ObamaCare’s War on Men

ObamaCare institutes several types of price controls on insurance premiums. The elimination of gender-based ratings forces young men to subsidize the substantially higher claims of young women, ending claims-based differentials of up to 70 percent under age 40. The 3:1 age rating limit requires younger people to subsidize older people, ending the roughly 6:1 rating that was based on actual costs. The elimination of health status as a rating factor forces those in good health to subsidize those in poor health, whether or not good health is due to self-control or lucky genetics.

In 2012, Milliman calculated how much the price controls are likely to raise costs for those unlucky enough to be affected by them. Here are some examples of the variations caused by market pricing for an Anthem HSA policy for an individual living in Marion County, Indiana, in November, 2011:

Sample Individual Health Insurance Premium Rates

Based on estimated rates for ObamaCare policies and subsidies keyed to exchange silver plans, Milliman concludes that ObamaCare rules would have the following impact on the cost of then current $5,500 deductible plans (ObamaCare outlaws individual market deductibles of $5,500.)

Men, especially the young ones, are the biggest losers.

ACA Premium Rate Impact

Comments (128)

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  1. Buster says:

    If you ask people on the street, it’s easy to get them to say that it’s not fair to charge sick people more for health coverage. But these same people on the street assume that the additional cost of covering a higher risk doesn’t cost anyone anything. It does cost more to insure a higher risk. Either insurers absorb the cost or other policy holder do.

  2. Joe Barnett says:

    I assume that most of the higher claims for under-40 women compared to men is due to reproductive health concerns. Since pregnancy isn’t a disease and contraception isn’t a medical treatment, the question arises whether it should be covered by health insurance.

  3. J.J. says:

    Im gearing up to pay all the costs Obamacare is fixing to impose upon me.

  4. Don McCanne says:

    With fire and police protection, the only real losers are those unfortunate enough to require their services. The rest of us who pay the taxes to support these functions are winners because we didn’t personally need them, but we had the security of knowing that they were always there for us.

    The same should be true with health care. We should all participate in funding a universal risk pool (i.e., single payer). The winners would be those of us who do not require much in the way of health care services, while all of us would benefit from the use of preventive health services.

    Obviously there is a great divide between those of us who believe that we should be in this together when it comes to our health, and others who believe that you should be on your own. Segregating healthy individuals into a separate low-cost risk pool (e.g., healthy young men) is a “we’re on our own” approach.

  5. Ron says:

    Joe: It could be a sub-coverage of sorts where women have the option of adding pregnancy-related coverage to their health insurance. However, I do think it would have to fall under health insurance because indeed it is a health-related condition which can lead to health complication and even mortality.

  6. Dennis Byron says:

    Mr. McCanne says:

    “With fire and police protection, the only real losers are those unfortunate enough to require their services. The rest of us who pay the taxes to support these functions are winners because we didn’t personally need them, but we had the security of knowing that they were always there for us. The same should be true with health care. We should all participate in funding…”

    I’m with Mr McCanne up until that point (forgetting the error that not all people who use emergency services pay the taxes that support ES). But whose to say funding “a universal risk pool” via insurance is the best way to go? Why not a free care pool like we have now in most places. We still pay as a group but not through the inherent inefficiency of insurance. And if Mr. McCanne believes “preventive health services” should be part of health insurance, why not add a long list of similar services to car and other property insurance?

    I don’t think there is “a great divide between those of us who believe that we should be in this together when it comes to our health, and others.” The divide is simply whether too much government intervention in the market and insurance are the best means for us to be “in this together?”

    [One thing I would say about the overall point -- if it was the point of the original post -- of men funding women's reproductive health... I think yes unless there is evidence of a lot of immaculate conceptions. But should sterile people and old women fund IVF?]

  7. Sam says:

    Just going off on a digression from the specific topic here, I just want to mention that in such a interdependent global world we live in…to think that everything is up to the individual is rather absurd. Even if you are the most responsible person with your health out there, you still end up being impacted and dependent on society for your overall health. There really is no way to go around this and therefore need to also acknowledge this in policy, which is why it’s so difficult and don’t think we’ve found the right avenues yet.

  8. Tim says:

    Health care is a very complicated area to address because, unlike some like to think, it goes beyond economic and monetary principles. Here you end up dealing with life and death throughout the transaction. It is the most impactful and yet easiest industry to play with a person’s life for personal gain if you have the power to do so. While we need to address these issues in an efficient way that champions personal responsibility, unfortunately there are instances where conditions go far beyond personal responsibility and an individual becomes vulnerable and dependent on outside support. The question is who is then the appropriate actor to intervene in that person’s vulnerable case. Insurance companies? We know how that can go down hill. Government? Not always reliable. The community? Well, not with pseudo-robotic and mechanical culture we have grown into. It comes down to addressing these issues from a cultural perspective more than anything.

  9. Clinton says:

    It really feels like I and my family are punished for taking good care of our health. We eat and exercise well and very rarely have had to visit a doctor. I have always been happy to choose the highest deductible plan but now will not be allowed to.

  10. Tracy says:

    A free market would allow the insurance companies to use all available information.

  11. Frank Timmins says:

    @Sam

    “Even if you are the most responsible person with your health out there, you still end up being impacted and dependent on society for your overall health.”

    But Sam, I think you make a serious error in your logic. You say “dependent upon society for your overall health”. I don’t think so. You are dependent upon “others” such as your physician and other healthcare services, but that is not “society”. You are mixing the economic requirements of “insurance” with the personal requirements of “healthcare”. If we continue to mix these two we will never be able to solve the problem of healthcare financing.

  12. Big Al says:

    “The elimination of health status as a rating factor forces those in good health to subsidize those in poor health, whether or not good health is due to self-control or lucky genetics.”

    Since hospitals and doctor’s offices are not the sole bastian of the fat and the mutant, we must assume that the Doc’s chosen ones (in control and genetically superior) may use these services as well, via injury, disease, or preventative medicine.

    I think the Doc went down the wrong alley on this one because nearly everyone here today understands the social and economic benifits of pooled groups. Obamacare is simply leveling the playing fields and providing the options of pools for everyone.

  13. S. Steinberg says:

    To John Goodman or the article’s author — or to anyone who can answer this question:

    In addition to this problem, I’ve also read elsewhere a comment that, under Obamacare, “If you’re on kidney dialysis your treatment will end at the age of 55.
    The same for cancer patients and heart related illnesses over the age of 60″. Is that comment actually true?

    And, if it’s true, will the same condition described in that comment also apply to anyone who’s on MEDICARE?

    For that matter, for how many OTHER conditions would patients over the age of 60 or 65 NOT be treated, or not be AS COMPREHENSIVELY & POSITIVELY treated (especially if comprehensive and positive treatments might otherwise have been available & applied), due to OBAMACARE?

  14. Doctor Tom says:

    To Don McCanne:
    Unfortunately you are comparing apples to oranges in your post.

    Those who require fire and police services do so because of actions that may be out of their control. Muni, County, State and Federal laws and regulations are designed to strictly protect the individual from the need to call fire or police.

    Building codes must be strictly adhered to, laws are written to impose serious penalties on those who wold cause harm to the individual, etc.

    In addition, citizens have the opportunity to further reduce the risk of loss by contracting with home security firms to be better positoned to protect life, limb, property and possesions from loss.

    In healthcare there are no official restrictions. Diabetics, cardiac patients, hypertensives, smokers, those who over indulge in alcohol and those who abuse drugs (among a whole list of others)all are free to live their lives in total disregard to a “healthy” lifestyle. There are no laws commanding wight loss, exercise or healthy lifestyles. There are no regulations controlling the consumption of health threatening substances.

    Those who do practice these virtues are therefore condemned to pay increased rates to cover those who do not with no penalty going to the latter.

  15. Mark Kellen, MD says:

    Just to make sure we all agree on terms. Medical care is what you get after you are sick. This generally requires doctors and hospitals.

    Healthcare is what you do for yourself: eat right, exercise, stable relationships, manage stress, avoid bad habits like drugs, alcohol, smoking.

    Politicians and bureaucrats do not understand this.

    My guess is that 70-75% of everyone in a hospital at the present time is there for a self inflicted reason. Making the rest of us involuntarily pay for self inflicted injuries in others is tyranny.

    I am more than happy to subsidize the child born with a genetic defect, or the individual trying to improve, not so much the drug abuser or alcoholic who likes to use table saws at 2 am.

  16. Frank Timmins says:

    @Dr. Tom

    “There are no laws commanding wight loss, exercise or healthy lifestyles. There are no regulations controlling the consumption of health threatening substances.”

    Be careful Doctor Tom. If the Bloombergs of the world have their way there soon will be.

  17. Dennis Byron says:

    to S. Steinberg

    These Obamacare rules (cutting off cancer treatment at 55) will also apply to all people use UPPER CASE in blog comments

  18. Don McCanne says:

    Dr. Kellen,

    “Healthcare is what you do for yourself: eat right, exercise, stable relationships, manage stress, avoid bad habits like drugs, alcohol, smoking. Politicians and bureaucrats do not understand this.”

    Apparently you don’t understand the definition of health care either:

    Health care: the maintaining and restoration of health by the treatment and prevention of disease especially by trained and licensed professionals (Merriam Webster)

    Also, “My guess is that 70-75% of everyone in a hospital at the present time is there for a self inflicted reason.”

    Wow. You’d better quit guessing and go back and brush up on medicine. It’s a scientific discipline based upon facts, not guesswork.

  19. Uwe Reinhardt says:

    John:
    When I read your sentence: “The elimination of gender-based ratings forces young men to subsidize the substantially higher claims of young women, ending claims-based differentials of up to 70 percent under age 40″ I have two distinct reactions.
    One the one hand, the remnants European DNA I still carry in my body makes me applaud this subsidy from men to women.
    On the other hand, the now dominant American DNA in me has my blood boil at the very thought of this subsidy.
    These different reactions are triggered by different images of what children and women are in society.
    Europeans view children as national treasures and treat the creatures who beget them (women) with great respect. Thus, in Germany the premiums for children up to age 22 (I believe it is) are paid by the federal government and are tax financed. Childless single men there subsidize women and children with their premiums and tax dollars, perhaps on the thought that when these single men are old and decrepit and aching and fearing death, some strange mother’s children will bring them succor. And mothers get federal monthly stipends for their work raising children. Germans, for example, worship mothers even more than their beloved Apfelstrudel.
    A recent ranking of the 10 best places to be a mother had mainly European countries in it. http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/STATEOFTHEWORLDSMOTHERSREPORT2012.PDF The united States ranked 30th. http://www.guardian.co.uk/society/2013/may/07/most-dangerous-countries-childbirth-africa
    As I have written in The New York Times, Americans seem more inclined to view children as the human analogues of pets that are, in the first place, their parents’ financial responsibility. http://economix.blogs.nytimes.com/2009/04/24/seriously-what-is-a-child/ At its crudest, one finds that sentiment expressed in the bumper sticker: ”You breed them, you feed them!” Yes, mothers are breeders. It is they who get pregnant, with only minimal participation by men. And as I once remarked in a speech at the Palo Alto Clinic, we definitely do appreciate apple pie more than we appreciate mothers.
    So as a mainly American male now, I concur entirely with John: It is outrageous that men should subsidize women with their health insurance premiums. It is nothing other than a war on men.
    Unfortunately, the unjust, socialist European thinking has long crept into America’s workplace, where men routinely subsidize women through their direct contribution to health insurance premiums and pay cuts. Which is one reason why we should abolish employment-based health insurance. It’s just private socialism.

  20. Doctor Tom says:

    To Don McCanne

    To paraphrase your entry:

    “Health care: the maintaining … of health by the … prevention of disease … (Merriam Webster).

    What Dr Kellen was saying. You don’t need doctors and other health professionals to handle this part of the definition

  21. Maureen Ward says:

    Dr Kellan and Don McCanne,

    Personally, I appreciate wordsmiths that look at words and see definitions outside the common misuse of them Yes, health care should be Dr Kellan’s definition so it would make conversation and our thinking clearer as to what we are talking about. Clearly heath care is different than medical care even though the dictionary gives “common” usage definitions and it supports sloppy thinking.

    Second, Mr. McCanne, I think we should have a study to determine what percentage of hospital or medical care in general are self inflicted medical problems versus genetic or congenital medical problems. I bet you would find that Dr. Kellan’s “guess or estimate” is pretty close to the truth given the statistics of obesity and misuse of alcohol and drugs in this county and the medical issues flowing from this lack of health life style.

  22. Wanda J. Jones says:

    John and Colleagues:

    This is a more than usually fundamental topic of interest. It takes a man to make a baby. Too many of them make the baby but leave it to the woman to bear and raise. It does not seem to be an excessive counter-balance that they should pay more for their health insurance.

    For those who feel “community” is a great value and should be manifest in a single payer program–to others of us, that is confusing a religious value with a business principle and with a real world assessment of who can perform the very delicate task of allocating funds well. The business principle is allocating funds in a way that is neither coercive nor blind to facts and variations in preferences. As we are seeing, our national government cannot measure up to that goal. For all those who wish it would, give yourself a shower of current information of how HHS is now executing the run-up to Obamacare, such as limiting deductibles on policies associated with health savings accounts, taxing private health plans, and many more. For those who remember being happy about the privacy bill, HIPPA, just recall that if there is a single payer program, all, all, all of your personal information will be in the hands of our nosy government, and you can bet that both you and your doctor will be electronically monitored and rules applied to your care that you never heard of. Remember Fox News? The Associated Press? Better not be a drinker, or fat, or a motorcycle buff, or a man who beats his wife. All kinds of moral rules will be shoved down the healthcare system’s throat and there will be no private sector option to which to escape. Be careful what you ask for.

    As to community, remember when distinctive country of origin communities were the ones who built hospitals and educated nurses? German, French, Jews, English, Irish, –which is a lot better solution than to mistakenly assume that the US as a whole can develop a sense of community and mutual obligation. That national program would “crowd out” many existing true community solutions. Shriners…etc.

    Try, try, to distinguish your personal value system from a realistic, workable public policy direction.

    Wanda J. Jones, MPH, President
    New Century Healthcare Institute
    San Francisco, CA

  23. Lisa says:

    What did Sandra Fluck’s boyfriends expect? Of course they have to kick in for her FREE birth control.

  24. Bob Hertz says:

    Regarding Prof Reinhardt’s comments on how Germany (and other northern European nations) treat mothers and children………

    it is not pleasant to say this, but social democracy took hold in societies that were all white (and almost all Christian, though I think that is less signficant.)

    Even in the USA, the further you get away from the Deep South and the Mexican border, the more benefits you see for women and children. I live in Minnesota and have lived in North Dakota. I have visited Vermont and New Hampshire often.
    The benefits in these places are not all that far from northern Europe’s.

    Many Americans oppose child welfare benefits because of the race of the children involved.

    I do not have a solution, but Prof Reinhardt is normally very even-handed, and I think that in this small instance he kind of lobbed a cheap shot across the net.

  25. Jim Rude says:

    I would like to know the dollar value, in terms of medical care, that is attributed to treating inherited genetic maladies versus medical treatments due to accidents and problems associated with life style choice for people below age 65 (medicare eligible age) The focal point of this debate is about how much an individual should be responsible for sharing the costs associated with his/her medical care. To say that we are all in this together and therefore, we should all be placed into a large community pool fails to account for the fact that everyone is not equally interested or motivated to improve their health. Those who choose to ignore common sense health practices….why should they not pay more? To do otherwise is to establish a social policy that passively creates an incentive to remain “fat and happy”.

  26. Doctor Tom says:

    to Wanda Jones

    “Too many of them make the baby but leave it to the woman to bear and raise. It does not seem to be an excessive counter-balance that they should pay more for their health insurance.

    That is a patently sexist and fundimentally offensive stereotype. I am a father of two and yes my wife hasd to bear our children. Maybe you know a better way to bring them into this world. And yes she did a disproportionate amount of raising our children because I was in medical school followed by internship and residency. We elected for her to ba a stay at home Mom which meant increased indebtedness during those years and longer hours for me moonlighting to provide a proper home environment.

    How do you approach Gay men about the increased cost of healthhcare to cover the needs of women who have babies. Yes, a minority of them are interested in having children and are willing to adopt or go through a surrogate but those are their choices and they pay for that privlege outside of their health insurance.

    Why should healthy, sexually active men who are responsible about their approach to sexual relationship[s and birth control be any more burdened with the increased cost of womens’ reproductive health issues than anyone else who has to cover the cost of the “fat and happy” morbidly obese, chain smoking, alcohol swilling, diabetic hypertensive who is totally noncompliant to his/her doctor’s instructions?

  27. Ron Bachman says:

    And the key to a financially sustainable ObamaCare is getting young healthy people to participate in the charade.

    Look for a headline in February 2015:”Surprisingly the Number of Uninsureds Rise Under ObamaCare.”

    Surpisingly…No expect it.

  28. Vince says:

    Interesting topic and it seems to have raised many different issues and reactions.
    Health care should be more about prevention of illness than about treatment. Under our current system and especially under the ACA, healthcare is only about the treatment of illness and injury.
    Health insurance, like any other insurance is about transferring of risk, risk that we will get sick or injured and need to pay. We place that burden at the feet of the insurance company and because we do not really get to choose which company we have, our employer does, and how long we have it, there is no incentive to cover true prevention services.
    If we make insurance choice real and make insurance more portable we can make the risk taken by the insurance company less. They will then be able to offer more prevention services because they know that this customer may be with them a long time and it will save them money for keeping their customers healthy. They will be able to offer reward for healthy behavior, for keeping cholesterol under control, for exercising regualry etc, etc, etc similar to other types of insurance that have riske transferred to them by homeowners, care owners etc.

  29. Mark Kellen, MD says:

    So much for medicine as a “scientific” discipline.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182327/

    Title: Why Most Published Research Findings Are False.

  30. Chi says:

    Uwe Reinhardt says: “It is they (women) who get pregnant, with only minimal participation by men.”

    I would describe the participation of men in pregnancy as key, not minimal.

  31. Vince says:

    Medicine is a scientific discipline.
    How we finance and pay for the services is what is and what has been discussed the entire time of the so called “health care debate”. Nothing was ever said about true care.
    There is nothing in the ACA, nothing in the single payer models that promote innovation in the scientific model.
    True, free market, consumer based, portable models of insurance that reward innovation in delivering the best, most scientifically sound approaches are the only ones that allows for the development of that science.

  32. Al says:

    Uwe, if “Europeans view children as national treasures” why do you think European fertility rates are lower than the fertility rates in the US?

  33. Al says:

    Don McCanne says: “With fire and police protection…” “…The same should be true with health care.

    Why? …And if we want to equate fire and police protection with health care shouldn’t we recognize that those important community services are provided and regulated by the communities, not the federal government and that the types of services vary considerably between communities?

    Speaking about protection, isn’t the primary responsibility for protection really the individual? If you think differently take note of the following: 911 Dispatcher Tells Woman About To Be Sexually Assaulted There Are No Cops To Help Her

    “http://seattle.cbslocal.com/2013/05/23/911-dispatcher-tells-woman-about-to-be-sexually-assaulted-there-are-no-cops-to-help-her-due-to-budget-cuts/”

  34. Al says:

    If one wants everyone to be insured it is best done voluntarily. Common sense tells me that means we should want to get the young accustomed to buying insurance. By making their rates higher than the value of the insurance we are doing the opposite.

  35. Big Al says:

    @ lil Al,

    “If one wants everyone to be insured it is best done voluntarily.”

    Lest you forget, we currently have, and have had, a voluntary health care system. Government going broke, premiums skyrocketing, insurer abuses, skyrocketing provider costs, and 45 million uninsured citizens … is the reason we are finally taking matters in hand with the PPACA.

    ‘Voluntary’ is a nice concept but as practical as voluntary car insurance. The public roads are available to you, so you pay the price … insurance.

  36. Uwe Reinhardt says:

    To Al:

    You are missing the argument. What men and women decide tyo do about reproduction in their privacy is one thing.

    The point is that once a baby is born, society takes financial responsibility for its health care and thanks the mother for bringing the baby to term and birth for bestoweing the baby on society.

  37. Uwe Reinhardt says:

    To Bob Hertz:

    I accept your point that not all American men think about women the way John and many others on this blog do — especially in Minnesota, which always reminds me more of Europe than do other areas of the US.

  38. Frank Timmins says:

    @ Big Al

    “Lest you forget, we currently have, and have had, a voluntary health care system. Government going broke, premiums skyrocketing, insurer abuses, skyrocketing provider costs, and 45 million uninsured citizens … is the reason we are finally taking matters in hand with the PPACA”

    Come on Big Al. I have to think you know better than this. There are reasons we have had all those problems you describe above, and none of them have anything directly to do with a “voluntary” system, and the Rx for eliminating them is most certainly not the PPACA. In fact most of these problems will be exacerbated by the ACA, and fraud, graft and all manner of dirty dealing will become commonplace. Anyone with any understanding of human nature knows this is a given.

    Let’s look at it. Government going broke (read: fraud and abuse)? Would the poster child for single payer not be Medicare/Medicaid? You may have noticed a “bit” of fraud and abuse in these programs (while honest practitioners are being routinely abused to the point that they are dropping Medicare involvement in droves.

    Insurer abuses? If you mean patients being denied benefits resulting from underwriting and contract reasons, you haven’t seen anything until you have the bureaucrats determining the worthiness of “certain” patients having an expensive procedure.

    Skyrocketing premiums? Perhaps you have noticed the warnings from the major carriers of where the rates are going next year when the ACA becomes fully “implemented”.

    And please forget the “Uninsured” issue. We now know that this is nothing but a rallying cry for the radical left wing agenda of nationalizing healthcare.
    Once again, this is about developing a system to nurture the best healthcare possible for the most people. “Insurance” is not the primary focus. It is merely a tool to shift risk.

    The PPACA is already a massive failure, and it hasn’t even been fully implemented yet. We should be talking about initiatives that actually work, instead of arguing about the degree to which this dead horse smells.

  39. Big Al says:

    Lil Franky,

    Volunteer: Personal Choice to Participate.

    Government Costs – go up for indigent service reimbursements to hospitals as a direct result of people choosing not to participate in insurance programs and walking away from their bills.

    Provider Costs – go up as a direct result of patients choosing not to participating in insurance programs and walking away from their bills.

    Insurer Abusive Practices – of off-loading the healthy-challenged is a direct result of insurers keeping their bottom lines up … by offsetting losses incurred by people choosing not to participate in insurance programs.

    Skyrocketing Premiums – are a direct result of people choosing not to participate in insurance programs, therefore reducing pool sizes, and in turn increasing the remaining participant’s rates … nasty upward spiral.

    Since the PPACA addresses all of these issues, including the billions lost to that pesky “‘bit” of abuse and fraud, I think that the ACA horse we are all riding smells foul to you … because of your head placement.

  40. Uwe Reinhardt says:

    Response to Chi:

    My preferred metric was “relative time devoted to begetting a baby.” I prefer that metric, because it makes my case better. On that metric, the man’s contribution is minimal, relative to the woman’s.

    You may be using a different approach, one that would not work as well for me.

  41. Doctor Tom says:

    Big Al,

    ACA may address these issues but it in no way rectifies them.

    A healthy 35 yo male will elect not to pay the outrageous increase in premium and instead pay the minimal fine imposed by the govt which will in no way cover the lost revenue of the annual premium.

    When he has a significant medical condition he will then buy insurance for the duration of his need and then dump it again when the economics indicate a diminishing return.

    In spite of the rhetoric coming out of the White House fraud, abuse and thuggery will run rampant in the system as it does now. Just ask the AP, Fox News and any of a number of nonprofit groups who chose not to support the current administration’s candidate and positions.

  42. Big Al says:

    Dr. Tom,

    If your 35 year old chooses to pay the fine, and his employer also chooses to pay their $2000 fine for him, and he also chooses to ignore the cost sharing and credits available to him … I suppose the first medical procedure that this ‘unique’ person would undergo would be to reattach his nose.

    Bottom line, ACA may not rectify every issue that has been borne from our ‘voluntary’ health care system … but it is a reasonable start. If you have improvements, send them in but the good ole days and obstructionism aren’t constructive options.

  43. Bob Hertz says:

    2 quick comments about maternity:

    a. Dr Reinhardt, I think that you missed the painful point of my post above.

    The men of Arizona, Texas, Alabama, et al. do not oppose maternity benefits because they dislike women.

    They oppose the color of the children who are born in greater numbers thanks to social insurance.

    b. Per my reading, many thousands of Ameircan families were in debt to hospitals after childbirths in the 1950′s.

    In other words, we have been barbaric about this issue for a long time.

  44. Al says:

    Big Al, Al isn’t little, but neither is he fat. Al likes to take care of himself.

    “Government going broke”

    Is that is a good excuse for more government making the same mistakes over and over again? Health care doesn’t need to cost so much, but government is expert at inflating costs and the money supply.

    What is wrong with voluntary? If the person chooses not to be insured he can be sued for whatever he owns and even for future earnings. Furthermore if government stayed out of health care most of us would be covered by high deductible insurance that saves tons of money while providing good care.

    If one has no money he has to be subsidized anyway. Stick with me big Al and we will both become rich and enrich the nation while doing so. The other way is a downhill sewer.

  45. Al says:

    Uwe, I don’t know how your response relates to my question.

    Uwe, if “Europeans view children as national treasures” why do you think European fertility rates are lower than the fertility rates in the US?

    By the way I would rather an individual take care of the offspring. It creates a stronger mind and body.

    I’ve been to Europe many times and have not seen more caring parents than in the US though one would think that with the low fertility rates those that wanted children so much would demonstrate a higher level of caring due to selection. Maybe your surroundings are different than mine.

    • Uwe Reinhardt says:

      Al:

      My point has nothing to do with how much parents care for their own children. Nor have I done work to assess differences, if any, in the degree of caring for their children among parents.

      I wrote about what happens when a caring mother does not have the money to buy needed health care for her children.

      • Al says:

        Uwe, it has been a few days so maybe I missed something in the recent translation.

        I think this is the statement of yours that you are referring to:
        “The point is that once a baby is born, society takes financial responsibility for its health care and thanks the mother for bringing the baby to term and birth for bestoweing the baby on society.”

        I think it is a horrible thing when society has to take care of the financial responsibilities of a child. Sometimes it is necessary for others to provide that love and money to a child (and family) in need, but it sounds to me that you are acting as if the child is a child of society. He isn’t and society has never been very good at bringing up children.

  46. Al says:

    Big Al writes: ” ACA may not rectify every issue that has been borne from our ‘voluntary’ health care system … but it is a reasonable start. If you have improvements, send them in”

    Simple, dump the ACA and go to a market place. Save big bucks, give the same or better care and everyone is happier. (Take note I would not leave those in need without help.)

  47. Big Al says:

    (Skinny Average Al),

    What part of ‘go to a [unregulated] market place’ have you missed over the last 70 years. Been there … done that … improve now. The ACA isn’t government health care. It’s simply your ‘market place’ with a few more protections and duties.

    ‘Dump the ACA’ is not an option, nor constructive. You’re more than welcome to ride along with us.

  48. Al says:

    “(Skinny Average Al),

    What part of ‘go to a [unregulated] market place’ have you missed over the last 70 years.”

    Big Al, being Al means being in good shape, both mind and body. Not to big, not too small, just right. Cut down on those 16 ounce Cokes.

    You realize of course that the federal government has been integrally involved in the healthcare system since WW2 and among many other disasters left us with third party payor which is a major cause of our problems. You don’t see third party payer when you go to your favorite grocery store or ice cream store, do you? Think about why not.

  49. Frank Timmins says:

    @Bob Hertz

    “The men of Arizona, Texas, Alabama, et al. do not oppose maternity benefits because they dislike women.

    They oppose the color of the children who are born in greater numbers thanks to social insurance.”

    Really Bob? So this is a “race” issue? I can only surmise this twisted hypothesis is standard thinking from the Al Franken constituency. Consequently no further comment is necessary.

    • Uwe Reinhardt says:

      Frank:

      You have never heard of racism, even in the US?

      • Frank Timmins says:

        Uwe, I’m not certain as to the definition of “racism”. If you are talking about “Obama style racism”, I think I know what that means. Doesn’t that mean using racial discrimination as an excuse for economic failure or felonious acts? I understand that sometimes one can even be a “racist” in this definition by NOT giving “preferential” treatment to a certain group. It’s very confusing for me.

        Perhaps “bias” is a more accurate term today, don’t you think? No honest person (white, black, yellow, etc.)can deny personal biases, but those biases are a weak factor in everyday events of a healthy culture. One might instinctively “prefer” to work for, hire, buy from, sell, etc. from someone that looks the same as one, but that preference is quickly negated by other factors such as skills, temperament, personality, price and other more important factors.

        Racism in the U.S? Yes, I have heard of it with hoods, crosses and burning crosses – all that stuff. But any institutional practice of same seems to have gone out of style quite some time ago along with fins on Detroit iron.

      • Al says:

        Uwe, as you know there is racism all over the world and to some extent racism or bias will always exist for most people seem to be more comfortable with people that are similar to them. I think Americans are great and pretty fair. Not only that, but we are quite a mixture of people.

        Yes there are some loonies out there, but on the whole America has done quite well. America paid a terrible price for slavery with over 500,000 deaths. That history is long over.

  50. Doctor Tom says:

    Big Al

    You presume that 35 yo male will be employed full time in a business that has 50+ employees.

    Since a signif number of these people work for small businesses who are typically exempt from the fines and penalties or elect to commit to more part time employees to avoid the requirements of the ACA then penalties and fines will not accrue to cover losses.

    I find it hard to understand how this person is cutting off his nose when he guarantees himself more disposable income by only buying insurance when and if he needs it.

  51. Big Al says:

    Skinny Average Al,

    If your 35 year old is only working part time for a small employer who chooses to ignore available tax credits to facilitate coverage for its employees, it’s safe to say that the 35 year old will be in the ‘lower’ income brackets, and therefore eligible for greater government support … to the point that his premiums might be below the $695 penalty. If he still refuses on principal … I suppose there will alway be those who put $elf before community.

    Again, you can lead an elephant to water, but it does him no good without his trunk.

  52. Bob Hertz says:

    Frank Timmins, if you want to, read MIchael Lind’s article called “Uninsured LIke Me.”

    You can also look up the comments by Southern Democracts in 1965 that Medicare was horrible because hospitals would have to integrate.

    You can also look up the comments by many legislators in Calif and Aris that Medicaid was acting as a magnet to attract illegal immigrants.

    The deeo South has been looking for ways to ‘export’ poor blacks to the North since 1930, and skimpy health benefits is one way.

    The border states have a real problem, and I personally have some sympathy for the anti-immigrant cause. We cannot afford to be the health care system for Mexico.

    I just think that the racial factor in the Medicaid debates should be acknowledged instead of never mentioned.

  53. Al says:

    @Big bigger biggest Al: “If your 35 year old… ”

    Ask yourself a question. If the goal is to promote the desire and will for everyone to spend their money on health insurance why would one want to overcharge the young so much that they learn to hate it. That doesn’t make sense unless one believes in force at which time one is nothing more than a petty dictator.

    It seems our styles differ. You are asking for a bloated big government where force is the mechanism of control. That to me doesn’t make much sense.

    • Big Al says:

      @ In contention Al,

      I see that we are entertaining each other with our banter but not making much headway.

      There is no goal to steal your pennies. There is no attack on the young. There is no petty dictator. There is no Jabba government. There is only the will of the people, their Congress, and their Constitution, of which we need to cooperate with to the best of our ability … not cast aspersions. Improve … not dump.

      Agreed, whining and armchair vitriol towards our representatives is the great American pastime and some deserve medals (of sour grapes). Good luck.

  54. Charles Johnsen says:

    Once again, all of this is confusion over what insurance is. Insurance shares risk, not cost. And car insurance does not pay for gas or tires or a new timing belt.
    How about this? No 3rd party payments, no mixing of medical care with health care, no mixing of government and private action or costs, no more “insurance” for a runny nose but only for those diseases which will take away your house and car.
    And then this: making others pay for bad moral decisions enables those bad decisions. Mercy for the sad case of one person has led us into subsidizing conduct not tuned to human nature.

  55. Frank Timmins says:

    @Bob Hertz

    What do comments made by “Southern Democrats” in 1965 have to do with “Southern Republicans” (or Democrats either) in 2013? You are living in the past sir.

    With regard to California politicians citing Medicaid attracting illegal immigrants, they are no doubt correct. How is that racist?

    You write, “I just think that the racial factor in the Medicaid debates should be acknowledged instead of never mentioned.”

    I think you are not only incorrect, but you are bringing into play an emotional factor which cannot be dealt with in a healthcare problem resolution and poisoning the water in the process. This kind of race baiting has been going on in politics quite long enough.

    Medicaid is a program for the poor. Are all Medicaid recipients Black? Are all Medicaid recipients Hispanic? Nothing in the healthcare debate could be more irrelevant than race.

  56. Al says:

    @Big, bigger, Biggest Al: “There is no goal to steal your pennies. There is no attack on the young. There is no petty dictator.”

    You are a funny guy and must be kidding especially in the way you change another’s words so that your own don’t appear so silly.

    Most folk that are informed recognize the trillions spent and most realize that if there was no attack on the young (your words) they they wouldn’t be charging the young multiples more than their risk required. …And yes force and intimidation are what dictators use.

    Maybe you ought to give up on those 16 ounce Cokes.

  57. Bob Hertz says:

    I am going to take one last shot at explaining my admittedly leftist position in Medicaid.

    The states which are refusing Medicaid are trying to minimize state taxes. Several of them do not have any state income tax at all, and want to keep it that way.

    Many of these states frankly have a goal of attracting wealthy retirees. Low taxes
    are a big part of this attraction, of course warm weather helps too.

    These states know that expanding Medicaid will make their state a more comfortable place for poor people to live. This will raise future taxes, and frankly will probably raise the crime rate too.

    A lot of people were not bothered when Hurricane Katrina forced many poor persons out of New Orleans. I understand that, I am not a saint either.

    I just think that this unpleasant reality should be recognized.

    Bob Hertz, The Health Care Crusade

  58. Frank Timmins says:

    @Bob Hertz

    Okay Bob, I don’t disagree with anything you said in your last post. You didn’t say anything about race being a motivation. You may think this a fine point because you identify people by race. IMO doing so perpetuates racial problems. Race is not the problem. Poverty and cultures that cultivate it are.

  59. Al says:

    “my admittedly leftist position”

    Bob H., the unpleasant reality is that Florida (warm, low taxes, attracts wealthy retirees) has a fairly balanced budget compared to a lot of states and when a state runs out of funds they cannot help anyone or they have to rely upon the taxpayer. That deprives the taxpayer of their earned cash so that they deprive their own children and families.

    Florida’s problems, at least a great number of them, come from too much government and the inability of the left to control costs and see to it that the funds they demand spent are used correctly. Just today it is reported that governor Scott of Florida signed the bill that prohibits state electronic benefit transfer cards from being used in bars and gambling establishment. How did that use permitted by the left for years help the children? Help the children is the sound bite of the left, but little do they care when they deprive the working families of their earned income thus depriving their children along with the ability of people to create wealth.

    You brought up Hurricane Katrina and that is a good example of where the problem lies. The problem is **circular**. Preparation for natural disasters, retirement, health etc requires people to prepare in advance. Without that preparation people prepare even less so they require from others more and so the circle goes. New Orleans is an excellent example. Some people depended upon government for almost everything and government failed miserably. The police left and even stole, school buses were left unused while people were stuck without transport on their roof tops to prevent themselves from drowning, chaos, etc. was the result of such dependency on government.

    Hurricanes are a constant threat to Florida, but it appears people are more prepared than they were in New Orleans though with each government intervention they become less so. Andrew was one of the worst storms ever, leveling homes inland where hurricane risk is supposed to be low. The death rate was low and though a huge entire area was devastated we didn’t see the chaos seen in New Orleans. When one hit my area we saw relatively prepared people. Some doctors remained in the hospitals to provide care because they didn’t have families and children to protect. They made rounds on everyone’s patients and in the end charged no fee.

    Recently we have seen government intervention in the form of anti-gouging laws. They prohibit the price of gas from being raised and prohibit the sale of generators and the like from being marked up. Years earlier when there wasn’t enough gas it was brought in and prices did rise, but there was gas and generators. A later hurricane that occurred over a three day weekend wasn’t such a bad one, but we had no gas and people needing supplies like generators couldn’t buy them. That is what the left offers us.

    Back to healthcare. What have we heard from the left when studies like the Oregon Study, Finkelstein and McKnight, Rand and more show that the money the left demands to be spent is being thrown into a giant hole. They don’t get rid of the hole. The answer is consistent, spend more.

  60. Ron Bachman says:

    Interesting back and forth on this issue. Maybe Bob could understand that states not expanding Mediciad want to create an opportunity society where the poor can get ahead and experience the American dream of upward mobility. Maybe a liberal accepting the dependency state could at some level accept the good intentions on “tough love” to benefit those the left have relegated to never ending poverty. Maybe a more limited dependency state that does not have 72 million on Medicaid could actually help the most needy rather than support they many who could help themselves. It is not the conservatives oath that is cold hearted, it is the liberal view that is fatalistic and pessimistic.

  61. Ramesh Chandra says:

    We have to recognize the fundamental differences in this discussion. We have to recognize substantial amount of choices people make are not dictatable. To assume the role of GOD is the major folly in the socialistic and communist or even handed basis outlooks. Policies can only be justifiable on the basis of not imposing behaviours on some to hopefully benefit many others. They can be mainly limited to foster individual choices, protection from exploitation and crime, and facilitation of general welfare without infringing on basic rights,. Entitlements are not rights.

    Human beings evolved from killing each other for food to caring for people as a society. Most of the caring happened as a community , not as a Government.

    If you expect to give our personal caring to an authority, it leads into waste and misuse.

    So please don’t encourage throwing the responsibilities on Government that communities need to pay attention.
    Our activism need to focus on making public servants accountable to their fiduciary responsibilities.

    This is where majority ogf conservatives come from.
    Liberals and progressives are best spending their time on how voluntary community relationships can be developed.
    There is a place for both.
    None of us are racists or merely exploiters(minority will be).
    So let us focus on the efficient handling of society affairs.

    Obamacare is not only an abominition, it is diverting our attention on how to really take care of things.

    Our first goal should be making Government meet its fiduciary responsibility.
    Its irresponsible debt piling has to stop.
    It needs to encourage the development of high returns from our natural resources.
    It need to get out of affairs which states and communities need to handle.
    It needs to unbundle us from top heavy Government.
    It needs to convert the resources wasted on unemplyment offices and convert them to employment offices.

    There are so many things Government can do effectively and we are asking it to do our responsibilities.

    Let us really focus on proper roles and develop plans based on them.

    9

  62. Big Al says:

    @Chandra

    You describe a philosophy which is, though admirable, unrealistic and confused. Your core tenant, ‘that people will just do the right thing and help each other’ borders fantasy. Most people do not directly support the needy, and those who do, do so on condition that it facilitates their personal biases or meets certain tax criteria. This sounds cold, but unfortunately it is true.

    This is where your ‘Abominable Governments’ step in. We have elected our neighbors to act in the best interests of our neighborhoods (Home Owners Assn.), Cities (Mayor and Councils), Counties (Commissioners), States (Governor and Legislature), and Nation (President and Congress). Our neighbors ‘ARE’ our government and are trying to address unattended social ills wrought by the human condition.

    You demand that government reduce spending, then eviscerate them because they have implemented the ACA which the CBO reaffirms will reduce the debt.

    You aggrandize private enterprise then turn around and want the government to ‘create employment’.

    You ignore States desperately seeking Federal funds to operate all of their social programs, while demanding the Feds stay out of State affairs.

    Yes, our neighbors in DC waste money and it needs to be addressed, but responsibly.

    Yes, our neighbors in DC have incurred debt taking care of our seniors, the poor, the young, and defending us; therefore, is our job to pay that debt. If that entails higher taxes, let’s get it done. Stop whining.

  63. Ramesh Chandra says:

    What a twisted outlook Big Al.
    Xreation of a welfare socirty is not taking care of the needy,
    Your philosophy is exactly what has hindered the growth of this country.
    I am not attributing all truistic attributes to the general public.
    As humans we learned how to organize, set up rules that give us ability create checks and balances.
    Checks and balances require discipline.
    What u r advocating just writing checks.
    And who were to write these checks and from whose accounts.
    We gave congress the right to impose taxes with prudence , but maintaining fiscal responsibility.
    Apparently we need more checks to curtail this irrational exuberance of writing checks.
    I never offered ize fits all solutions.
    Greed every where can , will and is causing nususe of power and weakth.
    You are not shifting wealth from poor when u tax and grow Government and institutions.
    You are fattening the inefficient.
    You are not helping the needy and poor.
    You are drugging them with small freebies.
    Stop preaching, do real help.
    Find things that really make a difference.

  64. Frank Timmins says:

    Very well stated Ramesh Chandra. Of course it would help if Big Al would refrain from basing much of his philosophy upon false pretenses.

    For example, what legitimate economic expert still claims that the ACA will “reduce the debt”. This defies any application of common sense. Of, course this could be accomplished by denying benefits (which is in reality the only option in this scenario). Even Big Al admits in his “neighbors in D.C. waste money”. Yet he is willing to turn over 1/6 of the economy to these bureaucrats. Amazing

    And by the way, these states “desperately seeking federal funds” is a direct result of the citizens of these states being stripped financially by federal mandates and bureaucratic intrusion.

    If one makes false assumptions, any arguments projections based upon those assumptions can be of no value.

  65. Al says:

    Of course Frank your assertions are on target as are those of Ramesh. The other voice simply avoids looking at history and the facts. Government programs don’t seem to work as well as they think if they work at all and do no harm.

    Let us just take a look at the poverty rates before and after the War on Poverty took place in 1964 for if anything the opposite is true and the government caused harm.

    Poverty was fast declining before the legislation was passed and around 1960 poverty rates were ~22.5% on a sharp decline so in 1965 the rate was ~17.5%. That fall continued until about 1969 when the legislation was first getting started and the poverty rate reached a low of ~12.5%. After the legislation had time to actually affect the poverty rates we see the drop stalling and rates wiggling around with an end to the decline in poverty. In 1982 poverty rates were ~15%. In 1993 15.5% and in 2010 15.1%. and that decline in poverty rates ending.

    The blathering from the left might be entertaining, but nothing is better than the facts.

    • Ramesh Chandra says:

      The fallacious path of ur thinking is that we advocate all or nothing approach.
      Govt has a role.
      The people who are governing need to put their house in order first.
      They need to understand their role first.
      Guarding the constitution and meeting their fiduciary responsibilities come first.
      As the governed we need them to balance our budget , donot leave debt hanging, maximize the returns of the assets we gave them to work with, tax minimally, and protect the US territory and its citizens(whereever they might be). Then look to the people what else they need from the govt, not just by railroading but by democratic processes.
      Instead u guys like to railroad legislation and say u have to pass to rad it.
      Lie to the congress that aca is not a tax, but accept the aca is constitutional because supreme court said it is a tax.
      I will consider ACA is illegal, because it has not been voted as a tax.
      There is so much railroading.
      Americans won’t accept this, because we don’t take tyranny lightly.

      • Al says:

        @Ramesh “The fallacious path of ur thinking is that we advocate all or nothing approach.”

        I don’t think anyone denies government has a role. It is a matter of downsizing and having government manage those things it is supposed to manage. Contract law et. al. is a big role for government and effectively manages most of our problems in a manner subscribed to by Adam Smith.

        “The people who are governing need to put their house in order first.”

        That is the problem when one places too much power in the hands of another. We prepare less, government provides more, we prepare even less, government provides even more…. on and on. To break the cycle we have to prepare more whether it be for retirement, healthcare or whatever.

        Make sure you keep in mind that Al and Big Al are two different people with almost polar opposite view points.

  66. Big Al says:

    Ramesh, ‘we the people’ have already ‘organized, set up rules, and created checks and balances; it is called the Constitution, Government, and Due Process. Our house is in order and government’s roll is constrained by such process. ‘Our’ creation of safety-net programs and commerce regulations over the decades does not, in itself, constitute reckless irresponsibility by our representatives. And yes, we do need to buck up and pay those costs incurred instead of being armchair anarchists.

    Frank, you infer that the CBO is illegitimate and that Obamacare is, in effect, nationalizing over 1/6 of our economy. Don’t you see a bit of disgruntled exaggeration in those sentiments? I’m certain you would embrace the CBO if they supported your personal bias, and Obamacare is simply plugging holes in the private health care industry for the welfare of both the majority of people and the government’s bottom line.

    Average Al, wouldn’t poverty rates have to do more with the economy of the time, rather than as result of selective ‘leftist’ legislation?

    We all have the same goals. I favor a balanced budget. I disagree with programs that create dependency. I resist legislation that exceeds reasonable regulation of private commerce. I want to pay as little tax as necessary. I want to cut waste and fraud. However, I do not endorse elimination of the programs and regulations that have emerged from the real needs of the people over the years. Welfare programs such as Social Security, Medicare, Medicaid, TANF, Food Stamps, and unemployment were all designed as supplemental or temporary assistance available to all citizens, and though I believe in effective restructuring of these programs, I see a responsibility as a society to see them sound.

  67. Ramesh Chandra says:

    “Ramesh, ‘we the people’ have already ‘organized, set up rules, and created checks and balances; it is called the Constitution, Government, and Due Process.”
    Onfortunately some of you are going around defeating the letter and spirit of the above.
    ” Our house is in order and government’s roll is constrained by such process.”
    Our house is not in order. Which household deliberately goes thru such huge debt burden?
    ” ‘Our’ creation of safety-net programs and commerce regulations over the decades does not, in itself, constitute reckless irresponsibility by our representatives. And yes, we do need to buck up and pay those costs incurred instead of being armchair anarchists.”
    It is the reckless irresponsibility of our big institutions that created the political, financial and non-profit blobs, not real safety nets. If you and ur buddy from omaha are so want to pay for it, why doesn’t he donate his money from post-tax money to his trust, instead of govt. tax money?
    “Average Al, wouldn’t poverty rates have to do more with the economy of the time, rather than as result of selective ‘leftist’ legislation?”
    It sure is a major factor, Governing in a responsible way would have provided a lot more opportunities for these people.
    Welfare programs are poorly structured w/o proper business praxtices. There are better ways of structuring them, All the trusts have given a free checkbook to the treasury. Do u know for soc sec to be self-sustaining, it just need to get 1% more return on its investment? The trustees have no authority to make such a huge fund self-sustaing. We created public and private funds with total disregard to sound management principles.
    The best way to do things is have flat sales tax(with lower tax on food stuff), set aside a national fund for real social net with trustees who can carry their fiduciary responsibility.
    Very few people in all the big organizations showed that they are to be trusted. We do have a huge capable, trustworthy people. I am not pessimistic.
    What we need is dialogues with crucial conversations , not biased outlook.

  68. Frank Timmins says:

    @Big Al

    “I’m certain you would embrace the CBO if they supported your personal bias…”

    The CBO report was based on false and incomplete information,not taking into account the “unintended (but inevitable) consequences of the ACA which have now (as many predicted) come to light. It is quite simply another utter failure much like LBJ’s “War on Poverty” of ill-conceived progressive politics. And, like the WOP, accomplishes nothing but the advancement of the nanny state at the expense of overall prosperity.

    Of course there are holes in the “private healthcare industry”, but most of them are the result of government interference in the market process. I am no advocate of leaving the system as is, but the true reforms necessary do not mix well with the goals of the progressives to create top down economic management. In other words, the real reforms necessary to improve the system have never ever been tried in this country.

    In what way am I exaggerating the impact of the ACA with the corrupt IRS holding economic sway over every American? If anything it is worse than simply stating that it nationalizes 1/6 of the economy. It impacts 100% of the economy.

  69. Al says:

    @Big, bigger and Biggest Al: ” wouldn’t poverty rates have to do more with the economy of the time, rather than as result of selective ‘leftist’ legislation?”

    Poverty rates do reflect the time as well, but we can note grossly that poverty rates were falling very fast before the legislation for the War on Poverty was enacted. After the legislation poverty rates rose and then been relatively stable for decades. I think I might have erred in my above statement for I think in 1993 poverty rates were 15.1% (not 15.5%) and in 2010 15.1% totally flat despite the huge amounts of money spent by the taxpayer. Likely much of this is due to that circular movement I described earlier. When government provides too much people prepare less and thus have less.

    “I disagree with programs that create dependency. ”

    But, everything you have written earlier contradicts that and much of what follows. Consider the circularity of dependency and the welfare state. That doesn’t mean government cannot assist. It can, but it shouldn’t interfere with the marketplace and should be done at the lowest level possible. Every program you mention has been misused and abused. That tells you that the federal government isn’t very good at these things. How much the government should and can interfere is open to debate, but that is not what you have been saying. You approve of the welfare state at the highest levels of government despite its effect on the marketplace.

  70. Ramesh Chandra says:

    Al and Big Al,
    The main reason Govt programs fail is because they end up being designed for middlemen gaining power and money. That is why they really don’t give enough to people for whom they are intended to. The objectives, the guiding principles , policies and processes get designed by in-computes. They can be designed in a lean solution basis. If the leadership does not come from the President, it has to come from congress. How innocent these people is evident when u observe they don’t even baseline budget discussions, on the last budget line item. They confuse themselves and confuse the heck out of the public. Either they need to get nerdier or replaced by better nerds.

  71. Big Al says:

    @ Tiny Al,

    I support programs that have a definite logical benefit to the nation, but that is not a carte blanche approval of every aspect of all legislation. I believe in effective ‘restructuring’ of existing programs that are proven to create dependency or are unsustainable. I don’t agree with the radical approach of “just dump it”. For instance, Social Security should reduce benifits to match revenues in order to become perpetual … not just ‘dump it’ or continue printing money to pay seniors many, many times more than what they contributed to the program.

    “But it shouldn’t interfere with the marketplace.”
    Since we exist in a world of greed, ‘The Marketplace’ cannot be sacrosanct and must be regulated by Congress [according to the Constitution]. We both agree it should be with as little impact as possible to protect the general welfare.

    General Welfare be damned, I think the core resistance to Obamacare is the diet for certain insurer and provider pocketbooks and whose name is on the legislation. Help improve it, but get used to it.

  72. Ramesh Chandra says:

    Big Al, I thank you for continuing this Crucial discussion.
    If we focus on management principles and things that can be done and not get distracted by class warfare, we can achieve a lot.
    First is the waste in current Govt. This should be cleaned up in the next 90 days.
    Second, SS and medicare. Current seniors are getting what they contributed for. Problem is just like so many mismanaged pension funds, the trust funds are mismanaged by giving the trustees not enough leeway to invest in slightly better returns. This is because both the branches love to have these trusts as though it is theirs, not the peoples. If the trustees can generate 4% returns as opposed to current 3%, the trusts can be self-sufficient. But they are forced to invest in treasuries, so that the two branches can play games with budgets. There is no need to tax trust participants more.
    Next budget process should be at-least 2 years and zero-base based. There cannot be any thing sacrosanct and go thru crucial examination.
    Budget lines need to be clearly demarcated and These are all simple processes to follow.
    If we start here , it becomes easier to discuss other topics.

  73. Big Al says:

    @ Lil Al again,

    “Make sure you keep in mind that Al and Big Al are two different people with almost polar opposite view points.”

    I beg to differ. If we have the nation at heart, we share the same goal. We are both fiscally conservative. We both want the most effective government possible. We both want our fellow man to succeed and prosper. I may be a bit more supportive of progress and legislative innovation (and grip my pocketbook a little looser), but we are both proud Americans.

  74. Frank Timmins says:

    @ Big Al

    One last comment regarding your post – “I think the core resistance to Obamacare is the diet for certain insurer and provider pocketbooks and whose name is on the legislation”

    I can’t speak for the healthcare provider community other than to say I would prefer that my money line the pockets of the people who one day may save my life as opposed to the civil servant bureaucrat who is primarily concerned about whether or not his drinks will be comped on his next Vegas junket.

    I can speak from some experience on the insurance company side because if have been in the health insurance business for almost 40 years. Trust me, there is no significant resistance to the ACA by the insurance carriers that dominate the healthcare arena. And why should there be? In theory they pick up premium for all those mysterious “uninsured” for which the ACA mandates coverage. No, just as with the AARP, deals have been made between the Obama administration and certain “critical” insurance industry leaders for support. The well being of the American citizen was not the subject of the deal.

  75. Ramesh Chandra says:

    Frank, u r so right.
    One thing is all businesses will try to take every change in stride and try to make a profit out of it. What most people don’t know is that insurance carriers make a net return of 3%. That is less than what treasury pays Soc sec admin. for ss funds.
    If u look ast it, all exchanges are built by insurance co. (software).
    The problem is that there is so little real information people pay attention to and they focus on generalities.

  76. Ron Bachman says:

    Amen and amen to the collusion between big government and big business. In this case – big insurers. They make most of their money NOT through risk contracts, but as administrators processing claims, providing self-insured services (legal, actuarial,vcommunications, wellness, disease managment and on and on.

    Beware of BIG anything…BIG business, BIG government, BIG Associiations, and even BIG Religion.

    Our founding fathers wanted a smaller government with dispursed power. Why many today want the opposite is beyond me. King Obama, Queen Pelosi, and Prince Harry Reid? Give me a break.

  77. Ramesh Chandra says:

    Ron,
    U got one thing wrong.
    Harry is the queen mother.
    He is equivalent to Shakuni, the uncle who helped the bad family cheat their good cousins and steal their kingdoms in a crap game(he must have built Los Vegas).
    That resulted in the first real world war with millions of deaths and whole indus valley blood soaked and filled the entire Indian continent with carcasses.

  78. Al says:

    Juvenile Al,

    We have all seen your homework on these pages. You can try to explain yourself, but your words are in black and white.

    Take your F and transfer to basket weaving. We know you like school and America, but sleeping in class won’t get you anywhere.

    Bye.

    Al

  79. Ron Bachman says:

    Guys, this continual promotion of racism behind everything is tiresome.

    I understand that for liberals “racism” is like original sin that can never be forgiven. It does not matter that you personally are not biased or hateful to others of another race, it does not matter that you help or assit others, it does not matter that you vote for a black man, it does not matter that you are even black yourself. You see this original sin of racism has no Jesus Christ to grant forgiveness and salvation through grace. In the secular world of liberals, the only salvation for racism is to convert to liberalism. If you are a liberal you can then call every one and every thing racist, even if your policies are the equivalent of modern day plantationism.

    • Uwe Reinhardt says:

      I think, Ron, you may be protesting too much here.

      I have seen a lot of literature suggesting that social solidarity works best in culturally and racially homogeneous groups. Although post-war Europeans have generally abided by social solidarity in health care, that implicit social contract is being sorely tested by the waves of recent immigration. Just look at Sweden.

      I would be the first to agree that we have made great strides in the US in fighting racism. Until the Supreme Court decision of 1965, for example (Loving vs Virginia),interracial marriage was illegal in many states in the U.S. and punished by jail. And that 15 years after the abolition of similar laws in Nazi Germany. Fortunately, I married my Chinese wife after 1965 and thus was protected by a federal regulation.

      But to deny that there are remnants of racism in our culture and politics strikes me as a bit pollyanish.

      How can you be so sure that racism has disappeared from our landscape? Have you not followed the recent kerfuffel over an ad featuring an interracial couple?

  80. Ron Bachman says:

    I never said it never existed or has disappeared. I said that no matter what we do as individuals or as a society, liberals cry racism for everything these days because it is a sin that we can never be absolved of unless we become liberals. As Jimmy Carter once said, “Life is not fair.” Every bad occurance, every ill that befalls one, and every adverse decision by a boss-politician-neighbor is not because or racism. Your argument of racism and victimization gets boring, but I understand my race has sinned a sin that will NEVER be forgiven or absolved through any social program or charity work. I will only find final salvation in death or the Democrat party. Some how Christian slavery was forgiven and forgotten. Some how black on black slavery is forgotten or ignored. Maybe this is really a political use of racism ????

    • Uwe Reinhardt says:

      Ron:

      I think you are over-reacting and stereotyping to a degree that is not helpful here.

      Have a drink and have a good weekend.

      Best,

      Uwe

  81. Ramesh Chandra says:

    It is sad that we moved so far away from the topic for the blog. I am guilty of moving it a little bit, because i felt the items i talked about need to be addressed first. Then it is easier to talk about health care solutions. Please let us get back to things we really need to focus on.

  82. Ron Bachman says:

    Ramesh, you are right we have moved away from the topic. But I get tired of Ivy League elites pointing to racism as the root cause of everything, including being against ObamaCare. It is a cheap political ploy that always as in this blog diverts the issue from the need to discuss the fact that we all want to have a better and more just society. We can honestly differ about how best to accomplish that without shouting “racism.”

    Uwe, I don’t drink. I clouds the mind. Have a glass of water and flush it out.

    • Uwe Reinhardt says:

      See, Ron, there you go again, stereotyping: All Ivy League professors are the same, in your mind. That is a very simplistic assumption.

      Let me remind you that it was Bob Hertz who brought in the issue of race when he wrote, in a much earlier comment: “Many Americans oppose child welfare benefits because of the race of the children involved.” Do you know that he is an Ivy League professor, to impute that statement to the Ivy League?

      I actually had not even thought of that explanation and merely tried to explain to you why Bob Hertz would offer such a remark. I presume he was alluding to the literature i mentioned which says that social solidarity thrives best when people are culturally and racially homogeneous.

      If you have issues with that literature, then take it on. Don’t label people. Have I called you by a label or disposed of your argument with a label?

      Maybe you should have a real drink after all. It’s know to be good for your health — less bile in your gut, I suppose, because you get mellow.

      • Al says:

        Uwe, a lot has been made of race, too much in fact, and that is counterproductive. Unfortunately, all too often race is used in a political attack and most of those times the racial attacks start from the left. Remember, historically and today it was mostly the left and progressivism that promoted race hatred.

        The Democratic convention of 1924 was known as the Clanbake convention because the clan (KKK) was so influential in that convention. Eugenics was a major part of early progressivism and a lot of that was based upon race. Some of the great leftist heroes were very clear on their positions towards certain racial groups with regard to eugenics. They didn’t want them to breed and some didn’t want them taking the better jobs. It remains true today and many of the leftist policies of today are paternalistic and in my opinion represent remnants of deep seated racism with the belief that certain minorities are unable to care for themselves. Of course a type of guilt might be involved as well along with other emotions.

        I want to make it clear that I don’t think all or most from the left are racists nor do I believe that of Ivy League Professors or any other group. I was simply discussing history or yesterday’s news.

        • Big Al says:

          @ Al,
          Sorry, been away and now it looks interesting again. I brought my poking stick;)
          (I am fiscally conservative and have always leaned Republican … until 2008.)

          Debating historical racism is well and good but what is important is the here and now. The Conservative Parties (or righties if you prefer) have created a reputation for themselves, through direct action and platforms, of racism, gender bias, and economic cast bias. This perception has been evidenced by election results and polls of the youth.

          1) Immediate creation of countless Tea Party groups in 2008, in light of no significant tax changes or liberties being ripped away, was a good indication that these groups were uncomfortable with the ‘skin shade’ of the new President … of which I have personally observed on innumerous occasions.

          2) The great recession saw the righties foaming at the mouth to round up and expel all Mexicans (in some cases illegal or legal). Continued immigration reform roadblocks support this bias.

          3) Countless legislative measures by righties to restrict or eliminate women’s reproductive rights is a good measure of conservative gender oppression.

          4) Righties war on the poor is conflicted at best. While calling for restriction or elimination of programs earmarked for the poor and needy (which are also part of Social Security Insurance Program), they don’t take equal action against the largest welfare drain on this nation … the retirement program. Most current SS recipients have drawn numerous times what they have ever contributed. Fact.

          Finally … the ACA, originally a Republican brainchild, the constant banter of how terrible the program is precludes the righties from being able to see the good parts of the program. I would venture to say that of the 460+ aspects of the ACA, not more than a handful are reasonably objectionable. It appears to the young that the righty perspective may have more to do with the author than the content.

          Have fun with these points.

          • Frank Timmins says:

            Big Al, I will have some fun with your points. Thank you.

            That Tea Party “reputation” you mention is promoted by a left wing dominated national media of which is a huge influence on “the youth” and their polling. So the “reputation” was not created by the Tea Party, but rather by a biased and powerful media opposition. Perhaps rather than take the media at its word you may want to actually go to a Tea Party meeting and see for yourself.

            1) The “immediate creation of Tea Party groups was a direct result of the political changes promised by that “President with a different skin shade”. Perhaps you overlooked the strong Tea Party endorsements of Herman Cain (with an even darker skin shade).

            2) Yeah, those nasty persistent Tea Partiers continue to insist on the rule of law and enforcement of immigration rules. Let’s see, the opposition argument to that position is…..what?

            3)Hmmmm…”conservative gender oppression”. That sounds like a term coined freshly out of DNC planning session. Nice slogan – inaccurate and inflammatory, and a light headed throwaway line for a sensitive and complicated subject, but nice marketing anyway.

            4)”Righties war on the poor”. I think a more accurate description of the entitlement culture war would be “Lefties plan to keep blacks politically sedated and on the Plantation”. What part of the conservative efforts to reform both the entitlement mess as well as Social Security and healthcare have you missed Al. Social Security reform was one of the first things GWB tried to address when he was elected (and was immediately rebuffed by the Left).

            Al, let’s not bend historical facts in the process of trying to make points.

            • Big Al says:

              @ Frank
              Thanks for playing. I have been actively involved with Tea Party members in my area, not as a member but as a sounding board, since 2008. Predominantly middle to late age white males with log biases on their shoulders, sometimes makes dialogue difficult. Righty bias is a perception from the left just as lefty media bias is a perception from the right. Both have basis but are still perceptions.

              1) Endorsement of Herman Cain isn’t an accolade that I would advertise.

              2) It’s not following immigration laws that troubles me, it’s resistance to change of those laws that is the problem.

              3) Your “sensitive and complicated” segue doesn’t change the fact that conservatives are trying to overturn RvW and leave any type of personal reproductive choices in the purview of legislators.

              4) I didn’t say that the Republicans didn’t address SS reform, it’s just that the Tea Party drums beat harder for the smaller aspect of SS that supports the poor than they do for normal retirees whose need is debatable.

              Thanks

              • Frank Timmins says:

                Big Al, Is there a problem with middle age white males? Would I be biased if I pointed out that the NAACP is primarily composed of middle age black males with oversensitive race biases on their shoulders that make dialogue difficult?

                I believe that the reference to Cain was in response to your implication that the Tea Party had a “lack of comfort” with the skin color of the president. Your personal opinion of Cain is not relevant. The fact that skin color was and is not a basis for Tea Party preferences is relevant.

                You seem to be mistaken about the Tea Party position on immigration. “Appropriate” reform is right at the top of the list. However, just passing new legislation just so it can be said it is passed is not an advisable approach. I think the idea is to correct the problem, not make it worse.

                The position of the TP on RVW is that it should not be a federal concern but rather a local (state) issue. And yes, there are good arguments on both sides. In any case it is not a debate that is clearly defined as is the struggle over centralized (Statist) government vs. preservation individual freedom and protection of the U.S. Constitution.

                The TP position on SS is about “reform” that allows the system to survive, or the creation of a new system than can “survive”. It was not intended to be an entitlement program.

                • Big Al says:

                  As a white middle-aged male living in Idaho, I do see a striking difference between the transparency of a group identifying themselves as the ‘National Association for the Advancement of Color People’ … and groups of predominantly white mid-late aged males seeking to undo the last hundred years of social legislation (dump the Fed, dump the IRS, dump the EPA, dump taxes, dump welfare, dump dept. of education, dump the U.N., dump the ACA, etc.) hiding behind the name Tea Party Patriots. The National Association for White Male Regressionists (NAWMR) would be more honest and comparable.

                  WRT Cain, agreed, that the TP platform does not specify skin color, but direct dialogue with many TP members does. Sorry, this point is difficult to prove …withdrawn.

                  WRT immigration, I agree that legislation should be appropriate, but TP strict intransigence for bigger walls, deportations (self or roundups), and no amnesty or benifits makes ‘appropriateness’ elusive.

                  My favorite subject. If you elude that it is a state issue, where does one go to challenge said statues? All roads end at SCOTUS and we’ve road this mule before. RvW is the perfect balance between individual rights and state’s rights.

                  I agree that SS must be modified again to be a supplement and perpetual, but comments from local TP rings something like, “Social Security is not an entitlement; I paid for it … and they better not ”’touch it ”’. Sorry, again only many personal observations but i’m sure it rings a bell.

          • Al says:

            @Big Al

            “I am fiscally conservative and have always leaned Republican”

            We are so relieved to hear those words, but who cares when it is your actions and philosophy that count. It would be better if you simply admitted to being an uniformed leftist for then at least you would be honest.

            All the statements you make cannot wipe out the progressive and leftist history from the Clanbake, to trying to prevent blacks from getting better jobs, to eugenics in an attempt to reduce minority populations in a legal fashion. That is the type of love you seem to support.

            I hesitate to answer you 4 points on such a list as this, but I seem to have no choice.

            1)”uncomfortable with the ‘skin shade’ of the new President …”

            As I brought up to Uwe the left are the first to play the race card and you have adequately demonstrated that. If one could make two statements that reflected the vast beliefs of all the Tea Parties this is what ties them all together. (1) A strong belief in the Constitution and (2) A belief in a balanced budget. I guess you don’t believe in either or you too would support the basic principles behind the Tea Party movement.

            2) “foaming at the mouth to round up and expel all Mexicans ”
            Here we have an uniformed leftist that for a second time plays the race card. Sovereign nations maintain their own borders and that is what you are complaining about. If there is large scale racism then it is against the European, the Asian, the African and every other ethnic and racial group that is kept out by those that like to play the race card. It is the other people, not the Mexican, that are denied entry into this country.

            3) Women’s productive rights: Free choice not only includes the right to abortion, it also includes the right to keep the child and no one is more offended by that right than those on the left. It so happens that everyone is divided as to when the life of a child can be ended. I believe Peter Singer ( I think another from Princeton) or one of his colleagues made the theoretical suggestion that the life of a child could be extinguished some years after birth and another suggestion that an animal should have the same rights as a human. Do you agree with terminating the life of a child already born? We do that today when an abortion fails and a child is born alive and viable only to be left on the table to die. Maybe you were what Uwe was referring to when he rightfully discussed the precious nature of children and that some did not seem to value them enough.

            4) The poor: Apparently you didn’t learn from my missive above. Perhaps those with weak egos have to show how caring they are to others and that is why they throw other people’s money at the problem (not their own) instead of seeing to it that all people have the opportunity to improve their conditions. Some think providing them money and leaving them in a ghetto is good enough. I think we all did a disservice to a specific minority, for with our overzealous attempt to help we committed a kind of cultural genocide.

            The ACA was not a Republican idea. The ACA is one of the worst written pieces of major legislation ever to be passed by Congress. That and the rest of healthcare are what this particular blog is all about so perhaps you will read and absorb a bit before expounding upon your talking points that you seem not to deeply understand.

            • Big Al says:

              So you’re saying that if someone doesn’t agree with your philosophy, they are a ‘uniformed leftist?’ Sorry to say, but I am probably more fiscally conservative than you. I thought you would have derived that from my comments on cutting back on welfare (especially Social Security). I am, on the other hand, socially responsible, liberal with respect to individual liberties, and a strict adherent to the Constitutional process. Your modeling of Right and Left needs updating … or rebooting.

              I t seems most of your issues concern your pocketbook rather than the general welfare, and yes, the basis for the ACA and its notorious mandate was the conservative elements in our Capital. For you reading enjoyment, here is a Forbes article.
              http://www.forbes.com/sites/aroy/2012/02/07/the-tortuous-conservative-history-of-the-individual-mandate/

              You really need to relax more when discussing these topics. Have one on me.

              • Al says:

                @Big Al,

                You played the race card twice in your last posting and now you ask:

                “So you’re saying that if someone doesn’t agree with your philosophy, they are a ‘uniformed leftist?”

                The philosophy one believes in doesn’t tell us whether or not they are informed. What they say does.

                Take your next sentence for example:

                “I am probably more fiscally conservative than you.”

                That is an uninformed statement.

                “I t seems most of your issues concern your pocketbook rather than the general welfare,”

                No, my issues have more to do with freedom, economic freedom with regard to the issue of the pocketbook. I don’t mind spending money on others that need help and do that all the time.

                Perhaps there are specific gaps in your knowledge. Perhaps not, but a little review wouldn’t hurt. Please permit me to suggest an essay that I have suggested to others. You might have already read it here at the NCPA, but it deserves a second and third reading as it puts things together in such an easy and readable fashion.

                http://www.ncpa.org/pub/what-is-classical-liberalism

                At least you will have an organized way of approaching the subject and then when you wish to flame a specific ideology you can do so in better form. You can even use it to batter Republicans or even some of those that are thought to be conservatives. Maybe you will want to batter some Liberals as well. It will help you.

                You referred me to an excellent Forbes article and I thank you even though I read the article when it was first published. This article appears to be your evidence that conservatives were the “basis for the ACA”. Don’t go overboard. The Heritage Foundation was responsible for pushing the individual mandate, but that is not the ACA, but none the less some think that this accusation makes a good talking point for the left.

                If you read the entire article then you would already realize that the Heritage Foundation is quite embarrassed over this proposal and renounces it. But, you should also realize that this proposal was not for the federal government rather for a state government. As you know there is a difference and that difference is stated in the Constitution. Did you also read the reasons why the Heritage Foundation changed its mind? They should have also realized that such a proposal required force and such force should be reserved for existential situations or for the primary reasons the government was established.

                • Big Al says:

                  Al: “The ACA was not a Republican idea.”

                  Big Al: “the basis for the ACA and its notorious mandate was the conservative elements in our Capital.”

                  Yes, originating in DC with the conservative Heritage Foundation (including numerous Republican legislators), then was curried by Republican legislators through numerous iterations over the years. Yes, the base concepts for the mandate were conceived by conservative elements in our Capital. You can’t worm you way out on this one.

                  Race Card: Racism is, unfortunately, still alive and ugly in the United States. You can’t argue with my personal observations of TP member bias since you weren’t privy to the conversations. As you inferred earlier, someone may be innocent in their mind, but their actions speak volumes. (Irrational exuberance over anything anti-Obama, fomenting over walls and roundups while at the same time scratching their heads wondering how to capture that demographics’ vote is sad to watch for an observer.

                  It is always telling when someone resorts to decrying … uniformed or unread in a discussion. Intransigence is a disease to overcome. Good luck.

                  • Al says:

                    @Big Al: “You can’t worm you way out on this one.”

                    Can you not read? Here was my reply to your statement “the basis for the ACA”

                    I said “This article appears to be your evidence that conservatives were the “basis for the ACA”. Don’t go overboard. The Heritage Foundation was responsible for pushing the individual mandate, but that is not the ACA, but none the less some think that this accusation makes a good talking point for the left.”

                    It sounds like you spend too much time on Twitter reading only sound bites.

                    The dislike for Obama stems from his policies and his lack of forthrightness. Most conservatives, Republicans etc. didn’t vote white or black and that is why many that call themselves by those names stayed at home rather than voting for the white guy. But, on the left we note that Black Americans voted more heavily in this election than in others. That would indicate but not be dispositive of a black/white relationship.

                    Go through the history of the left along with the progressive movement and carefully read the underlying statements behind progressive policy. Pure racism. Look at history and starting with Lincoln take note which party supported the ideas of racism. Yes, the Democrats changed their tune when they realized the black vote was important (demeaning them in the process) and yes Republicans can be totally dishonest and just as bad as Democrats. I’m neither so you don’t insult me when you bash Republicans.

                    I agree with you to be careful when someone decry’s uninformed, but in this case one can read the substance of my comments and the lack of it in yours.

  83. Bob Hertz says:

    I am Bob Hertz and I once went to a wedding in Princeton NJ, where I toured the campus of Princeton U. That is the extent of my Ivy League connection.

    I live in northern Minnesota. Our state was settled by Scandinavians and Germans.

    Germans had national health insurance of a kind in 1870, so there has always been a liberal attitude here.

    Minnesota had a socialist governor in the 1930′s, Floyd B Olson. It also had Hubert Humphrey, who moved the Democratic party to the left and helped his proteges run the state for many years after he went to the Senate.

    I do not question that we have a lot of “limousine liberals” in Washington who are attracted more to social engineering than real progress. However America also has a lot of real liberals too, who look at Medicaid and see it as compassion and solidarity. Right or wrong.

  84. Ramesh Chandra says:

    Let us stick to specifics. The main subject is costs of Obama care and its breaking of constitution and fundamental rights. There are better ways of providing avenues foe better care. We certainly need to have some crucial conversations on the specifics. But fixing health care and Obama care first requires attention to money matters. Energy is where our the immediate imoact is. Getting rid of waste and cleaning up executive branch is the other. Next comes structural changes in our budgeting, and fiduciary responsibility checks. Then we need checks on the Imperial Presidency.//then delegation of duties to States and checks on their misuse. So many imp things to do. Pkease don’t be distracted by things which won’t get us no where. Let Go.

  85. Ron Bachman says:

    I didn’t say Ivy League professors, I said Ivy League elites, but if the mortar board fits… Even though 90+% of professors identify themselves as liberal, I would never stereotype them as all progressives.

    Funny how you say I stereotype, when you continually misread my mtyped words.

    Uwe: “How can you be so sure that racism has disappeared from our landscape?”

    Ron: “I never said it never existed or has disappeared.”

    Ron: “But I get tired of Ivy League elites pointing to racism as the root cause of everything, including being against ObamaCare.”

    Uwe: “All Ivy League professors are the same, in your mind.”

    Uwe, you are a well recognized national figure with lots of answers. Maybe listening to the words of others who would might disagreeg with your philosophy of “man governing man” would provide you some insights into alternative to reaching that Great Society that we both would want.

    Neither stereotyping nor word distortions moves us along a constructive path.

    My apologizes for any insults perceived. As a born Yankee(Pa)and now a converted Southerner (Ga), I get real sensitive to the racism that is cast upon both conservatives and Southerners in particular. …talk about stereotyping!

  86. Ramesh Chandra says:

    We keep going round and round around pieces of soured cheese.
    Why can’t we start with the assumption that everybody has good intentions and focus on one subject at a time.
    the main point John was trying to make is: People should pay for what they use and not expect others to split the excess with them. Does n’t this make perfect sense. Sandra Fluke has a lot of guts to saying she is woman’s rights advocate for wanting her out of wedlock sex expense should be $3k and should be covered by everybody taking that burden. Can anybody tell me the justice in this?

    • Uwe Reinhardt says:

      I can easily agree with your point on Sandra Fluke. I do not want to subsidize other people’s sexual activities either. But I see a difference between subsidizing maternity care for women and subsidizing hook ups for college girls.

      • Frank Timmins says:

        @Uwe Reinhardt

        I have always thought it a curious position to presume that the community should supplement maternity expenses. Of course this is water that has long since passed under the bridge, but maybe someone can provide some logic. The idea of insurance is to pool “like” risks among a grouping large enough to produce critical mass to fund “unpredictible risks”.

        Put another way, anyone theoretically can have cancer, high blood pressure, auto accidents, etc. Only some can and will have maternity expenses. Is it fair for you and Big Al to pay for my kids? Is that really fair for single people, married couples who cannot have children or…. gay couples? Just asking.

      • Al says:

        Uwe, I agree with you on subsidizing maternity care for women to provide for absolute needs, but the subsidy should not go so far as to promote the activity that requires a subsidy.

  87. Ramesh Chandra says:

    Now that we agree on Sandra Fluke case, let us move on to maternity.
    Complications in maternity are covered in all regular policies Cesarean can be choice or due to choice. These are the type of things that when applied as coverage for everybody with no limits increase the general costs.For the same treatments maternity can cost %900 to $25000 and mostly can be negotiated for $3k. Keep in mind this is not the critical illness portion of maternity. The federal exchanges temporary unlimited coverage for critical ill people is a good experiment. It showed why insurance can not cover these and keep premiums controlled. Even then the Fed could not do it.
    We can find solutions, but it requires thoughtful analysis, not jumping to Amateurish plans.

  88. Ramesh Chandra says:

    Uwe,
    The answer is no.
    Your definition of insurance is correct.

    Maternity is a choice. It is also an expense of the family not individual.

    Desperate situations have solutions.
    If anybody wants to open this topic, I will be open for discussion.

  89. Bob Hertz says:

    Frank and Ramesh –

    I am somewhat baffled by your libertarian position that maternity should not be subsidized by other taxpayers.

    For over 150 years, America has subsidized public schools for all children, and people without children have paid taxes for education.

    The instinctive argument was that this is an investment in the future of the nation.

    Frankly, I have felt that maternity is in the same category.

    In terms of health care financing, I have always felt that if the general public can pay Medicare taxes to give heart operations to 85 year olds, we can certainly pay taxes to help 20 year old mothers.

    I do not have the exact numbers at hand, but I think that if the government paid $7500 for every childbirth
    the total outlay would be less than $40 billion a year. Medicare spends more than that every month, on people who have already had a full life.

    (Ramesh is correct that insuring complications is very tricky. I will comment on that separately.)

  90. Al says:

    Bob, whenever this type of analogy is used (education, police, fire, etc.) something very important is left out. All of these are handled on state or local levels, not the federal level. Local people are able to choose what is best for themselves and their families. I don’t know why one assumes disinterested folk in Washington can do a better job.

    Education is a partial exception to local control as the federal government gradually takes over more of the burden. I wouldn’t be so proud of those results especially since this is a well developed nation that pours ton’s of money into the system. I think education demonstrates the opposite of what you are trying to say and tells us the more federal involvement in state affairs the worse things become.

    • Big Al says:

      “Bob, whenever this type of analogy is used (education, police, fire, etc.) something very important is left out. All of these are handled on state or local levels, not the federal level. Local people are able to choose what is best for themselves and their families. I don’t know why one assumes disinterested folk in Washington can do a better job.”

      Al, what you leave out is that education, police, fire, food stamps, Medicaid, etc. are all handled at the local level … with Federal funds and Federal criteria. It is a saprophytic relationship.
      Get on board.

      • Al says:

        Big Al,

        Board more carefully so you don’t hit your head. Police and fire are paid almost entirely locally except for the Stimulus package. Some places don’t even pay for firemen and use voluntary fire departments. Education has increasingly been encroached upon by the feds and our education system is not something to be proud of considering how developed we are and how much money we spend.

        Medicaid and food stamps are federal programs. Check out the Oregon Study and let me know how confident you are that the health care provided by Medicaid today is providing value for our dollar. Take a look at the number of people on food stamps. Take a look at what that money is spent on. I love people that buy expensive non nutritious snack foods on my dime while mayors are trying to limit the size of cokes to those that pay out of their own pockets. Put on your glasses and then reread my comment for it is obvious you didn’t read it carefully the first time.

        • Big Al says:

          At least you didn’t pull the Romney blunder saying that the Fed doesn’t pay for police, fire or education at all. http://www.washingtonpost.com/blogs/fact-checker/post/romneys-claim-that-the-federal-government-doesnt-pay-for-teachers-firefighters-police/2012/06/15/gJQAACgxeV_blog.html

          Your original insinuation was that local services are best left locally. I agree, the Feds agree … but one cannot disagree that the Feds have, and do, fund alot of local service. To the tune of $370 billion since 1980 … plus all the ‘evil’ Stimulus funds greedily sucked up by both liberal and conservative states. I reiterate, state services use alot of Federal funds, in turn the Feds certain criteria on the funds. You wouldn’t want Barry throwing your money away would you?

          Food Stamps (SNAP) is a Federal program but run by State and local agencies.

          Medicaid is administered by the States but mostly funded by the Feds.

          Bottom line, local, State, and Federal monies and efforts are involved in most social programs. Hanging your hat on ‘local knows best’ is a bit out of touch.

          • Al says:

            You should stick to Twitter, but I do note a correct thought “Stimulus funds greedily sucked up by both liberal and conservative states.”. I agree and there should have been no Stimulus and probably no TARP at least the way it was managed and doled out.

            “Hanging your hat on ‘local knows best’ is a bit out of touch.”

            If you would read a bit more carefully and not Twitterize what everyone says you will note that I have said that things should be handled as close to the people as possible. This doesn’t say the federal government cannot be involved only that the default should not be the federal government.

            I don’t want to debate other programs since healthcare is the list topic and more specifically the blog above. But, have you not noticed how poorly administered many of these programs are? You sound as if you believe a person working in Washington has superior knowledge. Remember he comes from a place just like you and me and he can be a dope in Washington or locally. The difference is locally he has to face the people of the community and generally he will know a bit more about their needs. Would you want a person who never left south Florida to suddenly manage a federal national snow removal program?

  91. Frank Timmins says:

    @ Bob Hertz

    Regarding your comment on maternity benefits, I don’t see the public education system as a good analogy, although it is a subject worthy of a separate discussion.

    Insofar as the maternity issue, as I said it is water under the bridge (unless we want to discuss particular benefits that are candidates for “elimination” as the inevitable future costs of the ACA will mandate).

    But philosophically I don’t understand why we should pay taxes to “help 20 year old mothers” (nor 40 year old mothers for that matter). What does a heart operation for an 85 year old have to do with a “voluntary” event such as a pregnancy? This would be more analagous with a decision to have “elective” cosmetic surgery, and I don’t see anyone (even the socialized medicine promoters) advocating for that.

    Moreover, the scary part of your comment is the inference that it is up to you, me or any bureaucrat to determine when someone has “had a full life”. The implications of that type of discussion in the context of healthcare is disturbing.

  92. Ramesh Chandra says:

    Let us be clear:
    1. Medicare is a trust for people who contributed to the system. It was mismanaged because the trust is controlled by the executive branch, not allowed to run as a separate trust.
    2. One wasted charity doesn’t provide justification to another wasteful charity. Some here seem to like to make my children as society’s children. That is how u r justifying maternity coverage. This is one place where a customer can save a lot of money , if they have 2 spend from out of pocket or HSA. Why can’t u c the wasteful spending that is created by bureaucracy?
    4. Medicaid is supposedly 2 provide for the destitute. This is where safety-net principle get misused.
    5. The efficiency of a system depends on how well the functions and requirements are segregated and solutions r worked out independently, and then – then only u is what conflicts r there. You have to be able to apply the mathematical principle of completeness and necessity tests to each piece.
    6. By separating safety-net needs from rest of the economy, we can find the best solutions.
    7. The simplest way of taxation is just a consumption tax with varying percentages for what is consumed. These taxes can collected by the States and managed by the states. There should be consumption tax on internet sales. I can’t imagine that internet gateways cannot be programmed for sending the tax to the right state.
    6. Fed govt. was given a huge amount of resources. Its budget should be based on min needs and maximum ROR(rate of return) on its assets. States can contribute in a fair formula, if exvcess is needed.

    It is not that difficult to take a black box approach.
    None of what i said encroaches in anybody’s rights.

    I hope the board will discuss each of these items.

  93. s goldbarg says:

    @ Ramesh Chandra,

    If your children are US citizens, they are “society’s children” whether you like it or not. So are all the other children.

    When you are sitting helpless in your wheel chair in the nursing home, and the enormous orderly looms above you and says, “Mr. Chandra, it’s timer for your enema,” do you want that orderly to have had life experiences that made him and his mother feel valued and respected ? Do you want him to feel that he and his family and friends had a fair shake in life ? Or do you want him to feel embittered that his mother and he were called parasites, and that they barely scraped by?

    The question is about the children who take over this world, and in whose mercy you and Mr. Goodman shall be. Before you make judgements about what is fair today, because you will likey be around tomorrow, too. So please, thinkof your future and consider your hemorrhoids.

  94. s goldbarg says:

    Obamacare is way too expensive, and I also think the SCOTUS is wrong about the constitutionality.And we still find uninsured people, so it isn’t doing what Congress set out to do.

    40% of the cost of health care is the insurance company bureaucracy.

    Institute single payor or Public Option and these costs will shrink dramatically.

  95. Frank Timmins says:

    @ s goldbarg

    With all due respect your “orderly” scenario is a horribly lame argument for collectivizing our society. Your concerns about the future generation would be better received if concentrated on the trillions of dollars of debt that we are presenting them (the ACA being one the major contributors).

    In fact, it is important that you understand that the “judgements” that Goodman and Chandra are making today are specifically made with the future generations in mind. It is not us older codgers that will suffer the most under this catastrophe of personal freedom and economic stability. It is those who follow us that will suffer the consequences.

    By the way, if you think the cost of the insurance company bureacracy is out of order, what kind of waste do you think we will have with a government bureacracy?

  96. Big Al says:

    @ Goldbarg
    The ACA is as far toward single payer that the administration could go at this juncture. In time the U.S. will get there, so be patient.

    @ Frank Timms

    If you can substantiate, through official source, that the ACA will increase the debt instead of decrease it (as still asserted by the CBO) please give me the information … else stop posting that inaccurate rhetoric.

    The ACA was enacted for future generations and it will alleviate many health industry problems until universal health care and/or single payer can be implemented for everyone instead of just Medicare, Medicaid, Tri-care, VA, CHIP, etc. Put everyone in the same game.

    Can you explain how your ‘personal freedom’ has been ‘catastrophically’ affected by the ACA? Again, emotional and inaccurate rhetoric.

  97. Ramesh Chandra says:

    Oh Oh Goldberg,
    1. Society has no children. Children are in society. Neither U nor the society has ownership of the children. They r individual living being. Society is a not-natural person. Can’t have children.
    2. u r too arrogant 2 assume that i have no respect or sympathy for fellow citizens. That i don’t recognize inter-dependencies in society. You have every right to be generous to the other person, but not forcing things on others with no respect to their rights.
    3. We all have a fair shake in life. Some of us)most) have to work harder than others and smarter.
    4. U keep on diverting the subject from fundamentals. Talk about individual,local govt., state and federal govt. roles. Design a systems which do not get entangled in ur fantasies. Talk with ur experiences , not with wishy-washy poetry u create. I came from a city with half communists and half socialists and every one of them is an entrepreneur. They can fantasize a lot more than u can/ But when actually doing things , they know they have ro stand on their own legs.
    So focus on the minimum and inp roles each body gas to play, u will simplify life a lot and u will c things clearly.

  98. Bob Hertz says:

    Ramesh indicated that he did not want to pay more for a health policy that included maternity benefits.

    Up until now, the optional exclusion of maternity benefits has been the main reason for lower premiums for men in the individual market.

    (Group policies have had to include maternity, making them immediately more expensive. Maternity is by far the largest cause of hospitalization under age 50.)

    Insurance companies can easily lose money by offering maternity coverage. They can get a large claim in just nine months or less on a woman enrollee who was in perfect health when she bought the policy. (and who can drop the policy once the claim is paid)

    In group insurance, everyone pays higher premiums so that maternity can be covered and the insurer not go broke.

    The ACA is moving individual coverage toward group coverage in this respect, and premiums will follow.

    Group insurance is subsidized by the employer.
    In the ACA, the government will act in the role of the employer, paying most of the premium.

    Was this the best solution to the problems of the individual market for women of child bearing age?

    (the problem was that young people with individual policies often took on large debts after a childbirth.
    How often this happened, I do not know.)

    The ACA does have a pattern of using $50 billion solutions to solve a $3 billion problem. This might be another one.

    So once again, I empathize with the goals of the ACA, which makes me a leftist, but I do so with a calculator.

    Incidentally, I think that all the participants in this lively exchange have been guys. Maybe Linda Gorman had one post. All the rest of us might be missing something valuable.

  99. Ramesh Chandra says:

    The crux of the discussion, should solutions be looked at near the problem or God-ify to remote control. Can we first state our hypothesis correctly?

    You don’t work top down. U need 2 work bottom up.

    Then issues related to differences can be looked at.

    Soviet union failed trying to imitate US model.
    So is Euro having problems.
    Greeks need to come up with Greek solution, Not a German imposed one.

    Unions like marriage can work well, until each gets their space and each goes to the other after they try to solve their issues themselves.

    You cannot build communities by dumping everything in the center and top.
    Even India learned that.

    So answer me one thing:
    Do u want to go bottom to top, or top to bottom?