House Passes Health Care Reform

http://www.latimes.com/features/health/la-na-healthcare-passage22-2010mar22,0,2788293.story

by Xichekolas • 16 years ago

152 263 16 years ago

kgrin• 16 years ago

For all of the talk about the impact of higher cap gains taxes on startups, the far more important impact is likely to be that potential founders will have a (slightly) easier time leaving their jobs and purchasing insurance on a less-broken individual market.

mmastrac3• 16 years ago

Plus it'll be easier for us to poach employees with families from big companies. I couldn't imagine what it would take to get someone with a preexisting condition at a startup.

Vivtek• 16 years ago

You couldn't. I mean, speaking as the father of a child with kidney disease - forget it. Impossible. That freedom, the freedom to start a company even if your children are sick, is granted only to the very rich in this country.

Until - I hope - now. It remains to be seen how much hash was made of the bill during the sausage-making process.

cperciva3• 16 years ago

I couldn't imagine what it would take to get someone with a preexisting condition at a startup.

It's easy: Just open an office in Canada.

For what it's worth, "pre-existing medical condition" is the #1 reason why Tarsnap is not a YC company.

gte910h2• 16 years ago

The day pre-existing conditions don't matter is the day the us explodes with small businesses.

waterlesscloud5• 16 years ago

There's a difference between "covered" and "doesn't matter". What I'm not sure about is what, if any, the price difference in premiums will be. Just because they're required to cover you doesn't mean they have to do it cheaply.

I do know adults with preexisting conditions will be in some sort of special "temporary pool", whatever that might mean. No clue on the cost.

jacoblyles6• 16 years ago

As a counterpoint, countries that already have this are far behind the US in small business creation. Despite this supposed handicap, the United States has the most dynamic large economy in the world. It turns out that the government soaking up a large portion of the GDP to pay for expensive public benefits diverts capital away from financing private ventures, and this has a detrimental effect on entrepreneurship.

If universal health care were really that important to entrepreneurship, why isn't Silicon Valley in Europe?

seldo2• 16 years ago

Depending on your definition of "don't matter", that day is today:

http://www.csmonitor.com/USA/Politics/2010/0320/Health-care-...

When Obama signs the bill, anybody with a pre-existing condition will be able to a (temporary) national insurance plan for those with high-risk conditions. In 2014, it will become illegal for insurance companies to deny coverage for pre-existing conditions, and that plan will end.

ubernostrum3• 16 years ago

According to the CBS summary of the bill as passed by the House (http://www.cbsnews.com/8301-503544_162-20000846-503544.html), the ability to deny coverage for pre-existing conditions will be phased out, and such denials will be banned starting in 2014.

MartinCron7• 16 years ago

It's not just founders, it's a big deal with startup staffing in general. I took an effective pay cut when I went to work for a startup because they weren't big enough to buy health insurance in bulk the way my previous employer could.

My CEO wrote about this last year: http://www.benhuh.com/2009/08/01/the-killer-fear-of-guarante...

grandalf13• 16 years ago

Why does it matter whether your pay cut was in the form of a perk or salary?

Clearly if your startup employer chose to offer you cash instead of a healthcare plan, it did so because it thought you'd value the cash + flexibility more than you'd value the plan.

It's simple for any small business to sign up for a group plan for employees... and it's not the cost that is the issue, it's the perceived value of the service.

ubernostrum3• 16 years ago

Indeed. One of the smartest things in the bill -- and yet one which has received little to no fanfare -- is the mandate for insurance exchanges.

In case you haven't followed that, the idea is basically to match up people who are looking for private insurance with companies offering policies, but to build in the ability to lump the customers together into ad-hoc risk pools. For the insurer this is the same as taking on, say, a medium-sized company with X employees, which means the terms offered can be far better than traditional individual policies.

vishaldpatel• 16 years ago

I wonder if this can then be bundled up into a security :P (pretty evil, I know..)

jcnnghm3• 16 years ago

So won't that result in somebody that's healthy, like me, having to pay more so somebody that doesn't take care of themselves can afford health care.

anamax7• 16 years ago

> For all of the talk about the impact of higher cap gains taxes on startups

It's not startups. It's single people making more than $200k or married couples making over $250k.

The latter affects more people than the former.

SlyShy• 16 years ago

I sometimes wonder if these stories belong here, due to the incendiary properties and tangential relationship to start-ups. Not that I don't think Hacker News could handle the discussion more or less maturely.

curtis2• 16 years ago

If any such story ever belongs on HN, I think you can make a case that this story is it.

dryicerx• 16 years ago

A startup/small-business related point on the bill is "A tax credit becomes available for some small businesses to help provide coverage for workers."

Just trying to make the top story in HN at least a tiny bit relevant to HN...

tptacek3• 16 years ago

From my casual read, that's for businesses where the average wage is pretty close to the minimum wage.

blogimus• 16 years ago

Average wages need to be $50,000 or less:

From WSJ: http://online.wsj.com/article/SB2000142405274870453490457513...

Tax credits for businesses: Businesses with fewer than 25 employees and average wages of less than $50,000 could qualify for a tax credit of up to 35 percent of the cost of their premiums.

jrockway4• 16 years ago

Like he said, relevant to startups.

jpwagner5• 16 years ago

It's very relevant to HN. Sorry there's no code snippets in it for you...

ericd5• 16 years ago

The post is relevant, but only because this will affect startups. Most of the discussion here isn't relevant to HN - the discussion should be trying to fit this into the context of how the bill affects startups/small businesses.

eserorg• 16 years ago

Pre-Market U.S. Stock Futures: http://money.cnn.com/data/premarket/

jrockway4• 16 years ago

Of course. Money that goes to ensuring your employees don't die is money that won't go to the investors as dividends, which means the stock goes down.

In the long run, a healthier workforce should increase productivity, and then stocks will go up.

rue• 16 years ago

You say that as if most stock market transactions have anything to do with the actual company and not just the stock itself.

jerf2• 16 years ago

It will be interesting to see how the markets react to this.

My personal theory, which I haven't seen anyone else state, is that the reason we heard from the bond raters last week about how the US might lose its AAA status is an oblique threat to so downgrade our rating if this bill passes. Even if we merely apply the conservative "three times more than the government says it will cost" we're stacking on another staggering amount of debt and entitlement on an economy that can't take it. (Given our current entitlement loadout even if our economy were to start rebounding tomorrow at record pace we're still in deep trouble in the not-so-distant future... and that's before we handed out yet more entitlements.) I'm not ready to "predict" it, but I wouldn't be surprised we lose it in the near future, as in, single-digit weeks.

They'll be right, too. An entity deep in debt whose only priority is to pile it on even deeper is an entity that is not going to be cleaning up its finances anytime soon. We'll have earned it.

dennisgorelik• 16 years ago

I wish they (President and Congress) closed Iraq's financial black hole first and only then entered new spending spree. That's what Obama promised during his presidential campaign. Sigh.

ewjordan• 16 years ago

"It will be interesting to see how the markets react to this."

The markets reacted to this long ago, which is why we're not seeing much of a reaction to it now (the market is now up by about the amount it was down when the parent posted that link) - nobody had any real doubt as to whether this would ultimately pass or not, the only question was exactly what provisions would be taken out or put in to ensure that it did.

No comment on our debt problems, however - I'd tend to agree that eventually someone needs to pay the piper, though I think single-digit weeks might be underestimating it.

luigi• 16 years ago

Another way this bill affects readers of HN: Parents can keep children up to 26 years old on their health insurance. Previously, the age limit was determined by individual insurance companies or individual states.

ronnier2• 16 years ago

I'd be ashamed to be in my 20's and be on my parents insurance plan.

Xichekolas10• 16 years ago

So you'd be ashamed to be in grad school? (Or doing a startup right out of college?)

Often the insurance offered by a parent's plan blows away what can be had through the University. Of course, you can buy individual insurance fairly cheaply... unless you aren't in perfect health, or are a girl.

AngryParsley• 16 years ago

That feeling of shame is better than having no insurance or having to pay lots of money for private insurance.

spamizbad• 16 years ago

Speak for yourself. Where was this bill 5 years ago when i was 22: I broke my clavicle when some asshole did a hit-and-run and ended up dumping my entire savings (~$9K) into medical costs.

I would have loved to have my parent's insurance pick up the tab on that one.

jpwagner5• 16 years ago

Ugh, Ronnier, I fully agree with you, but you stated this in the wrong way given that the system has developed the way it has.

It is a bit shameful to be dependent on one's parents at 26, but because of employer based-benefits and the fact that is it NOT shameful to not yet be locked into a profession at 26 means that family insurance plans are a necessary reality.

The real question is why the system had never evolved to allow affordable family plans rather than employer based benefits. I have some thoughts, but that will make this an even more heated discussion.

RK• 16 years ago

For much of my mid 20's I had no health insurance. That was shameful.

grizzydot• 16 years ago

Hmm...I got kicked off my parent's health insurance after graduation, but I'm still under 26. Would this bill allow me to get back on my parent's insurance or is strictly for children still on their parent's insurance?

hzlz2• 16 years ago

[I posted this on the other thread, which seems to have been deleted as a dupe. Sorry if it's against protocol to re-post. But I tried to find both sides, good-and-bad wrt startups.]

Some discussion of the impact on startups in the thread at http://news.ycombinator.com/item?id=1208019

While it didn't discuss all of these, it seems to me that the things that will directly impact startuppers:

Pros

- Community rating, no recision, etc will make it easier for people with pre-existing conditions to get coverage. For people who have pre-existing conditions (or who have kids who have pre-existing conditions) and don't have a spouse at a bigco and want to do startups, it makes it possible.

- Might also make it easier for bootstrappers to get coverage.

Cons:

- The new taxes are concentrated on capital gains, so will tax startups and angel investors most of all. [This bill proposes a 3.8% increase on cap gains. The administration is also planning to change the regular cap gains from 15 to 20%, so if everything passes the rate will go from 15% to 23.8%, or a 58.6% increase.]

- Shifts costs from the older to the younger, so most startups here will pay more.

- In realistic scenarios, will probably increase the deficit, affecting interest rates. But that's long-termand not clear.

Pro or con, depending on what you think:

- Mandatory coverage will require that you have coverage during a bootstrapping phase.

A mix of good and bad for startups, depending on where you are in the process.

jbarciauskas• 16 years ago

I've heard this a number of times but not heard it detailed: in what way are the CBO estimates unrealistic? What more realistic assumptions would you make, and what is their effect on the deficit?

Also how is it shifting costs from the older to the younger? It seems more that it is shifting costs from the near-bankrupt uninsured to those who make significant portions of their income from capital gains, i.e. the wealthy.

hzlz2• 16 years ago

I don't want to get into politics on either side, and there are several factors:

- The first is the "doc fix". Basically, there's a 21% automatic cut in the payments to doctors in Medicare. That would lower the payouts to the point where doctors would often lose money seeing a patient, and doctors would stop seeing Medicare patents. Like with the AMT, each year congress approves a temporary fix. It is likely that, while under CBO rules the score assumes there won't be more temporary fixes, there actually will be.

- There are several areas where the bill promises unspecified future cuts. The CBO numbers takes them at their word. Consensus is that these cuts won't actually happen.

- ~$53B comes from the fact that Social Security will take in more money because more companies will pay people wages so they can buy health care on their own instead of the company paying for it. However, it doesn't count the fact that SS will have to pay out correspondingly more.

- The CBO looks at a 10-year horizon. Most of the costs are scheduled not to start immediately, but to ramp way up later.

There are a bunch of other 'hacks' in the CBO scoring to keep the cost near the promised $900bn. Both sides do it, but they discovered a bunch of new tricks this time around. It means that, going forward, CBO numbers on large bills (from both sides!) are probably worse-than-meaningless.

On the older-to-younger q, it's mostly about how community-rating is implemented.

curtis2• 16 years ago

I can't imagine any shifting of costs from older to younger can be that big of a deal since we are already on the hook for everyone 65 and older, thanks to Medicare.

jerf2• 16 years ago

"in what way are the CBO estimates unrealistic? What more realistic assumptions would you make, and what is their effect on the deficit?"

The CBO is bound to look at the next ten years of effects. In order to make it look even remotely palatable, the bill collects four years of revenues before a significant amount of the benefits kick in. It is difficult to imagine a reason for this that doesn't involve gaming the CBO's estimates. (It's not as if our government is all like, "Oh, gosh, we really need to save up some money before we hand this entitlement out." It wouldn't matter anyhow because that wouldn't significantly affect the long term viability of this plan; what matters is steady-state income vs. spending.) Multiplying the estimated cost by 10/6 is a decent start to get a true view of the costs.

The CBO itself has also called attention to the fact that the scoring of this bill assumes that the so-called "doc fix", in which the payouts given to Medicare doctors will be cut in accordance with the law back to a certain rate unless a bill is passed to prevent this cut. This bill is passed every year, and there is no reason to believe this Congress will not pass that bill either (and quite substantial reason to believe it will). You can look around for how big that is, but it's pretty big.

This bill shifts yet more burden directly onto the States as unfunded mandates, which are not scored as Federal burden (for instance, "Find" the second instance of "mandate" in http://www.wdef.com/news/reaction_to_healthcare_reform_passa... ). Nevertheless, not only will we have to pay them, we will have to pay them in a context where we can't even borrow our way out of it as States ability to borrow is constrained compared to the Feds. I live in Michigan.... WTF is Michigan going to do with another few billion in mandates?

The CBO has its scope very tightly defined by law, and it's been getting increasingly gamed over the years. This completes the gaming. They might as well disband the office, IMHO, Congress has figured out how to bypass them.

Costs are shifted onto younger people by the mandate for people to purchase insurance or pay a penalty. Many of today's uninsured are young, healthy, and uninsured by choice. You may disagree with that choice, but that's beside the point. The point is that they are not paying into the system. Not all younger people are affected by this due to some other provisions (nothing says government at work like taxing with one hand and crediting with the other), but quite a few are. Coryrc linked this, I'm "borrowing" it: http://www.newsweek.com/id/224020

Incidentally, I give this provision a very high chance of being struck down on Constitutional grounds, but that of course leaves the entire rest of the bill in place. The CBO estimate can't assume that will happen, but if it does the already-screwy revenue numbers just get screwier.

Please carefully read the statements I am making here and note their factual content. I will not deny I think this bill is an enormous, enormous mistake, but it is not my opinion that taxes are collected for four years before benefits are paid out, it is not my opinion that the bill contains unfunded mandates on States, it is not my opinion that younger people will have to buy insurance or pay penalties (the reason why is arguably my opinion but extremely-well founded). It is my opinion the CBO might as well disband. It isn't my opinion that the insurance mandate is facing a constitutional challenge, though of course who will win that is currently a matter of opinion. To the best of my knowledge, these aren't "talking points", these are simply part of the bill as it stands.

mediaman3• 16 years ago

To add to the others' responses, the following New York Times article goes into some detail to the CBO estimates and why the author believes their figures are unrealistic, mostly not due to any bias at the CBO but due to strictness of their mandate.

http://www.nytimes.com/2010/03/21/opinion/21holtz-eakin.html...

patrickgzill2• 16 years ago

I think the Amish will suddenly start gaining a lot of new, adult members.

This bill is an abomination.

marshallp2• 16 years ago

Your thinking on this matter are an abomination

Locke1689• 16 years ago

As an explanation of why you're being downvoted, neither of you are contributing anything to this discussion -- keep flame wars out of HN, ok?

grandalf13• 16 years ago

One thing that bothers me about taxes is that they are around 20-30% of profits. If you take on a business partner and give him/her 20%, you expect something in return.

What do we get for our taxes? Wars and social programs that will be bankrupt long before we can benefit from them. (roads, etc., are < 1%).

I would be OK with paying the taxes for social programs if I thought those programs would be sustainable into my old age, but they aren't and nobody seems to care, even though this is widely known.

So when you write the IRS a big check, you are paying for old people, and when you are old you will not receive the same treatment.

By the way, most of the cost of healthcare is in areas where the money has very little yield, such as end of life care for the elderly, bypass operations, stents, and statins. If people actually had the opportunity to consider the value of healthcare, reform would be nothing like what it is now.

Next time you see an old person eating bacon and eggs in a restaurant, picture that person's bypass operation, years of statins, and excessive end of life care that you are paying for... and think to yourself how perverse "reform" is.

Meanwhile, there are millions of so-called "illegal immigrants" who can't even call the police if they are assaulted or abused (for fear of deportation) being left out of the reform.

Most of your income taxes go to wars and medicare, and most of the healthcare reform goes to the practitioners who practice useless surgeries and interventions on a vulnerable population of elderly.

The "reform" bills don't change anything, they just transfer even more of the wealth of young people to the elderly and their exploiters.

jeremymcanally2• 16 years ago

The idea behind a big piece of the reform is to reward doctors who push preventative care over pills, surgeries, and continued treatment. Therefore (ideally) we will see less and less of these preventable surgeries since doctors and hospitals are striving to reduce their preventable and recurring care for patients (i.e., they get cash if they reduce it).

gojomo2• 16 years ago

Can you provide a reference for this "cash benefits for doctors who reduce long-term costs" portion of the bill?

patrickgzill2• 16 years ago

My one-sentence view of what is going to happen in America is that "repudiation is coming" - on multiple levels, people, organizations, maybe even states will say "sorry, we can't fulfill obligation X any longer, we are done paying" .

patio11• 16 years ago

Or, less extreme, changing the terms of the promise after the promise is made. Very few pension funds are so comprehensively mismanaged that they will not be able to pay any pensions, but very few are so competently managed that they will be able to pay all promised pensions, so look for them to do things like means testing to get out of their obligations. ("You spent the last forty years saving money by yourself!? Pfft, what do you need a pension for. Amscray, we've got people who actually need the money to look out for.")

This is inevitable for social security, and I'm thinking the gold-plated public pensions (and many private ones) will follow suit.

adolph• 16 years ago

Case in point: "But even if the decision does leave some Arizona children without health-care coverage, Orient said, there is no alternative in the state's current financial situation. 'At a certain point, it doesn't matter how good you think a program is,' she said. 'If you can't pay for it, what are you going to do?'"

http://www.azcentral.com/arizonarepublic/news/articles/2010/...

coryrc• 16 years ago

And for anyone who doesn't believe you, here's Newsweek's take on increasing the burden on the young:

http://www.newsweek.com/id/224020

jacoblyles6• 16 years ago

My favorite proposed solution is "defined contribution instead of defined benefit", which would address most of the incentive problems and inequities you mention.

In Washington, they call it "privatizing" and run you out of town.

kurtosis• 16 years ago

I find myself very sympathetic to your view - especially the part about not wanting to pay for wars. I have also frequently heard people claim that entitlement programs to support the elderly are "unsustainable" - but I honestly don't understand what this means. Do you mean that the costs of providing for our elders would grow without bound? Also, if you know of a nice explanation that presents the evidence that entitlement programs like social security are doomed I would be very grateful if you could provide some links. I would really like to know.

Xichekolas10• 16 years ago

The entitlement unsustainability is entirely a problem of demographics. People are living longer and having fewer children, so the ratio of young working people (who pay) to old retired people (who benefit) is diminishing.

The classic answers are to either increase FICA taxes or cut benefit levels... which seems idiotic, when the obvious solution (to me) is to just raise the eligibility age. Part of the problem is that people are living longer, and are mostly healthy and able to work longer, so raise the retirement age.

MartinCron7• 16 years ago

I like driving too, but don't focus too narrowly on roads. I think you're getting benefit from more than < 1% of taxation. Public education helps everyone. Research helps everyone. Having a criminal justice system helps everyone (well, the non-violent drug offenders would disagree). Having a strong civil legal system helps everyone. Meat inspectors help everyone. Financial regulators help everyone.

You could even say that knowing that we don't have senior citizens starving and dying in the streets as helping everyone. I like knowing that I live in a society that takes care of many of the less fortunate.

I'm not saying that government is good at solving every problem, but focusing on just roads, wars, and old people is very narrow.

startuprules2• 16 years ago

I would dare to say that our government sucks at solving any problem. A few examples:

U.S. Teens Trail Peers Around World on Math-Science Test http://www.washingtonpost.com/wp-dyn/content/article/2007/12...

U.S. prison population dwarfs that of other nations http://www.nytimes.com/2008/04/23/world/americas/23iht-23pri...

Lehman Cooked The Books Prior To Collapse; Geithner And NY Fed Implicated http://thelibertyguardian.com/2010/03/lehman-cooked-the-book...

Let's face it; our government is setup to help the big corporations.

muhfuhkuh2• 16 years ago

I always have and always will take umbrage with how people downplay the government's role in ameliorating the lives of people.

Case in point, can anyone really deny that the overwhelming majority of the cures and vaccines for deadly afflictions that have plagued the US (and the planet, for that matter) have been developed in a university or non-profit lab under the funding, technology transfer, and/or support of governments (in the US case, the NIH)? Polio (Salk), TB vaccine (Calmette), the list goes on. Hell, even Norman Borlaug helped eradicate famine in several parts of the 3rd world under the encouragement (and part-funding) of the Roosevelt administration.

You're right that it's not just about socialized interstates and bunker bombs. It's truly about doing those things that just _cannot_ fit on any sane balance sheet trading on Wall Street (or if they tried, investors would truly revolt).

grandalf13• 16 years ago

As you'll notice in my comment I was not arguing against a social safety net. I was arguing against "paygo" social programs that will not be sustainable in the face of demographic change. I was not arguing against the criminal justice system either. And as you point out, nonviolent drug offender enforcement is a huge burden on society for a variety of reasons.

Not only do I not want senior citizens starving and dying in the streets, I want to be sure that a senior citizen 50 years from now won't starve or die in the streets.

Consider what congress has done to social security benefits over the past few decades. Right now the social security retirement age is OLDER than the average lifespan of African American men. Why are you defending this approach?

People work hard for years and plan for retirement only to have the social security retirement age increased. If a private firm did this the CEO would end up in jail. Why are you defending this racket?

If you're going to take by force 12.5% of someone's lifetime earnings (all most middle class people can afford to put away for retirement), you'd damn well better live up to the promise you made to him about what he'll get and when.

You seem to think that taxes == good social programs. On the contrary, the current budget is full of unsustainable things that only exist to give a handout to one special interest group or another... everyone knows they aren't sustainable and that they exploit those paying in now, but there is a collective action problem (which, incidentally, you are helping to perpetuate).

I've paid lots of money into social security... where has it gone? To fund the war in Iraq. Where will it be when I retire? By that time Soscial Security will probably have been cancelled or merged into the general budget or turned into a welfare program. I really don't understand why you would defend a regressive tax that allows congress to avoid having to be accountable for what it spends.

Daniel_Newby2• 16 years ago

"Next time you see an old person eating bacon and eggs in a restaurant, picture that person's bypass operation, years of statins, and excessive end of life care that you are paying for..."

Cardiovascular disease is mostly caused by carbohydrate consumption and inactivity. The Feds subsidize these, and health care "reform" will make the problem worse.

grandalf13• 16 years ago

Not to nitpick, but I think it's mostly caused by refined carbohydrate consumption, high fructose corn syrup, smoking, and obesity.

jamiequint• 16 years ago

"most of the healthcare reform goes to the practitioners who practice useless surgeries and interventions on a vulnerable population of elderly"

A lot of doctors don't want anything to do with medicare patients because they are often breakeven at best and in many cases a net loss. They are many times required to care for these patients in order to maintain hospital accreditation programs that allow them to look attractive to patients with insurance (where the hospital actually makes some profit).

It is good to pay attention to healthcare availability, but no sustainable solution can ignore the cost side. Excess litigation has played a significant role in the massive overinflation of healthcare costs. Flooding hospitals with patients with government insurance - likely to be net-negative income for hospitals - is going to destroy the healthcare system faster than it fixes it.

stretchwithme5• 16 years ago

I think you see things very clearly. Such is the quagmire of a declining democracy where most people are intent on shifting the costs of their decisions to everybody else.

abrown28• 16 years ago

well... 234 years was a good run.

marshallp2• 16 years ago

234 was a good run ... of not being a country civilized enough to look after it all it's sick

rajat2• 16 years ago

Why should the average 20-30+ year old even carry insurance? The penalty is only $250 a year, rising to $750 in a few years. They can't deny you insurance based on pre-exiting issues. So why not just pay the penalty, which can be substantially less than the policy, until you have an issue?

waterlesscloud5• 16 years ago

It's a very good question.

Of course, if the healthy behave that way, it drives up the premiums for everyone else.

chancho2• 16 years ago

$750/year is about the cost of so-called "catastrophic" insurance: high deductible, low monthly. Worthless for the kind of chronic ailments that old people suffer, invaluable for things like car accidents or leukemia. Only an idiot would rather pay the fine than buy this kind of insurance.

waterlesscloud5• 16 years ago

My understanding is that this type of insurance is not an option under this law.

rajat2• 16 years ago

Catastrophic insurance, with a high deductible, is what I carry. They are going to be grandfathered, but no new policies of this kind will be allowed under this law. An all encompassing health insurance, with the kind of deductible they have legislated, is not cheap.

Daniel_Newby2• 16 years ago

"Why should the average 20-30+ year old even carry insurance?"

Because an accident or infection can run up $50k in costs before you can even put the paperwork through.

rsheridan67• 16 years ago

Can, but probably won't, and if it does, the average twenty-something doesn't have so many assets that it's a huge loss to declare bankruptcy.

Besides, twentysomethings all* think they're immortal and that nothing bad will happen to them anyway.

*And by all, I mean some.

defen• 16 years ago

So I opposed this bill, but now I have an honest question: Rationally speaking, shouldn't I cancel my health insurance? I'll pay the fine, which is way less than my current premiums, and I'll just wait until something goes wrong to buy insurance, since I can't be turned down.

blasdel2• 16 years ago

The ban on pre-existing condition screening doesn't kick in until ¿2014?

There's a temporary public option for the people who would otherwise still be fucked until then. I'm not sure if you'll be able to get that on short notice.

rsheridan67• 16 years ago

That's really not very far away. Few young healthy people are going to develop cancer or something nasty and expensive like that in the next three and a half years.

tdoggette3• 16 years ago

See rajat's thread, above.

utnick• 16 years ago

I don't think that would be a very good move.

If you have a serious health problem ( heart attack, stroke, accident ), you will not have time to fill out all of the paperwork and buy insurance because you will need help immediately.

Also insurance companies will probably have processing times of weeks when onboarding new customers, so you won't be able to just get the flu and then decide to have insurance that month.

aresant2• 16 years ago

I promise +1 Karma to the first person that puts together an infographic actually explaining where, exactly, $100 billion a year of tax payer money is going to go, and what we are going to get in exchange.

I am all for affordable healthcare for everybody, just desperately afraid of how the gov't typically overspends.

robryan3• 16 years ago

It seems worrying that the best solution to a more efficient and cost effective system they come up with involves spending a lot more money now.

Looking at American policies from an outside perspective, it seems the government is unwilling to be the one that will actually suggest that maybe the answer to many current budget problems is to spend less.

Adam5033• 16 years ago

No.

The best most cost effective solution to health care is single payer government operation of the health care system. It's a tried and proven over decades to cut the cost of health care all over the rest of the industrialized world.

For some ludicrous reason, the beloved-by the British UK model of health care is called "communism" if it's even mentioned here

When did Great Britain turn communist? I completely missed that event.

lallysingh• 16 years ago

Subsidies on premiums. In exchange, on top of the healthcare for everyone, we'll hopefully reduce current costs (for those who are covered by medicare) for last-minute emergency care by earlier diagnosis and treatment.

carterschonwald• 16 years ago

exactly, the models for the overall cost are based upon a long term savings of TRILLIONS of dollars in treatment costs by making preventative medicine be very very strongly encouraged. There are actually financial penalties in the form of ~2.5% tax on income for those who are not insured, and a 2.5k+ tax penalty per uninsured employee for businesses, and other things on top of that too.

stretchwithme5• 16 years ago

If you want to see how successful government health care will be, look at Medicare. Its a great example of how the true costs of things, low quality and large amount of fraud can be overlooked for decades.

The main objective is punishing those that wish to pay for their own care and retain control over it by shifting everyone else's costs to them.

Then once people give up fighting the current and get their care covered by the government, they lose control of what happens and accept lower quality because at least it is free.

Then whatever entity is providing care performs whatever possible procedure and drugs they can get away with, while starving the hell out of any preventive measure may make sense. The money spent follows the lobbying.

but don't worry, it will be years before you fall into this sink hole and your family come and visit you as you go down, so it won't be all bad

rms• 16 years ago

Nate Silver already did it for a slightly older version of the bill but I don't think anything of much substance has changed. http://www.fivethirtyeight.com/2009/12/why-progressives-are-...

anonjon3• 16 years ago

I think the idea that government naturally has to overspend is wrong. It is a meme that people tend to trot out whenever there is a political discussion (along with the other side is bums and politicians are unethical crooks).

In this particular case, the idea is that we pay $100 billion a year of tax payer money. (For comparison sake, the F-22 program alone cost 65 billion including development. You could only buy 500 F-22s for $100 billion)

With that 100 billion dollars, we attempt to bring into line the 2.3 trillion dollars that we spend a year on healthcare. (16% of GDP).

16% of GDP is way more than other western countries spend on healthcare. http://en.wikipedia.org/wiki/Health_care_compared#Cross-coun...

Other western countries spend about 8-10% GDP on healthcare.

So lets do the math. Lets say we spend tax money on healthcare and we only manage to get it down 1% from 16% to 15%. That would be a 1/16th reduction on 2.3 trillion dollars... approximately 140 billion dollars. So if we even manage to knock 1% off of the amount spent on healthcare by doing this, we've sent 40 billion dollars back to the taxpayers.

If we get more than 1% off of our %GDP towards healthcare, we start making some serious bucks for Americans. If we got our % spent on HC down to even 10% we would have made a 540 billion dollar win on this issue.

(Yes, it comes in the form of taxes, but it also means that in the long run you aren't paying as much for insurance premiums... health insurance premiums might as well be a tax that doesn't go to the government, as having healthcare isn't optional if you plan on living for a significant amount of time...)

richcollins2• 16 years ago

You are assuming that we would get the same value for the new amount spent.

iamelgringo• 16 years ago

"I am all for affordable healthcare for everybody, just desperately afraid of how the gov't typically overspends."

Medicare currently operates on a 3% margin. That is, 97% of funds in the medicare program go toward reimbursing patient care. The vast majority of private health insurers operate on a 20-30% margin. The rest of the money goes towards marketing, sales, and towards profit.

Like it or not, every body is shouldering the cost of uninsured patients. One in 6 Americans don't have health insurance, yet they still consume health care. Who pays for that? Everybody does. Hospitals are under a federal mandate to care for everyone regardless of ability to pay. So, to compensate for their losses on uninsured patients. They artificially inflate the rates they charge everyone else to compensate. So, every time you use the health care system, you are paying for uninsured people's care.

Hospitals that have a disproportionately large share of uninsured and minimally insured patients (e.g. a county hospital, non-profit hospitals in the ghetto, small rural hospitals in farming country) routinely need and receive government subsidies to function. Those hospitals are largely subsidized by special funding bills.

Universal coverage, just means that we are now going to be explicit in determining how we are going to pay for people's health care.

edit: added 3rd paragraph.

tbrooks3• 16 years ago

In order to bring down the cost of health care, the government would have to operate the system more efficiently than the market does. I can't think of anything the government operates more efficiently than the market does.

tdoggette3• 16 years ago

But the government's not running the system, contrary to what you may have heard from the people that got the GOP talking points memo. The bill keeps the private-insurer system in place.

tbrooks3• 16 years ago

So how will the government lower costs without sacrificing quality of care?

mediaman3• 16 years ago

I'm generally pro-private sector, but the stats on our health care insurance system are astounding. The OECD averages (which are primarily statist health care systems) about 8.9% of GDP spent on health care. The US averages 16%. US has fewer doctors per capita, lower physician visit frequency, lower life spans, and more uninsured.

I'll grant you that the private sector is more efficient than the government sector in the vast majority of cases. The health care insurance system is not one of them.

tbrooks3• 16 years ago

I would argue that government involvement in the private sector is why our system is broken. I don't mean for this to sound snarky, but what nation runs a better health care system than the US? The quality (for the cost) of medical care in the US is far better than any other nation.

Both Canada and Britain have gov't health programs. 25% of the people in Canada wait 6 months or more for surgery, in Britain that number is higher. In the US, only 5% wait that long. The waiting time for an MRI in Canada is 10 weeks.

miked• 16 years ago

According to the WHO, the US has the most responsive health care system in the world. It also has the highest cure rate for many types of cancer. Much of the high cost of our system is due to an out-of-control tort system, which this bill maintains. Trial lawyers are major campaign contributors to the Dems, and they get to keep all their goodies. So those costs are still going to be around. Also, the government allows doctors to control the number of physicians coming thru the med schools. This allows doctors to control their own supply and thereby keep their prices high. Nothing in the bill's 2700+ pages addresses this either.

aresant2• 16 years ago

An interesting aside - house dems tacked onto this bill an overhaul of student lending which eliminated $60b of private lending in exchange for a wholly gov't controlled program:

http://www.washingtonpost.com/wp-dyn/content/article/2010/03...

haupt2• 16 years ago

What's interesting to me is that the thing passed with absolutely no Republican support whatsoever.

This insane partisanship cannot last.

beilabs• 16 years ago

As an outsider (Irish) I find it interesting that this occurred. Usually at least one backbencher in Ireland would support the opposing view based on their own such morales. Was this down to pressure from their own party, their constituency or just pure spite to derail something that was not their own idea in the first place?

I'm not pro/against the issue; I have no stake in US healthcare.

haupt2• 16 years ago

Traditionally the Republicans are just contrary to anything the Democrats propose (as far back as I can remember). All of the Republicans I know personally are pro-lifers and this bill specifically addresses the use of government funds with respect to abortion.

So it's probably a bit from each category.

tokipin• 16 years ago

it was party, based on what they saw as a far-right "grassroots movement" called the Tea Party. they chose the strategy to completely go against democrats to try to deprive them of any victories, in order to keep the population angry ("congress can't do shit in the worst economy since the great depression") and use that anger to sling shot back into majority control

the funny thing is the Tea Party is partly artificial

it will be interesting to see how this plays out for the rest of the year, especially when people notice that massive balls of communist fire aren't raining down on the nation

waterlesscloud5• 16 years ago

There's also the possibility that they believe it's bad legislation. And the the democrats voted for it as a partisan measure.

Just throwing that out there.

I've never understood why it's only the opposition that can be partisan and not the majority.

InclinedPlane4• 16 years ago

It's more interesting that there's a 60% Democratic majority in both houses and yet this bill just barely passed with only 1 vote more than the minimum necessary.

jcnnghm3• 16 years ago

The Democrats could pass it alone. They didn't want to because they don't want to be accountable for this clusterfuck.

InclinedPlane4• 16 years ago

Missing in this thread so far is a discussion of whether or not this bill is even remotely constitutional.

Not only does it seemingly institute a poll tax, it stretches the "commerce clause" of the constitution beyond all reasonable limits, it violates the 10th amendment, and article 2 section 8.

But I suppose all of that will become irrelevant in our glorious new future where the life of every citizen of the US is dependent on the efficiency, fiscal discipline, and humane kindness of federal and state bureaucracies. Indeed, this is a future I think we all look forward to, as all of these glorious institutions have provided a hearteningly robust history exemplifying all of those qualities to the fullest. Haven't they?

jrockway4• 16 years ago

the life of every citizen of the US is dependent on the efficiency, fiscal discipline, and humane kindness of federal and state bureaucracies

How? Get some cash, find a doctor, and give him cash to fix you. Nothing is stopping you from doing that under the new system.

it violates the 10th amendment, and article 2 section 8

No, it doesn't. You can argue that the 10th amendment didn't go far enough, but that is orthogonal.

The new healthcare regulations are not unprecedented; consider agencies like the FAA and the FCC (shouldn't each state regulate their airspace and radio spectrum), FHA (shouldn't each state build their own expressway system?), etc. Basically, your argument makes about as much sense as "income tax is illegal", and regardless of how you feel, the constitutional law is not on your side.

Were you really making so much money on capital gains that this is going to affect you negatively in any way?

InclinedPlane4• 16 years ago

How? Get some cash, find a doctor, and give him cash to fix you. Nothing is stopping you from doing that under the new system.

I find it intriguing that your purported solution to the limitations of this legislation is the very antithesis of the program itself. This seems like a weakness in the reasoning behind the plan. Not to mention that the problem is more that the quality of care, at any price, will degrade and that we will all become less wealthy as our government takes more of our money and spends it ever less efficiently.

Also, each state does own, build, and operate their own expressway systems. How exactly do you imagine the FHWA operates? There is not some federal agency that builds interstates across the nation, ignoring state boundaries. Rather, the FHWA provides a set of standards, design advice, and substantial federal funding to local agencies which then make their own decisions on building their own roads. The US government doesn't own and didn't authorize or oversee the construction of, say, I-5 or I-95 they merely coordinated with local governments to do so. This is how a healthy cooperation across local and federal government works.

Anyone who doesn't recognize that this bill represents an unprecedented leap in the involvement of the federal government in every individual's business and livelihood is living in a fantasy world.

Were you really making so much money on capital gains that this is going to affect you negatively in any way?

This is a specious argument. They came for X, and I did nothing... Principles matter. Extorting taxes out of others to pay for your own healthcare may seem just fine and dandy an idea if no one you or I know would pay those taxes, but it's a bad idea on principle.

To adapt a common phrase, those who sacrifice liberty for universal healthcare deserve neither.

Zak2• 16 years ago

The Constitution actually provides for Federally funded and managed roads for the purpose of mail delivery.

jacoblyles6• 16 years ago

It's going to be interesting to see if the Supreme Court finds that the Constitution allows the Federal government to force people to buy health insurance. With a 4 liberal, 4 conservative, and 1 swing vote split, they could go either way.

One thing's for sure, this bill will be challenged.

btilly3• 16 years ago

The court is not all about politics.

The whole thing is about regulating a commercial transaction (buying health insurance) and taxes (aka fees). Both are areas that there is a lot of precedent saying that Congress is within its rights.

grandalf13• 16 years ago

We should all be wary of the mandate. The uninsured used to be victims, and soon they will be criminals.

andybak• 16 years ago

You've got some incredibly complex proposals being thrown into an incredibly complicated system (and by that I mean the entirety of the social, political and economic realm - not just health-care).

The law of unintended consequences is going to play out here massively. Not only is it an intractable problem to predict the outcome from our perspective but it will be near-impossible for historians in decades hence to look back and separate which of their present society's ills were caused by this bill or by the million other factors that occurred in the intervening years.

DanielBMarkham• 16 years ago

I have been biting my tongue on other venues regarding this bill, which is a good sign it's probably not a good idea to discuss here.

Having said that, I'll put on my business hat and begin adapting. What's this mean for my startup?

1) Those of you who say the country is waiting for affordable insurance until startups take off are smoking crack. It's a great benefit, sure, but young folks don't need health insurance and startups are lucky to keep the lights on, much less pay fines to have everybody insured. The process of getting new employees may greatly be enhanced, but we need a thousand pre-employee startups for every one looking for employees, so that's where to look for impact, not with insurance. Not sure there is any impact at all for dirt-poor young startups. It should be interesting how the income requirements work -- can you get 15K in investments and keep that for operating? Or does that make you rich enough to start having to pay fines? Having said all of that (which you might hate), it's a great thing to keep your insurance.

2) Those of you saying that it's the end of Western free civilization are completely overstating the case as well. It's going to add 16 thousand new IRS agents, sure, and there will undoubtedly be new regulatory burdens associated with hiring employees and growing. The key metric to watch here is public debt. We're in a debt explosion and, to some, this just pours gasoline on the fire. If that assumption is true, and I believe it is, then watching the national debt rating could be an early indicator that different business configurations might be better than locating and operating in the states. (That doesn't mean you can't start out here, just once in growth mode getting the hell out of Dodge might be worth it) If the country is going broke, sooner or later somebody is going to come looking for any profits you might be making. I'm not saying it is or it isn't. I'm saying that it looks like a legit concern to me -- you can do the math.

3) Medical and insurance discussions will now become political ones. In other words, somebody has to say "no" in order for any kind of health service plan to work without going broke. It used to be those people were the insurance companies. It was a lot of fun hating the insurance companies. Now that we're regulating the insurance companies like utilities, however, that person is going to be some bureaucrat somewhere. Your best access to him, if you have an employee with a complaint or are looking for some kind of change, is probably through your Congressman, giving your local Congressional weasel even more power than he currently has. This means all startups, from dollar one, need to have some face time with their Congressperson if at all possible. Increasingly he/she is the guy who influences more and more details of operating -- bandwidth availability, insurance standards (now), investment criteria, etc.

I hope that sounded reasonably neutral. I certainly didn't feel angry while writing it. While the immediate impacts are very low, over time I think this is a major change in the country's direction. Small business guys need to pay attention.

House Passes Health Care Reform

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