Your bloody signature :D I was watching TV and not paying attention and wondering what was wrong with my cursor.

I know! Best. Signature. Ever.

It caught me out too once. It's really annoying, and great at the same time.

NM, too many brick walls in this thread!

thats not true unless the country has an agreement with healthcare providers - and its not universal ; for example , whilst i have an EHIC card for within the EU , when i was in austria a few years back , we were told we could only use certain doctors or hospitals and there would be a `top up` to any care provided.


and in the us - you have no insurance , you pay the bill - the NHS wont pay it

I over generalized. Ive heard of Canadians using emergency medical care in the States and the Canadian government foots the bill. Either way the US isn't going to provide health care to visiting foreigners; took us long enough to cover our own people.

That was a pretty funny episode.

... except our own people are still not covered. Note how this changes so little, by ensuring that people who don't work continue to collect at the expense of those who do... and those who work hard but don't make enough money to buy insurance are now not only going to be screwed by not having healthcare, but also by a penalty. Oh, and the penalty is just large enough to be basically an insult, rather than enough to actually pay for any kind of healthcare. Given that it starts at $800, and the per-capita healthcare spending in the US tops $8000/yr, I think anyone who can do math realizes exactly how useful this measure is.

The concept is certainly important, in that everyone is going to have to pitch into the common healthcare fund, because it's the one expense that only an infinitesmal percentage of the population can bear on their own. But the execution of it is toothless and deeply flawed.

Similarly to the fiasco of the Massachusetts plan which this legislation was roughly based on, and similar to the federal homeowner subsidies, the bank bailouts, the car maker bailouts, and more or less the entire cluster**** of the past decade, the law's consequence will largely be to reward sitting at home and collecting welfare, and punish the working class.

However, don't get me wrong, the fact that this is a turd of a bill doesn't mean I wanted it struck down. The fact of the matter is that I was equally terrified of the Supreme Court decision going the other way. After all, our healthcare system is in a desperate need of reform, and defeat of this act would likely sideline such an effort for years. Also, some provisions of the act are essential to the proper functioning of the healthcare system and should have been law decades ago. Things like ensuring that pre-existing illnesses don't prevent people from obtaining insurance, which in the past meant that if you lost your job (which had company insurance) and you were ill, you were basically left with the choice to go bankrupt or die... and most likely did both.

I'm not aware of many countries that provide overseas healthcare. I have annual travel insurance to cover me as there is no way I would rely on the NHS picking up the tab in Kuala Lampur!

We actually have morons here that are FOR this new healthcare? Must be some goody goody two shoes city dwelling young folks on here that does not mind letting the government have a finger on every aspect of your life because that is exactly what they are attempting to do. We are letting government have way too much control. I do NOT need or want somebody telling me what is good for ME. I can feel my blood boiling already so I am going to step out of this thread. http://www.discussworldissues.com/fo...ilies/mad1.gif

Can you tell me your understanding of what Obamacare is? What does it change?

--- Post Update ---

Gnius,

You did not touch the fact that, somehow, this plan attempts to make health care more affordable. Nor did you consider the fact that a non-trivial portion of the population gets -at least- partially subsidized health care through their employer. Not as many working-classers are paying 8k/year out of pocket as you imply.

Also, please expand on what you consider a "fiasco" in Massachussettes. I work with many middle-classers from Massachusetts that actually approve of the system. Please tie in an explanation for this comment "reward sitting at home and collecting welfare, and punish the working class" in context of the Massachusetts system.

In a nutshell, the principle idea behind Obamacare is that if you force everyone to get insurance, the cost pool is divided between more people, meaning the overall cost to each individual is lower.

The sad fact is, and no one who opposed OC actually wants to debate this point specifically, is that those who are neither insured nor in Medicare, do actually get emergency treatment anyway. Who pays? People with insurance. Not only that, but people who have inadequate insurance and end up being bankrupt or on payment plans they can never complete, also have had their treatment, the hospital got their cash and someone paid. Again, it's people with insurance.

So the argument that "I don't want the government telling me how to live" is simply not applicable to this situation.

Even if you're the most heartless individualist, you'd have to recognize that you either force people to contribute somehow, or completely withhold treatment altogether for those who cannot, or will not pay. You cannot have it both ways.

It's unfortunate that it's impossible to have a measured debate on this subject without retreating into rhetoric about socialism or other nonsense.

I am currently injured have been trying to make this point for a month. My 21k medical bill (before insurance) is not because I got an expensive procedure but because there is the cost of risk embedded in that price. I probably got 5-10k worth of medical attention and the rest goes to pay for those that can't.

I still say a real 5.5% tax added to medicare or some such was the move to make. With what the SCOTUS decided, there will be no savings. None at all. That was all achieved by the states picking up all of the administration fees, and 10% of all new additions to medicaid rolls. Just today Texas declined, as others already have and more shall. You will see a huge amount of people with insurance through their company being dropped. As long as the company spends $2000+ they save money even with fines. The bill likely wouldn't have worked well with everyone on the same page... without, it has no chance. It might even cost more. We'll see.

There is a more fundamental question to answer too, which is this. Where is the money actually going?

It's easy to blame the HMOs... after-all, they're making money and it's easy to hate them. But against a 3-trillion dollar bill, they're "only" making profits in the low-billions. Not an enourmous overhead to be sure.

So what about the hospitals? They're making a killing, right? Maybe some do, but then again there are hospitals that are going bankrupt. Why? Well, back in the early 80's, pretty much anyone and everyone was able to go to hospital for any reason the doctor said. Whether a broken spine or just some respite, hospitals accommodated everyone for everything. There were 7800 hospitals in 1985 (now there are 5800, down 17%) while the population has grown 30%. The fewer hospitals are emptier too.

Now, patients are only admitted for more serious issues, which are more expensive and far less profitable (because of the reasons we've outlined above... many are not paying and need treatment anyway). Ironically, advances in medical care have starved hospitals of income. Keyhole surgery, outpatient treatments, quicker recoveries due to better drugs and therapies etc. And finally, hospitals spend a lot of time and money fighting "over charge" claims made by the commission insensitived Recover Audit Contractors, not to mention the hordes of managers and administrators they have to hire to ensure such charges never occur.

So if the hospitals are not making the money, who is? Doctors? Well, a primer on Doctor Vs Hospital billing might be helpful here. From watching ER or other TV shows, you might be forgiven for thinking doctors are employed by hospitals. Zing. Usually no, they're independent but have 'hospital privileges'. Doctors charge out independently to the insurance companies, and their billing is rarely tied to hospital billing. Insurance companies don't like paying the doctors (they don't like paying anyone, it hits their bottom line) but doctors don't go through nearly the hell hospitals go through.

Insurance companies will deny payment to the hospital for the tiniest discrepancy between the chart and the treatment. Even if there is literally forensic evidence that a treatment was absolutely necessary, and the doctor messed up the chart, as far as the HMO is concerned, it never happened. Who gets the kick? The hospital, not the doctor. All the doctor gets asked is "did you see the patient today"?

Anyway, are US doctors over-paid? The US is ranked 3rd in Doctors pay overall (behind Austria and The Netherlands) but barely in the top 20 for doctors per capital (way behind Cuba, the EU average, UK, Malta, Israel and others). So the money isn't going to the doctors.

So... where does the money go? Where?

Zoo,

Good post.

To answer your question without a thread of jest: Goldmann Sachs. I just have a hunch.

Now, stop talking medicine and go fabricate some libor.

I might just do that... although if I see another post about finance, I might go into a rant about the over-stating of derivative values or debt. I think Reuters made a comment this morning about the LIBOR being linked to "$500 trillion of derivatives contracts". If only some of the bloggers they now seem to employ knew the difference between a notional value and cash value, we might have some intelligence in the financial news, rather than just sensational waffle.

Same applies to the amazing figures they attribute to debt.

Do you mean to say that if you lend me 100 bucks and I pay you back, then lend you 100 bucks and you pay me back, 400 dollars worth of contracts were not exercised?

No. On the derivatives I mean if we trade a swap on $10m notional, 5% Vs float and the net difference until termination is $50,000, then the contract is 'worth' $50,000, not $10m and not even 5% of $10m over 2 years.

On the debt, I mean if I lend you $100, and you lend $90 of that to a friend and he lends $50 of that to another friend, the principle outstanding (and thus the debt) is still $100, not $240.

I see. (I was being tongue-in-cheek).

Correct me if I am wrong but it sounds like you are saying the actual value, not the leveraged value, should be reported.