ACA Repeal/Replace: Progressives Face Moral Dilemma

[Bob Butler 54]

(03-13-2017, 01:16 PM)Kinser79 Wrote:

(03-13-2017, 12:24 PM)Bob Butler 54 Wrote: Kinser

I perceive insurance programs as a risk sharing proposition.  I’ve paid a lot of money into home insurance.  I’ve never had the sort of disaster that has called for use of the policies.  If one is a gambler, one might think it cost effective to not buy the insurance.  Insurance companies are out to make a profit.  The odds they give you aren’t particularly advantageous.  On average, being uninsured is a financial win.

Except in a disaster, where it isn’t.  It seems prudent for me to share the burden, so those who have been lucky help out those who haven’t been.

Agreed on all points.  In fact there was never a point where we disagreed on this except perhaps on the fact that I don't think it moral for the state to force anyone into these "risk sharing pools".  Most people who are smart would if offered (but they really can't due to the insistance on some of maintaining an ancient system that never really worked that well to start with) purchase individual health care insurance when they are young and healthy, lock in a lower premium and then they are covered.

This of course necessitates the abolition of employer based health care insurance.  A particular generation seems to be hung up on keeping this insurance (probably because they are old) because the older set of the generation just younger than them wants to keep it too.

I do see a problem if those who have a particularly light burden don't want to share the burden.

And, yes, there are those who benefit from the old system, and those who don't want to risk a change to the system.  Part of the problem.

(03-13-2017, 01:16 PM)Kinser79 Wrote:

Quote:For the healthy and wealthy, poor or no health coverage can similarly seem attractive.  One can convince one’s self that there is such a thing as a free lunch, and roll the dice.  I wouldn’t consider that prudent, but some are willing to live on the edge.

Those who are rich are usually that way because they aren't stupid.  Generally speaking wealthy people get personal coverage fairly quickly.  Its a case of "in case shit".  With the poor their problem is they cannot afford the insurance plans offered.  I'd imagine because of a lack of competition in the market.

Since monopolies cannot exist without government collusion it seems to me that the last thing we want in such a market is governmental interference--and certainly not more of it where it already exists.

Some don't trust the government.  Some don't trust corporations, including the insurance companies.  There is no lack of reasons for such distrust.  I'd note that which group is more distrusted has become a cultural and political thing.  You can state your particular prejudice, but take note that there are many with just a strong a distrust of big pharmacy and the insurance companies.  The proper goal might be to minimize bureaucracy all together, public or private.

(03-13-2017, 01:16 PM)Kinser79 Wrote:

Quote:If one isn’t healthy and wealthy, the odds are much different.  Being uncovered is not by any means a good gamble.  If someone still young enough to think himself immortal wants to roll dice, I have no great desire to prevent him.  However, when the healthy and wealthy want to set up schemes to force those who are not healthy and wealthy to roll dice against absurd odds for deadly stakes, I get very dubious.

I see your point, it is valid, I'll grant you that.  However, attempting to construct any system wherein you force the healthy and the wealthy to essentially pay the medical bills of the non-healthy and the non-wealthy it would never pass.  Indeed had the Democrat Controlled house opened up the bill for debate in 2009 it would have never passed.  The House and Senate (both Democrat Controlled at the time) used special rules to even pass the law.

In short the biggest problem with Obamacare is that it is primarily a give away to insurance companies, is terribly expensive, was not subject to debate on the floor of either house openly and simply does not work.  I remember when Pelosi said "We have to vote for it to see what's in it." I told my mother and BF that day "This is going to be a disaster."

Turns out, I was right.  I've never lost money betting that something that private enterprise does poorly government can't do less well.

A disaster?  I'm doing all right.  Massachusetts seems quite ready to shift back to Romney Care.  It might be a disaster by the standards of Florida culture, but not all see it that way.  Some are ready to share burdens.

I have an equal dislike for how big pharmacy and the insurance companies meshed with the Republican desire to make Obama look bad.  Passing the ACA wasn't Congress's finest hour.  My current vaguely wistful hope is that the Republicans will be too divided to work without the Democrats.  The middle of both parties might have to work together for a change.

I can agree the Democrats didn't play their cards very well, but there is more than enough blame to go around.  That's water over the dam, though.  The question is whether the Republicans are united enough to push their own ideas on the country, or whether there will be some real give and take this time around.  So far, no such give and take.  It feels like the Democrats are waiting for the Republicans to discover they aren't united enough to railroad.

(03-13-2017, 01:16 PM)Kinser79 Wrote:

Quote:There is a lot to be said for letting the states trial and error a bunch of different schemes.  However, in the process they are going to force lots of impossible dice rolls with deadly stakes.  I am doubtful about that.  If past schemes have not been ideal, neither are many of the possible future schemes.

Okay, great.  Again a valid point.  So your solution to that problem is to take 20% of the USA's economy and subject it to being overturned every 4-8 years?  How you do not see that as worse is beyond me.  

I am taking advantage of the fact that it is far easier to state displeasure of this plan or that's lack of perfection than it is to find a plan that is perfect.  I'm also not expecting the Republicans to let go.  They'll try to push their values on the entire country, as Obama did.  

It seems possible that if the two parties are forced to work together, the problem might get solved.  Fifty different solutions will leave it unsolved in parts of the country.

(03-13-2017, 01:16 PM)Kinser79 Wrote:

Quote:I’m not going to throw extreme partisan style hissy fits if it is attempted.

You wouldn't have to...there will be plenty who share whatever your opinion is to scream and yell for you.

Here we're in total agreement.

(03-13-2017, 01:16 PM)Kinser79 Wrote:

Quote:I feel more firm that health care should not be optimized for the benefit of the healthy and wealthy.  One should start with a goal of providing everyone coverage, and look for some way to share the burden reasonably.  Anyone moving in the opposite direction is moving in the wrong direction.

Health care needs to be optimized for maintaining health in those already healthy, wealthy or not.  This means that preventative medicine must be looked at first.  I would say the largest problem with health care itself, and by extension health care insurance (which are not the same thing) is that Americans tend to view health care as something you need when you get sick.  This view is wrong.  It is worse than wrong, it is wrong and stupid.  It is also why costs are as high as they are.

Once the focus is switched to the preservation of health in those healthy and then treating as best we can the unhealthy costs for health care and health care insurance goes down.  This is why Health Canada, the NSH and the European systems work at least moderately well.

This is one reason I oppose the approach of emergency rooms also becoming general practitioners for the poor.  Emergency rooms don't, can't and shouldn't do preventative maintenance without anyone paying for such services.

For a while, after I was young, healthy and immortal, but before Romney Care kicked in, I did out of pocket health care.  When I got insurance again, my health care provider started doing full preventative maintenance, something I'd never considered important when I was younger.  There was a skin specialist checking for surface cancers, a sleep specialist checking for apneas, a diabetic specialist, and someone who looks up people's rear ends for a living.  If one hasn't a solid form of coverage, one isn't going to get these things, certainly not in an emergency room.

(03-13-2017, 01:16 PM)Kinser79 Wrote:

Quote:And, no, I don’t want to nitpick your experiences in Florida.  I’ve just have had very different experiences in Massachusetts.  Both your own feelings and Florida’s culture wish to avoid sharing the burden.  Both myself and Massachusetts culture lean the other way.  I don’t see much point in nitpicking details.

I would submit that solutions that might work in MA wouldn't really work in FL and vise versa.

I'm doubtful that either region would even try the other's approach at this point.