The anti-reform forces lose - and predictably, they go hysterical

[fpb]

I am not a lawyer and I thank God for that, but frankly, only a lawyer (or a political obsessive) could seriously treat the "purchase" of health care in the same light as the "purchase" of broccoli. And as the concept of health care did not exist in 1776, the notion that it is unconstitutional is about as helpful as to declare that the Moon landings were unconstitutional.

To me, this has the same feel as the American unwillingness or incapacity to contemplate serious legal reform - such as the introduction of a system of Administrative Justice such as most Code Napoleon countries have - and admit that new areas of life and experience have arisen. On the one hand, the monstrous complexity and private-only nature of Obamacare makes it unlikely to succeed in the long run; on the other, if the Republicans imagine that there is a majority for what America has now in the way of healthcare, they are living on the Moon.

The worst thing from my point of view is that while an Obama victory would mean a clash of State and Church not seen in a free country since the Combes government in France, on the other hand the Church's social doctrine has no friends among the Republicans and would mean that any alliance with them to resist Obama and his cohort of Church-hating harridans such as Sebelius and Pelosi would be dangerous and deceptive. Plus, the Republicans have seen fit to choose the worst possible candidate... at this point, I can't see a positive outcome.

Comments

[mindstalk.livejournal.com]

Romneycare's working decently in Massachusetts. Romneycare/Obamacare/PPACA seem similar to what Switzerland/Germany/Netherands use -- they're all-private heavily regulated insurers. Regulated to the point of being non-profit and having their premiums set by regulators, which is further than we're going, but the structure is similar.

[fpb.livejournal.com]

My big issue is the assault on religious freedom, on which I hope the Court will feel differently - it has, after all, already struck down other Obamaite attempts to invade the religious sphere.

[fpb.livejournal.com]

However, the difference between no-profit and for-profit-dependent-on-regulators is immense and dangerous. The space for corruption in the latter description is practically infinite. I have seen how it works in the privatized industries here in the UK - in particular the railways - and I am not impressed.

[mindstalk.livejournal.com]

That's a valid concern I'm sympathetic too, though it doesn't seem to be a problem in Massachusetts yet.

[jsl32.livejournal.com]

It's heavily over budget, which is the sort of objection I have. It's one thing if you can more or less pay for it, a whole nother if you cannot. Also, about 1/6 of the population there cannot use their expensive insurance because they can't afford to after paying the premiums. They have nothing left over for co-pays.

This is also a problem in Switzerland, I believe about 12-15% there have financial problems related to making the premium payments, despite the regulations around how much can be charged.

America has fairly strict premium regulation as well, and most of its insurers remain not-for-profit too. People really don't get how much of this stuff America already has going on.

[fpb.livejournal.com]

As a matter of fact, we do. We understand that it is only some ten per cent of the population that is not covered. However, with us they are. And we pay less, as a percentage of GDP, to be all covered, than you do to be only 90% covered. Oh yes, that terrible, inhumane, crushing Euro-healthcare!

[jsl32.livejournal.com]

It's not even 10%, more like 5ish (about 15-20 million uninsured, mostly young and physically active). And you have smaller, more dense countries, with more ethnic homogeneity, fewer people with chronic conditions caused by diet/lifestyle and you *pay for fewer things*. So we have a very similar coverage (for most countries compared to the US I see 95-99% estimates of population coverage) and we do more stuff for our very ethnically diverse, older, more risk-pursuing, far more spread-out population.

If you compare Scandinavian-descent people in America to their relatives, you have very similar LE and outcomes, despite very different health care system structures. With Mexicans, the outcomes are better than in Mexico for Mexican-ancestry people.

I do think America could be doing a whole lot better with health care provisions, but the Obamacare thing is just more of the same stuff that adds to cost (requirements for services at a premium rate due to cronyism and regulatory capture), only with fewer mechanisms to pay for it than we already had.

I don't think the different systems in various chunks of Europe are utterly awful, but it is just as silly to think we can bolt a mechanism from a very different societal structure onto the crazyquilt that is America and get instantaneous lower costs and *more services performed by more people*.

I mean, we are all going to end up paying a bunch more for even less stuff in pretty much every nation as long as people make an idol out of health care as purchasing immortality.

[fpb.livejournal.com]

Thanks for an answer that shows sanity and argues as if argument were possible. I still disagree with you, but considered to what one has to endure in this kind of environment, you are an angel out of Heaven.

[mindstalk.livejournal.com]

"about 1/6 of the population there cannot use their expensive insurance because they can't afford to after paying the premiums. They have nothing left over for co-pays"

Source?

Of course, there are obvious solutions like increasing the subsidies and regulating the premium/co-pay structure more...

As for being over budget -- maybe, though I remember reading that was overblown. But I also note that Romneycare started a year or two before the Second Great Depression -- which means higher unemployment, lower tax revenues, and more people than expected turning to the state system. So "over budget" may mean only "the economy is broken", not "the system is itself flawed".

[jsl32.livejournal.com]

But who's paying for the subsidies?

As for the unaffordability thing, here is one link mentioning the co-pay problem, but they appear to have locked the rest of the article down.
http://www.boston.com/news/local/massachusetts/articles/2009/06/21/costs_are_keeping_patients_from_care/

This is an unblocked article about the more general issue of people not being able to afford the fancy insurance at all, but there not being a mechanism for the state to cover them instead:
http://www.boston.com/lifestyle/health/articles/2011/02/07/more_get_waivers_of_health_insurance/?page=full

[mindstalk.livejournal.com]

Of note: "State officials said they excused the majority of waiver applicants in large part because of the protracted sour economy, which made insurance unaffordable for more people... regulators have significant latitude to authorize waivers by taking into account factors such as a home foreclosure"

"But who's paying for the subsidies? "

In the long run, taxpayers. In the short run, sovereign borrowing, until we're out of the depression. This is why it's important to keep up full employment, and why simplistic balanced budget requirements are very bad.