Comments on FiveThirtyEight: Politics Done Right: Health Care > Environment? It's the Economy, Stup...

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2009-10-10T04:51:18.439-04:00

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2009-03-30T11:07:00.000-04:00

To: Saint Dude, SnW, and PeteKent,Increasing the n...

2009-03-24T11:01:00.000-04:00

To: Saint Dude, SnW, and PeteKent,

Increasing the number of people in the pot receiving healthcare will not by itself lower costs for all. Supply and demand economics will only work to lower costs if the population increase comes from those people who only use it infrequently, which is probably just the opposite of what would happen. Also without more doctors those already in practice will be in the position of being able to charge more for their services not less due to supply/demand.

Before any meaningful reduction of costs can occur there must be changes to our society other than just giving everyone care. We could make healthier lifestyle choices. All schools could offer classes on good nutrition and its health benefits. Courts awarding megabucks to patients could be eliminated except in obvious cases of malpractice. Someone said earlier that Medicine is not an exact science. Patients, lawyers, and juries must come to understand this fact. As stated there must also be a substantial increase in the number of available doctors to care for these new people who will seek treatment. Once we have more doctors hospitals can stop seeing non-emergency cases in ER's. More medical personnel and hospitals will also mitigate long waiting lists for elective surgery.

Even if we successfully lower costs are you really interested in Government controlling another healthcare system? I'm not! It hasn't been able to effectively administer the Medicaid, Medicare, and Social Securtiy programs. I don't want them now telling me what type of healthcare I'm entitled to and which doctor is going to treat me. Given a choice I am in favor of less Government in my life, not more.

SnW,If your reading of the constitution is correct...

2009-03-23T13:00:00.000-04:00

SnW,
If your reading of the constitution is correct, and frankly I think its a stretch at best, why is it a congressional matter at all? Why isn't the issue before the SCOTUS? And as such it doesn't need to be a political issue for Obama.

But your idea that popular will has not affect on the law is frankly naive at best. In an ideal world then maybe it would be ok, BUT we all know that all laws are subject to popular will. The court only deals with issues that popular will pushes upon it and the legislative branch is not going to stretch popular will beyond a certain level. So to seperate popular will from the law is just a silly point. (If you doubt this then compare Plessy vs Freguson and Brown vs School Board of Topeka.)

What does God or Gay have to do with health care. ...

2009-03-23T11:38:00.000-04:00

What does God or Gay have to do with health care. You let this idiot sidetrack you.
Larger cycle, he's been doing this for a while. So I thought I'd get it over with and bite.
Well, fuck it, if you're going to bullshit me why shouldn't I bullshit you?
... I'm not but I guess I should get ready for you to really cut loose with the bullshit now?
I've repeated myself a dozen times-our government does not apply the laws based upon the whims of an angry mob, soc who cares if you're enraged or not? It's the Constitution, stupid.

Oh, and one more thing? I neither need nor want your help.
Yup, there it is. That is patently false. Otherwise why are you here thread after thread impatiently shaking an angry fist at Obama for "doing nothing"? Tossing out doomsaying about the Gay Vote is going to abandon him.

If it was all about the Constitution you could just STFU and sit back at ease. But that isn't the case, is it? No, debate and public opinion matter, too. Something you are handling in a ham-handed manner, something that you are proving decidedly bad at. Part of it is trying to get into theological arguments about gay marriage. But every time you bring up the Bible you LOSE. You lose in public opinion because while people are likely to be convinced that the Constitution is on the side of civil unions, there is only a very small slice of the public that could be swayed to consider that the Holy Trinity is down with it, or even neutral on it. You want this all framed in the Constitution. You DO NOT want the Bible to come into this, you don't want that forefront in people's minds when making this decision. Because right or wrong, that's going to go poorly for you.

So tone down the bullshit, stop talking about the Bible, concentrate on the Constitution when discussing this, focus on what the law does (meaning being flexible on wording of "civil unions" over "marriage", if you aren't already), and when you feel your panties getting in a knot stare at this picture till you feel the panic subside. :P

When it comes to large scale endeavours that requi...

2009-03-23T03:16:00.000-04:00

When it comes to large scale endeavours that require long term planning, the federal government is more efficient. It beats the private sector and that's just the facts Jack.

If it works for the DOD why can't it work for healthcare.

What does God or Gay have to do with health care. ...

2009-03-23T02:56:00.000-04:00

What does God or Gay have to do with health care. You let this idiot sidetrack you.

Oh, and one more thing? I neither need nor want yo...

2009-03-22T19:46:00.001-04:00

Oh, and one more thing? I neither need nor want your help.

You know Dwight, the thing I love most about you i...

2009-03-22T19:46:00.000-04:00

You know Dwight, the thing I love most about you is your ability to attack the argument and not the person making it. You're such a pillar of calm strength, someone who never flies off the handle into an irrational rage.

Well, fuck it, if you're going to bullshit me why shouldn't I bullshit you?

I've repeated myself a dozen times-our government does not apply the laws based upon the whims of an angry mob, soc who cares if you're enraged or not? It's the Constitution, stupid.

> The passage refers to the need to obey the laws ...

2009-03-22T19:30:00.000-04:00

> The passage refers to the need to obey the laws of man which are distinct from the laws of God-pay your taxes to the Roman empire even though Rome is not a christian state.

Which has f*ck all to do with what you were talking about. You were trying a huge bullshit stretch at best. It'll only serve to enrage the vast majority of those that strongly don't agree with you (whom you aren't going to win over anyway) and have you coming off as a either an two-faced blowhard or a babbling nutcase to those that are on the fence (which you WILL require). None of which is going to help you out.

Stop reaching into/bringing up the Bible/Jesus to try make your case. It only makes it harder for us that ARE trying to help. :/

Incidentally, the majority of Americans have recen...

2009-03-22T18:41:00.000-04:00

Incidentally, the majority of Americans have recently voted Democratic. Should we therefore hold a referendum on whether Republicans should be allowed to vote, since they comprise a despised minority at this particular moment?

There's as much justification for denying Republicans the vote as there is for denying me the right to marry.

We should come up with a minority name for Republicans-I'm thinking we could call them 'Evil-Americans'. It's a little derivative, though. Inhuman Slime has more of a ring to it, although I'm not sure it would catch on as well as EA would.

There is however a legal argument defining what eq...

2009-03-22T18:36:00.000-04:00

There is however a legal argument defining what equality is-and that is really the goal here. The Equal Protection Clause states that whatever standard you apply for what marriage is defined as, you have to apply it equally-I can't pass a law that would require a poll tax, for example, since this would unfairly prevent those unable to pay the tax from voting. Nor could I discriminate against uneducated Americans by requiring a test to access the polls. Likewise, you cannot define marriage as heterosexual as this would de facto exclude homosexuals from marrying.

The Tenth Amendment says anything that is not in the Constitution or the Amendments is reserved for the States to sort out. As the 14th Amendment says whatever standard for marriage must apply to all citizens equally, Alabama would have to either downgrade everyone to a civil union or to allow me to marry, much as Alabama not only has to recognize the Senator for California as a Senator, but also cannot exclude impoverished residents from voting for their own Senator.

You seem to confuse the popular will with the law. They are not one in the same, nor have they ever been; were they, there would be no need for a Constitution at all- all matters would simply be handled by whatever the majority declares on a referendum at any particular time. We don't do that in this country-if we did, miscegenation laws would not have been struck down by the SCOTUS in Loving vs Virginia. The rights of the minority are respected in a democracy such as our own, no matter what the howling mob outside the courtroom may think.

If you would rather live in a lawless anarchic state where whoever can rally the most troops decides who has rights and who does not, move to Somalia.

SnW,I don't believe I have voiced any opposition t...

2009-03-22T18:17:00.000-04:00

SnW,

I don't believe I have voiced any opposition to equal marriage in the past. (My view is that the state should only deal in civil partnerships, and they should be open to all, let religions define what marriage is for them). But I don't believe that right now it is a major priority, worthy of risking political capital on. (Though i understand why you feel differently than I do on this issue).

Where I say a judge may have to use a level of moral judgement is because right now there is no 'letter of the law' about what Marriage is. I thought a socially conservative judge would have no difficulty in defining a marriage as being between a man and a woman, and there would be little to change that view. In deed if a case came to a court where the lack of a definition was a problem, then I think that might force congress' hand on a law defining marriage, and even with a Democratic majority, I wouldn't bet my house that a congressional definition of marriage would allow for gay marriage. The equal protection clause only goes so far on this one. It would only force Alabama to recognise a couple married in California as married, not to offer Gay Marriage to its own residents.

This is one of those times that taking the wrong direction could put back your case 50 years. (Roe v Wade has been around for 35 years without a hint of Christian Conservatives managing to overturn it after all). I think it is a time when careful footsteps are required.

Mark,Given that you have stated nothing but opposi...

2009-03-22T18:01:00.000-04:00

Mark,

Given that you have stated nothing but opposition to Equal Marriage in the past, I don't think taking advice from you would be wise on my part, any more than I would take advice from the RNC if I were running for office as a Democrat.

There's no need for the judge to consider morality-the letter of the law as well sas its spirit will suffice. The Equal protection Clause is the thrust of my argument, not the Bible, which is the opposition's. Interestingly, my basis for argument is in the Constitution-and theirs is not.

SnW,Just on gay marriage (how did that ever get in...

2009-03-22T17:56:00.000-04:00

SnW,

Just on gay marriage (how did that ever get into a thread about healthcare and the environment btw?) Its a tough one. I still think that the best way to argue the case is not the rights path you take. I think a far more worthwhile route is the financial road that Dwight suggests. I think the rights path is dubious at best, as it requires a leap of faith in the moral view of a judge on what marriage should be defined as, and is easily over trumped by a definition of marriage law (which would be tough to turnover constitutionally, however unfair that might be).

But I think Obama is right when he says that most Americans can agree that a gay partner should be allowed death benefits. I think it would be hard to argue legally that someone cannot chose who should receive benefits when they die, and I think that civil partnerships are not to be sniffed at, as you seem to. Its a big step forward, and sometimes in the US these things have to be done one step at a time.

Mark and Dwight,The passage refers to the need to ...

2009-03-22T17:44:00.000-04:00

Mark and Dwight,

The passage refers to the need to obey the laws of man which are distinct from the laws of God-pay your taxes to the Roman empire even though Rome is not a christian state.

Neither is America.

And our laws are also distinct from those of the church. You must obey our laws, even the ones that contravene your religion. Your religion's laws are not greater than those of the state. For instance, if you were to commit murder and tell the judge God commanded you to do it, you would still be guilty of murder, no matter if you can find justification for it in the OT, the NT, the Book or Moron or the Koran. Your religion simply does not trump the laws of the state.

The argument for Equal Marriage is not about the tax benefits so much as it is about equality. Whether you want to accept my way of life or not, the fact remains that we are equals before the law. I personally find christianity to be loathsome. Does this mean I have the right to discriminate against christians? Despite the fact that your religion is more of a choice than my sexuality, and therefore something one could make a far stronger argument in favor of legalizing discrimination against, such a thing would violate the constitutional protections of the minority who are considered equal to the majority.

Therefore, marriage is equal no matter whether it is heterosexuals or homosexuals being married. As such, asking me to accept a civil union would require you to do the same.

I think much of the current dissatisfaction with F...

2009-03-22T17:10:00.000-04:00

I think much of the current dissatisfaction with Federal Healthcare is the inadequate performance of Medicaid system, the system for the indigent. Unlike Medicare, the system for the elderly, Medicaid reimbursement has been cut to the bone.

Obama is willing to spend billions to fix healthcare in general. The poor of this country are suffering desperately; it is time to increase Medicaid reimbursement to assure available treatment to all Americans regardless of payor source.

Unless you want a Cuban style system, as portrayed so unrealistically in Michael Moore’s “Sicko”, you do not want a single payor system even if you move to universal healthcare. Only the free market can assure competition and adequate distribution of resources. It seems to do it so well everywhere else, so why not in Healthcare?

One of the current problems with Medicaid is that reimbursement rates are so below market standards that few doctors if at all will serve this community, especially given the geography that many of the indigent find themselves in – either remote rural or urban / ghetto -- that it is very hard for them to attract doctors.

Given the President’s laser-like focus on reforming healthcare you have to wonder why he continually recites that a central problem with high healthcare costs is that the uninsured are using emergency rooms for care, when Medicaid patients are also choking the ER. Medicaid patients who cannot otherwise find a practitioner to treat them. Naturally, treating this population in the ER is as expensive as any other and much more wasteful given the availability of government healthcare insurance to pay for their care.

I heard an anecdote once of a cardiologist in the South being given a check for less than $2.00 for performing heart surgery on a Medicaid patient. This was 10 years ago. The situation has only gotten worst so consequently only the most desperate, least qualified doctors and a handful of do-gooders (many associated with religious groups and the rest mostly doctors donating their services) ten d to the needs of one of the most vulnerable populations.

You would think that the President who is such a fine orator and was once a law teacher would want to teach the people about Medicaid and let folks know that there is a basic problem: no one wants to serve the segment.

Now that Obama controls the army, I suppose he could use some tanks to force the docs to treat the folks in the Hood.

Or he could raise reimbursement and make it attractive for doctors and medical facilities to situate or otherwise serve where the indigent are and there might be a chance in doing a fair amount of good.

It’s an incremental step, and in these hard times it certainly an apt one. Even spending on doctors is stimulus.

You have to wonder why this has not been more of a short-run focus.

(You can now follow me on Twitter: PeteKent01)

And actually plenty is written about of Jesus' ear...

2009-03-22T17:00:00.000-04:00

And actually plenty is written about of Jesus' early life. Many of the Apocryphal Gospels include details of Jesus' early life.

http://en.wikipedia.org/wiki/New_Testament_apocrypha

Incidentally I have never really understood the arguement that inconsistencies in the New Testament make that document as a whole worthless. Plenty of modern histories, written with much more intellectual rigour (in modern terms) than the bible, have inconsistencies with each other, and we don't just through those out. The New Testament is not designed as a historical account (in modern terms) more an attempt to learn meaning from Jesus' life.

Incidentally I should add that I do kind of agree with WnS's larger point that the Bible is not a good starting point for direct influence on law making. Even the commandments are not designed to be laws as such. The Bible is about personal responsibility, laws are by definition almost, about collective responsibility, how we act as a society, and an agreement of how we interact with each other.

Dwight saidActually Dwight, there is a specific pr...

2009-03-22T16:38:00.000-04:00

Dwight said
Actually Dwight, there is a specific proscription against basing laws on Biblical principles int he New Testament. "Give to Caesar what is Caesar's and to God what is God's"

That's an, um, interesting interpretation of that passage. *cough*
------------------------------

I have to say I am with Dwight on this one. Without wanting to go to far down a theological conversation, its not at all a passage that is about seperation of church and state, its about obeying the laws of society AS WELL as the laws of God. Actually its a wider point about the hypocrisy of religious rulers at the time.

> And how do you interpret it? As a call for a chr...

2009-03-22T15:56:00.000-04:00

> And how do you interpret it? As a call for a christian version of Sharia?

You clearly do not understand what was on the coin (the prelude to that passage) and the context of that situation. :/

Just stick to "civil unions for the same tax benefits and legal protections afforded to marriage" and steer clear of any mention of theology. If you frame it as a theology debate you haven't a hope in hell of winning. You'll just end up looking silly and undermining the goal ... which are those legal and tax benefits, right?

Dwight,And how do you interpret it? As a call for ...

2009-03-22T15:10:00.000-04:00

Dwight,

And how do you interpret it? As a call for a christian version of Sharia?

Okay.Under the current system of insurance in the ...

2009-03-22T15:08:00.000-04:00

Okay.

Under the current system of insurance in the US (which is really a non-system), people who are likely to become ill or suffer injury self-select into programs that offer low deductables and copays. People who are not likely to become ill or injured (myself, for example) opt for no insurance or for something with low premiums and we don't care that much about copays or deductables.

The insurance carrier has a problem. The first group is costly-their risk is so high that the insurance company is more likely than not to have to pay out beaucoups bucks, so they have to recoup that cost by charging a very high premium. The second group is only profitable if the sign up for insurance at all-unless a state law like Massachusetts' forces them to, they're better off not having insurance since they're more likely to pay into the system than get anything out of it.

So the insurance carrier cannot distribute the risk. If they had just as many likely to become sick people as they had people who were unlikely to become sick, the risk could be distributed evenly-the total payments coming into the system would be equal to or greater than the total payments going out, therefore allowing for a very low premium for everyone.

A universal single payer health plan would allow for extremely low premiums for all members since the risk distribution is such that there would be no need for a high premium to cover the likelihood of paying out more than comes in from copays and deductables. The low premium means employers don't have the burden they now carry of having to pay the large part of the premium.

In other words, a universal single payer system is good for business, good for people on limited incomes as well as people on better incomes, since the low cost is the same for everyone rich or poor in the system, everyone benefits.

If you are worried about the possibility of waiting lists and rationing, allow me to make two points. 1) If you cannot afford insurance at all, then you're not getting medical care at all, and a waiting list for elective surgeries would seem like a luxury. That's how it is for the majority of Americans today. 2) We have existing government bodies whose job it is to recruit and entice people to practice medicine and nursing in the United States, namely the HRSA. If we improve the quality of our secondary education in the United States so that more American kids are qualified to enter medical school upon completion of their bachelors programs, and we beef up the HRSA's existing mandate to recruit more of these qualified Americans to study and practice medicine, we can meet the new load of patients quite easily. There are already laws on the books which direct the government to see to it that there are hospitals and clinics within close proximity to most Americans-no new legislation would need to be passed to meet the new load. We would just have to enhance the existing departments' ability to do the job they are already tasked to do. The hard part of meeting the new load is already done- all that is missing is legislation creating the universal single payer system itself.

Actually Dwight, there is a specific proscription ...

2009-03-22T14:49:00.000-04:00

Actually Dwight, there is a specific proscription against basing laws on Biblical principles int he New Testament. "Give to Caesar what is Caesar's and to God what is God's"

That's an, um, interesting interpretation of that passage. *cough*

@Rick - interesting, albeit snide, talking point.A...

2009-03-22T14:23:00.000-04:00

@Rick - interesting, albeit snide, talking point.

At one level you are correct. Increased demand for healthcare may potentially increase costs both at the individual and aggregate level. Individual prices would likely go up, unless there is a matching increase in supply (see above). And aggregate costs may go up because a greater amount of healthcare would be provided.

However, this whole supply/demand dynamic would be true regardless if everyone paid out of pocket or if no one did.

Are you arguing that no one should have health insurance because insurance obscures the true cost of care? Are you arguing for the nonsensical position that people that pay the full price for their insurance are more prudent in their use of medical services compared to people that receive subsidized policies? If so, do you think that employers should be allowed to provide insurance as a component of employee benefits?

One can debate if healthcare is a fundamental human right or not. Of course it is a right in most countries in the world, even some of the most impoverished and or authoritarian. I tend to think that a society that does not ensure the basic health of its population is rather petty, pathetic, and cruel.

Beyond fundamental human rights, there are obvious economic benefits to ensuring access to basic healthcare for all citizens. The sick and injured are much less productive than the healthy. Our current system forces many families into bankruptcy, which not only saps the time and resources of the affected families, but it also produces negative ripple effects throughout the economy - think foreclosures. Those without coverage put off basic care and present with advanced symptoms that are much more expensive to treat. And many without the means do not ultimately pay - instead you do.

Actually Dwight, there is a specific proscription ...

2009-03-22T12:28:00.000-04:00

Actually Dwight, there is a specific proscription against basing laws on Biblical principles int he New Testament. "Give to Caesar what is Caesar's and to God what is God's"

Therefore, no matter what the OT says, that is not intended to be the law of the land. It's intended to be a private matter between the believer and God. The state is not God's representative on Earth, tasked with the enforcement of his will. The state is a manmade institution.

Now, I personally feel that the Bible is a manmade institution as well. No eyewitness accounts of Jesus' birth exist-all four gospel writers wrote decades after he lived and died. They're inconsistent on major details of his life-only two mention the virgin birth, and the resurrection was left out until centuries after he died. To this day, his childhood is completely absent. He pops out of Mary's vagina and disappears until he's 30 years old. If you were to apply the same standards to a biography of anyone else, it would never be accepted as historical fact. Imagine if we had an account of George Washington's life, written by four authors who made no reference to sources predating the mid 1800's,. half of whom describe a ridiculous story of his birth and the other half refuses to discuss his birth at all, the circumstances of his death are not added to any of the biographies until the late 1990's, and the whole subject of his first thirty years of life are completely absent from any account. It would be garbage. Nobody would look at that as history.

Further, the US is not and never has been a theocracy. The Constitution has specific proscriptions against a religious test for candidacy to high office, and the First Amendment bars official recognition of any religion by the government. Nowhere in the Constitution is any name of God mentioned. This is government by man, not by church.

So no matter what the OT says on homosexuality, it doesn't matter. 1) the Bible itself says it is not to be used as a basis for secular law 2) The Bible is not something that can be taken literally as the word of God, because it was written with human hands and human errors abound throughout it 3) The United States has distanced itself from theocracy since its inception. We are a democracy, not theocracy demos meaning of the people and theosmeaning of religious institutions.

The decisions as to how this country is run are to be made jointly by the majority of the people of this country and the Constitutional restraints against mob rule-we do not take our orders from the Vatican in this country. The Pope is not our King.