(10-09-2013 05:27 PM)Owl 69/70/75 Wrote:  

(10-09-2013 05:23 PM)OptimisticOwl Wrote:  

(10-09-2013 02:34 PM)Owl 69/70/75 Wrote:  I think a better approach for republicans would have been simply to let it take effect and fail, which I think it simply has to do.

The danger in this is that we will get used to the flaws, inefficiencies, higher costs, poorer service, etc. the way we have gotten used to $3 gas. Remember the howls just a few years back? How can we expect people to pay $40 for a fill up and get by? Now it is routine.

Yes, but if you introduce Bismarck at that point, you should be able to get a consensus favoring it. There are a couple of Bismarck countries that tried single-provider first and changed because of the problems.

Is France one of them? Maybe becoming France has some upside.

(10-09-2013 05:32 PM)OptimisticOwl Wrote:  

(10-09-2013 05:27 PM)Owl 69/70/75 Wrote:  

(10-09-2013 05:23 PM)OptimisticOwl Wrote:  

(10-09-2013 02:34 PM)Owl 69/70/75 Wrote:  I think a better approach for republicans would have been simply to let it take effect and fail, which I think it simply has to do.

The danger in this is that we will get used to the flaws, inefficiencies, higher costs, poorer service, etc. the way we have gotten used to $3 gas. Remember the howls just a few years back? How can we expect people to pay $40 for a fill up and get by? Now it is routine.

Yes, but if you introduce Bismarck at that point, you should be able to get a consensus favoring it. There are a couple of Bismarck countries that tried single-provider first and changed because of the problems.

Is France one of them? Maybe becoming France has some upside.

France is a Bismarck country. They pretty much adopted it after WWII. That's the same time frame that Beveridge was developing NHS for UK. Germany was the first Bismarck country, starting at the time of, guess who, Bismarck. The other Bismarcks pretty much fell into line, some time between 1870 and 1950, with most of them experimenting with some form of single-payer/single-provider before converting. Nobody has gone from Bismarck to single-payer or single-provider. Under Tony Blair, UK took a hard look at converting to a Bismarck system. Blair once caught a fair amount of heat for saying something to the effect that UK didn't really need to fix NHS as long as they had France as a backup (don't have exact quote, but was on a rugby trip where several in the group were very incensed about the comment).

The individual Bismarck systems vary, but the basic concept is the same--everybody has a private insurance policy, multiple insurers compete for the business (240 in Germany, through exchanges run by the states, with everyone able to purchase off ANY state's exchange--see the big difference between this and Obamacare's "exchanges"?), some basic portion is funded by the government for everybody, paid for out of some mix of social security and consumption taxes, and individuals and employers are able to supplement with private care and private insurance. The basic coverage (the "free" side) is generally provided by docs on contracts (and docs contract out to the "free" side in exchange for free med school) and non-profit hospitals, and insurance is provided by non profit carriers, or by private carriers for no profit (they do it for the cash flow and the mailing list), and is very highly regulated, generally with pretty hefty co-pays to discourage abuse. The "pay" side is generally provided by private docs and for-profit hospitals, and can be covered by private insurance (which employers typically provide as a benefit since it's cheap, and employers don't want there employees stuck in a queue on the free side), and all financial aspects are pretty much unregulated, much freer market than here. France spends about $3500 per person per year on health care, with about $2500 coming from the government (which basically buys everybody a bad HMO) and $1000 coming from individuals (with about 90% covered by private insurance). As an example of how they vary, while 90% of the French have private insurance (note, higher than the percentage here), in Germany you have to have a minimum income (about $80,000 last I checked) in order to be able to buy private insurance; I much prefer the French approach there. Malpractice is a much lower cost in Bismarcks because they are pretty much all in civil law jurisdictions where large jury awards for punitive damages are eliminated by the system. If I were developing one here, I'd adopt Swedish "no fault" malpractice.

I don't really have time to delve back into this thread today, but I thought this was fairly humorous.

http://hardballtalk.nbcsports.com/2013/1...-playoffs/

(10-09-2013 02:34 PM)Owl 69/70/75 Wrote:  My answer to the who is responsible part is that it takes two to have a disagreement, and both sides pretty much appear to be in adolescent temper tantrum stage... I don't think getting Obamacare repealed is even on the table as a possibility. It's really difficult for me to understand why republicans are spending so much political capital on this, except that they really are the stupid party...

"Tantrum" and "stupid" is more or less my take on the situation. I'm not sure why, after 40 (?) failures to repeal Obamacare in Congress, the Republicans didn't just increase their focus on gaining more seats in the next round of elections. It would be quite the event if they "win" this battle but lose control of the House in the next elections because voters are rightfully upset about the shutdown.

BTW, have Congress members and their staffs been furloughed?

(10-09-2013 03:41 PM)georgewebb Wrote:  ...On the other hand, I have never heard anyone who, when pressed for specifics, argues that the tendency of particular constitutional provisions to be forgotten or ignored without amendment is a strength...

Please do press the federal government about this! I miss the Fourth Amendment.

FTR, I have only disdain for both the Republicans and Democrats. Cleaning house sounds very tempting! The system JustAnotherAustinOwl described in the second post sounds somewhat like the system in Canada. The Canadian system, if I recall correctly, also has significantly lower caps on campaign spending and much shorter campaign durations.

(10-10-2013 07:40 PM)Caelligh Wrote:  

(10-09-2013 03:41 PM)georgewebb Wrote:  ...On the other hand, I have never heard anyone who, when pressed for specifics, argues that the tendency of particular constitutional provisions to be forgotten or ignored without amendment is a strength...

Please do press the federal government about this! I miss the Fourth Amendment.

Fourth Amendment jurisprudence is fascinating, not least because it starts with text that is at once wonderfully clear and agonizingly ambiguous: "The right of the people to be secure in their persons, houses, papers and effects against unreasonable searches and seizures shall not be violated..."

But what is a search? Electronic surveillance? GPS tracking?
What are a persons' papers and effects? Are records of my phone calls, maintained by a telecom company, "my" effects?
And what is unreasonable?

I think this may be the most interesting of all constitutional jurisprudence

To the top point, I believe that the Tea Party's current goal is not to fundamentally alter the government, but run it as it should be run, to wit, a majority party in the lower chamber that doesn't let itself get bullied by the executive. The elephants are seeking compromise in a divided government- a challenging goal, especially with a President whose recent tagline has been "I will not negotiate." I find the biggest problem for the tea party politicos is not their goal, but their inability to communicate it. In the past, they have sent several ACA repeal bills up to the Senate only to be denied, which was largely symbolic; however, the goal around the shutdown has been primarily to delay the individual mandate and repeal the medical device tax. Is it a ploy to gain time to try again for repeal? Obviously. That doesn't inherently mean there subgoals are inherently bad. I think that a major fact that goes largely ignored is that the House has sent 26 bills to the Senate to fully fund the government for the coming year, many of which are reasonable and moderate. On arrival, Mr. Reid has let exactly zero of them go to a vote. Who is really saying "I'm taking my ball and going home"?

As for a parliamentary system, it is indeed fascinating. There are things about it I like...I think there would be a few more people sent to Washington than the single digit cohort who think like me there now; that said, as you may be able to tell from my writings that I'm the type who thinks that the federal government should accomplish very little. As such, I like the current system, so long as they follow their own rules. What does it mean for the government to follow its own rules? That's a rant for another day.

(10-11-2013 04:10 PM)That Guy 2012 Wrote:  To the top point, I believe that the Tea Party's current goal is not to fundamentally alter the government, but run it as it should be run, to wit, a majority party in the lower chamber that doesn't let itself get bullied by the executive. The elephants are seeking compromise in a divided government- a challenging goal, especially with a President whose recent tagline has been "I will not negotiate." I find the biggest problem for the tea party politicos is not their goal, but their inability to communicate it. In the past, they have sent several ACA repeal bills up to the Senate only to be denied, which was largely symbolic; however, the goal around the shutdown has been primarily to delay the individual mandate and repeal the medical device tax. Is it a ploy to gain time to try again for repeal? Obviously. That doesn't inherently mean there subgoals are inherently bad. I think that a major fact that goes largely ignored is that the House has sent 26 bills to the Senate to fully fund the government for the coming year, many of which are reasonable and moderate. On arrival, Mr. Reid has let exactly zero of them go to a vote. Who is really saying "I'm taking my ball and going home"?

As for a parliamentary system, it is indeed fascinating. There are things about it I like...I think there would be a few more people sent to Washington than the single digit cohort who think like me there now; that said, as you may be able to tell from my writings that I'm the type who thinks that the federal government should accomplish very little. As such, I like the current system, so long as they follow their own rules. What does it mean for the government to follow its own rules? That's a rant for another day.

I haven't been following these happenings as close as many others have been per the responses here. These 26 bills sent to the Senate that you said were "reasonable and moderate," only to never see the light of day, did they all leave the ACA alone? Or did all of them somehow try to defund or delay some aspect of it?

If they tried to touch the ACA they were dead on arrival, and it is well known that it would be. As some have said on here, the Reps would be best served to just leave the ACA alone and let it fail or succeed. If it fails, they get to say I told you so, repeal it and look a lot better than the Dems. If the ACA somehow works out, then the US has affordable healthcare for most everyone and people with existing conditions cannot be denied.

"...if it somehow works out..."

It WILL somehow work out, just not well.

my fear is not that it will fail, but that it won't fail badly enough, leaving us with a badly performing, expensive ACA that becomes a sacred cow. I think that is exactly what proponents want. there is a lot of space between utter failure and spectacular success.

(10-12-2013 11:06 AM)OptimisticOwl Wrote:  "...if it somehow works out..."

It WILL somehow work out, just not well.

my fear is not that it will fail, but that it won't fail badly enough, leaving us with a badly performing, expensive ACA that becomes a sacred cow. I think that is exactly what proponents want. there is a lot of space between utter failure and spectacular success.

Of course there is an in between as you suggest. However, I feel as if the opponents will not let it mire in mediocrity. There is already a ton of weight behind repealing the ACA before it has even been implemented. If it is anything but a smashing success, I would think that those against the ACA would not let it limp on and become a sacred cow. But then again, this is political, so nothing is certain.

I will pick a bone with the idea that the proponents want it to become a sacred cow that performs badly. I think that a majority of those in favor of the ACA genuinely want it to succeed and reach the lofty goals that have been publicly stated. Whether or not those goals are reached is to be seen.

(10-12-2013 12:36 PM)RiceLad15 Wrote:  I will pick a bone with the idea that the proponents want it to become a sacred cow that performs badly. I think that a majority of those in favor of the ACA genuinely want it to succeed and reach the lofty goals that have been publicly stated.

They don't want it to perform badly, but they do want it to be a sacred cow.

I think a lot of those who favor it think it is a wonderful thing, a panacea. But higher up, I think that the idea is, regardless of how well or how poorly it works, if they can just get it in place it will be trebly harder to dislodge. The goal is to have something they can call a thoroughbred politically, even if in reality it is just a sickly camel. So we could easily end up with a system that delivers poor healthcare at a high price and that destroys the budget, but people will bitterly cling to what they know rather than face the unknown.

For most proponents, I think that will be good enough.

(10-12-2013 12:36 PM)RiceLad15 Wrote:  I will pick a bone with the idea that the proponents want it to become a sacred cow that performs badly. I think that a majority of those in favor of the ACA genuinely want it to succeed and reach the lofty goals that have been publicly stated. Whether or not those goals are reached is to be seen.

Obamacare simply cannot succeed. It is based on unsound economics. If we add people to the insurance rolls, that will increase demand. If we pay doctors and other providers less, that will reduce supply. Reducing supply while increasing demand has never worked one time in the history of the planet. And if we don't reduce the amounts paid to docs and other providers, then the costs will skyrocket as we add the administrative burden of the IPAD, HCC, CCO (technically part of "stimulus") and other newly created agencies to the already high existing costs (for which Obamacare includes no remedy other than paying docs and other providers less).

And I will pick a bone with you. I don't think the proponents have any goal for it except to increase the federal government's intrusion into the lives of private citizens and to fail in a way that paves the way to a single-payer health care system. There has been no secret on the part of Obama or many other democrat leaders that they see Obamacare as the first step on the way to single-payer.

And there is not a single-payer system in the world that works well, particularly when you get to populations over about 6 million. But if republicans do not come with some other viable option, that's where we are headed. And it will make Obamacare look like a smashing success.

What republicans need to do is come up with an alternative. I have been suporting a French Bismarck-style approach for years, dating back to Hillarycare in the 1990s (and the Heritage plan then was a step in that direction). If you lopped HCC, IPAB, and CCO off from Obamacare, what's left could actually be converted to a Bismarck plan. That's my hope for the direction we will go. But I don't see either party going that way right now.

I hate to keep saying it, but it really has gotten to be the stupid party versus the evil party.

(10-12-2013 01:53 PM)Owl 69/70/75 Wrote:  I hate to keep saying it, but it really has gotten to be the stupid party versus the evil party.

So when I vote, it really is a choice of the lesser of two evils?

(10-12-2013 01:56 PM)OptimisticOwl Wrote:  

(10-12-2013 01:53 PM)Owl 69/70/75 Wrote:  I hate to keep saying it, but it really has gotten to be the stupid party versus the evil party.

So when I vote, it really is a choice of the lesser of two evils?

Or the lesser of two stupids?

(10-12-2013 02:09 PM)Owl 69/70/75 Wrote:  

(10-12-2013 01:56 PM)OptimisticOwl Wrote:  

(10-12-2013 01:53 PM)Owl 69/70/75 Wrote:  I hate to keep saying it, but it really has gotten to be the stupid party versus the evil party.

So when I vote, it really is a choice of the lesser of two evils?

Or the lesser of two stupids?

Works out the same either way.

(10-12-2013 01:53 PM)Owl 69/70/75 Wrote:  

(10-12-2013 12:36 PM)RiceLad15 Wrote:  I will pick a bone with the idea that the proponents want it to become a sacred cow that performs badly. I think that a majority of those in favor of the ACA genuinely want it to succeed and reach the lofty goals that have been publicly stated. Whether or not those goals are reached is to be seen.

And I will pick a bone with you. I don't think the proponents have any goal for it except to increase the federal government's intrusion into the lives of private citizens and to fail in a way that paves the way to a single-payer health care system. There has been no secret on the part of Obama or many other democrat leaders that they see Obamacare as the first step on the way to single-payer.

Maybe I'm just not jaded yet, but I just can't believe this first line of reasoning across the board, period.

IMO, it's disingenuous to say that one of the two goals of proponents of the ACA is to increase the federal government's reach into the lives of citizens. For the most part, they want to try and provide health insurance for people who cannot afford it, and it just so happens that way they have devised to accomplish that goal is by using the government. I understand people disagreeing with the ACA because it does increase the role of government by extending the reach into healthcare and I genuinely am interested in hearing their opinions. But I start to become suspicious and uninterested when hyperbolic and sensational rhetoric starts, such as suggesting that the ACA is just a power play to control your life.

If I misinterpreted what you are saying then I offer my apologies.

I think the "disingenuous" and "hyperbolic and sensational" parts are pretty gross misrepresentations, and I accept your apology for those comments.

We are probably just going to have to agree to disagree. But before settling for that, perhaps you could answer one question. Faced with the opportunity to reform health care the people behind Obamacare could have conducted a comprehensive analysis of existing systems worldwide, which would almost certainly have led them to conclude that the Bismarck muti-payer systems do the best job of providing universal care, particularly in large systems, and do so with less direct government involvement than we had before Obamacare. But that's not what they did. Instead of doing any such analysis they pushed an approach that greatly increases government micro-management and has been described by many of its proponents, from Obama down, as a first step toward a single-payer system, when as opposed to Bismarcks, single-payer systems fare very poorly in worldwide comparisons. Why? If that does not suggest very strongly to you that my comments have considerable evidentiary support, then we will just have to agree to disagree.

(10-12-2013 05:18 PM)Owl 69/70/75 Wrote:  I think the "disingenuous" and "hyperbolic and sensational" parts are pretty gross misrepresentations, and I accept your apology for those comments.

We are probably just going to have to agree to disagree. But before settling for that, perhaps you could answer one question. Faced with the opportunity to reform health care the people behind Obamacare could have conducted a comprehensive analysis of existing systems worldwide, which would almost certainly have led them to conclude that the Bismarck muti-payer systems do the best job of providing universal care, particularly in large systems, and do so with less direct government involvement than we had before Obamacare. But that's not what they did. Instead of doing any such analysis they pushed an approach that greatly increases government micro-management and has been described by many of its proponents, from Obama down, as a first step toward a single-payer system, when as opposed to Bismarcks, single-payer systems fare very poorly in worldwide comparisons. Why? If that does not suggest very strongly to you that my comments have considerable evidentiary support, then we will just have to agree to disagree.

I understand your line of thinking, but like you said, we'll have to agree to disagree too. Mainly because I don't know the conversations and decisions that happened behind closed doors, but this could just be my youthful optimism tinting my glasses.

I don't know what went on behind closed doors either. But I can look at the results and eliminate some possibilities.

And when I look at Obamacare with an awareness of what options would have been available, then, "Let's do something to improve health care," eliminates itself pretty quickly.

They must have had some purpose in mind, and the ones I suggested are the only ones that appear to fit the facts that I do know.

(10-12-2013 04:51 PM)RiceLad15 Wrote:  IMO, it's disingenuous to say that one of the two goals of proponents of the ACA is to increase the federal government's reach into the lives of citizens.

It strikes me as quite ingenuous to think that such is NOT one of their goals -- or at least (in their view) an outcome devoutly to be wished for its own sake.

My experience is that expansion of governmental roles is a constant desire of leftists, not least because they almost always imagine themselves as the ones who would do the governing.

(10-12-2013 05:32 PM)georgewebb Wrote:  

(10-12-2013 04:51 PM)RiceLad15 Wrote:  IMO, it's disingenuous to say that one of the two goals of proponents of the ACA is to increase the federal government's reach into the lives of citizens.

It strikes me as quite ingenuous to think that such is NOT one of their goals -- or at least (in their view) an outcome devoutly to be wished for its own sake.

My experience is that expansion of governmental roles is a constant desire of leftists, not least because they almost always imagine themselves as the ones who would do the governing.

I would differ only to note that the Bush-Cheney republicans participated just about as enthusiastically in government expansion as any democrat. I don't think it's a partisan thing. I think people in DC, regardless of their persuasion, become mesmerized by power and willing to do almost anything to get more.