Now that Obama is re-elected, can we stop pretending that Obamacare is some kind of socialist program and call it what it is: privatization?

This is privatization at its core; instead of the government offering a service they pay private industry to provide that service and attach requirements. Is it socialism when we hire road contractors, or school lunch service vendors? No, its privatization.

I'm not talking about whether its good or bad, just can we have a reasonable discussion about what it is? At its core its privatization and its paid for by new taxes.

11/7/2012 4:38:32 PM

Obamacare is a massive expansion of Medicaid, as well as subsidization of the cost of care for lower-income earners through a complex set of fees and taxes, mostly on businesses. That is not privatization in any way, shape or form.

11/7/2012 4:42:06 PM

let's start with you telling me why it was even needed when EMTALA has been in place almost 30 years now?

(and, yes, i do agree healthcare reform was needed, i just believe this was an extreme way to do it, and it is set up in a way that could eventually evolve into a horrendous NHS form of administering healthcare; slippery slope, and whatnot. the same reason i was adamantly opposed to the Patriot Act).

11/7/2012 4:44:54 PM

It's an advancement of paternalism. It asks employers to do more for their employees' health coverage, as a response to rising costs. A number of people on the margins will be assisted by expanded federal programs, but in most cases their employer will take a penalty too.

The only problem is that employers have wanted to be dealt out of this system for the last decade. Hiring has more friction that ever and most of what I see from Obamacare is a functional increase of the minimum wage - a battle the Democrats haven't been able to win on its own merits.

I'm all for government taking care of its people. I'm personally agnostic to the degree of our taxes we use for such purposes. But it doesn't do that, it creates responsibilities and passes them on to other people. Obama had my vote in 2008, and he lost it in 2012 for this exact reason.

11/7/2012 4:52:30 PM

Quote :

"That is not privatization in any way, shape or form."

Who is providing the service, where does the money go?

11/7/2012 4:54:24 PM

I've always wondered why the federal government doesn't own more businesses beyond a bank.

If a state needs to hire a construction crew/contractor for a new government building or to build a new bridge or repair roads, then hire the federal company and all the profits go towards the national debt.

If the insurance companies are making so much money off of premiums, then why not have a federally-owned insurance policy where that money can be used for government-funded programs?

I feel like the same thing could happen in manufacturing and service distribution. It would create jobs, likely provide tax-free services (since the money is going to where the taxes would go anyway), and help fix the national economy.

Biggest downside is it creates major competition for private business owners. But that's what capitalism is all about, right?

11/7/2012 4:55:55 PM

the only difference between obamacare and a voucher-type plan is the amount of individual control you think you have. they are both privatization and they will/would both increase costs.

11/7/2012 5:01:11 PM

Quote :

"Who is providing the service, where does the money go?"

As I said previously, a large part of Obamacare is the expansion of medicaid, which is expected to insure 10-12 million more patients by the time it fully kicks in in 2014. Other provisions include the subsidization (or socialization, if you will) of health insurance payments to those who make up to 400% of the poverty rate.

Privatization implies that a service traditionally provided by the government is now being outsourced. In the US, the government has never been the main provider of healthcare so the term "privatization" doesn't apply.

11/7/2012 5:03:23 PM

They all use private healthcare, its funneling money to private industry. It's privatization.

Quote :

"In the US, the government has never been the main provider of healthcare so the term "privatization" doesn't apply."

But it could be, if we had real government healthcare

[Edited on November 7, 2012 at 5:05 PM. Reason : .]

11/7/2012 5:05:08 PM

Quote :

"If a state needs to hire a construction crew/contractor for a new government building or to build a new bridge or repair roads, then hire the federal company and all the profits go towards the national debt."

Insurance is a special case, but generally speaking, government-provided services are grossly inefficient compared to the private sector. I should know; I work for a contractor that does public works projects. I work with public officials every day. They simply don't run a tight ship because there is no competition to keep the costs down. In addition, the centralization of power (government-owned industry) invites both political corruption and graft, as we see over and over again when countries try this. It starts with city officials giving sweetheart deals to friends and relatives, and culminates with laws being written that explicitly favor public industry over the private sector.

If you tasked city workers with building all of our roads, public buildings, waterlines and the like, you'd see a lot of incredible cost overruns and projects that never get completed, coupled with corruption on a massive scale.


[Edited on November 7, 2012 at 5:16 PM. Reason : 2]

11/7/2012 5:08:43 PM

Quote :

"They all use private healthcare, its funneling money to private industry. It's privatization."

Obamacare is an overhaul of the health insurance industry, not the healthcare industry.

11/7/2012 5:10:27 PM

So lets take the building roads project. For DOT projects, the DOT will bid scopes along with private companies and will take them if they win. I should know, I've bid against them as a contractor that did public works projects.

Also, efficiency is not the issue of concern, cost to the consumer are.

11/7/2012 5:15:44 PM

Quote :

"Obamacare is an overhaul of the health insurance industry, not the healthcare industry."

and

Quote :

"They all use private healthcare, its funneling money to private industry. It's privatization."

its not socialism, its privatization, and its the problem

11/7/2012 5:16:44 PM

Efficiency is always a matter of concern when competition is taken out of the equation. bdmazur was suggesting that we end the bidding process and cut private contractors out of public works projects.

Your example obviously doesn't apply.

11/7/2012 5:18:51 PM

Quote :

"its not socialism, its privatization, and its the problem"

Are you trying to get into a semantics bitchfest or simply refuse to admit when you're wrong?

Obamacare expands governement involvement in health insurance, socializing the cost of care for the poor. It's not privatization at all. Our health insurance system has always been largely private.

[Edited on November 7, 2012 at 5:24 PM. Reason : 2]

11/7/2012 5:21:37 PM

Quote :

"Also, efficiency is not the issue of concern, cost to the consumer are."

What?

How on Earth did you decouple these two things?

11/7/2012 5:51:55 PM

Quote :

"Are you trying to get into a semantics bitchfest...?"

it's his trademark tactic.

11/7/2012 5:55:22 PM

How about we stop pretending that Obamacare is anything that can be characterized by a single word or phrase.

11/7/2012 6:05:23 PM

Quote :

"How on Earth did you decouple these two things?"

If there is no profit motive, and thus a lower profit margin, you can be less efficient and less expensive. cost is the metric we need to look at.

Quote :

"Obamacare expands governement involvement in health insurance, socializing the cost of care for the poor. It's not privatization at all. Our health insurance system has always been largely private. "

it has always been private, obamacare is more of the same. its more privatization. it doesn't somehow stop being privatization because it has always been privatization. obamacare is more of the same thing, its not socialist reform. obamacare is no socialist or socialism, the government is not providing healthcare.

there is no socialization, socialization would be government provided healthcare and its what we need to stop increasing prices.


[Edited on November 7, 2012 at 7:30 PM. Reason : obamacare is not socialist, lets stop pretending]

11/7/2012 7:25:06 PM

Quote :

"Insurance is a special case, but generally speaking, government-provided services are grossly inefficient compared to the private sector. I should know; I work for a contractor that does public works projects. I work with public officials every day. They simply don't run a tight ship because there is no competition to keep the costs down. In addition, the centralization of power (government-owned industry) invites both political corruption and graft, as we see over and over again when countries try this. It starts with city officials giving sweetheart deals to friends and relatives, and culminates with laws being written that explicitly favor public industry over the private sector. If you tasked city workers with building all of our roads, public buildings, waterlines and the like, you'd see a lot of incredible cost overruns and projects that never get completed, coupled with corruption on a massive scale. "

I'm talking about government workers being hired out for private contracts. Make them a competitor in the private sector, therefor increasing the level of services provided as well as bringing extra $$$ into the national funds.

11/7/2012 7:30:19 PM

Quote :

"At its core its privatization and its paid for by new taxes."

Not even close. At its core, Obamacare is meant to completely destroy the health insurance market. That is its intent, and that is what it will do. That is NOT privatization. The ultimate goal is socialized medicine, which is why Obamacare is socialism, pure and simple.

Quote :

"Biggest downside is it creates major competition for private business owners. But that's what capitalism is all about, right?"

Dude. Government doesn't compete with business. It essentially eradicates it. To borrow a phrase from the republican primary, "Government competes with business the same way an alligator competes with a duck: it eats it."

Quote :

"its not socialism, its privatization, and its the problem"

If you think that "privatization" is the problem in healthcare today, then you simply don't understand what is happening. To suggest that we have anything resembling a "free market" in healthcare is to be willfully ignorant of the facts.

Quote :

"If there is no profit motive, and thus a lower profit margin, you can be less efficient and less expensive."

If there is no profit motive and also no incentive to run a fiscally solvent operation, then what makes you think costs won't rise?

11/7/2012 7:59:13 PM

^ So requiring everyone to buy PRIVATE insurance with their own money (or possibly with government money) is SOCIALISM?

11/7/2012 8:34:45 PM

Quote :

"this was an extreme way to do it, and it is set up in a way that could eventually evolve into a horrendous NHS form of administering healthcare"

This system doesn't even set up a generally available public insurer, let alone a government-owned network of hospitals; any "evolution" toward the nationalization of basic health-care would need further Congressional and Constitutional action.
(I put "evolution" in quotes because the actual NHS was instituted at once from a nearly all-private system in the UK.)

11/7/2012 8:35:19 PM

^^ private insurance that must provide every last thing the government says it must have? What part of that, to you, is "private"? It's actually worse than private, in that case. Moreover, like I said, the intent of Obamacare is to destroy the private health insurance companies so that democrats can say, with a big shit-eating grin, "Hey, we tried the free market and it didn't work. Now on to socialized medicine!!!" When your intent is socialism from the beginning, you don't get free-market brownie points by claiming to do something via private companies

11/7/2012 8:38:22 PM

Ground beef is not private, because the USDA says it must contain at least 73% actual meat to be called "ground beef"; health insurance companies are not private, because HHS says their revenues must be used for at least 85% actual health-care.

11/7/2012 8:42:02 PM

Ummm. Dictating some specifications for a product is not the same as dictating damned near every specification for it. Surely you can see the difference between the gov't saying what something must be in order to be sold at all, and gov't saying what something must be in order to receive a certain label, right? This isn't a matter of only "x% of premiums must go to such and such a service." This is a matter of nearly the entire product being directly specified by the government.

Second, the purpose of USDA labeling of ground beef is not to undermine the entire beef industry so that the gov't can later take it over.

Moreover, Chance would have us believe that if any part of the system is claimed to be private, even if it actually isn't, then the whole entire system is private, and that is absurd. Ronnie's Widgets might supply one specific bolt for my car, but that doesn't mean the maker of my car is Ronnie's Widgets.

11/7/2012 9:10:18 PM

Can we also stop pretending that health care is something that can ever be adequately addressed by a "free market" approach? Can we please acknowledge that there is an inherent uniqueness to health care that makes it impossible for a "private" system to ever work?

For one, consumers are assumed to act rationally in a free market. Left to their own devices, consumers don't purchase health care rationally, they only purchase it when their need for it is at the absolute highest. This would be like only buying food when you started starving to death. Would the free market still work for food?

A free market also requires competition and choice to work. The nature of health care constrains competition and choice. When your liver fails, you need a new liver. You can't get some other treatment or medicine that will fix it. There is only one choice, and you'll pay whatever it costs to not die. When your kid gets a 106 degree fever in the middle of the night, you don't shop around for the cheapest urgent care center, you haul ass to the closest one or call for an ambulance.

So can we please just admit that health care is a unique problem that requires unique solutions?

[Edited on November 7, 2012 at 9:48 PM. Reason : :]

11/7/2012 9:46:06 PM

Quote :

"Can we also stop pretending that health care is something that can ever be adequately addressed by a "free market" approach?"

At the point where you can show that, sure.

Quote :

"Left to their own devices, consumers don't purchase health care rationally, they only purchase it when their need for it is at the absolute highest."

Maybe, maybe not. That is why letting people pay the penalty for their bad decisions comes in to play. When you bail people out for making bad decisions, what, exactly, do you expect them to do? You are comparing what people do today, where we are encouraging bad decisions, to how people would behave without the horrible incentives that our gov't meddling has provided. If you want people to make good decisions, then you want LESS of what we currently have, and you certainly don't want Obamacare. When people can now buy health insurance at any time, no matter what, then what incentive is there to do the responsible thing and purchase it ahead of time?

Quote :

"A free market also requires competition and choice to work. The nature of health care constrains competition and choice."

Except it really doesn't. There is nothing inherent in health care that constrains competition and choice. You are suggesting that the only way there is choice and competition is right when you need it, yet nothing could be further from the truth. There other ways that choice and competition can enter the market. is it not possible that I might choose my living arrangements based on the locations of urgent care centers? If an area has a reputation for being a "health care desert," then people aren't going to move there, or, someone is going to try and swoop in and provide some kind of services to that area.
Furthermore, you are trying to equate emergency services with any and all types of health care, and that's just myopic.

11/7/2012 10:01:49 PM

Quote :

"Let's stop pretending Obamacare is socialist Now that Obama is re-elected, can we stop pretending that Obamacare is some kind of socialist program and call it what it is: privatization? "

These kind of sentences make me feel like a brain aneurysm is imminent.

11/7/2012 11:01:41 PM

Quote :

"That is why letting people pay the penalty for their bad decisions comes in to play. "

Right, but that's the thing, when someone makes a poor decision in how they buy health care, it's the responsible consumers of care that pay the penalty. Again, this is unique to health care.

Quote :

"There other ways that choice and competition can enter the market. is it not possible that I might choose my living arrangements based on the locations of urgent care centers? If an area has a reputation for being a "health care desert," then people aren't going to move there, or, someone is going to try and swoop in and provide some kind of services to that area."

Again, you're assuming consumers will act rationally. What if they don't?

Quote :

"Furthermore, you are trying to equate emergency services with any and all types of health care, and that's just myopic."

No it's not. Emergency care and expensive treatments for unforeseen chronic conditions is the reason why health care is such a problem. It's why we need insurance.

11/8/2012 12:24:49 AM

I'm willing to bet $1,000 that not a single person in this thread read Obamacare.

11/8/2012 12:55:01 AM

did you?

11/8/2012 1:32:00 AM

Hell no. It's impossible to read. It's written in machine code (GO TOs, POINTERS, LOOPS, EXCEPTIONS, AMENDS, STRIKEOUTS). Only a computer or 1000 people assigned to reading 2 pages could read and interpret that bill.

11/8/2012 1:43:02 AM

Perhaps I may be of assistance: I am skilled in Logo.

11/8/2012 1:55:38 AM

I've read parts of it; although the text of the bill doesn't make a compelling narrative (it's mostly, as IdiotSavanTxBoY alluded to, a set of instructions for modifying the United States Code, and therefore requires cross-referencing the Code to determine its effect), the places where large pieces of text are added definitely help you get an idea about it.
This is the law as entered into the Statutes at Large: http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf

If you want "compelling narrative," consider reading Supreme Court opinions; I recommend the one upholding most of Obamacare without granting general authority to compel the purchase of a product or service, while making its Medicaid expansion voluntary on the part of the states.
The slip opinion for NFIB v. Sebelius is here: http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf

11/8/2012 2:23:50 AM

Quote :

"Ummm. Dictating some specifications for a product is not the same as dictating damned near every specification for it. Surely you can see the difference between the gov't saying what something must be in order to be sold at all, and gov't saying what something must be in order to receive a certain label, right? This isn't a matter of only "x% of premiums must go to such and such a service." This is a matter of nearly the entire product being directly specified by the government."

"Certain label" is what sells the product...if it was labeled 5% beef nobody would buy it. So his analogy is actually quite on the spot.

11/8/2012 2:36:24 AM

Some people are having trouble with this because in their mind private==free market.

As soon as you see that this is not true, you will recognize that we have private health care and it has ballooned because of privatization. Our health care is not a free market, would not be a free market with any kind of voucher plan, and is private. Its the worst kind of privatization and its the reason costs are so high.

We need actual socialized healthcare.

11/8/2012 7:03:42 AM

Quote :

"For one, consumers are assumed to act rationally in a free market. Left to their own devices, consumers don't purchase health care rationally, they only purchase it when their need for it is at the absolute highest. This would be like only buying food when you started starving to death. Would the free market still work for food? "

Can we stop pretending that "health insurance" is equivalent to "health care"? Of course people only buy health care when they need it. That's because buying it at any other time is a waste of money because its not a product you can store. What you're saying is like saying people only buy veterinary care when they need it most.

11/8/2012 8:00:14 AM

A welfare state is not Socialism. Obamacare did not put the means of production into the hands of the working class. Words have meanings. Stop.

11/8/2012 8:01:22 AM

Quote :

"I'm willing to bet $1,000 that not a single person in this thread read Obamacare."

It's almost as though law is a complex thing that, like all complex things, we have a class of skilled specialists to read and interpret.

I mean, I guess if you like frivolous lawsuits and loopholes, we can pare down the laws to one page apiece, but I personally prefer it be thorough rather than simple.

11/8/2012 8:06:07 AM

Quote :

"If there is no profit motive, and thus a lower profit margin, you can be less efficient and less expensive. cost is the metric we need to look at."

Oh boy. Alright, let's break this up. If we speak of efficiency, we could be speaking of efficiency of:
- The delivery of health care
- The payment for health care by insurance

Obamacare does have some provisions for the latter. There is talk of improving the efficiency of the delivery of health care, for instance, reducing the number of unnecessary procedures.

But regarding what you said, pretty much every single bit is wrong. When where there be no profit motive? That's not changed at all. There will be some expansion of Medicaid but a larger expansion of the people on the rolls of private insurance. That results in more profit motive. The companies are prevented from spending <60% of the premiums on hospital payments, but virtually none of them are below this margin to begin with. This also ignores the obvious fact that insurance profits are on the order of 2% of total costs. If you're looking to reduce cots, this is a truly epic fail. Insurance fucks it up, not because of profits, but because of adding extra work in an effort to maximize profit (denying payments, lawsuits, on and on), and the system you speak of has nothing at all to address this.

Insurance companies will continue to fuck us over like they always have. Does Obamacare actually do anything to reduce insurance company profit, other than the <60% item? Do you see just how much shit you're talking here?

11/8/2012 8:21:36 AM

Quote :

"A welfare state is not Socialism."

another important distinction

thanks, Str8foolish

Quote :

"But regarding what you said, pretty much every single bit is wrong. When where there be no profit motive? That's not changed at all. There will be some expansion of Medicaid but a larger expansion of the people on the rolls of private insurance. That results in more profit motive. The companies are prevented from spending <60% of the premiums on hospital payments, but virtually none of them are below this margin to begin with. This also ignores the obvious fact that insurance profits are on the order of 2% of total costs. If you're looking to reduce cots, this is a truly epic fail. Insurance fucks it up, not because of profits, but because of adding extra work in an effort to maximize profit (denying payments, lawsuits, on and on), and the system you speak of has nothing at all to address this. Insurance companies will continue to fuck us over like they always have. Does Obamacare actually do anything to reduce insurance company profit, other than the <60% item? Do you see just how much shit you're talking here?"

You are completely misunderstanding everything I have said. In no way have I endorsed or supported Obamacare. In no way have I stated that profits are the only cause (or primary cause) or increased costs. I was responding to a specific question/comment.

Costs are out of control because privatization funnels government money to the private industry. There is no market feedback, its very similar to how education costs have increased. Health care has no incentive to reduce costs because they government spending will just rise to match them. The only way that costs can be controlled, is through government negotiation of rates for money from federal programs. Vouchers would still be the same system, except it would likely weaken the ability of the government to negotiate these rates so prices would increase any faster.

The way to keep costs down and maintain access is to keep government money in government services, have the government provide some level of healthcare, and allow private healthcare to exist along with it.

[Edited on November 8, 2012 at 8:29 AM. Reason : .]

11/8/2012 8:23:41 AM

Quote :

"The way to keep costs down and maintain access is to keep government money in government services, have the government provide some level of healthcare, and allow private healthcare to exist along with it. "

Right, that option we abandoned before we reached the final form of Obamacare.

11/8/2012 8:39:13 AM

For real. Obama started campaigning on universal, single payer, then it was downgraded to a public option, then finally the mandate because they thought Republicans would agree to one of their own ideas if the Democrats proposed it (ha ha ha).

If Obamacare is Socialist, the Republicans of the 1990's were Socialist, and campaign-2008-Obama was fucking Kim Jong Il.

[Edited on November 8, 2012 at 8:48 AM. Reason : .]

11/8/2012 8:47:39 AM

Obama never campaigned on universal single payer. His campaign plan was a series of reforms to lower the cost of care, but he opposed any kind of individual mandate.

After the election, he realized that the individual mandate was necessary in order to spread coverage to the poor and uninsurable.

[Edited on November 8, 2012 at 9:30 AM. Reason : 2]

11/8/2012 9:29:52 AM

healthcare costs are what drive healthcare costs, not the payer. if you want to control costs you have to fix all the problems that exist at the provider level. anyone who tells you otherwise is a lying sack of shit (politicians) or an idiot (political supporters)

the best way to start fixing providers is to start implementing process controls whole hog. the few good bits of obamacare are the penalties that punish poor process controls, but they're limited in scope and amount.

We need more work at the provider level and less smoke and mirrors about payment.

11/8/2012 9:34:51 AM

I agree there are several good bits of Obamacare. My problem is that I don't trust the people in charge to identify what's good and what's bad. Case in point...

Quote :

"healthcare costs are what drive healthcare costs, not the payer. if you want to control costs you have to fix all the problems that exist at the provider level. anyone who tells you otherwise is a lying sack of shit (politicians) or an idiot (political supporters)"

Let's think about who we're really dealing with. Politicians (including good old BO) have rallied against price "gouging" in the northeast after Sandy. They found it preferable that people would wait in line for 6 hours to get gas, over the concept of private actors making a profit on the scarcity.

Just think about how much good people in the area could have done with 6 hours when there was so much damage to homes and infrastructure, think about the people who could have used help! Freeing up the time, in and of itself, is enough of a reason to allow markups.

They don't care. The sense of morality about profits in the health care industry is more important to them than people getting the care they need.

11/8/2012 10:01:57 AM

Quote :

"Obama never campaigned on universal single payer. His campaign plan was a series of reforms to lower the cost of care, but he opposed any kind of individual mandate."

http://www.youtube.com/watch?v=fpAyan1fXCE

11/8/2012 10:22:03 AM

That was from 2003, dude.

In the 2008 election cycle, he his healthcare stance was a series of reforms that preserved the employer-based model of coverage, while lowering cost. He opposed any type of mandate until after he was elected.

http://www.politifact.com/truth-o-meter/statements/2009/jul/16/barack-obama/obama-statements-single-payer-have-changed-bit/

[Edited on November 8, 2012 at 10:31 AM. Reason : 2]

11/8/2012 10:29:29 AM

Quote :

"Can we stop pretending that "health insurance" is equivalent to "health care"? Of course people only buy health care when they need it. That's because buying it at any other time is a waste of money because its not a product you can store. "

But that's essentially what health insurance is, health care "you can store". The problem is, people only buy it if they believe they really need it. However, it's impossible to predict when and if you will need health care, so people who do this are not acting rationally either.

[Edited on November 8, 2012 at 10:40 AM. Reason : :]

11/8/2012 10:30:58 AM