danivon wrote:Archduke - cost may not be an issue at an individual level for many at the point of getting care, but it certainly is for the US as a whole. The reforms under Obama might not be much of a solution, but the pre-existing system wasn't going to be sustainable either.

danivon wrote:So, to cut it short, Steve, the Republicans in the House want to repeal first, and later on think about what reforms they may want to see.

I'm not sure why you consider my question invalid.

Seems you are making a heap of assumptions. It's really quite simple...

Before 2009, the healthcare budget was spiraling, insurance premiums were increasing, millions were not covered (and so when they became ill often ended up being a burden on everyone else), and while outcomes are pretty good, they are not much better than for a country like France or Germany which spend about 2/3 per capita on healthcare (public & private combined).

Whatever the effects of the recent Act, simply calling for repeal first means going back to those underlying issues again. Frankly, I'm surprised that there isn't any more thinking going on about how to deal with them.

Republicans were not 'denied' anything in terms of input. They were on committees, they had a say.

Since it's basically one-party rule in Washington nowadays, Democratic leaders including Harry Reid and Nancy Pelosi are seriously considering pushing President Obama's beloved healthcare legislation through Congress without the normal conference committee work involving both party's members from both houses.

Such a select conference committee is normally charged with reconciling differing House and Senate bills on the same issue before final votes in each house on the compromise version.

But since American voters collectively wanted so much change so badly in 2008, they handed over the White House, House of Representatives and Senate to Democrats with such lopsided majorities that, much as in Chicago, the ruling party doesn't really need any Republican help driving the differing bills through a blender to produce a final version, possibly by early February.

Congressional Democrats will meet with Obama at the White House this evening to discuss the....

...strategy, some in person, some via videoconferencing. House Democrats will caucus Thursday to discuss a final decision on strategy for when they reconvene next week.

As our colleague James Oliphant reports, such a beeline has some advantages for Democrats. While they don't need Republican help, they also don't need the GOP's avowed obstructionism. Simply choosing conference committee members offers numerous opportunities for long procedural delays in a democracy.

And the president has stressed healthcare urgency for months; remember, he wanted all this done by the first week of August last year because he saw poll support dropping and wanted to avoid entanglement with the 2010 elections.

But here we are in 2010. And there are the elections just 305 days away.

A new Rassmussen Reports poll out Monday finds that a majority of Americans believe the new plans will hurt healthcare quality, 59% figure it will actually increase healthcare costs, 57% oppose the bills' intent to cut Medicare benefits by hundreds of billions of dollars and, for some reason, 78% of Americans suspect the Obama administration cost estimates are way under the actual expenses.

Democrats simply ramming the immense measure through, however, might look heavy-handed to some moderate Americans, while having one party's leadership secretly craft the final bill behind closed doors fits more with a policy of official opacity than oft-promised transparency.

Reporters and the public will get their first look at the bill, which Reid has been crafting behind closed doors for the past month using pieces of bills passed by two Senate committees earlier this year, when it is posted on Reid's Web site, possibly sometime tonight.

Reid called it a bill that "saves lives, saves money and protects Medicare -- makes Medicare stronger."

Earlier today, the non-partisan Congressional Budget Office released its estimates of the bill, said to cost $849 billion over 10 years and cover 31 million Americans who are currently uninsured.

They just retreated to outright opposition for ideological reasons and let the democrats fight out the details between the Blue Dogs and the liberals. Politically, perfect oppositionalism. But it was their decision to avoid constructive work.

The poll finds that 40 percent of those surveyed said they support the law, while 41 percent oppose it. Just after the November congressional elections, opposition stood at 47 percent and support was 38 percent.

As for repeal, only about one in four say they want to do away with the law completely. Among Republicans support for repeal has dropped sharply, from 61 percent after the elections to 49 percent now.

Also, 43 percent say they want the law changed so it does more to re-engineer the health care system. Fewer than one in five say it should be left as it is.

A new Rasmussen Reports national telephone survey finds that 58% of Likely U.S. Voters at least somewhat favor repeal of the health care law, with 44% who Strongly Favor it. Thirty-seven percent (37%) are opposed to repeal, including 26% who Strongly Oppose. (To see survey question wording, click here.)

These numbers mark little change from a week ago and are consistent with findings since March of last year when Democrats passed the law. Support for repeal has ranged from 50% to 63% in weekly tracking since then. The new Republican-controlled House recently voted to repeal the law, but the Senate with its Democratic majority is not expected to follow suit.

Similarly unchanged is the belief by 56% of voters that the cost of health care will go up under the new law, a view shared by 53% to 61% since last March. Twenty percent (20%) disagree and expect costs to go down. Nineteen percent (19%) say they will stay about the same.

Only 21% say the quality of health care will get better under the new law. Fifty-two percent (52%) say quality will get worse, while 22% predict that it will stay the same. Since last March, the number who think the new law will worsen health care quality has ranged from 48% to 55%.

danivon wrote:Republicans were not 'denied' anything in terms of input. They were on committees, they had a say.

Doctor Fate wrote:It's really quite simple: Why is it government's job to "deal with the ever-rising costs of healthcare?"

It's just a matter of time. The numbers don't lie and Democrats can't thwart the will of the American people forever.

Archduke Russell John wrote:

danivon wrote:Republicans were not 'denied' anything in terms of input. They were on committees, they had a say.

Actually they were. There was one committee that reported out a bill that included Republican input. It was Senate Finance committee with Max Baucus as the Chair. However, before the Bill was introduced on the floor of the Senate, Harry Reid stripped anything Republican out of it.

And just because the Republicans are on the committee doesn't mean they get a say. Everything in the committee is run by the Majority Chair. The Chair can decline to allow discussion or vote on a Minority amendment/bill. Further, I believe any Republican proposals in Committee were voted down in committee.

danivon wrote:

Doctor Fate wrote:It's really quite simple: Why is it government's job to "deal with the ever-rising costs of healthcare?"

Ummm. Because it's taking up about 1/6 of GDP and rising, and yet for millions of Americans is providing inadequate cover (meaning a drain on the economy as people are unable to work or are laden with debt).

But perhaps the more important numbers are things like the cost of healthcare to the taxpayer, the cost of private care, the rising costs of treatments, the number of people not covered, the number of industrial days lost to illness...

People can think what they like (and they do), and they can be fickle, the public.

The underlying issues are not going away.

danivon wrote:And they were unable to present amendments on the floor to restore or add new ideas?

danivon wrote:I know how committees work. I've been the Majority Chair of one at a council. I was, however, pretty generous ;-)

danivon wrote:Still, there is the scope for minority reports, and committees only submit bills to the floor, they do not decide what gets passed.

Doctor Fate wrote:In that event, the government ought to take over food, clothing, housing and transportation too. The first three of which are at least as important as healthcare.

danivon wrote:

Doctor Fate wrote:In that event, the government ought to take over food, clothing, housing and transportation too. The first three of which are at least as important as healthcare.

Well, all are indeed pretty important. The government in already involved in food, housing and transportation as far as I'm aware:

Food.
Regulation of food through the FDA
Subsidies for food producers
Food Stamps for the poor
Any more?

Housing.
Regulation of rental and purchase markets
Public housing schemes
housing assistance for the poor
Any more?

Transportation.
Building and maintaining roads
Setting up and subsidising public transport
Any more?

Now, I accept that you may despise the fact that the government is involved in those things, but it is. So your point is what, exactly?

There are a fair number of homeless people in the US, but not as many as are uninsured on health. You don't have a problem with starvation. Clothes are cheap and fairly easily available, so there's not much of a problem there.

Tom, Archduke. Sounds to me like the Republicans lost straight up and down votes. I'm sure that they put forward 100 amendments, but I wonder how many were constructive, and how many were attempts to derail the bill (I've seen how raising a load of amendments is designed to kill off, rather than enhance a bill).

But still, I'm not seeing from you guys what the actual proposals are that the Republicans would seek to deal with the problems that were evident before the Act. Vague stuff like 'less gubmint' is all very well, but what?

The GOP bill is an amalgam of market-oriented measures that would limit medical malpractice lawsuits, expand the use of tax-sheltered medical savings accounts, let people shop for insurance outside of their own states, and make it easier for small businesses and hard-to-insure people to get coverage. The ideas reflect conservatives' suspicion of sweeping new programs, federal spending and additional regulation.

Unlike the Democratic plan, it does not include subsidies or other provisions that would make coverage more affordable to people of modest means.

Interstate competition seems to be about the best one I've seen.

Doctor Fate wrote:That human beings cannot survive without food, yet the government doesn't provide it equally for all people. Somehow when it seeks to do this for medical care, it's a "good" thing and medical care is a "right."

The same can be said about housing. I can just imagine the "thrill" of the rich and famous being escorted out of their homes and into a block house, a la Judge Dredd.

Government cannot solve problems that are not actual problems. Medical insurance is only a problem because the government has set up a ridiculous number of regulations. Instead of creating more, what about rolling a few back and seeing what happens?

The GOP bill is an amalgam of market-oriented measures that would limit medical malpractice lawsuits, expand the use of tax-sheltered medical savings accounts, let people shop for insurance outside of their own states, and make it easier for small businesses and hard-to-insure people to get coverage. The ideas reflect conservatives' suspicion of sweeping new programs, federal spending and additional regulation.

Unlike the Democratic plan, it does not include subsidies or other provisions that would make coverage more affordable to people of modest means.

The question really comes down to this: if one is going to do a massive program (and the ACA is clearly that), then why not steal the best ideas already out there (Switzerland, etc.) and come up with a hybrid? If not that, then why not change things incrementally--seeing what works and then adjusting as needed?

danivon wrote:

Doctor Fate wrote:That human beings cannot survive without food, yet the government doesn't provide it equally for all people. Somehow when it seeks to do this for medical care, it's a "good" thing and medical care is a "right."

Yet that's not what the Act does. It doesn't really increase government provision so much as increase the regulation in the market.

While it improves the minimum level of cover that people can buy (and tries to make them buy it), it does not enforce equality.

The same can be said about housing. I can just imagine the "thrill" of the rich and famous being escorted out of their homes and into a block house, a la Judge Dredd.

You are telling me that the ACA means that rich people can't pay for top level cover any more? That they can only take the basic mandatory cover?

Government cannot solve problems that are not actual problems. Medical insurance is only a problem because the government has set up a ridiculous number of regulations. Instead of creating more, what about rolling a few back and seeing what happens?

So, what regulation would you remove. And what potential drawbacks do you think might arise from it's removal?

Limiting Torts looks to me like extra regulation (government telling people what they cannot sue for).

I agree that cross-state selling would seem to fit with what the US could do with it's pre-existing system. Expanding tax-shelter for savings sounds ok, but I wonder how many people would actually benefit (what proportion of people would use that rather than use insurance?), and the last one 'make it easier' is vague in the extreme. How do you make it 'easier'? Force the price down, subsidise it, reduce the minimum level of cover?

The question really comes down to this: if one is going to do a massive program (and the ACA is clearly that), then why not steal the best ideas already out there (Switzerland, etc.) and come up with a hybrid? If not that, then why not change things incrementally--seeing what works and then adjusting as needed?

Oh, that's too funny! Whenever we foreigners suggest you look at the rest of the world, your right wing like to point out the uniqueness of the USofA, and how "we just can't act like you do, it's not in our nature".

The Swiss system is pretty good, and the Swiss are similar in outlook to Americans. Your GDP/capita is about the same according to the OECD. Not sure how much you'd really like it though.

Insurance is compulsory, which seems to be a major bugbear for you with the new US Act. Premiums for people on low incomes are subsidised by the state. There are copayments for treatment via an excess and a percentage above the excess. Insurance companies cannot make any profit on the compulsory scheme, but they can offer extra cover.

Providers themselve are a mixture of public and private, but quite a bit of the private provision is publicly subsidised.

It is a lot cheaper though. Less than 11% of GDP. Of course, Switzerland is a lot smaller than the USA.

Doctor Fate wrote:Well, the problem with compulsory insurance is the Constitution. We'll see, but on the face of it, it's unconstitutional. The USSC may decree it constitutional, but if it is, we had better never elect another Democratic President and Congress combo or we will have given them the keys to force whatever they want on us.

It is a lot cheaper though. Less than 11% of GDP. Of course, Switzerland is a lot smaller than the USA.

Again, I'm not saying buy it lock, stock and barrel. However, a bit of it, a bit of a few other systems, throw in a dash of competition, and we might have a uniquely American system that works. The Harry Reid model is a disaster.

danivon wrote:The problem is that the compulsory insurance part of the Swiss system is pretty core to it. Other than that there is free competition between insurers, pretty much. The problem is that whenever you look at healthcare systems that work well, the mandatory part is the one that seems to be pretty important. At a stroke it reduces a lot of overheads (you no longer have to check whether someone has basic cover before you treat them, for example). Standardising cover also reduces bureaucracy and duplication. If that's done right.

And as to whether it's unconstitutional? Well, I think that the well being of the people comes under General Welfare, but whether that is enough to include it, I don't know. It won't be your view (let alone mine) that counts, but that of the USSC - assuming the Act remains in place long enough for it to get there.