Obamacare

How Will ObamaCare Bureaucrats Learn to Say "No"?

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As Ed Morrissey of Hot Air points out, The New York Times is now getting around to talking about how ObamaCare will ration medical treatment. From the Times:

So figuring out how we can say no may be the single toughest and most important task facing the people who will be in charge of carrying out reform. "Being able to say no," Dr. Alan Garber of Stanford says, "is the heart of the issue."

Morrissey writes:

[Times writer] David Leonhardt goes on to praise ObamaCare as the start of saying "no" to people who want more health care.  That's an interesting tack for the Times to take, especially after its screeching over the use of "death panels" by critics, which meant exactly the same thing.  Now they admit that the "most important task" of the people running the ObamaCare reform is to deny people medical care — under circumstances where a group of elites decide it's not worth it.

Once again, we have people looking at this from the notion of a shortage, crisis market.  If we want to solve the problem of overutilization, which is what ObamaCare purports to do, we're going about it in exactly the wrong manner.  We need to restore pricing signals in order to make consumers aware of the consequences of their decisions, not shield those costs even further by having taxpayers subsidize even more of those costs.  That would require getting insurance out of the way of normal, routine medical care and using it only for catastrophic issues, and providing tax-free shelters for medical-care funds controlled by individual consumers.

Instead, we're slowly turning the entire medical system into an HMO, only this time with Congress and the executive branch running it.

Read the whole thing here.

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  1. That would require getting insurance out of the way of normal, routine medical care and using it only for catastrophic issues, and providing tax-free shelters for medical-care funds controlled by individual consumers.

    THIS * 10^42

    1. hmmm… isn’t that what a HDHP and a HSA accomplish?

      1. Yes and no. They’re kind of the worst of all possible worlds as long as the bulk of others’ expected and elective costs are being paid for indirectly via insurance. I did the calculations when I was offered a choice between a traditional PPO and a high-deductable plan by my last employer, and the former worked out far, far better for me, because the prescription drug copays set a low cap on my expected costs. Needless to say these drugs are 100% elective. I won’t die from seasonal allergies and mild psoriasis, but the insurer doesn’t distinguish, which of course contributes to higher costs for truly unexpected and emergency care.

        1. Are your allergy and psoriasis drugs prescription?

          If you take OTC allergy drugs, the HSA works out better, as you get to buy them pre-tax instead of post-tax, but yeah, if you are taking a bunch of elective prescription drugs, the other may work out better.

          Of course, under Obama-care, HSAs can no longer be used to buy OTC drugs.

          1. Yup, they’re prescription. The two drugs in question work much better than anything else I’ve found over the counter.

            I didn’t know that you can’t buy OTC drugs via HSAs under Obamacare. I guess I’m still “finding out what’s in it”. No wonder PhRMA loves this shit.

            1. The ruling that you could get OTC drugs under FSAs (and HSAs) was actually made by a Bush Administration officer. You see, the law was vague about it. The new law “clarifies it.”

              To be totally accurate, I believe you can still get insulin and anything that’s OTC but you have a doctor’s note for it. Remember, the whole thing is predicated on the idea that you’re too stupid to make decisions yourself.

        2. I did the calculations when I was offered a choice between a traditional PPO and a high-deductable plan by my last employer, and the former worked out far, far better for me, because the prescription drug copays set a low cap on my expected costs.

          In your case I’m sure you’re right, comparing the high deductible plan alone and not considering premiums. However, in my case my company does two things:

          1) The high-deductible plan includes a HRA (like an HSA but company funded, rolls over unlike a FSA)
          2) The company really passes along the premium savings.

          For us, it’s a situation where in order to get a deductible $800 lower people pay $1000 more in premiums.

          1. If I recall correctly, there was a HRA component, but even that wasn’t enough to tip the scales, since outside of an occasional dose of Advil I don’t spend all that much in over the counter costs. The premiums were slightly lower, but my contribution to the PPO was ridiculously low in the first place (something like $70 every month) thanks to generous employer subsidy.

            Of course we could return that situation to normalcy by killing the employer tax credit for insurance premium subsidies, but try getting *that* passed.

            1. An HRA isn’t just for over the counter costs. (And the Administration is making it harder for OTC use anyway.) You submit your expenses as a claim under many of them.

              What’s nice in our case is that the HRA is administered as part of the insurance plan, so there’s no separate submitting the claim or paperwork. When your normal insurance claim gets processed, the insurance company takes money out of the HRA if any is in there. So you apply it to the deductible. The point is that if you don’t apply it all in one year, you bank it and can use it next year, or forever after that.

              1. “The point is that if you don’t apply it all in one year, you bank it and can use it next year, or forever after that.”

                I thought that the HRA went *poof* if you ever leave your employer. A little cursory Googling seems to confirm this too. Of course this just cuts to the stupidity of the employer-funded health insurance system.

                1. I thought that the HRA went *poof* if you ever leave your employer. A little cursory Googling seems to confirm this too.

                  Yes, that’s the sucky part about the HRA. An HSA is better for that reason, as long as it’s integrated with the insurance so you don’t have to file additional claims and paperwork.

                  Both are still better than FSAs.

                  In my case, I’ve been working somewhere for four years, and have had low spending years and high spending years. The HRA has worked out really well for me.

        3. Brian, you DO realize that you are a walking advertisement for adverse selection – the very market failure that makes private health insurance epically and catastrophically fail?

        4. It was the opposite for me (High deductible vs PPO). The PPO could only be less expensive if my family only visited the doctor 4 times in a year, but we completely met our high deductible. In this case, premiums plus copays would be less. In all other cases, we would be cash to the good, with a potential $3k upside if nobody gets sick. Of course, with 2 small children there is zero chance of coming in at less than 10 visits to the doctor…

      2. But preventative care is essential is making sure Americans continue to spend more on health care!

    2. I’ve been ranting about how we need LESS insurance and not MORE insurance since this whole stupid “debate” started. It’s good to see that I’m not the only one. Maybe the idea will start to get some traction now.

      The cost of insuring for unexpected and emergency care will continue to rise so long as expected and elective costs are paid for indirectly through insurance. That no-one on Team Blue seems to get this simple point isn’t surprising, but I haven’t been hopeful about Team Red. Maybe, just maybe, they’ll have it figured out by the time they take back Congress.

      1. My rants on it get blank stares outside of H&R.

        1. Really? Mine get snarls and disapproving looks.

      2. They made tiny changes to encourage HSAs as part of Medicare Part D. Could have done more, of course, but first-dollar coverage is really, really popular.

        Devil’s in the details, of course– the idea of Medicare Part D isn’t entirely stupid, as it’s pretty dumb for Medicare to cover expensive surgery but not less expensive drugs that can be alternatives. It should have been able to pay for itself, though.

        1. Of course first dollar coverage is popular. Most people suck at anticipating their own expenses. The security blanket is worth a lot to them.

          I don’t think HSAs are a particularly good idea in general. Do I get a food savings account? No, I just buy food when I’m hungry or I think I’m going to be hungry in the near future. I don’t get what policy objective is being served with the tax advantage. The only thing I can see being plausible to encourage via tax policy is carrying a level of insurance that can adequately cover emergencies and unexpected diagnoses, in order to reduce the bankruptcy rate.

          1. The point of the HSAs was to level the playing field with the tax advantages of low deductible plans. High deductible plan + HSA has no more tax distortion than a low deductible plan, but people are more efficient about their first dollar spent since money saved can be used in future years. (FSAs are much worse with the “use it or lose it” idiocy.)

            1. Yes, but why have a tax advantage for either low deductible plans or HSAs? I’d rather get rid of the distortion entirely.

              1. Because getting rid of the distortion entirely is really, really unpopular.

                Look at Obama’s promises. Heck, look at what happened to McCain, proposing to replace the deduction with a much less distortionary tax credit that was for all insurance. I think it was the only thing Obama ran ads about in Virginia.

                There were people commenting here who didn’t realize that, e.g., a $5000 tax credit was better than a $15000 deduction for most.

              2. If you want to get rid of the distortion, a universal HSA plan is a possible transition. Abolishing it entirely is political suicide.

          2. What is your factual basis for labeling HSA’s not a particularly good idea? Care to elaborate?

            The data, and basic common sense, show that HSA’s are a great free market way to allow people to self insure and lower costs – while maintaining freedom and choice. Try googling Indiana’s experience with HSA’s. As long as health care costs are tax deductible (for some but not all due to our discriminatory screwed up tax code), HSA’s make great sense.

            By the way, food is not identical to health care. The food market is far freer than health care and is therefore far more consumer friendly with more competition, greater convenience, more choice and lower costs. But food savings accounts or insurance are unecessary since, unlike health care, there are no catastrophic food events.

      3. John Goodman (the creator of HSAs, not the actor) has been saying this for a while. His blog is excellent, BTW.

        1. Wow, it really is. Thanks for the pointer. Great grist for policy wonkery.

  2. That would require getting insurance out of the way of normal, routine medical care and using it only for catastrophic issues, and providing tax-free shelters for medical-care funds controlled by individual consumers.

    Shhhh! Don’t you know that opponents of ObamaCare have no ideas?

    Instead, we’re slowly turning the entire medical system into an HMO, only this time with Congress and the executive branch running it.

    And we all remember how well their (HMOs) attempts to control costs were received.

    Get ready for waiting lines for knee and hip replacements.

    1. Don’t you know that opponents of ObamaCare have no ideas?

      Well, we already knew that slightly strengthening HSAs counted as doing “absolutely nothing” on health care.

  3. Dang, I think I’ll have to move Hit and Run from my “Libertarian Blogs” bookmarks folder to the “Neocon” folder.

    /JRB

    1. Or, you could learn to read.

    2. WTF? Opposing the Obamacare plan makes you neocon?

      1. “Neocon” seems to have lost much of its original meaningless meaning.

        1. It wasnt originally meaningless, if you go by “Trotskyite followers of Strauss and Kristol [sr]”.

          1. The original meaning was also something like:

            “Former members of the Left converted to the Right out of practical considerations, like empirical studies suggesting that big government didn’t work. At their best, brought intellectual rigor of a numerical sort to an American Right dominated by arguments based on philosophical intuition (whether conservative or libertarian).”

            1. Or what I said.

      2. This guy Jay froths at the mouth every time Reason links to Instapundit. I bet this time it’s a link to Hot Air.

        1. Hot Air – founded by someone who actually wrote a book called “In Defense of Internment: The Case for Racial Profiling in World War II and the War on Terror”

          Despicable

          /Jay

          1. Purity! Sweet ideological purity! Let not this site be stain by the tained links of the heathen unbelievers! Shun them! shun! I say!

            1. It’s not about being pure – it’s about not linking to crypto-fascists.

              /Jay

  4. That’s an interesting tack for the Times to take, especially after its screeching over the use of “death panels” by critics, which meant exactly the same thing.”

    Humans are always looking for new ways to believe two opposing facts at the same time.

    1. But, see, “Death Panels” was an unfair slur and aren’t actually in the bill, because, ummmm, the actual words, “death panels” aren’t actually, ummmm, in the bill.

      Silly knuckle draggers, you are no match for our journalistic sophistry.

  5. David Leonhardt goes on to praise ObamaCare as the start of saying “no” to people who want more health care.

    It is fun to watch the paroxysms writers at the NYT go through when a Doctor has the temerity to say no when a woman demands an abortion. Surely there are cheaper ways to prevent carrying a pregnancy to term.

  6. But don’t you darn libertopians understand? Having medical care denied by the government is compassionate and good! You’ll be making a patriotic sacrifice for the glorious collective!

    1. I think you’re stealing from me.

      Your owner is more likely to just point out that people who disagree with the blue team are all poopy heads and hypocrites. Smug moral grandstanding is my boat.

  7. I find it absolutely stunning how supporters of “health care reform” don’t actually give a shit if it delivers what they said it delivers; all they cared about was that it got passed. So basically, it was another motherfucking god damned TEAM RED TEAM BLUE fight.

    Fuck all of you eternally in the ass. I’m going to punch the next one of you who even speaks to me.

    1. After you punch em, can I kick em while they are down?

      1. Hell, you can work them over with a blackjack. In fact, please do.

        1. I find it absolutely stunning

          Really?

          1. I find it stunning the extent to which they actually don’t give a shit. I guess I shouldn’t be surprised, but I know some actually good-hearted (but still pie-in-the-sky dumb) liberals who do think people will be better off.

            What I failed to account for is how much the true partisans don’t give a shit; they’re at war against the other side and all that matters is victories over them. And again, I knew that, having observed partisan scum like joe, but even I have failed to credit these people with the true depths of mendacity that they will sink to.

            1. I guess I shouldn’t be surprised

              Your carefully built-up cynicism cred is hanging in the balance.

              1. I’m not really worried.

                1. Tomorrow is another day, and two minutes from now is another thread…all to be ground up and digested and obliterated in the great black blogholesphere.

            2. Didn’t you know? It’s vitally important today that the uninsured get access to medical care in 2014.

            3. but I know some actually good-hearted (but still pie-in-the-sky dumb) liberals who do think people will be better off.

              I have been told more than once that if I “actually knew someone who was going to be helped” by Obamacare, my opinion would be different.

              In other words, my principles are meaningless when the looters’ intent is just so goddamn noble.

        2. just so you guys know…I agree with you today. I just speak up more when there are differences.

    2. Exactly. It’s all about beating the other side.

      1. Which in America’s political environment is the most rational, pragmatic stance you can take.

        My first inclination is to not let the theocratic warmongering plutocrats gain control. Actual good policy from the semi-sane side is gravy.

        1. Tony, what do you think of Caprica? I find it to be well done, but I just can’t get into it.

          1. I watched the season out of loyalty to BSG. It’s kinda slow and shallower than I expected. I found it interesting, but I don’t really get the point yet. I also have a longstanding hatred of prequels. But I am definitely interested in seeing where it goes.

            1. You used to watch The Gilmore Girls, didn’t you.

              1. No I don’t know anything about that program other than I’ve heard the name.

                1. Suuuuuure.

              2. Not Tony but I for reasons beyond Alexis Bledel and Lauren Graham being hot used to watch that show.

                It made me laugh and was “pleasant”, for lack of a better term.

                1. I’m hoping that Mrs. Graystone, despite her spectacular abilty to work those skin-tight dresses, is really dead. Fuck! her character was fingernails-on-the-chalkboard annoying to the nth degree.

                  1. I’ve heard that a lot, but I found her character to be one of the most interesting, at least potentially. Her loyalty to her husband in conflict with the horrors he may be perpetrating is good dramatic stuff.

            2. Don’t spoil Caprica for me, I’m waiting for DVD.

              1. Missed it, by that much.

            3. Your nerd cred is deep enough for libertarianism. We hope to someday convert you.

        2. “My first inclination is to not let the theocratic warmongering plutocrats gain control. Actual good policy from the semi-sane side is gravy.”

          I give you credit. I’d have already killed myself had I ever gotten to the stage of delusion you’re in. Stronger than I, you are.

          1. I’m not delusional, I’m cynical. Delusion is believing that you can escape the two-party system by hoping.

          2. Tony, you’re not cynical. You’re naively trusting of anyone with a (D) after their name, and anything announced by or associated with the State.

            1. It would be convenient for you if that were true.

        3. “Which in America’s political environment is the most rational, pragmatic stance you can take.”

          Of course it is! Our politicians have worked hard to come up with this fantastic system of economic gerrymandering. No matter who you are, you can be sure what team you’re supposed to be rooting for, because that team is working for your advantage and the disadvantage of somebody else.

          1. Not really. One team is working to nobody’s advantage except their own, and the other team still has a modicum of statesmanship left in it.

            It is not more intellectually sound to create a false equivalence because you think that makes you above it all.

            1. “Not really. One team is working to nobody’s advantage except their own, and the other team still has a modicum of statesmanship left in it.”

              I can assume that you don’t know what it’s like to actually be one of the productive members of society, because if you are one it’s pretty obvious that Team Blue has got it in for you more so than the other guys.

              1. I love that phrase “productive member of society.” I am certain you’re referring less to people who actually work for a living doing and making things and more to people who have merely made money for themselves.

                1. Yeah, I use a printing press to make money for myself. How do you make yours?

                  Of course I’m making money by doing and making things, dipshit. I don’t get the money unless someone pays me for what I’m doing.

                  1. Betting on derivatives isn’t exactly the most productive activity I can think of. Turns out it was monumentally destructive. But it was a good way to make lots of money.

                    There are few things more abhorrent to me than the idea that just because you have lots of money that means you’re more productive than someone who doesn’t. A janitor at a school works harder and does more good than a lot of CEOs.

                    1. “Betting on derivatives isn’t exactly the most productive activity I can think of. Turns out it was monumentally destructive. But it was a good way to make lots of money.”

                      Yeah, and look who the banks and investment firms put into office. Or are you deluded enough to believe that if they wanted McCain as president, we’d still have Obama in the White House? Here’s a hint: they used to call Biden the “Senator from MBNA” for a reason. Biden is to Obama as Cheney was to Bush.

                      Point being that the people who got rich off financial fuckery went Team Blue this time. They know what side their bread is buttered on.

                      “There are few things more abhorrent to me than the idea that just because you have lots of money that means you’re more productive than someone who doesn’t.”

                      It’s pretty easy to be productive of things nobody wants. Your responsibility is to be productive of things other people do want if you’re able to, so that you don’t have to be a burden on others.

                      “A janitor at a school works harder and does more good than a lot of CEOs.”

                      {{citation needed}}

                    2. CEOs make people barf. Janitors clean it up.

                    3. Tony|4.7.10 @ 5:28PM|#
                      “…A janitor at a school works harder and does more good than a lot of CEOs.”

                      Cite, please.

            2. Hey, Tony made a post that I can agree with the text wholeheartedly. I disagree with what he meant, of course.

              1. Tony, I don’t really see how either D’s or R’s are more on Wall Street’s side.

                The R’s definitely are mroe favorable to people who are actually “doing and making” things considering they favor (a) less taxes, and (b) less regulation.

                You see, people who earn their living by actually producing shit are the ones MOST TARGETED by the Democrats high-taxing, micromanaging ways.

                The people who benefit most from the Democrat’s policies are useless parasites.

                1. Hazel I’m not interested in your opinion of who makes up the undesirables in your fascist world.

                  It’s just adding immoral, cruel insult to stupid fascist injury to call the least fortunate, least free, most laboring people the parasites and the plutocrats who engineer the economy in their favor the productive.

                  1. Yeah, people who start their own businesses are “plutocrats who engineer the economy”. People who live on welfare are the “most laboring people” in the economy.

                    Fuck you Tony. You are the facist.

                    1. At least I don’t believe absurd crap like poor people are privileged and rich people are oppressed. Isn’t this utter bullshit just a little stale by now?

                    2. What makes you think that people that start their own businesses are “rich”?

                      Look, the reason I support freer markets is because it *allows* people to escape from poverty and become rich. You don’t get there by being dependent on the state. And an economy controlled by the government is one that favors people who are more politically connected. Who are often propbably wealthier, but that’s not relevant. The point is that it’s fundamentally unjust and unfair for the government to be handing out favors to some people at the expense of others.

                      A clear set of simple minimal rules that everyone can understand is the most just system, even if it results in unequal outcomes. Even if people start from unequal starting points.
                      As soon as the state starts handing out handicapps and favors, the handicaps and favors will be unequally distributed.

                      All the regulations and taxation supported by the Democrats have the effect of making it difficult to impossible for an individual to escape from poverty through any mechanism other than gaming some government system and getting a tax loopshole or an earmark. Do you want people getting out of poverty by doing something genuinely productive in the market? Or d you want them doing it by being a token black board member who greases the right politicians hands so they can get a minority-preference government contract?

      2. Sheesh, give us a break!
        Budget restraints dictate that we can do only one thing at a time.

        Elect Obama? Check.
        Gloat for a year? Yup.
        Pass ObamaCare? Affirmative.
        Get all cynical and shit? Working on that one.

  8. The New York Times plan for sweet, sweet health care savings:

    – Convince Americans they’re still getting good care when they’re not
    – No more dangerous CT scans
    – No more useless Cesarean sections
    – Stop treating prostate cancer
    – Cardiac stents and bypasses are a waste of time and money. Cardiologists will be reassigned to office jobs.
    – Incomplete or unavailable data will be reinterpreted as evidence of treatment ineffectiveness
    – Expect patients to turn down care themselves with no incentive to do so
    – Skip prenatal tests for minor ailments such as Down’s Syndrome
    – Telling patients they’re close to death and should leave the ICU sooner rather than later
    – Pay doctors less
    – Hope and pray

    1. extra mandantory vaccinations

  9. Rationing, huh? As Sarah Palin might say, you betcha.

  10. Of course, as more and more people forego various kinds of care, bad outcomes will increase.

    Its a fucking trial lawyer’s dream. What a coincidence.

    1. Wait’ll you see the Dems’ plan for Universal Legal Insurance.

    2. Except you can’t sue the government

  11. Sometimes Grandma is just going to get the pills.

    1. A gramme is better than a damn.

  12. 1. Liberals fundamentally believe that it’s more fair for the state to deny everyone a particular class of medical care than for the ability to get that medical care to be subject to the individual’s ability to pay.

    Better death panels for all than having some people get treatment and some people not get treatment based on ability to pay.

    1. Well, not death panels for connected government employees, of course.

      What’s astounding is that liberals somehow think that they won’t be subject to denials. Somehow. I just don’t understand how you can be that stupid, but man, they manage it.

      1. That is very easy Epi. I wish I could release records of how many CMH (Medicare/Caid) pre-auth refusals I get.

        Not to mention the mountain of paperwork.

        I’m outta CMH in less than 90 days.

        It’s gonna be hard, but I believe worth it.

        1. What year do we get the suicide booths?

          1. We don’t. That much autonomy is anathema to the success of HCR.

    2. Except nobody is talking about limiting people’s access to all the care they can pay for.

      Capitalism isn’t going away because we have minimum universal standards.

      1. Except nobody is talking about limiting people’s access to all the care they can pay for.

        Nobody is too strong. Some people actually do point to Canada as a model.

        And this plan actually does make it illegal to get care that people prefer, if people prefer a catastrophic plan.

        Also, we already limit people’s access to all the care they can pay for, by, e.g., banning paying for bone marrow.

        1. Well not letting you get less coverage than the minimum is not quite the same thing as not letting you get more care than you need, is it?

          I haven’t thought enough about this idea about a market for organs, but at first blush it sounds like a horrifically classist idea to me.

          1. Well not letting you get less coverage than the minimum is not quite the same thing as not letting you get more care than you need, is it?

            Is not letting you get less religion than the minimum is not quite the same thing as not letting you more religion than you need? Or education? Or athletic training? Or citizenship training in mandatory service? Or are just your ideas of moral needs the ones that it never hurts people to impose?

            I haven’t thought enough about this idea about a market for organs, but at first blush it sounds like a horrifically classist idea to me.

            Even if the money paid to the people who donate organs is paid for out of the government? (Which would make sense in the case of kidneys, since all dialysis is paid for free, since dialysis is rare enough for that to be affordable. The government could pay kidney donors a lot and still come out ahead.) Even if donating the organ doesn’t cause health problems?

            Assuming that you know better than poor people whether they should take money or not sounds like a horrifically classist idea to me.

          2. Tony, bone marrow isn’t an organ. But it is the sweeping regulatory stupidity you seem to be in favor of that treats it as if it were.

        2. not to mention this drives costs up artificially so it prices a lot of people out of the market that would not have been otherwise, unless you get a subsidy from the government

      2. “Except nobody is talking about limiting people’s access to all the care they can pay for.”

        Haha, yeah, if you’re a fucking billionare. The rest of us will just increase our consumption until we’re no longer being penalized for not consuming enough (thanks to the ban on denying coverage due to pre-existing conditions), then we’ll all scratch our heads and wonder why everything costs so damn much.

      3. Sure they are, Tony.

        All future insurance plans have to be approved by the High Commissar of Health Insurance Czardom or whatever title they give whatever asshole bureaucrat is in charge of the exchange.

        The exchange system empowers officials to approve or deny plans based on the coverage they offer.

        Since the system will be PAYING FOR the coverage of lower-income Americans via a system of subsidies, it will be necessary to set benefit limits on the plans.

        Not to mention the fact that any plan that offers more than the minimum will immediately be destroyed by the ability of exchange participants to pay for cheaper plans while they’re healthy and then jump into the more extensive plan when they’re sick.

        There are a number of cleverly-designed new bureaucratic powers in the system now to force all system participants to “level down” the care they provide.

        If all of the above don’t work, in Massachusetts they just demonstrated the next step: freezing the premiums of private plans. Once they start freezing the premiums of private plans, what do you think will happen to the most extensive plans, Tony?

        1. I can’t say what will happen in the future, and I don’t like the Obamacare plan at all. For all I know you could be right.

          But I do know that anybody with means will be able to purchase whatever care they want, just as they always have been.

          1. I don’t really know what type of health care plan you’re for. I do know that healthcare inequality is just as bad or worse in the UK as before they had the NHS.

            1. Even if I assume your NCPA source is accurate about that, I still wholeheartedly agree with the sentiment that “the essence of a satisfactory health service is that rich and poor are treated alike, that poverty is not a disability and wealth is not advantaged.”

              1. Tony|4.7.10 @ 5:39PM|#
                “Even if I assume your NCPA source is accurate about that, I still wholeheartedly agree with the sentiment that “the essence of a satisfactory health service is that rich and poor are treated alike, that poverty is not a disability and wealth is not advantaged.”

                ^ The statement of a true economic ignoramus.

                1. I don’t give a shit if your precious economic equations fulfill your arbitrary OCD purity requirements. Healthcare is a right in the modern civilized world. Would that the US joined it.

                  1. Would that you fell down about fifty flights of stairs.

          2. Maybe. But you realize that the system will become two-tiered in that case … low-quality care for medicare/medicaid/insurance patients, and high-quality care for out-of-pocket patients. Right?

          3. Tony|4.7.10 @ 4:49PM|#
            “But I do know that anybody with means will be able to purchase whatever care they want, just as they always have been.”

            I’d guess you’re right. It will take either a huge amount of money in the US or airfare to which ever country decides to be ‘the source’, but the market doesn’t go away. It just gets distorted by government activity.
            The probable result is worse care for the poor, a large proportion of the more prosperous population gaming the system and driving up tax costs, and the wealthy buying what they want.
            The market is constant; the costs are distorted by the government.

            1. I’m not sure out-of-pocket care will get that much more expensive.

              What’s likely to happen is that the government will cap reimbursment rates for medicare/medicaid petients, and set similar limits on what doctors can charge the regulated insurance companies on the exchanges.

              As a result some doctors will start turning those patients down. That will create waiting lists for patients with the regulated insurance or on medicare/medicaid. People with the money to afford it will then jump the list by paying out of pocket instead.

            2. This constant market is a total abstraction. There has never been and never will be a market not influenced by government. You wouldn’t want one either, because it means children sex slaves are fair game. Oh no! Government is fucking with the market by forbidding child slavery. And there’s such a large demand! It’s corrupt! Must wash hands… must flip light switch 5 times… I get my boxer shorts at K-Mart in Cincinnati.

              Government should distort the market because the market isn’t delivering universal healthcare, which in almost every instance it occurs in countries on this planet is more efficient than what we have. The market should serve the people, not the other way around.

              1. (sniff sniff) Tony, call the FD, your strawmen are burning. Or is that smoked red herring?

                1. I’m not invoking a straw man. I truly believe Ron L thinks government should intervene to prevent child sex slavery regardless of how it distorts the market.

              2. How would we know whether the market can deliver health care to all? We’ve had a 50/50 government/private health care system for decades now. That makes it pretty hard for you to prove that the private part is causing all the problems, and hard for me to prove the government part is causing all the problems.

                1. And … what would the best plan be in a situation where nobody can prove their ideas for reform will work? Let some folks try a system with more government involvement and others try a system with less government. But that would mean letting others have a choice about how to run their own lives — can’t have that now.

                  1. There’s already been plenty of experimentation with national health plans. Of all the systems that have been tried ours is the most free market and also one of the worst.

                    1. The market should serve the people, not the other way around.

                      Seeing as how market prices are a reflection of real consumer demand, the market does serve people. And it does so best when left alone.

                      Attempting to manipulate it inevitably make the market serve not people, but the state.

                    2. Dude, until the recent passage of the health care bill, 50% of all health care dollars were spent by the government. (Now, it will be more.) You lose all pretense of intellectual legitimacy when you, with a straight face, point to it as an example of a free-market system.

      4. Anyone who advocates a single payer system most definitely is talking about limiting people’s access to all they can pay for. It’s in the definition of such a system, and the number of people who support such a system are greater than zero and in important positions.

    3. One of my Facebook friends actually said that in his perfect socialist world, rich people would be prohibited from getting better medical care.

      1. I’ve had political science professors tell me life was better in the medieval period than now because the gap between the peasant and lord was smaller than the gap between Donald Trump and a poor person today.

        1. Times were even better when those progressive Mongols showed up and redistributed all the gold and women!

      2. One of my Facebook friends…

        You can stop right there.

    4. And your point is …?

    5. Liberals fundamentally believe that it’s more fair for the state to deny everyone a particular class of medical care than for the ability to get that medical care to be subject to the individual’s ability to pay.

      It takes a lot of liquor to get them to the point where they readily admit it, but I agree with you. This is EXACTLY what most of the silent supporters of this shit believe and why they think the current system is so horrible. Yes, they’re worried that the quality of their care is likely going to decline, but at least it’s going to be fair and that’s the most important thing in life, after all.

      They’ll also use the word “community” a lot, too, when explaining it to you. I’ve learned to just ignore that.

    6. May be true of some liberals.

      Most liberals I know simply think if we just had the right people in charge (i.e. not Republicans) then everybody could have top-notch health care and those best-and-brightest people will uncover all kind of efficiencies of scale that make it possible to pay for it all. It’s a stretch to call it a belief, though; it’s simply an echoing of superficially-held opinion among all the people they socialize with.

  13. I think it’s perfectly reasonable for their to be limits to healthcare paid for with other people’s money. Shit setup the death panels I say.

    (of course people should be free to spend as much as they want of their own resources).

    1. Can I set the limit at $0?

      1. I wouldn’t be opposed to that, lol

  14. “So figuring out how we can say no may be the single toughest and most important task facing the people who will be in charge of carrying out reform.”

    There’s no reason to reinvent the wheel here–Medicare already denies coverage more often than any HMO ever would.

    It’s called “Medical Necessity”, and it’s been around for decades. It’s been interpreted to mean whatever government bureaucrats decide is “reasonable and necessary” given certain guidelines.

    http://www.ssa.gov/OP_Home/ssact/title18/1862.htm

    The Committee deciding that certain tests, procedures and medications are no longer “medically necessary” is precisely what critics of ObamaCare were talking about when they were talking about rationing, and why anyone in the healthcare industry would feign surprise at this or pretend its something we haven’t dealt with before is beyond me.

    It’s been a standard part of Medicare reimbursement procedure for decades…

    There’s no new news here.

    1. But…but…everyone’s COVERED!

      See above post to Episiarch.

    2. But how can the government deny people free medical care? It’s a fundamental human right.

      1. You’re rights are whatever a committee of bureaucrats say they are. …and it’s been that way for decades.

        See, in the end, you were gonna end up on Medicare anyway. It’s always been that way, it’s just for a lot of people, they think of 65 as being a long way away. And then once you’re stuck on it, you start wondering why everybody else shouldn’t have to suffer like you.

        But it’s been this way for decades. The worst thing about ObamaCare isn’t that it’s invented anything new–it’s that it’s trapped us all in the same boat as the poor and the elderly. …who most of us, outside the healthcare business, never see out of the warehouse.

        It’s really a shame–a national disgrace, actually–how badly we treat our elderly and sick. …but now we’re all gonna get that treatment. It’s a shame…

        …when Grandma gets rejected for a hip replacement when a wheelchair will do. When I get rejected for treatment, it’s a tragedy.

        It’ll happen to all of us eventually. …unless we’re killed in some horrendous accident. We will be refused treatment–or never offered it in the first place. The way things are now, there’s no way around it.

  15. Obama wants to give people all the health care they want, but Bush gave all the medicine to the oil companies!

  16. That’s an interesting tack for the Times to take, especially after its screeching over the use of “death panels” by critics, which meant exactly the same thing.

    Brilliant. And I hope people will take every opportunity to remind the Times about this.

    1. Oh, the Times and other media elements has gone further in its campaign against intemperate metaphors. Apparently “targeting” Congressional seats is now completely scaring, at least when said by Palin.

      I don’t particularly like her, and I can think of a dozen more qualified candidates off the top of my head, but I don’t understand the negative reaction to her either.

  17. Doom
    DOOM
    DOOM

  18. This can’t be true. Reason’s Cathy Young and Cato Institute expert Michael Tanner assured us that the death panel charge is unfounded.

  19. I prefer the name “push-pin” thank you.

  20. I got to thinking about the thread a few days ago about people ‘gaming the system’ in Massachusetts- and the group of us that responded that if healthcare is a ‘right’ you can’t ‘game the system’. Receiving healthcare is a right. FULL. FUCKING. STOP. Therefore those that recieved healthcare could not be ‘gaming the system’. It brought me to start thinking of something.

    Once we declare healthcare a right, but yet strangely a right with limits on how much the system will invest to insure you’re able to maintain that right (yeah, get your head around that logic behind progressive thought) someone has to make the decision as to what, when, and how much healthcare (right) you’ll receive.

    At some point there’s going to be a case of an older person with a condition which is, say, terminal without a major and expensive procedure. How do we decide he gets that procedure? Well, I’m guessing that some kind of panel will be formed. And on that panel will be the predictable blend of lawyers, doctors, healthcare economists and the ever-scary “bioethicists”. Let’s say this procedure is very expensive– say $100,000. And this man is very old, 87 years old. Without it, the man dies. But with it, he only has a 34% chance of surviving, and even if he does, it’ll likely only extend his life 5 to 7 years. If this panel decides the man doesn’t get the procedure, what moniker might we reasonably place on this panel?

    1. It all depends on who actually came up with the idea for this panel, you see.

    2. Well, there’s deciding whether they can save his life. So, obviously, a “life panel”.

    3. I dunno… Is the guy a voting member of the AARP? Does he live Florida or Ohio?

  21. “Now they admit that the “most important task” of the people running the ObamaCare reform is to deny people medical care ? under circumstances where a group of elites decide it’s not worth it.”

    How can the left possibly square rationing as the primary method to hold down costs with their rationale for Obamacare that heathcare should be a positive right?

    It cannot. If you ration, then there is no enforcable positive “right” to be treated. Furthermore, those progressives whose ultimate goal is a single payer system, do not believe that access to health care is negative right either, because there would be no legal way around the rationing board as that would mean more than one payer. The left’s basic slogan for health care reform on their terms is a lie.

    What does the Left actually believe in? Equality and the rule of the intellectual elite. The masses will be treated the same, wealth by itself will not get you better treatment. Wealth that buys you political pull will. The Left is uncomfortable with the idea that the chaos of prices and the market is a moral and equitable way to allocate scarce healthcare resources. Having such decisions made by supposedly impartial philosopher king experts is to them a more rational and moral way.

  22. Wow, who could have seen this coming.

    Well, I suggest the people charged with figuring out how to say no take their cue from Ezekiel Emanuel, MD. His system is based on worth to the community. As a group, old people are the most worthless, of course, and will be those to whom “no” is said most often (and people wonder why the Tea Party movement is so full of senior citizens). The next most worthless group are infants and very young children (children still in the womb have zero value). As you get older and more educated, your value to the community increases and those in their prime working/earning years are of the highest value.

    Now, I don’t what arrangements will be made for the subsets within the groups. Will college professors, for instance, be accorded more value than, say, janitors? How about the homemaker who’s in the high value demographic but is past her child-bearing years and is emptying her nest? Surely she can’t be worth much anymore. I can see the no sayers have their work cut out for them.

    Who would have thought a few years ago that we’d actually be discussing shit like this in America. Seems to me the “right” to health care isn’t as inalienable as they would have us believe.

  23. I say ‘no’ to every single fetus that works at the NYT.

    The only medical procedure they are allowed are abortions.

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