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Read the rules in the OP before posting, please. In order to ensure that this thread continues to meet TL standards and follows the proper guidelines, we will be enforcing the rules in the OP more strictly. Be sure to give them a re-read to refresh your memory! The vast majority of you are contributing in a healthy way, keep it up! NOTE: When providing a source, explain why you feel it is relevant and what purpose it adds to the discussion if it's not obvious. Also take note that unsubstantiated tweets/posts meant only to rekindle old arguments can result in a mod action. | ||
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Sermokala
United States14208 Posts
On February 09 2017 01:54 TheTenthDoc wrote: Can someone Trumpsplain to me what this means? The courts should help me win beacuse I want to win and I'll respect the courts more if they're more helpful to me? I think I missed a win or winning in there but you get the gist of the translation I think. | ||
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Gorsameth
Netherlands22570 Posts
On February 09 2017 01:54 TheTenthDoc wrote: Can someone Trumpsplain to me what this means? "If these Judges want the courts to be respected they should allow my EO". | ||
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WolfintheSheep
Canada14127 Posts
I'd translate it as "I'm always right get off my lawn." | ||
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kwizach
3658 Posts
On February 08 2017 14:01 GreenHorizons wrote: Defending the ACA would be a worse use of time than advocating for Medicate for all. Cruz was right about private insurers doubling profits under the ACA and some of the other shortcomings, even if he distorted them and suggested absurd solutions. Bottom line being, arguing for the ACA is a stupid thing for Democrats to do. More people support a medicare for all option than keeping or repealing the ACA. Why would Democrats want to fight for the ACA when they already won the argument with the American people about Medicare for all being the best choice moving forward. Lamenting that no Democrat had the popularity and/or chutzpah to go out there and try to defend insurer profits doubling, or premiums going up, or keeping doctors/plans, or the other promises that didn't come true says a lot about the state of that wing of the Democratic party. Source Source Arguing for the ACA is absolutely not a stupid thing for Democrats to do, because the GOP is about to attempt to repeal it (which probably contributes to the reform now being more popular than ever). And in order to either successfully prevent the repeal or maximize the negative political fallout for the GOP in case they do repeal it, Democrats must strongly push back against the false narrative that the GOP is trying to promote about the ACA supposedly being in the process of unraveling. The ACA was overall a clear net improvement over what existed before it and it should be strongly defended as such. Sanders didn't do a good job of defending it because he wasn't prepared well enough for the debate. He got a couple of good lines in ("access doesn't mean a damn thing"), but he was unable to effectively refute Cruz' misleading or outright false claims about the costs and disadvantages of the ACA (for example with regards to part-time workers), or even for that matter about European healthcare systems when Sanders started promoting single payer. He was also surprisingly utterly unprepared for the question the hairdresser asked him about not employing more than 49 people because she wouldn't be able to afford providing her employees with healthcare. This was easily one of his most unconvincing answers of the night. He also declared he did not think maternity care coverage costs should be spread out, which was a baffingly wrong answer, failed to defend various aspects of the ACA which are essential to its functioning, and failed to point out how the GOP is responsible for some of its failings. Single payer is not happening under Trump and GOP leadership in Congress, and the priority should be defending the ACA and the people who'll suffer from its repeal. In addition, of course, there's nothing wrong with promoting the benefits of a single payer system, since such as system would indeed be even more of an improvement over the ACA. Even in this respect, however, Sanders was not particularly effective, since despite his sincerity and good will he did not bring numbers and solid arguments to the table in order to counter Cruz' narrative that it would be unfeasible and too costly to have such a system in the US. | ||
KwarK
United States44286 Posts
Insurance is a great way for people with a low average cost but a high potential downside to mitigate risk, if you have a 0.1% chance of having a $100,000 bill then it makes perfect sense for 1,000 people to get together, all put $100 into a pool, and have nobody get fucked if shit hits the fan. That's what insurance is for, taking the statistically average cost of a risk, rather than your actual cost. For a lot of people the statistically average cost of the risk is literally the same number as the actual cost. If you've got a long term chronic condition then the statistically average cost of your likely medication will be the same number as what you actually spend on that medication, and still just as unaffordable. With this in mind, insurance for specific individuals that takes into account their own specific risks is never going to work as a means of providing healthcare to the sick in society. It just can't work. Insurance companies aren't interested in taking a loss on sick individuals, they'll price accordingly and if the person couldn't afford the treatment they won't be able to afford the premium. The only way to make insurance work is through collective contracts which don't examine the specific individual to determine the premium but rather the statistical expected costs of the group as a whole. Some people will be far healthier than average and will be throwing money into insurance which they'll never get back. Others will be known long term costs that would be uninsurable were they not being averaged with a large number of very healthy people who, in effect, subsidize them. If you have employer provided health insurance, this is how it works. The employees are taken as a collective group and offered a group rate. So if you're currently paying health insurance, or getting it taken out of your paycheck as part of your total compensation (you still pay, even if your employer provides it for free), you're already subsidizing your older coworkers (or being subsidized if you're one of the uninsurables). You would be far better off opting out of employer provided health insurance, getting a private health insurance plan after a rigorous health screening for 1/10th the cost and banking the rest of the money. But you're generally not allowed to do that by your employer because it's written into their contract with the insurance provider because they know that if people were allowed to do that then the majority that subsidize the minority would all bail and the health insurance premiums for the minority would reflect their true costs. So, the current employment based system gets around the obvious problem with grouped health insurance plans (the people getting fucked opting out) by trying to make paying insurance premiums mandatory. And that gets us to the ACA. The Census Bureau says that around 55% of Americans are already subscribed to these group insurance plans through their employer. The problem is how to insure the rest. Many of them will be uninsured by choice because they know that they're far too healthy for the health insurance premiums offered to be a good bet, they can self insure for routine costs, and if the very worst happens and they get hit by a $200,000 bill or a lifetime chronic condition, well, they won't be left to die, the state will pick up the check. Others are uninsurable and incapable of getting, or even doing, the kind of work from which you get health insurance. The bill for these also falls on the state because we have collectively decided not to let people die on the street. The ACA wanted to provide affordable insurance for the uninsurable population, but the only way to do that was to force healthy people to subsidize the cost. That is, and always has been, the reality of any group health insurance program. It doesn't matter if it's public or private, state run or employer provided, any group health insurance program relies upon forcing the healthy to subsidize the unhealthy. A lot of people found themselves fucked by the ACA because the direct costs of the uninsurable population were being grouped with their premiums. A lot more resented being forced to buy health insurance. But this is how it had to be. Trump offered those people a way out, while simultaneously promising that the uninsurable population would not lose the coverage funded by the people Trump wants to let out. I'm assuming that the delay in Trump's Executive Order repealing the ACA is due to someone in the White House explaining this concept to him. I have my employer provided health insurance gladly and I don't mind subsidizing those older and less healthy than me. I want a society which takes care of its sick and I know that such a system will inevitably have winners and losers, I accept my lot. I think American politics would be infinitely improved if more people were capable of considering the Veil of Ignorance. If, hypothetically, you asked someone before they were born if those born with genetic conditions should be sentenced to a lifetime of poverty while those without pay nothing, or whether everyone should share the costs with a negligible individual burden, I think most people would pick the latter. But if you ask them once they already know that they're a part of the healthy majority, suddenly they take the view "I'm healthy, why should I have to pay for them". It's a cultural sickness. Take 20 homeless guys, give each an envelope. In 10 envelopes there are the deeds to 2 houses (20 total). The other 10 are empty. If you ask them before they open their envelopes if they'd just like to have a house each and ignore the contents of their own envelopes they'll go for it. If you ask them afterwards it's suddenly "but why should I have to give that bum my vacation home". The bits everyone hates about the ACA are necessary to the ACA. It can't be fixed because it's working as intended. The only way to improve it would be to create a state run insurance company and mandate that everyone pay premiums to that, much like the way many European countries run their public health insurance. | ||
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farvacola
United States18869 Posts
Single Payer or die! Though Germany's system isn't quite single payer and that looks to work fairly well too. | ||
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oneofthem
Cayman Islands24199 Posts
let's say, give them vouchers to the VA system, for example | ||
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ChristianS
United States3304 Posts
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KwarK
United States44286 Posts
On February 09 2017 02:53 farvacola wrote: Quite the appropriate return post, I say. Single Payer or die! Though Germany's system isn't quite single payer and that looks to work fairly well too. Single payer isn't much different from a state provided health insurance system where you pay premiums to the state run insurance company. Your individual risk is grouped with the rest of the nation. They work out the statistical cost of treating the people in that group (the entire nation) and charge everyone a premium. Money comes out of my pay to fund the NHS and I call it the NHS tax but if I were to call it an insurance premium to a state run health insurance company then it'd be essentially the same. Sure, the NHS is vertically integrated, it does the accounting, billing, actuary work, hospitals, clinics, GPs, health checkups, public health programs and so forth, but it's not inconceivable that a healthcare provider could be integrated with a health insurance company. The great trick was to tell people that employer provided health insurance isn't really coming out of their paycheck so it's not like taxes and anyway, it's a great deal because you need health insurance. The reality is that most people don't need health insurance beyond a cost limitation policy and that most people are overpaying and getting fucked because their employer provided plan forces them to subsidize others. And once we pull back the curtain on that it makes a hell of a lot more sense just to get a NHS. | ||
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Mohdoo
United States15743 Posts
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Acrofales
Spain18438 Posts
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KwarK
United States44286 Posts
On February 09 2017 03:01 oneofthem wrote: thing is, i'd prefer a situation where you identify that group of extreme high cost, chronic patients and get more standardized and effective care to them. let's say, give them vouchers to the VA system, for example And then the treasury picks up the bill and the cost is just passed straight back to general taxation which, like buying health insurance since the ACA, is mandatory. Doesn't fix the part people hate. Healthy people don't want to know that they have to subsidize the unhealthy. It's fine with employer provided health insurance because that doesn't cost you anything and nobody really knows how that works, but taxpayers know that high cost patients getting "free" healthcare through the VA is hitting them. The healthy must be forced to subsidize the unhealthy and until they recognize that there is no way around it and that doing so has large upsides they are always going to want to vote for a guy who says "I'll make it so you can have your cake and eat it too". The ACA may be the best part of Obama's legacy honestly, attempting to tackle this problem was always going to be political suicide, the many were always going to have to pay for the few and they're always going to be mad about it. It's certainly far from perfect but it's broken the ground and those who follow him aren't going to have to sacrifice the same kind of political capital he did. Also thanks guys. Honestly the first month I was glad to be away. I QQ'd out of pretty much anything political. I only started really following things again after the inauguration. | ||
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oneofthem
Cayman Islands24199 Posts
On February 09 2017 03:09 KwarK wrote: And then the treasury picks up the bill and the cost is just passed straight back to general taxation which, like buying health insurance since the ACA, is mandatory. Doesn't fix the part people hate. Healthy people don't want to know that they have to subsidize the unhealthy. It's fine with employer provided health insurance because that doesn't cost you anything and nobody really knows how that works, but taxpayers know that high cost patients getting "free" healthcare through the VA is hitting them. not really about magically making the cost disappear, it's a way of more effective cost control. neither insurance(mostly medicare in this case actually) or providers have any incentive to reduce their revenue from the heavy care segment. the va has far lower cost for chronic patients. | ||
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Krikkitone
United States1451 Posts
On February 09 2017 02:51 KwarK wrote: Some people are fundamentally uninsurable. It's the same as home insurance. If you tried to buy flood insurance for your house on a flood plain that flooded annually, or wildfire insurance in the counties that burn down every year, the premium would be equal to the cost of your house. It would have no value. Insurance is a great way for people with a low average cost but a high potential downside to mitigate risk, if you have a 0.1% chance of having a $100,000 bill then it makes perfect sense for 1,000 people to get together, all put $100 into a pool, and have nobody get fucked if shit hits the fan. That's what insurance is for, taking the statistically average cost of a risk, rather than your actual cost. For a lot of people the statistically average cost of the risk is literally the same number as the actual cost. If you've got a long term chronic condition then the statistically average cost of your likely medication will be the same number as what you actually spend on that medication, and still just as unaffordable. The issue becomes that people need insurance against chronic conditions they acquire/their children are born with. That is what is missing, since those are effectively random risks*. Just like having insurance against a seismic event that makes your house's location into a flood zone where it wasn't before. *with controlled known factors like age, smoking/drugs, diet, exercise, etc. that the insurance company can attempt to charge more for if they know. (That doesn't solve the problem of people who Currently have chronic conditions when the system first starts up or people who immigrate to the US with chronic conditions... but that is essentially what is needed going forward) Combine "chronic condition insurance", catastrophic insurance, and some form of health saving (since you know you will cost more as you get older) and you have all the elements that are needed for an ongoing system. | ||
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zlefin
United States7689 Posts
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Thieving Magpie
United States6752 Posts
On February 09 2017 03:42 zlefin wrote: kwark -> it seems a bit odd that you mention flooding, what with the problems with the national flood insurance program charging far too little for some highly at risk properties; and the political will to fix that being somewhat lacking and failing in some of their attempts to do so. That's free market issues isn't it? For the most part, people don't really feel the need to get flood insurance like they feel the need to see a doctor. | ||
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zlefin
United States7689 Posts
On February 09 2017 03:44 Thieving Magpie wrote: That's free market issues isn't it? For the most part, people don't really feel the need to get flood insurance like they feel the need to see a doctor. it's that it's not a free market due to being government run, and not being required to run to actuarially sound standards iirc. so some people are paying more than they should, and some far less. in particular some people just build in dumb/risky places and get functionally subsidized. not sure of all the details, just that there's some wonky things with it. I'd rather just require that homeowner's policies also cover flood damage and let the market sort it out. or a good reason why they don't just do that. | ||
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KwarK
United States44286 Posts
On February 09 2017 03:47 zlefin wrote: it's that it's not a free market due to being government run, and not being required to run to actuarially sound standards iirc. so some people are paying more than they should, and some far less. in particular some people just build in dumb/risky places and get functionally subsidized. not sure of all the details, just that there's some wonky things with it. I'd rather just require that homeowner's policies also cover flood damage and let the market sort it out. or a good reason why they don't just do that. I thought insurers generally don't include catastrophes in homeowners insurance. Flood, volcano, earthquakes etc are normally excluded as being too big to insure. Either way, it's not really comparable to health insurance. People can move away from floodplains, they can't move out of their bodies. And houses don't get inevitably more waterlogged until they eventually submerge the way that people get old and die. | ||
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zlefin
United States7689 Posts
On February 09 2017 03:52 KwarK wrote: I thought insurers generally don't take on catastrophes. Flood, volcano, earthquakes etc are normally excluded as being too big to insure. Either way, it's not really comparable to health insurance. People can move away from floodplains, they can't move out of their houses. And houses don't get inevitably more waterlogged until they eventually submerge the way that people get old and die. I guess catastrophes used to be too big to insure, that would make sense historically, but in the modern economies, with how much international finance there is, and reinsurance, it should be possible to cover natural disasters fine. it's not like it's 1850 wherein getting finance of the scope necessary to cover a major disaster might be impractical. | ||
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Thieving Magpie
United States6752 Posts
On February 09 2017 03:47 zlefin wrote: it's that it's not a free market due to being government run, and not being required to run to actuarially sound standards iirc. so some people are paying more than they should, and some far less. in particular some people just build in dumb/risky places and get functionally subsidized. not sure of all the details, just that there's some wonky things with it. I'd rather just require that homeowner's policies also cover flood damage and let the market sort it out. or a good reason why they don't just do that. You're talking about FEMA right? https://www.fema.gov/national-flood-insurance-program If you're really interested in the federal program running flood insurance just read up on it and let us know. | ||
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