Show Me

Voters in Missouri voted to nullify the mandatory insurance requirement of the new healthcare law. Though I’m sure we’ll be hearing how it’s part of a groundswell against Obama and Congress, I’ll take the simpler explanation that everyone wants to eat cake, but nobody wants to get fat. Mandatory insurance is the unpleasant part of HCR that makes the whole thing work, and it’s not surprising that the least palatable part of the bill is unpopular.

Also, too: why do states schedule votes on initiatives and referendums during primaries, which have a low turnout of the most partisan voters?

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94 replies
  1. 1
    NobodySpecial says:

    Also, too: why do states schedule votes on initiatives and referendums during primaries, which have a low turnout of the most partisan voters?

    Question asked and answered before the question mark!

  2. 2
    r€nato says:

    I’d like to wish a happy birthday to our Kenyan-born secret Muslim sociaIist comrade Barack Saddam Hussein Osama bin Laden al-Qaeda. Obama Akbar!

  3. 3
    SiubhanDuinne says:

    *why do states schedule votes on initiatives and referendums during primaries, which have a low turnout of the most partisan voters?*

    I somehow don’t think this is an accident.

  4. 4
    Cliff says:

    Also, too: why do states partisans schedule votes on initiatives and referendums during primaries, ?which Because they have a low excellent turnout of the most partisan voters?!

    fixt’

  5. 5
    Comrade Javamanphil says:

    When you’ve been promised for 30+ years you can have the cake and eat it without getting fat, I can understand where the voters may have gotten this impression. Tax rates of 0% = infinite federal revenue, bitches! It’s morning in American and we are too stupid to make it until lunch.

  6. 6
    homerhk says:

    Presumably some of those who voted against the individual mandate were on the liberal side of the fence as well since I seem to recall that Obama “betrayed” them by introducing the mandate.

    When commentary is made to the effect that Americans aren’t prepared to sacrifice for anything that should explicity include whiny liberals as well as the idiotic right.

    How many articles on FDL complained about the individual mandate during the health care debate?

  7. 7
    NobodySpecial says:

    I’m nominating the new Pimps song “I.M. ‘Merica” as the new National Anthem.

    Gimme backyard gimme white fence
    I’m America, yeah I am me
    Gimme fast food gimme fat free
    And I will eat without a conscience, watch and see
    Gimme white man gimme money
    I’m America, yeah I’m the dream
    Gimme Nickelback gimme fake tits
    And I will burn down all your cornfields
    Burn down all your oilfields, watch and see
    Gimme white meat and celebrities
    I’m America, yeah I am me
    Gimme white teeth and a facelift
    And I will crush all those who dare to be not like me
    Gimme white bread gimme herpes
    Gimme pancakes gimme Valtrex
    I’m America, yeah I’m the cream
    Gimme Taco Bell gimme big screens
    Gimme Megan Fox gimme anal
    I’m America, yeah I’m the dream
    And I will sleep on all my riches comfortably

  8. 8
    djork says:

    It’s morning in American and we are too stupid to make it until lunch.

    Nice!

  9. 9
    Sentient Puddle says:

    From my understanding, this proposition doesn’t really do a damn thing. It does nothing for the time being because there’s no mandate in effect, and by the time it does go into effect, a lot of people are expecting the courts to weigh in on this, which either nullifies the proposition or reaffirms it (and in the case of the latter, the proposition is still useless because if the courts say the mandate is no good, then it’s pretty much the case nation-wide).

    As for why the vote wasn’t held in November, do you really think Robin Carnahan would have appreciated that?

  10. 10
    Perry Como says:

    I grew up in MO. True story: I once argued with a high school friend about soshulized medicine. He is against single payer, I’m for it. Of course, he gets his health insurance through his job with the government…

    /facepalm.jpeg

  11. 11
    toujoursdan says:

    In the 1980s Reagan came into office promising something for nothing and we’ve gotten used to it. We want all the benefits of a welfare state (for ourselves, not for others) with none of the demands of it.

    I hope our new Chinese masters have a decent healthcare plan.

  12. 12
    Tom Mathers says:

    What are the palatable parts of the bill that you feel would get widespread support in a stand-alone vote, beyond the unicorns and rainbows? Be as specific as you’d like

  13. 13
    Keith G says:

    Ok, if Missouri would/could eject mandatory purchase of health care insurance, wouldn’t that make the Missouri market wildly loss profitable for insurance corporations?

    As a result, wouldn’t that mean that fewer sellers would enter the market? If the folks from the land of Rush want to and can do this, good for them. I just do not want to hear their weepy bull shit when they realize how limited and fucked up their health care choices become.

  14. 14
    Napoleon says:

    My understanding is that MO dems agreed to allow that onto the ballot only if it appeared during the low turn out primary to keep it away from the general where it could do damage to the Dems and the Reps went along with it instead of fighting the timing.

  15. 15
    stuckinred says:

    @homerhk: Who gives a fuck about FDL. . .and what you think for that matter?

  16. 16

    […] John Cole writes, Though I’m sure we’ll be hearing how it’s part of a groundswell against Obama and Congress, […]

  17. 17
    Pug says:

    @Comrade Javamanphil: It’s morning in American and we are too stupid to make it until lunch.

    Have to agree with that statement.

  18. 18
    Napoleon says:

    @Tom Mathers:

    Every part of it polls well except for the mandatory insurance. Of course everything else is not possible without the manditory insurance so you really can’t offer them as stand alones, at least if you are sane (ie, a Democrat).

  19. 19

    @Sentient Puddle:
    I am so glad you explained that. I was just going to ask what was the effect of such votes.

    But if they are merely exercises in self expression, I can continue with my life and not worry.

    It does seem like a lot of money spent by the states to accomplish something that won’t make a difference.

  20. 20
    James Hare says:

    Well these assholes don’t accept taxation that returns more money to their state than it takes, so they’re just morons. There’s no reason to attribute some strange calculus to their actions anymore. They’re reactionary idiots who don’t know any better than to whine about things they don’t like. The emotional maturity of the tea party movement makes my friends’ toddlers look like elder scholars.

    Just gotta keep working on convincing the girlfriend to move to Canada. The shit-show-fail-parade that is the United States of America isn’t worth the fight anymore. This selfish bunch of twats dishonors the memories of folks who fought and died for this country. They’ve got no problem sending other people off to die in supposed defense of “freedom” but the second they’re asked to given ANYTHING for their country they’re nowhere to be found. They can’t even be asked to pay for the wars they agitate for.

  21. 21
    Nick says:

    @homerhk:

    Presumably some of those who voted against the individual mandate were on the liberal side of the fence as well since I seem to recall that Obama “betrayed” them by introducing the mandate.

    well, yes, many Democrats did vote for Prop C in Missouri, but even had they not, it still would have passed, so whether or not there was a liberal contingency voting yes, it didn’t matter at all.

  22. 22
    homerhk says:

    @stuck in red
    unfortunately I have very little nice to say about FDL. I was making the point that although this vote might play as if Missouri is vastly republican given the skewed vote against the individual mandate, that feature was also violently opposed by the firebaggers.

    If you are asking my personal view, the individual mandate is necessary given the system that was designed. It should, ironically, be especially popular with those in favour of single payer because single payer does not work unless EVERYONE contributes (in the UK, I contribute via national insurance which is on top of the 50% income tax rate I pay). But those single payer supporters often can’t seem to understand that.

    I thought the healthcare reform that was passed under President Obama was an excellent bill motivated by a genuine desire to see a first world country give first world health services to ALL people. I think that in 20 years time it will be seen as the best part of Obama’s legacy to the country – hopefully top of a very long list. I think those that complain about the lack of a public option are extremely short sighted and think in year increments rather than this President who thinks in decade increments.

  23. 23
    Fogeyman says:

    I live in small-town southeast Missouri, which, like most of the state outside of St. Louis & Kansas city, is overwhelmingly Republican. You get big Republican turnouts for primaries, because there are choices for a lot of state offices. Democrats not so much, because most Democratic candidates in my part of the state run unopposed in primaries — there just aren’t enough people willing to run (and those we have are usually conservative).

    So, a majority opposing “Obamacare” is not surprising. Depressing, but not surprising. I always knew which way the vote would go, at least where I Live.

  24. 24
    madmatt says:

    It isn’t that everybody pays, its that we have to pay ins co scum who take 30% off the top forever, until those vampires are out of the mix the dems can kiss my ass!

  25. 25
    Tom Mathers says:

    @ Napoleon
    Isn’t that the inherent problem though? Everyone (including me) is for all the stand-alone parts. Paying for it, responsibly, and SOMEWHAT equitably, is where the whole thing derails, in my estimation.

  26. 26
    Keith G says:

    @madmatt: What?

    That seems to be a rather silly formulation.

  27. 27
    different church-lady says:

    Mandatory private insurance “makes the whole thing work” in the same way that jamming a bunch of crumpled-up newspaper under one leg of an tottering ladder makes it safe to climb the thing.

  28. 28
    asdf says:

    I’m in the process of applying for health insurance through the new Federal High Risk Pool. I’ll spare you my story but let me say that if this goes through my life will be infinitely better.

    It’s like a freaking miracle.

  29. 29
    different church-lady says:

    @Comrade Javamanphil: Fat numbers have been revised down for the second quarter, seasonally adjusted…

  30. 30
    numbskull says:

    @homerhk: But we didn’t get single payer, did we? What we got is a law that says that I MUST give money to the same assholes who created the problems (healthcare INSURANCE problems) and who will wildly profit from my being forced to give them this money. This further solidifies the “role” of a useless middleman, one who used to skim off the top, but who now gets to stand in front of a fire hose and just suck it all in.

    I understand that everyone must participate. But please, let’s stop pretending that we don’t know why some liberals (and others) might not like the mandate.

    Oops: I see maddmatt beat me to it.

  31. 31
    demo woman says:

    Insurance prices would skyrocket if companies had to insure everyone without a mandate. Overwhelmingly people support the idea of signing up for insurance without preexisting conditions being considered. You can’t have both. Republicans do not want to point this out.

  32. 32
    Napoleon says:

    @Tom Mathers:

    Maybe, but the alternative is do nothing which is worse.

  33. 33
    Pug says:

    @Tom Mathers:

    What are the palatable parts of the bill that you feel would get widespread support in a stand-alone vote, beyond the unicorns and rainbows? Be as specific as you’d like

    The part that says you can’t be turned down for a pre-existing condition would pass any vote overwhelmingly.

    The part that says an insurance company can’t drop your coverage if you get sick would pass.

    The part that says children can stay on their parent’s insurance until 26 would pass.

    In other words, the good stuff would pass. Just don’t expect me to pay anything for it, OK?

  34. 34
    homerhk says:

    @numbskull,

    people who don’t like the healthcare bill from the left always omit a few things on top of the fact that insurance companies will still be there and everyone is forced to buy insurance, as follows:

    – although insurance companies will still be there, there are some pretty tough additional regulations on them that have been imposed

    – out of the 30 million or so people who will now get access to healthcare from this bill, approximately half of them will get it by increasing medicaid and childrens insurance; so they are not additional customers for insurance companies.

    – the point about single payer is that although US didn’t get one this time, the structure and economic model is very similar to single payer so it can rightly be seen as the first step towards it.

  35. 35
    Mary says:

    Well, actually, even in St Louis and Kansas City counties (urban Obama supporters), many voted against the mandate:

    St. Louis: 42% yes; 58% no
    Kansas City: 43.5% yes; 56.5% no

    Informing your readers of that, would have been much more honest.

  36. 36
    El Cid says:

    Missouri conservatives would be okay with the ebbil librul soshullists from Taxachusetts etc. paying for Missoury’s helf kur.

  37. 37
    geg6 says:

    @Mary:

    I guess that just shows that even among Missourians who voted for Obama, the reason it’s called the “Show Me” state is that there’s so much stupid in that state that just about everyone there needs finger puppets to figure out the most basic of principles like having to pay for the things you want.

  38. 38
    Ash Can says:

    @madmatt:
    @numbskull:

    How’s about you guys explain to me how a mandate to spend 85% of premium revenue on benefit payouts results in a 30%/”wild” profit margin for insurance companies?

  39. 39
    numbskull says:

    @homerhk: Didn’t say I don’t like the healthcare insurance reform bill overall. I’m happy with lots of it. Every time I discuss mandates I have to list all other aspects of the bill? How much time do you have?

  40. 40
    homerhk says:

    @numbskull, fair enough – it did seem that you didn’t like the bill, however and the list of issues you have with it I think are an incomplete list if you don’t mention the things that are in the bill to minimise/balance the potential downsides.

  41. 41
    numbskull says:

    @Ash Can: I didn’t write anything about a 30% profit. I don’t care if the profit is 30% or 3% or 300%. What do the insurance companies do with that money? They buy politicians and media to … wait for it … defeat further healthcare insurance reform. Now we’ve codified the revenue stream for that.

    Sorta kinda annoying.

    There has to be a mandate of some sort, even with pixie-dust single-payer systems; it’s a necessary evil. But still, why should I pretend that being forced to give insurance companies (and especially the current companies) money is a good thing when it’s not?

  42. 42
    aimai says:

    @homerhk:

    Uh, people were and are against the individual mandate because they saw this way of administering a tax to pay for healthcare as the least publicly popular of the ways of doing it. Because it would enable the crazies to try to hive off the individual mandate and bust the system. Its not that people didn’t get that you can’t have full coverage without some kind of individual mandate. Its just that the “individual mandate” is really, really, hard to sell to the individual especially if they are already resistant, badly informed, or right wing.

    Creating an across the board health care tax for an NHS style system is actually easier to defend at the voter level because its pretty clearly a trade off. You see X amount debited from your salary but you also grasp that X ++ is not being paid out for health care coverage anymore and you are guaranteed health care even when you are not working.

    I’m not interested in refighting this battle, and I wasn’t an FDL’er to begin with, but lets get our stories straight. People opposed the individual mandate because they thought it was stupid politics. And it was.

    aimai

  43. 43
    mds says:

    From the linked article:

    “This really wasn’t an effort to poke the president in the eye,” said State Senator Jim Lembke, a Republican. “First and foremost, this was about defining the role of state government and the role of federal government. Whether it’s here in Missouri with health care or in Arizona with illegal immigration, the states are going to get together on this now.”

    So, in the future, if you’re somehow asking yourself “stupid or lying?” about a wingnut’s verbal vomitus, just remember this passage, which further underscores that the answer can be “both.”

    (1) “This really wasn’t an effort to poke the president in the eye.” Liar. I’m pretty sure he even volunteered that, to make it clear that it wasn’t aimed at the socialist Muslim negro Hitler who wants to ban Christianity and destroy America. Oh, dear me, no.

    (2) “This was about defining the role of state government and the role of federal government.” A lot of those things are already defined by the Constitution that you pretend to love so much, you illiterate mouthbreathing fuckwit. And the immigration one in particular is so unequivocally reserved to the federal government that it makes me wonder who dresses you every morning, since you obviously can’t handle it yourself.

  44. 44
    aimai says:

    @geg6:

    Two thumbs up for changing the name “Show Me State” to “With Fingerpuppets and Semaphore, please.”

    aimai

  45. 45
    Hiram Taine says:

    @aimai:

    Creating an across the board health care tax for an NHS style system is actually easier to defend at the voter level because its pretty clearly a trade off. You see X amount debited from your salary but you also grasp that X ++ is not being paid out for health care coverage anymore and you are guaranteed health care even when you are not working.
    (…) People opposed the individual mandate because they thought it was stupid politics. And it was.

    This, in spades.

    After being jacked around by the health insurance companies for well over a decade I hate those immoral imbeciles with the heat of a billion supernovae, it steams my ass to a degree I’m not able to adequately convey to be forced under penalty of law to give them one fucking penny more of my money.

    Somehow I don’t think I’m alone in that.

  46. 46
    liberty60 says:

    Did Obamacare sweep away the parasitic health insurance companies and replace them with a publicly run single payer?

    Naw.

    But it will provide insurance to people who otherwise could not afford it. I count that as a win. Yes, this is the half a loaf argument, and in politics its always about getting as much of a loaf as possible.

    People forget that the choice wasn’t ever between Liberal McDreamy and Progressive Darling, but between a centrist Democrat and the Confederate Stooges.

  47. 47
    kay says:

    @Mary:

    It’s hugely broad, Mary. I hope Missouri voters recognize they just severely limited any changes in state law regarding health care:

    1.330. 1. No law or rule shall compel, directly or indirectly, any person, employer, or health care provider to participate in any health care system.

    It has a saving’s provision, that protects state and federal law that is currently in place, but if I were a Missouri child support obligor (the person who pays) , I’d immediately challenge any change in the administrative rules regarding Medical Support Orders. I would submit that Missouri can not now institute even a rule change regarding Medical Support Orders, and those benefit the minor children of unmarried parents, they’re operative in all 50 states, and have been since 2007.

  48. 48
    numbskull says:

    @homerhk:

    the list of issues you have with it

    would by definition be different from the list of things I like about it, right? And, the specific topic of the thread is the MO vote on the mandate to pay insurance companies for insurance, right? (Sorry, just had to be a tweaky asshole; this is firmly tongue-in-cheek).

    Seriously, though, I’m not convinced (but I could be, so please help me out here) that the rules intended to mitigate how much insurance companies will get and how they will spend their newfound wealth will really work.

  49. 49
    Ash Can says:

    @numbskull:

    I didn’t write anything about a 30% profit.

    I know you didn’t. That’s why I addressed my question to madmatt too, not just you.

  50. 50
    b-psycho says:

    @homerhk: I’m forgetful, so I have the following question: Among the regulations supposedly meant to make forcing people to buy private insurance reasonable, did they include any form of cap on how much insurance companies can charge for individual plans?

    If not, then I don’t see how the subsidy to people who otherwise wouldn’t be able to afford it is going to work in the long run. I imagine an endless cycle of premium increases, under the reasoning “fuck ’em, Uncle Sucker is gonna help ’em pay our extortion anyway, the sky is the limit”.

  51. 51
    John Bird says:

    Well, you’re half right in that mandatory insurance is necessary for health care reform, but basic universal health insurance is also necessary for health care reform.

    Hopefully, one day we will get “HCR” worth calling HCR.

    I mean, we do need both, a la Clinton’s plan in the primaries, but without the second, you can understand why some people are skeptical about the first – cui bono?

  52. 52
    burnspbesq says:

    @Keith G:

    I just do not want to hear their weepy bull shit when they realize how limited and fucked up their health care choices become.

    Ah, but you will. You know you will.

    Harking back to last week’s exchange of views with BTD about the District Court decision in the Arizona case, since when did it become in the public interest to have referenda on state laws that pretty clearly seem pre-empted by Federal law? I understand the concept of political Kabuki, but this seems a particularly pointless exercise.

  53. 53
    burnspbesq says:

    @asdf:

    I’m in the process of applying for health insurance through the new Federal High Risk Pool. I’ll spare you my story but let me say that if this goes through my life will be infinitely better.

    Stories like yours need to be heard. Please keep us posted on your progress.

  54. 54
    4jkb4ia says:

    The NYT story on Sunday explained this. Democrats in the state legislature wanted Prop C to be in August so that the conservative voters would not come out for that in November and help Roy Blunt.

    As I told dday yesterday, the primary electorate was skewed towards Republicans because they were the only ones who had contested statewide races. Both Robin Carnahan and Susan Montee cruised. Also yesterday we had a brutal heat wave(101 degrees), but turnout was 24% as expected.

    (I am very pleased because both Maria Chappelle-Nadal and Rory Ellinger won by the skin of their teeth in my state legislature districts. Those Obot demographics are mighty in the right places. Ellinger even had an Obama-style typeface on his website.)

  55. 55
    Comrade Javamanphil says:

    @different church-lady: Always take the under.

  56. 56
    Cacti says:

    @madmatt:

    It isn’t that everybody pays, its that we have to pay ins co scum who take 30% off the top forever, until those vampires are out of the mix the dems can kiss my ass!

    Okay, pretend your dream has come true. The Private Insurance industry is abolished forever.

    Now, what do the thousands of people who used to work in that industry do for a living?

  57. 57
    4jkb4ia says:

    (All four candidates for the State Senate seat were black, so “Obot” does NOT mean race here.)

  58. 58
    brantl says:

    “Also, too: why do states schedule votes on initiatives and referendums during primaries, which have a low turnout of the most partisan voters?”

    Because they are trying to minimize expense (polls are already open, with all of that commitment, etc.) and they have at least SOME people coming. Do you think they’d have more if they saved it to be done by itself, or that you should only have them during the general elections?

  59. 59
    asdf says:

    OK, burnspbesq, I’ll do it. Should know something by the 15th of this month.

  60. 60
    Nick says:

    @Cacti:

    Now, what do the thousands of people who used to work in that industry do for a living?

    Repent their sins?

    I think the correct number is millions though.

  61. 61
    burnspbesq says:

    @asdf:

    Good luck!

  62. 62
    Cacti says:

    @Nick:

    I think the correct number is millions though.

    Teh wiki quotes a study that says 470,000, but that was from 2004.

    But really, what’s another half-million people out of work in a 10% unemployment market?

  63. 63
    Xenos says:

    @Cacti:

    But really, what’s another half-million people out of work in a 10% unemployment market?

    In this case, an improvement. Even if they go on unemployment or welfare for decades they will cost this country far less than they are costing it now.

  64. 64
    malraux says:

    @Cacti: Well, leaches do have legitimate health care uses.

    But more broadly, just because an organization has been extraordinarily good at rent seeking doesn’t justify keeping it around. Arguing that the very problem with insurance companies, the fact that they are able to skim so much off the top, is a reason not to get rid of them strikes me as crazy.

  65. 65
    CalD says:

    And the correct response to a publicity stunt is…

    I’m sorry, what were we talking about?

  66. 66
    bago says:

    @Cacti: I thought that was the beauty of Capitalism. We get to repurpose those workers to more efficient jobs! The market has Spoken!

  67. 67
    Winston Smith says:

    Missouri absorbs $1.32 of Federal Spending for every dollar it generates in Federal revenue.

    I almost with the Missouri conservatives would get what they wish for, as a lot of them are on unemployment and food stamps right now.

  68. 68
    Cacti says:

    @malraux:

    Okay, so what do the 470,000 people out of work do for alternative employment?

    Until that question can be seriously answered by the “Kill Private Insurance, Hurr Durr, Single Payer!” crowd, why should anyone take you seriously?

  69. 69
    Jules says:

    I just talked to my mother.
    Her and Dad are Dems and support HCR and they did not go vote.
    I’d smack them if I lived close enough.

  70. 70
    shortstop says:

    lets get our stories straight. People opposed the individual mandate because they thought it was stupid politics. And it was.

    The ratio of Dems who say, “It was stupid politics, and here’s why it won’t sell to most voters” to the Dems who say only, “Why should I pay one more cent to the insurance companies?! Let the whole system go down!” is about 1/100.

  71. 71
    malraux says:

    @Cacti: Unemployment Insurance, then move into another part of the corporate system. There’s still insurance. Heck, there’d still be health insurance, just as medicare hasn’t run private insurance out of the game for older folks. Certainly there would need to be some people needed to handle the increased government bureaucracy.

    But the fact that our system is headed for a cliff means that something has to be done. The current trajectory isn’t sustainable, a lot of those folks are going to be unemployed eventually anyway.

    Sure we should make the transition to a sensible system with a goal of minimizing problems. But dealing with those job losses or transformations is relatively minor compared to the benefits. This is really really weak concern trolling.

  72. 72
    Cacti says:

    @malraux:

    But dealing with those job losses or transformations is relatively minor compared to the benefits. This is really really weak concern trolling.

    Dealing with hundreds of thousands of lost jobs is concern trolling?

    Wow. That goes right up there with “The Taliban are just fighting to defend their country” for really stupid shit I’ve heard on BJ.

    The automotive industry employs far fewer people than the insurance industry, and it was bailed out to save it from its self-induced collapse.

  73. 73
    brantl says:

    @Cacti: Because we shouldn’t have to worry about finding work for people that are currently working as financial lamprey?

  74. 74
    malraux says:

    @Cacti: So we phase in single payer over some period of time, allowing time for the market to adapt. Medicare for all, the scheme I favored, would have probably been implemented by gradually broadening the enlistment criteria. Arguing that because a rent seeking corporation has been really really good at extracting rents it should be allowed to continue doing so is frankly foolish.

  75. 75
    Cacti says:

    @brantl:

    Because we shouldn’t have to worry about finding work for people that are currently working as financial lamprey?

    Hurr durr, single payer!

  76. 76
    numbskull says:

    @Ash Can: You have a strange logic in your land…

  77. 77
    numbskull says:

    @Cacti:

    Now, what do the thousands of people who used to work in that industry do for a living?

    Worst argument I’ve heard all day, and I just got out of a four hour grant review meeting.

  78. 78
    tigris says:

    Just like cap-and-trade, it was originally a Republican idea. Watch their current compromise positions, those are the beyond-the-pale Socialist ideas of the future.

  79. 79
    aimai says:

    @shortstop:

    That is complete and utter crap. You made that number up. And in any event my point was narrowly directed at the accusation that everyone who opposed the individual mandate did it because they were starry eyed dreamers. They weren’t. And your imaginary large number of Dems who were opposed to paying for health insurance don’t enter into it.

    aimai

  80. 80
    numbskull says:

    @Cacti: Uh, dude, I drive cars. Other people do, too. Cars have intrinsic value to our 21st century society.

    OTOH, creating a massive spreadsheet that is so complicated that only you can use it, thus forcing us to pay you to use it, then further manipulating the spreadsheet to increase your pay, is not a service with intrinsic value.

    It’s just not.

    The vast majority of what goes on with healthcare insurance is churn to make money for healthcare insurers and other sycophants. There is very little true service provided. There is no intrinsic value to most of it. And given the problems that such a byzantine system is causing us right now, toooooday, with no hypotheticals, I think that an argument can be made that the country would be better off simply paying the 470K to do almost anything else. Hell, my car needs washing as waxing right now as you’re reading this. There’s a job with intrinsic value…to me anyway.

    Further, it’s silly to start your argument from a supposition that all 470K jobs would go poof overnight. For instance, if we truly had single payer (which I’m not saying I think is necessarily the best solution), there would be new government jobs to manage the system, just like SS and Medicare/Medicaid and the military and x and y and z.

  81. 81
    Edoc says:

    Wasn’t the individual mandate originally a Republican supported counter-proposal, back in the 90’s when Hillarycare was on the table?

  82. 82
    Cacti says:

    @numbskull:

    Further, it’s silly to start your argument from a supposition that all 470K jobs would go poof overnight.

    You say it’s silly and yet

    Because we shouldn’t have to worry about finding work for people that are currently working as financial lamprey?

    This is the actual position of some if not many on the Firebagger left.

    Private Insurance must die! Who cares what they do for a living afterwards?! Yaargh, Rage!

    When I read things like that, it makes me think the writer is less concerned with improving the scope and affordability of healthcare than they are in sticking it to an industry that they don’t like.

  83. 83
    Cacti says:

    @numbskull:

    Worst argument I’ve heard all day, and I just got out of a four hour grant review meeting.

    Sitting in a room with you for four hours must have been torture on everyone else.

  84. 84
    malraux says:

    @Cacti: Why don’t you go concern troll somewhere else?

    Look, before we can even talk about what sort of transitional assistance should be given to those who work in the health insurance system, we’d have to figure out what version of single payer we are moving towards. Moreover, I’d argue that even if the result were mass unemployment for all those in the field currently, the move is still worth it without any sort of assistance. You have to weight the negative of the unemployment with the damage that insurance based health care does currently.

    Look, the do not call legislation put a bunch of people out of work, but its hard to say that we shouldn’t have implemented it because of that.

  85. 85
    Cacti says:

    @malraux:

    Moreover, I’d argue that even if the result were mass unemployment for all those in the field currently, the move is still worth it without any sort of assistance.

    Well, good luck with that.

    I hope I never end up on the receiving end of your ideological wankery “for the greater good”.

  86. 86
    Ailuridae says:

    I’ll just mention the same thing I always do in these debates. While insurance companies are not particularly useful the bill did a lot to reign in their biggest excesses. And while a public option would drive down costs it has less to do with the fact that it wouldn’t have the evils of an insurance company and more to do with the fact that it would be a large enough group of people to negotiate down the exorbinant sums doctors and provider networks provide for services. That’s why Medicare is so cheap. Go to a blood-sucking hospital or doctor’s group in a town with more than one and tell them that if they don’t do procedures at such and such a rate they lose everyone over 65 and they suddenly become very reasonable. Do it as a private insurance company with 1/6th of the market and you can easily be turned away? That’s why a Medicare expansion works – it drives down the ability of doctors to gouge patients.

    All of that is a long way of saying the following. Excess medical inflation has almost nothing to do with insurance company profits. Excess medical inflation has almost nothing to do with, say, medical malpractice costs. What it really comes down to, no matter how much people try to demagogue the issue and avoid the obvious truths is that rising medical costs are about doctor compensation and provider profits (which aren’t mutually exclusive). Any one telling you any other reason whether its slinkerwink or nyceve or the Hudson Institute are lying to you and taking you for a dupe.

    Now a lot of you are dupes but at this point at least you’ve had someone tell you what’s what.

  87. 87
    malraux says:

    @Cacti: go troll somewhere else. Seriously, I’ve offered a few options for dealing with the problem. So have others. Moreover, if some form of single payer were to make it to the legislation stage, you would be durn sure that politicians would be sure to have some sort of plan.

  88. 88
    shortstop says:

    That is complete and utter crap. You made that number up.

    Um, how could you tell?

    It’s called making a sarcastic remark — or, if you like, rank hyperbole. I have to say I didn’t predict that someone would challenge it as an actual supposed stat.

    And in any event my point was narrowly directed at the accusation that everyone who opposed the individual mandate did it because they were starry eyed dreamers. They weren’t.

    I know it. Not everyone who did was. But my point was that the vast majority of the complaints I’ve heard from Dems about the mandate fell more on the side of complaining about the unfairness of requiring insurance/further enriching the insurance companies than on the side of proffering thoughtful analyses of why a mandate was dangerous politically (as it happens, I agree that it was — perhaps unavoidably dangerous under the circumstances, but still risky). Now, perhaps a large number of people prefer to couch their substantive political criticism in temper tantrums about letting the whole system fail “so we can get real reform” and so on. But I’m thinking that if the politics were what concerned most people, they were free to say so — and they mostly, from what I could see in my pretty wide reading and listening, didn’t.

  89. 89
    different church-lady says:

    @Cacti: Move ’em into processing the government run insurance program.

    Duh.

  90. 90
    Elie says:

    I personally believe that states that vote for these exclusions should be excluded — let them explain to their constituents why they can’t be covered while everyone else in the country is covered…

    It is the damned weirdest thing evah, that “poh assed” white folks like to keep getting in the backside from rich white folks and that it seems to feel good to them. No wonder in times past I read somewhere that the rich English land ownners would use the Irish and other un “noble” white poor folks to help run down prey during hunts and otherwise be the white “slaves”. Apparently, this must be a genetic flaw for some too many of them.

    Just sayin as a black woman who doesnt like to talk about this kind of thing but sheesh…

  91. 91
    mclaren says:

    Mandatory insurance is the unpleasant part of HCR that makes the whole thing work blow up because it forces people to pay infinitely rising premiums and does nothing about controlling the constantly skyrocketing cost of U.S.medical care…

    Fixed.

    Deluded people like mistermix proclaim that Obama’s non-reform health care “reform” has fixed America’s broken health care system. They tell us the system “works.” It doesn’t work, since Obama’s non-reform does nothing about infinitely rising medical costs in America.

    Costs continue to skyrocket, going up and up and up and up and up and up, year after year, decade after decade, doubling and tripling and quadrupling, up and up and up as far as the eye can see. Naturally I’m not the only person pointing this out — Austin Frakt, health economist at Bostom University, has this to say about the ongoing trainwreck misnamed “American health care”

    If Medicare costs keep escalating 2.5 percentage points above GDP, as they have been in recent decades, the program will double in size relative to GDP in 20 years (from 5% to 10%). How will that additional spending be financed? Consider the options:

    Take on more public debt to finance Medicare? In the current and foreseeable political climate, that seems an unlikely choice, if not a fiscally irresponsible one. Debt-financed Medicare can’t be a long-term solution.

    Raise taxes? Newhouse calculates that income tax rates will have to increase by 160% by 2050 to cover Medicare costs. Can you imagine any politician suggesting, let alone voting for, increasing the marginal rate for those in the 25% income tax bracket to 66%? Me neither. Not going to happen. (By the way, federal tax revenue has stayed within a fairy steady band of about 15-20% of GDP for sixty years. That suggests a small appetite for radical increases in taxation.)

    What about decreasing spending on other government services? Newhouse provides the following figure illustrating this idea (click to enlarge). If health spending increases at just 2 percentage points above GDP (which is low by historical standards), government spending on non-health goods and services must plummet (yellow line).

    Source: “The curve will be bent” (Of course it won’t, what will happen is what always happens in America when unsustainable trends start — they run to their outermost extremes until the entire system falls apart, then we get riots and national guard troops and burning cities, and mass unemployment and lynch mobs, and only then do we get reform.)

    Here’s an enlightening graph showing how unustainable the cost of the U.S. health care system actually is. Source: Washington Post.

    Incidentally, these catastrophic graphs are actually mild and unreasonably optimistic. They greatly understate the catastrophe bearing down on us as our health care system continues to collapse.

    These graphs don’t show the accelerating increase in spending for America’s unsustainable military-industrial complex. While every other government department has watched its spending get frozen this year, Obama has greenlit an 8% increase in U.S. military spending. In the worst recession since 1930, U.S. military spending is climbing sharply — and it’ll continue to go up, skyrocketing even as deflation sets in and millions of Americans lose their houses and become homeless and even as food stamps get cut and children starve in the streets.

    You may have seen that article yesterday about the sick guy in a wheelchair who robbed a bank so he could go to prison and get decent medical care. This will become increasingly common.

    In the face of the massive ongoing increases in U.S. military spending, there will actually be far less money left to spend on our total budget than these graphs indicate. So budget cuts will have to become much more savage as health care costs spiral upward forever and ever, never ending, ever increasing.

  92. 92
    mclaren says:

    @Ailuridae:

    All of that is a long way of saying the following. Excess medical inflation has almost nothing to do with insurance company profits. Excess medical inflation has almost nothing to do with, say, medical malpractice costs. What it really comes down to, no matter how much people try to demagogue the issue and avoid the obvious truths is that rising medical costs are about doctor compensation and provider profits (which aren’t mutually exclusive). Any one telling you any other reason whether its slinkerwink or nyceve or the Hudson Institute are lying to you and taking you for a dupe.

    Close. Excess medical inflation results in part from doctors in America making too much money (from 4x to2x what doctors make in every other first-world country, and that’s only direct fees — it doesn’t count the gigantic fees doctors get when they set up their own imaging labs and blood work labs and specialty clinics and overbill hospitals by 10x to 40x what the tests cost in other developed nations like Germany or Japan. Example: a CAT scan that costs $1500 in America costs $150 in Japan. A CBC Chem 7 blood panel that costs $25 in France costs $450 in America. And so on). Doctors in America make millions every year compared to a typical income of $40k to $50k in other developed countries.

    Provider profits covers for-profit hospitals, which make incredible profits in the broken U.S. health care system, and medical devicemaker profits, which are unebelievable — vacuum-formed plastic disposable surgical tools costing 25 cents to manufacture get sold to hospitals for $40 and then billed to the patient for $1200.

    But a large part of these obscene profits result not just from greed and wild overpricing ($10 aspiring, $20 cotton balls in hospitals) but from rampant sweetheart contracts and price non-disclosure agreements that lock “preferred providers” into monopoly arrangements with specific hospitals and doctors regardless how high their costs are:

    What has received far less scrutiny is the collusion operating underneath this system. The regional “networks” that hospitals and their allied physicians form to negotiate with insurers often exclude competitors and lock in exorbitant prices that are passed on as premiums.

    Keith Smith, an anesthesiologist and co-founder of the Oklahoma Surgery Center in Oklahoma City, posts his surgery center’s prices online, a rarity in the industry. But he points to the “preferred provider organizations,” or PPOs, that he contends have morphed into medical cartels that make deals with insurers to monopolize care in their region.

    So the main cause of massive health care cost increases in America is a combination of greed by doctors/hospitals/medical devicemakers/insurers, collusion and corruption and kickbacks and bribes and sweetheart contracts and nondisclosure agreements, and monopoly cartels lof devicemakers/doctors/hospitals/insurers that act to lock in high prices and shut out competition. As Ailuridae points out, it has little to do with health insurance providers — they’re merely the visible endpoint of the endless skyrocketing cost increases. The starting point for the endless spiral of American health care costs is the greedy corrupt medical devicemakers who typically use huge kickbacks to doctors and hospitals to induce them to buy a particular wildly overpriced medical device instead of someone else’s cheaper brand, then the greed and corruption and collusion moves up the chain to greedy corrupt doctors who run their own specialty clinics that wildly overbill hospitals (google the New Yorker article “McAllen Texas and the High Cost of Medical Care”), the greedy hospitals that collude with doctors and devicemakers and insurers to wildly overbill insurance companies, and insurers who create monopoly cartels with only one insurance provider in an entire region to make certain they can continue to overbill the person paying the premiums, which increase infinitely with no end in sight.

    But Ailuridae makes a huge mistake when she claims:

    That’s why a Medicare expansion works – it drives down the ability of doctors to gouge patients.

    Medicare expansion only works if you expand medicare to include everyone…in other words, if you expand medicare to the point where it turns into a nationalized insurance system.

    If you merely expand medicare to include a few million more people, the doctors simply refuse to accept medicare patients.

    This is what’s happening now. Google for articles like “More doctors refusing new medicare patients.” You’ll see hundred and hundreds of articles about how doctors are turning down medicare patients because medicare doesn’t pay enough.

    “Crisis looms: Medicare coverage doesn’t pay enough, doctors refuse service, and Medicare patients can’t make up the difference even if they want to.” Alaska Business Monthly,1 November 2007.

    USA Today reports that doctors are starting to refuse to accept new medicare patients due to cuts in payments:

    The number of doctors refusing new Medicare patients because of low government payment rates is setting a new high, just six months before millions of Baby Boomers begin enrolling in the government health care program.

    The problem keeps getting worse and worse and worse:

    • The American Academy of Family Physicians says 13% of respondents didn’t participate in Medicare last year, up from 8% in 2008 and 6% in 2004.

    • The American Osteopathic Association says 15% of its members don’t participate in Medicare and 19% don’t accept new Medicare patients. If the cut is not reversed, it says, the numbers will double.

    • The American Medical Association says 17% of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31%.

    Medicare expansion only makes America’s broken health care system fail faster unless we expand medicare to include everyone in a nationalized health care system.

    The only way to stop the endless skyrocketing medical costs in America is to strip the profit out of the system. Tinkering around the edges with Obama’s non-reform HCR bill won’t work, isn’t working, and is only making things worse, and people are now injuring themselves so they can get into an ER and cajole doctors into fixing their old injuries that they can’t afford to get surgery for. People are now robbing banks so they can get into prison and get decent health care.

    This is the collapse of society. It can’t continue. And it won’t. We’re just a hairsbreadth away from mass riots, burning hospitals, doctors dragged out of their Rolls Royce and hung from lampposts, nurses kidnapped and forced to give care for dying children at gunpoint. If you think this kind of situation can continue as the middle class disappears and the American economy disintegrates, you’re kidding yourself. People will not accept being told their child has to die because the hospital won’t cough up a fifty-cent dose of antibiotics now that the family has lost their middle-class jobs. That family will tear down the hospital with their bare hands.

  93. 93
    Ailuridae says:

    @mclaren:

    Medicare expansion only works if you expand medicare to include everyone…in other words, if you expand medicare to the point where it turns into a nationalized insurance system.
    If you merely expand medicare to include a few million more people, the doctors simply refuse to accept medicare patients.

    Actually there is a tipping point long before “everyone” to achieve market leverage on doctors. Yes, there will always be doctors who refuse to take them in any instance unless they are required to but that is the luxury of a constrained supply for doctors. This will sound jingoistic but its not – its insane that the Us medical cabal arranged to have a deficit of graduating doctors to fill vacancies every year; fully one quarter of US doctors are educated outside of the country with 80% of them being foreign nationals. You could drive down wages for doctors in a fucking hurry if you started to graduate 110%-120% as many doctors as anticipated vacancies. I prefer a single payer system (through a deficit reducing expansion of Medicare) but the market can drive down wages its just doctors have formed a cabal against the interests of the rest of America.

    The only way to stop the endless skyrocketing medical costs in America is to strip the profit out of the system. Tinkering around the edges with Obama’s non-reform HCR bill won’t work, isn’t working, and is only making things worse, and people are now injuring themselves so they can get into an ER and cajole doctors into fixing their old injuries that they can’t afford to get surgery for. People are now robbing banks so they can get into prison and get decent health care.

    But this can’t be true, right.? There are at least a half a dozen different options advanced democracies besides the US have taken to provide health care – adopting any of them would almost singularly destroy the deficit and the medical inflation problem (with the UK being by far the best)

    It can’t be “nothing but single payer will work” when, indeed, there are other systems working besides single payer. Now I prefer a non-profit system but that doesn’t mean my preference is the only solution.

  94. 94
    Doofus says:

    @Ailuridae: Dead thread and all, but I do want to get my comment in on this topic.

    In this debate, health insurance companies serve as the blame sponge for all of the misallocated resources and price gouging in the health care sector. The real battle in medical financing in the next 5-10 years is in Medicare reimbursement rates and policies. Everything else is FUD.

    The real test of PPACA is in the Medicare Payment Advisory Board. If that is successful in taking Medicare reimbursement out of Congress’s hands and in avoiding capture by the AHA and AMA then that and that alone will “bend the cost curve” in the health care sector.

    I think that the individual mandate in conjunction with the MLR changes and the revision to exchanges will force insurers to more closely align with Medicare reimbursement rates, and give the best chance to put the squeeze on health care providers. That’s my hope at least.

    And just like most other successes of the Obama administration (whatever makes the DFH’es happy has gotta be destroyed) this reform works best the less the left is happy about it. So I am completely fine with Obamacare being called a bust in the short-term if this ignorance will allow it to get a handle on health care reimbursement in the 5-10 year time span.

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