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  • Originally posted by Jefferson1775 View Post
    I fixed it for you. Compliance with a law is not voluntary.
    Is the concept of taxation something new? You're also forced to pay for the military. Oh, that's a government service, not private? Well, don't pay for insurance then. All that will happen is you will be paying a higher tax. I am currently paying a higher tax for not having children, am I therefore forced to have children?

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    • Originally posted by quikky View Post
      Is the concept of taxation something new? You're also forced to pay for the military. Oh, that's a government service, not private? Well, don't pay for insurance then. All that will happen is you will be paying a higher tax. I am currently paying a higher tax for not having children, am I therefore forced to have children?
      I merely corrected your choice of words. Saying that a law "asks" people to do something is inaccurate.

      If I decide not to buy health insurance and then also decide not to pay the fine required in the new law (it's unconstitutional so I'm practicing civil disobedience, whatever), I would likely be thrown in a cage. That's not much of a choice.
      In matters of style, swim with the current. In matters of principle, stand like a rock.

      This message has been intercepted by the NSA, the only branch of government that listens.

      Comment


      • Originally posted by quikky View Post
        I can agree with this. My only counterpoint would be that if everyone is covered, perhaps it will reduce ER visits for non-emergency care.
        No it won't. Some people just aren't smart enough to use services correctly.

        Comment


        • Originally posted by Jefferson1775 View Post
          I merely corrected your choice of words. Saying that a law "asks" people to do something is inaccurate.

          If I decide not to buy health insurance and then also decide not to pay the fine required in the new law (it's unconstitutional so I'm practicing civil disobedience, whatever), I would likely be thrown in a cage. That's not much of a choice.
          No one is literally forcing you to buy health insurance, you are simply encouraged, via tax policy, to do it. We have a ton of things like this in our tax code - certain behaviors result in a lower tax burden.

          The issue then becomes not paying a higher tax, which is different than being forced to do something. Like I said, consider the fact that if you have children, you are eligible for a lower tax rate due to additional deductions, credits, etc. The other side of that coin is that if you do not have children, you are not eligible for said lower taxes, i.e. you pay a higher tax for the same income just due to the fact that you are not a parent. If I don't pay this higher tax for not having children, I can also be thrown in a cage. So, am I thus forced to procreate?

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          • Originally posted by Neckhammer View Post
            No it won't. Some people just aren't smart enough to use services correctly.
            Yes, it will. The only question is how much and whether it will ultimately drive costs down.

            Consider this: Out of the people that visit the ER without insurance, there are two groups - A. people who are there without an emergency, and B. people who are there due to an emergency. Within group B, there are two further groups - 1. people who have a sudden emergency, such as a heart attack, trauma, severe pain, etc., and 2. people who have a gradually developed emergency, such as a perforated stomach ulcer. Group B2 is the one primarily affected by insurance. If someone in group B2, using the example of ulcer perforation, had insurance and could have gone to a primary care provider when the problem was developing, the emergency could have been prevented and the overall cost of treatment would be lower for the person.

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            • Originally posted by quikky View Post
              Yes, it will. The only question is how much and whether it will ultimately drive costs down.

              Consider this: Out of the people that visit the ER without insurance, there are two groups - A. people who are there without an emergency, and B. people who are there due to an emergency. Within group B, there are two further groups - 1. people who have a sudden emergency, such as a heart attack, trauma, severe pain, etc., and 2. people who have a gradually developed emergency, such as a perforated stomach ulcer. Group B2 is the one primarily affected by insurance. If someone in group B2, using the example of ulcer perforation, had insurance and could have gone to a primary care provider when the problem was developing, the emergency could have been prevented and the overall cost of treatment would be lower for the person.
              Seems like a lot of ifs to me. How do you know that group B2 can not be further broken down. In fact I would say group B2 must be further broken down and I would wager a large percent of that group continues using the emergency room in an inappropriate manner. But maybe I'm just cynical.

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              • Originally posted by Neckhammer View Post
                Seems like a lot of ifs to me. How do you know that group B2 can not be further broken down. In fact I would say group B2 must be further broken down and I would wager a large percent of that group continues using the emergency room in an inappropriate manner. But maybe I'm just cynical.
                The point is, there will be people who will use preventative care vs. emergency care if they have insurance. What we don't know is how many.

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                • 39 Democrats Fold, Side With Republicans' "Keep Your Cancelled Health Care Plan" Bill

                  The Republicans' "Keep Your Health Plan Act of 2013" bill has passed the House (as somewhat expected). However, what is more critical - as we noted previously - is that a large number of Democrats broke ranks and voted for the bill.

                  39 House Democrats voted in favor, shunning Obama's proclamation that he would veto the bill **
                  39 Democrats Fold, Side With Republicans' "Keep Your Cancelled Health Care Plan" Bill | Zero Hedge

                  ** O'Bummer must have LIED again this week when he apologized and said that he would allow people to keep their insurance for a year! This is becoming a 3 Ring Circus!

                  Impeach Obama

                  Grizz
                  Last edited by Grizz; 11-15-2013, 04:00 PM.

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                  • Originally posted by quikky View Post
                    The point is, there will be people who will use preventative care vs. emergency care if they have insurance. What we don't know is how many.
                    See, but then we get into the real nuts and bolts of it. I don't think we provide "preventative care". Its all chronic care, and getting people in for chronic care earlier rather than to the emergency room later isn't gonna save us a whole helluva lot. If we wanna end the debate lets actually get people healthy rather than masking their problems with an ever expanding list of prescriptions that only contribute to long term disability. But thats just from my clinical stand point. For me all the political posturing is a moot point if we can't do what needs to be done in terms of real health and prevention. For another thread though I suppose.

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                    • Originally posted by quikky View Post
                      The point is, there will be people who will use preventative care vs. emergency care if they have insurance. What we don't know is how many.
                      I have no doubt that people will use a service that they do not have to pay for. The question is who is going to pay for it if the vast population of Young Invincibles needed to pay for this care does not enroll and chooses the penalty. There is a reason doctors and hospitals are opting out of ACA. It's because they are completely unsure of how they get reimbursed for care given.

                      So we'll have fewer available doctors and care facilities in the ACA exchanges and no clear way to pay for people who will sign up (the already ill). How is this a good thing?

                      Comment


                      • Originally posted by magnolia1973 View Post
                        I do think Obama fucked up by lying about health care reform and the bottom line impact on some pocket books.

                        The democrats fucked up by not being EXTREMELY forthcoming that this was about redistributing the costs of insurance.
                        Insurance is always about redistributing costs. Perhaps you are opposed to insurance in principle.

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                        • Does excess iodine cause severe schadenfreude?

                          Comment


                          • Originally posted by quikky View Post

                            Consider this: Out of the people that visit the ER without insurance, there are two groups - A. people who are there without an emergency, and B. people who are there due to an emergency. Within group B, there are two further groups - 1. people who have a sudden emergency, such as a heart attack, trauma, severe pain, etc., and 2. people who have a gradually developed emergency, such as a perforated stomach ulcer. Group B2 is the one primarily affected by insurance. If someone in group B2, using the example of ulcer perforation, had insurance and could have gone to a primary care provider when the problem was developing, the emergency could have been prevented and the overall cost of treatment would be lower for the person.
                            A pretty good point, so I can only add to it:

                            Your Group A, or the people that are there without true emergencies, actually makeup a VERY large percentage of most visits. I have rotated through ERs in 4 cities, and it would be fair to say that about 70% are not actual emergencies....what some do not know about is that these are ALSO very costly for the system, as due to the liabilities and unknown nature of the case an ER doctor must be very aggressive in testing. (I.E. Throw the sink at it, which costs a lot) I saw people with common eye issues that I can easily treat myself, minor falls, broken bones that occurred during business hours that a GP can fix for 10% the cost, etc.....enormous cost savings could be made just by diverting these people to non-ER facilities when hours permit.

                            Group B, of actual emergencies, are usually broken down into trauma or CV issue that is possibly life-threatening, such as a stroke, aneurysm, or MI....but I would break them down into two different groups that are not trauma-related:

                            1) People that KNEW they were in trouble, have been getting treated. Usually insured.
                            2) People that have had little to no care. Usually uninsured.

                            Overall though, the fact is that people that have no insurance, or skeleton insurance (many cases even worse) are an enormous burden on the system financially. Both do not have their care monitored, and the costs of their emergency care, whether a true emergency or not, are passed on to everyone as they almost always cannot pay.
                            "The soul that does not attempt flight; does not notice its chains."

                            Comment


                            • Originally posted by skotcharu View Post
                              I have no doubt that people will use a service that they do not have to pay for. The question is who is going to pay for it if the vast population of Young Invincibles needed to pay for this care does not enroll and chooses the penalty. There is a reason doctors and hospitals are opting out of ACA. It's because they are completely unsure of how they get reimbursed for care given.

                              So we'll have fewer available doctors and care facilities in the ACA exchanges and no clear way to pay for people who will sign up (the already ill). How is this a good thing?
                              The bolded above is completely invented tripe. Sorry.

                              How exactly would I, as a physician in a private practice, "opt out of the ACA"?

                              All that it is, in any state, are a few long-standing insurers that have allowed their plans to be sold through the government. In my state it is only BCBS and MVP, both of which pay pretty much 100% of the time with immediate reimbursement. I can only "opt out" in the sense that I will refuse to carry Blue Cross or MVP, which is financially idiotic. It would be like taking car insurance claims without taking State Farm or Allstate....you would only be losing yourself money for no reason.

                              Additionally, the idea that the ACA is going to make us "unsure of how they will get reimbursed" is completely made-up horseshit as well.....ask ANY doctor what insurance they love to see at the top of the superbill for a patient, and I would bet 95% will say "medicare".....that is because it is done by the government, not an insurance company whose entire business model depends on not paying me part of the time. If I say they need it and they have Medicare, it gets done, I get paid top dollar, no fuss.

                              What doctors DO hate to deal with are the fly-by-night insurers that are totally bare bones, in both prices and benefits. (As an example, I had a patient recently whose "insurance" paid the first FIFTY DOLLARS of a hospital visit, then it was all on them. You can't go pee in the bathroom of a hospital for less than that) When I have my people call these racketeers, you will be getting a 90 min harangue about how they are not paying you.

                              Most of these insurers that the ACA is making illegal, many of which can be bought for less than $100 a month, are no different than Joe Pesci's character in "Casino":

                              "He had a system. It wasn't very sophisticated, but it worked....when he won, he collected. When he lost, he told the bookies to go F*** themselves."

                              This is their business model. I deal with them all the time. Drop you as soon as you actually need much of anything.

                              What has happened is that there are a very small number of very ideological healthcare networks and docs that have decided they will not be taking any ACA plans, which do not even exist yet, out of pure political backlash. They are willing to LOSE money to do it, and they make a lot of noise and get themselves onto Fox News for doing it.

                              I think the ACA is a terrible idea and a corporatist handout, but none of the GOOD reasons for hating it are ever brought up. All that is ever brought up is single-minded corporatism to combat a law that is also single-minded corporatism to different backers. It is all so sad to me.

                              Sorry for the rant and it's not at you at all, just the ideas I see constantly floated around with no educated rebuttal.
                              "The soul that does not attempt flight; does not notice its chains."

                              Comment


                              • Originally posted by TheyCallMeLazarus View Post

                                I think the ACA is a terrible idea and a corporatist handout, but none of the GOOD reasons for hating it are ever brought up. All that is ever brought up is single-minded corporatism to combat a law that is also single-minded corporatism to different backers. It is all so sad to me.

                                Sorry for the rant and it's not at you at all, just the ideas I see constantly floated around with no educated rebuttal.
                                Thank you for saying it!
                                Life is death. We all take turns. It's sacred to eat during our turn and be eaten when our turn is over. RichMahogany.

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