Health Care Reform

[Túrin Turambar]

The House could still pass the Senate Bill as-is (although that's unlikely apparently), the Senate could pass a new bill with the aid of Olympia Snowe, the Republicans could back down on a fillibuster and allow cloture on a new Senate Bill, or reconcilliation between the two houses could be used. It seems likely that some sort of bill will be passed on healthcare, although it's been looking steadily weaker every month.

I don't pretend to understand parliamentary procedure, so I know this idea won't work but I don't know why; perhaps someone here can explain: why don't the Democrats just let each of the 41 Republican senators filibuster -- no one of them could manage to do it for more than two straight days, and then when they're done, 82 days from now, pass the bill?

As I understand it, all that the minority need to do is simply vote ‘nay’ on a cloture motion. In other words, someone moves that the debate ends and the bill is voted on, and they can all simply vote against it. Unless the cloture motion is passed, the bill can’t be voted on, and so can’t be passed.

I have to admit that I’m getting less and less impressed with the Congressional Democrats and, to a lesser extent, the Administration. I have no idea why they didn’t simply move a simple, progressive bill first, say to expand Medicare to universal coverage, even if it had no chance of passing. It would have moved the entire debate closer to their preferred position, and possibly wedged both conservative Democrats and Republicans representing blue states. The former would know that they would need to explain their opposition to their local party when they were next up for re-nomination, and the latter would know that their vote could easily be used in campaign ads against them. As it stands, despite their huge numerical disadvantage in both houses the Republicans have been able to steadily drag the debate over to their side. Obama is looking more and more like he’s going to be remembered as another Clinton rather than as the next FDR or Reagan.

[halplm]

The House could still pass the Senate Bill as-is (although that's unlikely apparently), the Senate could pass a new bill with the aid of Olympia Snowe, the Republicans could back down on a fillibuster and allow cloture on a new Senate Bill, or reconcilliation between the two houses could be used. It seems likely that some sort of bill will be passed on healthcare, although it's been looking steadily weaker every month.

I don't pretend to understand parliamentary procedure, so I know this idea won't work but I don't know why; perhaps someone here can explain: why don't the Democrats just let each of the 41 Republican senators filibuster -- no one of them could manage to do it for more than two straight days, and then when they're done, 82 days from now, pass the bill?

As I understand it, all that the minority need to do is simply vote ‘nay’ on a cloture motion. In other words, someone moves that the debate ends and the bill is voted on, and they can all simply vote against it. Unless the cloture motion is passed, the bill can’t be voted on, and so can’t be passed.

I have to admit that I’m getting less and less impressed with the Congressional Democrats and, to a lesser extent, the Administration. I have no idea why they didn’t simply move a simple, progressive bill first, say to expand Medicare to universal coverage, even if it had no chance of passing. It would have moved the entire debate closer to their preferred position, and possibly wedged both conservative Democrats and Republicans representing blue states. The former would know that they would need to explain their opposition to their local party when they were next up for re-nomination, and the latter would know that their vote could easily be used in campaign ads against them. As it stands, despite their huge numerical disadvantage in both houses the Republicans have been able to steadily drag the debate over to their side. Obama is looking more and more like he’s going to be remembered as another Clinton rather than as the next FDR or Reagan.

I continue to see this pov around the net, and it's astonishing to me. You simply cannot blame the republicans for the democrats failing to pass anything. The republicans could not stop them. What is constantly missed when this opinion is put forth, is that the democrats that didn't blindly vote for whatever was thrown at them from the closed door secret meetings... were operating with regards to what their constituents wanted. It had nothing to do with what party they were!

This would be admirable for the most part, except for the fact they caved to a few hundred million in bribes in the end...

It was the Tea Party movement and Town Hall Protestors that stalled the health bill in the summer, and they had NOTHING to do with the republican party. The only reason they could get the bribes to work at christmas is because people were paying attention to things like family and the holidays instead of making their senators listen to them (probably the people answering the phones were on vacation too).

There's a reason you see "Can you hear us now" on signs at conservative rallies. People are tired of their elected officials ignoring them for whatever kickbacks they get in office.

[JewelSong]

I'm less than impressed with the whole kit and kaboodle. I'm sick of the bickering, sick of the name-calling, sick of the blaming, sick of the politicians, sick of the talk-show hosts, sick of the "my side is right, your side is sh*t" mentality.

I blame everyone.

[yovargas]

Limbaugh is not out of touch, he is conservative.

So you think his apparent suggestion to not bother with insurance and just save is a reasonable solution?

[N.E. Brigand]

On the one hand, I would expect them to drive something through somehow, because that's just how out of touch with the rest of us they are.

A majority of Americans want either the health care bill currently under consideration, or a more liberal bill.

You are incorrect. What leads you to believe this?

Comments like this, that I have encountered repeatedly at different sources as such polls appear:

The fundamentals of the situation remain exactly the same. Most Americans oppose health care reform. However, a significant chunk -- enough to form a sizable majority when combined with supporters -- oppose it because it doesn't go far enough. Which is to say, the Democrats' position commands the center in a polarized atmosphere.

Maybe it's not true. I Googled for actual polling, but in the two results I found, respondents weren't asked why they opposed the current plan. One was a recent Rasmussen poll showing only 36% in favor of the bill, with no indication of the breakdown between those opposed because it does too much, and those opposed because it does too little.

[halplm]

Limbaugh is not out of touch, he is conservative.

So you think his apparent suggestion to not bother with insurance and just save is a reasonable solution?

I think that if people paid for their health care rather than paid insurance companies to do it, the cost would be lower across the board, which would be a very good thing.

The problem is how would you get to that point, because with how things are right now, that is not possible.

The commonly presented idea by many Republicans of "Health Care Savings accounts" is an attempt to try and implement something like this... but then again, apparently no one has heard this idea presented by any republicans...

[halplm]

Maybe it's not true. I Googled for actual polling, but in the two results I found, respondents weren't asked why they opposed the current plan. One was a recent Rasmussen poll showing only 36% in favor of the bill, with no indication of the breakdown between those opposed because it does too much, and those opposed because it does too little.

I agree the pollsters aren't asking the right questions, but this is usually because they are trying to get the answer they want.

The best way to see what the public really is behind, is to go slowly and do things in small chunks. The bits everyone likes will pass easily, and the ones that most people don't want, will either get left behind, or be done in a way that is at least acceptable.

There's no reason it can't be done this way unless the goal is something other than reform people want (as it has been to this point).

[Primula Baggins]

Limbaugh is not out of touch, he is conservative.

So you think his apparent suggestion to not bother with insurance and just save is a reasonable solution?

I think that if people paid for their health care rather than paid insurance companies to do it, the cost would be lower across the board, which would be a very good thing.

The problem is how would you get to that point, because with how things are right now, that is not possible.

The commonly presented idea by many Republicans of "Health Care Savings accounts" is an attempt to try and implement something like this... but then again, apparently no one has heard this idea presented by any republicans...

And what's your solution if somebody needs a quarter of a million dollars' worth of health care in the course of six months (as I have) or, in the case of a heart attack or a car accident, in the course of a single week? It happens a lot, Hal; I count at least two dozen in my immediate circle of RL friends and family.

Do you know anyone making an ordinary middle-class salary who could save that much?

[halplm]

So you think his apparent suggestion to not bother with insurance and just save is a reasonable solution?

I think that if people paid for their health care rather than paid insurance companies to do it, the cost would be lower across the board, which would be a very good thing.

The problem is how would you get to that point, because with how things are right now, that is not possible.

The commonly presented idea by many Republicans of "Health Care Savings accounts" is an attempt to try and implement something like this... but then again, apparently no one has heard this idea presented by any republicans...

And what's your solution if somebody needs a quarter of a million dollars' worth of health care in the course of six months (as I have) or, in the case of a heart attack or a car accident, in the course of a single week? It happens a lot, Hal; I count at least two dozen in my immediate circle of RL friends and family.

Do you know anyone making an ordinary middle-class salary who could save that much?

I am not advocating (nor was Limbaugh) that insurance is not a good idea for such things. Anyone can have a major health problem come up that they can't afford, and insurance built to spread the risk of that happening among lots of people is one way to handle that.

However, if people were saving, and using those savings to take care of their checkups, their broken arms, their stitches and infections and such... the cost of everything would go down... maybe the quarter of a million you needed would have only been fifty or a hundred thousand, which while still needing the help of insurance, would have been easier on the insurance, and overall reducing the insurance costs as well!

[JewelSong]

People should have their basic health maintenance covered. That way, everyone will go for check-ups on a regular basis and illnesses that might be catastrophic might be caught in time to do something about it.

If everyone is paying out of pocket, no one will go for maintenance as long as they feel okay. It is is cheaper to take care of people before problems arise than to wait until they need something big done. Not unlike a car.

If people stayed healthier to begin with, the cost of health care would go down. An ounce of prevention is worth a pound of cure, they say.

The reason lots of uninsured people end up in the ER is because they have no place else to go. They can't afford the regular check-ups or the preventative care they need, so they only go when it's critical. Which ends up costing WAY more than if they had been seen by a regular doctor.

[N.E. Brigand]

Is it true, as I have read, that Massachusetts has a state health care plan that is very similar to the Congressional bill under consideration, and that the new Senator-elect voted for that state plan?

[Griffon64]

I'm less than impressed with the whole kit and kaboodle. I'm sick of the bickering, sick of the name-calling, sick of the blaming, sick of the politicians, sick of the talk-show hosts, sick of the "my side is right, your side is sh*t" mentality.

I blame everyone.

I tend to feel the same way. Imagine if the energy poured into trashing the other side was actually poured into hammering out a workable way to bring down health care costs across the board. It can be done, in varying degrees, but the political will for that simply seems lacking. It has to be more spending, or jockeying for position, or trashing the other party, instead. Not that the politicians are the only ones guilty of that. The general public do the same.

[Frelga]

I'm less than impressed with the whole kit and kaboodle. I'm sick of the bickering, sick of the name-calling, sick of the blaming, sick of the politicians, sick of the talk-show hosts, sick of the "my side is right, your side is sh*t" mentality.

I blame everyone.

I tend to feel the same way. Imagine if the energy poured into trashing the other side was actually poured into hammering out a workable way to bring down health care costs across the board. It can be done, in varying degrees, but the political will for that simply seems lacking. It has to be more spending, or jockeying for position, or trashing the other party, instead. Not that the politicians are the only ones guilty of that. The general public do the same.

[halplm]

People should have their basic health maintenance covered. That way, everyone will go for check-ups on a regular basis and illnesses that might be catastrophic might be caught in time to do something about it.

Really? What's the motivation to go if they feel healthy and the cost is covered? You know, aside from the copay. Why is that motivation any less if the visit only cost $20 and no insurance covered it?

If everyone is paying out of pocket, no one will go for maintenance as long as they feel okay. It is is cheaper to take care of people before problems arise than to wait until they need something big done. Not unlike a car.

Indeed it is, but what you're talking about is not cheap health care, it is manditory health care where the government punishes you for not doing what they say is appropriate for your health. That's not exactly freedom. How long until they ban fat, sugar, caffeine, alcohol... oh wait, they tried that... etc etc. Shall we all have some wheatgrass with our protein sludge for dinner tonight? Why don't we just plug ourselves into the matrix right now

If people stayed healthier to begin with, the cost of health care would go down. An ounce of prevention is worth a pound of cure, they say.

The reason lots of uninsured people end up in the ER is because they have no place else to go. They can't afford the regular check-ups or the preventative care they need, so they only go when it's critical. Which ends up costing WAY more than if they had been seen by a regular doctor.

Oh, hey, maybe if the preventative care were cheaper, because the insurance companies weren't involved, they'd be able to afford it.

The bottom line is, the "reform" you're talking about is dictating to people how to live their lives to be "healthy" and people don't want that. People like being able to decide for themselves.

[Primula Baggins]

First: a basic physical will never cost $20. The basic lab work will cost more than that even in an insurance-free nirvana, and on top of that you've got the doctor and assistant's time, and the doctor at least won't be paid minimum wage. It's not ever going to cost $20.

Second: Plenty of people can't spare $20 (or rather, $50, or $75) for anything they see as optional. They won't get preventive care, any more than uninsured people now do.

Third: Some preventive care is expensive. A mammogram costs $200 to $400, typically (once a year); a colonoscopy costs $1000 to $1500 (every 2 or 5 or 10 years). Even if that cost could be halved, magically, by removing insurance from the equation, people can't or won't pay that much when they don't think they're sick.

[Inanna]

I do find the costs of certain procedures in US just too high. We've had MRIs done in India, and couple of years ago, we had to have an MRI done in US. The MRI in India (an MNC Philips MRI machine, likely to be very similar to the one used in US) cost 100$, the one in US cost ~6000$. Finally, the clinic billed the insurance company for ~4500$. This is just unbelievable, I cannot imagine how the same procedure, with a machine that costs almost the same in two countries can be so much more expensive in US. I don't get it.

[halplm]

I wasn't saying a basic physical would be $20, although I bet you could get it down close to that. I said a visit... you know, when the parent brings their kid in with a runny nose and just wants to know they don't have ebola.

The key difference between my perspective and the idea that people have to have insurance or they won't keep themselves healthy... is that I think each person is responsible for their own health, and the opposing view thinks that the government should make sure everyone does what the government thinks is healthy.

[Ellienor]

Yeah, I don't have vision insurance and when we went to get new lenses for my husband and my daughter's glasses (no new frames, mind you) and replacement contact lenses for my husband, it was over $700.

I don't know what the solution is, but people just being on their own to pay crap like that just doesn't work. I'm in a pretty high bracket of income but $700 just off the top is painful. If it were ten years ago I would just skip it and my daughter would just have to make do with her old glasses that are not strong enough anymore. Well, no, actually, she would get new lenses but my husband and I...tough luck. Actually, a few years ago I had contacts only that were ancient and my glasses were broken, so I just wore my contacts from first thing in the morning to last thing at night. Actually, I had to wear the broken glasses (no side piece on one side) after I had my last baby because I couldn't wear my contacts right away.....

Oh, and we also have no dental, so I have to pay for my own and my family's dental work. If something expensive happens, also out of my pocket.

Sucks.

The idea, is, Hal, that if preventative care and routine care was more easily accessed, then people would not wait until something routine because catastrophic and more expensive. This point of view is borne out by studies, and by the experience in Europe.

[Ellienor]

And each person isn't responsible for their own health. It's like what happened to the banks. Profits are taken for private, but the losses are socialized. Here, the profit entails the amount you save when you don't pay health insurance premiums, and the loss is socialized (the emergency room treats you anyways, courtesy of everyone else, when you break your leg).

So, it's false to say that the alternative system is that people take responsibility for their own health.

And as far as Limbaugh not paying insurance and saving money, I have read that virtually all the superwealthy do not have insurance because, what's the point? Anything they could possibly have done will not cost them more than a fraction of their wealth, so very few have health insurance.

[Griffon64]

The key difference between my perspective and the idea that people have to have insurance or they won't keep themselves healthy... is that I think each person is responsible for their own health, and the opposing view thinks that the government should make sure everyone does what the government thinks is healthy.

If, in general, every person should be responsible for their own health ( or you know, parents for kids, etc etc ) I don't see that as workable unless every person is also directly responsible for the costs that they incur through their decisions. So, if someone uses that freedom to decide not to get an annual basic physical and some screening done as recommended by a doctor, and then comes down with a half million or whatever case of some illness that could have been detected early and treated for much less - well, then I do not want to be the pool of more prudent individuals who have to cough up to fund the first person's irresponsible choices.

And I don't see that happening, ever, where people would be given free rein on their medical choices and then be left twisting in the wind when their choices backfire.

In other words, I do not see this level of freedom translating into lower health care costs. Especially not in a country like the USA, where obesity rates and some other related health indicators like diabetes rates are not looking that good.

I don't have any answers, but that's OK since I'm not an elected official or industry expert. I do expect that a first world country should be able to get a system in place where health care isn't a huge financial drain for many citizens, though. After all, other first world countries have done it.

ETA: cross posted with Ellienor, who made a similar point.