Current Odds: "The US Supreme Court to rule individual mandate unconstitutional before midnight ET 31 Dec 2012", 77.3% chance

  • Posted by a hidden member.
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    Jun 23, 2012 8:07 PM GMT
    I would not have pegged the odds to be this high... but if you're in a betting mood... so I guess the real question is whether or not they strike down the mandate or the entire act.

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    Jun 23, 2012 8:36 PM GMT
    Jonathan Chait in New York magazine tries to explain what happens to the administration's healthcare reform law, depending on which parts of it the supreme court overturns:

    In ascending order, the Court might:

    1. Leave it all in place.

    2. Technically eliminate the mandate to buy health care while leaving in place the fine for not having health insurance. (Essentially upholding the fine as a tax while technically eliminating the requirement.)

    3. Eliminate the mandate, and the fine, but leave in place the regulations that insurance companies not discriminate against people with health risks and the subsidies for buying insurance.

    4. Eliminate the mandate, the fine, insurance regulations, and the subsidies.

    5. Nuke the entire law.

    The main point to keep in mind, says Chait, is that "the most likely scenarios in which the Court finds the mandate unconstitutional still leave most of the law in place."
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    Jun 23, 2012 9:03 PM GMT
    Ex_Mil8 saidJonathan Chait in New York magazine tries to explain what happens to the administration's healthcare reform law, depending on which parts of it the supreme court overturns:

    In ascending order, the Court might:

    1. Leave it all in place.

    2. Technically eliminate the mandate to buy health care while leaving in place the fine for not having health insurance. (Essentially upholding the fine as a tax while technically eliminating the requirement.)

    3. Eliminate the mandate, and the fine, but leave in place the regulations that insurance companies not discriminate against people with health risks and the subsidies for buying insurance.

    4. Eliminate the mandate, the fine, insurance regulations, and the subsidies.

    5. Nuke the entire law.

    The main point to keep in mind, says Chait, is that "the most likely scenarios in which the Court finds the mandate unconstitutional still leave most of the law in place."


    I suspect that's a distinct possibility. Not sure that it's a probability though - too bad they don't have a betting market on that. Chait has a history of being wrong as do most pundits - because they're paid to be polemics.
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    Jun 23, 2012 9:08 PM GMT
    i find this tragic. Really absolutely tragic

    People, brainwashed by advertising, foolishly fight against their own best interests

    It really hurts me. But it hurts them more... fighting to deny themselves affordable healthcare

    It´s a genuine tragedy and undermines the USA´s claim to be a civilised society.
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    Jun 23, 2012 9:11 PM GMT
    GonzoTheGreat saidi find this tragic. Really absolutely tragic

    People, brainwashed by advertising, foolishly fight against their own best interests

    It really hurts me. But it hurts them more... fighting to deny themselves affordable healthcare

    It´s a genuine tragedy and undermines the USA´s claim to be a civilised society.


    And I think you're an idiot if you think that this poorly written bill that is likely to have at least parts of it to be found unconstitutional to be the gateway to a civilized society. It's kind of presumptuous and arrogant to believe that you know better for others than they do themselves - but that's pretty typical of smug liberals - especially ones abroad who despise the wealth and power of Americans. But hey that's just me.
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    Jun 23, 2012 9:24 PM GMT
    riddler78 said
    GonzoTheGreat saidi find this tragic. Really absolutely tragic

    People, brainwashed by advertising, foolishly fight against their own best interests

    It really hurts me. But it hurts them more... fighting to deny themselves affordable healthcare

    It´s a genuine tragedy and undermines the USA´s claim to be a civilised society.


    And I think you're an idiot if you think that this poorly written bill that is likely to have at least parts of it to be found unconstitutional to be the gateway to a civilized society. It's kind of presumptuous and arrogant to believe that you know better for others than they do themselves - but that's pretty typical of smug liberals - especially ones abroad who despise the wealth and power of Americans. But hey that's just me.


    We tend to take universal health care for granted here in the UK. It is far from perfect, but most people who actually use it think it is excellent. I think the US is a great country, but you have to admit, its health care system is woeful if you are poor or uninsurable.

    "They came with rotting teeth, shattered glasses and broken bodies. In the predawn darkness outside the Los Angeles Sports Arena, they lined up last year by the thousands, waiting as the sun burned their backs for healthcare they could not afford."

    images?q=tbn:ANd9GcSxKuUpkSB8uE70p38A_eH

    http://articles.latimes.com/2011/oct/16/local/la-me-free-clinic-20111016
  • nanidesukedo

    Posts: 1036

    Jun 23, 2012 9:28 PM GMT
    riddler78 said
    GonzoTheGreat saidi find this tragic. Really absolutely tragic

    People, brainwashed by advertising, foolishly fight against their own best interests

    It really hurts me. But it hurts them more... fighting to deny themselves affordable healthcare

    It´s a genuine tragedy and undermines the USA´s claim to be a civilised society.


    And I think you're an idiot if you think that this poorly written bill that is likely to have at least parts of it to be found unconstitutional to be the gateway to a civilized society. It's kind of presumptuous and arrogant to believe that you know better for others than they do themselves - but that's pretty typical of smug liberals - especially ones abroad who despise the wealth and power of Americans. But hey that's just me.



    Damn right. Insurance is stupid for "healthy" people. I mean, the ED is free, ain't it? Not like all those people without insurance and no way to pay that go to the ED in accidents or tragic turns of health (forseen or unforseen, preventable or not) have an effect on the rising cost of healthcare.

    I mean, if you are healthy now, there's no way your insurance would ever be so cruel as to kick you off when you need it most.

    Born with a congenital birth defect? God obviously hates you and it should be harder for you to live/make ends meet because of it.

    Preventative care? Who needs that - people can take care of themselves. Pregnancy? be abstinent. Can't afford to go to a PCP to get your lipids, BP, blood glucose, thyroid..etc checked.. Nope, not gonna cost a shit ton when everything crashes down - they could've prevented it themselves with better diet and exercise.

    Here's the thing: This really is an issue where the American public doesn't know how difficult it can be to manage healthcare costs if one gets ill.

    People come in every day freaking out because they've fallen in the "doughnut hole."
    They come in with accidents and unforseen illness (healthy people before this) with no insurance and now have bills that can be tens of thousands of dollars (If bad enough, 100,000 dollars++).

    Now that they have the illness, no insurance will touch them (at least nothing affordable - high risk pools are NOT affordable for the large majority of Americans).

    Insurance kicks people off all the time for any reason they can find, leaving people who were secure before completely screwed financially.

    Is the bill perfect? No. It fixes so many loopholes that the public doesn't know exist... The same way that people don't know the tax code and how taxes work on the intricate level, the public obviously doesn't know how insurance and the healthcare system works besides what they see on TV and that they are being told that they have to have health insurance.

    Not only does the law patch up many of these holes, it addresses a very, very fundamental concern: If you have no health insurance and you aren't a millionaire/very well off, you are quite possibly gonna jack up the cost of healthcare for everyone else.

    Part of me hopes that this does get ruled unconstitutional so we can get to working on a single payer, universal system.
  • Posted by a hidden member.
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    Jun 23, 2012 9:32 PM GMT
    american health care provision (not the actual quality of the care if you can afford it) is an international scandal.

    period.


    Oh, and "despise the power and wealth of america"

    hahahahahahahhaa

    haaaaaaaaaaahahahahahhaa

    I love that line. It´s up their with "hate our freedoms" and "why do they hate us" for delusion.
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    Jun 23, 2012 9:47 PM GMT
    Ex_Mil8 said
    riddler78 said
    GonzoTheGreat saidi find this tragic. Really absolutely tragic

    People, brainwashed by advertising, foolishly fight against their own best interests

    It really hurts me. But it hurts them more... fighting to deny themselves affordable healthcare

    It´s a genuine tragedy and undermines the USA´s claim to be a civilised society.


    And I think you're an idiot if you think that this poorly written bill that is likely to have at least parts of it to be found unconstitutional to be the gateway to a civilized society. It's kind of presumptuous and arrogant to believe that you know better for others than they do themselves - but that's pretty typical of smug liberals - especially ones abroad who despise the wealth and power of Americans. But hey that's just me.


    We tend to take universal health care for granted here in the UK. It is far from perfect, but most people who actually use it think it is excellent. I think the US is a great country, but you have to admit, its health care system is woeful if you are poor or uninsurable.

    "They came with rotting teeth, shattered glasses and broken bodies. In the predawn darkness outside the Los Angeles Sports Arena, they lined up last year by the thousands, waiting as the sun burned their backs for healthcare they could not afford."

    images?q=tbn:ANd9GcSxKuUpkSB8uE70p38A_eH

    http://articles.latimes.com/2011/oct/16/local/la-me-free-clinic-20111016


    I'd absolutely agree that the healthcare system in the US is horribly structured - but there are alternatives that have been slowly built in. What is incredible to me as someone who does travel a bit for those who debate healthcare here is that the Canadian system of universal healthcare or the American one is always presented as a binary choice as if there aren't a plethora of other models to look at around the world like Singapore or even Hong Kong.

    This bill makes things worse all around. They even sought to limit health savings accounts that at least attempts to put some of the responsibility for costs on individuals rather than third party payors. The tax code is one of the reasons that the Americans find themselves in the situation they are today - which is a throw back to the second world war (much like ownership restrictions for airlines). They should first either eliminate the healthcare deduction for businesses or open it up for individuals as well so that healthcare insurance can be portable and individuals take greater responsibilty for plans that work best for them.

    Finally, it's ludicrous that while there are certainly those who both want insurance and can't afford it (given that there are many who don't want healthcare insurance), that the system has to be changed for everyone. No, healthcare insurance is not just for the healthy as evidenced by the fact that while there are some Americans who do not have healthcare insurance, the large majority do have access to some form or another. It's even worse that the US spends more per capita on Medicare/Medicaid than Canada spends per capita - especially since in the US, most people aren't even eligible for Medicare/Medicaid.

    For those who believe in public healthcare, you know, perhaps you should figure out how to fix the spending in place already first.
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    Jun 23, 2012 9:53 PM GMT
    Ex_Mil8 saidJonathan Chait in New York magazine tries to explain what happens to the administration's healthcare reform law, depending on which parts of it the supreme court overturns:

    In ascending order, the Court might:

    1. Leave it all in place.

    2. Technically eliminate the mandate to buy health care while leaving in place the fine for not having health insurance. (Essentially upholding the fine as a tax while technically eliminating the requirement.)

    3. Eliminate the mandate, and the fine, but leave in place the regulations that insurance companies not discriminate against people with health risks and the subsidies for buying insurance.

    4. Eliminate the mandate, the fine, insurance regulations, and the subsidies.

    5. Nuke the entire law.

    The main point to keep in mind, says Chait, is that "the most likely scenarios in which the Court finds the mandate unconstitutional still leave most of the law in place."


    PS: http://dailycaller.com/2012/06/22/pelosi-if-mandate-ruled-unconstitutional-rest-of-health-law-wont-work-video/

    If the Supreme Court rules the individual mandate unconstitutional, House Minority Leader Nancy Pelosi said the rest of the health care law wouldn’t work from a “financial standpoint.”

    “Well, just to borrow a Supreme Court metaphor, you have to eat your vegetables,” Pelosi said at her weekly press briefing Thursday. You have to have the mandate in order for this to work from a financial standpoint but it doesn’t mean that — in other words, we want to keep those in place. The biggest difference in the lives of the American people — well, let me say one of, because — in terms of this legislation is that you cannot be deprived of coverage if you have a pre-existing medical condition. This is huge.”

    In addition to preventing insurance companies from denying those with pre-existing conditions, the Patients Bill of Rights portion of the law also allows individuals under 26 years of age to stay on their parents’ health plan.

    “The insurance companies even say that they really can’t do that unless the premiums skyrocket,” Pelosi continued. “So if the American people like the idea that they can — they and their children for a lifetime — cannot be deprived of health care and health insurance because of a pre-existing medical condition, than that will require some other action in order for that to happen.”
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    Jun 23, 2012 10:13 PM GMT
    riddler78 said What is incredible to me as someone who does travel a bit for those who debate healthcare here is that the Canadian system of universal healthcare or the American one is always presented as a binary choice as if there aren't a plethora of other models to look at around the world like Singapore or even Hong Kong.


    Explain.

    Here's what I know about Hong Kong's health system (after all, we were a British colony):
    1. Universal public option with very little copays. Care options are initially restrained by cost--e.g. if you can do peritoneal dialysis (the cheaper option), you have to do it, unless there's a medical contraindication or you can pay for hemodialysis yourself. Wait lines for clinic visits are long but you get care eventually.
    2. People who can pay for private care out of pocket can do so. There are many private hospitals in Hong Kong who take cash, as well as private practitioners.

    People in Hong Kong don't mind a 2-tiered system, going from the most "socialist" to the most "capitalist." Let's imagine how that works in the US. icon_lol.gif
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    Jun 23, 2012 10:29 PM GMT
    q1w2e3 said
    riddler78 said What is incredible to me as someone who does travel a bit for those who debate healthcare here is that the Canadian system of universal healthcare or the American one is always presented as a binary choice as if there aren't a plethora of other models to look at around the world like Singapore or even Hong Kong.


    Explain.

    Here's what I know about Hong Kong's health system (after all, we were a British colony):
    1. Universal public option with very little copays. Care options are initially restrained by cost--e.g. if you can do peritoneal dialysis (the cheaper option), you have to do it, unless there's a medical contraindication or you can pay for hemodialysis yourself. Wait lines for clinic visits are long but you get care eventually.
    2. People who can pay for private care out of pocket can do so. There are many private hospitals in Hong Kong who take cash, as well as private practitioners.

    People in Hong Kong don't mind a 2-tiered system, going from the most "socialist" to the most "capitalist." Let's imagine how that works in the US. icon_lol.gif


    That sounds about right. I recently had to go to a clinic in HK, paid out of pocket - was pretty reasonable - about $30 bucks to see a doctor including the prescription and it was fast. As noted however, the US has enough money to provide for a universal public option because it spends more per capita than Canadians do despite the fact only a small minority of Americans are even eligible for these programs.

    Personally, I think it makes sense to have a system for the poorest of Americans - but why should the system change for all Americans?

    One of the key problems is that entitlement programs keep getting bigger and more unwieldy and while this can provide for some political capital in the short run, it sells out not only taxpayers but also primary beneficiaries and those who need these services the most because they are unsustainable. So here's my question to you: Given that medicare/medicaid funds are spent so poorly why should other Americans trust the same system that regulates and manages these programs with more money and authority?
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    Jun 23, 2012 10:34 PM GMT
    So you agree with the IPAB-like manner of rationing care then? (It goes much farther than the IPAB--if you need dialysis and you can't pay for it yourself, you HAVE to do peritoneal dialysis because it's cheaper. Tell that to the libertarians and Republicans.

    I totally agree that there should be a public option. THAT would be changing the system for everybody. Having everybody buy (or have help buying) insurance is a minute change at best compared to that.

    The public option was not included and the individual mandate was included in the ACA to court Republican votes. Explain that to the Republicans.

    Just so you know, as currently formulated, the AMA (consistent with their principles on ethics) does not endorse a multi-tiered system.
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    Jun 23, 2012 10:35 PM GMT
    q1w2e3 saidI totally agree that there should be a public option. THAT would be changing the system for everybody. Having everybody buy (or have help buying) insurance is a minute change at best compared to that.

    The public option was not included and the individual mandate was included in the ACA to court Republican votes. Explain that to the Republicans.

    Just so you know, as currently formulated, the AMA (consistent with their principles on ethics) does not endorse a multi-tiered system.


    You avoided my question I see. I would suggest that there shouldn't be a public option until this question is answered and resolved: Given that medicare/medicaid funds are spent so poorly why should other Americans trust the same system that regulates and manages these programs with more money and authority?
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    Jun 23, 2012 10:39 PM GMT
    It's your own opinion that Medicare funds are spent poorly. I know plenty of people that say that its administrative costs are much lower. True, there's fraud, but tell me there isn't any fraud with private insurances. (If so, why are there so many settlements with insurance companies with the federal government).
    http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/
    How about if you think of having the IPAB multiplied 10 times and applying that to the US, if you like Hong Kong's system? icon_lol.gif

    BTW, we already have the private pay-for-service part in the US. It's never really gone away, and is on the upswing with concierge practices. We just don't have the equivalent public option in the US.
  • conservativej...

    Posts: 2465

    Jun 24, 2012 1:17 AM GMT
    riddler78 saidI would not have pegged the odds to be this high... but if you're in a betting mood... so I guess the real question is whether or not they strike down the mandate or the entire act.

    http://www.intrade.com/v4/markets/contract/?contractId=745353


    I think we will see the decision next week before the court
    adjourns for summer recess. I do not know the content of the decision. I do know from poeple inside the court, that the decision has been printed.

    My odds:

    Striking down the mandate 9 to 1 in favor of the strike.

    Trashing the entire bill .... odds of 6 to 4 to trash the entire bill. (Or 3 to 2 for you purists.)
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    Jun 24, 2012 4:03 AM GMT
    q1w2e3 saidIt's your own opinion that Medicare funds are spent poorly. I know plenty of people that say that its administrative costs are much lower. True, there's fraud, but tell me there isn't any fraud with private insurances. (If so, why are there so many settlements with insurance companies with the federal government).
    http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/
    How about if you think of having the IPAB multiplied 10 times and applying that to the US, if you like Hong Kong's system? icon_lol.gif

    BTW, we already have the private pay-for-service part in the US. It's never really gone away, and is on the upswing with concierge practices. We just don't have the equivalent public option in the US.


    I'm not even talking about the fraud or the administrative expenses. Why is it that Canada can provide universal healthcare to everyone at a cost that's lower than the cost per capita that what the US spends on medicare/medicaid? Do you acknowledge that only 15-20% of Americans even qualify for Medicare/Medicaid? This means that Americans ALREADY spend 5-6 times more on medicare/medicaid recipients than Canada does. That's an objective fact. Once you acknowledge that fact, can you still claim that Medicare funds are spent well?

    Would you make the argument that Medicare/Medicaid recipients have a quality of care that is 5-6x better than Canada's healthcare system?

    I know you have private pay for service - the public option isn't really necessary if you have an alternative for the poorest. But further, again, why would you trust the same system that regulates and manages Medicare/Medicaid with more money and authority?
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    Jun 24, 2012 4:09 AM GMT
    riddler78 said< the wealth and power of Americans. But hey that's just me.
    Actually, it will NEVER be you!
    Thankfully!icon_wink.gif
  • Webster666

    Posts: 9217

    Jun 24, 2012 4:24 AM GMT
    Regardless of what the Republican Supreme Court decides, as long as there are health insurance companies, we'll be paying a fortune for health care.
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    Jun 24, 2012 2:24 PM GMT
    riddler78 said
    q1w2e3 saidIt's your own opinion that Medicare funds are spent poorly. I know plenty of people that say that its administrative costs are much lower. True, there's fraud, but tell me there isn't any fraud with private insurances. (If so, why are there so many settlements with insurance companies with the federal government).
    http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/
    How about if you think of having the IPAB multiplied 10 times and applying that to the US, if you like Hong Kong's system? icon_lol.gif

    BTW, we already have the private pay-for-service part in the US. It's never really gone away, and is on the upswing with concierge practices. We just don't have the equivalent public option in the US.


    I'm not even talking about the fraud or the administrative expenses. Why is it that Canada can provide universal healthcare to everyone at a cost that's lower than the cost per capita that what the US spends on medicare/medicaid? Do you acknowledge that only 15-20% of Americans even qualify for Medicare/Medicaid? This means that Americans ALREADY spend 5-6 times more on medicare/medicaid recipients than Canada does. That's an objective fact. Once you acknowledge that fact, can you still claim that Medicare funds are spent well?

    Would you make the argument that Medicare/Medicaid recipients have a quality of care that is 5-6x better than Canada's healthcare system?

    I know you have private pay for service - the public option isn't really necessary if you have an alternative for the poorest. But further, again, why would you trust the same system that regulates and manages Medicare/Medicaid with more money and authority?


    Now you're being unfair. You do realize that the US cost of healthcare is higher not just in Medicare/Medicaid, but in the private market as well? The reason other countries with universal healthcare can spend much less on healthcare than the US is due to their ability to regulate prices. And prices are what's driving healthcare expenditures up.

    Medicare prices are amongst the lowest (the VA probably has lower prices).

    http://www.pbs.org/newshour/rundown/2011/11/why-does-healthcare-cost-so-much.html
    NEWSHOUR: From an international perspective, why are health care costs in the United States so much higher than any other OECD country?

    MATTHIAS: High spending by the U.S. on health must either be because the price of healthcare is higher than in other countries, or else because it provides more health activities than other countries, or a combination of the two. Evidence suggests that both factors are important, but particularly prices. The same set of hospital interventions (including the normal delivery of a baby, a Caesarean section, a hip or knee replacement, etc.) cost 60 percent more in the United States than in a selection of other countries. Similarly, 50 high-selling pharmaceuticals cost 60 percent more in the United States than in Europe. But the United States also uses a lot of expensive diagnostic tests, such as MRI and CT scans, and performs a lot of interventions where it is not always clear-cut whether the procedure is necessary or not -- tonsillectomies, knee replacements, and so on. On the other hand, perhaps surprisingly, the U.S. does not have many doctors relative to its population, not many hospital beds, and people do not spend long in hospital when they have to be admitted. Overall, therefore, high prices are the main reason for high health care spending in the United States.


    ACA attempts to regulate prices (e.g. IPAB and allowing Medicare to negotiate drug prices, which was forbidden by Medicare Part D originally).

    As for the portion of eligibility for Medicare/Medicaid, here you got me. Of course, as designed right now, Medicare only covers 48 million people, because you have to be 65 or above or have other qualifying criteria.
    ------------------
    I go back to my original question: if you like Hong Kong's model so much, are you willing to have the US do the following:
    1. A universal public option where care is rationed, and
    2. A private system which allows people to pay for their own care (and not just for $30 office visits, but for $50000/year dialysis treatments)?

    And will you agree that Hong Kong's model would be a much more drastic change than what the ACA does (which is to expand private insurance coverage in the US)?
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    Jun 24, 2012 2:42 PM GMT
    riddler78 said
    GonzoTheGreat saidi find this tragic. Really absolutely tragic

    People, brainwashed by advertising, foolishly fight against their own best interests

    It really hurts me. But it hurts them more... fighting to deny themselves affordable healthcare

    It´s a genuine tragedy and undermines the USA´s claim to be a civilised society.


    And I think you're an idiot if you think that this poorly written bill that is likely to have at least parts of it to be found unconstitutional to be the gateway to a civilized society. It's kind of presumptuous and arrogant to believe that you know better for others than they do themselves - but that's pretty typical of smug liberals - especially ones abroad who despise the wealth and power of Americans. But hey that's just me.


    Ironic post is ironic.
    Here; fixed.

    ".. It's kind of presumptuous and arrogant to believe that RIDDLER knows better for others than they do themselves - but that's pretty typical of smug RIDDLER who is not an US citizen... nor lives there" icon_lol.gif
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    Jun 24, 2012 2:44 PM GMT
    meninlove said
    riddler78 said
    GonzoTheGreat saidi find this tragic. Really absolutely tragic

    People, brainwashed by advertising, foolishly fight against their own best interests

    It really hurts me. But it hurts them more... fighting to deny themselves affordable healthcare

    It´s a genuine tragedy and undermines the USA´s claim to be a civilised society.


    And I think you're an idiot if you think that this poorly written bill that is likely to have at least parts of it to be found unconstitutional to be the gateway to a civilized society. It's kind of presumptuous and arrogant to believe that you know better for others than they do themselves - but that's pretty typical of smug liberals - especially ones abroad who despise the wealth and power of Americans. But hey that's just me.


    Ironic post is ironic.
    Here; fixed.

    ".. It's kind of presumptuous and arrogant to believe that RIDDLER knows better for others than they do themselves - but that's pretty typical of smug RIDDLER who is not an US citizen... nor lives there" icon_lol.gif
    I concur!
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    Jun 24, 2012 4:32 PM GMT
    q1w2e3 said
    riddler78 said
    q1w2e3 saidIt's your own opinion that Medicare funds are spent poorly. I know plenty of people that say that its administrative costs are much lower. True, there's fraud, but tell me there isn't any fraud with private insurances. (If so, why are there so many settlements with insurance companies with the federal government).
    http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/
    How about if you think of having the IPAB multiplied 10 times and applying that to the US, if you like Hong Kong's system? icon_lol.gif

    BTW, we already have the private pay-for-service part in the US. It's never really gone away, and is on the upswing with concierge practices. We just don't have the equivalent public option in the US.


    I'm not even talking about the fraud or the administrative expenses. Why is it that Canada can provide universal healthcare to everyone at a cost that's lower than the cost per capita that what the US spends on medicare/medicaid? Do you acknowledge that only 15-20% of Americans even qualify for Medicare/Medicaid? This means that Americans ALREADY spend 5-6 times more on medicare/medicaid recipients than Canada does. That's an objective fact. Once you acknowledge that fact, can you still claim that Medicare funds are spent well?

    Would you make the argument that Medicare/Medicaid recipients have a quality of care that is 5-6x better than Canada's healthcare system?

    I know you have private pay for service - the public option isn't really necessary if you have an alternative for the poorest. But further, again, why would you trust the same system that regulates and manages Medicare/Medicaid with more money and authority?


    Now you're being unfair. You do realize that the US cost of healthcare is higher not just in Medicare/Medicaid, but in the private market as well? The reason other countries with universal healthcare can spend much less on healthcare than the US is due to their ability to regulate prices. And prices are what's driving healthcare expenditures up.

    Medicare prices are amongst the lowest (the VA probably has lower prices).

    http://www.pbs.org/newshour/rundown/2011/11/why-does-healthcare-cost-so-much.html
    NEWSHOUR: From an international perspective, why are health care costs in the United States so much higher than any other OECD country?

    MATTHIAS: High spending by the U.S. on health must either be because the price of healthcare is higher than in other countries, or else because it provides more health activities than other countries, or a combination of the two. Evidence suggests that both factors are important, but particularly prices. The same set of hospital interventions (including the normal delivery of a baby, a Caesarean section, a hip or knee replacement, etc.) cost 60 percent more in the United States than in a selection of other countries. Similarly, 50 high-selling pharmaceuticals cost 60 percent more in the United States than in Europe. But the United States also uses a lot of expensive diagnostic tests, such as MRI and CT scans, and performs a lot of interventions where it is not always clear-cut whether the procedure is necessary or not -- tonsillectomies, knee replacements, and so on. On the other hand, perhaps surprisingly, the U.S. does not have many doctors relative to its population, not many hospital beds, and people do not spend long in hospital when they have to be admitted. Overall, therefore, high prices are the main reason for high health care spending in the United States.


    ACA attempts to regulate prices (e.g. IPAB and allowing Medicare to negotiate drug prices, which was forbidden by Medicare Part D originally).

    As for the portion of eligibility for Medicare/Medicaid, here you got me. Of course, as designed right now, Medicare only covers 48 million people, because you have to be 65 or above or have other qualifying criteria.
    ------------------
    I go back to my original question: if you like Hong Kong's model so much, are you willing to have the US do the following:
    1. A universal public option where care is rationed, and
    2. A private system which allows people to pay for their own care (and not just for $30 office visits, but for $50000/year dialysis treatments)?

    And will you agree that Hong Kong's model would be a much more drastic change than what the ACA does (which is to expand private insurance coverage in the US)?


    How is this unfair? Other countries do not regulate their prices - certainly not HK - so *your* question is the unfair one. Your quoted article states that the costs of healthcare are 60% more in the US than other countries - and yet the cost of medicare/medicaid spending is 4-5x higher than what is spent per capita in Canada. How do you square the difference?

    I didn't say that I liked the HK model "so much" I said it was an alternative model than just the US and Canada. I think a first step to reducing costs in the US would be to change the tax system and reduce the third party payor system of HMOs and medicare/medicaid. Again, I throw this back to you - given that there is such a large differential in cost of care how can you argue that the US should throw even more money at the same administrative and organizational systems that have brought you medicare/medicaid in its current form?
  • Posted by a hidden member.
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    Jun 24, 2012 4:35 PM GMT
    meninlove said
    riddler78 said
    GonzoTheGreat saidi find this tragic. Really absolutely tragic

    People, brainwashed by advertising, foolishly fight against their own best interests

    It really hurts me. But it hurts them more... fighting to deny themselves affordable healthcare

    It´s a genuine tragedy and undermines the USA´s claim to be a civilised society.


    And I think you're an idiot if you think that this poorly written bill that is likely to have at least parts of it to be found unconstitutional to be the gateway to a civilized society. It's kind of presumptuous and arrogant to believe that you know better for others than they do themselves - but that's pretty typical of smug liberals - especially ones abroad who despise the wealth and power of Americans. But hey that's just me.


    Ironic post is ironic.
    Here; fixed.

    ".. It's kind of presumptuous and arrogant to believe that RIDDLER knows better for others than they do themselves - but that's pretty typical of smug RIDDLER who is not an US citizen... nor lives there" icon_lol.gif


    I have to wonder if you even understand the meaning of the word irony. And this coming from you - someone who has little understanding of either financial services or the sustainability of the Canadian healthcare system despite being some assistant branch manager at some point. icon_rolleyes.gif You've made the repeated argument that the Canadian healthcare system is somehow sustainable despite continuous public statements from the CMA and any number of other medical practitioners.

    Is it your argument then that the US isn't a civilized country?
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    Jun 24, 2012 6:16 PM GMT
    riddler78 said
    How is this unfair? Other countries do not regulate their prices - certainly not HK - so *your* question is the unfair one. Your quoted article states that the costs of healthcare are 60% more in the US than other countries - and yet the cost of medicare/medicaid spending is 4-5x higher than what is spent per capita in Canada. How do you square the difference?


    It's unfair because while you're saying that Medicare and Medicaid are expensive when it's the whole system (including private and insurance-based) that is more expensive. And when steps towards reducing growth of expenditure (e.g. IPAB) are introduced, that's decried as socialism. I would submit to you that if Medicare has much more clout in negotiating prices, you will see a lot less growth in medical expenditure.

    Here's Hong Kong's public hospital drug formulary. While they don't "regulate" prices, if it's on a higher tier, it won't be prescribed, unless you can pay for it yourself. There's your public clout which is sorely lacking in the US. (I can tell you that some of the drugs they have as for general use are so old that you can't even find them in the US any more, because the companies that make them stopped making them due to lack of profit.)
    http://www.ha.org.hk/hadf/en_hadf.html

    This list of non-covered meds are routinely prescribed in the US.
    http://www.ha.org.hk/hadf/pep_pdf/sfi_list_120414.pdf

    http://www.ha.org.hk/hadf/en_background.htmlRapid advances in medical technology have brought in many new drugs into the pharmaceutical market every year. It would be impossible and impracticable for public hospitals in any country to provide a full range of drugs. Consequently, international healthcare providers have to make rational choice on the best available drugs, which have to be made public based on rational use of public resources and enhanced accountability. The World Health Organisation (WHO) also recommends health authorities around the world to establish their own mechanism for standardisation of their drug formulary.

    For more than a decade, 156 countries have already followed WHO's advice and developed their national list of essential medicines, taking into account their disease prevalence, available evidence on efficacy and safety, and comparative cost effectiveness.


    So to answer your question, I think that yes, Medicare and Medicaid are way more expensive than similar care in other countries, and that's because they are subject to the same unfettered market forces towards newer and more expensive meds, and they both lack the same stringent formulary restriction and price negotiation common in other countries. The solution is to give them more clout in price negotiation comparable to the amount of care they provide.
    Here's a start:
    http://www.nejm.org/doi/full/10.1056/NEJMp1109926