Obama on Letterman....

[Azure]

Originally Posted by Gozer

So you strongly support dropping costs but anyone who can't afford it shouldn't get it.

Is that fair?

I suppose you missed the part where I said after proper reform, the public option should be considered.

[Shazam]

Originally Posted by Gozer

So you strongly support dropping costs but anyone who can't afford it shouldn't get it.

Is that fair?

This is not a dig at Azure, but I don't think he really has any idea of how American health care works other than in the very abstract.

[Gozer]

Originally Posted by Azure

People have a problem affording health care coverage in the US. That is a known problem. So wouldn't it help if the first thing you did was try to bring down those costs by creating more competition, by implementing tort reform, by introducing regulation that keeps insurance companies from screwing over people they agreed to cover, and SHOULD be covering instead of just using government taxpayer funded money to create the illusion that none of those problems exist because the person directly by the health care isn't paying as much?.

"Competition" models don't work in health care because the object of health care is to ensure health across the board, not to reduce costs and maximize profit. Maximizing profits means less goes to care and more goes to shareholders. Profit should not be part of the health care equation. Moreover, competition assumes that consumers are well enough informed to know what they need and they don't, so they cannot shop intelligently.

[CaptainCrunch]

Originally Posted by Gozer

So you strongly support dropping costs but anyone who can't afford it shouldn't get it.

Is that fair?

If you look at his whole concept and the government regulates the insurance industry then the reduction in costs should lead to a reduction in premiums to a more reasonable level where it can either be covered by the individual or through the tax system.

But to me, government controlled health care while its nice because you don't really see your bill is not cost controlled by the states in any kind of competant manner.

Canada's health care system to a large extent is having a lot of problems in terms of delivery because the government doesn't treat it as a business where your cost control should come at the expense of the overwhelming beaurocracy which is being run like a job creation program.

Hospitals are badly under equipted and under bedded nurses to me are over worked and underpaid as are some of the other fields at work because the government knows nothing about running a health care system and are treating it like another government department where you throw money at the problem with very little oversite and hope that the problem fixes itself, and its not that simple.

Meaningfull reform is not just about the insurance industry in the U.S. or the costs to the average joe. Meaningful reform should be auditing the health care system overall and making it more cost effective and at least zero profit or slightly profitable so that any excess cash can either be returned to the tax payer, or rammed into improvements.

[CaptainCrunch]

Originally Posted by Gozer

"Competition" models don't work in health care because the object of health care is to ensure health across the board, not to reduce costs and maximize profit. Maximizing profits means less goes to care and more goes to shareholders. Profit should not be part of the health care equation. Moreover, competition assumes that consumers are well enough informed to know what they need and they don't, so they cannot shop intelligently.

I somewhat disagree with this.

If you set standards and then have a competition model then the profits or dollars will be saved by looking at how the system operates and not the delivery of a satisfactory product, and thats what health care is, a product.

If you defined things like waiting times, average number of beds per region or area, minimum equipment requirements and number of doctors and nurses per patient and make that the 10 commandments of health care then in order to be profitable you have to look at other areas of the system that are maybe not patient facing as cost control centers.

[Iowa_Flames_Fan]

Originally Posted by Azure

That proper reform NOT subsidization, should be introduced to help bring down those costs so that more people can afford insurance.

I'm curious as to what, specifically, you mean by "proper reform."

It sounds like we agree about the main problem that is faced by health care in the U.S. (and, to a lesser extent, Canada) right now: rising costs. But I'm not really clear about how you plan to solve it. You've mentioned tort reform, but that's a measure that although it might slightly limit the money that victims of malpractice are entitled to, is unlikely to do anything to address the real problem, which is cost of services.

I guess I'm not persuaded that you have an idea for "proper reform" beyond not liking the one that Obama is backing, and that was drafted by congressional democrats.

I don't love it either, but my feeling is that my reasons are different; I don't like it because it's overly complex, because it includes massive payouts to insurance companies and pharmaceuticals, and because it is a very unambitious sort of reform, one which basically attempts to work within the existing billing structure to create equality of access, but does nothing to address cost. It creates better access, and may distribute the cost more equitably, but it doesn't bring it down.

Your reasons are a bit harder to discern: you criticize Medicare--based on high costs--but isn't it quite probable that high medicare costs are related to the high cost of medical service in the U.S.? You criticize the public option, because you think it's similar to Freddie Mac and Fannie Mae--this one puzzles me, because a better analogy would be social security.

Most puzzling of all, you don't seem to disagree in principle with the idea that health care should be accessible to all people in a developed nation. If that's so, then you've essentially said that the most important issue to you is access--which is the only problem this bill actually addresses!

I think that if you knew more about the Congressional Democrats' bill, you might actually agree with it. That is, you would if it were called "the libertarian, freedom-loving, individual rights and democracy social-liberal-but-fiscal-conservative bill."

[Azure]

Originally Posted by Gozer

"Competition" models don't work in health care because the object of health care is to ensure health across the board, not to reduce costs and maximize profit. Maximizing profits means less goes to care and more goes to shareholders. Profit should not be part of the health care equation. Moreover, competition assumes that consumers are well enough informed to know what they need and they don't, so they cannot shop intelligently.

I never said that costs will be made minimal and everyone will be profitable. I just said that with certain reform, costs could be reduced. Which is all Obamacare is supposed to do too. Reduce the costs of insurance.

And I don't necessarily agree that adding more insurers to the mix will not increase the competition which should decrease prices.

Obviously the President himself believes the lack of insurers is a problem, considering he cited it last night. He just said it with unbelievable stupidity considering the only thing stopping insurers from operating outside the state is government regulation.

[Iowa_Flames_Fan]

Originally Posted by Azure

Obviously the President himself believes the lack of insurers is a problem, considering he cited it last night. He just said it with unbelievable stupidity considering the only thing stopping insurers from operating outside the state is government regulation.

Previously, you've said that health care should be a state issue, and that the Feds shouldn't interfere. Now you're criticizing the President for state regulations of insurance companies?

Colour me confused.

[Azure]

Originally Posted by Iowa_Flames_Fan

I'm curious as to what, specifically, you mean by "proper reform."

I'm not going to go into specifics again, and I can't find my other post where I explained what reforms I would advocate, but there are certain things that can be done to help lower the costs.

In short....

http://online.wsj.com/article/SB1000...072865070.html

[EddyBeers]

Originally Posted by Azure

Obviously the President himself believes the lack of insurers is a problem, considering he cited it last night. He just said it with unbelievable stupidity considering the only thing stopping insurers from operating outside the state is government regulation.

Gold, I agree, Obama should just wipe out the over 1,900 State regulations that make interstate competition virtually impossible. Get on with that Obama, first stop Mississippi. Come down there and order the State government to rescind all health care regulation so that you can create a national health care market.

[EddyBeers]

Originally Posted by Azure

I'm not going to go into specifics again, and I can't find my other post where I explained what reforms I would advocate, but there are certain things that can be done to help lower the costs.

In short....

http://online.wsj.com/article/SB1000...072865070.html

• Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

So you want Obama to march into the each individual state and order them to repeal all state laws that prevent insurance companies from operating across state lines?

[Azure]

Originally Posted by Iowa_Flames_Fan

Previously, you've said that health care should be a state issue, and that the Feds shouldn't interfere. Now you're criticizing the President for state regulations of insurance companies?

Colour me confused.

Obama has never once suggested that the state regulation of insurance companies be reformed and yet he is complaining about the lack of insurers for people to choose from.

Like I said, unbelievably stupid.

And it has nothing to do with wanting state control over health care either.

Nor did I ever say the Feds shouldn't interfere. If you would actually bother to read what I said in the 2,000 posts I made about this subject, instead of just resorting to stupid rhetoric, you'd notice that I said the execution of the actual health care should be state controlled. I have no problem with something similar to the Canadian Health Act being enforced by the US government to make sure each state follows the same regulations. And part of that health act, assuming that there still is a private option on the table should be that each state allows out of state competition by insurance companies.

[Azure]

Originally Posted by EddyBeers

Gold, I agree, Obama should just wipe out the over 1,900 State regulations that make interstate competition virtually impossible. Get on with that Obama, first stop Mississippi. Come down there and order the State government to rescind all health care regulation so that you can create a national health care market.

Originally Posted by EddyBeers

So you want Obama to march into the each individual state and order them to repeal all state laws that prevent insurance companies from operating across state lines?

Did I ever say that?

People are looking towards Obama, and not their state governments for health care reform. Part of the reform he should be pushing for is allowing insurers to operate out of state lines. Is he? No. Has he ever even talked about this issue outside of last night? No.

So why would he complain about the lack of insurers when he's not even suggesting to Congress to work with each state and include the reform as part of the health care bill?

[Gozer]

I've never heard the other side of the state-controlled insurance debate.

Is there fear that dropping the restrictions will result in rich states buying all the insurance in poor states and driving up their prices?

[Azure]

Originally Posted by Gozer

I've never heard the other side of the state-controlled insurance debate.

Is there fear that dropping the restrictions will result in rich states buying all the insurance in poor states and driving up their prices?

The way I understand it, each state just prohibits the insurance companies in their state to operate in another state.

Which, when people move from one state to another, creates a massive headache. Especially when its tough to find good insurance in the first place.

I don't think it has anything to do with state-controlled insurance, as in a state run insurance program.

People should be able to buy a nationwide insurance that covers them everywhere they move or go to.

And Obama should be trying to work with each state to repeal those ridiculous laws.

[Azure]

Another reason to repel those stupid state laws is so that insurance companies can operate country wide, appeal to a broader audience, obtain more customers(or lose them all cause their coverage sucks)...and offer better rates due to competition and more customers as well.

Its not fair that people in smaller states like Idaho might have to pay more for insurance than people in New York would have simply because the insurance company in New York has more customers and more revenue, and therefore can offer lower rates, while the people in Idaho have to pay more for insurance, because the insurance companies there deal with the SAME costs, but less revenue due to less potential customers.

EDIT: I just looked up auto insurance, and they can operate out of state jurisdiction. Same thing should happen with health care.

[EddyBeers]

Originally Posted by Azure

Did I ever say that?

People are looking towards Obama, and not their state governments for health care reform. Part of the reform he should be pushing for is allowing insurers to operate out of state lines. Is he? No. Has he ever even talked about this issue outside of last night? No.

So why would he complain about the lack of insurers when he's not even suggesting to Congress to work with each state and include the reform as part of the health care bill?

I imagine that Obama thinks there are two ways to skin a cat and also correctly believes that trying to get 50 states to agree to a federal intrusion into their right to regualte state commerce would have a likelihood of success on par with passing a bill that includes a single payer health care system, constitutional recognition of gay marriage and taxpayer funded abortions. That dog just would not hunt (abolishing state regulations of commerce).

Although I would encourage Boehner, Cantor, McConnell and the rest of the GOP braintrust to make it a major part of their 2010 platform. "We, the GOP, as part of our on-going efforts to reform health care, have included as a major plank our initiative to grant the federal government the power to regulate individuals states legislation concerning commerce". I think such a plank might save Pelosi's House majority and would likely allow her to increase her seat totals.

[Gozer]

Originally Posted by Azure

Its not fair that people in smaller states like Idaho might have to pay more for insurance than people in New York would have simply because the insurance company in New York has more customers and more revenue, and therefore can offer lower rates, while the people in Idaho have to pay more for insurance, because the insurance companies there deal with the SAME costs, but less revenue due to less potential customers.

Costs in Idaho are not the same as costs in New York.

I suspect (I'm trying to expand my knowledge in the area) that these laws are there to prevent customers in New York (where rent employees and doctors are expensive) from buying insurance in Idaho (where everything is cheaper) which causes Idaho's market to be inflated.

Regardless, the problem with your theory is that at some point it becomes a zero-sum game where insurance companies in state A are not competitive with state B (for whatever reason) and premiums normalize nationally. In a truly macabre twist, the insurance employees in state A join the long line of the "tough bananas" crowd trying to afford insurance that will rise for as many states as it will drop.

Is this the kind of progressive reform that is a better solution than subsidies?

edit: that's not even addressing the hysteria that would overcome the political right if he started mandating state commerce

[Iowa_Flames_Fan]

Originally Posted by Azure

People are looking towards Obama, and not their state governments for health care reform. Part of the reform he should be pushing for is allowing insurers to operate out of state lines. Is he? No. Has he ever even talked about this issue outside of last night? No.

So the only way Obama can be a success in your mind is if he gets all 50 states to simultaneously change their own regulatory systems.

I'm beginning to understand why you don't like him. Anything he does, you'll just invent something even more impossible that he didn't do yet.

It's called the utopia fallacy. Sure, it would be great if the health care industry were regulated by the feds rather than the states (which is what you're advocating, btw). However, this is not practical. Your argument is that unless Obama does that (which we can probably agree is impossible) he can't do anything at all. That's fallacious reasoning. Just because you can't do X,Y and Z together doesn't mean you shouldn't do just X and Y.

Not to mention that you're calling him "stupid" for even talking about this issue at all! So to sum up--you'd prefer that he eliminate all state regulations of the insurance industry, in the process trampling states' rights and arrogating to the federal government regulatory authority over something that it does not currently have--and to do it without telling anyone about it, ever!

And I'm the one who's using rhetoric? Seriously--Obama can't win with you. He should go back to saving starving children from tigers.

In all honesty, if you want to avoid giving the impression that you hate Obama because you just don't like him, then you should at least outline reasonable criteria by which you might judge him to be successful. If nothing could possibly please you, then that's a pretty good indication that your objections are personal and ideological, not practical.

[Iowa_Flames_Fan]

Originally Posted by Azure

I'm not going to go into specifics again, and I can't find my other post where I explained what reforms I would advocate, but there are certain things that can be done to help lower the costs.

In short....

http://online.wsj.com/article/SB1000...072865070.html

OK, that helps a lot. Let's do this point-by-point:

• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs).
The author never specifies what these legal obstacles are--and his example is a program that already exists at Whole Foods, making it pretty unlikely that these legal obstacles are particularly burdensome. In any case, this is a band-aid reform, and one that would do nothing for the problem of the uninsured and access.

• Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.

Good idea. That might be why Obama's plan does this. Check, and check.

• Repeal all state laws which prevent insurance companies from competing across state lines.

LOL!!!!!!

• Repeal government mandates regarding what insurance companies must cover.
THAT's a good idea. Allow the insurance companies to pick and choose what services make financial sense for them to cover, and let the consumer pay for the rest. That's just.... well, ruinously stupid doesn't quite cover it.

• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year.

Tort reform is a favourite canard of the right. Miniscule savings at best--and then we're just going to hope that those tiny savings are passed on to the consumer... just because doctors and insurance companies are good people? Forgive me for being slightly more cynical about human nature.

• Make costs transparent so that consumers understand what health-care treatments cost.

Hmm. Good idea. So we should create government regulation to control billing practices? I like the way this guy thinks.

• Enact Medicare reform.

Er.... Okay? Sure. Let's do that. Next year. This year we're kinda busy.

• Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.
Right, because charitable contributions aren't already tax deductible.