ACA, "No thanks I'll just pay the penalty"

[Guy Kilmore]

What I learned in this thread so far, is that FLoW doesn’t believe in the following:

Duress: threats, violence, constraints, or other action brought to bear on someone to do something against their will or better judgment.

Some Rapes:

Rape: unlawful compelling of a person through physical force or duress to have sexual intercourse.

If I used the definition of Willing that is being used here, I logically run afoul of these two issues. What a long semantics argument that was basically pointless. It really feels like it is just an attempt to avoid saying “want.”

[Merentha]

FLOW: So what's your point? What is your endgame? I explained why I thought Americans were "willing" to pay higher prices. You've set off a huge tangent that serves zero purpose unless you, somehow, think that the status quo is fine by virtue of being the status quo. Americans are "willing" to pay higher prices. So. Fucking. What. I'm not, and I don't think Americans should be, and I'd like to work to fix this. And? You have no argument except this insistence that "Americans are okay with it" which is a totally meaningless statement, which is why everyone else is saying "uh, yeah, this is a pretty semantic argument."

In other words, the American people are willing to pay higher prices for meds because they (rightly or wrongly) believe that government-mandated lower prices will diminish the number of good medications coming to market.

This is almost entirely what I said earlier, and your response was "now you're explaining why people are willing." A) not everyone argues with you all the time. B) sometimes people are willing to see where you're going with an argument and so just accept your premise and c) So what? Are you suggesting we should look into the actual merits of the argument that lower prices (incidentally, allowing Medicare to negotiate is NOT government-mandated pricing, and I refuse to let that slip past) would stifle drug growth? Because you could have said that about 5 pages ago, and dropped this asinine argument about your special snowflake definition of want.

edit: I really hate that smiley.

[Former Lord of Winterfell]

Sorry, I wasn't aiming that at you. Here is my problem with what you posted. If you scrap ACA, what are the people who won't have access to healthcare do for the ten or twenty years it will take to put something better in place because the self-serving corporations and their lobbyists do everything conceivable to delay and sabotage any attempt to put limits on their cash cow.

I'm a bit confused. Are you talking now about drug prices, or the ACA? I'm going to assume it's jus the ACA, and this isn't about drug prices.

It is tough to respond to something like this that contains so many loaded words and phrases. So I'm just going to make three sort of general points that I hope answer your question.

1) It is very easy to get caught up in particular sad stories about someone's medical condition, ask "but what are you going to do about that", and consider that the game-winner of an argument. And yet, even here, most folks acknowledge that financial considerations, the proverbial "death panels", must exist on some level. That's why there was such a strong reaction on the left to the claim that Obamacare had "death panels". Some tough financial choices have to be made, as sad as that sounds. And they will continue to be made under the ACA. In fact, ObamaCare still will leave a great many people without insurance -- they admit that.

2) Regarding health care costs in the U.S. I think it is largely due to the demands Americans make on that system. Just as an example, we have insurance through my wife's company, and one of the options a few years ago that they tried was an HMO, because it was significantly cheaper than the other options. We loved it, but other people...not so much. They didn't like that the offices weren't as convenient, they didn't like that they couldn't choose their doctor as easily, etc. etc. etc. So, they ditched it after a year for a significantly more expensive plan. In other words, they were willing to pay more because those bells and whistles were worth it to them. And then, they bitched about the cost.... And also, part of those demands "we" make on the health care system -- specific mandated coverage, etc.. -- are actually made by the government, which further drive up cost.

3) I don't want to regurgitate arguments made on this board repeatedly years ago. I'll simply say that I think if Americans were to change their expectations, and enact some reforms, the cost of care would drop dramatically, and a lot more people would be able to afford it without creating a new entitlement program, with which I do have a conceptual opposition to anyway.

Do you think the insurance industry isn't motivated solely by finding the sweet spot where they can extract the maximum in revenue while providing the minimum in care?

I think that's generally a fair characterization.

If we give in to them, now, we've lost. They've bought and paid for to many politicians who fraudulently call themselves elected representatives. They don't represent the people who voted for them. They represent whoever pays the most.

This is the type of comment I just don't know how to respond to. Look, I am not in the pharmaceutical industry. I don't own any stock in any pharmaceutical industry. Nobody has bought my support or opposition to anything. Yet, I still oppose the ACA. And it is, I don't know, frustrating, insulting, etc. when people start off from the assumption that everyone on the other side is either bought and paid for, or a moron.

[awesome possum]

I get the feeling that you guys are being trolled by FLoW again.

Instead of feeding him more, because he is clearly enjoying it, I will give another reason the ACA will be better than what we had even if its not the best option.

My wife got sick in January of last year and from January to August she was in the hospital for roughly four of those eight months. She was "healthy" for a grand total of 4 or so weeks. In that time she had her appendix, gall bladder, and uterus removed - one every couple months. She contracted what her doctor said was the worst case of c-diff he had ever personally seen. It was so bad that she was on antibiotics that cost $1000 for one week of treatment and when that inevitably wouldn't work she would be hospitalized again so that they could keep her isolated and treat it with even stronger antibiotics.

I ran out of sick and vacation time within a month of her getting sick and our work schedules have always been laid out so that we don't need childcare, I come home from work and she goes in. But now she was in the hospital and I had to stay home on days we couldn't find a friend or family member to take our toddler. She also didn't have insurance because my old insurance (before my company was bought out by a corporate giant) was terrible, would have cost 50% of each of my paychecks to insure her (compared to about 8% now). Since she was out of work and I was missing so much work I was pretty much part time, she was able to get on the state program in February and it's coverage went back three months.

It was a life-saver, until literally her last two days in the hospital in August at which point we found out that she had her state-coverage terminated... the reasoning was that her paperwork was missing a page (the state required about a dozen pages of paperwork - proof of housing, rent, etc - to be filled out anew every two or three months). Now I very specifically remember faxing this paperwork and triple-checking to make sure everything was included. But somehow one page got lost and that was enough for them to terminate her state-coverage.

About a month later we got the bill for the two days she was without coverage. Over $80,000. For TWO DAYS. We're pretty much looking at needing to file bankruptcy for two days of being in the hospital. I can't even imagine if she hadn't been on the ball and gotten that state coverage. I mostly want to file out of spite - I could care less about my credit rating as we both have good jobs that pay for everything we need - but it doesn't change the fact that two hard-working, responsible adults were nearly financially wrecked for two days of uninsured hospital care.

This shouldn't happen in a society/country that claims to be so damned great.

[TerraPrime]

I find it bizarre, to say the least, to assume that the average voter and consumer have the vigor of the R&D departments of pharmaceutical companies in mind when they make purchasing and voting decisions. It seems to beg the question in this case, to say that drug prices are high because consumers care about R&D, when we the only fact we have is that consumers are paying the sticker price for these drugs. It is just as valid to say that consumers are paying the price because they lack options for alternatives, instead of imputing a positive motive of supporting R&D in pharmaceutical companies.

I think it's probably more accurate to say that the word "price control" elicits a knee-jerk reaction from most Americans due to its association with socialism and communism, and so when it is applied to the pharmaceutical companies, many of them will reject the proposal just based on their fundamental principle of favoring free market solutions. That, at least, is more believable, than to assume that the general public knows thing 1 about R&D, let alone care enough about it to opt for paying more to support it.

[Shryke]

Mostly it seems like FLOW wants to take an established fact (people in the US pay more for drugs) with an ambiguous cause and pretend that the only possible reason for this fact is the one that supports his position/the status quo.

[Guy Kilmore]

I get the feeling that you guys are being trolled by FLoW again.

Instead of feeding him more, because he is clearly enjoying it, I will give another reason the ACA will be better than what we had even if its not the best option.

My wife got sick in January of last year and from January to August she was in the hospital for roughly four of those eight months. She was "healthy" for a grand total of 4 or so weeks. In that time she had her appendix, gall bladder, and uterus removed - one every couple months. She contracted what her doctor said was the worst case of c-diff he had ever personally seen. It was so bad that she was on antibiotics that cost $1000 for one week of treatment and when that inevitably wouldn't work she would be hospitalized again so that they could keep her isolated and treat it with even stronger antibiotics.

I ran out of sick and vacation time within a month of her getting sick and our work schedules have always been laid out so that we don't need childcare, I come home from work and she goes in. But now she was in the hospital and I had to stay home on days we couldn't find a friend or family member to take our toddler. She also didn't have insurance because my old insurance (before my company was bought out by a corporate giant) was terrible, would have cost 50% of each of my paychecks to insure her (compared to about 8% now). Since she was out of work and I was missing so much work I was pretty much part time, she was able to get on the state program in February and it's coverage went back three months.

It was a life-saver, until literally her last two days in the hospital in August at which point we found out that she had her state-coverage terminated... the reasoning was that her paperwork was missing a page (the state required about a dozen pages of paperwork - proof of housing, rent, etc - to be filled out anew every two or three months). Now I very specifically remember faxing this paperwork and triple-checking to make sure everything was included. But somehow one page got lost and that was enough for them to terminate her state-coverage.

About a month later we got the bill for the two days she was without coverage. Over $80,000. For TWO DAYS. We're pretty much looking at needing to file bankruptcy for two days of being in the hospital. I can't even imagine if she hadn't been on the ball and gotten that state coverage. I mostly want to file out of spite - I could care less about my credit rating as we both have good jobs that pay for everything we need - but it doesn't change the fact that two hard-working, responsible adults were nearly financially wrecked for two days of uninsured hospital care.

This shouldn't happen in a society/country that claims to be so damned great.

I help people with state programs in MN all the time. I am not familiar with your state, so take this with a grain of salt, but there is usually an appeals process with these decisions and can grant some leeway time to get that paperwork in, which then can grant the coverage retroactively. You might already know this or have enquired. I am sorry you had to go through that.

[Former Lord of Winterfell]

FLOW: So what's your point? What is your endgame?

Is this really such a hard concept? Sheesh.... I didn't have an "endgame". I was responding to Robin's post about why prices are higher overseas than in the U.S. And I truly believe the reason for that is that Americans demand far more of their medical system than do people in other countries. We want no wait times, instant care, only the best specialists, and the newest drugs on demand, even if they are only marginally better than the alternatives. We also want to know that the brightest minds in the country are working constantly on new procedure and drugs to help alleviate illness. And we are apparently willing to pay for all that. Else, obviously, we wouldn't be paying.

I think other nations have made more compromises on those issues, and are willing to accept some diminution in health care (on the individual level) in exchange for significant cost savings. Now I know I've read in a few places that there are some drugs that are available in the U.S. that are not available in Canada because of the pricing. The Canadians, through their elected representatives, have said that they're not willing to pay that price, and would sooner do without.

Americans are "willing" to pay higher prices. So. Fucking. What.

Someone asked a question, and I gave an answer. It wasn't me who went apeshit when confronted with the idea that Americans are willing to spend more on healthcare. I don't understand the brouhaha either. I thought it was a relevant response to the question Robin raised as to why we end up "subsidizing" other nations with respect to phaemaceutical. We are simply willing to spend more money in exchange for getting the newest stuff, and they're only willing to pay half-price.

I'm not, and I don't think Americans should be, and I'd like to work to fix this. And? You have no argument except this insistence that "Americans are okay with it" which is a totally meaningless statement, which is why everyone else is saying "uh, yeah, this is a pretty semantic argument."

It's not meaningless in the context of answering Robin's question, which is what I was doing. The rest of the world gets a partial free ride because Americans demand so much of our health system, and therefore pay extra so that more drugs get developed.

Are you suggesting we should look into the actual merits of the argument that lower prices (incidentally, allowing Medicare to negotiate is NOT government-mandated pricing, and I refuse to let that slip past) would stifle drug growth?

No. Consider that I was just answering a question with the answer that I think is the most correct. You're looking for a broader implication than that, and there really isn't one.

Because you could have said that about 5 pages ago, and dropped this asinine argument about your special snowflake definition of want.

This is like a bad joke. I never used the word" want" It would be asinine to claim that people want or prefer higher prices. The definition of "willing" I used (and I didn't even check the dictionary although someone else did) was entirely correct, not some "special snowflake" definition. I can't even think of what word I should have used instead that would have been more accurate, because "willing" conveyed precisely the correct point when explaining why prices in the U.S. and overseas were different. Those health systems are not willing to pay those prices, and would forego the drug if necessary. We are willing to pay that price because we want the drug.

Seems like the right word to me.

[Former Lord of Winterfell]

I get the feeling that you guys are being trolled by FLoW again.

Instead of feeding him more, because he is clearly enjoying it, I will give another reason the ACA will be better than what we had even if its not the best option.

Just to point out (again), all I was doing was responding to a very specific point about drug prices raised by Robin that actually had nothing to do with the ACA. So when people bitch and say "what does that have to do with the ACA", I'm kind of at a loss because I never said it did.

[Guy Kilmore]

Willing is a word used to describe motivation and not a word to describe an actionable behavior. If I used willing the way you are using it, then you invalidate concepts that exist in the English language. Duress is no longer something that can happen as a causal factor in people's actions. (If I do something and that is proof of my willingness and duress occurs when I do something against my will then we run into a little logical problem here.) When you say, "Americans are willing to pay higher prices on medication," you are ascribing a motivation to that particular group. People are disagreeing with you because you are unwilling to provide some kind of evidentiary statement that the motivation described is willingness and not absent some other factors that could be enacting upon one's motivation. I think you are aware of this and are just trolling, which is a shame because I do like to read your view points.

[TrackerNeil]

Now, if the public ignored or disregarded those ads, the bill might pass. But the public wouldn't ignore them, and much of the public probably would have been thinking along those lines anyway. That campaign would resonate, and Americans would come to identify govenrment price controls with fewer good drugs coming to market. The bill would get crushed, because the American people will not buy into the idea of substantial government price controls for medication.

In other words, the American people are willing to pay higher prices for meds because they (rightly or wrongly) believe that government-mandated lower prices will diminish the number of good medications coming to market.

This is the argument from assertion, and it's not the first time you've resorted to it in this thread. Arguing that a given proposition is obvious, self-evident, and in need of no data just doesn't work for me any more, not when it comes to public policy. So I'm going to back out of this debate, to return if/when some facts enter the field of play.

[TrackerNeil]

sorry, double post

[Former Lord of Winterfell]

I think it's probably more accurate to say that the word "price control" elicits a knee-jerk reaction from most Americans due to its association with socialism and communism, and so when it is applied to the pharmaceutical companies, many of them will reject the proposal just based on their fundamental principle of favoring free market solutions.In other words, they're willing t That, at least, is more believable, than to assume that the general public knows thing 1 about R&D, let alone care enough about it to opt for paying more to support it.

Careful -- your elitist ego is showing.

I don't share the same low opinion of Americans that you do. It doesn't take a degree to understand that if you cap prices, you're going to be limiting the incentive to produce new product.

[TerraPrime]

Careful -- your elitist ego is showing.

I don't share the same low opinion of Americans that you do. It doesn't take a degree to understand that if you cap prices, you're going to be limiting the incentive to produce new product.

To be fair, I think the same of all nationalities, not just Americans.

People are selfish and incentivized to look out for their own interests first. The type of voting and purchasing behavior require some altruism or very long-term strategy. I see no evidence that in general, people vote and purchase following those guidelines.

[Former Lord of Winterfell]

Willing is a word used to describe motivation and not a word to describe an actionable behavior. If I used willing the way you are using it, then you invalidate concepts that exist in the English language. Duress is no longer something that can happen as a causal factor in people's actions. (If I do something and that is proof of my willingness and duress occurs when I do something against my will then we run into a little logical problem here.)

You can be under duress to do something, and still choose whether to do it or not. The bully in the lunchroom comes up to two kids, and demands their lunch money or he'll punch them in the face. One kid is willing to give up his lunch, and does. The other is not willing to give up his lunch, and takes the punch in the face. The concept of duress still exists. Their response to the duress is different. That's the exact point I was making with respect to the drug prices.

All that aside...what fucking difference does it makes? I've explained repeatedly the context in which I used it. Yet, you still want to debate the word choice rather than the concept. That is just boring at this point.

[Former Lord of Winterfell]

First, Merentha, thank you for addressing the core issue here.

I'm responding to these at the same time since they're essentially asking the same question. And the answer is the same for the both of them, which is that you're presenting a hypothetical question which skews the debate by simplifying the nature of the process through only presenting a binary solution.

It is not hypothetical question at all, because it is one those countries have actually faced. And again, I've read instances where some drugs are not sold overseas because of these price restrictions.

The most rational and most likely solution is that an equilibrium will be reached as the price for drugs in the U.S. will come down while the prices for drugs around the world will go up by some amount significantly less than the current pricing of drugs in the U.S.

Why would those other countries raise their prices at all?

The explanation for this is that the foreign countries would be unable to pay for markups of 300-400% in drug prices, while U.S. drug manufacturers would be committing suicide by refusing to sell those drugs below the current U.S. price point. Therefore, they'd bring prices in the U.S. down to a point where other countries would be willing to pay.

Which may well be right at what they're paying right now. I mean, they've said that's a low as they're going to go, right? And if the drug companies thought they could squeeze out a bit more, they'd have done so.

Focusing exclusively on demand is creating a disconnect because drugs are obviously being supplied to those countries at a price point less than that which has been established in the U.S. This disconnect is further exacerbated by proposing a binary hypothetical where the only two choices are either 1) pay the U.S. price or 2) don't buy the drugs at all, while ignoring 3) bringing prices in the U.S. down and prices in the other nations up.

Ultimately, there come a point at which negotiations/haggling ends, and those nations ultimately have two choices -- pay the price being demanded, or not. And I think that price point may vary significantly from country to country.

Now this is an area where there can be a lot of useful discussion, but which largely ends up getting passed over in favor of throwing more red meat to each respective base. The U.S is currently the most favorable nation for a company to bring its new drug online. It takes about 1/3 less time to gain approval of a new drug and there are no price controls, aside from those limited ones imposed in negotiations with insurance companies, to limit profit taking. As a rational consumer, my primary concern is access. Will I have access to the bleeding edge drug I need both now and in the future? My self-interested, rational approach would tell me that, based on my current career and earnings, my expected future career and earning, the health care system that is currently in place, and the growing trend of older workers experiencing an insurance gap after being laid off and before they're eligible for Medicare tells me that, no, I probably won't. So the question I would ask myself is: am I willing to somewhat diminish the rate at which bleeding edge medications are introduced in order to obtain greater access to the ones which are introduced in the future? My gut feeling is that most people would say yes, and the debate would only be over how much to diminish introduction and how much to increase access. But that rational debate is short-circuited by billions of dollars of lobbying and the complicit politicians that money buys.

Now that is a debate that would require a lot more knowledge that the average person can reasonably obtain. Every drug would have a separate calculus involved for each invidual, based on individual wealth, need for the drug over time, etc.. As a practical matter, you're going to be able to make a conceptual call, and that's about it. This calculus also is enormously affected by what happens when drugs go out of patent, when they'll probably be affordable by the vast majority of people.

I agree that it would. But I'd argue that it is also rational to profess a desire to balance the rate at which new drugs are introduced with increased access to those drugs which do get introduced, even if the introduction rate is lower.

Well sure it is. But I'm not sure there is really a clear calculus that can come up with the right balance. Honestly, I'd have no idea how to come up with that balance and be confident in my result. I'm really torn. On the one hand, new drugs can be ridiculously expensive. On the other, they'll still be out of patent soon, and far more affordable. That's a gigantically tough thing to balance, and I think the non-U.S. world is fortunate that the U.S. leans towards the side of higher prices, and more development.

Your usage is completely loose. You're taking the broadest definition of "choice" and using that definition to make meaningful statements about economic processes, but that's simply not how it works. Choosing life over death is always a rational choice, but it is not a meaningful choice in an economic sense if the spectrum of choices are artificially constrained by coercion, force or other means.

That's true on a purely individual present-time basis. For example, if you go up to a person dying from a particular disease, and say "we can give you a cure but it is going to cost you $100,000", that person is going to pay anything. But that's generally not how overall prices are set because of third party/group decision-making. The ACA (as an example) includes the so-called death panels precisely to make those tough cost/benefit decisions even though the individual patient at that moment is under great duress, and wants anything possible to be spend on his/her behalf. So in the context of how so many of those cost-control decisions are made outside the individual context, the issue of "duress" isn't quite the same.

Likewise, when we vote for politicians based on their ideas regarding health care, etc., many of us are not under any personal duress at that time. We're making a more general determination on where we want things to come down on the cost/benefit spectrum. That's really what is happening when issues like government cost controls come up, and it is at that point where the issue of willingness to pay more comes in. And as I said, duress generally doesn't apply there.

[Illyrio Mo'Parties]

Hey kids,

I have nothing to contribute to this thread, but seeing as the topic is health insurance in America, and there seems to be lots of Americans on here, I thought I'd ask a couple of questions and satisfy my curiosity:

1. Why do Americans so often get their health insurance through their employer?

2. Americans - do you like getting health insurance through your employer?

3. Is is true that health insurance companies are forbidden from trading across state lines, or something like that? Like, say you lived in Arkansas, you couldn't buy health insurance from a company in New Jersey?

In return I will be happy to answer and any all questions about the Australian health care system. Although to be honest I don't really understand how it works here either

[Robin Of House Hill]

1. A long time ago, health insurance was offered by employers because it was cheap.

2. Depends on who is paying.

3. Insurance companies may be licensed to do business in multiple states or may have subsidiaries in multiple states.

[TrackerNeil]

Grody Brody, I will answer as best I can.

1. Why do Americans so often get their health insurance through their employer?

In World War II, war-essential industries were wage-controlled, meaning they could not change wages without government approval. To get around this, and to attract the best employees they started offering health insurance. So in a very real sense, government policy started this.

2. Americans - do you like getting health insurance through your employer?

I don't, no.

3. Is is true that health insurance companies are forbidden from trading across state lines, or something like that? Like, say you lived in Arkansas, you couldn't buy health insurance from a company in New Jersey?

True, and that's a good thing; otherwise, it would be a race to the bottom as every insurance company moved to the states with the most lax regulations.

[Robin Of House Hill]

3. Is is true that health insurance companies are forbidden from trading across state lines, or something like that? Like, say you lived in Arkansas, you couldn't buy health insurance from a company in New Jersey?

True, and that's a good thing; otherwise, it would be a race to the bottom as every insurance company moved to the states with the most lax regulations.

I realize I'd misread his question., but your answer isn't quite accurate, either. All they need do, is form a separate corporation in each state, while they hold all the shares of each corporation. Fifty separate legal entities, all owned by the same corporate parent.