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The Moral Dilemmas of Obamacare Print E-mail
By George J. Marlin   
Friday, 27 December 2013

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In his novel Sybil, nineteenth-century British Prime Minster Benjamin Disraeli described a character as “distinguished for ignorance” because he “had only one idea and that idea was wrong.”  The idea – promoted for decades by high-minded social engineers – that a national healthcare law would benefit all Americans qualifies for the 2013 Disraeli Award.

The only Obamacare fan who called it right was former House Speaker Nancy Pelosi who said, “We have to pass the [health care] bill so that you can find out what’s in it.”  The American people have found out a lot since the October 1, 2013 rollout and little of it has been for the good, particularly the false claim that it would be “affordable.”

Over 5.8-million people have received notices that their individual policies have been canceled and there has been sticker shock over prices of replacement policies that have received the administration’s seal of approval.  Even the New York Times conceded in a front-page, above-the-fold story, “New Health Law Frustrates Many Middle-Class Americans.”  One insurance broker is quoted complaining: “Everybody was thinking that Obamacare was going to come in with more affordable rates.  Well, they’re not more affordable.” And we’re just getting started: wait until companies start seeing what the future looks like in 2014.

As Catholics, we have an obligation to apply moral principles to economic life.  Hence, heads of families, medical professionals, and employers have an obligation to provide a sense of stability, reasonable security, and honest services to those in their charge. Obamacare is challenging those moral principles.  Americans are finding them hard to uphold as they are being forced to make healthcare decisions that impact their lives.

A single working mother of two children told me that her family policy, which cost about $8,000 a year, had $20 doctor visit co-pays, and $200 per person deductibles, was canceled.  When she finally was able to log on to the government website, she learned that the cost of replacement coverage would remain the same but co-pays would double and deductibles would skyrocket to $3,500 per person.  The increased co-pay will mean less preventive care for her and her children.  And a catastrophic health issue could break her financially.

If a member of her family has an accident, she may have to choose between paying the deductible or making a mortgage payment, or paying utility, insurance and tuition bills or buying enough food to feed her family.  Obamacare is upsetting this mother’s moral compass.  She is losing sleep over this; praying the day never comes when she is forced to make such choices. 

Medical doctors are also facing ethical dilemmas.  With reimbursements being cut, many are opting out of various medical networks.  In California, for instance, approximately 70 percent of MDs are refusing to participate in the state exchanges.  The president of the California Medical Association, Dr. Richard Thorpe, said doctors can’t afford to work at a loss: “We need some recognition that we are doing a service to the community.  But we can’t do it for free.  And we can’t do it at a loss.  No other business would do that.”

A GP doctor I know is opting out because to break even under Obamacare he would have to increase his patient volume to a point where he would not be able to spend enough time with each of them to properly diagnose their ailments.  To maintain his ethical and medical standards he has reached out to long-time patients and offered his own plan.



The doctor has proposed limiting his practice to 300 people willing to pay an annual fee of $1,000.  In return for that payment he would be available to provide all their routine medical needs throughout the year.

My friend believes this is a fair plan because it would give him an adequate revenue stream to support his office and the time to provide adequate care.  While he has been troubled that he would have to turn away patients, he has concluded that Obamacare has given him no other alternative.

A small business I am familiar with that is severely impacted by Obamacare is being forced to make difficult choices. For years this company has provided Cadillac health care to employees at no cost to them.  Although the plan has been very expensive, the principals have believed it was the right thing to do.

Now these managers have been told that to maintain the present level of coverage, premiums will go up somewhere between 50 to 100 percent when their new cycle begins.  The projected costs, however, are unaffordable and over the next few months they will have to choose an alternate plan.

Because the company employs fewer than fifty people, one practical alternative that would save a small fortune is to direct their employees to go to the Obamacare exchanges to procure their own coverage and to pay for it themselves. 

Here’s the predicament:  Management believes it is immoral to throw their employees under the bus and let them fend for themselves at the exchanges.  This means their only option is to choose an affordable but less attractive plan that will cost their employees significantly higher out-of-pocket costs.

The Affordable Care Act has coerced fair-minded employers, dedicated doctors and struggling families into painful moral dilemmas. These are people, by the way, who care about others and aren’t opposed to a society taking care of the neediest. But there were and are other ways of solving problems than via the arrogant belief that the government can manage one-sixth of the U.S. economy. We’re only beginning to see the consequences of that fantasy.

I hope Pope Francis finds an opportunity to comment on the immorality of those who concoct government schemes that, however well intentioned, harm the common good, violate the principle of subsidiarity by curtailing the freedoms of individuals, families, and groups, and hurt the very people they intended to help.

 
 
George J. Marlin, Chairman of the Board of Aid to the Church in Need USA, is an editor of The Quotable Fulton Sheen and the author of The American Catholic VoterHis most recent book is Narcissist Nation: Reflections of a Blue-State Conservative.
 
 
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Comments (27)Add Comment
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written by Jack,CT, December 27, 2013
Great summation of the grim realitys of
this new law.

I agree with all Mr Marlin says and I can
tell you as a person on Medicare I never
in a million years felt I would be in better
shape than "One' on a HMO!

The incentive to remain Poor and even poorer
yet is never greater as the cash for "Insurance"
only grows the poorer and larger the family as
the Welfare state becomes Nationalized and those
who worked all there lives get squeezed even more
to pay for frankly irresponsable laws and people,I
wish there were a nicer way to put it there just is
not.

We seem to forget that those of us who went into
medicine and worked long hours to get there never
exspected to get rich.
We simply want to live well and cutting the incentives
for the kind of people you want saving your life is
and should send shivers.
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written by Rich in MN, December 27, 2013
Great article! I especially like your last paragraph. If our Holy Father is, in fact, playing some sly "rope-a-dope" game with the mainstream media, there will come a time when he will need to throw a few very deliberate, unambiguous punches, even if he risks losing his complimentary subscriptions to the National Catholic Reporter, the Advocate, and whatever bit of "hall of mirrors" wisdom that NARAL happens to publish.

And I am one of those "fanatical alarmists" who believe that health care driven by positive law will issue in the next brutal chapter of the nightmare begun in January 1973. Recently, I saw a video of a talk given about 6 months ago by Daniel Becker of "Personhood USA." This is a wonderful talk that I strongly encourage people to hear. In my opinion, Becker offers clear evidence that nature isn't the only thing that abhors a vacuum. The spiritual world also abhors a vacuum. When we drive out God and the angels in obedience to God, something else will come flooding into the void, and the first words whispered in our ears will be, "You can be just like God."
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written by grump, December 27, 2013
What is immoral about America's health care system is the outrageous prices charged to patients.

Here is my bill from a "non-profit" Catholic hospital whose slogan is "where caring makes the connection."

"Foot X-Ray" $310.25 (3 photos and 5 minutes time by radiologist)
"Office Visit" on one day, two separate charges: $71.90 for the doctor and $76.31 for "use of facilities". I was there for 25 minutes.
"Venipuncture" $14 (a poke with a needle to draw blood), takes 2 seconds
"PSA Screening Test" $161.32 - 5 minutes of lab work.
"UA Complete auto w/o micro" - $55.29. Peeing in a bottle.
Total bill: $689.07.
Most covered by Medicare but still on the hook for a chunk.
After Obamacare siphons off billions from Medicare, seniors will be stuck with much larger co-pays. The result is to discourage sick people from going to the doctor. I have many other medical issues but am reluctant to pile up more debt. For example, a hip replacement. Cost estimate is $29,700 for hospital and drugs ONLY; does not include the price charged by the orthopedic surgeon, which the hospital did not have on hand. Probably will work out to six figures.

When I asked the hospital for an explanation of the charges on my latest bill I was told that their prices are "in line" with hospitals.

Years ago, I had a cyst on my backside that required extensive treatment over a period of time. Our family doctor, bless his soul, came to our house in a snowstorm and took care of it. Total charge: $35 and "pay when you can." Now that was true caring.

As for Francis weighing in, I can only imagine him saying, "After all, who am I to judge?"
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written by william manley, December 27, 2013
This post is just a rehash of all the criticism that has been heaped at the ACA in the past few months. What I am waiting for from this website is the framework of a national medical plan that will be affordable and effective. If you care about the poor, what is your plan?
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written by ken tremendous, December 27, 2013
where to begin...

first Marlin conveniently forgets that every staple of Obamacare-from the individual mandates, to a shift away from employer provided insurance to an individual model, higher deductibles and out of pocket costs for consumers, to the even the dreaded IPAB were the center of conservative health care reform ideas. Now it turns out that they don't work that well in practice.

Read the other comments, Mr. Marlin. We have in the US the most expensive health care in the world. It costs 50% more for a traditional delivery of a baby than it does for a C-section in the next most expensive country. Hip replacements, open heart surgery, MRI, cat scans, insulin, you name it, it costs way more in the US than anywhere else.

Yes I know that conservatives claim that the higher costs are due to govt. involvement...though any one with two eyes can see that every country in the world besides the US has strong cost control regimes that outlaw higher prices by profiteering doctors and hospitals. In other words, more government involvement rather than less is the key to holding down costs. Don't trust me on this. Read the right wing journal Weekly Standard entitled "The Great Unmentionable"...which for once accurately questions the long held GOP commitment to keeping American doctors incomes high.

To answer William Manley's question...no such proposal will be forthcoming from this page. What the whole health care debate comes down to--like everything else in American politics is which tribe you identify with.

Democrats side with those who have high medical needs, the poor, the sick, the un--and underinsured.

Republicans--even ones who wrap themselves in the mantle of Catholic teaching-- side with those with low medical needs and/or who already have insurance, especially Cadillac plans, hospitals, and high salaried doctors--especially specialists who would love to pay even less for medical malpractice and thus enjoy even more time on vacation.

I wonder which group of people Pope Francis sides with?

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written by Matt, December 27, 2013
I agree that the Healthcare system we had (pre-ACA) had major flaws. We should not go back to that system . On the other hand, ACA was written to "guarantee" that the situation would worsen considerably. I marched in Washington against the passage of the ACA and the information was available to all. We did not need to pass it to know what was in it.

A framework for the best healthcare(though never perfected)is one where it is based on a truly free market such as the prices of Surgery Center of Oklahoma actually demonstrate. That of course is not all - there has been a monopoly between the healthcare industry, pharmaceuticals and the large health insurance companies. That monopoly has to be broken up to allow competition and price deflation. Finally we need to get the government out of healthcare as it is the largest most powerful monopolistic force. A good religious group would be a better provider - Currently the faith-based institutions accepted a backseat rather than the drivers seat in heath care for the poor. They now "manage and distribute" government funds as the government dictates.
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written by Jack,CT, December 27, 2013
Psa tests, Xrays,Urine workups etc are not billed by
or givin to a health care worker but a "Company"!
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written by Jack,CT, December 27, 2013
Not To Mention people are over tested' and
Procedures over done as Docs are fearful of
suits!
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written by Jack,CT, December 27, 2013
@Bill Manley,Perhaps you should understand
that "NationalMedical Plans"
Are Not A Good Idea.
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written by CCR, December 27, 2013
Listen, there is this very expensive service which - by reasons we are not going to do a thing about - is getting more ans more expensive every year. Now, here is the solution: let us create a huge bureaucracy to provide this service to everyone in such a way that the cost of the service plus the cost of the bureaucracy will make it affordable to those who could not afford the cost of the service in the first place.

That is basically the proposal put before the American people. Now, if you expect this to work as presented originally... I have a great bridge over the Hudson River that I can let you have for just all the money you have in the bank.

Too many voters on drugs, if you ask me.
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written by Jack,CT, December 28, 2013
@CCR, Great! Could not Have Said it Better!
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written by CCR, December 28, 2013
The problem, Jack in CT, is that the electorate appears to be unable to make such a simple distinction. I can expect the American electorate to be arbitrary but not downright idiotic as it seems presently to be the case. Now I realize why I am unemployed and yet so many are taking home checks. There can be no democracy in a country populated mostly by fools, perverts, and knaves. The lies are out, the killings will follow very soon.
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written by Chris in Maryland, December 29, 2013
William M and Ken T:

It is not wise for you to believe lawyers, who are paid by the hour, when they tell you that they are going to set wages and prices for doctors and nurses.

It is not wise for you to believe in govt bureaucrats, who have gold-plated health insurance subsidized by taxpayers working in the real world, when they tell you that you are going to like "the health plans" they concoct for you - while they exempt themselves from their own concoction.

Even a person who is a genius can't behave intelligently when there are no market-based prices set for services. Since hospitals and medical providers don't publish their prices, people are not free to choose what is best for their medical care, because the basis for choice does not exist. The current POTUS, his entire party, much of the GOP establishment, AARP and most hospital and insurance administrators don't believe citizens deserve to know prices or make choices.

Some moral and ethical doctors and nurses are trying to fight this organized oppression, which is designed to reward politicians, bureaucrats and big-medicine, by publishing their own prices and working directly with patients and keeping the politicians, bureaucrats and big-medicine out of the examination room.
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written by diaperman, December 29, 2013
By my reckoning Chris you are less than 10 years from collecting medicare whose rates are set wholly by the govt. Get back to me when you give that up in favor of the mythical free market unicorns.
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written by CCR, December 29, 2013
@diaperman:

1+1 will always be less than 1+1+1

The unicorns will eventually impale anyone believing otherwise.
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written by Chris in Maryland, December 30, 2013
Diaperman:

Even though you seem to believe in the mythology of Medicare, and I may be stuck with the reality of Medicare (among other failed "great society" interventions), that doesn't mean Medicare works.

There is no market in medicine because lawyers and financiers make sure their is none. Medicine is a "good and a service," (not a right) and costs and prices are hidden, because the vested interests of the "great society" centralize the excess profits for themselves, and distribute them where they please. That is immoral.

And when and if I am dependent on Medicare - it will probably be something like an impoverished form of "Tricare" for military retirees - which my family experienced - and Tricare stunk. Which is why people on Medicare try to establish "Medicare Advantage" supplements, which the "great society" now also wants to snuff out.

Just because Medicare is forced by law to exist doesn't mean I have to believe in it.

You are free to pledge allegiance to it, if you choose to. I will not.
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written by diaperman, December 30, 2013
No mythology Chris. Your point about price transparency is true but irrelevant to the broader issue.

Unless you're richy rich you are not going to be able to afford modern medical care that a person in your age group is likely to need...even with prices completely out in the open.

One way to see this is to look at the soaring cost of veterinary care which has no govt. involvement and little private insurance. The average vet bill per pet has gone way up...basically because owners have money, owners love their pets, and vets are good businessmen that capitalize on these things by developing and selling new ways of keeping pets healthy and living longer. Why do you think for-profit health care for people woulds somehow have a different dynamic when clearly we value human life even more than our beloved pets?


Medicare is expensive but believe it or not its per capita costs are less than private insurance and its rate of growth has generally been slower than private insurance as well. The reason is simple...the government is a massive buyer and has the ability to hold down reimbursements much more than do private insurers. It is much like Walmart who as a large buyer will not let its suppliers make much money and thus can sell goods more cheaply.



I know this conflicts with your free market ideology but national health insurance plans work reasonably well largely because they are even more aggressive at driving health care spending down even than Medicare and Medicaid. We pay doctors nurses, hospitals, medical suppliers, and drug companies more in the US, not because they are better here, but because our political system is for the moment committed to keeping them the most highly paid in the world.

Sometimes market forces drive the cost of things up over time not down and health care is a good example of this. The free market does not magically make every good cheaper over time!
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written by Chris in Maryland, December 30, 2013
Diaperman:

I thought the purpose of a market was to make the price of a good an equitable price - not a cheaper one. I guess you are looking for something else, like what they say in business - you want broad-band services for dial-up prices. Only the govt employees get that with their medical subsidies.

Of course market forces drive things up and down, and under the market ideology - medical prices would also go up and down, and then stabilize, as information spread in the so-called info age. But this won't happen under the current system of stupidity.

Some people are foolish or otherwise ill inclined and choose to pay for things they don't need or shouldn't promote, as in your example of vet medicine, chemotherapy for dogs. That is stupid - but those people pay the cost of their own stupidity. Paying for condoms for law school students at Georgetown is a higher form of stupidity and mendacity, concocted by the ruling political tribe, and the cost shifted onto responsible people who prefer that law school students wait until after they graduate to start fleecing people.

Under your socialist ideology, which I don't think you have thought through very much, the problem that seems to bother you is that the politically powerful don't make every decision for you about wages and prices.

Or are you telling me that some prices and wages should be set by a market, and if so, why?

You keep pulling the lever for people who exempt themselves and their powerful allies from the "master plan." You are not only running out of other people's money, you are running out of other people, and you are running out of time. Credit will stop. The Great Society is a lie.
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written by diaperman, December 30, 2013
No...I believe in markets too, Chris.

They just don't work well for health care. Why not? The problem is only partly stupid spending. I don't know why you think people don't spend stupidly on health care for themselves if they do for pets. But if people blow collectively billions of dollars on medically worthless herbal remedies and dietary supplements it's their own fault. No biggie. (It does sort of throw water on the Republican view that doctors and patients making decisions together is the best way to contain costs!)

But mostly the problem here is one of distribution. An open market for medical care just leaves too many people with too little care. If people can't afford lobster or filet mignon or bmw or 2500 square foot mcmansions no big deal...the free market provides plenty of good substitutes. But in the case of necessary health care for a sick person, Chris, there really is no substitute.

To give an example,my wife contracted stage 3 breast cancer at age 31. With our meager earnings at the time (I was just finishing an MA) we would never have been able to afford the treatments that actually saved her. We did have good insurance fortunately. But we could very easily have not had it. Moreover, the cost of care has risen so much that even private insurance is unaffordable for many low salaried workers, and would have been for my wife if she had been, say a cashier at Dollar General. And private insurance is out of the question for older people. Premiums in the open market for a policy with the actuarial value of medicare would easily surpass what most seniors earn.

So private insurance is not all that workable. It won't work at all for the poor and the very old. So the govt. steps in to shore it up. It takes away old people who would be for all practical purposes uninsurable and poor people who could not afford the premiums. Then it works OK for people who have modest health care needs..as long as they don't lose their job or get sick. But even here the govt. has to regulate health insurance--in terms of preexisting conditions, in terms of portability, in terms of renewability etc. Otherwise even the private markets would utterly fail. The temptation is just too strong for companies to limit their sales to the 90% people who aren't likely to get sick which makes rates affordable for healthy people but leaves a big chunk of people uncovered. For me, as a Catholic this is unacceptable.

My point is having some form of insurance is a practical necessity and having at least some govt. involvement is necessary too. Otherwise you really would face a much larger problem of people going without medical care.

So given that there is going to be at minimum govt. insurance of some sort for the elderly and the poor--and indirect supports for everyone else, we need to take practical steps to limit the public expense precisely so that we don't bankrupt ourselves. One way to do this is refuse treatments that are deemed not cost effective. Another way to do this is to take steps to bring medical reimbursements to providers more in line with the rest of the world.

The plan you seem to be advocating is 1) whine about government involvement which exists everywhere in the world including the US (while grudgingly accepting medicare benefits) 2) resist any attempts to control costs to the program by deriding as "socialism" any attempts for the government to cut payments to docs and drug companies 3) scaremongering about the deficit--which itself is largely driven by out of control medical costs

How much sense does this all make Chris?
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written by Chris in Maryland, December 31, 2013
Diaperman:

Your own family's experience is that private insurance worked for you. Your trust in the govt solution is contradicted by the very example of your own life.

Why do you persist in believing that people in govt care about people more than people in private practice? I can assure you they do not. Surveys of people in govt always show that the vast majority are in govt for one thing above all - their belief that they - as govt workers - are financially secure.

As the current POTUS stated, the purpose of his administration is to "reward our friends and punish our enemies." Having attended a prominant school of govt - I can assure you that the motivations voiced by my classmates employed in govt were profoundly political, they are not for the "common-good."

Perhaps you sense you have nothing to fear, since you believe you are counted among "the friends" of govt.

You complain that medical costs are too high, but you don't discuss why - they driven up by unnecessary / unwanted expenditures, imposed by govt lawyers in the DC beltway, and fed/state govt laws/regs that prevent commerce in health insurance across state lines, and "black-box" pricing that allows big govt, big med and big insurance to keep their revenues and margins where they want them, at the cost to middle class people, who are too weak to shield themselves legally, so their income can be fleeced to line the pockets are of the "well-positioned" in govt, med and insurance.

The people that will/are getting hurt are "the goose that lays the golden egg" - the local doctor/nurse whose practice gets fleeced and loses the incentive to do what God made him/her to do; the middle class families that are/will lose their income, and pay new gigantic premiums & deductibles for impoverished care, and likewise lose their ability to spend money where it is better spent, on real medical needs that they have for their own families, on education, or on goods and services from local business. All of that spending which would flow and spread to others is snuffed out. The avowed purpose stated by the POTUS is to fleece these people, shift their money to the politically positioned who cooperate with "the solution," and reward the reliable voting block with the leftovers.

Because of state/fed govt and lawyers, we don't have "medical insurance" in this country, we have destroyed the option for "insurance" and replaced it with the requirement for "medical benefits" which pays for things not needed, or at excessive costs, because >50% of "beneficiaries" have no incentive to control costs, because someone else pays the cost for them (i.e., the local medical practice, the middel class taxpayer, future unborn taxpayers who get the cost shifted to them by the current and hence-unaccountable govt who borrows, etc).

You complain that med costs are too high. They are too high because fed/state govts and lawyers force wasted spending, and benificiaries don't see/pay the costs. And now you are advocating for complete intervention by fed/state govts and lawyers. Excessive political intervention has caused the problem, and you hold that the solution is complete political intervention.

The people who make sense to me are the doctors and nurses that oppose this insanity, and are trying to offer something different - insurance for catastrophic illness, markets for normal everyday medical services, safety-nets for those that can't afford one or both of those, and a govt that preserves - rather than destroys - those 3 things.
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written by Chris in Maryland, December 31, 2013
Also Diaperman:

You ought to be very wary about "refusing treatments that are deemed not cost effective."

What makes you so sure that some 3rd party govt bureaucrat sitting on a decision board with a centralized budget that is hemorraging money is going to make a medical decision in your favor? Take your wife's situation, add 20 years to her life, or put her at stage 4 instead of stage 3. I can tell you Diaperman - you are going to get some pretty rough treatment - a lot rougher than Kathleen Sebelius will ever get - because she will have what will be legally and/or economically impossible for you - her current federal gold-plated health insurance subsidized 67% by taxpayers, or private insurance.

I have 2 of 4 children with learning disabilities. If, as you strongly believe - govt really cares about health care -why, may I ask, do the state and fed govts insist on tax "deductions" for health care expanses? Allow me to answer - because they love my tax revenue more. So instead of giving tax "credits" for medical expenses, which would allow people like me to pay for the care of my children, they take thousands, and throw me back hundreds. And they take my thousands, and they spend it on immoral purposes, like paying for contraception for a reliable part of their voting block.
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written by diaperman, December 31, 2013
OK Chris so higher deductible catastrophic plans with more price transparency for more "routine" stuff.

Not the worst idea in the world if you have a decent income and have no serious medical needs. Would probably be better for most people than what we have now. But how do you tell a type one diabetic or a cancer survivor that battles recurrence every two years to get "catastrophic" insurance. They've sort of already had the catastrophe you know. Maybe we need a special high risk pool for them, which come to think of it is also a center right reform idea. But they cost money and alas, we both know that Republicans hate spending money on the sick who are never a big voting bloc anyway. Democrats for there part just wanted to change the whole system and I think we agree this has not gone well either. But if you're mad you should be mad at the GOP who could have made this issue go away for a lot less money than Obamacare will end up costing. But again, the stupid party A wants to spend no money and so stupid party B wants to spend way more money.

The other more basic macro-problem goes back to the fact that health care is an 80-20 proposition --80 % of the costs are generated by 20% of the population. Catastrophic care keeps rates low for healthy people but by definition does nothing to control the health expenses of the sick. Which is why both private insurers and govt. take steps to drive down health reimbursements from the top. My only point to you is that historically govt. is much more effective at this than private insurance. You say you support a safety net...fine which maybe means that you realize this. But keep in mind--any safety net is going to imply a pretty big governmental role. A recognition of that basic fact would cause you to tone down your overheated criticisms of Obama.

But speaking of costs, you are not wrong in saying that the govt. bears some of the responsibility for this. But let's look at this more closely. Suppose WalMart wanted to put a nurse practitioner or a PA in each of their stores to treat low income people who lack insurance. Wal Mart could surely do this and would be a great way of delivering low cost medicine to poor underserved people. Why don't they?

It's illegal in most states in the country to do this...that why. Most states require NP's and PA'a are "supervised' by physicians which of course guarantees that doctors incomes are protected. And if you do a little legwork you'll find that GOP governed states by supposedly "free market" conservative types are some of the worst offenders in this regard.

The federal govt. also makes it very difficult for foreign doctors to emigrate to the US which also screens out low cost competition. Again,,,mainly the GOP is completely owned by the AMA in this regard.

And don't get me started with the REpublican love affair with drug companies and their resistance of even modest attempts to bring drug costs more in line with what the rest of the world pays.

SO contrary to what you might think Chris, I am a Republican and have been since 1988. But I also call them like I see them and am sick to death of the disingenuous nonsense repeated by my party on this issue. If you looked at the issue more honestly, I think you'd see our side--with its commitment to entrenched interests who benefit from the status quo--bears a great deal of the blame. Our sympathies should be with the most vulnerable, not with the most powerful.

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written by Chris in Maryland, December 31, 2013
Diaperman:

Per your argument - you should stop digging - it is not persuasive to deride free markets by pointing out another case where govt doesn't allow free markets.

You assert you are a Republican - I didn't say what you are - but I don't see how your claim has any bearing on your comments on this issue.

On a sincere and happy note, I wish you and your wife and family a blessed and happy new year, and a happy 7th Day of Christmas.

In Christus Veritas - Chris
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written by Chris in Maryland, December 31, 2013
Diaperman:

What history is that? Please give specifics and comparisons - rather than general assertions.
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written by Chris in Maryland, December 31, 2013
D-Man:

I do agree with you that it is wrong that health insurance is linked to employment - its yet another case of a govt concoction that failed - I mean - why can't we buy health insurance they way we buy life insurance? Answer = govt.
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written by diaperman, December 31, 2013
THe Republican comment was a response to an earlier salvo you launched about " you guys keep pulling the lever". I've never "pulled the lever" for a Democratic presidential candidate and I don't expect to in 2016 either.

Well I'm not supposed to link but the issue of private insurance vs. medicare has received a ton of play.

try some of the links here (among many other places)

http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/

Of course the right will respond that Medicare is just cost shifting onto private insurance. But this proves too much. If it is cost shifting it is only because Medicare is much better at holding down reimbursements than private insurance. The latter has done terribly at this since back in the 90's and the rise of the dreaded HMO's. Patients don't like cost controls any more than doctors do!

And as for exactly the same procedures being way, way more expensive in the US than anywhere else here's this

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/26/21-graphs-that-show-americas-health-care-prices-are-ludicrous/

I think it is obvious that for whatever faults they otherwise have public insurance plans do a much better job at keeping costs down, which they have to because they would go broke if they did what the US does.

In the US we have one party that secretly and theoretically prefers that social insurance should not exist at all, but loves doctors, private insurers and pharmaceutical companies too much to really try hard to control costs and so in practice thinks that social insurance (if it has to exist) must maximally reward private interests while at the same time having blank check with no effective cost control at all. And we have another party that is committed to expanding the inefficient system as far and wide as possible. This is how we get the mess of the US health system. It would make a lot more sense if we just struck the bargain in the US that practically every other country has and just accept a universal system in exchange for making it as stingy as possible. Maybe medicaid for everyone--which is dirt cheap--with top offs allowed for people who want to buy more. That ensures everyone gets something but others can buy more if they want. Something like education, or police and fire protection. But the GOP is a long way from being ready for that!

You're in Maryland eh. I'm in Northern VA. Maybe we should grab a beer sometime.

Have a Happy New Year. Be safe!!!!
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written by Chris in Maryland, January 02, 2014
D-Man:

The objective is not to keep costs down, the objective is to keep costs equitable. Equitable prices are impossible under govt intervention, which = collusion of govt with vested political and business interests (which destroys prosperity of the many in the process of centralizing and taking profits for their political and business supporters). And govt intervention in health care is and has been the norm for 50+ years.

You are arguing for low prices in medicine - well - you are on the path to get them D-Man. As in all economies, what you get for low-priced medicine is low-value medicine.

You and I will get that under what you propose/support. The POTUS will never accept that for his family. The entire federal workforce will never accept that for their families. All of the exempted Labor Union employees will never accept that for their families. None of the exempted political/business factions that have paid protection money to both political parties will ever have to accept that for their families.

Tha factions and interests I have listed are gigantic in size, tens of millions of people getting gold-plated medical care subsidized by taking income from taxpayers employed by private businesses while they are forced into the low-cost, low-value regime you are (unintentionally?) supporting.

I see that you voice a strong animus toward doctors. That strikes me strikes me as ill-aimed (doctors are providing an actual good), since it is the BIG GOVT/BIG BIZ lawyers who are fleecing the whole thing to maintain their political and economic status quo.

Re: every other country? I thought these were all failing societies/economies? Already further down the road to collapse because they believe in the political fantasy of low-cost / hi-value medicine. Meanwhile over-consuming and charging the bill to the current under-employed and as yet unborn generations (you know - what POTUS accused previous POTUS of doing). "Eveyone's doing it" is not a persuasive reason, in light of the failure of the very idea.

Thank you for the good wishes...if we ever get a chance to have a beer, that would be great...if we don't get the chance, it's only because of other pressing things.

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