Will Murkowski sell out?

[Norman Bernstein]

Re: Will Murkowski sell out?

I have to admit, I like the idea of health-care being in the hands of the states. I like it a lot. Of course, the devil is in the details. I really don't understand why libs don't like it.

Tell me, is it less important to treat diabetes in Alabama, than it is, in Massachusetts?

Perhaps heart disease screening really doesn't need to be done in Missouri, but is absolutely essential to the health of New York residents.

Maybe Delaware thinks that paying for kidney transplants is more economical, in the long run, and far better for patients, than years, or decades, of dialysis.... but Texas thinks it's OK to condemn it's citizens to continuous (and debilitating) dialysis, because it appears on the surface, and in the short run, to be cheaper.

The flaw of turning over health care decisions to the states is the rather stupid presumption that the health needs of the citizens of different states are different. There is only one standard for health care... the appropriate level of care. Block-granting Medicaid is permission for states to apply political and economic litmus tests to the standard of health care for its citizens. This is a case where the 'subsidiarity' argument fails.... and 'subsidiarity' isn't appropriate in EVERY case.

[Norman Bernstein]

Re: Will Murkowski sell out?

ObamaCare sucks for everyone who has to use it in the individual market..

Maybe it sucks for YOU... but has saved lives for others. Whose standard shall we use, in deciding whether a program is, on balance, and in the aggregate, a good thing or not?

[S.V. Airlie]

Re: Will Murkowski sell out?

Tell me, is it less important to treat diabetes in Alabama, than it is, in Massachusetts?

Perhaps heart disease screening really doesn't need to be done in Missouri, but is absolutely essential to the health of New York residents.

Maybe Delaware thinks that paying for kidney transplants is more economical, in the long run, and far better for patients, than years, or decades, of dialysis.... but Texas thinks it's OK to condemn it's citizens to continuous (and debilitating) dialysis, because it appears on the surface, and in the short run, to be cheaper.

The flaw of turning over health care decisions to the states is the rather stupid presumption that the health needs of the citizens of different states are different. There is only one standard for health care... the appropriate level of care. Block-granting Medicaid is permission for states to apply political and economic litmus tests to the standard of health care for its citizens. This is a case where the 'subsidiarity' argument fails.... and 'subsidiarity' isn't appropriate in EVERY case.

Exactly!

[sharpiefan]

Re: Will Murkowski sell out?

Maybe it sucks for YOU... but has saved lives for others. Whose standard shall we use, in deciding whether a program is, on balance, and in the aggregate, a good thing or not?

How about the care congresscritters approved for themselves?

[TomF]

Re: Will Murkowski sell out?

I have to admit, I like the idea of health-care being in the hands of the states. I like it a lot. Of course, the devil is in the details....

The devil really is in the details.

In Canada, health care is in the hands of the Provinces and Territories. As a result, we have 13 different plans, with 13 different sets of guidelines, policy practices, fee codes etc. This is a result of the Constitutional allocation of responsibilities dating back to our 1867 British North America Act, which gave Health (and Education BTW) solely to Provinces, while reserving other sectors solely for the Feds.

As a result, in many respects Canada's mosaic of care is vastly less efficient than it could be, with significant variations from province to province. There is one helluva lot of cost and delay and waste hung up in interminable negotiations among Provinces/Territories too - how much to reimburse when a citizen from Alberta gets sick while in Ontario, what to do when a patient from Newfoundland needs specialized care only available in Nova Scotia. etc. You'd not believe the enormous annual cost of negotiating and administering those things, particularly when each Province/Territory has also created its own rubrics for the drugs to fund, the number of visits to this or that provider to cover, the pay scales for the various different types of personnel who actually do the work.

What makes it workable for Canada at all is the 1967 Canada Health Act. The Federal government has no Constitutional responsibility for Health care, but the Constitution does reserve what it calls "Spending Power." The Canada Health Act sets out some provisions which, if Provinces/Territories follow them, will result in the Feds transferring block grants to subsidize the provision.

The conditions require Provinces/Territories to actually provide care to any Canadian who happens to require it, and to transfer-bill with the citizen's own home province. It sets out a nominally prescriptive direction that insured services must cover "medically necessary" care, while letting the provinces mostly duke out how that phrase ought to be interpreted. Etc. In practice, it means that every Canadian jurisdiction mostly offers the same kinds of care, though the level of access etc. will vary somewhat both from province to province and region to region. And it ensures that every Canadian is eligible to receive that care on the same basis as any other Canadian - without regard to their financial status etc.

Were someone to transport me back to the Constitutional Conferences of the 1860s, I'd implore the Fathers of Confederation to leave Health with the federal government. What was thought then to be a piddling little expense compared with the big stuff of national defence etc. would become a monster, and would perhaps paradoxically become a key opportunity for building Canadians' sense of living in a shared nation.

If America were to put states in charge, I'd strongly argue for something analogous to the Canada Health Act's requirements for access to any citizen, from any American state, with the state governments duking out reimbursement practices. I'd eliminate health insurers' rights to actually own hospitals or otherwise be involved in the direct delivery of services too - to functionally remove the means to exclude people's care in this or that hospital because they were "out of network."

And, I'd make sure that the Federal government provided a "public option" plan which citizens from any part of America could purchase, which would itself implicitly define the minimum basket of "necessary services," and establish the price-point for those services with which private insurers would need to compete.

[peb]

Re: Will Murkowski sell out?

Maybe it sucks for YOU... but has saved lives for others. Whose standard shall we use, in deciding whether a program is, on balance, and in the aggregate, a good thing or not?

Look, for the vast majority who have it, the premiums are too high, and even if the government subsidy covers most of the premiums, the deductibles are absurd. So, yes, you can say it is "saving lives", but that doesn't change the fact that it sucks for almost everyone who has a policy on the individual market. So we can sit still with ObamaCare, a system that saves lives, but still sucks for any normal use, or we can try to move forward. Look, I am on board with a single-payer system (I use that term grudgingly, as I realize it is the preferred term, but I sincerely hope we do not outlaw supplemental insurance), but it ain't going to happen on a national level. Not anytime soon. It didn't happen in 09-10 because not even enough democrats would support it. The crap about it being a compromise for republican support is a joke (see my post about the irony of this thread). ObamaCare is the best that the democrats could develop among themselves. And the 09-10 political environment (ie Dems controlling 59-60 votes) is not likely to happen again. And if it does, will the democrats all support a single-payer? They didn't last time.
So how to move forward: simple, let the states do it. Vermont was on the verge of doing it on their own, until they found out it was utterly impossible budget wise under the ObamaCare umbrella. If we simply go to block grants to the states, do you seriously thing Vermont won't move forward, and many other states? Likely your own?

[peb]

Re: Will Murkowski sell out?

Tell me, is it less important to treat diabetes in Alabama, than it is, in Massachusetts?

Perhaps heart disease screening really doesn't need to be done in Missouri, but is absolutely essential to the health of New York residents.

Maybe Delaware thinks that paying for kidney transplants is more economical, in the long run, and far better for patients, than years, or decades, of dialysis.... but Texas thinks it's OK to condemn it's citizens to continuous (and debilitating) dialysis, because it appears on the surface, and in the short run, to be cheaper.

The flaw of turning over health care decisions to the states is the rather stupid presumption that the health needs of the citizens of different states are different. There is only one standard for health care... the appropriate level of care. Block-granting Medicaid is permission for states to apply political and economic litmus tests to the standard of health care for its citizens. This is a case where the 'subsidiarity' argument fails.... and 'subsidiarity' isn't appropriate in EVERY case.

Oh come now. Your argument doesn't hold water. If I had diabetes and worked for a major corporation, I would be much more likely to have adequate healthcare than I do with my current policy.

Are you telling me its less important to treat diabetes for people who are self-employed than it is for

important to treat diabetes in Alabama, than it is, in Massachusetts?


Tell me, is it less important to treat diabetes for a self-employed person, than it is, for an employee of Google?

Perhaps heart disease screening really doesn't need to be done for self-employed folks, but is absolutely essential to the health of Microsoft employees.

Or lets take it the other direction: I could make the same arguments you make internationally. Why don't we just turn healthcare over to the UN and give the global taxation powers to cover the whole world.

Tell me, is it less important to treat diabetes in Venezuela, than it is, in United Kingdom?

Perhaps heart disease screening really doesn't need to be done in India, but is absolutely essential to the health of Canadian residents.

To say that everything has to be implemented perfectly, for everyone, at the same time is to say we are not going to do anything. The world is not a perfect place. But we can make progress at local levels much easier than we can at higher levels.

[Paul Pless]

Re: Will Murkowski sell out?

Oh come now. Your argument doesn't hold water. If I had diabetes and worked for a major corporation, I would be much more likely to have adequate healthcare than I do with my current policy.

Are you telling me its less important to treat diabetes for people who are self-employed than it is for

important to treat diabetes in Alabama, than it is, in Massachusetts?


Tell me, is it less important to treat diabetes for a self-employed person, than it is, for an employee of Google?

Perhaps heart disease screening really doesn't need to be done for self-employed folks, but is absolutely essential to the health of Microsoft employees.

you make norman's argument for him

[S.V. Airlie]

Re: Will Murkowski sell out?

Look, for the vast majority who have it, the premiums are too high, and even if the government subsidy covers most of the premiums, the deductibles are absurd. So, yes, you can say it is "saving lives", but that doesn't change the fact that it sucks for almost everyone who has a policy on the individual market. So we can sit still with ObamaCare, a system that saves lives, but still sucks for any normal use, or we can try to move forward. Look, I am on board with a single-payer system (I use that term grudgingly, as I realize it is the preferred term, but I sincerely hope we do not outlaw supplemental insurance), but it ain't going to happen on a national level. Not anytime soon. It didn't happen in 09-10 because not even enough democrats would support it. The crap about it being a compromise for republican support is a joke (see my post about the irony of this thread). ObamaCare is the best that the democrats could develop among themselves. And the 09-10 political environment (ie Dems controlling 59-60 votes) is not likely to happen again. And if it does, will the democrats all support a single-payer? They didn't last time.
So how to move forward: simple, let the states do it. Vermont was on the verge of doing it on their own, until they found out it was utterly impossible budget wise under the ObamaCare umbrella. If we simply go to block grants to the states, do you seriously thing Vermont won't move forward, and many other states? Likely your own?

I had a choice between 3 deductibles, all that was offered by one of the companies; $600.00, $1200.00 and $1500.00. I chose door # 1. Paid off in about two months. So, what are the high ones you're referring to per?

[katey]

My deductible is $6600.

[Chris Smith porter maine]

Re: Will Murkowski sell out?

I'm thinking health care benefits should be taxed as regular income, right now it's a tax break to the upper classes for the most part, sure some middle class jobs still come with it but they have become few and far between.

[Norman Bernstein]

Re: Will Murkowski sell out?

Oh come now. Your argument doesn't hold water. If I had diabetes and worked for a major corporation, I would be much more likely to have adequate healthcare than I do with my current policy.
Are you telling me its less important to treat diabetes for people who are self-employed than it is for important to treat diabetes in Alabama, than it is, in Massachusetts?
Tell me, is it less important to treat diabetes for a self-employed person, than it is, for an employee of Google?
Perhaps heart disease screening really doesn't need to be done for self-employed folks, but is absolutely essential to the health of Microsoft employees.

As Paul has pointed out, you're making my argument FOR me.... thank you.

Or lets take it the other direction: I could make the same arguments you make internationally. Why don't we just turn healthcare over to the UN and give the global taxation powers to cover the whole world.
Tell me, is it less important to treat diabetes in Venezuela, than it is, in United Kingdom?
Perhaps heart disease screening really doesn't need to be done in India, but is absolutely essential to the health of Canadian residents.

Now you're grasping at ridiculous arguments.

Yes, self employed individuals have the same needs as those working for an employer... as well as those who don't work at all. One's health requirements don't vary, as a function of location, or employment status. There is only ONE standard for health care, and it's based on medical need, not the judgment of politicians. Block-granting Medicaid to the states is a virtual guarantee, however, that the quality of care will be based on the judgment of politicians.

The proof? Why did 19 states refuse to expand Medicaid, under the ACA, as provided for? It would have cost them NOTHING over the first three years, and then they'd be reimbursed 90% by the federal government... but what happened? Those in states who refused, got poorer care, or NO care... all based on partisan politics, not medical need. The reason they refused? Partisan politics, and NOT the best interests of it's citizens.

To say that everything has to be implemented perfectly, for everyone, at the same time is to say we are not going to do anything. The world is not a perfect place. But we can make progress at local levels much easier than we can at higher levels.

Yes, progress MIGHT be made at local levels... and so can 'regress'. The Graham-Cassidy bill would provide the cover for irresponsible politicians in irresponsible states to provide poor medical care to many of their residents. Consider the fact that barely 24% of the population thinks this bill is a good idea... and it's universally rejected by nearly all major health organizations, who know a thing of two about health care. We KNOW the justification for this bill: it's to deliver on a campaign promise, and by doing so, give many Republican politicians cover, to hopefully avoid being primaried by the right in the next election.

If the bill had merit, then why does it have to be passed with NO public input, NO hearings, and virtually NO debate?

[peb]

Norman, based on your response, Obamacare is completely unjustified. I obviously do not have as good of healthcare insurance as others on this thread, my deductible is over 12k with premiums of 14k. Obamacare sucks, based on your own reasoning.



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[peb]

I had a choice between 3 deductibles, all that was offered by one of the companies; $600.00, $1200.00 and $1500.00. I chose door # 1. Paid off in about two months. So, what are the high ones you're referring to per?

I am going out on a limb here and guessing you are describing something other than a individual insurance offered on the healthcare marketplace. Mabe you are over 65 and describing a medicare supplemental package?

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[Norman Bernstein]

Re: Will Murkowski sell out?

Norman, based on your response, Obamacare is completely unjustified. I obviously do not have as good of healthcare insurance as others on this thread, my deductible is over 12k with premiums of 14k. Obamacare sucks, based on your own reasoning.

I am sorry that your particular insurance sucks (whether it has anything to do with Obamacare isn't known, since you have no clue as to what it might have been without Obamacare)

However, the solution to the health care issue is NOT to simply establish a system where it sucks, for OTHER people.... As it most certainly would, if this abortion of a health care bill were to pass.

Would you be happy if YOUR costs were to drop dramatically, if in doing so, other people were unable to obtain health care?