actions were delays and exemptions. Congress blocked some minor portions. The major change was the Supreme Court’s ill-advised decision allowing the states to opt out of the Medicare expansion. That’s going to require some kind of fix to get poor people covered.
As to what’s illegal, I assume that will be resolved in court at some point. Are you a constitutional scholar? Do Obama’s executive actions have some unique aspect that previous presidents’ didn’t?
Don
“So basically, conservatives and Republicans have abandoned the principle that all Americans have a right to basic health care. Do you hold that position? If you do, we have a fundamental difference of values.”
I really do believe that this is the critical difference and that it is one of values. Either one sees health care as a human right or one sees it as a societal good as one poster put it earlier.
This to me is the difference between necessity and “nice to have”. For me health care should be considered as much a right of citizens as is protection by our military. To be safe, it is necessary to have protection, not only against foreign enemies, but also from the internal and social enemies or hunger, homelessness, illness. It the goal is a strong society, it cannot be built by people who are weak or ill. We as humans have the obligation to care for others.
And yes, we can afford it as a nation. It would mean re prioritizing. It would not mean the destruction of the middle class ( actually I suspect that without the fear of losing ones home or savings or job to illness ) the middle class might be significantly better off as medical costs have often been the straw that broke the proverbial back of the middle class family just making it before illness struck. It would not mean the descent into some kind of mythical
“socialist hell” as some on the right have claimed.
So basically, conservatives and Republicans have abandoned the principle that all Americans have a right to basic health care.
Define “basic” and then I will tell you if you are correct or not.
And one more point to make. Do all people have a right to basic food and basic shelter? Because without those they would die. And if you believe so, then why don’t you advocate for the government to take over all food production and all housing?
Dorte
“However, if they never had a disease (such as cancer) and are screened now and still don’t have it, then knowing that may help psychologically, but it is not a help in the real sense, since they don’t have the disease to begin with.”
With your post as my only indication, I think that you and I may have a fundamentally different view of the value of screening tests and preventive health care.
With screening tests for a given disease, there is a benefit not only to the individual, but also to the population as a whole. Many people who have not gone in to medicine perceive health care as a strictly private matter. Those of us who are in the business are keenly aware that there is a societal effect of the individual choices that we all make with regard to health care.
If we take cervical cancer screening as an example, when abnormal cells that have a high probability of progressing to cancer are found early, we are able to save the life of the individual woman. By preventing the more expensive to treat invasive cancer we also improve the health of the overall community since she will not be passing on HPV which can infect her partner(s) and their future partner(s) and because the money that would have been spent on cancer treatment is now available for research or management of other diseases. This effect is true for all sexually transmissible diseases. It is our policy ,for example ,to screen all sexually active women under the age of 24 for gonorrhea and chlamydia every year, both for her own protection and for the protection of other members of her age cohort.
Another benefit of preventive care can be seen with immunization. When an individual has insurance, they are more likely to take advantage of services such as immunization. This also has a community wide benefit as is seen in the current epidemic of pertussis. Staying up to date on pertussis immunization is quite literally life saving for infants under one year of age. While it is true that you would probably never know that you had saved a life, the reality is that this effect is real.
Hi Tia,
You write, “With your post as my only indication, I think that you and I may have a fundamentally different view of the value of screening tests and preventive health care.”
I don’t have a fundamentally different view of the value of these things, but I may have a different view of their cost. Before we get to the cost aspect, however, I’ll discuss the frequency of screenings, which relates to their cost.
In your next post, you describe recommended frequency of screenings for women, including those for breast cancer. You write that women should have a “mammography every one to two years starting around age 40 ( again for the average risk woman).” Suppose a patient and her provider are part of a state-funded program to cover mammography, and both of them need to choose how often to receive/provide one. Which would each choose? The patient is in a low-income group (not paying state income tax), so she will not pay anything, even indirectly, for the service. Therefore, she would probably choose to do it every year to be more safe. The doctor in question is in a higher-income group (presumably, so he/she would be paying state income tax for it indirectly), but the cost to him/her is small, so he/she would probably recommend to the patient to do it every year.
The point is that people tend to use things more when they perceive them to be free.
However, those who are taxed to provide the service are those who are paying the bill. You have said that you personally don’t mind paying more taxes to fund things you believe in, but taxes by nature are not a choice (since they are enforced). So all tax-payers end up paying for these screenings, whether they support them (like you do) or not.
So the question of free screenings come down not only to the problem of overuse but to the problem of income redistribution. To put it bluntly, why would a working couple trying to feed/clothe/send their own children to college want to pay extra so that someone else can have extra mammograms?
In other words, paying for preventive screening for poor people is a balancing act: Patients/doctors should not overuse funds, or sooner or later taxpayers will elect legislators who will not approve those programs.
As another example, consider the sign-ups for Obamacare on the federal marketplace. Nine out of every ten people who have signed up qualify for subsidies, and those subsidies reduce premium prices by 76%. The cost to taxpayers is $11 billion.
http://hotair.com/archives/2014/06/18/report-obama-admin-congratulates-itself-on-cutting-subsidy-eligible-enrollees-premiums-by-an-average-of-76-percent/
Do taxpayers want to fund this? They have no choice, since Obamacare is the law of the land. However, when the employer mandate kicks in (2015) and many employees probably lose their employer-provided insurance (I provided two relevant links in my above post of July 19, 12:35 a.m.), they will be forced onto the exchanges. Will they get a subsidy? Probably not. Will their premiums be higher. Probably so. You see, they (as taxpayers) are subsidizing Obamacare now, but soon there will be nobody to subsidize them.
Do you think that this scenario sounds good?
In any risk pool, those who aren’t currently using health care are ‘subsidizing’ those who are. The ACA expanded the risk pool to include all Americans, including the poor and those with pre-existing conditions. The more who sign up, the broader the risk pool and the less the burden on the others who are paying. All of us, as we age, use more health care. The majority of your expense comes in the last years of your life.
The grand bargain of the Affordable Care Act was that it handed the insurance companies an enormously larger risk pool over which to spread the cost of insuring more Americans. It will only work, cost-wise, if there is an individual mandate. The employer mandate is less crucial, but provides some important financing. So if we all want to get rid of the employer mandate, and have everyone responsible for his or her own insurance, some of the cost would probably have to be recouped–probably in the form of a tax on employers. I think that is politically unlikely.
Employer-based health coverage is the reality for most in America. The problems with that are becoming obvious, such as these religious exemptions. But since there isn’t likely to be any modification of the ACA, at least not within the next 2 – 3 years, then we will simply have to work with this patchwork of coverage that includes holes being created by court decisions such as Hobby Lobby.
Hi Don,
As I alluded to in my post of July 21, 12:09 a.m., the fact that subsidies are paid for by taxpayers means that the new risk pool is not a closed system.
In a closed system, participants would pay once (for premiums without subsidies) or in effect less than once (for premiums with subsidies). In the new insurance system (as a result of Obamacare), the former group’s taxes pay for the latter group’s subsidies, so the former group ends up paying in effect more than once. This is one of the main reasons why Obamacare is unfair, since it is not only an insurance system but a means of wealth redistribution.
Why is wealth redistribution unfair if it serves a social good? We do that for all kinds of things.
Why does it matter if the system is open or closed?
Why does it matter if the lower-income subsidies are paid for by the overall system, or by taxes, or by some combination of the two?
People who can’t afford health care, fully or partially, are either going to go without it (and get sick and die), or use the system and be unable to pay for it. Or they will be on a partially or fully subsidized health system. The money has to come from somewhere for that. The funds for the ACA came from expanding the pool (individual mandate), various fees, various taxes. It’s a combination of revenues.
Conservatives, over the last 5 – 6 years, have moved to a position of opposition to universal health coverage. As recently as 2007, conservatives and Republicans advocated for universal coverage and the individual mandate. Even Jim DeMint is on record for those things. Then there was a gradual shift to opposition to any expansion of the federal role in health insurance, complete opposition to raising taxes and fees, and governors refused to consider expansion of health services to their poorest citizens. So basically, conservatives and Republicans have abandoned the principle that all Americans have a right to basic health care. Do you hold that position? If you do, we have a fundamental difference of values.
If Obamacare is repealed, I will lose my health care. It’s that simple.
Wouldn’t you call it unfair to take 60% of someone else’s income? Why do we have a right to their money? Some people call that theft, Dr. Walter Williams being one of them.
The funds for the ACA didn’t come from expanding the pool; they are being put on our nation’s credit card, something Obama has become a master at.
As time goes on, no matter how grating she was, Sarah Palin was right – we will have Death Panels. I’m currently friends with several older Americans over 75 and 80, and the majority of them have battled at least 2 major illnesses; some have battled 4 or 5. There are enormous costs there, and rationing is the only way under the ACA to even come close to paying the tab.
So you complain about lies on one comment, and then repeat the most egregious, outlandish, ridiculous lie on another comment.
We will have rationing of services, which will lead to deaths; Palin simply gave it a memorable name that stuck with the public.
We will not have any more “rationing of services” than we had done by insurance companies. In fact, we’ll have less.
Don, on this you are either guessing or hoping.
You wrote: “The grand bargain of the Affordable Care Act was that it handed the insurance companies an enormously larger risk pool over which to spread the cost of insuring more Americans.”
The sign-up rate for youngsters for Obamacare hasn’t happened, so the system has added older, sicker people, but not the numbers of young healthy people needed. So rates will rise, possibly skyrocket, in the next go around.
You wrote: “. But since there isn’t likely to be any modification of the ACA, at least not within the next 2 – 3 years,…”
There have been over 40 changes to the ACA; Obama has made at least 24 unilaterally, which I thought was illegal under our Constitution.
http://www.galen.org/newsletters/changes-to-obamacare-so-far/
As noted on a previous reply, the signup rate for young people has been sufficient because it has met the expectations of the insurers as they established their rates.
Here is Kaiser’s analysis of what would happen to rates under various percentages of young adult signups: http://kff.org/health-reform/perspective/the-numbers-behind-young-invincibles-and-the-affordable-care-act/
Note that significant discrepancies are covered by the ‘risk corridor’ reimbursement from the federal government. Your assertion that rates will “possibly skyrocket” seems unfounded.
Most of the President’s actions were delays and exemptions. Congress blocked some minor portions. The major change was the Supreme Court’s ill-advised decision allowing the states to opt out of the Medicare expansion. That’s going to require some kind of fix to get poor people covered.
As to what’s illegal, I assume that will be resolved in court at some point. Are you a constitutional scholar? Do Obama’s executive actions have some unique aspect that previous presidents’ didn’t?
Don
“So basically, conservatives and Republicans have abandoned the principle that all Americans have a right to basic health care. Do you hold that position? If you do, we have a fundamental difference of values.”
I really do believe that this is the critical difference and that it is one of values. Either one sees health care as a human right or one sees it as a societal good as one poster put it earlier.
This to me is the difference between necessity and “nice to have”. For me health care should be considered as much a right of citizens as is protection by our military. To be safe, it is necessary to have protection, not only against foreign enemies, but also from the internal and social enemies or hunger, homelessness, illness. It the goal is a strong society, it cannot be built by people who are weak or ill. We as humans have the obligation to care for others.
And yes, we can afford it as a nation. It would mean re prioritizing. It would not mean the destruction of the middle class ( actually I suspect that without the fear of losing ones home or savings or job to illness ) the middle class might be significantly better off as medical costs have often been the straw that broke the proverbial back of the middle class family just making it before illness struck. It would not mean the descent into some kind of mythical
“socialist hell” as some on the right have claimed.
So basically, conservatives and Republicans have abandoned the principle that all Americans have a right to basic health care.
Define “basic” and then I will tell you if you are correct or not.
And one more point to make. Do all people have a right to basic food and basic shelter? Because without those they would die. And if you believe so, then why don’t you advocate for the government to take over all food production and all housing?
Dorte
“I wish that Obamacare could be repealed and replaced, and I wish as before that I don’t get sick.”
Wishing that one does not get sick is fine. However, I would strongly recommend being proactive rather than reactive with regard to one’s health. A truly proactive and sometimes life saving approach is to get regular health care evaluations which for women include cervical cancer screening every three years ( for the average risk woman), mammography every one to two years starting around age 40 ( again for the average risk woman), colon cancer screening after age 50, Cholesterol, blood sugar and thyroid testing every two to three years after age 40-50 depending on additional risk factors and staying current on one’s immunizations. Of course, all of this can be done without any insurance at all by paying up front for your tests. Most people I know do not choose this course of action if they are not insured. I consider this reactive because there are many conditions that do not have any associated symptoms until the disease has caused significant damage to vital organs such as the liver, kidneys or heart after which point it can be very difficult and expensive to manage.
Hi Tia,
You write, “Most people I know do not choose this course of action if they are not insured.”
I guess I am in the minority of those people you know. You might have guessed that based on my posts on other issues.
Hi Dorte
Since you are deliberately choosing not to carry insurance, I have some questions for you.
What if you are in a life threatening car accident tomorrow and you are now disabled and cannot work. Lets further say that this is a “no fault accident ” and so there is no one to sue. What do you feel is the right course of action and why ?
Do you feel that you should be provided only with ER care and stabilized even if you need far more extensive care ? Who should pay for the ER services ? If you believe that you should receive hospital services and or skilled nursing or rehabilitative services until such time as you are able to resume work, who do you believe should pay for this care ?
What if you are permanently disabled and can no longer work at all ? Do you believe that you should be helped….and if not by the government, then by whom ?
Hi Tia,
Since you responded to me on this thread (if that is what it is called) I thought you might say that you were glad that I’m not going to die from one of those preventable diseases. I guess not.
Thanks for the post, though. I’d like to answer it in full, but I’d rather not tell everyone in the world about personal details of my life. Suffice it to say that I am not employed but help my mother manage her household.
If I were catastrophically hurt, I would pay the bill myself first, and then my mom would want to kick in for the rest. Perhaps my Dad would kick in some. I would use the minimum amount of services, so that probably would not include rehabilitative care. The goal would not be to be patched up enough to resume work–I’m not employed now!–but to be able to crawl around my house if need be. I believe that if I could crawl I could learn to walk, since I did that once before, some 50 years ago.
If this catastrophic event happened after my parents were dead (you can guess their ages, based on mine), I would want even less services. I might even decide I wanted to be allowed to die. You see, my only dependents are my cats, and I could probably get someone to take care of them.
In other words, I don’t have the life you think I have. I don’t have the life I thought I would have. I have the life I have, and it’s good enough. In fact, it’s great because it’s the one I have.
Of course, if the accident actually happened I might change my mind. I can’t predict how I would feel when actually faced with those circumstances. However, I have the sense now that “my” life is basically over. I still live (here I am typing), but there is less of “me”–wants, desires, goals–and since there is less of “me” there is more room in my experience for things which are “not-me”. Of course, this me/not-me distinction is ridiculous, since when there is less of me, there is less of not-me as well. There is more of everything around.
In other words, I feel more connected to everything and everyone since I don’t separate myself out so much or since there is less to separate out to begin with.
A logical extension of this is that it would not be terrible to die as long as doing so hurt nobody. When I’m here, I’ll do my best to do what I think I am here to do–no, what I am almost certain I am here to do–and then “I” will be gone. In fact, “I” am almost already gone. And that’s good. In fact, it’s great.
And lest you tell me, in doctor mode, that I am depressed, I’ll tell you that that’s not very possible, since there is not much “I” there. If you tell me that you know better than I do, I’ll tell you that’s not likely, since now I know things for myself.
I’m glad I’ve reached this place. All my life I hoped I would. I didn’t anticipate how I would get here or how I would be when I got here, but the important thing is that I am here.
So thanks for asking about this possible catastrophic event. It gave me the opportunity to tell you a little about my life.
Dorte
“In other words, I don’t have the life you think I have. ”
Prior to this post, I knew absolutely nothing about your life and therefore had no thoughts whatsoever about what it might be like.
It would seem that at least some of your thoughts are based on the willingness to accept that death is a normal part of life and therefore you do not place expensive medical care as high on your list of “must haves” as some people do. We share this view point. I do not mind the thought of dying, which we will indeed all do at some point. However, I certainly do mind the thought of extensive surgeries, intractable pain and disability
which are other potential outcomes.
And it is important not to forget that some people value life over all else, often for religious reasons and would do anything to keep themselves or a loved one alive. For people without insurance, this can be a virtual impossibility.
Someone pays for all care. Whether it is the person themselves, their relatives, their insurance company, or the entire society either through insurance premiums or through our taxes. So unless an individual has signed paper work that says in case of accident or being “found down”
do not resuscitate and carries this message with them everywhere, they are acknowledging whether they admit it or not, that they are willing to accept governmental help to pay for their care. Only the truly wealthy,
the fully insured ( and not with the “skinny” plans of the pre Obamacare
days which often did not cover anything worth covering, but that people were” happy with ” because they didn’t understand the fine print)
or those willing to accept being left at the side of the road to die are not going to be using “other people’s money” to pay for their health care.
Most people are not aware of this because we do not see the bills for the
“health care” of others.
I appreciate that you are willing to share so much of your story since it is the individual stories and perspectives that provide the richness to our dialogues here.
In other words, I don’t have the life you think I have. I don’t have the life I thought I would have. I have the life I have, and it’s good enough. In fact, it’s great because it’s the one I have
I love this line. Perfect. You are happy and satisfied with life because you have it.
I wish more people would adopt this thinking.
Unfortunately the lyrics to one of my favorite songs too often ring true…
I turn on the tube and what do I see
A whole lotta people cryin’ “Don’t blame me”
They point their crooked little fingers ar everybody else
Spend all their time feelin’ sorry for themselves
Victim of this, victim of that
Your momma’s too thin; your daddy’s too fat
Get over it
Get over it
All this whinin’ and cryin’ and pitchin’ a fit
Get over it, get over it
You say you haven’t been the same since you had your little crash
But you might feel better if I gave you some cash
The more I think about it, Old Billy was right
Let’s kill all the lawyers, kill ’em tonight
You don’t want to work, you want to live like a king
But the big, bad world doesn’t owe you a thing
Get over it
Get over it
If you don’t want to play, then you might as well split
Get over it, Get over it
It’s like going to confession every time I hear you speak
You’re makin’ the most of your losin’ streak
Some call it sick, but I call it weak
You drag it around like a ball and chain
You wallow in the guilt; you wallow in the pain
You wave it like a flag, you wear it like a crown
Got your mind in the gutter, bringin’ everybody down
Complain about the present and blame it on the past
I’d like to find your inner child and kick its little ass
Get over it
Get over it
All this bitchin’ and moanin’ and pitchin’ a fit
Get over it, get over it
Get over it
Get over it
It’s gotta stop sometime, so why don’t you quit
Get over it, get over it
Hi Frankly,
I’m glad you liked my comment. Your song made me laugh.
Dorte
“I wish that Obamacare could be repealed and replaced, and I wish as before that I don’t get sick.”
Wishing that one does not get sick is fine. However, I would strongly recommend being proactive rather than reactive with regard to one’s health. A truly proactive and sometimes life saving approach is to get regular health care evaluations which for women include cervical cancer screening every three years ( for the average risk woman), mammography every one to two years starting around age 40 ( again for the average risk woman), colon cancer screening after age 50, Cholesterol, blood sugar and thyroid testing every two to three years after age 40-50 depending on additional risk factors and staying current on one’s immunizations. Of course, all of this can be done without any insurance at all by paying up front for your tests. Most people I know do not choose this course of action if they are not insured. I consider this reactive because there are many conditions that do not have any associated symptoms until the disease has caused significant damage to vital organs such as the liver, kidneys or heart after which point it can be very difficult and expensive to manage.
Hi Tia,
You write, “Most people I know do not choose this course of action if they are not insured.”
I guess I am in the minority of those people you know. You might have guessed that based on my posts on other issues.
Hi Dorte
Since you are deliberately choosing not to carry insurance, I have some questions for you.
What if you are in a life threatening car accident tomorrow and you are now disabled and cannot work. Lets further say that this is a “no fault accident ” and so there is no one to sue. What do you feel is the right course of action and why ?
Do you feel that you should be provided only with ER care and stabilized even if you need far more extensive care ? Who should pay for the ER services ? If you believe that you should receive hospital services and or skilled nursing or rehabilitative services until such time as you are able to resume work, who do you believe should pay for this care ?
What if you are permanently disabled and can no longer work at all ? Do you believe that you should be helped….and if not by the government, then by whom ?
Hi Tia,
Since you responded to me on this thread (if that is what it is called) I thought you might say that you were glad that I’m not going to die from one of those preventable diseases. I guess not.
Thanks for the post, though. I’d like to answer it in full, but I’d rather not tell everyone in the world about personal details of my life. Suffice it to say that I am not employed but help my mother manage her household.
If I were catastrophically hurt, I would pay the bill myself first, and then my mom would want to kick in for the rest. Perhaps my Dad would kick in some. I would use the minimum amount of services, so that probably would not include rehabilitative care. The goal would not be to be patched up enough to resume work–I’m not employed now!–but to be able to crawl around my house if need be. I believe that if I could crawl I could learn to walk, since I did that once before, some 50 years ago.
If this catastrophic event happened after my parents were dead (you can guess their ages, based on mine), I would want even less services. I might even decide I wanted to be allowed to die. You see, my only dependents are my cats, and I could probably get someone to take care of them.
In other words, I don’t have the life you think I have. I don’t have the life I thought I would have. I have the life I have, and it’s good enough. In fact, it’s great because it’s the one I have.
Of course, if the accident actually happened I might change my mind. I can’t predict how I would feel when actually faced with those circumstances. However, I have the sense now that “my” life is basically over. I still live (here I am typing), but there is less of “me”–wants, desires, goals–and since there is less of “me” there is more room in my experience for things which are “not-me”. Of course, this me/not-me distinction is ridiculous, since when there is less of me, there is less of not-me as well. There is more of everything around.
In other words, I feel more connected to everything and everyone since I don’t separate myself out so much or since there is less to separate out to begin with.
A logical extension of this is that it would not be terrible to die as long as doing so hurt nobody. When I’m here, I’ll do my best to do what I think I am here to do–no, what I am almost certain I am here to do–and then “I” will be gone. In fact, “I” am almost already gone. And that’s good. In fact, it’s great.
And lest you tell me, in doctor mode, that I am depressed, I’ll tell you that that’s not very possible, since there is not much “I” there. If you tell me that you know better than I do, I’ll tell you that’s not likely, since now I know things for myself.
I’m glad I’ve reached this place. All my life I hoped I would. I didn’t anticipate how I would get here or how I would be when I got here, but the important thing is that I am here.
So thanks for asking about this possible catastrophic event. It gave me the opportunity to tell you a little about my life.
Dorte
“In other words, I don’t have the life you think I have. ”
Prior to this post, I knew absolutely nothing about your life and therefore had no thoughts whatsoever about what it might be like.
It would seem that at least some of your thoughts are based on the willingness to accept that death is a normal part of life and therefore you do not place expensive medical care as high on your list of “must haves” as some people do. We share this view point. I do not mind the thought of dying, which we will indeed all do at some point. However, I certainly do mind the thought of extensive surgeries, intractable pain and disability
which are other potential outcomes.
And it is important not to forget that some people value life over all else, often for religious reasons and would do anything to keep themselves or a loved one alive. For people without insurance, this can be a virtual impossibility.
Someone pays for all care. Whether it is the person themselves, their relatives, their insurance company, or the entire society either through insurance premiums or through our taxes. So unless an individual has signed paper work that says in case of accident or being “found down”
do not resuscitate and carries this message with them everywhere, they are acknowledging whether they admit it or not, that they are willing to accept governmental help to pay for their care. Only the truly wealthy,
the fully insured ( and not with the “skinny” plans of the pre Obamacare
days which often did not cover anything worth covering, but that people were” happy with ” because they didn’t understand the fine print)
or those willing to accept being left at the side of the road to die are not going to be using “other people’s money” to pay for their health care.
Most people are not aware of this because we do not see the bills for the
“health care” of others.
I appreciate that you are willing to share so much of your story since it is the individual stories and perspectives that provide the richness to our dialogues here.
In other words, I don’t have the life you think I have. I don’t have the life I thought I would have. I have the life I have, and it’s good enough. In fact, it’s great because it’s the one I have
I love this line. Perfect. You are happy and satisfied with life because you have it.
I wish more people would adopt this thinking.
Unfortunately the lyrics to one of my favorite songs too often ring true…
I turn on the tube and what do I see
A whole lotta people cryin’ “Don’t blame me”
They point their crooked little fingers ar everybody else
Spend all their time feelin’ sorry for themselves
Victim of this, victim of that
Your momma’s too thin; your daddy’s too fat
Get over it
Get over it
All this whinin’ and cryin’ and pitchin’ a fit
Get over it, get over it
You say you haven’t been the same since you had your little crash
But you might feel better if I gave you some cash
The more I think about it, Old Billy was right
Let’s kill all the lawyers, kill ’em tonight
You don’t want to work, you want to live like a king
But the big, bad world doesn’t owe you a thing
Get over it
Get over it
If you don’t want to play, then you might as well split
Get over it, Get over it
It’s like going to confession every time I hear you speak
You’re makin’ the most of your losin’ streak
Some call it sick, but I call it weak
You drag it around like a ball and chain
You wallow in the guilt; you wallow in the pain
You wave it like a flag, you wear it like a crown
Got your mind in the gutter, bringin’ everybody down
Complain about the present and blame it on the past
I’d like to find your inner child and kick its little ass
Get over it
Get over it
All this bitchin’ and moanin’ and pitchin’ a fit
Get over it, get over it
Get over it
Get over it
It’s gotta stop sometime, so why don’t you quit
Get over it, get over it
Hi Frankly,
I’m glad you liked my comment. Your song made me laugh.
Note that the company is not preventing any employee from using any type of contraceptive available. They are only wanting to not pay for some that are not supported by their beliefs.
That is the essence of the lie that this is a war on women. Just because I don’t want to pay for something for you, does not mean I am against you.
Now, if I was legislating to take away influence, choice or resources that you enjoy, then yes, call it a war.
That is why I see liberals as being at war with humanity.
Cogent points. For the record, Hobby Lobby covers 16 types of contraception free of charge, including 2 types of oral contraceptive.
http://www.theblaze.com/stories/2014/07/01/is-hobby-lobby-really-banning-birth-control-and-preventing-its-workers-from-being-able-to-make-their-own-health-care-decisions/
And how many of those 16 types does Eden Foods plan to cover now?
TBD
“For the record, Hobby Lobby covers 16 types of contraception free of charge, including 2 types of oral contraceptive.
Your statement is true but ignores two critical points that I have made several times.
1)For women who cannot use hormonal contraception, there is only one highly statistically form of contraception and it is not covered by Hobby Lobby. This is the Paraguard IUD which is not an abortifacient even though Hobby Lobby claims that their religious beliefs are that it is. Many women who cannot use hormonal contraception cannot use it precisely because they have a medical condition ( uncontrolled HTN, heart, blood clotting problem, cancer) that would also make pregnancy very dangerous. So the Supreme Court has essentially said that the sentiments of the employers take precedence over not only the sentiments of the employee but could potentially cost her life if she conceived. Significant “material harm” in my book.
2) They also will not cover the Mirena IUD which is frequently used for control of excessive bleeding not successfully managed by other means even if not being used for contraception. Does anyone believe that this is justifiable lets say for the celibate woman ?
I simply do not believe that the religious beliefs of any group should determine the health care of another group. I am not sure that all of you who support this decision would do so if another religious tradition were involved.
Certain groups of Hmong believe that a an open surgery will cause a person to lose their soul. So if there are Hmong owners of a large for profit business and a woman is employed by them, should the insurance they provide not cover a medically indicated Cesarean ?
If not, why not ?
Of the examples that Justice Ginsburg made, no payment for your transfusion if you happen to be employed by a large company owned by Jehovah’s Witnesses ? These would be the logical extensions of the principle that the majority opinion.
Then why can’t these infrequent, unusual cases (patients) pay for contraceptive method 19 or 20?
I see no reason why a religious group should pay for a medical procedure they consider murder.
TBD
OK, so now explain to me why they should not have to cover it for celibate or lesbian women who are using it for other medical indications.
And explain to me why my tax money goes to make weapons of war which I consider murder ( defined as the killing of innocent life) which we all know occurs during war ( including plenty of fetuses still within their mother by the way). Where is the outcry over those deaths?
And explain to me why my tax dollars are used to fund the death penalty which I also consider murder.
There have been Christian Scientists in my family who, in two cases, chose to die of cancer without treatment, pain medication, or any intervention. It was, to put it mildly, hard on their families. More to the point, their beliefs would not permit medical treatment of any kind. In our family, and my in-laws’, they did not extend those practices to their children, but that has often occurred. Some Christian Scientists might believe that their beliefs extend to those who work for them, or to their families. So the precedent is set by the Supreme Court: a Christian Scientist employer can refuse to cover any medical insurance?
My son works for a large company that was recently purchased by the largest company in that industry. The new owners are LDS. My son put in several weeks of unpaid training to get the certification needed for his job. Fortunately, the new owners have not shown any inclination to change the benefits. But now, thanks to the Supreme Court, they could?
According to a 2009 report, more than 50% of private employment in the US is with “closely-held corporations.” Extrapolated to today’s work force, that is over 60 million employees. All now potentially subject to the religious beliefs of their employers.
Don, what other parts of the Constitution don’t you like?
Article 1, Section 2 had some real problems, even when amended by the 14th.
The 18th amendment was a real buzz kill.
How about you? Do you think the Constitution was perfect as written?
Basically, we’re asking you. Conservatives are very fond of the slippery-slope arguments when it comes to things like gun control. So let’s take that slippery-slope concept and apply it to the religious freedom argument that the SCOTUS has just upheld. You believe that any employer of any religion has the right to impose any religious belief on his or her employees? If not, where do you draw the line? Which religions? Which beliefs? Catholic business owners like Eden Foods already intend to stop paying for insurance that covers contraception. Any contraception. So we’ve given you examples: Jehovahs Witnesses, Christian Scientist. Do you draw a line anywhere?
Note that the company is not preventing any employee from using any type of contraceptive available. They are only wanting to not pay for some that are not supported by their beliefs.
That is the essence of the lie that this is a war on women. Just because I don’t want to pay for something for you, does not mean I am against you.
Now, if I was legislating to take away influence, choice or resources that you enjoy, then yes, call it a war.
That is why I see liberals as being at war with humanity.
Cogent points. For the record, Hobby Lobby covers 16 types of contraception free of charge, including 2 types of oral contraceptive.
http://www.theblaze.com/stories/2014/07/01/is-hobby-lobby-really-banning-birth-control-and-preventing-its-workers-from-being-able-to-make-their-own-health-care-decisions/
And how many of those 16 types does Eden Foods plan to cover now?
TBD
“For the record, Hobby Lobby covers 16 types of contraception free of charge, including 2 types of oral contraceptive.
Your statement is true but ignores two critical points that I have made several times.
1)For women who cannot use hormonal contraception, there is only one highly statistically form of contraception and it is not covered by Hobby Lobby. This is the Paraguard IUD which is not an abortifacient even though Hobby Lobby claims that their religious beliefs are that it is. Many women who cannot use hormonal contraception cannot use it precisely because they have a medical condition ( uncontrolled HTN, heart, blood clotting problem, cancer) that would also make pregnancy very dangerous. So the Supreme Court has essentially said that the sentiments of the employers take precedence over not only the sentiments of the employee but could potentially cost her life if she conceived. Significant “material harm” in my book.
2) They also will not cover the Mirena IUD which is frequently used for control of excessive bleeding not successfully managed by other means even if not being used for contraception. Does anyone believe that this is justifiable lets say for the celibate woman ?
I simply do not believe that the religious beliefs of any group should determine the health care of another group. I am not sure that all of you who support this decision would do so if another religious tradition were involved.
Certain groups of Hmong believe that a an open surgery will cause a person to lose their soul. So if there are Hmong owners of a large for profit business and a woman is employed by them, should the insurance they provide not cover a medically indicated Cesarean ?
If not, why not ?
Of the examples that Justice Ginsburg made, no payment for your transfusion if you happen to be employed by a large company owned by Jehovah’s Witnesses ? These would be the logical extensions of the principle that the majority opinion.
Then why can’t these infrequent, unusual cases (patients) pay for contraceptive method 19 or 20?
I see no reason why a religious group should pay for a medical procedure they consider murder.
TBD
OK, so now explain to me why they should not have to cover it for celibate or lesbian women who are using it for other medical indications.
And explain to me why my tax money goes to make weapons of war which I consider murder ( defined as the killing of innocent life) which we all know occurs during war ( including plenty of fetuses still within their mother by the way). Where is the outcry over those deaths?
And explain to me why my tax dollars are used to fund the death penalty which I also consider murder.
There have been Christian Scientists in my family who, in two cases, chose to die of cancer without treatment, pain medication, or any intervention. It was, to put it mildly, hard on their families. More to the point, their beliefs would not permit medical treatment of any kind. In our family, and my in-laws’, they did not extend those practices to their children, but that has often occurred. Some Christian Scientists might believe that their beliefs extend to those who work for them, or to their families. So the precedent is set by the Supreme Court: a Christian Scientist employer can refuse to cover any medical insurance?
My son works for a large company that was recently purchased by the largest company in that industry. The new owners are LDS. My son put in several weeks of unpaid training to get the certification needed for his job. Fortunately, the new owners have not shown any inclination to change the benefits. But now, thanks to the Supreme Court, they could?
According to a 2009 report, more than 50% of private employment in the US is with “closely-held corporations.” Extrapolated to today’s work force, that is over 60 million employees. All now potentially subject to the religious beliefs of their employers.
Don, what other parts of the Constitution don’t you like?
Article 1, Section 2 had some real problems, even when amended by the 14th.
The 18th amendment was a real buzz kill.
How about you? Do you think the Constitution was perfect as written?
Basically, we’re asking you. Conservatives are very fond of the slippery-slope arguments when it comes to things like gun control. So let’s take that slippery-slope concept and apply it to the religious freedom argument that the SCOTUS has just upheld. You believe that any employer of any religion has the right to impose any religious belief on his or her employees? If not, where do you draw the line? Which religions? Which beliefs? Catholic business owners like Eden Foods already intend to stop paying for insurance that covers contraception. Any contraception. So we’ve given you examples: Jehovahs Witnesses, Christian Scientist. Do you draw a line anywhere?
Frankly
Do you believe that Obamacare should be repealed or its provision for those not previously covered revoked ?
If so, then you would most definitely be legislating to take away resources that might daughter and I “enjoyed”.
Especially if you consider continuing to live “enjoyment”.
Frankly
Do you believe that Obamacare should be repealed or its provision for those not previously covered revoked ?
If so, then you would most definitely be legislating to take away resources that might daughter and I “enjoyed”.
Especially if you consider continuing to live “enjoyment”.
TBD
“You example of charity starting at home (essentially) is a perfect one.”
Charity starting at home is of course a good point. However, I do not believe that it should also end at home.
Or with one’s church. Or within one’s own community. I believe that charity should exist where it is needed and that it is most powerful when it is all inclusive and not dependent on belonging to any one “tribe”, or race, or religion, or state or country.
TBD
“You example of charity starting at home (essentially) is a perfect one.”
Charity starting at home is of course a good point. However, I do not believe that it should also end at home.
Or with one’s church. Or within one’s own community. I believe that charity should exist where it is needed and that it is most powerful when it is all inclusive and not dependent on belonging to any one “tribe”, or race, or religion, or state or country.
TBD
“We will have rationing of services, which will lead to deaths; Palin simply gave it a memorable name that stuck with the public.”
We already had rationing of services. We called it fee for service. No ability to pay, no service.
There is another kind of rationing. The delay and difficulty of getting services can serve the same purpose as having no insurance.
Three weeks ago our daughter had an ongoing problem with pain in her lower back. We’ve been trying to find a new GP since her doctor left but we kept being told the various doctors weren’t accepting new partnership patients. This kid has six specialist but needs a GP as well so I read the blurbs for the docs who are accepting new patients and call to make an appointment. The “service” that makes appointments hears about HCM, ICD, heart attacks, anoxia, hypothermic therapy, Intensive care, etc and insists on a reason for the appointment. Well, she needs meds refilled and she has this backache that just won’t resolve. So we get to the appointment without a back ache but with a migraine headache. Can’t take imetrex, it could kill her, but something for nausea would be good. The doctor wants to know who we are–parents who take her to appointment and act as memory aides. She then says she demands complete honesty from her patients and since there is no acute backache, we lied to her and this just won’t work out. Goodbye. Now the manager is trying to find a doctor who is willing to take her on as a patient–I guess she will be more trouble than partnership pays for. The joys of poverty insurance coverage. All plans are not created equally.
Yup, like the VA.
TBD
“We will have rationing of services, which will lead to deaths; Palin simply gave it a memorable name that stuck with the public.”
We already had rationing of services. We called it fee for service. No ability to pay, no service.
There is another kind of rationing. The delay and difficulty of getting services can serve the same purpose as having no insurance.
Three weeks ago our daughter had an ongoing problem with pain in her lower back. We’ve been trying to find a new GP since her doctor left but we kept being told the various doctors weren’t accepting new partnership patients. This kid has six specialist but needs a GP as well so I read the blurbs for the docs who are accepting new patients and call to make an appointment. The “service” that makes appointments hears about HCM, ICD, heart attacks, anoxia, hypothermic therapy, Intensive care, etc and insists on a reason for the appointment. Well, she needs meds refilled and she has this backache that just won’t resolve. So we get to the appointment without a back ache but with a migraine headache. Can’t take imetrex, it could kill her, but something for nausea would be good. The doctor wants to know who we are–parents who take her to appointment and act as memory aides. She then says she demands complete honesty from her patients and since there is no acute backache, we lied to her and this just won’t work out. Goodbye. Now the manager is trying to find a doctor who is willing to take her on as a patient–I guess she will be more trouble than partnership pays for. The joys of poverty insurance coverage. All plans are not created equally.
Yup, like the VA.
There are a few ideas being expressed about how people utilize health care services and how they are paid for that I would like to address as a primary care provider.
1) The idea that if something is “free” people will use more of it.
This does not prove to be the case with preventive medicine and screening. It is the lower socioeconomic groups
that tend to screen less frequently, even when the service is “free to them”. I see this in our outreach to try to
get people to come in for screening. This may be because of mistaken ideas about the nature of the disease
being screened for, it may be because of fears about the test itself, or it may be because it is just more difficult
for them to get to the facility. There are lots of factors besides just cost.
2) Why should a working family have to pay for screening for others when they are trying to support their own
kids ?
A few thoughts on this.
1. Because this is the system we have built politically and economically. I have asked myself repeatedly, why
when I was trying to raise my kids was I paying to make weapons to go blow up people in Iraq, a war which
I did not support. We have decided as a society that we will pay for the projects that our elected officials
decide are critical to the well being of our country. Now those on the right may feel that paying for “someone
else’s medical care is not “critical”. I feel it is much more critical than blowing up someone else in their home.
But then, maybe that’s just me.
2. Because, if it is their infant that doesn’t die of pertussis because someone else got their free immunization
made possible by the “redistribution of wealth” ( aka resources) then it will be well worth it for them. They
just won’t ever know that this is what saved their child’s life.
3. If the example that was given previously of the struggling family paying for someone else’s screening were
an accurate depiction of our entire economic system my idea of providing basic health for all might not be
feasible. But it is not. In addition to the working poor, we also have individuals who make, and take home,
far, far more than they could ever reasonably spend. And in some cases they do it at the expense of their
underpaid workers. So here we have a case, not of redistribution of money, but of redistribution of wealth
if you factor in the time spent earning the money, from the working poor to the rich. We just don’t happen
to call it that. But since, time is the same for everyone, that is actually what is occurring.
The fact is that if you look across our entire society, we have more than enough “wealth” to pay for health
care. We just prefer clinging to the idea that if something is labelled “free market” it has to be good and
if something even slightly whiffs of “socialism” it must be bad without ever considering the nuances.
Their are clearly pros and cons to any complex system. Until Obamacare, we had decided as a society to
cling tooth and nail to the dysfunctions of our own system, either minimizing or pretending its problems.
Now we have a new system that at least attempts to address those problems. Is it any surprise that this attempt to address the problems will introduce new problems of its own ? Why would that be any more surprising than the fact that President Bush’s efforts to free the world of Saadam Hussein produced its own set of problems ?
Every initiative carries with it pros and cons.
As Don has pointed out, the ACA is advantageous to him as it was to me. Others will dislike what they see as take aways. Does anyone find this surprising. It is far, far to early to judge whether this will overall be a positive or a negative. But in the entire time that the United States has been in existence we have tried the “fee for service” and “free market” approach with results that were statistically far from the best in the world for all except the
very wealthy who themselves or through their insurers could afford the cutting edge treatments. In my view it was long past time to try something else. This would not have been my first choice…but at least it was an attempt rather than blind acceptance of a failed means of health care delivery.
There are a few ideas being expressed about how people utilize health care services and how they are paid for that I would like to address as a primary care provider.
1) The idea that if something is “free” people will use more of it.
This does not prove to be the case with preventive medicine and screening. It is the lower socioeconomic groups
that tend to screen less frequently, even when the service is “free to them”. I see this in our outreach to try to
get people to come in for screening. This may be because of mistaken ideas about the nature of the disease
being screened for, it may be because of fears about the test itself, or it may be because it is just more difficult
for them to get to the facility. There are lots of factors besides just cost.
2) Why should a working family have to pay for screening for others when they are trying to support their own
kids ?
A few thoughts on this.
1. Because this is the system we have built politically and economically. I have asked myself repeatedly, why
when I was trying to raise my kids was I paying to make weapons to go blow up people in Iraq, a war which
I did not support. We have decided as a society that we will pay for the projects that our elected officials
decide are critical to the well being of our country. Now those on the right may feel that paying for “someone
else’s medical care is not “critical”. I feel it is much more critical than blowing up someone else in their home.
But then, maybe that’s just me.
2. Because, if it is their infant that doesn’t die of pertussis because someone else got their free immunization
made possible by the “redistribution of wealth” ( aka resources) then it will be well worth it for them. They
just won’t ever know that this is what saved their child’s life.
3. If the example that was given previously of the struggling family paying for someone else’s screening were
an accurate depiction of our entire economic system my idea of providing basic health for all might not be
feasible. But it is not. In addition to the working poor, we also have individuals who make, and take home,
far, far more than they could ever reasonably spend. And in some cases they do it at the expense of their
underpaid workers. So here we have a case, not of redistribution of money, but of redistribution of wealth
if you factor in the time spent earning the money, from the working poor to the rich. We just don’t happen
to call it that. But since, time is the same for everyone, that is actually what is occurring.
The fact is that if you look across our entire society, we have more than enough “wealth” to pay for health
care. We just prefer clinging to the idea that if something is labelled “free market” it has to be good and
if something even slightly whiffs of “socialism” it must be bad without ever considering the nuances.
Their are clearly pros and cons to any complex system. Until Obamacare, we had decided as a society to
cling tooth and nail to the dysfunctions of our own system, either minimizing or pretending its problems.
Now we have a new system that at least attempts to address those problems. Is it any surprise that this attempt to address the problems will introduce new problems of its own ? Why would that be any more surprising than the fact that President Bush’s efforts to free the world of Saadam Hussein produced its own set of problems ?
Every initiative carries with it pros and cons.
As Don has pointed out, the ACA is advantageous to him as it was to me. Others will dislike what they see as take aways. Does anyone find this surprising. It is far, far to early to judge whether this will overall be a positive or a negative. But in the entire time that the United States has been in existence we have tried the “fee for service” and “free market” approach with results that were statistically far from the best in the world for all except the
very wealthy who themselves or through their insurers could afford the cutting edge treatments. In my view it was long past time to try something else. This would not have been my first choice…but at least it was an attempt rather than blind acceptance of a failed means of health care delivery.
Dorte
“I don’t think that I have a responsibility to participate in something I find destructive.”
Let’s apply that more broadly. Just three examples.
1. I find wars destructive….so I shouldn’t have to pay taxes that go towards weapons production.
2. I find long prison terms for non violent crimes such as drug dealing destructive to families so I shouldn’t have
to pay taxes to support our prison system.
3. I find four attempts to get a conviction for “gang related” activity destructive….so I shouldn’t have to pay
taxes to support our local judicial system.
This is not how we have structured our society. We have a system in which we follow the laws that our elected leaders enact. We do this whether we like them or not. To not follow the laws is fundamentally not just a rejection of that particular law, but a rejection of our system. Unfortunately, none of us get to just pick and choose which laws we are going to adhere to. That is called anarchy and I doubt you will find many people even on the political extremes who believe that is a good option.
Hi Tia,
I think that you are misinterpreting my words. I am under the law and will follow it, which means that I will pay the tax. If that is good enough for the IRS, it should be good enough for you.
Tia, per number “2” – my understanding is that most criminals in jail for drug crimes are dealers of drugs. I don’t consider them “non violent”. These deals are also often plead down – so there are multiple charges, and they take a plea deal on one of the lesser charges to make things look as tame as possible. Same thing happened recently with the priest who had three or four felony charges logged against him with a minor, he took a plea deal on one of the lesser felonies, and won’t have to register as a sex offender.
Given that drugs have ravaged our nation, I’m surprised that you take a less serious view towards drug dealers. Again, my understanding is that most drug dealers aren’t in jail for dealing two joints, they are in there for larger quantities of drugs, typically harder drugs like heroine and crack. (Crack prison times were passed that are longer than cocaine due to the huge amounts of violence that surrounded the drug.)
When we look at how drugs are peddled to young people, and when we see that a large percentage of the so called homeless have a serious drug or alcohol problem, I’d think you’d want to stem the flow of such deleterious items. Same goes for an open border, where many of our drugs come from… and a larger quantity here means a lower price point, which means more and younger users.
We’ll see what happens with the next congressional election.
The war on drugs has ravaged our nation more than the drugs themselves. As for the plea bargain, even if you are innocent, once charged you will be advised to plead guilty to a lesser charge with a lower sentence than you’d get if you went to trial and lost on the original charge. We think it is guilty until proven innocent but the plea system and the case load (thank you, war on drugs) means the system is designed to plead down and so the time.
The war on drugs hasn’t been kind to Mexico either. It was ill conceived and a waste of lives and money.
TBD
“I’m surprised that you take a less serious view towards drug dealers.”
I don’t know what I have written that would make you think that I “take a less serious view towards drug dealers”.
I take addiction very seriously. However, I do not believe that our “war on drugs” has been anymore successful than prohibition was. I do not believe that low level drug dealers or
“mules” should be locked up for years for non violent albeit illegal actions. Some of these people will have been exposed to far more violence in our prisons than they would ever have committed out in the society.
I think that it will be very interesting to see how the progressive decriminalization of marijuana plays out across the various states. Then we will have some current idea how decriminalization of an arbitrarily criminalized substance plays out. I suspect that what we will find will be an overall gain for our society. But that is purely speculation on my part at this time.
Dorte
“I don’t think that I have a responsibility to participate in something I find destructive.”
Let’s apply that more broadly. Just three examples.
1. I find wars destructive….so I shouldn’t have to pay taxes that go towards weapons production.
2. I find long prison terms for non violent crimes such as drug dealing destructive to families so I shouldn’t have
to pay taxes to support our prison system.
3. I find four attempts to get a conviction for “gang related” activity destructive….so I shouldn’t have to pay
taxes to support our local judicial system.
This is not how we have structured our society. We have a system in which we follow the laws that our elected leaders enact. We do this whether we like them or not. To not follow the laws is fundamentally not just a rejection of that particular law, but a rejection of our system. Unfortunately, none of us get to just pick and choose which laws we are going to adhere to. That is called anarchy and I doubt you will find many people even on the political extremes who believe that is a good option.
Hi Tia,
I think that you are misinterpreting my words. I am under the law and will follow it, which means that I will pay the tax. If that is good enough for the IRS, it should be good enough for you.
Tia, per number “2” – my understanding is that most criminals in jail for drug crimes are dealers of drugs. I don’t consider them “non violent”. These deals are also often plead down – so there are multiple charges, and they take a plea deal on one of the lesser charges to make things look as tame as possible. Same thing happened recently with the priest who had three or four felony charges logged against him with a minor, he took a plea deal on one of the lesser felonies, and won’t have to register as a sex offender.
Given that drugs have ravaged our nation, I’m surprised that you take a less serious view towards drug dealers. Again, my understanding is that most drug dealers aren’t in jail for dealing two joints, they are in there for larger quantities of drugs, typically harder drugs like heroine and crack. (Crack prison times were passed that are longer than cocaine due to the huge amounts of violence that surrounded the drug.)
When we look at how drugs are peddled to young people, and when we see that a large percentage of the so called homeless have a serious drug or alcohol problem, I’d think you’d want to stem the flow of such deleterious items. Same goes for an open border, where many of our drugs come from… and a larger quantity here means a lower price point, which means more and younger users.
We’ll see what happens with the next congressional election.
The war on drugs has ravaged our nation more than the drugs themselves. As for the plea bargain, even if you are innocent, once charged you will be advised to plead guilty to a lesser charge with a lower sentence than you’d get if you went to trial and lost on the original charge. We think it is guilty until proven innocent but the plea system and the case load (thank you, war on drugs) means the system is designed to plead down and so the time.
The war on drugs hasn’t been kind to Mexico either. It was ill conceived and a waste of lives and money.
TBD
“I’m surprised that you take a less serious view towards drug dealers.”
I don’t know what I have written that would make you think that I “take a less serious view towards drug dealers”.
I take addiction very seriously. However, I do not believe that our “war on drugs” has been anymore successful than prohibition was. I do not believe that low level drug dealers or
“mules” should be locked up for years for non violent albeit illegal actions. Some of these people will have been exposed to far more violence in our prisons than they would ever have committed out in the society.
I think that it will be very interesting to see how the progressive decriminalization of marijuana plays out across the various states. Then we will have some current idea how decriminalization of an arbitrarily criminalized substance plays out. I suspect that what we will find will be an overall gain for our society. But that is purely speculation on my part at this time.
[edit: I have removed your posts that are about Obama. Please keep to the topic of the thread. Don]
My posts were about Tia Will saying that we can’t just choose what laws we can obey or ignore. I just showed a couple of examples of laws that aren’t obeyed which Tia would consider anarchy. Sometimes Don I think you let your political leanings come in to play when you decide which posts to delete. All I ask for is fairness to all posters regardless of which side of the political aisle they are on.
If you have concerns about moderation practices on the Vanguard, you can contact me at donshor@gmail.com. If you don’t want to discuss it with me, you can contact David. You frequently post off-topic criticisms of the president. I will remove them. I am really not concerned whether you think what I do is fair. If you disagree, I have explained what you can do about it. What you cannot do about it is discuss it here.
I would hope that the Vanguard and David Greenwald would like his blog to be considered fair to all who post.
BP, a simple solution to this problem would be to have a daily “National” article in which comments about Obama would be on topic.
We realize that you want to keep your identity anonymous, and we think there is a solution that can accomodate your desire on both fronts. Are you interested in pursuing such a solution? If you are then post a reply here and we will create an anonymous dialogue space where we can discuss how you can submit the daily (or periodic) articles.
Hi Matt,
You are as resourceful here as you were on the water issue. That’s a compliment.
Matt, as one of the editorial board members of the Vanguard I have to say that you’ve been reasonable and fair. This article is about Hobby Lobby and the Supreme Court’s decision about their right to ban certain birth control options. Now go read the 236 comments and see how many posts have swayed off that topic. My post was in reply to Tia Will’s post saying that “none of us get to just pick and choose which laws we are going to adhere to” to which I pointed out a couple of laws that Obama chooses not to follow. It was totally in the flow of the conversation but yet it gets erased when so many other off topic posts are allowed to remain. Like I said, all I ask for is a level playing field for all. Yes, I would love to post an occasional article on some ripe topics that I know the Vanguard would never touch.
BP, I am not going to get in the middle of Don’s moderation. The point you make has some resonance for me, but you need to temper that with the understanding that Don and I no longer speak to one another due to irreconcilable differences of opinion about Mace 391.
Regarding your final sentence, the Vanguard has a very liberal publishing policy, and as long as the ripe topic you choose to write on is practical, we will publish it.
BP. why not give it a go? A different voice in Davis!
Don, thank you. I don’t want this blog to be an echo chamber. I appreciate different perspectives but the O-badman rants get old.
So we can’t bring Obama’s name into an article about OBAMAcare but it’s okay to infuse Sarah Palin’s name as was used in earlier posts?
Hi Barack Palin,
I think that it would be great if you wrote some articles. Your posts are pretty condensed, as I remember, so a 1,000-word article (or however long they are) would allow readers to immerse themselves more in your thought process. Then they would be more able to ask intelligent questions and learn from your point of view.
[edit: I have removed your posts that are about Obama. Please keep to the topic of the thread. Don]
My posts were about Tia Will saying that we can’t just choose what laws we can obey or ignore. I just showed a couple of examples of laws that aren’t obeyed which Tia would consider anarchy. Sometimes Don I think you let your political leanings come in to play when you decide which posts to delete. All I ask for is fairness to all posters regardless of which side of the political aisle they are on.
If you have concerns about moderation practices on the Vanguard, you can contact me at donshor@gmail.com. If you don’t want to discuss it with me, you can contact David. You frequently post off-topic criticisms of the president. I will remove them. I am really not concerned whether you think what I do is fair. If you disagree, I have explained what you can do about it. What you cannot do about it is discuss it here.
I would hope that the Vanguard and David Greenwald would like his blog to be considered fair to all who post.
BP, a simple solution to this problem would be to have a daily “National” article in which comments about Obama would be on topic.
We realize that you want to keep your identity anonymous, and we think there is a solution that can accomodate your desire on both fronts. Are you interested in pursuing such a solution? If you are then post a reply here and we will create an anonymous dialogue space where we can discuss how you can submit the daily (or periodic) articles.
Hi Matt,
You are as resourceful here as you were on the water issue. That’s a compliment.
Matt, as one of the editorial board members of the Vanguard I have to say that you’ve been reasonable and fair. This article is about Hobby Lobby and the Supreme Court’s decision about their right to ban certain birth control options. Now go read the 236 comments and see how many posts have swayed off that topic. My post was in reply to Tia Will’s post saying that “none of us get to just pick and choose which laws we are going to adhere to” to which I pointed out a couple of laws that Obama chooses not to follow. It was totally in the flow of the conversation but yet it gets erased when so many other off topic posts are allowed to remain. Like I said, all I ask for is a level playing field for all. Yes, I would love to post an occasional article on some ripe topics that I know the Vanguard would never touch.
BP, I am not going to get in the middle of Don’s moderation. The point you make has some resonance for me, but you need to temper that with the understanding that Don and I no longer speak to one another due to irreconcilable differences of opinion about Mace 391.
Regarding your final sentence, the Vanguard has a very liberal publishing policy, and as long as the ripe topic you choose to write on is practical, we will publish it.
BP. why not give it a go? A different voice in Davis!
Don, thank you. I don’t want this blog to be an echo chamber. I appreciate different perspectives but the O-badman rants get old.
So we can’t bring Obama’s name into an article about OBAMAcare but it’s okay to infuse Sarah Palin’s name as was used in earlier posts?
Hi Barack Palin,
I think that it would be great if you wrote some articles. Your posts are pretty condensed, as I remember, so a 1,000-word article (or however long they are) would allow readers to immerse themselves more in your thought process. Then they would be more able to ask intelligent questions and learn from your point of view.
Don Wrote: “According to a 2009 report, more than 50% of private employment in the US is with “closely-held corporations.” Extrapolated to today’s work force, that is over 60 million employees. All now potentially subject to the religious beliefs of their employers.”
It makes no sense that employers should be responsible for providing health care. As you know, it is a historical accident that the US implemented this crazy system. It’s too bad that our political leaders will not address such a basic issue that is causing so many problems. This whole “Hobby Lobby” issue would not even exist if worker’s healthcare was not dependent upon their employers.
Don Wrote: “According to a 2009 report, more than 50% of private employment in the US is with “closely-held corporations.” Extrapolated to today’s work force, that is over 60 million employees. All now potentially subject to the religious beliefs of their employers.”
It makes no sense that employers should be responsible for providing health care. As you know, it is a historical accident that the US implemented this crazy system. It’s too bad that our political leaders will not address such a basic issue that is causing so many problems. This whole “Hobby Lobby” issue would not even exist if worker’s healthcare was not dependent upon their employers.
Big ruling today which could effect the ACA, federal subsidies found to be illegal. It may go to a higher court which is dominated by Democrats, who most likely will vote along party lines.
Dorte, Congressman Dr. Tom Coburn had a plan that he offered years ago: there is an Executive Summary, and then a larger plan. Obama didn’t consider it’s many relevant suggestions.
Now, after Obamacare, he is also part of a group that has offered to repeal and replace the ACA with a better plan. It is called called the Patient Choice, Affordability, Responsibility, and Empowerment Act, or the Patient CARE Act (PCA). Here is an 8=page Summary.
http://www.hatch.senate.gov/public/_cache/files/bf0c9823-29c7-4078-b8af-aa9a12213eca/The%20Patient%20CARE%20Act%20-%20LEGISLATIVE%20PROPOSAL.pdf
Here also is an article covering the PCA plan.
http://healthaffairs.org/blog/2014/02/12/a-senate-gop-health-reform-proposal-the-burr-coburn-hatch-plan/
In a sad note, Obama’s lie about being able to keep your doctor’s has come home to roost with Dr. Cobuen, who is now suffering from cancer. “Republican Sen. Tom Coburn revealed Tuesday that his ObamaCare insurance plan does not cover his cancer specialist, forcing him to pay out of pocket — in the latest reminder of complications with the health law as President Obama prepares to address the nation.”
http://www.foxnews.com/politics/2014/01/28/coburn-says-obamacare-cost-him-coverage-for-cancer-doctor/
I thought the senate excluded themselves from ADA and kept their gold plated health coverage. You can’t have it both ways. And as far as coverage changing, I had blue cross insurance for decades and I swear every year there was something else they didn’t cover. They paid for my son to get speech therapy, two years later they no longer covered the same service for my daughter. They paid for othodics for a long time, then they stopped. Every year they new policy came and summarized all the changes which included co-pays. So why all the whining about coverage changing? That is the nature of free market medicine. If it gets used too much, don’t cover it any more. KEEP YOUR PROFITS AT ALL COSTS Well all costs to the consumer. Really private health insurance is a game rigged for the insurers. Put everyone in the same pool, give them the same coverage and the cost per person foes down dramatically. And cut out all the paper work. Give everybody one card that covers everything like they so in France. Put all the billing departments out of work and save money.
Topcat
I have long wanted the separation of health care from employment for a number or reasons.
1. Your point about interference in the health care decisions of the individual is an obvious reason
2. This system traps people in jobs that they may not be a good fit for because they cannot afford to lose
coverage.
This is not good for the individual, the company, or our society as a whole.
3. This system also keeps people in unhealthy social situations. I have had women who cannot leave failed
relationships because they need the health care insurance that hinges on their husbands employment. Now, I
am all in favor of strong families, but not families that are forced to stay together for their health care.
4. People who are not employed outside the home, or are self employed need insurance just as much as those
who are employed outside the home, so what is the moral justification for favoring one group over another ?
These are all good points or concerns, and I think that the Patient CARE Act (PCA) covers much of this.
Tia,
You make excellent arguments for separating health care from employment.
In addition, I could point out that employers with less than 50 employees are not required to provide healthcare. A lot of people fall in this category. Also, some employers have limited hours worked so that an employee is “part time”. Once again, the employer doesn’t have to provide healthcare.
With all of these issues I am amazed that there seems to be no political movement towards separating healthcare and employment.
Hi TrueBlueDevil,
Thanks so much for the references. I read all of them. Coburn’s plan seems to be very good. What do you think that people can do to support it? Also, people who now have Obamacare (especially those who were previously uninsured) might be fearful of it (since it involves repeal and replacement),and they might think that the latter would never happen. What can people do to convince them otherwise?
Big ruling today which could effect the ACA, federal subsidies found to be illegal. It may go to a higher court which is dominated by Democrats, who most likely will vote along party lines.
Dorte, Congressman Dr. Tom Coburn had a plan that he offered years ago: there is an Executive Summary, and then a larger plan. Obama didn’t consider it’s many relevant suggestions.
Now, after Obamacare, he is also part of a group that has offered to repeal and replace the ACA with a better plan. It is called called the Patient Choice, Affordability, Responsibility, and Empowerment Act, or the Patient CARE Act (PCA). Here is an 8=page Summary.
http://www.hatch.senate.gov/public/_cache/files/bf0c9823-29c7-4078-b8af-aa9a12213eca/The%20Patient%20CARE%20Act%20-%20LEGISLATIVE%20PROPOSAL.pdf
Here also is an article covering the PCA plan.
http://healthaffairs.org/blog/2014/02/12/a-senate-gop-health-reform-proposal-the-burr-coburn-hatch-plan/
In a sad note, Obama’s lie about being able to keep your doctor’s has come home to roost with Dr. Cobuen, who is now suffering from cancer. “Republican Sen. Tom Coburn revealed Tuesday that his ObamaCare insurance plan does not cover his cancer specialist, forcing him to pay out of pocket — in the latest reminder of complications with the health law as President Obama prepares to address the nation.”
http://www.foxnews.com/politics/2014/01/28/coburn-says-obamacare-cost-him-coverage-for-cancer-doctor/
I thought the senate excluded themselves from ADA and kept their gold plated health coverage. You can’t have it both ways. And as far as coverage changing, I had blue cross insurance for decades and I swear every year there was something else they didn’t cover. They paid for my son to get speech therapy, two years later they no longer covered the same service for my daughter. They paid for othodics for a long time, then they stopped. Every year they new policy came and summarized all the changes which included co-pays. So why all the whining about coverage changing? That is the nature of free market medicine. If it gets used too much, don’t cover it any more. KEEP YOUR PROFITS AT ALL COSTS Well all costs to the consumer. Really private health insurance is a game rigged for the insurers. Put everyone in the same pool, give them the same coverage and the cost per person foes down dramatically. And cut out all the paper work. Give everybody one card that covers everything like they so in France. Put all the billing departments out of work and save money.
Topcat
I have long wanted the separation of health care from employment for a number or reasons.
1. Your point about interference in the health care decisions of the individual is an obvious reason
2. This system traps people in jobs that they may not be a good fit for because they cannot afford to lose
coverage.
This is not good for the individual, the company, or our society as a whole.
3. This system also keeps people in unhealthy social situations. I have had women who cannot leave failed
relationships because they need the health care insurance that hinges on their husbands employment. Now, I
am all in favor of strong families, but not families that are forced to stay together for their health care.
4. People who are not employed outside the home, or are self employed need insurance just as much as those
who are employed outside the home, so what is the moral justification for favoring one group over another ?
These are all good points or concerns, and I think that the Patient CARE Act (PCA) covers much of this.
Tia,
You make excellent arguments for separating health care from employment.
In addition, I could point out that employers with less than 50 employees are not required to provide healthcare. A lot of people fall in this category. Also, some employers have limited hours worked so that an employee is “part time”. Once again, the employer doesn’t have to provide healthcare.
With all of these issues I am amazed that there seems to be no political movement towards separating healthcare and employment.
Hi TrueBlueDevil,
Thanks so much for the references. I read all of them. Coburn’s plan seems to be very good. What do you think that people can do to support it? Also, people who now have Obamacare (especially those who were previously uninsured) might be fearful of it (since it involves repeal and replacement),and they might think that the latter would never happen. What can people do to convince them otherwise?
Don Shor: You believe that any employer of any religion has the right to impose any religious belief on his or her employees? If not, where do you draw the line?
Draw the line at material harm.
Not emotional harm (because that IS a slippery slope), but harm that can be quantified as something of value lost or taken away.
There is no material harm in the Hobby Lobby decisions because:
1. Employees that do not support owner’s decisions and practices can quit and work somewhere else. A job with any private company is not an entitlement. Free choice is not impacted because there are alternatives. The employees are not slaves.
2. There are plenty of alterative birth control options available. And for those few that are not, employees can spend their own money to get them. That would be their choice… their free choice.
In fact, even if a company decides it will not pay for any contraceptive, the employees continue to have freedom of choice. They are not materially harmed.
Now, if the courts forced the Hobby Lobby owners to abandon their beliefs in support of the types of birth control they opposed, then the owners would be materially harmed in the loss of freedom to chose to uphold their beliefs… again… beliefs that would not cause material harm to the employees because they are still free to choose. If the practice of those beliefs cause material harm to others (as would many aspects of Sharia Law), then it would require a balanced decision, and I would agree that a company should not be allowed to materially harm its employees with policies based on religious beliefs or other beliefs for that matter. But again, employees can quit and work for another company, so that material harm argument becomes very difficult to prove.
I think one fundamental difference in perspectives for this debate is that some people seem to think of companies as not being entitled to protection of rights, and employees being hyper-entitled to any and all protections up to and including things that only cause even hurt feelings.
And others see companies as being privately owned by people who’s rights are equal to the rights of employees.
Obviously contraception has value. And as Tia Will has pointed out, the specific contraceptions that they object to (out of clear ignorance) are often prescribed for non-contraceptive purposes. Does Hobby Lobby now get to see a doctor’s note as to why something is medically needed?
An obvious issue is that the employer is trying to meddle in one specific aspect of their employees’ personal lives. They are interfering in the doctor-patient relationship. Even the courts can’t do that, if I recall.
Because of this ruling, I am coming to the conclusion that employers who don’t want to pay for specific aspects of health care should simply pay the fine (tax per the Supreme Court) and send their employees to the exchanges. They are violating the privacy of their employees, and doing so in a gender-specific manner.
Dozens of other companies are now intending to meddle in the private lives of their employees. It is ludicrous to set this precedent that could potentially affect millions of employees, and then fall back on the argument that ‘they can just quit and work for another company. We are talking about a huge percentage of the work force here. Did you ever, when you applied for a job, think to inquire about the religious beliefs of the owners, and ask how that might affect your benefits?
Ruth Bader Ginsburg has this exactly right. And if it snowballs, I’m afraid it sets the stage for a move toward single-payer. That would make some people happy, I guess.
They are not meddling. The employee can do anything they want to do. They can go get any kind of contraceptive that they want to get or that the doctor prescribe to them. The company is not preventing that. Your argument is disingenuous. You are projecting harm that is not there.
What if the employee wants gastric bypass or the doctor prescribe it but the company refuses to cover it? Are you going to claim material harm for that too?
Get real.
Yes, of course. If the doctor thinks that is necessary, that is between the patient and the doctor. Health plans cover health care. This level of micromanagement by the employer is ridiculous.
Here’s the main point. They’re not paying for the gastric bypass. They’re not paying for the specific form of contraception. They’re paying for the insurance coverage. They shouldn’t even know the details of what an employee goes to a doctor for. They shouldn’t even know what the insurance plan is being billed for. They can offer a range of plans, with a range of coverage, to all of their employees equally. The minimum coverage is now regulated by the government. What the employee actually uses it for? None of their business. It is a clear violation of the employee’s privacy that they are even trying to make these distinctions.
They aren’t paying for medicine. They aren’t paying for treatment. They are paying for insurance.
Frankly
“What if the employee wants gastric bypass or the doctor prescribe it but the company refuses to cover it? Are you going to claim material harm for that too?”
Of course it should be covered. The statistical efficacy of gastric bypass is significantly higher than any of behavioral and medical means of weight loss.
So why exactly would we not want the most effect therapy to be covered.
I am completely missing your point here. Could you explain ?
I am simply afraid of the following…
Someone covered under your medical goes through some mental issues… Employer is Scientologist.. Guess what, they dont believe in pysch drugs.. NO antidepressants for you or your loved one..
Need a blood transfusion.. Your Jehovas Witness employer says no!
Medical needs should not involve anyone but yourself and your doctor!!!
The medical needs absolutely should not involve anyone but the patient and their doctor. However, the financial responsibility for the delivery of care to address those medical needs is an entirely different matter. An employer has every right to decide that his/her financial needs absolutely should not involve anyone but the employer and their chosen insurance carrier. Similarly, an employee has every right to decide that his/her compensation needs should include a certain level of coverage, and then include the meeting of those compensation needs in their employment negotiations.
With that said, if the employer is a Scientologist opposed to the provision of psych drugs and an employee believes that their compensation package should include the value of psych drug coverage, then all the employee has to do is calculate the value of the psych drug coverage and accept an increase in salary in lieu of the coverage that the employer is morally opposed to providing. Same thing for blood transfusion coverage if the employer is a Jehovah’s Witness. If the employee wants to work for the company, then accepting the responsibility for getting enough higher salary/pay to be able to cover the antidepressant/blood costs is a very small price to pay.
They aren’t paying for medicine. They aren’t paying for treatment. They are paying for insurance.
You are not making a good point with your hairsplitting.
When is the last time you purchased a company policy?
There are a lot of procedures that are covered or not covered based on cost. You can ask to have procedures added or deleted and there will be a cost differentiation.
In this case there are adequate alternatives.
Gastric bypass is generally not covered as a default. It is expensive and there are alternatives called diet and exercise. Just like there are alternatives to the few types of contraception and or abortion tools that the company does not want to pay for.
So, it gets back to this point that you are disingenuous in your arguments because there are copious moral equivalency arguments that cannot be won unless your position is that every employer should pay for every procedure that any employee might demand.
If they don’t pay for it, then it is likely that in many instances the taxpayers will pay for it. So they object morally to paying for it indirectly through insurance. Should they be required to pay taxes to cover procedures that they object to on moral grounds?
An employer who objects to very specific medical procedures on religious grounds should not offer health insurance. They should just pay the fine, which is actually a tax according to the SCOTUS, and their employees can buy their own health insurance through the exchanges. There is, as you would like to say, an alternative for the employer.
Hi Just Me,
You write, “Medical needs should not involve anyone but yourself and your doctor!!!” I agree. However, the question is what things are needed and who will pay for them.
Consider the treatments you cite: blood transfusions and antidepressants. You claim that both are needed, but that is not always true.
–In the case of blood transfusions, a patient planning a surgery could schedule blood donations for him/herself, which I think Jehovah’s Witnesses are OK with, i.e., will pay for.
–In the case of antidepressants, the patient could use behavioral treatments which might be more effective and which Scientologists would probably pay for.
Assuming, however, that both blood transfusions and antidepressants are needed, let’s consider whether the four types of birth control which Hobby Lobby objected to are needed as well.
–As Tia pointed out, in some cases these birth control methods (or some of them) are the best choice to prevent pregnancy. However pregnancy is predicated on sexual activity (in this case), so is sexual activity needed? It might be wanted by either or both partners, but is it needed?
Assuming so (as we did for blood transfusions and antidepressants), let’s consider what the treatments in question involve.
–In the case of blood transfusions and antidepressants, they are done to benefit the individual in question.
–In the case of the types of birth control that Hobby Lobby objected to, they are done to benefit the individual in question at the expense (or the believed expense) of the fertilized egg. (I add the wiggle room because Tia said that an IUD, which was one of the methods objected to by Hobby Lobby, actually prevents fertilization, not implantation.)
In any case, interference with implantation was what Hobby Lobby objected to, since they do not want to pay for an insurance plan which covers birth control methods which harm what otherwise would or could become a human being.
Therefore, your analogy does not hold because the treatments you cite (blood transfusions, antidepressants) do not target something which could become a human being. In fact, no other treatments (other than therapeutic abortions) do so. In this way, the Hobby Lobby decision is not a slippery slope.
Don Wrote: “Dozens of other companies are now intending to meddle in the private lives of their employees.”
This illustrates the ridiculousness of having health care tied to employment. This whole “Hobby Lobby” discussion would not be an issue if we did not have this ludicrous system of providing health care.
This “ludicrous” system has provided the majority of innovation in the world. New techniques, new drugs, new procedures to save lives.
TBD The “Ludicrous” was merely referring to the system of having employers being responsible for providing healthcare.
Employers cannot ask their potential employees about their religious beliefs. Can prospective employees ask the interviewer what the owners religious beliefs are? Would the interviewer even know? Given how corporations buy up other corporations, would employees know know who owned them? (Yeah, sounds like slavery, whose our master now?). What if you worked for a place 20 years and you worked your way up the ladder but now Hobby Lobby bought the company…so just quit and get another job. Let’s opt for universal health care.
Don
I would certainly be happier ; )
I am having a very hard time reconciling how anyone who believes that the government should be as little involved in our personal decision making as possible, believes that it is somehow all right for our employers to have any say, whether direct or indirect, in what medical options an individual should or should not have. I do not believe that health care should ever depend upon employment. But since it currently does, there should be strict firewalls between the employer and the insurance, and between the insurance company and the decision making between the employee patient and their doctor.
Hi Tia,
You write, “I am having a very hard time reconciling how anyone who believes that the government should be as little involved in our personal decision making as possible, believes that it is somehow all right for our employers to have any say, whether direct or indirect, in what medical options an individual should or should not have.”
If anyone provides anything, that person/entity has a say over it. If you don’t like what an employer says, you could get a new job. If you don’t like what the government says, you could get a new country. Which is easier/more fair?
Our system of government is set up so that the latter should not have to occur (e.g., three equal branches–executive, legislative, judicial– providing checks and balances; states rights; freedom of speech and of the press). However, recent national events are posing a Constitutional crisis.
Jonathan Turley is a Constitutional scholar who has spoken out about this. His column today concerns the opposing rulings yesterday regarding subsidies to the federal exchange, which were not mentioned in the ACA as originally passed.
http://jonathanturley.org/2014/07/23/a-tale-of-two-circuits-obamacare-is-either-on-life-support-or-in-robust-health/
His column starts out like this:
“Call it the “Tale of Two Circuits.” It was either the best of times or the worst of times yesterday for Obamacare.”
It ends like this:
“Regardless of the merits of the statutory debate over the ACA, the question comes down to who should make such decisions. For my part, I agree with the change but I disagree with the unilateral means that the President used to secure it. President Obama has pledged to “go it alone” in circumventing opposition in Congress. The Fourth Circuit decision will certainly help him fulfill that pledge. The result is that our model of governance is changing not by any vote of the public but by these insular acts of institutional acquiescence.
The court may call this merely deferring to an agency but it represents something far greater and, in my view, far more dangerous. It is the ascendance of a fourth branch in a constitutional system designed for only three.”
What do you think?
Dorte
I am curious about your thoughts about Hobby Lobby not covering the IUDs for non contraceptive purposes. There are non contraceptive conditions for which I commonly recommend the Mirena IUD.
All of these are common, not “outliers” or “rare”.
1) Heavy bleeding leading to anemia in women who are not candidates for estrogen
2) Treatment of PCOS with its rare or non existent
periods putting women at increased risk of uterine cancer
3) Women with an overgrowth condition of the lining of the uterus ( hyperplasia) which if left inadequately treated can progress to uterine cancer.
None of these conditions has anything at all to do with the prevention of pregnancy, nor does it have anything to do with whether or not the woman is even sexually active.
What a blanket policy of denying payment for a Mirena IUD does is place the employer squarely in the middle between the patient and the doctor
( even in the case of a virgin) because of their narrow objection to what is only one potential use of the IUD.
Dorte
“President Obama has pledged to “go it alone” in circumventing opposition in Congress. The Fourth Circuit decision will certainly help him fulfill that pledge. The result is that our model of governance is changing not by any vote of the public but by these insular acts of institutional acquiescence.”
I have a couple of thoughts about this.
1. I believe that it is a fear based argument which does not address the actual implications with regard to the ACA. It is a claim that the law should be abolished because their might be development of something the author refers to as a “fourth branch of government”. Fear based reasoning tends to lead to paralysis. Not a good strategy seen from a doctors point of view.
2. There would have been no need for Obama to
“go it alone in the first place” if the opponents of the ACA, and most of Obama’s policies for that matter had not defined their main goal as to defeat him even before he was sworn in to office.
If we are going to worry about the Constitutional basis of our government, perhaps we should worry about those who choose not to recognize the outcome of not one, but two Presidential elections.
It has been Barack Millhouse Obama who has changed the ACA dozens of times without going to Congress for approval. How is that Constitutional?
Obama had to “go it alone”? How about he never wanted help from the right side of the isle. Social Security, Medicare, and many other major laws had bi-partisan support. Not the ACA, which even those on the Left run away from; and they exempt themselves from it’s own provisions!
It was Democratic Congressman Patrick Moynihan that said any major legislation needs 70 votes to survive, and Obama never worked to gain that support.
The sad thing is he has likely spent more time golfing, watching sports on TV, and giving speeches, than he has on the VA, Israel, the border, or job creation.
Tia, I don’t see you arguing Hobby Lobby’s objection to the “morning after” pill. So I gather you agree with their thinking on that item?
Hi Tia,
Although I am not a lawyer or ethicist, I’ll try to provide a perspective which each of these professionals might have regarding the birth control methods which are on the exempt list for Hobby Lobby.
–What a lawyer might say:
The Supreme Court case was about Hobby Lobby’s religious beliefs (that a fertilized egg is the beginning of human life and that they as employers should not be complicit in harming it). Therefore, it does not matter in regards to them that such a device can be used for other purposes. They are still exempt from paying for it.
If you, however, have scientific evidence that any of the exempted birth control methods prevent the fertilization of the sperm and egg, you can contact the Supreme Court or the ACLU (both have websites) to see whether any such method can be removed from the list.
–What an ethicist might say:
Although you know that that IUD is a life-saver, Hobby Lobby considers it (based on their religious beliefs) to be a life-taker. Therefore, you should respect their beliefs (and the Supreme Court ruling) and not ask them to consider paying for it.
The whole issue doesn’t matter much anyway, realistically speaking, since Judge Alito suggested in the majority opinion that the government (i.e., taxpayers) could pick up the tab. They have been paying for all birth control methods for employees of non-profit religious employers since 2012/2013, and the President could expand that executive order to include the exempted birth control methods for employees of for-profit religious employers (such as Hobby Lobby).
For information on that, see the following:
http://www.forbes.com/sites/theapothecary/2014/07/01/the-supreme-courts-hobby-lobby-decision-didnt-overturn-a-single-word-of-obamacare/
So basically Justice Alito said it’s ok for the President to take unilateral executive action to solve this problem.
Tia – the employer does not cover gastric bypass surgery.
You need to explain how this is any different and why it also would not be material harm under your thinking.
Frankly
In my opinion, they should. Treatment options should be based on best evidence driven access not that someone’s religious feelings are going to be injured if a patient opts for a treatment that the employer does not believe in for whatever reason.
I have said repeatedly that I do not believe that health care should in any way be linked to employment.
You have still not told me what the “good alternatives” to the Paraguard IUD are for my cancer patient who cannot use hormonal contraception, and certainly would not in the middle of treatment for cancer be able to just go out and find a new job.
Tia, given the fact that you are dealing with a cancer patient, I would think tubal ligation would make a lot of practical sense. The likelihood of further child bearing is very small given the cancer status. It seems like addition by subtraction makes a lot of sense. More sense than subtraction (of pregnancy risk) by addition (of a foreign body).
Ok – I read your previous that you think this should be covered.
So, Tia – what procedures do you agree are okay to not be covered by the employer? Are there any? Is everyone materially harmed because there is something not covered?
It seems to me that as a doctor you might have a conflict of interest here. After all the more procedures employers are forced to pay for the better for your industry.
I have a receding hairline, should my employer pay for my hair transplant?
I keep forgetting to wear a hat and so I am increasing my risk for skin cancer. I think that should justify that procedure being covered. Right?
Frankly
I think that you are forgetting what group my practice is with. Doing more procedures does not generate any more income for me.
What I believe is that all medically indicated precedures demonstrated effective should be covered.
All elective procedures should not be covered. So, your skin cancer should be covered even if it resulted from forgetting to wear a hat. Your hair transplant, sorry, cosmetic, you pay for it yourself.
It really is not that complicated.
What if someone has mental disorders because they’re fat, ugly or bald?
Then should they be allowed cosmetic surgery?
Frankly
“In fact, even if a company decides it will not pay for any contraceptive, the employees continue to have freedom of choice. They are not materially harmed.”
If they health care insurance is part of their compensation ( as of course it is) and if the IUD ( with its cost of about $800, is therefore not provided and it is the woman’s only option, which is not rare as I have posted previously, then of course she is being materially harmed. You have chosen not to respond to my example of my patient with cancer. You have also chosen not to address the issue of women who need the Mirena IUD
also not covered by Hobby Lobby for non-contracptive purposes. Thus Hobby Lobby would not be covering a device just because they did not want to, not because it breeched their religious beliefs since if the woman was celibate, or a lesbian, no religious principle of their would be broken by her use of the Mirena.
Definite material harm, since at Hobby Lobby, the majority of their workers would not be paid enough to afford these needed medical treatments on their own from their non medical compensations. Definite material harm.
And definite material harm in defensive of nothing but the sentiments ( religious preference)not materially harming the owners of Hobby Lobby in any way.
Why exactly should your “material harm” criteria only apply to the workers and not to the owners of Hobby Lobby ?
Tia, my wife and I faced the healthcare issue you outline here in 1973. She went the IUD route and got pregnant again, with the baby’s skull growing around and encapsulating the IUD in the baby’s brain matter. Ultimately, spontaneous abortion was her body’s way of dealing with that unnatural situation.
Shortly after that rather horrific medical event, I went and got a vasectomy … which is the course of action that we should have taken in the first place. It is foolproof, final and a very simple medical procedure. I don’t know why more people don’t use it as the option of first choice. How often do you prescribe a vasectomy as the alternative of choice?
Good point Matt. That procedure is covered.
Sorry to hear about that unfortunate event in you and your wife’s history.
We also should note that there is that other free procedure for a woman… just say no.
That is really not too difficult is it? I mean we call boys and men dogs because they cannot control their libido, but I guess women do not have the same expectations?
I think they do.
But then somehow this woman’s freedom to say no is dismissed and it is the company that is at fault.
Right.
While I am completely against any employer dictating which medical procedures I can and cannot obtain through my doctor, I am slightly appaled by your answer here… Just say no??? I am sure every rape victim who ended up pregnant by rape never said no, correct? Lets think about those female employees walking to their cars after work.. What if one of them get raped in a dark parking lot????? They are forced to carry a baby and live with that rape for the rest of their lives???? Just say no!!! Just say no works as well in rape cases as well as banning assault rifles!
Ah yes… the rape argument. The fall-back position for those crusaders of the “war on women”.
So, let’s just put that aside. I agree that rape demands that the woman has access to any and all procedures to terminate the pregnancy as she and her doctor decide.
But rape is a crime. If my house is burglarized and I am beat to beyond recognition and barely survive, will my employer be required to pay for all my cosmetic surgery to get me back to my beautiful self?
See my point?
Please don’t use rape to make up for the lack of argument. It is a cheap and disingenuous move. And it diminishes the point that it is one of the most terrible crimes that can be committed on a person.
If you are having a problem with my “just say no” point that face up to it and make your point.
YOU said that woman can “Just say No”, not me! Obviously Just say no doesnt always work! Bottom line, my medical options are between ME and my DOCTOR, not my employer!!!! My medical is none of my employers business. I still have doctor/patient confidentiality!!!
I am sure that all rape victims who “Just said no” would love to talk to you!!!
Why exactly should your “material harm” criteria only apply to the workers and not to the owners of Hobby Lobby ?
Tia – think this through. I am repeating myself again.
The owners hold well-established and common religious beliefs that cause them to not want to pay for medical procedures that conflict with their religious beliefs. But let’s say for the sake of argument that religious beliefs are not involved, and the owners just have a moral conflict with certain “birth control” methods they deem barbaric or even unacceptable.
I am someone in that camp. I don’t support abortion tools that are branded as birth control. I think we call them abortion tools and we have that argument separately. I have a moral and logical conflict, not a religious one. But I have a big moral, logical and Constitutional conflict with the left trying to impose their beliefs over the top of others.
The harm to the employee is that the employer will not pay for certain procedures. But this is not material harm because:
1. There are a lot of other procedures that the employer does not pay for, and for this claim of material harm to stick, it would have to apply to all employees desiring a procedure not covered. And we cannot, so it does not.
2. The employer pays for many other forms of birth control.
3. The employee has free choice:
a. pay out of pocket for any procedure or medical product not covered by the employer.
b. choose abstinence.
c. get a job with another company that covers those procedures desired.
However, if the courts ruled against the employer, the owners would have two choices:
1. Comply and break their beliefs.
2. Close down the company.
In both cases they would be materially harmed.
When choice exists, you are just talking about preference of option and preference for who will pay for it… you are NOT able to make a case of material harm.
My employer does not provide me a car allowance. Am I materially harmed by that?
In fact, the woman harm factor is manufactured. It is the left trying to exploit the war on women for political purpose. I think the majority of women are much too intelligent to be exploited this way. And those that would make this a war on women event are already so much man-haters like Janeane Garofalo it would not make any difference.
They aren’t paying for the medical procedures. They are paying for the insurance. The patient and the insurance company are paying for the medical procedures.
You are splitting hairs again to avoid points.
Every policy has a list of covered and not covered items. You can add or delete items at a cost differentiation. Those changes are covered with policy riders.
The employer is paying for the insurance that covers the procedures and drugs covered on the policy. And in that they are absolutely paying for at least a portion of the procedures (depending on deductibles and out of pocket maximums, etc.)
Employers have a direct decision authority and responsibility to decide what is covered and what is not, and to work with their insurer to dial in the policy the way they want it to be. They are not preventing the employer from going to get any procedure they want to get… the issue is what will be paid for.
So Don, what happens if you are a Kaiser patent and your employer provides you a kaiser policy, and you want to go see an orthopedic specialist outside of the Kaiser network… and your GP agrees that this doctor is the top resource for your particular problem. Is it the employer’s responsibility to pay for that?
Again, you can go to see that specialist.
So, if they don’t want to pay for certain things, they can just pay a tax instead of providing health insurance.
Don, employers sit down with insurance companies and custom design the parameters of he insurance coverage that they want to offer to their employees. Once the coverage parameters are agreed upon, then the various insurance companies submit bids to the employer in order to win that piece of business. The employer then awards the contract to the winning bidder.
Nowhere during that selection process is any patient involved.
Frankly
Ok let’s say I agree with you that women can just say no ( which is one of your most ridiculous comments ever since you don’t seem to feel that men have any responsibility in this regard) however, let’s take your premise full on.
Please explain to me again why Hobby Lobby doesn’t have to provide insurance that will pay for the IUD for medical management of conditions of the celibate woman or the lesbian ? Surely there would be on moral or religious conflict in these cases.
Don Shor: You believe that any employer of any religion has the right to impose any religious belief on his or her employees? If not, where do you draw the line?
Draw the line at material harm.
Not emotional harm (because that IS a slippery slope), but harm that can be quantified as something of value lost or taken away.
There is no material harm in the Hobby Lobby decisions because:
1. Employees that do not support owner’s decisions and practices can quit and work somewhere else. A job with any private company is not an entitlement. Free choice is not impacted because there are alternatives. The employees are not slaves.
2. There are plenty of alterative birth control options available. And for those few that are not, employees can spend their own money to get them. That would be their choice… their free choice.
In fact, even if a company decides it will not pay for any contraceptive, the employees continue to have freedom of choice. They are not materially harmed.
Now, if the courts forced the Hobby Lobby owners to abandon their beliefs in support of the types of birth control they opposed, then the owners would be materially harmed in the loss of freedom to chose to uphold their beliefs… again… beliefs that would not cause material harm to the employees because they are still free to choose. If the practice of those beliefs cause material harm to others (as would many aspects of Sharia Law), then it would require a balanced decision, and I would agree that a company should not be allowed to materially harm its employees with policies based on religious beliefs or other beliefs for that matter. But again, employees can quit and work for another company, so that material harm argument becomes very difficult to prove.
I think one fundamental difference in perspectives for this debate is that some people seem to think of companies as not being entitled to protection of rights, and employees being hyper-entitled to any and all protections up to and including things that only cause even hurt feelings.
And others see companies as being privately owned by people who’s rights are equal to the rights of employees.
Obviously contraception has value. And as Tia Will has pointed out, the specific contraceptions that they object to (out of clear ignorance) are often prescribed for non-contraceptive purposes. Does Hobby Lobby now get to see a doctor’s note as to why something is medically needed?
An obvious issue is that the employer is trying to meddle in one specific aspect of their employees’ personal lives. They are interfering in the doctor-patient relationship. Even the courts can’t do that, if I recall.
Because of this ruling, I am coming to the conclusion that employers who don’t want to pay for specific aspects of health care should simply pay the fine (tax per the Supreme Court) and send their employees to the exchanges. They are violating the privacy of their employees, and doing so in a gender-specific manner.
Dozens of other companies are now intending to meddle in the private lives of their employees. It is ludicrous to set this precedent that could potentially affect millions of employees, and then fall back on the argument that ‘they can just quit and work for another company. We are talking about a huge percentage of the work force here. Did you ever, when you applied for a job, think to inquire about the religious beliefs of the owners, and ask how that might affect your benefits?
Ruth Bader Ginsburg has this exactly right. And if it snowballs, I’m afraid it sets the stage for a move toward single-payer. That would make some people happy, I guess.
They are not meddling. The employee can do anything they want to do. They can go get any kind of contraceptive that they want to get or that the doctor prescribe to them. The company is not preventing that. Your argument is disingenuous. You are projecting harm that is not there.
What if the employee wants gastric bypass or the doctor prescribe it but the company refuses to cover it? Are you going to claim material harm for that too?
Get real.
Yes, of course. If the doctor thinks that is necessary, that is between the patient and the doctor. Health plans cover health care. This level of micromanagement by the employer is ridiculous.
Here’s the main point. They’re not paying for the gastric bypass. They’re not paying for the specific form of contraception. They’re paying for the insurance coverage. They shouldn’t even know the details of what an employee goes to a doctor for. They shouldn’t even know what the insurance plan is being billed for. They can offer a range of plans, with a range of coverage, to all of their employees equally. The minimum coverage is now regulated by the government. What the employee actually uses it for? None of their business. It is a clear violation of the employee’s privacy that they are even trying to make these distinctions.
They aren’t paying for medicine. They aren’t paying for treatment. They are paying for insurance.
Frankly
“What if the employee wants gastric bypass or the doctor prescribe it but the company refuses to cover it? Are you going to claim material harm for that too?”
Of course it should be covered. The statistical efficacy of gastric bypass is significantly higher than any of behavioral and medical means of weight loss.
So why exactly would we not want the most effect therapy to be covered.
I am completely missing your point here. Could you explain ?
I am simply afraid of the following…
Someone covered under your medical goes through some mental issues… Employer is Scientologist.. Guess what, they dont believe in pysch drugs.. NO antidepressants for you or your loved one..
Need a blood transfusion.. Your Jehovas Witness employer says no!
Medical needs should not involve anyone but yourself and your doctor!!!
The medical needs absolutely should not involve anyone but the patient and their doctor. However, the financial responsibility for the delivery of care to address those medical needs is an entirely different matter. An employer has every right to decide that his/her financial needs absolutely should not involve anyone but the employer and their chosen insurance carrier. Similarly, an employee has every right to decide that his/her compensation needs should include a certain level of coverage, and then include the meeting of those compensation needs in their employment negotiations.
With that said, if the employer is a Scientologist opposed to the provision of psych drugs and an employee believes that their compensation package should include the value of psych drug coverage, then all the employee has to do is calculate the value of the psych drug coverage and accept an increase in salary in lieu of the coverage that the employer is morally opposed to providing. Same thing for blood transfusion coverage if the employer is a Jehovah’s Witness. If the employee wants to work for the company, then accepting the responsibility for getting enough higher salary/pay to be able to cover the antidepressant/blood costs is a very small price to pay.
They aren’t paying for medicine. They aren’t paying for treatment. They are paying for insurance.
You are not making a good point with your hairsplitting.
When is the last time you purchased a company policy?
There are a lot of procedures that are covered or not covered based on cost. You can ask to have procedures added or deleted and there will be a cost differentiation.
In this case there are adequate alternatives.
Gastric bypass is generally not covered as a default. It is expensive and there are alternatives called diet and exercise. Just like there are alternatives to the few types of contraception and or abortion tools that the company does not want to pay for.
So, it gets back to this point that you are disingenuous in your arguments because there are copious moral equivalency arguments that cannot be won unless your position is that every employer should pay for every procedure that any employee might demand.
If they don’t pay for it, then it is likely that in many instances the taxpayers will pay for it. So they object morally to paying for it indirectly through insurance. Should they be required to pay taxes to cover procedures that they object to on moral grounds?
An employer who objects to very specific medical procedures on religious grounds should not offer health insurance. They should just pay the fine, which is actually a tax according to the SCOTUS, and their employees can buy their own health insurance through the exchanges. There is, as you would like to say, an alternative for the employer.
Hi Just Me,
You write, “Medical needs should not involve anyone but yourself and your doctor!!!” I agree. However, the question is what things are needed and who will pay for them.
Consider the treatments you cite: blood transfusions and antidepressants. You claim that both are needed, but that is not always true.
–In the case of blood transfusions, a patient planning a surgery could schedule blood donations for him/herself, which I think Jehovah’s Witnesses are OK with, i.e., will pay for.
–In the case of antidepressants, the patient could use behavioral treatments which might be more effective and which Scientologists would probably pay for.
Assuming, however, that both blood transfusions and antidepressants are needed, let’s consider whether the four types of birth control which Hobby Lobby objected to are needed as well.
–As Tia pointed out, in some cases these birth control methods (or some of them) are the best choice to prevent pregnancy. However pregnancy is predicated on sexual activity (in this case), so is sexual activity needed? It might be wanted by either or both partners, but is it needed?
Assuming so (as we did for blood transfusions and antidepressants), let’s consider what the treatments in question involve.
–In the case of blood transfusions and antidepressants, they are done to benefit the individual in question.
–In the case of the types of birth control that Hobby Lobby objected to, they are done to benefit the individual in question at the expense (or the believed expense) of the fertilized egg. (I add the wiggle room because Tia said that an IUD, which was one of the methods objected to by Hobby Lobby, actually prevents fertilization, not implantation.)
In any case, interference with implantation was what Hobby Lobby objected to, since they do not want to pay for an insurance plan which covers birth control methods which harm what otherwise would or could become a human being.
Therefore, your analogy does not hold because the treatments you cite (blood transfusions, antidepressants) do not target something which could become a human being. In fact, no other treatments (other than therapeutic abortions) do so. In this way, the Hobby Lobby decision is not a slippery slope.
Don Wrote: “Dozens of other companies are now intending to meddle in the private lives of their employees.”
This illustrates the ridiculousness of having health care tied to employment. This whole “Hobby Lobby” discussion would not be an issue if we did not have this ludicrous system of providing health care.
This “ludicrous” system has provided the majority of innovation in the world. New techniques, new drugs, new procedures to save lives.
TBD The “Ludicrous” was merely referring to the system of having employers being responsible for providing healthcare.
Employers cannot ask their potential employees about their religious beliefs. Can prospective employees ask the interviewer what the owners religious beliefs are? Would the interviewer even know? Given how corporations buy up other corporations, would employees know know who owned them? (Yeah, sounds like slavery, whose our master now?). What if you worked for a place 20 years and you worked your way up the ladder but now Hobby Lobby bought the company…so just quit and get another job. Let’s opt for universal health care.
Don
I would certainly be happier ; )
I am having a very hard time reconciling how anyone who believes that the government should be as little involved in our personal decision making as possible, believes that it is somehow all right for our employers to have any say, whether direct or indirect, in what medical options an individual should or should not have. I do not believe that health care should ever depend upon employment. But since it currently does, there should be strict firewalls between the employer and the insurance, and between the insurance company and the decision making between the employee patient and their doctor.
Hi Tia,
You write, “I am having a very hard time reconciling how anyone who believes that the government should be as little involved in our personal decision making as possible, believes that it is somehow all right for our employers to have any say, whether direct or indirect, in what medical options an individual should or should not have.”
If anyone provides anything, that person/entity has a say over it. If you don’t like what an employer says, you could get a new job. If you don’t like what the government says, you could get a new country. Which is easier/more fair?
Our system of government is set up so that the latter should not have to occur (e.g., three equal branches–executive, legislative, judicial– providing checks and balances; states rights; freedom of speech and of the press). However, recent national events are posing a Constitutional crisis.
Jonathan Turley is a Constitutional scholar who has spoken out about this. His column today concerns the opposing rulings yesterday regarding subsidies to the federal exchange, which were not mentioned in the ACA as originally passed.
http://jonathanturley.org/2014/07/23/a-tale-of-two-circuits-obamacare-is-either-on-life-support-or-in-robust-health/
His column starts out like this:
“Call it the “Tale of Two Circuits.” It was either the best of times or the worst of times yesterday for Obamacare.”
It ends like this:
“Regardless of the merits of the statutory debate over the ACA, the question comes down to who should make such decisions. For my part, I agree with the change but I disagree with the unilateral means that the President used to secure it. President Obama has pledged to “go it alone” in circumventing opposition in Congress. The Fourth Circuit decision will certainly help him fulfill that pledge. The result is that our model of governance is changing not by any vote of the public but by these insular acts of institutional acquiescence.
The court may call this merely deferring to an agency but it represents something far greater and, in my view, far more dangerous. It is the ascendance of a fourth branch in a constitutional system designed for only three.”
What do you think?
Dorte
I am curious about your thoughts about Hobby Lobby not covering the IUDs for non contraceptive purposes. There are non contraceptive conditions for which I commonly recommend the Mirena IUD.
All of these are common, not “outliers” or “rare”.
1) Heavy bleeding leading to anemia in women who are not candidates for estrogen
2) Treatment of PCOS with its rare or non existent
periods putting women at increased risk of uterine cancer
3) Women with an overgrowth condition of the lining of the uterus ( hyperplasia) which if left inadequately treated can progress to uterine cancer.
None of these conditions has anything at all to do with the prevention of pregnancy, nor does it have anything to do with whether or not the woman is even sexually active.
What a blanket policy of denying payment for a Mirena IUD does is place the employer squarely in the middle between the patient and the doctor
( even in the case of a virgin) because of their narrow objection to what is only one potential use of the IUD.
Dorte
“President Obama has pledged to “go it alone” in circumventing opposition in Congress. The Fourth Circuit decision will certainly help him fulfill that pledge. The result is that our model of governance is changing not by any vote of the public but by these insular acts of institutional acquiescence.”
I have a couple of thoughts about this.
1. I believe that it is a fear based argument which does not address the actual implications with regard to the ACA. It is a claim that the law should be abolished because their might be development of something the author refers to as a “fourth branch of government”. Fear based reasoning tends to lead to paralysis. Not a good strategy seen from a doctors point of view.
2. There would have been no need for Obama to
“go it alone in the first place” if the opponents of the ACA, and most of Obama’s policies for that matter had not defined their main goal as to defeat him even before he was sworn in to office.
If we are going to worry about the Constitutional basis of our government, perhaps we should worry about those who choose not to recognize the outcome of not one, but two Presidential elections.
It has been Barack Millhouse Obama who has changed the ACA dozens of times without going to Congress for approval. How is that Constitutional?
Obama had to “go it alone”? How about he never wanted help from the right side of the isle. Social Security, Medicare, and many other major laws had bi-partisan support. Not the ACA, which even those on the Left run away from; and they exempt themselves from it’s own provisions!
It was Democratic Congressman Patrick Moynihan that said any major legislation needs 70 votes to survive, and Obama never worked to gain that support.
The sad thing is he has likely spent more time golfing, watching sports on TV, and giving speeches, than he has on the VA, Israel, the border, or job creation.
Tia, I don’t see you arguing Hobby Lobby’s objection to the “morning after” pill. So I gather you agree with their thinking on that item?
Hi Tia,
Although I am not a lawyer or ethicist, I’ll try to provide a perspective which each of these professionals might have regarding the birth control methods which are on the exempt list for Hobby Lobby.
–What a lawyer might say:
The Supreme Court case was about Hobby Lobby’s religious beliefs (that a fertilized egg is the beginning of human life and that they as employers should not be complicit in harming it). Therefore, it does not matter in regards to them that such a device can be used for other purposes. They are still exempt from paying for it.
If you, however, have scientific evidence that any of the exempted birth control methods prevent the fertilization of the sperm and egg, you can contact the Supreme Court or the ACLU (both have websites) to see whether any such method can be removed from the list.
–What an ethicist might say:
Although you know that that IUD is a life-saver, Hobby Lobby considers it (based on their religious beliefs) to be a life-taker. Therefore, you should respect their beliefs (and the Supreme Court ruling) and not ask them to consider paying for it.
The whole issue doesn’t matter much anyway, realistically speaking, since Judge Alito suggested in the majority opinion that the government (i.e., taxpayers) could pick up the tab. They have been paying for all birth control methods for employees of non-profit religious employers since 2012/2013, and the President could expand that executive order to include the exempted birth control methods for employees of for-profit religious employers (such as Hobby Lobby).
For information on that, see the following:
http://www.forbes.com/sites/theapothecary/2014/07/01/the-supreme-courts-hobby-lobby-decision-didnt-overturn-a-single-word-of-obamacare/
So basically Justice Alito said it’s ok for the President to take unilateral executive action to solve this problem.
Tia – the employer does not cover gastric bypass surgery.
You need to explain how this is any different and why it also would not be material harm under your thinking.
Frankly
In my opinion, they should. Treatment options should be based on best evidence driven access not that someone’s religious feelings are going to be injured if a patient opts for a treatment that the employer does not believe in for whatever reason.
I have said repeatedly that I do not believe that health care should in any way be linked to employment.
You have still not told me what the “good alternatives” to the Paraguard IUD are for my cancer patient who cannot use hormonal contraception, and certainly would not in the middle of treatment for cancer be able to just go out and find a new job.
Tia, given the fact that you are dealing with a cancer patient, I would think tubal ligation would make a lot of practical sense. The likelihood of further child bearing is very small given the cancer status. It seems like addition by subtraction makes a lot of sense. More sense than subtraction (of pregnancy risk) by addition (of a foreign body).
Ok – I read your previous that you think this should be covered.
So, Tia – what procedures do you agree are okay to not be covered by the employer? Are there any? Is everyone materially harmed because there is something not covered?
It seems to me that as a doctor you might have a conflict of interest here. After all the more procedures employers are forced to pay for the better for your industry.
I have a receding hairline, should my employer pay for my hair transplant?
I keep forgetting to wear a hat and so I am increasing my risk for skin cancer. I think that should justify that procedure being covered. Right?
Frankly
I think that you are forgetting what group my practice is with. Doing more procedures does not generate any more income for me.
What I believe is that all medically indicated precedures demonstrated effective should be covered.
All elective procedures should not be covered. So, your skin cancer should be covered even if it resulted from forgetting to wear a hat. Your hair transplant, sorry, cosmetic, you pay for it yourself.
It really is not that complicated.
What if someone has mental disorders because they’re fat, ugly or bald?
Then should they be allowed cosmetic surgery?
Frankly
“In fact, even if a company decides it will not pay for any contraceptive, the employees continue to have freedom of choice. They are not materially harmed.”
If they health care insurance is part of their compensation ( as of course it is) and if the IUD ( with its cost of about $800, is therefore not provided and it is the woman’s only option, which is not rare as I have posted previously, then of course she is being materially harmed. You have chosen not to respond to my example of my patient with cancer. You have also chosen not to address the issue of women who need the Mirena IUD
also not covered by Hobby Lobby for non-contracptive purposes. Thus Hobby Lobby would not be covering a device just because they did not want to, not because it breeched their religious beliefs since if the woman was celibate, or a lesbian, no religious principle of their would be broken by her use of the Mirena.
Definite material harm, since at Hobby Lobby, the majority of their workers would not be paid enough to afford these needed medical treatments on their own from their non medical compensations. Definite material harm.
And definite material harm in defensive of nothing but the sentiments ( religious preference)not materially harming the owners of Hobby Lobby in any way.
Why exactly should your “material harm” criteria only apply to the workers and not to the owners of Hobby Lobby ?
Tia, my wife and I faced the healthcare issue you outline here in 1973. She went the IUD route and got pregnant again, with the baby’s skull growing around and encapsulating the IUD in the baby’s brain matter. Ultimately, spontaneous abortion was her body’s way of dealing with that unnatural situation.
Shortly after that rather horrific medical event, I went and got a vasectomy … which is the course of action that we should have taken in the first place. It is foolproof, final and a very simple medical procedure. I don’t know why more people don’t use it as the option of first choice. How often do you prescribe a vasectomy as the alternative of choice?
Good point Matt. That procedure is covered.
Sorry to hear about that unfortunate event in you and your wife’s history.
We also should note that there is that other free procedure for a woman… just say no.
That is really not too difficult is it? I mean we call boys and men dogs because they cannot control their libido, but I guess women do not have the same expectations?
I think they do.
But then somehow this woman’s freedom to say no is dismissed and it is the company that is at fault.
Right.
While I am completely against any employer dictating which medical procedures I can and cannot obtain through my doctor, I am slightly appaled by your answer here… Just say no??? I am sure every rape victim who ended up pregnant by rape never said no, correct? Lets think about those female employees walking to their cars after work.. What if one of them get raped in a dark parking lot????? They are forced to carry a baby and live with that rape for the rest of their lives???? Just say no!!! Just say no works as well in rape cases as well as banning assault rifles!
Ah yes… the rape argument. The fall-back position for those crusaders of the “war on women”.
So, let’s just put that aside. I agree that rape demands that the woman has access to any and all procedures to terminate the pregnancy as she and her doctor decide.
But rape is a crime. If my house is burglarized and I am beat to beyond recognition and barely survive, will my employer be required to pay for all my cosmetic surgery to get me back to my beautiful self?
See my point?
Please don’t use rape to make up for the lack of argument. It is a cheap and disingenuous move. And it diminishes the point that it is one of the most terrible crimes that can be committed on a person.
If you are having a problem with my “just say no” point that face up to it and make your point.
YOU said that woman can “Just say No”, not me! Obviously Just say no doesnt always work! Bottom line, my medical options are between ME and my DOCTOR, not my employer!!!! My medical is none of my employers business. I still have doctor/patient confidentiality!!!
I am sure that all rape victims who “Just said no” would love to talk to you!!!
Why exactly should your “material harm” criteria only apply to the workers and not to the owners of Hobby Lobby ?
Tia – think this through. I am repeating myself again.
The owners hold well-established and common religious beliefs that cause them to not want to pay for medical procedures that conflict with their religious beliefs. But let’s say for the sake of argument that religious beliefs are not involved, and the owners just have a moral conflict with certain “birth control” methods they deem barbaric or even unacceptable.
I am someone in that camp. I don’t support abortion tools that are branded as birth control. I think we call them abortion tools and we have that argument separately. I have a moral and logical conflict, not a religious one. But I have a big moral, logical and Constitutional conflict with the left trying to impose their beliefs over the top of others.
The harm to the employee is that the employer will not pay for certain procedures. But this is not material harm because:
1. There are a lot of other procedures that the employer does not pay for, and for this claim of material harm to stick, it would have to apply to all employees desiring a procedure not covered. And we cannot, so it does not.
2. The employer pays for many other forms of birth control.
3. The employee has free choice:
a. pay out of pocket for any procedure or medical product not covered by the employer.
b. choose abstinence.
c. get a job with another company that covers those procedures desired.
However, if the courts ruled against the employer, the owners would have two choices:
1. Comply and break their beliefs.
2. Close down the company.
In both cases they would be materially harmed.
When choice exists, you are just talking about preference of option and preference for who will pay for it… you are NOT able to make a case of material harm.
My employer does not provide me a car allowance. Am I materially harmed by that?
In fact, the woman harm factor is manufactured. It is the left trying to exploit the war on women for political purpose. I think the majority of women are much too intelligent to be exploited this way. And those that would make this a war on women event are already so much man-haters like Janeane Garofalo it would not make any difference.
They aren’t paying for the medical procedures. They are paying for the insurance. The patient and the insurance company are paying for the medical procedures.
You are splitting hairs again to avoid points.
Every policy has a list of covered and not covered items. You can add or delete items at a cost differentiation. Those changes are covered with policy riders.
The employer is paying for the insurance that covers the procedures and drugs covered on the policy. And in that they are absolutely paying for at least a portion of the procedures (depending on deductibles and out of pocket maximums, etc.)
Employers have a direct decision authority and responsibility to decide what is covered and what is not, and to work with their insurer to dial in the policy the way they want it to be. They are not preventing the employer from going to get any procedure they want to get… the issue is what will be paid for.
So Don, what happens if you are a Kaiser patent and your employer provides you a kaiser policy, and you want to go see an orthopedic specialist outside of the Kaiser network… and your GP agrees that this doctor is the top resource for your particular problem. Is it the employer’s responsibility to pay for that?
Again, you can go to see that specialist.
So, if they don’t want to pay for certain things, they can just pay a tax instead of providing health insurance.
Don, employers sit down with insurance companies and custom design the parameters of he insurance coverage that they want to offer to their employees. Once the coverage parameters are agreed upon, then the various insurance companies submit bids to the employer in order to win that piece of business. The employer then awards the contract to the winning bidder.
Nowhere during that selection process is any patient involved.
Frankly
Ok let’s say I agree with you that women can just say no ( which is one of your most ridiculous comments ever since you don’t seem to feel that men have any responsibility in this regard) however, let’s take your premise full on.
Please explain to me again why Hobby Lobby doesn’t have to provide insurance that will pay for the IUD for medical management of conditions of the celibate woman or the lesbian ? Surely there would be on moral or religious conflict in these cases.
Hi Matt
First of all, I am so sorry to hear that you two had to go through that. I have gone my entire career without an IUD related adverse pregnancy outcome.
I frequently recommend that couples consider the option of vasectomy or female sterilization.
I do want to correct one comment that you made. Vasectomy is not foolproof if by that you mean 100% effective.
People frequently believe that, but it is not. There is a < 1 percent, but greater than 0 % chance that a vasectomy will fail, not because the doctor makes a mistake, but because the body does a tremendous job in its attempt to heal itself by re forming a connecting tube called a fistula. This is not a rare event. There are four forms of reversible contraception now available which are equally as effective as vasectomy. They are the Mirena IUD,
the Paraguard IUD, the Nexplanon and DepoProvera.
Sterilization procedures are very highly statistically effective means of contraception. However, they are limited to those who are absolutely certain that they have completed their child bearing. I have met many, many couples who either because they had changed partners, or had a child die, were extremely regretful about the choice to have a sterilization procedure. So while it is a great solution for some, it is not without its own set of potential problems.
Thanks for the kind words Tia. The whole process, including the spontaneous abortion, wasn’t easy for my wife, which made my decision to cut the problem off at the source a very easy one to make. Others regretted my decision, but I never did. Burdening another person with traumatic health problems seemed very selfish at the time, and still seems selfish.
Hi Matt
First of all, I am so sorry to hear that you two had to go through that. I have gone my entire career without an IUD related adverse pregnancy outcome.
I frequently recommend that couples consider the option of vasectomy or female sterilization.
I do want to correct one comment that you made. Vasectomy is not foolproof if by that you mean 100% effective.
People frequently believe that, but it is not. There is a < 1 percent, but greater than 0 % chance that a vasectomy will fail, not because the doctor makes a mistake, but because the body does a tremendous job in its attempt to heal itself by re forming a connecting tube called a fistula. This is not a rare event. There are four forms of reversible contraception now available which are equally as effective as vasectomy. They are the Mirena IUD,
the Paraguard IUD, the Nexplanon and DepoProvera.
Sterilization procedures are very highly statistically effective means of contraception. However, they are limited to those who are absolutely certain that they have completed their child bearing. I have met many, many couples who either because they had changed partners, or had a child die, were extremely regretful about the choice to have a sterilization procedure. So while it is a great solution for some, it is not without its own set of potential problems.
Thanks for the kind words Tia. The whole process, including the spontaneous abortion, wasn’t easy for my wife, which made my decision to cut the problem off at the source a very easy one to make. Others regretted my decision, but I never did. Burdening another person with traumatic health problems seemed very selfish at the time, and still seems selfish.
I am simply afraid of the following…
Someone covered under your medical goes through some mental issues… Employer is Scientologist.. Guess what, they dont believe in pysch drugs.. NO antidepressants for you or your loved one..
Need a blood transfusion.. Your Jehovas Witness employer says no!
Invalid arguments in consideration of material harm. If there are no alternatives and the lack of alternatives and or choice would cause material harm to the employee, than the employer is absolutely obligated to provide the coverage… unless it is too costly because then it harms the employer.
But note that there are a lot of exclusions in employer health insurance policies to control costs. Therapy and counseling are examples of services not covered by many plans.
And then we get to a comparison of material harm. If you demand that a company covers all these things and the company cannot afford it, then the company fails. So then, we must assess the level of material harm and make a judgement call.
But if there is not a cost argument, and there are not alternative solutions/treatments for the employee, I agree that the company should be compelled to cover the procedures or drugs.
Frankly
“Tia – think this through”
I did think it through, thoroughly and find you position untenable.
You state your criteria is “material harm”. Since if the employer were not specifically monitoring the individual care of each individual employee, which I think we would both agree that they have no right to do, then they would never even know if a woman were using an IUD, and they certainly would not if she were using it for contraceptive or medical purposes would they ? So how could they possibly be harmed in any way, material or emotional by something that they would not even be aware of ?
The patient on the other hand will certainly suffer very direct and sometimes very damaging material harm if she conceives when she should not, or in the case of the celibate or lesbian woman who has medical problems that she cannot address with the medical option that she and her doctor believe is best for her when no conceivable harm either material or emotional could come to the owners since their is no possibility whatsoever of conception. No conception = no abortion. This is not difficult to understand.
I am simply afraid of the following…
Someone covered under your medical goes through some mental issues… Employer is Scientologist.. Guess what, they dont believe in pysch drugs.. NO antidepressants for you or your loved one..
Need a blood transfusion.. Your Jehovas Witness employer says no!
Invalid arguments in consideration of material harm. If there are no alternatives and the lack of alternatives and or choice would cause material harm to the employee, than the employer is absolutely obligated to provide the coverage… unless it is too costly because then it harms the employer.
But note that there are a lot of exclusions in employer health insurance policies to control costs. Therapy and counseling are examples of services not covered by many plans.
And then we get to a comparison of material harm. If you demand that a company covers all these things and the company cannot afford it, then the company fails. So then, we must assess the level of material harm and make a judgement call.
But if there is not a cost argument, and there are not alternative solutions/treatments for the employee, I agree that the company should be compelled to cover the procedures or drugs.
Frankly
“Tia – think this through”
I did think it through, thoroughly and find you position untenable.
You state your criteria is “material harm”. Since if the employer were not specifically monitoring the individual care of each individual employee, which I think we would both agree that they have no right to do, then they would never even know if a woman were using an IUD, and they certainly would not if she were using it for contraceptive or medical purposes would they ? So how could they possibly be harmed in any way, material or emotional by something that they would not even be aware of ?
The patient on the other hand will certainly suffer very direct and sometimes very damaging material harm if she conceives when she should not, or in the case of the celibate or lesbian woman who has medical problems that she cannot address with the medical option that she and her doctor believe is best for her when no conceivable harm either material or emotional could come to the owners since their is no possibility whatsoever of conception. No conception = no abortion. This is not difficult to understand.
The ACA will have a horrible effect on serious illness and treatments, like cancer. We’re going backwards.
And your evidence for that opinion is what exactly?
Currently we waste 20-25 cents of every healthcare dollar on non-care costs. With a single payor reimbursement method, we could redirect 15-20 cents of that into care giving and research. A single payor system will result in better treatment, not worse. The numbers simply don’t lie.
If it were only that simple. Its not.
Forbes
How Obamacare Will Harm Cancer Patients
“Obamacare is going to degrade medicine but its ill effects will fall disproportionately on patients with serious conditions, especially those diagnosed with cancer.
“The legislation contains provisions that directly target patients with cancer because their care is perceived as costly. These policies couldn’t be more badly timed.”
“…First, Obamacare is going to block the ability of patients to seek out the specialist doctors who are most likely to prescribe these cutting edge treatments…”
“…Next, Obamacare tries to coerce doctors to cut down on their use of costlier drugs and tests by changing the way that they’re paid. The law uses “bundled” payments, where doctors get lump sums of money to care for patients with particular medical problems. The idea is to pit the cost of the treatments doctors prescribe directly against their earnings and give doctors a potent incentive to use cheaper remedies.”
“…But these schemes will slow adoption of new technology.”
“…Finally, Obamacare targets cancer drugs directly, by expanding a program called 340B, which siphons money away from drug developers in order to subsidize hospitals. The Obama Administration sees the program as a way to prop up the hospitals (a favored constituency) on the dime of less popular drug makers. But the oblique way the money is extracted from drug companies spawns a lot of harmful consequences that are increasing the cost of cancer care, and lowering its quality.”
“…Obamacare targets cancer drugs because they are pricey. But the fact is that spending on cancer medicines offsets other costs.”
“…None of the Obamacare policies lower the actual cost of the drugs. We should be addressing the high expense of developing these medicines, where enrolling a single cancer patient into a clinical trial can top $90,000 owing to FDA regulations.”
http://www.forbes.com/sites/scottgottlieb/2013/08/21/how-obamacare-will-harm-cancer-patients/
TBD
I think that you left out one important paragraph of the Gottlieb article.
“Insurers are barred from using the other tools that they’ve traditionally employed to keep the costs of policies in check: cost sharing, underwriting risk, adjusting premiums and benefits. The only thing that health plans are permitted to do under Obamacare is narrow the networks of providers that they contract with.”
There are two important points that he does not include in his analysis. He forgot to mention some of the other very important “tools to keep the cost of the policies in check”
such as denial of benefits once a very expensive diagnosis was made and not insuring those with pre existing conditions. Those two strategies were great for holding costs in check…but not so great if you were a cancer patient.
The other thing that Gottlieb fails to mention is that this is only having this effect in the fee for service model. In Kaiser, as I have pointed out, using a collaborative instead of a competitive model, we are actively hiring up, not narrowing our network. We have an advantage in getting a patient with a high cost diagnosis such as cancer to the correct level of advanced care as quickly as possible including to the best specialists whom we have been able to attract by allowing them to practice freely without the constraints of insurance companies and encouraging them to participate in research.
Do you think the article made some relevant points?
I have a loved one who is fighting cancer. It started as prostate cancer; we thought it was beaten, now it reared it’s head in the bladder (early detection). There is a new treatment (to me at least) where a fluid is inserted into the bladder, and the patient then goes home, lays down, and rotates every 15 minutes a quarter turn. The patient tries to keep the fluid in for 2 hours, if possible, then expels it. Patient feels like hell for 2 days, then gradually recovers. All was looking good, but then a 2nd set of follow up tests had one negative, and one positive. Yuck.
It is good to see these new, apparently less invasive and more targeted procedures (at least to my untrained eye).
One article … one opinion
Regarding “First,” if a patient with cancer has no insurance coverage then how many specialist doctors are going to be willing to even see the patient?
Also regarding “First,” what I hear you saying is that those specialist doctors will be going out of business because they can’t get paid for their outside the box approach to providing care. Is that what you are saying?
Regarding “Next” all you are describing is the kind of “managed care” that HMOs like Kaiser Permanente have been practicing since World War II. What you appear to be saying is that Kaiser Permanente practices “bad medicine.”
Regarding your third point, which sounds a whole lot like unsubstantiated opinion, what evidence do you have that the statement is true. As a point of comparison has Kaiser Permanente been slow to adopt new technology?
Regarding “Finally,” that “favored constituency” writes off as much as $170 million per year per hospital. In the current broken health care system, Hospitals provide a whole lot more free services (free care) than drug companies provide free services (free drugs). I don’t mean to demonize drug companies, but hospitals provide care to patients … drug companies do not.
Regarding “Obamacare targets,” I can guarantee you that if the drug companies provide actuarial/financial evidence that costs can be reduced then the Gates of Babylon will be opened for them.
The drug companies are the ones who incur the high expense of developing new medicines. They do it willingly because they make very, very substantial profits. I don’t disagree with you about the cumbersomeness of FDA regulations, but they are there to protect the safety of patients. Here is a question for you, “Which is more valuable, (A) the life that is lost due to the fact that he/she dies before a drug gets FDA approval, or (B) the life that is lost because an inadequately tested drug is allowed to come on the market, and subsequently produces adverse reactions?
One opinion, I believe from a doctor.
Matt, you asked for sources, so here is one other.
Survey: Fewer than 1 in 5 better off because of Obamacare; many more worse off
“Eighteen percent of Americans, or fewer than one in five, say they or someone in their family is better off because of the Affordable Care Act, according to a new poll by CNN. Nearly twice that number, 35 percent, say they or someone in their family is worse off. A larger group, 46 percent, say they are about the same after Obamacare as before.”
“..The CNN numbers are basically consistent with other surveys. The most recent Kaiser Family Foundation poll, for example, found that 18 percent said that they or their family were better off because of Obamacare, while 26 percent said they were worse off and 53 percent reported no difference.”
http://washingtonexaminer.com/survey-fewer-than-1-in-5-better-off-because-of-obamacare-many-more-worse-off/article/2551199
Another notable finding from that CNN poll: 40% favor Obamacare. 17% oppose it because it doesn’t go far enough; ie, not liberal enough. So these repeated statements that the public opposes Obamacare are not accurate in their basis. 57% of Americans, per CNN, either favor Obamacare or want something more liberal than Obamacare. Only 38% think it is too liberal.
Spot on, Don.
I don’t disagree with the polls even for a moment. Obamacare is a political compromise that only gets us part way to the fiduciary robustness of the ideal solution … a single payor system where care is provided by the same provider infrastructure that we have now, but the risk pool is not fractured into 50 different state risk pools, and then further fractured into separate insurance companies that waste obscene amounts of money on components of their businesses that do absolutely nothing to advance the delivery of care, like redundant marketing, redundant administration, redundant financial analysis, unnecessary reinsurance, stockholder profits, etc. When I came into healthcare in 1981 the administrative costs were just under 8% of the total healthcare bill. (2% of every dollar was spent on the provision of care. Now the adminstrative costs are between 20% and 25%. That means between 12% and 17% ofe every dollar spent on healthcare in this nation is WASTED!!!! You eliminate all the marketing departments and financial analysis departments and redundant layers of administration … and give those 12 cents to 17 cents of every dollar to the patients in the form of more and better care and the polls you are seeing now would be very different.
Matt,
1. The GAO just ran a test where the majority of fake signees for ACA were able to sign up. Can you name for me a private company that has remained in business with such an abysmal track record?
2. The ACA and its related state websites have cost over $5 Billion, and they still don’t work properly. Can you name for me a private company that has remained in business with such an abysmal track record of rolling out their website?
3. Can you name for me the country or countries which you think we should model our HC system after?
4. Per #3, caan you tell me how long it takes to get an appointment with a GP; and how long it takes to get in to see a specialist?
5. Matt, if the primary purpose was to cover the uninsured, why have we only had a net gain of 2 million new insured? (5% of the claimed uninsured)??
TBD, let me address your points 3. and 4. Regarding 3. there isn’t anything about ACA that is restructuring the Health Care system in the US. Health care providers (Hospitals and doctors) see patients the same way they always have. They start by asking for the patient’s insurance coverage. Then they verify that the coverage is current and valid, and then they schedule the patient’s appointment. So the answer to question 4. is that “it varies by provider.” Last Monday I called up UCD Medical Group to get an appointment with my GP for a healthcare issue that I would characterize as urgent (a golf ball sized mass had appeared overnight between my jawbone and the skin of my cheek). I was told that the earliest appointment slot they had for my GP was 4:45pm on Tuesday. When I responded that I believed my problem was more urgent than that, they transferred be to the triage department where I spoke to a nurse practitioner, who then facilitated an appointment the same day (Monday) with another GP in the UCD Medical Group. Since I am an established patient with them, never once did anyone ask for my insurance information. They had that on file in the computer. The process they went through would have been the same if I had ACA coverage or Medicare coverage or Blue Cross coverage or any other insurance coverage.
What ACA is is a step toward restructuring the incredibly wasteful, duplicative, bureaucratic, cumbersome, fiscally-unsustainable insurance system that provides the payments to the health care providers when they provide services to patients.
Now TBD let me address your points 1. and 2. I worked in the Health Care Information Technology industry for 25 years, so I know more than I want to know about health care information system issues like the ones you have described. They happen each and every day for the thousands of insurance company systems that exist. I visited the University of Florida Medical Group on a business call approximately 10 years ago, and the topic of the day was how and why multiple systems in multiple companies had allowed a $125,000 payment to have been made, accepted, deposited, posted on the patient’s account, and the credit balance written off for a medical procedure that has a standardized payment of $125.00. The insurance company that made the $125,000 payment was one of the nation’s largest, and the University of Florida Medical Group who received, posted and wrote off the $124,875 balance is also one of the country’s largest, and the information systems provider to University of Florida Medical Group was/is the largest company in their industry. All three of those companies are still in business today. Health care providers and health care insurance companies spensd well in excess of $5 billion per year on their information systems and according to a recent survey of company CEOs 87% of them believe the new information systems they have implemented are “a failure.”
Regarding your point 5. TBD, if the 2 million number is correct, then I believe we are 2 million people ahead of where we were before ACA.
LOL Matt, 2,000,000 more but at what cost? We probably could’ve bought them all health insurance policies and saved hundreds of billions of taxpayer money. In fact, do the math at $20,000 per policy with an avg.
of two people per plan, that comes to $20 billion which is a huge savings over the boondoggle in place now.
BP, while acknowledging your point, I think you are looking at this from the glass half empty perspective. Think about the cost that we will avoid when/if we get to a single payer system. No more financial analysts at hospitals crunching the numbers of various insurance company offerings to decide which ones to contract with. No more financial analysts at insurance companies crunching the numbers of various hospital offerings to decide which ones to contract with. No more financial analysts at insurance companies crunching the numbers of various medical services to decide the different amounts that they pay for the same service at each hospital they contract with. No more financial analysts at hospitals crunching the numbers of various medical services to decide whether they are being paid enough by the insurance companies for the service(s) they provide. No more marketing employees at each insurance company trying to differentiate one company from another by dancing on the head of a pin. A substantial proportion of the insurance companies would continue to provide third party administrator (TPA) services to the single payor. The gross redundancy that exists in the current system would be eliminated … increasing efficiency and making the claims submission process for patients infinitely easier to both understand and complete. Bottom-line the whole system would be a streamlined, efficient version of itself. The same doctors practicing at the same hospitals and healthcare plans (e.g. Kaiser, etc.) providing care to the same patients they always have … plus providing care to all the people who couldn’t get care before because they were uninsured. That to me is not a glass half empty. It is a glass that is much more than half full.
Or we could go to Michael Moore’s hospital in Cuba. What a hoot! … I met a Cuban-American who was a General Contractor in Cuba, was a big shot there. He told me horror stories about the typical hospitals there, not Castro’s hospital.
TBD, all the redundancy and waste and inefficiency and bureaucracy that I described is in the part of the system that does not provide care to patients. It is overhead pure and simple. All it does is add cost to a $600 procedure so that its price rises to $1,600, $2,200 or $3,000.
Matt, are you generally suspicious of the free market?
Not suspicious at all. Why do you ask?
Do you consider that $600, $1,200, $2,500, $3,000 scenario you provided as being an example of the free market in action?
The current healthcare system is about as far from being a free market as one can possibly get. With a one payor system for reimbursement, the healthcare marketplace will be much, much closer to a free market than it currently is. The healthcare insurance market will be less so though, but with considerably lower costs because the actuarial computations of risk will be for a massively larger risk pool. Given a choice of a healthcare delivery market that is more free with a healthcare insurance market that is less free vs. a healthcare delivery market that is less free with a healthcare insurance market that is more free, I will take the former rather than the latter 10 times out of 10.
TBD
This one I can answer. In my office, the answer to the the first question is same day for an acute problem and within 7 days for a totally routine issue if the patient is not on the premises, same day if they are. But, I would like to point out that this is not the case in the fee for service private practices in our area which you seem to believe provide “better care”. This is only possible because we have a policy that is virtually unheard of in the fee for service world and that is “todays work today”. It is coupled with another measure which is the patient gets the appointment that the patient wants. This is only possible if you have open, available appointments. Open appointments are anathema in fee for service medicine since that means money that is lost. If the service is prepaid, it really doesn’t matter whether or not every single appointment is filled. What matters is that the patient can get the appointment they want.
Tia, is this Kaiser that you describe? (Please, no need to answer any questions that are private information.) I’ve heard mostly good things about them.
Are there any other HC providers similar to Kaiser? I’ve heard stories about Shriner’s Hospital (??), I think they may not even have a billing system.
A family friend needed a procedure, and she was self-insured. Her specialist quoted her $1600 for moderately simple in-office procedure that would take 45 minutes (incl. lab work). A second quoted $2200. She called UCSF, and it was over $3,000. She then called a rural doctor’s office, and they quoted $600 if she paid with cash. My local mechanics would go out of business with a 400% price difference!
“A family friend needed a procedure, and she was self-insured. Her specialist quoted her $1600 for moderately simple in-office procedure that would take 45 minutes (incl. lab work). A second quoted $2200. She called UCSF, and it was over $3,000. She then called a rural doctor’s office, and they quoted $600 if she paid with cash. My local mechanics would go out of business with a 400% price difference!”
TBD, you have described the fatal problem with the current system perfectly. All of that would go away with a single payor system. There would be one price for all … and there would be no one who is saddled with the burden of being self insured.
Published pricing would work better, I believe. The problem is we have removed the patient from the decision-making process.
The prices are published. Your $600, $1,200, $2,500, $3,000 scenario is clear proof of that.
The problem you reference was created just after World War II when healthcare insurance was broadly adopted and employers began offering healthcare insurance as an employment benefit. Patients have been out of the decision loop ever since.
Matt, we could make it far easier. She had to call around and dig for this, and it was only her gut / guesswork that a rural practice might charge less, that got her the far lower figure.
I agree that it could be much easier. The current system is set up to penalize (to the maximum extent possible) people without insurance, either by denying them care entirely or by charging them exorbitant amounts. Even in your example the difference between $3,000 and $600 doesn’t tell the full story. Blue Cross (or similar insurance company) probably pays no more than $300 for that same service, Medicare pays even less, and Medi-Cal even less than Medicare.
What that system of perverse incentives does is force people like your friend to put off getting treatment when the medical problem is still relatively simple (and inexpensive to treat). Then the medical problem has time to fester and often spawn related problems. When the patient finally does get medical treatment the problem is much more complex and the cost of treatment is much more expensive. A proactive, preventative approach to healthcare is only available to those people who have health insurance.
The way to solve that problem is to make sure that everyone is covered by health insurance … either that, or do away with health insurance altogether, which would be even more disruptive to our economy.
Hi TBD
I missed your question yesterday, but gained some new information in the meantime so perhaps for the best.
Yes, my practice is with Kaiser. I think that it is important to note that I was describing only what occurs in my office. What I learned yesterday is that in my larger department which encompasses the entire North Valley from Davis to Folsom, the wait time for a routine appointment with a patient’s personal gynecologist for a completely routine appointment averages two weeks. A more urgent, but not emergent visit with any available gynecologist is same day. Not bad for a department of 70 gynecologists, but one of the huge advantages of Kaiser, is that we are currently working to improve even those numbers. I know because as a member of our administrative team I spend many hours ( often off the books) in evening meetings finding ways to cut wait times both for appointments and surgeries. We can focus on those areas because we already have gotten the wait time for most office procedures down to the same time as the initial appointment if the patient is willing. This happens because we do not have to wait for any “approval of payment” as Matt was alluding to. The improved efficiency is remarkable and is largely dependent on the elimination of the approval of the “third party” in the room with the patient and doctor, namely the insurance company rep. who actually decides what treatment will be compensated.
I would also like to weigh in on your question to Matt.
“Matt, are you generally suspicious of the free market?”
The free market has nothing to do with how fee for service medicine actually functioned prior to the ACA.
The moment that someone has chosen an insurance carrier ( most often one’s employer, not the actual patient) any “freedom” is lost. What the individual patient loses in this “free market” include but are not limited to the following:
1. The right to chose one’s own doctor. Even in Kaiser you can only chose from
amongst doctors who have chosen to practice within the Kaiser system.
Now imagine under single party payer, the ability to chose any doctor in the
country.
2. The right to chose which medication to take.
Under fee for service, you only get to chose from amongst the medicines on
your insurance’s formulary. In Kaiser we get around this through a number of
exemptions from which a provider can chose if a non formulary medication is
felt ( for medical reasons) to be better for the individual patient. If it is purely
for patient preference, the patient can still have the medication without any
delay. They are just expected to pay the difference.
3. The right to decide which procedure is best for you.
Under the usual fee for service model, once you and your doctor have decided
that you need to have procedure X done, under all but the most emergent
circumstances you have to wait until a non medical worker at your insurance
company decides to approve it. In the Kaiser model, if the procedure is office
based, you can have it done on the spot, or rescheduled if that is your wish.
If it involves surgery, you can be booked to see a specialist who does that
particular procedure within a few days. Now imagine a single party payer
system based upon the Kaiser model of delivery. You and your doc decide to do
procedure X and you get it done same day. No outside approval needed. This
works. I know because I have been doing it for the past 27 years.
4. No free market exists for doctors
The rules of the free market are not allowed to work for doctors. The number
of slots in medical school and and residency training have been held down artificially not by the government, but by doctors themselves for many, many years by the limited access to medical training. If you think that this is primarily to maintain the quality of physicians you would be incorrect. The main reason has been to artificially prop up physician compensation although it may to some limited degree also have helped with quality. My point in including this is to illustrate that this is not “free market” in the same sense that anyone can start a mom and pop type business, but this does not apply to doctors ( thank goodness) thus artificially limiting the supply. Not a free market solution.
5. In a free market, you get told up front how much you are going to pay for what ever it is you are going to buy. In fee for service medicine, you almost never are told the exact cost up front. Thus you have no idea of the actual cost ( worth ) of your procedure unless you really dig for it. Hardly a “free market” practice. And even, if you do manage to figure it out, it isn’t like you can just walk over from Kaiser to Sutter and ask if they have a better deal on procedure “X”. You are locked in by your employers insurance decision.
So let me tell you what I can envision.
1. A single party payer with access to health care by any licensed and appropriately credentialed physician limited only by patient choice.
2. Delivery of this care by the Kaiser or similar model. I believe that the Mayo works similarly. I am not familiar enough with Shriner policy to comment.
3. Completely collaborative practice amongst all physicians without regard to which group your doctor happens to belong to. Within Kaiser, I can refer freely to any specialist the patient and I choose. If my patient’s preference is to be seen as soon as possible and she doesn’t have a preference for one surgeon over another, I can book the first available appointment ( virtually always within a couple of days).
If she has a preference for a particular surgeon, I can chose that option and she may have to wait a little longer. The point is that we decide together with no third party interference. Now let’s suppose that I know that the very best surgeon for the procedure that she needs works with the Sutter group. Imagine how much better it would be if I could consistently be able to refer to the very best. This is the freedom we could achieve under single party payer with Kaiser model delivery.
4. What about the freedom and incentive to innovate.
Within Kaiser, we have without any financial incentive, had as a member of our group a world renowned gyn oncologist and researcher who along with others wrote largely on the basis of Kaiser research the new guidelines for cervical cancer screening.This allow screening to be done every three years rather than yearly, with decreased patient risk. This has led to improved outcomes at much less cost since the woman only needs a visit every third year rather than every year. These are the new nationally and internationally accepted standards.This was largely driven by the work of physicians who received no additional compensation ( just hour for hour pay as usual) and still managed a major innovation and money saver in our field. His motivation….improvement of patient care.
One of our surgeons came up with the idea for the Breast Cancer Stamp as a fund raising mechanism for breast cancer research all based on voluntary purchases of the Breast Cancer stamp. His additional monetary compensation for this “innovation” in funding ? Nothing. His motivation ? Improvement in breast cancer treatment.
These are only two cases of which I am aware in our vast system. I understand that there are similar research projects done in many areas of patient care that are not driven by the innovators desire for more money, which is not allotted in the Kaiser system , but rather by a genuine desire to improve medical outcomes.
So much for the idea that only financial gain will drive innovation.
Now imagine that we encouraged collaboration amongst everyone in the medical field freely. No trade secrets kept so that one could profit individually for personal profit. All studies and findings shared freely and openly to benefit the health of all.
Now there would be unheard of “freedom” to conduct research, benefit from everyone’s work to improve the quality of medical care. It would also do away with the incentive to exaggerate or even falsify ones findings for financial gain. If every
finding were put on the table for the inspection of all, this temptation would melt away.
People who object to “socialized” medicine are missing a few points.
1. What we have had traditionally is not a “free market”
2. Not all “socialized medicine” is the same. We are free to design our own
system choosing best practices wherever they may be found.
3. Systems are not static, a gradual move to elimination of competitive insurance
companies would result in more freedom for the individual patient although
less freedom for the insurance company to manipulate policy to maximize
their own profits, not patient health. If I had the choice of whose “freedom”
I would rather ensure, the patient’s or that of the insurance company, I would
opt for the patient every time.
The ACA will have a horrible effect on serious illness and treatments, like cancer. We’re going backwards.
And your evidence for that opinion is what exactly?
Currently we waste 20-25 cents of every healthcare dollar on non-care costs. With a single payor reimbursement method, we could redirect 15-20 cents of that into care giving and research. A single payor system will result in better treatment, not worse. The numbers simply don’t lie.
If it were only that simple. Its not.
Forbes
How Obamacare Will Harm Cancer Patients
“Obamacare is going to degrade medicine but its ill effects will fall disproportionately on patients with serious conditions, especially those diagnosed with cancer.
“The legislation contains provisions that directly target patients with cancer because their care is perceived as costly. These policies couldn’t be more badly timed.”
“…First, Obamacare is going to block the ability of patients to seek out the specialist doctors who are most likely to prescribe these cutting edge treatments…”
“…Next, Obamacare tries to coerce doctors to cut down on their use of costlier drugs and tests by changing the way that they’re paid. The law uses “bundled” payments, where doctors get lump sums of money to care for patients with particular medical problems. The idea is to pit the cost of the treatments doctors prescribe directly against their earnings and give doctors a potent incentive to use cheaper remedies.”
“…But these schemes will slow adoption of new technology.”
“…Finally, Obamacare targets cancer drugs directly, by expanding a program called 340B, which siphons money away from drug developers in order to subsidize hospitals. The Obama Administration sees the program as a way to prop up the hospitals (a favored constituency) on the dime of less popular drug makers. But the oblique way the money is extracted from drug companies spawns a lot of harmful consequences that are increasing the cost of cancer care, and lowering its quality.”
“…Obamacare targets cancer drugs because they are pricey. But the fact is that spending on cancer medicines offsets other costs.”
“…None of the Obamacare policies lower the actual cost of the drugs. We should be addressing the high expense of developing these medicines, where enrolling a single cancer patient into a clinical trial can top $90,000 owing to FDA regulations.”
http://www.forbes.com/sites/scottgottlieb/2013/08/21/how-obamacare-will-harm-cancer-patients/
TBD
I think that you left out one important paragraph of the Gottlieb article.
“Insurers are barred from using the other tools that they’ve traditionally employed to keep the costs of policies in check: cost sharing, underwriting risk, adjusting premiums and benefits. The only thing that health plans are permitted to do under Obamacare is narrow the networks of providers that they contract with.”
There are two important points that he does not include in his analysis. He forgot to mention some of the other very important “tools to keep the cost of the policies in check”
such as denial of benefits once a very expensive diagnosis was made and not insuring those with pre existing conditions. Those two strategies were great for holding costs in check…but not so great if you were a cancer patient.
The other thing that Gottlieb fails to mention is that this is only having this effect in the fee for service model. In Kaiser, as I have pointed out, using a collaborative instead of a competitive model, we are actively hiring up, not narrowing our network. We have an advantage in getting a patient with a high cost diagnosis such as cancer to the correct level of advanced care as quickly as possible including to the best specialists whom we have been able to attract by allowing them to practice freely without the constraints of insurance companies and encouraging them to participate in research.
Do you think the article made some relevant points?
I have a loved one who is fighting cancer. It started as prostate cancer; we thought it was beaten, now it reared it’s head in the bladder (early detection). There is a new treatment (to me at least) where a fluid is inserted into the bladder, and the patient then goes home, lays down, and rotates every 15 minutes a quarter turn. The patient tries to keep the fluid in for 2 hours, if possible, then expels it. Patient feels like hell for 2 days, then gradually recovers. All was looking good, but then a 2nd set of follow up tests had one negative, and one positive. Yuck.
It is good to see these new, apparently less invasive and more targeted procedures (at least to my untrained eye).
One article … one opinion
Regarding “First,” if a patient with cancer has no insurance coverage then how many specialist doctors are going to be willing to even see the patient?
Also regarding “First,” what I hear you saying is that those specialist doctors will be going out of business because they can’t get paid for their outside the box approach to providing care. Is that what you are saying?
Regarding “Next” all you are describing is the kind of “managed care” that HMOs like Kaiser Permanente have been practicing since World War II. What you appear to be saying is that Kaiser Permanente practices “bad medicine.”
Regarding your third point, which sounds a whole lot like unsubstantiated opinion, what evidence do you have that the statement is true. As a point of comparison has Kaiser Permanente been slow to adopt new technology?
Regarding “Finally,” that “favored constituency” writes off as much as $170 million per year per hospital. In the current broken health care system, Hospitals provide a whole lot more free services (free care) than drug companies provide free services (free drugs). I don’t mean to demonize drug companies, but hospitals provide care to patients … drug companies do not.
Regarding “Obamacare targets,” I can guarantee you that if the drug companies provide actuarial/financial evidence that costs can be reduced then the Gates of Babylon will be opened for them.
The drug companies are the ones who incur the high expense of developing new medicines. They do it willingly because they make very, very substantial profits. I don’t disagree with you about the cumbersomeness of FDA regulations, but they are there to protect the safety of patients. Here is a question for you, “Which is more valuable, (A) the life that is lost due to the fact that he/she dies before a drug gets FDA approval, or (B) the life that is lost because an inadequately tested drug is allowed to come on the market, and subsequently produces adverse reactions?
One opinion, I believe from a doctor.
Matt, you asked for sources, so here is one other.
Survey: Fewer than 1 in 5 better off because of Obamacare; many more worse off
“Eighteen percent of Americans, or fewer than one in five, say they or someone in their family is better off because of the Affordable Care Act, according to a new poll by CNN. Nearly twice that number, 35 percent, say they or someone in their family is worse off. A larger group, 46 percent, say they are about the same after Obamacare as before.”
“..The CNN numbers are basically consistent with other surveys. The most recent Kaiser Family Foundation poll, for example, found that 18 percent said that they or their family were better off because of Obamacare, while 26 percent said they were worse off and 53 percent reported no difference.”
http://washingtonexaminer.com/survey-fewer-than-1-in-5-better-off-because-of-obamacare-many-more-worse-off/article/2551199
Another notable finding from that CNN poll: 40% favor Obamacare. 17% oppose it because it doesn’t go far enough; ie, not liberal enough. So these repeated statements that the public opposes Obamacare are not accurate in their basis. 57% of Americans, per CNN, either favor Obamacare or want something more liberal than Obamacare. Only 38% think it is too liberal.
Spot on, Don.
I don’t disagree with the polls even for a moment. Obamacare is a political compromise that only gets us part way to the fiduciary robustness of the ideal solution … a single payor system where care is provided by the same provider infrastructure that we have now, but the risk pool is not fractured into 50 different state risk pools, and then further fractured into separate insurance companies that waste obscene amounts of money on components of their businesses that do absolutely nothing to advance the delivery of care, like redundant marketing, redundant administration, redundant financial analysis, unnecessary reinsurance, stockholder profits, etc. When I came into healthcare in 1981 the administrative costs were just under 8% of the total healthcare bill. (2% of every dollar was spent on the provision of care. Now the adminstrative costs are between 20% and 25%. That means between 12% and 17% ofe every dollar spent on healthcare in this nation is WASTED!!!! You eliminate all the marketing departments and financial analysis departments and redundant layers of administration … and give those 12 cents to 17 cents of every dollar to the patients in the form of more and better care and the polls you are seeing now would be very different.
Matt,
1. The GAO just ran a test where the majority of fake signees for ACA were able to sign up. Can you name for me a private company that has remained in business with such an abysmal track record?
2. The ACA and its related state websites have cost over $5 Billion, and they still don’t work properly. Can you name for me a private company that has remained in business with such an abysmal track record of rolling out their website?
3. Can you name for me the country or countries which you think we should model our HC system after?
4. Per #3, caan you tell me how long it takes to get an appointment with a GP; and how long it takes to get in to see a specialist?
5. Matt, if the primary purpose was to cover the uninsured, why have we only had a net gain of 2 million new insured? (5% of the claimed uninsured)??
TBD, let me address your points 3. and 4. Regarding 3. there isn’t anything about ACA that is restructuring the Health Care system in the US. Health care providers (Hospitals and doctors) see patients the same way they always have. They start by asking for the patient’s insurance coverage. Then they verify that the coverage is current and valid, and then they schedule the patient’s appointment. So the answer to question 4. is that “it varies by provider.” Last Monday I called up UCD Medical Group to get an appointment with my GP for a healthcare issue that I would characterize as urgent (a golf ball sized mass had appeared overnight between my jawbone and the skin of my cheek). I was told that the earliest appointment slot they had for my GP was 4:45pm on Tuesday. When I responded that I believed my problem was more urgent than that, they transferred be to the triage department where I spoke to a nurse practitioner, who then facilitated an appointment the same day (Monday) with another GP in the UCD Medical Group. Since I am an established patient with them, never once did anyone ask for my insurance information. They had that on file in the computer. The process they went through would have been the same if I had ACA coverage or Medicare coverage or Blue Cross coverage or any other insurance coverage.
What ACA is is a step toward restructuring the incredibly wasteful, duplicative, bureaucratic, cumbersome, fiscally-unsustainable insurance system that provides the payments to the health care providers when they provide services to patients.
Now TBD let me address your points 1. and 2. I worked in the Health Care Information Technology industry for 25 years, so I know more than I want to know about health care information system issues like the ones you have described. They happen each and every day for the thousands of insurance company systems that exist. I visited the University of Florida Medical Group on a business call approximately 10 years ago, and the topic of the day was how and why multiple systems in multiple companies had allowed a $125,000 payment to have been made, accepted, deposited, posted on the patient’s account, and the credit balance written off for a medical procedure that has a standardized payment of $125.00. The insurance company that made the $125,000 payment was one of the nation’s largest, and the University of Florida Medical Group who received, posted and wrote off the $124,875 balance is also one of the country’s largest, and the information systems provider to University of Florida Medical Group was/is the largest company in their industry. All three of those companies are still in business today. Health care providers and health care insurance companies spensd well in excess of $5 billion per year on their information systems and according to a recent survey of company CEOs 87% of them believe the new information systems they have implemented are “a failure.”
Regarding your point 5. TBD, if the 2 million number is correct, then I believe we are 2 million people ahead of where we were before ACA.
LOL Matt, 2,000,000 more but at what cost? We probably could’ve bought them all health insurance policies and saved hundreds of billions of taxpayer money. In fact, do the math at $20,000 per policy with an avg.
of two people per plan, that comes to $20 billion which is a huge savings over the boondoggle in place now.
BP, while acknowledging your point, I think you are looking at this from the glass half empty perspective. Think about the cost that we will avoid when/if we get to a single payer system. No more financial analysts at hospitals crunching the numbers of various insurance company offerings to decide which ones to contract with. No more financial analysts at insurance companies crunching the numbers of various hospital offerings to decide which ones to contract with. No more financial analysts at insurance companies crunching the numbers of various medical services to decide the different amounts that they pay for the same service at each hospital they contract with. No more financial analysts at hospitals crunching the numbers of various medical services to decide whether they are being paid enough by the insurance companies for the service(s) they provide. No more marketing employees at each insurance company trying to differentiate one company from another by dancing on the head of a pin. A substantial proportion of the insurance companies would continue to provide third party administrator (TPA) services to the single payor. The gross redundancy that exists in the current system would be eliminated … increasing efficiency and making the claims submission process for patients infinitely easier to both understand and complete. Bottom-line the whole system would be a streamlined, efficient version of itself. The same doctors practicing at the same hospitals and healthcare plans (e.g. Kaiser, etc.) providing care to the same patients they always have … plus providing care to all the people who couldn’t get care before because they were uninsured. That to me is not a glass half empty. It is a glass that is much more than half full.
Or we could go to Michael Moore’s hospital in Cuba. What a hoot! … I met a Cuban-American who was a General Contractor in Cuba, was a big shot there. He told me horror stories about the typical hospitals there, not Castro’s hospital.
TBD, all the redundancy and waste and inefficiency and bureaucracy that I described is in the part of the system that does not provide care to patients. It is overhead pure and simple. All it does is add cost to a $600 procedure so that its price rises to $1,600, $2,200 or $3,000.
Matt, are you generally suspicious of the free market?
Not suspicious at all. Why do you ask?
Do you consider that $600, $1,200, $2,500, $3,000 scenario you provided as being an example of the free market in action?
The current healthcare system is about as far from being a free market as one can possibly get. With a one payor system for reimbursement, the healthcare marketplace will be much, much closer to a free market than it currently is. The healthcare insurance market will be less so though, but with considerably lower costs because the actuarial computations of risk will be for a massively larger risk pool. Given a choice of a healthcare delivery market that is more free with a healthcare insurance market that is less free vs. a healthcare delivery market that is less free with a healthcare insurance market that is more free, I will take the former rather than the latter 10 times out of 10.
TBD
This one I can answer. In my office, the answer to the the first question is same day for an acute problem and within 7 days for a totally routine issue if the patient is not on the premises, same day if they are. But, I would like to point out that this is not the case in the fee for service private practices in our area which you seem to believe provide “better care”. This is only possible because we have a policy that is virtually unheard of in the fee for service world and that is “todays work today”. It is coupled with another measure which is the patient gets the appointment that the patient wants. This is only possible if you have open, available appointments. Open appointments are anathema in fee for service medicine since that means money that is lost. If the service is prepaid, it really doesn’t matter whether or not every single appointment is filled. What matters is that the patient can get the appointment they want.
Tia, is this Kaiser that you describe? (Please, no need to answer any questions that are private information.) I’ve heard mostly good things about them.
Are there any other HC providers similar to Kaiser? I’ve heard stories about Shriner’s Hospital (??), I think they may not even have a billing system.
A family friend needed a procedure, and she was self-insured. Her specialist quoted her $1600 for moderately simple in-office procedure that would take 45 minutes (incl. lab work). A second quoted $2200. She called UCSF, and it was over $3,000. She then called a rural doctor’s office, and they quoted $600 if she paid with cash. My local mechanics would go out of business with a 400% price difference!
“A family friend needed a procedure, and she was self-insured. Her specialist quoted her $1600 for moderately simple in-office procedure that would take 45 minutes (incl. lab work). A second quoted $2200. She called UCSF, and it was over $3,000. She then called a rural doctor’s office, and they quoted $600 if she paid with cash. My local mechanics would go out of business with a 400% price difference!”
TBD, you have described the fatal problem with the current system perfectly. All of that would go away with a single payor system. There would be one price for all … and there would be no one who is saddled with the burden of being self insured.
Published pricing would work better, I believe. The problem is we have removed the patient from the decision-making process.
The prices are published. Your $600, $1,200, $2,500, $3,000 scenario is clear proof of that.
The problem you reference was created just after World War II when healthcare insurance was broadly adopted and employers began offering healthcare insurance as an employment benefit. Patients have been out of the decision loop ever since.
Matt, we could make it far easier. She had to call around and dig for this, and it was only her gut / guesswork that a rural practice might charge less, that got her the far lower figure.
I agree that it could be much easier. The current system is set up to penalize (to the maximum extent possible) people without insurance, either by denying them care entirely or by charging them exorbitant amounts. Even in your example the difference between $3,000 and $600 doesn’t tell the full story. Blue Cross (or similar insurance company) probably pays no more than $300 for that same service, Medicare pays even less, and Medi-Cal even less than Medicare.
What that system of perverse incentives does is force people like your friend to put off getting treatment when the medical problem is still relatively simple (and inexpensive to treat). Then the medical problem has time to fester and often spawn related problems. When the patient finally does get medical treatment the problem is much more complex and the cost of treatment is much more expensive. A proactive, preventative approach to healthcare is only available to those people who have health insurance.
The way to solve that problem is to make sure that everyone is covered by health insurance … either that, or do away with health insurance altogether, which would be even more disruptive to our economy.
Hi TBD
I missed your question yesterday, but gained some new information in the meantime so perhaps for the best.
Yes, my practice is with Kaiser. I think that it is important to note that I was describing only what occurs in my office. What I learned yesterday is that in my larger department which encompasses the entire North Valley from Davis to Folsom, the wait time for a routine appointment with a patient’s personal gynecologist for a completely routine appointment averages two weeks. A more urgent, but not emergent visit with any available gynecologist is same day. Not bad for a department of 70 gynecologists, but one of the huge advantages of Kaiser, is that we are currently working to improve even those numbers. I know because as a member of our administrative team I spend many hours ( often off the books) in evening meetings finding ways to cut wait times both for appointments and surgeries. We can focus on those areas because we already have gotten the wait time for most office procedures down to the same time as the initial appointment if the patient is willing. This happens because we do not have to wait for any “approval of payment” as Matt was alluding to. The improved efficiency is remarkable and is largely dependent on the elimination of the approval of the “third party” in the room with the patient and doctor, namely the insurance company rep. who actually decides what treatment will be compensated.
I would also like to weigh in on your question to Matt.
“Matt, are you generally suspicious of the free market?”
The free market has nothing to do with how fee for service medicine actually functioned prior to the ACA.
The moment that someone has chosen an insurance carrier ( most often one’s employer, not the actual patient) any “freedom” is lost. What the individual patient loses in this “free market” include but are not limited to the following:
1. The right to chose one’s own doctor. Even in Kaiser you can only chose from
amongst doctors who have chosen to practice within the Kaiser system.
Now imagine under single party payer, the ability to chose any doctor in the
country.
2. The right to chose which medication to take.
Under fee for service, you only get to chose from amongst the medicines on
your insurance’s formulary. In Kaiser we get around this through a number of
exemptions from which a provider can chose if a non formulary medication is
felt ( for medical reasons) to be better for the individual patient. If it is purely
for patient preference, the patient can still have the medication without any
delay. They are just expected to pay the difference.
3. The right to decide which procedure is best for you.
Under the usual fee for service model, once you and your doctor have decided
that you need to have procedure X done, under all but the most emergent
circumstances you have to wait until a non medical worker at your insurance
company decides to approve it. In the Kaiser model, if the procedure is office
based, you can have it done on the spot, or rescheduled if that is your wish.
If it involves surgery, you can be booked to see a specialist who does that
particular procedure within a few days. Now imagine a single party payer
system based upon the Kaiser model of delivery. You and your doc decide to do
procedure X and you get it done same day. No outside approval needed. This
works. I know because I have been doing it for the past 27 years.
4. No free market exists for doctors
The rules of the free market are not allowed to work for doctors. The number
of slots in medical school and and residency training have been held down artificially not by the government, but by doctors themselves for many, many years by the limited access to medical training. If you think that this is primarily to maintain the quality of physicians you would be incorrect. The main reason has been to artificially prop up physician compensation although it may to some limited degree also have helped with quality. My point in including this is to illustrate that this is not “free market” in the same sense that anyone can start a mom and pop type business, but this does not apply to doctors ( thank goodness) thus artificially limiting the supply. Not a free market solution.
5. In a free market, you get told up front how much you are going to pay for what ever it is you are going to buy. In fee for service medicine, you almost never are told the exact cost up front. Thus you have no idea of the actual cost ( worth ) of your procedure unless you really dig for it. Hardly a “free market” practice. And even, if you do manage to figure it out, it isn’t like you can just walk over from Kaiser to Sutter and ask if they have a better deal on procedure “X”. You are locked in by your employers insurance decision.
So let me tell you what I can envision.
1. A single party payer with access to health care by any licensed and appropriately credentialed physician limited only by patient choice.
2. Delivery of this care by the Kaiser or similar model. I believe that the Mayo works similarly. I am not familiar enough with Shriner policy to comment.
3. Completely collaborative practice amongst all physicians without regard to which group your doctor happens to belong to. Within Kaiser, I can refer freely to any specialist the patient and I choose. If my patient’s preference is to be seen as soon as possible and she doesn’t have a preference for one surgeon over another, I can book the first available appointment ( virtually always within a couple of days).
If she has a preference for a particular surgeon, I can chose that option and she may have to wait a little longer. The point is that we decide together with no third party interference. Now let’s suppose that I know that the very best surgeon for the procedure that she needs works with the Sutter group. Imagine how much better it would be if I could consistently be able to refer to the very best. This is the freedom we could achieve under single party payer with Kaiser model delivery.
4. What about the freedom and incentive to innovate.
Within Kaiser, we have without any financial incentive, had as a member of our group a world renowned gyn oncologist and researcher who along with others wrote largely on the basis of Kaiser research the new guidelines for cervical cancer screening.This allow screening to be done every three years rather than yearly, with decreased patient risk. This has led to improved outcomes at much less cost since the woman only needs a visit every third year rather than every year. These are the new nationally and internationally accepted standards.This was largely driven by the work of physicians who received no additional compensation ( just hour for hour pay as usual) and still managed a major innovation and money saver in our field. His motivation….improvement of patient care.
One of our surgeons came up with the idea for the Breast Cancer Stamp as a fund raising mechanism for breast cancer research all based on voluntary purchases of the Breast Cancer stamp. His additional monetary compensation for this “innovation” in funding ? Nothing. His motivation ? Improvement in breast cancer treatment.
These are only two cases of which I am aware in our vast system. I understand that there are similar research projects done in many areas of patient care that are not driven by the innovators desire for more money, which is not allotted in the Kaiser system , but rather by a genuine desire to improve medical outcomes.
So much for the idea that only financial gain will drive innovation.
Now imagine that we encouraged collaboration amongst everyone in the medical field freely. No trade secrets kept so that one could profit individually for personal profit. All studies and findings shared freely and openly to benefit the health of all.
Now there would be unheard of “freedom” to conduct research, benefit from everyone’s work to improve the quality of medical care. It would also do away with the incentive to exaggerate or even falsify ones findings for financial gain. If every
finding were put on the table for the inspection of all, this temptation would melt away.
People who object to “socialized” medicine are missing a few points.
1. What we have had traditionally is not a “free market”
2. Not all “socialized medicine” is the same. We are free to design our own
system choosing best practices wherever they may be found.
3. Systems are not static, a gradual move to elimination of competitive insurance
companies would result in more freedom for the individual patient although
less freedom for the insurance company to manipulate policy to maximize
their own profits, not patient health. If I had the choice of whose “freedom”
I would rather ensure, the patient’s or that of the insurance company, I would
opt for the patient every time.
Anyone ever wonder about the cost per Obamacare enrollee? Here’s an article that says each new enrollee will cost taxpayers $100,000 each and that doesn’t cover the insurance, just the cost of getting new enrollees. What a waste.
“This is going to blow your mind, people. If just calculated based on what the “Affordable Care Act” is projected to cost Americans over a decade – now $1.3 trillion, that comes to a whopping $100,000 per new insurance enrollee.
This $100,000 per enrollee is not what the newly insured are paying for premiums, this is what the government is spending so the newly insured will get onto healthcare and pay their premiums.”
It must be Sarah Palin’s fault sincce I’m not aloowed to say anything bad about Obama on here.
http://www.ijreview.com/2014/04/131910-much-obamacare-costs-taxpayers-10-years-newly-insured-american-will-blow-mind/
BP, do you believe everything you read on the Internet? Let’s put that bunch of hokum to the test. In one year alone, one hospital in Sacramento wrote off $170 million of free care provided to the uninsured. Multiply that by 10 years (the decade time span referenced in the article) and one hospital’s write-off costs in one city are $1.7 billion.
Matt wrote:
> In one year alone, one hospital in Sacramento wrote off $170 million
> of free care provided to the uninsured.
I have a friend that works in the finance department of a major “not for profit” health care company. They way they are a “not for profit” is that they inflate the cost of “free” care to equal the cost of “profit” every year…
South of Davis
Your comment demonstrates that “cheating” to one’s own advantage is not limited to people “scamming the system” as TBD was alluding to with the anecdote about the number of people filing and having fictitious applications accepted.
To me this illustrates the need for oversight and checks and balances, not only on the government, but also on private for profit companies and non profits. The temptation to take advantage through exaggeration, misrepresentation and sometimes outright fraud would seem to be common place. I don’t think that we are likely to get beyond this until we stop elevating material wealth to the highest good in our society.
Tia wrote:
> I don’t think that we are likely to get beyond this until we stop
> elevating material wealth to the highest good in our society.
Who are the “We” that are “elevating material wealth to the highest good in our society” (does Gordon Gekko speak for America?).
I don’t want Tia to name any names, but I can’t name a single person in Town that I know who “elevates material wealth to the highest good”.
Tia seems to bash the right wing bible thumping Republicans often, but needs to remember if they wanted more “material wealth” they would not be spending time (unpaid) in church or abortion clinic protests when they could be earning money or shopping…
“Tia seems to bash the right wing bible thumping Republicans often, but needs to remember if they wanted more “material wealth” they would not be spending time (unpaid) in church or abortion clinic protests when they could be earning money or shopping.“
SoD, when I read your point above I was reminded of a quotation in Jared Diamond’s “Guns, Germs and Steel” which goes as follows:
The difference between the actions you describe that are “earning money and shopping” is that they are not fanatical. On the other hand the actions you describe that are “spending unpaid time in church or abortion clinic protests” is that they are almost always religious in nature, and quite often fanatical.
SoD, in order to comply with Medicare law, hospitals must charge every patient regardless of coverage the exact same charge amount for each unique service. Your statement that the health care company inflates the cost of “free” care to a level that is different than “not free” care is a gross violation of the law, which will result in jail time for the health care company’s executives.
Matt wrote:
> hospitals must charge every patient regardless of coverage
> the exact same charge amount for each unique service.
If Matt thinks hospitals “charge every patient regardless of coverage
the exact same charge amount for each unique service” he is so out of touch I don’t even know where to start.
I Googled Do hospitals charge everyone the same price and got 67 MILLION hits, the first link from the Huffington Post said:
“When a patient arrives at Bayonne Hospital Center in New Jersey requiring treatment for the respiratory ailment known as COPD, or chronic obstructive pulmonary disease, she faces an official price tag of $99,690. Less than 30 miles away in the Bronx, N.Y., the Lincoln Medical and Mental Health Center charges only $7,044 for the same treatment, according to a massive federal database of national health care costs made public on Wednesday.”
P.S. If Matt wants to get back to reality he should will call 5 hospitals to see if he gets the “exact same charge amount” when he tells them he needs to get a knee replaced…
Another major topic we haven’t even addressed … cheating the system, combined with a flawed system.
Washington Post
Federal undercover investigation signs up fake applicants for ACA coverage, subsidies
“In undercover tests of the new federal health insurance marketplace, government investigators have been able to procure health plans and federal subsidies for fake applicants with fictitious documents, according to findings that will be disclosed to lawmakers Wednesday.”
“…All but one of the fake applicants ended up getting subsidized coverage — and have kept it. In one instance, an application was denied but then approved on a second try. In six other attempts to sign up fake applicants via in-person assisters, just one assister accurately told an investigator that the applicant’s income was too high for a subsidy.”
http://www.washingtonpost.com/national/health-science/federal-undercover-investigation-signs-up-fake-applicants-for-aca-coverage-subsidies/2014/07/22/743a04fa-11ce-11e4-9285-4243a40ddc97_story.html
Anyone ever wonder about the cost per Obamacare enrollee? Here’s an article that says each new enrollee will cost taxpayers $100,000 each and that doesn’t cover the insurance, just the cost of getting new enrollees. What a waste.
“This is going to blow your mind, people. If just calculated based on what the “Affordable Care Act” is projected to cost Americans over a decade – now $1.3 trillion, that comes to a whopping $100,000 per new insurance enrollee.
This $100,000 per enrollee is not what the newly insured are paying for premiums, this is what the government is spending so the newly insured will get onto healthcare and pay their premiums.”
It must be Sarah Palin’s fault sincce I’m not aloowed to say anything bad about Obama on here.
http://www.ijreview.com/2014/04/131910-much-obamacare-costs-taxpayers-10-years-newly-insured-american-will-blow-mind/
BP, do you believe everything you read on the Internet? Let’s put that bunch of hokum to the test. In one year alone, one hospital in Sacramento wrote off $170 million of free care provided to the uninsured. Multiply that by 10 years (the decade time span referenced in the article) and one hospital’s write-off costs in one city are $1.7 billion.
Matt wrote:
> In one year alone, one hospital in Sacramento wrote off $170 million
> of free care provided to the uninsured.
I have a friend that works in the finance department of a major “not for profit” health care company. They way they are a “not for profit” is that they inflate the cost of “free” care to equal the cost of “profit” every year…
South of Davis
Your comment demonstrates that “cheating” to one’s own advantage is not limited to people “scamming the system” as TBD was alluding to with the anecdote about the number of people filing and having fictitious applications accepted.
To me this illustrates the need for oversight and checks and balances, not only on the government, but also on private for profit companies and non profits. The temptation to take advantage through exaggeration, misrepresentation and sometimes outright fraud would seem to be common place. I don’t think that we are likely to get beyond this until we stop elevating material wealth to the highest good in our society.
Tia wrote:
> I don’t think that we are likely to get beyond this until we stop
> elevating material wealth to the highest good in our society.
Who are the “We” that are “elevating material wealth to the highest good in our society” (does Gordon Gekko speak for America?).
I don’t want Tia to name any names, but I can’t name a single person in Town that I know who “elevates material wealth to the highest good”.
Tia seems to bash the right wing bible thumping Republicans often, but needs to remember if they wanted more “material wealth” they would not be spending time (unpaid) in church or abortion clinic protests when they could be earning money or shopping…
“Tia seems to bash the right wing bible thumping Republicans often, but needs to remember if they wanted more “material wealth” they would not be spending time (unpaid) in church or abortion clinic protests when they could be earning money or shopping.“
SoD, when I read your point above I was reminded of a quotation in Jared Diamond’s “Guns, Germs and Steel” which goes as follows:
The difference between the actions you describe that are “earning money and shopping” is that they are not fanatical. On the other hand the actions you describe that are “spending unpaid time in church or abortion clinic protests” is that they are almost always religious in nature, and quite often fanatical.
SoD, in order to comply with Medicare law, hospitals must charge every patient regardless of coverage the exact same charge amount for each unique service. Your statement that the health care company inflates the cost of “free” care to a level that is different than “not free” care is a gross violation of the law, which will result in jail time for the health care company’s executives.
Matt wrote:
> hospitals must charge every patient regardless of coverage
> the exact same charge amount for each unique service.
If Matt thinks hospitals “charge every patient regardless of coverage
the exact same charge amount for each unique service” he is so out of touch I don’t even know where to start.
I Googled Do hospitals charge everyone the same price and got 67 MILLION hits, the first link from the Huffington Post said:
“When a patient arrives at Bayonne Hospital Center in New Jersey requiring treatment for the respiratory ailment known as COPD, or chronic obstructive pulmonary disease, she faces an official price tag of $99,690. Less than 30 miles away in the Bronx, N.Y., the Lincoln Medical and Mental Health Center charges only $7,044 for the same treatment, according to a massive federal database of national health care costs made public on Wednesday.”
P.S. If Matt wants to get back to reality he should will call 5 hospitals to see if he gets the “exact same charge amount” when he tells them he needs to get a knee replaced…
Another major topic we haven’t even addressed … cheating the system, combined with a flawed system.
Washington Post
Federal undercover investigation signs up fake applicants for ACA coverage, subsidies
“In undercover tests of the new federal health insurance marketplace, government investigators have been able to procure health plans and federal subsidies for fake applicants with fictitious documents, according to findings that will be disclosed to lawmakers Wednesday.”
“…All but one of the fake applicants ended up getting subsidized coverage — and have kept it. In one instance, an application was denied but then approved on a second try. In six other attempts to sign up fake applicants via in-person assisters, just one assister accurately told an investigator that the applicant’s income was too high for a subsidy.”
http://www.washingtonpost.com/national/health-science/federal-undercover-investigation-signs-up-fake-applicants-for-aca-coverage-subsidies/2014/07/22/743a04fa-11ce-11e4-9285-4243a40ddc97_story.html
Frankly
“If there are no alternatives and the lack of alternatives and or choice would cause material harm to the employee”
This is exactly the situation that I have been describing for the medical ( not contraceptive) use of the Mirena
IUD that you are repeatedly choosing to ignore. I have had many, not a few, patient’s for whom this is the only successful management option for their heavy bleeding. Are you really going to claim this is not the case….or that being anemic and missing work because of it do not constitute material harm ?
Frankly
“If there are no alternatives and the lack of alternatives and or choice would cause material harm to the employee”
This is exactly the situation that I have been describing for the medical ( not contraceptive) use of the Mirena
IUD that you are repeatedly choosing to ignore. I have had many, not a few, patient’s for whom this is the only successful management option for their heavy bleeding. Are you really going to claim this is not the case….or that being anemic and missing work because of it do not constitute material harm ?
“Yes, I would love to post an occasional article on some ripe topics that I know the Vanguard would never touch.”
So why don’t you write an article, send it to David and see whether or not he posts it. When I sent him my first article, I had no idea whether or not he would post it. I for one would love to hear some new voices not only on posts, but generating articles.
If you don’t want your name used, why not consider just letting David or Matt know your identity and see if David will accept that as criteria for posting your article.
Alternatively, you could consider using your real name, and limiting your comments to actual information not including diatribes if you fear some sort of retaliation.
I think some folks are afraid to post or write because they are afraid that they will be criticized. My thought is ….so what if you are ? If Mr. Toad or any one else for that matter wants to get personal, why should it matter to me ? My voice is not for them if they think I am a hypocrite or whatever other name they are tossing around that day. My voice is for those who are open minded enough to consider a point of view that they might not have considered before.
Two thumbs up Tia. If BP wants to give me a call from a pay phone to protect his anonymity, then he can call me at 530-297-6237. Just don’t call collect BP. That isn’t practical.
The reason I choose to stay anonymous is because my wife is a teacher who is married to a conservative in a very liberal town. Who knows how many Vanguard posters or readers she might have as parents in her class? We all know how un-open minded some of you liberals can be so it’s best for her if I stay anonymous, she doesn’t need the aggravation. Matt, I’ll email David my story using Barack Palin as my name and we’ll see if David posts it.
Great, I look forward to it being the first of many.
I hope they print it. I once got a death threat on my telephone for simply stating and supporting conservative beliefs.
Thirty years ago I would have wondered if you were a bit of a nut. But then Sarah Palins grandpa-next door was audited over, and over again, after she entered the world stage. Then world-renowned neonatal surgeon Dr. Ben Carson spoke at the White House Prayer Breakfast, 10 feet away from Obama … and he has similarly undergone a protology exame by Uncle Sam year after year.
Tia, have you seen the Ben Carson Story staring Cuba Gooding Jr.? The mini documentary on youtube is also inspiring.
TBD
No, but you have definitely raised my interest.
I knew zippo about him until that prayer breakfast, then I gobbled up what I could find.
Wikipedia: “Dr. Carson was a professor of neurosurgery, oncology, plastic surgery, and pediatrics, and he was the director of pediatric neurosurgery at Johns Hopkins Hospital.[3] At age 33, he became the youngest major division director in Johns Hopkins history, as director of pediatric neurosurgery. He was also a co-director of the Johns Hopkins Craniofacial Center.”
“According to Johns Hopkins Hospital literature, “Dr. Carson focuses on traumatic brain injuries, brain and spinal cord tumors, achondroplasia, neurological and congenital disorders, craniosynostosis, epilepsy, and trigeminal neuralgia. He is also interested in maximizing the intellectual potential of every child.”[3]”
In a 22-hour operation, he became the first doctor to successfully separate conjoined twins joined at the head. “Carson figured in the revival of the hemispherectomy, a drastic surgical procedure in which part or all of one hemisphere of the brain is removed to control severe pediatric epilepsy.”
Some hope he runs for President, and he is fond of noting that a number of doctors signed the Declaration of Independence.
Barack: I have to think long and hard about whether I will print an article under a pseudonym byline. When Jeff Boone asked to do some pieces, I asked him to do it under his real name. So it’s not that I would censor your ideas. I’ll have to take it to the editorial board and see what they think. One way around that I suppose, could be that you simply send me your piece and I publish it under my name, stating, a reader sent us this story but asked that his/ her name remain anonymous.
David
As a member of your editorial board, I see your last proposal as a very good compromise. Another possibility would be to consider allowing BP ( or anyone) to post using their pseudonym as
long as they were willing to include a brief “about BP”
providing some background so that the readers will have some kind of reference point to understand what is informing the authors comments.
What say you BP ?
My personal thoughts are that pen names are used in publishing on a regular basis. BP will be submitting the article knowing that it will be reviewed by the Publisher (David) and the Editorial Board. Creating a bio for his pen name will give the readers an answer to the question “Why?” BP regularly informs us of the provenance of his beliefs. The bio won’t be anything that hasn’t been said before, but for the new reader it will set the stage.
Matt
Very much what I was thinking.
David, let me know what you and your editorial staff decide. I’m not going to go to the trouble of writing an article just to have it turned down for whatever reason by you and your minions.
We’re not going to turn it down, we have two ways forward.
I concur. Get writing BP. We will settle for nothing less than at least one article a week. 8>)
“Yes, I would love to post an occasional article on some ripe topics that I know the Vanguard would never touch.”
So why don’t you write an article, send it to David and see whether or not he posts it. When I sent him my first article, I had no idea whether or not he would post it. I for one would love to hear some new voices not only on posts, but generating articles.
If you don’t want your name used, why not consider just letting David or Matt know your identity and see if David will accept that as criteria for posting your article.
Alternatively, you could consider using your real name, and limiting your comments to actual information not including diatribes if you fear some sort of retaliation.
I think some folks are afraid to post or write because they are afraid that they will be criticized. My thought is ….so what if you are ? If Mr. Toad or any one else for that matter wants to get personal, why should it matter to me ? My voice is not for them if they think I am a hypocrite or whatever other name they are tossing around that day. My voice is for those who are open minded enough to consider a point of view that they might not have considered before.
Two thumbs up Tia. If BP wants to give me a call from a pay phone to protect his anonymity, then he can call me at 530-297-6237. Just don’t call collect BP. That isn’t practical.
The reason I choose to stay anonymous is because my wife is a teacher who is married to a conservative in a very liberal town. Who knows how many Vanguard posters or readers she might have as parents in her class? We all know how un-open minded some of you liberals can be so it’s best for her if I stay anonymous, she doesn’t need the aggravation. Matt, I’ll email David my story using Barack Palin as my name and we’ll see if David posts it.
Great, I look forward to it being the first of many.
I hope they print it. I once got a death threat on my telephone for simply stating and supporting conservative beliefs.
Thirty years ago I would have wondered if you were a bit of a nut. But then Sarah Palins grandpa-next door was audited over, and over again, after she entered the world stage. Then world-renowned neonatal surgeon Dr. Ben Carson spoke at the White House Prayer Breakfast, 10 feet away from Obama … and he has similarly undergone a protology exame by Uncle Sam year after year.
Tia, have you seen the Ben Carson Story staring Cuba Gooding Jr.? The mini documentary on youtube is also inspiring.
TBD
No, but you have definitely raised my interest.
I knew zippo about him until that prayer breakfast, then I gobbled up what I could find.
Wikipedia: “Dr. Carson was a professor of neurosurgery, oncology, plastic surgery, and pediatrics, and he was the director of pediatric neurosurgery at Johns Hopkins Hospital.[3] At age 33, he became the youngest major division director in Johns Hopkins history, as director of pediatric neurosurgery. He was also a co-director of the Johns Hopkins Craniofacial Center.”
“According to Johns Hopkins Hospital literature, “Dr. Carson focuses on traumatic brain injuries, brain and spinal cord tumors, achondroplasia, neurological and congenital disorders, craniosynostosis, epilepsy, and trigeminal neuralgia. He is also interested in maximizing the intellectual potential of every child.”[3]”
In a 22-hour operation, he became the first doctor to successfully separate conjoined twins joined at the head. “Carson figured in the revival of the hemispherectomy, a drastic surgical procedure in which part or all of one hemisphere of the brain is removed to control severe pediatric epilepsy.”
Some hope he runs for President, and he is fond of noting that a number of doctors signed the Declaration of Independence.
Barack: I have to think long and hard about whether I will print an article under a pseudonym byline. When Jeff Boone asked to do some pieces, I asked him to do it under his real name. So it’s not that I would censor your ideas. I’ll have to take it to the editorial board and see what they think. One way around that I suppose, could be that you simply send me your piece and I publish it under my name, stating, a reader sent us this story but asked that his/ her name remain anonymous.
David
As a member of your editorial board, I see your last proposal as a very good compromise. Another possibility would be to consider allowing BP ( or anyone) to post using their pseudonym as
long as they were willing to include a brief “about BP”
providing some background so that the readers will have some kind of reference point to understand what is informing the authors comments.
What say you BP ?
My personal thoughts are that pen names are used in publishing on a regular basis. BP will be submitting the article knowing that it will be reviewed by the Publisher (David) and the Editorial Board. Creating a bio for his pen name will give the readers an answer to the question “Why?” BP regularly informs us of the provenance of his beliefs. The bio won’t be anything that hasn’t been said before, but for the new reader it will set the stage.
Matt
Very much what I was thinking.
David, let me know what you and your editorial staff decide. I’m not going to go to the trouble of writing an article just to have it turned down for whatever reason by you and your minions.
We’re not going to turn it down, we have two ways forward.
I concur. Get writing BP. We will settle for nothing less than at least one article a week. 8>)
I am puzzled that anyone, whether they are in favor or opposed to the ACA would give any real credence to polls at this point in time. This program is in its infancy.
Any feelings ( including mine) about how well it may or may not work are very preliminary. I wrote my article as an observation mid year during the first year of implementation of the exchanges. It is far too soon to be making sweeping assessments.
I would urge patience and continued observation to see which aspects work well and which do not. There is plenty of time to adjust as we gain experience state by state.
The significance is that conservatives routinely cite the polls as to the public’s support for the ACA. In fact, a significant majority of Americans either supports the ACA (40%) or prefers a more liberal approach (17%). So there is little point in debating the merits of particular ‘repeal and replace’ proposals. They are attempts by some Republicans to appeal to a minority of Americans, basically members of their own party. Since the Tea Party opposes ANY replacement legislation, they wouldn’t even get their proposals to a floor vote of the House now, or in 2015, or in 2016. Maybe in 2017 they all can revisit the ACA, perhaps to improve it.
Don
Agreed. I also agree with you that their interpretation of the
polls is incorrect for reasons that you stated. And I also believe that any polling at this time is valuable only if one desires to spin the numbers for the purpose of bolstering one’s own predetermined conclusion unfettered by any actual evidence.
The way that Democrats are running away from Obama and Obamacare tells us a whole lot.
But don’t worry, odds are high the GOP will find a way to screw it up … even with Clinton apparently having a new girlfriend, and the galling tape of Hillary laughing at how she got a rapist off with a minimal sentence in Arkansas.
BPD
“even with Clinton….”
Forgive me but this is exactly the kind of comment that Don pulls. If you find that he pulls yours disproportionately more than others, perhaps you might want to clarify exactly how former President Clinton’s private social choices or how Hillary Clinton’s role as a defense attorney many years ago relate to Obamacare or explain exactly why you feel the need to post these completely irrelevant comments.
TBD
“The way that Democrats are running away from Obama and Obamacare tells us a whole lot.”
The only thing that this tells me is that there is a lot of uncertainty regarding how the controversies around this law will play out. That should be no surprise since politicians like businessmen and investors seem to loathe and fear uncertainty.
It says absolutely nothing about whether or not the ACA will help provide health care to those who were otherwise unable to get it….namely its major goal.
“Businessmen”? You mean business people?
Tia, please forgive my brief rhetorical flourish, but it does show how politics impact our nation. Someone will get a DUI or take a payoff, and that will impact the calculus.
So Tia, given all of the time, money, angst, and political wrangling … do you think having a net gain of 2 million newly covered, out of the claim of 40 million uninsured (5%), is success?
“So Tia, given all of the time, money, angst, and political wrangling … do you think having a net gain of 2 million newly covered, out of the claim of 40 million uninsured (5%), is success?”
Obviously I’m not Tia TBD, but my answer to Barak Palin (see https://davisvanguard.org/a-controversial-hobby/comment-page-3/#comment-241688 ) answers your question. We are crawling before we walk. That is always the case when something new is added to a highly entrenched bureaucratic structure/process.
Per the article cited, here are the total numbers of new insured via separate components of the ACA:
— 930,000 people able to get coverage through their parents (the under-26 rule).
— 2.6 million previously uninsured purchased through the exchanges.
— 3 million by expansion of Medicaid.
To me, that makes – based on an article by a conservative notable for his opposition to the Affordable Care Act – 6.5 million Americans who are newly insured due to the ACA.
The ACA has also benefited people who were previously insured, but who purchased in 2014 through the exchanges to save money because they are now partially subsidized. That number is probably, based on his article, in excess of 6 million people.
So it is reasonable to state that 10 to 12 million people have benefited from the Affordable Care Act. The CBO expects another 7 million or so to sign up next year.
PS Tia, I’ll answer my own question. If they added 30% or 40% new net gain, I’d call that significant progress. Five percent, no.
Don, you left off the millions who lost care due to the ACA requirements.
Legal cases are moving forward, here is one take on what could happen.
http://www.dickmorris.com/court-may-kill-obamacare-dick-morris-tv-lunch-alert/?utm_source=dmreports&utm_medium=dmreports&utm_campaign=dmreports
“Millions” didn’t lose care due to ACA requirements.
And I don’t consider Dick Morris an expert on anything whatsoever.
I am puzzled that anyone, whether they are in favor or opposed to the ACA would give any real credence to polls at this point in time. This program is in its infancy.
Any feelings ( including mine) about how well it may or may not work are very preliminary. I wrote my article as an observation mid year during the first year of implementation of the exchanges. It is far too soon to be making sweeping assessments.
I would urge patience and continued observation to see which aspects work well and which do not. There is plenty of time to adjust as we gain experience state by state.
The significance is that conservatives routinely cite the polls as to the public’s support for the ACA. In fact, a significant majority of Americans either supports the ACA (40%) or prefers a more liberal approach (17%). So there is little point in debating the merits of particular ‘repeal and replace’ proposals. They are attempts by some Republicans to appeal to a minority of Americans, basically members of their own party. Since the Tea Party opposes ANY replacement legislation, they wouldn’t even get their proposals to a floor vote of the House now, or in 2015, or in 2016. Maybe in 2017 they all can revisit the ACA, perhaps to improve it.
Don
Agreed. I also agree with you that their interpretation of the
polls is incorrect for reasons that you stated. And I also believe that any polling at this time is valuable only if one desires to spin the numbers for the purpose of bolstering one’s own predetermined conclusion unfettered by any actual evidence.
The way that Democrats are running away from Obama and Obamacare tells us a whole lot.
But don’t worry, odds are high the GOP will find a way to screw it up … even with Clinton apparently having a new girlfriend, and the galling tape of Hillary laughing at how she got a rapist off with a minimal sentence in Arkansas.
BPD
“even with Clinton….”
Forgive me but this is exactly the kind of comment that Don pulls. If you find that he pulls yours disproportionately more than others, perhaps you might want to clarify exactly how former President Clinton’s private social choices or how Hillary Clinton’s role as a defense attorney many years ago relate to Obamacare or explain exactly why you feel the need to post these completely irrelevant comments.
TBD
“The way that Democrats are running away from Obama and Obamacare tells us a whole lot.”
The only thing that this tells me is that there is a lot of uncertainty regarding how the controversies around this law will play out. That should be no surprise since politicians like businessmen and investors seem to loathe and fear uncertainty.
It says absolutely nothing about whether or not the ACA will help provide health care to those who were otherwise unable to get it….namely its major goal.
“Businessmen”? You mean business people?
Tia, please forgive my brief rhetorical flourish, but it does show how politics impact our nation. Someone will get a DUI or take a payoff, and that will impact the calculus.
So Tia, given all of the time, money, angst, and political wrangling … do you think having a net gain of 2 million newly covered, out of the claim of 40 million uninsured (5%), is success?
“So Tia, given all of the time, money, angst, and political wrangling … do you think having a net gain of 2 million newly covered, out of the claim of 40 million uninsured (5%), is success?”
Obviously I’m not Tia TBD, but my answer to Barak Palin (see https://davisvanguard.org/a-controversial-hobby/comment-page-3/#comment-241688 ) answers your question. We are crawling before we walk. That is always the case when something new is added to a highly entrenched bureaucratic structure/process.
Per the article cited, here are the total numbers of new insured via separate components of the ACA:
— 930,000 people able to get coverage through their parents (the under-26 rule).
— 2.6 million previously uninsured purchased through the exchanges.
— 3 million by expansion of Medicaid.
To me, that makes – based on an article by a conservative notable for his opposition to the Affordable Care Act – 6.5 million Americans who are newly insured due to the ACA.
The ACA has also benefited people who were previously insured, but who purchased in 2014 through the exchanges to save money because they are now partially subsidized. That number is probably, based on his article, in excess of 6 million people.
So it is reasonable to state that 10 to 12 million people have benefited from the Affordable Care Act. The CBO expects another 7 million or so to sign up next year.
PS Tia, I’ll answer my own question. If they added 30% or 40% new net gain, I’d call that significant progress. Five percent, no.
Don, you left off the millions who lost care due to the ACA requirements.
Legal cases are moving forward, here is one take on what could happen.
http://www.dickmorris.com/court-may-kill-obamacare-dick-morris-tv-lunch-alert/?utm_source=dmreports&utm_medium=dmreports&utm_campaign=dmreports
“Millions” didn’t lose care due to ACA requirements.
And I don’t consider Dick Morris an expert on anything whatsoever.
Matt
“given the fact that you are dealing with a cancer patient, I would think tubal ligation would make a lot of practical sense. The likelihood of further child bearing is very small given the cancer status.”
This is actually incorrect. This woman had not children. The likelihood of having a child in the future is actually quite high and if she is in full remission, has quite a good prognosis.
I guess that depends on the actual cancer. My daughter in law has been battling ovarian and cervical cancer, and I’m sure that biased my perspective. her chance of having a child, even if the cancer goes into remission is virtually non existent.
Matt
This observation is correct. Those of us who are not in medicine tend to hear the word cancer as one entity. Cancers are highly variable in their behaviors. There are some very nasty types that would as you noted virtually preclude having children.
Others are quite good prognosis if caught early and treated aggressively.
Matt
“given the fact that you are dealing with a cancer patient, I would think tubal ligation would make a lot of practical sense. The likelihood of further child bearing is very small given the cancer status.”
This is actually incorrect. This woman had not children. The likelihood of having a child in the future is actually quite high and if she is in full remission, has quite a good prognosis.
I guess that depends on the actual cancer. My daughter in law has been battling ovarian and cervical cancer, and I’m sure that biased my perspective. her chance of having a child, even if the cancer goes into remission is virtually non existent.
Matt
This observation is correct. Those of us who are not in medicine tend to hear the word cancer as one entity. Cancers are highly variable in their behaviors. There are some very nasty types that would as you noted virtually preclude having children.
Others are quite good prognosis if caught early and treated aggressively.
TBD
I do not have a specific number that I would label success or failure. This is playing out differently in different states. It would appear that California is being quite successful and in my system, as I have posted previously we have a significantly higher enrollment that our forecasters predicted. I am seeing this on a daily basis in my office. We are anticipating that even more growth next year.
As I have said a number of times, we will just have to wait and see. Success or failure often depends on one’s perspective. At this point, locally and regionally
* northern California” it has been better than we had predicted and the proportion of young healthy enrollees has been higher than predicted.
I am sure that for those who very much want this to fail, there will be plenty of studies and articles that demonstrate that “it is failing” but this is ideologically not factually driven. I say this not because this was my preferred solution but because we do not yet have enough data to know at this point and we do not have a universal measure that every one agrees to as a success barometer.
And of course, both sides are spinning the numbers like mad.
“I am sure that for those who very much want this to fail, there will be plenty of studies and articles that demonstrate that “it is failing” but this is ideologically not factually driven.”
Just as there will be plenty of articles and studies that will show “it’s a success”but those also will be ideologically not factually driven.
Agreed BP. Here is one of those articles
http://www.huffingtonpost.com/2014/07/23/obamacare-insurance-uninsured-rate_n_5615052.html It begins as follows:
“The number of Americans without health insurance declined by 10.3 million because of Obamacare enrollment, according to a report from the Department of Health and Human Services and the Harvard School of Public Health, published in The New England Journal of Medicine on Wednesday.”
If there are so many newly enrolled under the ACA, why are Obama and his cohorts running away from it as fast as they can? Why does Obama rarely talk about it anymore?
Yes, millions may have gained new policies from their employers, but Obama didn’t cause that.
And how do you count those who sign up for the ACA, but don’t pay?
Dick Morris had an interesting 3-minute analysis in April with a numerical breakdown and explanation which I have not double checked.
ObamaCare’s Phony Numbers – Dick Morris TV: Lunch Alert!
http://www.dickmorris.com/obamacares-phony-numbers-dick-morris-tv-lunch-alert/?utm_source=dmreports&utm_medium=dmreports&utm_campaign=dmreports
There have been so many delays and changes to Obamacare, it’s hard to get a grip as to where we are. It appears as if Democrats, and Obama, are delaying enacting some of the more painful measures so that they can keep the Senate in 2014.
Obama’s language used to be “it shouldn’t be repealed” to “it should be repaired”. He is now walking back his signature achievement… can you imagine Bill Clinton walking back his welfare reform months after passage?
This is a bunch of nonsense. Obama isn’t “running away from” his signal accomplishment. Most are paying; as the insurance execs testified before Congress, new enrollees through the exchanges are paying for their policies at the rate the industry expected.
The ACA is here to stay. It’s working.
BP
I completely agree which is why I have said that I recommend “expectant management” which is the medical way of saying, we have chosen a course of action, now we should wait and see how it works out with the understanding that future adjustments may be needed.
TBD
I do not have a specific number that I would label success or failure. This is playing out differently in different states. It would appear that California is being quite successful and in my system, as I have posted previously we have a significantly higher enrollment that our forecasters predicted. I am seeing this on a daily basis in my office. We are anticipating that even more growth next year.
As I have said a number of times, we will just have to wait and see. Success or failure often depends on one’s perspective. At this point, locally and regionally
* northern California” it has been better than we had predicted and the proportion of young healthy enrollees has been higher than predicted.
I am sure that for those who very much want this to fail, there will be plenty of studies and articles that demonstrate that “it is failing” but this is ideologically not factually driven. I say this not because this was my preferred solution but because we do not yet have enough data to know at this point and we do not have a universal measure that every one agrees to as a success barometer.
And of course, both sides are spinning the numbers like mad.
“I am sure that for those who very much want this to fail, there will be plenty of studies and articles that demonstrate that “it is failing” but this is ideologically not factually driven.”
Just as there will be plenty of articles and studies that will show “it’s a success”but those also will be ideologically not factually driven.
Agreed BP. Here is one of those articles
http://www.huffingtonpost.com/2014/07/23/obamacare-insurance-uninsured-rate_n_5615052.html It begins as follows:
“The number of Americans without health insurance declined by 10.3 million because of Obamacare enrollment, according to a report from the Department of Health and Human Services and the Harvard School of Public Health, published in The New England Journal of Medicine on Wednesday.”
If there are so many newly enrolled under the ACA, why are Obama and his cohorts running away from it as fast as they can? Why does Obama rarely talk about it anymore?
Yes, millions may have gained new policies from their employers, but Obama didn’t cause that.
And how do you count those who sign up for the ACA, but don’t pay?
Dick Morris had an interesting 3-minute analysis in April with a numerical breakdown and explanation which I have not double checked.
ObamaCare’s Phony Numbers – Dick Morris TV: Lunch Alert!
http://www.dickmorris.com/obamacares-phony-numbers-dick-morris-tv-lunch-alert/?utm_source=dmreports&utm_medium=dmreports&utm_campaign=dmreports
There have been so many delays and changes to Obamacare, it’s hard to get a grip as to where we are. It appears as if Democrats, and Obama, are delaying enacting some of the more painful measures so that they can keep the Senate in 2014.
Obama’s language used to be “it shouldn’t be repealed” to “it should be repaired”. He is now walking back his signature achievement… can you imagine Bill Clinton walking back his welfare reform months after passage?
This is a bunch of nonsense. Obama isn’t “running away from” his signal accomplishment. Most are paying; as the insurance execs testified before Congress, new enrollees through the exchanges are paying for their policies at the rate the industry expected.
The ACA is here to stay. It’s working.
BP
I completely agree which is why I have said that I recommend “expectant management” which is the medical way of saying, we have chosen a course of action, now we should wait and see how it works out with the understanding that future adjustments may be needed.
We’ve veered quite a way off topic here. To bring it back with the help of someone who is actually knowledgeable, I recommend this very short read of the Hobby Lobby decision and why it is not only morally wrong, but bad for the economy. If you don’t want to register with the Harvard Business Review, I’ll give you a short quote by the author, Matthew Stewart, below the link.
http://blogs.hbr.org/2014/07/hobby-lobby-and-the-separation-of-church-and-business/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+harvardbusiness+%28HBR.org%29&cm_ite=DailyAlert-072214+%281%29&cm_lm=sp%3Adavehar77%40yahoo.com&cm_ven=Spop-Email
“Consider the following: Company leaders should not imagine that they can escape the impending chaos simply by not being Hobby Lobby. In the new landscape, corporations may soon find themselves unable not to exercise their religious rights. Religious activists of all stripes will now have reason to pressure corporations to exercise these newfound rights. Moreover, since these new religious rights allow corporations to claim exemptions from laws that apply to other companies, company strategists will be obliged to consider them a potential source of competitive advantage or disadvantage. Could it become a breach of directors’ fiduciary duty not to consider the benefits of a religious strategy? And who exactly gets to decide the religion of a corporation? The majority owner(s)? The founder? The deceased founder? The mystical letter that the founder composed on her deathbed? Does the religious belief in question have to be sincere? And if so, who decides whether it is sincere — or “religious” at all?
Make way for the CRO — Chief Religion Officer. And beef up the legal department. The only real winners from the Hobby Lobby decision will be the lawyers.”
We’ve veered quite a way off topic here. To bring it back with the help of someone who is actually knowledgeable, I recommend this very short read of the Hobby Lobby decision and why it is not only morally wrong, but bad for the economy. If you don’t want to register with the Harvard Business Review, I’ll give you a short quote by the author, Matthew Stewart, below the link.
http://blogs.hbr.org/2014/07/hobby-lobby-and-the-separation-of-church-and-business/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+harvardbusiness+%28HBR.org%29&cm_ite=DailyAlert-072214+%281%29&cm_lm=sp%3Adavehar77%40yahoo.com&cm_ven=Spop-Email
“Consider the following: Company leaders should not imagine that they can escape the impending chaos simply by not being Hobby Lobby. In the new landscape, corporations may soon find themselves unable not to exercise their religious rights. Religious activists of all stripes will now have reason to pressure corporations to exercise these newfound rights. Moreover, since these new religious rights allow corporations to claim exemptions from laws that apply to other companies, company strategists will be obliged to consider them a potential source of competitive advantage or disadvantage. Could it become a breach of directors’ fiduciary duty not to consider the benefits of a religious strategy? And who exactly gets to decide the religion of a corporation? The majority owner(s)? The founder? The deceased founder? The mystical letter that the founder composed on her deathbed? Does the religious belief in question have to be sincere? And if so, who decides whether it is sincere — or “religious” at all?
Make way for the CRO — Chief Religion Officer. And beef up the legal department. The only real winners from the Hobby Lobby decision will be the lawyers.”
TBD
“Tia, I don’t see you arguing Hobby Lobby’s objection to the “morning after” pill. So I gather you agree with their thinking on that item?
Good question. While I do not agree with them on this, I do think that unlike with the other methods, there is a grain of support for their argument and also some facts that they may not realize that make their argument useless.
Here are my thoughts about the “morning after pill” also called Plan B.
In support of the Hobby Lobby position.
The only indication for Plan B of which I am aware is to prevent pregnancy by preventing the joining of a sperm
and egg, or potentially preventing implantation. They are choosing to focus on the latter possibility ignoring the
former mechanism. So they are basing their objection on a theoretical possibility. But at least this position has
some credible scientific backing.
Why I don’t believe it matters and thus am not writing about it:
Apparently unbeknownst to many, Plan B, is nothing but a form of combination birth control pills taken in a
very specific manner within a specified amount of time after intercourse. If a woman has access to
combination birth control pills, she can get essentially the same effect by taking them in this manner. Plan B
is good for the woman who does not have regular birth control pills because she does not have a prescription,
or because she does not need to be taking birth control pills on a regular basis ( think of cases of rape), or
if she is away from home and forgot her pill pack….
But she clearly has other options. This is not true for either the Mirena IUD or the Paraguard IUD. Neither of
these have “other equivalent options” and can be used in settings in which the woman may be at significant
risk of medical harm if she does not have access to them. In addition, the Mirena is frequently used for
medical indications other than contraception where there is no possible chance of conception. The Hobby
Lobby decision discriminates against these women for no conceivable reason including religious or moral.
The irony that I see in the Hobby Lobby position is that their position is ostensibly to prevent abortion. It has been shown again and again that the best way to prevent abortion is to prevent the unintended and unwanted ( not the same thing) pregnancy. What makes their position so ironic is that the Mirena IUD and perhaps a little more controversially from their strict definition of pregnancy ( namely any possibility at all that the sperm and egg have joined) in the case of the Paraguard, the IUDs are not abortifacients. The IUDs are along with the Nexplanon, the most effective reversible means of birth control available. The woman using any of these means has a less than
1% chance of conceiving in a year which is roughly equal to the efficacy of sterilization.
So if Hobby Lobby were really concerned about preventing abortion, the best thing that they could do would be to provide free IUDs and Nexplanons to their female employees of reproductive age and then sit back and watch the abortion rates drop. By taking this step, they would be preventing real pregnancies and real abortions, not hypothetical ones.
TBD
“Tia, I don’t see you arguing Hobby Lobby’s objection to the “morning after” pill. So I gather you agree with their thinking on that item?
Good question. While I do not agree with them on this, I do think that unlike with the other methods, there is a grain of support for their argument and also some facts that they may not realize that make their argument useless.
Here are my thoughts about the “morning after pill” also called Plan B.
In support of the Hobby Lobby position.
The only indication for Plan B of which I am aware is to prevent pregnancy by preventing the joining of a sperm
and egg, or potentially preventing implantation. They are choosing to focus on the latter possibility ignoring the
former mechanism. So they are basing their objection on a theoretical possibility. But at least this position has
some credible scientific backing.
Why I don’t believe it matters and thus am not writing about it:
Apparently unbeknownst to many, Plan B, is nothing but a form of combination birth control pills taken in a
very specific manner within a specified amount of time after intercourse. If a woman has access to
combination birth control pills, she can get essentially the same effect by taking them in this manner. Plan B
is good for the woman who does not have regular birth control pills because she does not have a prescription,
or because she does not need to be taking birth control pills on a regular basis ( think of cases of rape), or
if she is away from home and forgot her pill pack….
But she clearly has other options. This is not true for either the Mirena IUD or the Paraguard IUD. Neither of
these have “other equivalent options” and can be used in settings in which the woman may be at significant
risk of medical harm if she does not have access to them. In addition, the Mirena is frequently used for
medical indications other than contraception where there is no possible chance of conception. The Hobby
Lobby decision discriminates against these women for no conceivable reason including religious or moral.
The irony that I see in the Hobby Lobby position is that their position is ostensibly to prevent abortion. It has been shown again and again that the best way to prevent abortion is to prevent the unintended and unwanted ( not the same thing) pregnancy. What makes their position so ironic is that the Mirena IUD and perhaps a little more controversially from their strict definition of pregnancy ( namely any possibility at all that the sperm and egg have joined) in the case of the Paraguard, the IUDs are not abortifacients. The IUDs are along with the Nexplanon, the most effective reversible means of birth control available. The woman using any of these means has a less than
1% chance of conceiving in a year which is roughly equal to the efficacy of sterilization.
So if Hobby Lobby were really concerned about preventing abortion, the best thing that they could do would be to provide free IUDs and Nexplanons to their female employees of reproductive age and then sit back and watch the abortion rates drop. By taking this step, they would be preventing real pregnancies and real abortions, not hypothetical ones.
Frankly
““Businessmen”? You mean business people?”
Nope. I meant exactly what I wrote. I consider those of us who came equipped with the XX genetic variation equal partners in “mankind” as I do those who came equipped with the XY variant. ; ).
Frankly
““Businessmen”? You mean business people?”
Nope. I meant exactly what I wrote. I consider those of us who came equipped with the XX genetic variation equal partners in “mankind” as I do those who came equipped with the XY variant. ; ).
Dave Hart
Thank you for presenting the legal ramifications of this decision. I can only present the medical aspects which I believe be problematic enough in and of themselves since they fall within my area of expertise. However, there are also the legal and governmental nightmares that will eventually have to be dealt with.
Dave Hart
Thank you for presenting the legal ramifications of this decision. I can only present the medical aspects which I believe be problematic enough in and of themselves since they fall within my area of expertise. However, there are also the legal and governmental nightmares that will eventually have to be dealt with.
South of Davis
“elevates material wealth to the highest good”.
I am surprised that you cannot think of even one individual who does this.
Our very own Frankly frequently posts that only “material harm” should matter to people. It does not take much imagination given the content of the majority of his posts to realize that he only includes two criteria for what is
“material harm”. Money and religion are the only two things that seem to count in his prioritization of values…. and for full disclosure, I often cannot tell which of these two he values more highly so I guess that I should have stated “amongst the two highest goods”.
South of Davis
“elevates material wealth to the highest good”.
I am surprised that you cannot think of even one individual who does this.
Our very own Frankly frequently posts that only “material harm” should matter to people. It does not take much imagination given the content of the majority of his posts to realize that he only includes two criteria for what is
“material harm”. Money and religion are the only two things that seem to count in his prioritization of values…. and for full disclosure, I often cannot tell which of these two he values more highly so I guess that I should have stated “amongst the two highest goods”.