U.S. Politics 28

[Former Lord of Winterfell]

And here we go again...

Because the money that patients don't pay comes from one of several sources:

1) Insurance companies: Although they can't sell across state lines, that does not mean premiums cannot reflect state-specific trends. If Wellpoint is getting boned on the treatments it's covering, the company will make the money back through premium increases for everyone, from Alaska to Maine.

That's not true. Premiums are almost always set on a state-by-state or employer by employer basis. There already are too many variations between states for it to be done nationally. Any insurer that did try to recover higher premiums from states/employers that isn't justified by the experience within that state or with that employer is going to be noncompetitive. But hey, if Vermont is going single payer, then you don't have that problem anyway with private insurers.

2) State government: Although Arizona can't tax Vermonters, you'd better believe that any shortfalls are going to be made good through federal funds, which Vermonters do pay into.

Huh? Where's your evidence for that? States are having all sorts of financial problems, and they're not getting individualized bailouts from the feds.

3) Federal government: We all pay federal taxes, so when federal funds cover treatment for the uninsured, we're all on the hook.

You're generalizing in a way that doesn't reflect how things actually work. We've already got Medicare and Medicaid, so when we talk about the "uninsured", we're necessary talking about people who aren't covered by either. So exactly which federal program are you talking about that provides the "federal funds to cover treatment for the uninsured?" There is sort of a partial payment plan for public hospitals who treat uninsured, but part of the idea would be to quite playing that kind of shell game with federal money and just turn the responsibility over to the states. If you wanted to per capita block grant the same funds, fine.

And plus....I thought part of the argument for universal coverage is that some people aren't getting care?

[TrackerNeil]

I think I'm going to respectfully decline to continue a debate about health insurance. We've gone around and around on this issue and gotten nowhere.

On other matters...

I don't know, Ormond, but it seems to me that although Palin was too young to be a decision-maker in that instance, her family still benefited from the health care system she now disdains. That's strikes me as Smaug saying that killing dwarves is bad once he's sitting on a big pile of treasure.

[Former Lord of Winterfell]

I need to learn more about Vermont's plan. What happens to those who are currently or soon to be eligible for Medicare in Vermont? Does the state just say "No worries, you're covered under our new plan anyways?" If so, does that (however slightly) put more money into the CMS coffers for the rest of the nation?

According to what I've read, the Vermont plan has no effect on people on Medicare.

[Tempra]

I

I don't know, Ormond, but it seems to me that although Palin was too young to be a decision-maker in that instance, her family still benefited from the health care system she now disdains. That's strikes me as Smaug saying that killing dwarves is bad once he's sitting on a big pile of treasure.

Except, Smaug would be Palin's parents or her brother, not her. Do you really think it is fair to judge people based on the actions of third parties (even family)?

[Tormund Ukrainesbane]

According to what I've read, the Vermont plan has no effect on people on Medicare.

Kind of a cop out for single-payer eh? Cover everyone except the old, sick, expensive people. We'll go ahead and leave them to get paid for by the rest of the country.

[Ormond]

I don't know, Ormond, but it seems to me that although Palin was too young to be a decision-maker in that instance, her family still benefited from the health care system she now disdains. That's strikes me as Smaug saying that killing dwarves is bad once he's sitting on a big pile of treasure.

I think it's rather dangerous, though, to accuse someone of being a hypocrite because their family benefited from something when they were a child that they now disagree with.

Is someone whose father supported their family when they were a child through swindling, robbing, or drug running a "hypocrite" because as an adult they support laws against swindling, robbing, and drug running?

[Former Lord of Winterfell]

I think it's rather dangerous, though, to accuse someone of being a hypocrite because their family benefited from something when they were a child that they now disagree with.

That sort of bumps into the "Obama is a Muslim" argument as well.

[TrackerNeil]

I think it's rather dangerous, though, to accuse someone of being a hypocrite because their family benefited from something when they were a child that they now disagree with.

Is someone whose father supported their family when they were a child through swindling, robbing, or drug running a "hypocrite" because as an adult they support laws against swindling, robbing, and drug running?

I'm not accusing her of being a hypocrite, precisely, but I think that some one whose family has benefited from Canadian health care should be a bit more respectful in her tone when talking about that system. (That includes not starting talk about "death panels.) As a child of a poor single mother, I personally benefited from all manner of public assistance; should I someday decide I don't like those programs, I hope my opposition would be tempered and informed by that experience.

I guess I'd like a bit more thoughtfulness and humility, which I guess is wrong to expect from Sarah Palin.

[Former Lord of Winterfell]

Point 1 is key. It's not even allowed unless it gets a waiver under current law. 2017 would be a different president even if Obama is re-elected. Who can say who POTUS will be and how things will have changed by then?

That's a very good point. Of course, if you got rid of the ACA, that wouldn't be a problem, and Vermont would be free to do this.

Ah well, far better for the entire country to emulate the success Massachusetts has seen with RomneyCare....

[Tormund Ukrainesbane]

Obama changed the waiver to 2014.

[Swordfish]

3. Vermont is not like the rest of the country. First, the state is home to only about 600,000 people. It's not clear that the scale is large enough to test out a single-payer system and see if it could be instituted in larger states or nationwide. Vermont's existing private insurance market is also unlike most other places. The state has very strict insurance regulation that has whittled down the number of private insurers selling policies on the individual market. Turning Vermont's existing system into single-payer would be a huge change, but it's not the same as a big state like California making the jump or a far less regulated state like Alabama.

So.... What he;s saying is that vermont is a unique snowflake?

;)

[TrackerNeil]

Point 1 is key. It's not even allowed unless it gets a waiver under current law. 2017 would be a different president even if Obama is re-elected. Who can say who POTUS will be and how things will have changed by then?

There is a bill, sponsored by Ron Wyden and Scott Brown, that would amend the ACA to allow experimentation in 2014, but with a Republican House it's dead before it even took a breath. The GOP isn't interested in improving the ACA but destroying it. So much for bipartisanship...

[Former Lord of Winterfell]

TrackerNeil, just permit each state to opt out completely, and I'm fine with keeping it. How's that for a fair compromise?

[TrackerNeil]

TrackerNeil, just permit each state to opt out completely, and I'm fine with keeping it. How's that for a fair compromise?

That's what we call "repeal." I think if you want to do that, I'd prefer you went to the trouble of assembling the same friendly White House, House control, and filibuster-proof Senate majority that we had to get to pass the damned law.

[Former Lord of Winterfell]

That's what we call "repeal."

How is that repeal? It's just broadening the waiver program. And to do that, a state would have to pass a law that gets passed both the legislature and the Governor, so it's hardly automatic. A lot of states would keep the ACA. Presumably, anyway.

I think if you want to do that, I'd prefer you went to the trouble of assembling the same friendly White House, House control, and filibuster-proof Senate majority that we had to get to pass the damned law.

Weren't you the guy just talking about "bipartisanship", though? But anyway, I get your point. It's all about the votes.

But in that regard, I suspect you may have to get that friendly White House, House control, and filibuster proof Senate majority to get any meaningful amendments to the ACA passed. I mean, why should the GOP pass other amendments just to help along legislation to which it is opposed?

So if the bill as passed contains some design flaws that make it unworkable, or have unintended consequences, well, you better just hope that happens when you've got the White House and required Congressional majorities. Otherwise, the GOP will probably offer the option of the status quo, or repeal. And since it is purely a Democratic bill, written and passed exclusively by Democrats, it'll be tough to weasel out of responsibility for its consequences. So you probably ought to hope you guys got it exactly right the first time.

[Swordfish]

Heh. I'm not the most die-hard single-payer person you'll meet, but Taiwan, the UK, and Cuba are pretty different from each other.

As I said, it will be quite interesting to watch this play out. It seems likely to me that Vermont will get the waiver they want.

I agree. I can't think of any way that they would be able to deny the waiver without looking bad.

There is literally no limit to the enormity of the clusterfuck that could result from passage of the ACA.

[ThinkerX]

This was on '60 Minutes' last Sunday. It is the tale of a guy named Drake at the NSA who protested within the system against an illegal, monumental flop of an electronic evesdropping package called 'Trailblazer' (which also included warrentless wiretapping). Now he is facing charges under the Espianoge Act:

http://www.cbsnews.c...ain;contentBody

Trailblazer would be the NSA's biggest project. Hayden's philosophy was to let private industry do the job. Enormous deals were signed with defense contractors. Binney's Thin Thread program cost $3 million; Trailblazer would run more than $1 billion and take years to develop.

"Do you have any idea why General Hayden decided to go with Trailblazer as opposed to Thin Thread, which already existed?" Pelley asked.

"I believe he was convinced by others that going with a large-scale, industrial strength solution was the approach that NSA needed to take. You can't really understand why they would make that kind of a decision without understanding the culture of NSA," Drake said.

Asked to elaborate, Drake said, "Careers are built on projects and programs. The bigger, the better their career."

This might be just another Washington tale of competing defense projects and disgruntled losers - except the winner in this case, Trailblazer, was in deep trouble from the start. Contractors burned through hundreds of millions of dollars and still couldn't give the NSA the solution it urgently needed

In other articles pertaining to this, I have come across repeated mention that, despite his public stance to the contrary, President Obama's administration is far more relentless in punishing leakers and whistleblowers than any other president in recent history, including Bush II.

[TrackerNeil]

So if the bill as passed contains some design flaws that make it unworkable, or have unintended consequences, well, you better just hope that happens when you've got the White House and required Congressional majorities. Otherwise, the GOP will probably offer the option of the status quo, or repeal. And since it is purely a Democratic bill, written and passed exclusively by Democrats, it'll be tough to weasel out of responsibility for its consequences. So you probably ought to hope you guys got it exactly right the first time.

No, I don't think so. One thing about entitlement programs in this country is that they tend to expand, not shrink. Assuming the ACA survives the constitutional challenge, it will start affecting millions come 2014. By the time Republicans are in a position to repeal it - let's say Obama gets a second term, so 2017 - they'll lack the will. After all, who wants to be the one who takes away health insurance from millions of people? Maybe President Jindal wants to be that guy, but I doubt it. What's more likely is that the law will be adjusted here, expanded there, in the manner of all important legislation. Social Security went through that process, and the ACA will - and should - go through it as well.

BTW, and I know it pains you to admit this, but the ACA is the status quo. For more than a year now.

[Former Lord of Winterfell]

BTW, and I know it pains you to admit this, but the ACA is the status quo. For more than a year now.

I agree, although the vast majority of it isn't effective yet. I'm simply saying that if it doesn't work as written, the choice may be that it either stays as it is (not working), or it gets flushed. I don't think you'll see a lot of Republicans trying to help with fixes on something they don't believe can be fixed.

One thing about entitlement programs in this country is that they tend to expand, not shrink. Assuming the ACA survives the constitutional challenge, it will start affecting millions come 2014. By the time Republicans are in a position to repeal it - let's say Obama gets a second term, so 2017 - they'll lack the will.

Well, here's the thing -- there are inevitably going to be a lot of growing pains with this that are going to make a lot of people unhappy during the transition, even if the transition phase is ultimately successful. During that period (at least), the vast majority of people who already have their own insurance aren't really going to be seeing much of a benefit to themselves at all from the ACA because they already had insurance. The primary beneficiaries/constituency for the meat of the ACA -- the previously uninsured -- are pretty much a natural Democratic constituency anyway. And this will be happening during a time when the impending problems with Medicare are becoming larger as well.

I dunno -- maybe you're right. I just think you're taking a rosy view that everyone is going to be seeing significant benefits from this, when it can just as easily be spun as just another "welfare" program, and I don't those will be all that popular..

[TrackerNeil]

Well, here's the thing -- there are inevitably going to be a lot of growing pains with this that are going to make a lot of people unhappy during the transition, even if the transition phase is ultimately successful. During that period (at least), the vast majority of people who already have their own insurance aren't really going to be seeing much of a benefit to themselves at all from the ACA because they already had insurance. The primary beneficiaries/constituency for the meat of the ACA -- the previously uninsured -- are pretty much a natural Democratic constituency anyway. And this will be happening during a time when the impending problems with Medicare are becoming larger as well.

I dunno -- maybe you're right. I just think you're taking a rosy view that everyone is going to be seeing significant benefits from this, when it can just as easily be spun as just another "welfare" program, and I don't those will be all that popular..

Well, I wonder which Republican is going to be the one to say, "Hey, those 25-year-olds you've got on your policy? They're on their own. Oh, and the doughnut hole that was closed? It's wide open once more. And that protection against rescission, that's keeping Wellpoint paying for your chemo? Kiss that goodbye." Maybe Republican voters are less likely to have kids, be old, or have cancer, but...