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A story in two Tweets
Topic Started: Sep 21 2017, 12:05 PM (362 Views)
John D'Oh
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MAMIL
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His Gofundme is kind of like insurance after-the-fact.
What do you mean "we", have you got a mouse in your pocket?
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Aqua Letifer
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ZOOOOOM!
Opps.
I cite irreconcilable differences.
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George K
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Finally
John D'Oh
Sep 21 2017, 12:05 PM
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For the same reason that our menopausal female staff had to buy insurance that covered maternity?
A guide to GKSR: Click

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- Mik, 6/14/08


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KlavierBauer
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HOLY CARP!!!
I've never understood the "why do i have to pay for insurance that I don't need" question.

I understand the principle behind it, but the logic is folly.

The interesting thing in this specific scenario - is that he was forced to purchase insurance for that car that someone else hit - I'm hoping he understands that shared risk pool a bit better, now.
"I realize you want him to touch you all over and give you babies, but his handling of the PR side really did screw the pooch." - Ivory Thumper
"He said sleepily: "Don't worry mom, my dick is like hot logs in the morning." - Apple

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Copper
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Mandatory car insurance is completely different. That is to protect others on public roads. And possibly in the case of a car loan to protect the bank that made the loan.


The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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Copper
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KlavierBauer
Sep 21 2017, 01:54 PM
I've never understood the "why do i have to pay for insurance that I don't need" question.

I understand the principle behind it, but the logic is folly.


It's easy to understand. The logic is not folly.

The guy doesn't want to buy insurance.

It should be his call.

If it turns out that he would have been better off with it, too bad he lost.

It's no different than rolling the dice in Las Vegas except maybe that he has more control of the outcome.

I can't understand why you can't understand that.

Maybe you think you know better than him, but why is it so hard to understand that a young healthy guy thinks health insurance is a waste, for a large number of young healthy people it is.

The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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KlavierBauer
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HOLY CARP!!!
Quote:
 
Maybe you think you know better than him, but why is it so hard to understand that a young healthy guy thinks health insurance is a waste, for a large number of young healthy people it is.

What you're describing is the principle - which I understand and partially agree with.
What's folly is the logic behind is statement.

If you just want to buy what you want, skip insurance and go fee-for-service.
He's smart enough to understand that he will need coverage at some point in his life, as are you.

It's not completely different from car insurance ... There are substantial differences between the two models of course, but the idea of shared risk in the event that something occurs which you can't cover out of pocket, is the same between the two.

Required for the kind of shared risk pools we need in health insurance, is a sort of "triangle" of three main pillars. Healthcare policy as a whole has to address all three, or none of the pieces ever fit together very well (or at least, they typically don't).

So - if you want guarantee issue and affordability (without which, you can just stick with fee-for-service and skip insurance altogether), you have to have obligatory coverage.
The ACA would have fewer issues if the "fine" were substantially higher. Having it be more affordable to pay the fine and skip the premium is a large part of the hike in premiums. This is no secret at the healthcare policy level, and is well understood "in the industry" - but the public doesn't typically want to look at things with that level of detail.
That's not to say this is the "single" thing wrong with healthcare, but specific to the ACA, things would be much cleaner and sustainable with a larger fine - an incentive to insure.

Peter Schiff's got some great thoughts on this aspect, and he's a guy I wouldn't typically agree with on a lot of this stuff - but he understands the "triangle" and how it applies to the ACA specifically.
"I realize you want him to touch you all over and give you babies, but his handling of the PR side really did screw the pooch." - Ivory Thumper
"He said sleepily: "Don't worry mom, my dick is like hot logs in the morning." - Apple

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xenon
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Sep 21 2017, 02:58 PM
KlavierBauer
Sep 21 2017, 01:54 PM
I've never understood the "why do i have to pay for insurance that I don't need" question.

I understand the principle behind it, but the logic is folly.


It's easy to understand. The logic is not folly.

The guy doesn't want to buy insurance.

It should be his call.

If it turns out that he would have been better off with it, too bad he lost.

It's no different than rolling the dice in Las Vegas except maybe that he has more control of the outcome.

I can't understand why you can't understand that.

Maybe you think you know better than him, but why is it so hard to understand that a young healthy guy thinks health insurance is a waste, for a large number of young healthy people it is.

Don't we already pay for it though?

Quote:
 
Fifty-five percent of emergency care goes uncompensated, according to the Centers for Medicare & Medicaid Services

https://web.archive.org/web/20100304211332/http://www.acep.org/patients.aspx?id=25932

It's not like hospitals can let patients bleed out. The cost of the uninsured just gets pushed onto everyone else. Some dude who could have got statins will now go to the emergency room when he has a massive coronary.
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Luke's Dad
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The elephant in the room is that even with Obamacare, the guy would still likely need a GoFundMe to cover his deductible and because of the crappy coverage.
The problem with having an open mind is that people keep trying to put things in it.
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Copper
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KlavierBauer
Sep 21 2017, 03:20 PM

So - if you want guarantee issue and affordability (without which, you can just stick with fee-for-service and skip insurance altogether), you have to have obligatory coverage.

Guarantee affordability?

Nobody is going to guarantee that. And few would ever try to define that.

I have no trouble imagining that there are a lot of people who do not want or need health insurance.

Leave them alone, let them assume the risk and let them keep their money.

If most people want to pool their money and buy insurance, fine. Let them do it.

If it is too expensive or not available that is not the problem of the few that don't participate.
The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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Copper
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xenon
Sep 21 2017, 03:34 PM
The cost of the uninsured just gets pushed onto everyone else.

Actually to start with it is "pushed on" the uninsured. They get a bill.

If they have the money they'll pay. If they don't it's likely they can't afford the insurance anyway.

My obamacare premium for me and my wife this year was over $14K. And the deductible is $14K.

I take $28K out of my pocket before the insurance starts to pay. That is way beyond anyone's definition of affordable.

Then it starts over again the next year.
The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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xenon
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Sep 21 2017, 03:54 PM
xenon
Sep 21 2017, 03:34 PM
The cost of the uninsured just gets pushed onto everyone else.

Actually to start with it is "pushed on" the uninsured. They get a bill.

If they have the money they'll pay. If they don't it's likely they can't afford the insurance anyway.

My obamacare premium for me and my wife this year was over $14K. And the deductible is $14K.

I take $28K out of my pocket before the insurance starts to pay. That is way beyond anyone's definition of affordable.

Then it starts over again the next year.
Well - by some estimates more than half of emergency visits are still uncompensated - so that got pushed on to someone - those hospitals are still paying their employees and shareholders.

I hear you though, man - but to me the much of the U.S. healthcare system is just an absolute mess. It needs incremental improvement though - not two political parties tearing the other sides' ideas down when the pendulum swings their way. I don't know what's so anathema to the republicans about the individual mandate now - they could have easily got something passed that fixed Obamacare instead of starting with a blanket repeal.

It's the worst of a private and socialized system mashed together. I grew up in Canada, they have their own share of problems there (they're actually a bit too far on the socialized/private balance towards socialized - should be closer to some European models) - but there's no bananas crap like that over there.

And the U.S. is already pretty socialist - if we can define that as % of GDP spend on public healthcare programs:

https://data.worldbank.org/indicator/SH.XPD.PUBL.ZS?locations=US-CA-FR-GB-NO

The philosophical narrative doesn't match the data sometimes.
Edited by xenon, Sep 21 2017, 04:15 PM.
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KlavierBauer
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HOLY CARP!!!
Quote:
 
Guarantee affordability?

Nobody is going to guarantee that. And few would ever try to define that.


Guarantee Issue, and affordability - two separate things.
This is kind of exactly what I'm talking about ...

Quote:
 
I have no trouble imagining that there are a lot of people who do not want or need health insurance.

Leave them alone, let them assume the risk and let them keep their money.


Everyone *will* need medical coverage of some sort or another at some point. Most health costs are incurred in the final years of life - but let's say you're right and tons of people won't ever need to pay $10k per day just for room/board at their local hospital - they can't just safely assume this risk on their own.
First, it would be a federal crime to turn them away from EDs. Second, there is a public health concern with allowing people to simply choose whether or not they want to treat illness.

Quote:
 
My obamacare premium for me and my wife this year was over $14K. And the deductible is $14K.

I take $28K out of my pocket before the insurance starts to pay. That is way beyond anyone's definition of affordable.

This is not an ACA issue, but your state's exchange and the companies selling plans where you live.
Those rates are dictated by a number of factors - many of which are affected by the very low fine I mentioned earlier.
Let's assume though, that your particular plan were the most affordable possible - even $14k would be incredibly cheep if you were in the hospital for surgery and accompanying tests. My open heart surgery was well over a half million in billed expenses. I'd much rather owe the hospital $14k than $500k.

How many times have you been hospitalized for more than a day and dealt with these issues and the insurance companies afterward?
"I realize you want him to touch you all over and give you babies, but his handling of the PR side really did screw the pooch." - Ivory Thumper
"He said sleepily: "Don't worry mom, my dick is like hot logs in the morning." - Apple

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Copper
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Quote:
 
Guarantee Issue, and affordability - two separate things.

Affordability has become next to impossible, forget about it.

Guarantee Issue, is terrifying to insurance companies because it is impossible to calculate.

Quote:
 
they can't just safely assume this risk on their own.


Sure they can. That's what people do. They make choices. If they are wrong they lose. It happens every day with all kinds of choices.

Quote:
 
Second, there is a public health concern with allowing people to simply choose whether or not they want to treat illness.


So what are you saying? The feds are going to force expensive treatments on people whether they want them or not? How does that work? "Take this hip replacement or we are going to toss you in jail", is that it?

Quote:
 
This is not an ACA issue, but your state's exchange


This is definitely an ACA issue. My rates were less than 1/3 of that before ACA mandated these unlimited liabilities for the insurance companies. I have had two new companies since ACA started and now both have left the State because they have had huge losses here.

And you don't have to assume. My $14K policy with a $14K deductible was the cheapest available plan - $28K out of pocket before the insurance kicks in was the cheapest possible last year. And that company went out of business because it was not enough, this year should be worse.

Quote:
 
any of which are affected by the very low fine I mentioned earlier


Fining people who can't afford the premiums is not going to cover a lot of costs.

Quote:
 
even $14k would be incredibly cheep if you were in the hospital for surgery and accompanying tests.


No kidding, that's why I buy insurance. It's all about catastrophic coverage. The day-to-day stuff is all out of pocket.

The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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KlavierBauer
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HOLY CARP!!!
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Guarantee Issue, is terrifying to insurance companies because it is impossible to calculate.

I'm not sure what you're trying to say here, but we have Guaranteed Issue currently, there's nothing to calculate.
I have two kidney transplants and a bionic heart, I want to purchase health insurance. Guaranteed Issue means I can get it.
Affordability means that I can't simply be denied-by-cost as an endgame around the Guaranteed Issue ... that's why these two always go together.

Quote:
 
So what are you saying? The feds are going to force expensive treatments on people whether they want them or not? How does that work? "Take this hip replacement or we are going to toss you in jail", is that it?

Argumentum ad Absurdum much? It's pretty clear that's not what I'm talking about.
To your point, however, there is a thing called "implied consent." If you collapse of a heart attack, the ambulance is going to pick you up, treat you, and get you to the hospital where you'll continue to be treated. So yeah - in some cases you *will* be treated outside of your consent because certain consent is implied. Get a DNR if you don't want to be treated.

Quote:
 
Fining people who can't afford the premiums is not going to cover a lot of costs.

Of course not - people who can't afford the fee can qualify for exemption.
The fee/tax is designed for healthy, young, high-income earners who realize it is cheaper to pay a few hundred bucks than pay for an insurance premium, thus removing themselves from the pool of shared risk that they'll still be tapping into someday. This drives everyone else's premiums up, of course.
Again - you might appreciate Peter Schill's take on this, as a fellow conservative.

Quote:
 
No kidding, that's why I buy insurance. It's all about catastrophic coverage. The day-to-day stuff is all out of pocket.

That's great - it's really really nice to be healthy, isn't it? (I assume so - I don't know)
Cherish that as long as you can - it will disappear.
The point isn't that the system (or even the ACA) is great - the point is that we have something we can work on and improve upon right now that will affect people's lives in a very real and positive way.
"I realize you want him to touch you all over and give you babies, but his handling of the PR side really did screw the pooch." - Ivory Thumper
"He said sleepily: "Don't worry mom, my dick is like hot logs in the morning." - Apple

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Copper
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KlavierBauer
Sep 21 2017, 07:42 PM
Quote:
 
Guarantee Issue, is terrifying to insurance companies because it is impossible to calculate.

I'm not sure what you're trying to say here, but we have Guaranteed Issue currently, there's nothing to calculate.

The insurance company calculates how much they expect to spend to cover their liabilities.

Then they set their rates higher than that so they will make a profit.

If you are running an insurance company and can't do this calculation you are out of business.

Quote:
 
The fee/tax is designed for healthy, young, high-income earners who realize it is cheaper to pay a few hundred bucks than pay for an insurance premium, thus removing themselves from the pool of shared risk that they'll still be tapping into someday. This drives everyone else's premiums up, of course.


Everyone knows how the economics work. The point is that these people who don't buy insurance should be able to buy or not buy whatever they want. The fact that the premium might go up if some people don't buy insurance is not a good reason to just take money from these people.

If you don't want to buy health insurance, fine, then you don't get the benefits. And no you don't get free care anyway, you get a bill.

Quote:
 
The point isn't that the system (or even the ACA) is great - the point is that we have something we can work on and improve upon right now that will affect people's lives in a very real and positive way.


You want people to spend their money to your benefit, fine, that is great, everyone wants the government to support their favorite cause. I just don't buy the idea that this cause takes special priority over the individual and their right to make their own choices about buying a commercial product.

The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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KlavierBauer
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HOLY CARP!!!
We obviously will have to agree to disagree on this one - but I still don't understand it.

As most here know, I'm someone who identifies highly with Libertarianism, but departs in favor of the group in some of the many areas where Libertarianism fails. I value liberty, I favor a smaller, under-control government, and I value and cherish the power of the individual to manifest their dreams. *BUT* I can't support those things at the cost of everyone who isn't me ...
I want pot growing gay couples guarding their property (should they choose to) with AR-15s.
But there are places where we simply have to do things as a group - not to infringe upon the liberty of anyone, but to guarantee that the foundations of liberty to sacred to us (the ability to pursue one's happiness, while alive) are available to all of us. We do this on myriad levels in everyday ways that we don't care about.
We pay for roads we don't use, we pay property taxes that fund schools for the people who decide to have kids, we oblige people to insure their automobiles, and we allow the state to manage emergency services. All of these would be better managed by private companies, but the risk could very well outweigh the reward, because all of these areas allow for a disruption in the fundamental liberties of the Individual.

I'm happy to pay taxes to educate the kids in my neighborhood and around the state. I don't want one of those smartass carbon-producing replicants, but for those who do, I want it to be educated enough to take society further than I was able to.
That's a public service and a public health concern if not available.

I guess I can support a system where people can opt-out - but would you (or others) support the associated cost? We'd have to basically rewrite federal law about treatment at EDs, we'd have to overhaul the EMS system to know who they can/can't save, etc.
It seems that the young guy above doesn't want to be "forced" to pay into the pool of shared risk, but he also has an expectation that after a car wreck, an ambulance shows up and takes him off to the place where he gets fixed. I'm also guessing he's against the idea that when they get him to the hospital, the surgeon checks to see if he's a payer and if not, lets him die on the table.

I'd rather we all get to the point of realizing that like education and freedom of travel/movement, healthcare is part of "life, liberty, and the pursuit of happiness." We all chip into either a public, or privatized system (i.e., tax or obligatory premium), and we all receive the care we need, when we need it.
Or we could be like Germany and have a system that allows both sides (public vs. private) to coexist fairly well. (shout out to Klaus)

"I realize you want him to touch you all over and give you babies, but his handling of the PR side really did screw the pooch." - Ivory Thumper
"He said sleepily: "Don't worry mom, my dick is like hot logs in the morning." - Apple

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Copper
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The need for food, clothing and shelter is at least as important as healthcare, and it is certainly more universal.

Why don’t you want the feds to force everyone to buy their food, clothing and shelter from the federal government?

And I am not talking about charity or people who are unable to make choices those are special cases.
The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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KlavierBauer
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HOLY CARP!!!
I'm failing to see a corollary between food and healthcare that's meaningful. Neither food, clothing, or shelter have a single for-profit industry sitting between the consumer and consumption. I can make food, clothing, and shelter if I need - the fact that no single entity controls 100% of access to these things allows them to follow normal economic patterns.

Also, I'm not advocating that people be forced to purchase anything from the federal government. I'm asking that everyone who will use healthcare (100% of the population) pay into the shared pool of risk - and that those who choose not to, pay a tax. Really no different than the public education system in this regard.
A kid has a "right" to sit in a classroom for 1/3 of their life, but should only have a right to be treated for cancer if he/she can afford it?

I'd understand some of that logic if healthcare were gold, and the earth would literally never get any more than it already has today. That's not the case, though. It's a scalable product/service whose physical costs *should* drop proportionally to Moore's law, since its progress is linked very tightly to increases in processor speed and technology.
There are no physical laws violated in working as a society to provide this as a basic human right as we do food and potable water (water actually, is a much more limited resource than healthcare and yet we have fountains spitting the stuff out all over every populated area).

But - I'm staring off into StarTrek future now, and I'm not sure we're ready to think about what we *could* do as a species, we're still too worried about what's "fair" and economical.

The point is simple - if you want guaranteed issue and affordability (which most people I've talked to on either side of the aisle, *do*), you have to have something *like* the Individual Mandate.
"I realize you want him to touch you all over and give you babies, but his handling of the PR side really did screw the pooch." - Ivory Thumper
"He said sleepily: "Don't worry mom, my dick is like hot logs in the morning." - Apple

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Copper
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KlavierBauer
Sep 22 2017, 09:28 AM
I'm failing to see a corollary between food and healthcare that's meaningful. Neither food, clothing, or shelter have a single for-profit industry sitting between the consumer and consumption. I can make food, clothing, and shelter if I need - the fact that no single entity controls 100% of access to these things allows them to follow normal economic patterns.

you have to have something *like* the Individual Mandate.

Food is more necessary than healthcare. If you want the government to supply a necessity food would make a lot more sense than healthcare.

What is this single for-profit industry? Do you think that healthcare or insurance comes from a single supplier?

We have all kinds of independent pharmacies, doctors, hospitals, EMTs, insurance companies and many other suppliers.

And they compete with each other.

As far as the individual mandate is concerned, the majority of non-elderly people get their healthcare through their employer so the individual mandate doesn't apply to them.

For the remaining population many, like me, buy insurance on the open market which is now obamacare for most.

That leaves those who don't have insurance from either of those sources and also don't have Medicaid. If you really think that group represents a large amount of untapped money I think you are probably wrong. First, it is a small group and second these folks don't have a whole lot of money. The reason most of them don't have health insurance is probably because they can't afford it.

You are not going to make health insurance affordable by taking money away from a small group of people who can't afford health insurance. There is little or no money there to be taken.

The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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Frank_W
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Resident Misanthrope
Is being sassy a necessity? Should the government supply more bling and sassyness, free of charge to the dreamers who want to also be quite sassy? Perhaps they could even start supplying packets of super fresh sassy in MRE packets, because, after all, don't our troops deserve a little sassyness in their lives?

Just wondering...
Anatomy Prof: "The human body has about 20 sq. meters of skin."
Me: "Man, that's a lot of lampshades!"
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KlavierBauer
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HOLY CARP!!!
Quote:
 
Food is more necessary than healthcare. If you want the government to supply a necessity food would make a lot more sense than healthcare.

Still failing to see the corollary - you haven’t made a different argument, you’ve just reiterated the last one. I never said that anyone should purchase healthcare - or food - from the government. I very clearly stated that people have to pay into the system if they expect to get something from it. Currently, for most, the system is privatized, so they (like you) pay their premiums to a for-profit insurance provider.
Which segues into your next question.
Which single for-profit industry to think I’m referring to? I’m only aware of one single for-profit industry within the healthcare industry; called healthcare.

Your last two paragraphs were already addressed in previous posts. There’s either a lack of understanding about the myriad pieces to the ACA, or you’re not reading what I’m writing. (Or I’m incoherent, which I’ll grant is a possibility)
"I realize you want him to touch you all over and give you babies, but his handling of the PR side really did screw the pooch." - Ivory Thumper
"He said sleepily: "Don't worry mom, my dick is like hot logs in the morning." - Apple

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Copper
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KlavierBauer
Sep 22 2017, 05:52 PM

Which single for-profit industry to think I’m referring to? I’m only aware of one single for-profit industry within the healthcare industry; called healthcare.


Quote:
 
I never said that anyone should purchase healthcare - or food - from the government.


You want the government to force everyone to buy health insurance.

And if they don't, they pay the government a fine.

That is being forced to pay the government for health insurance.

Quote:
 
I can make food, clothing, and shelter if I need - the fact that no single entity controls 100% of access to these things allows them to follow normal economic patterns.


What is this single entity that controls 100% of access to the healthcare industry?

The healthcare industry is made up of thousands of unrelated professionals, suppliers, manufacturers, hospitals and all sorts of independent individuals and companies.

The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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KlavierBauer
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HOLY CARP!!!
Quote:
 
That is being forced to pay the government for health insurance

No, that is paying a tax when you decide to opt-out of something that you will still expect to receive benefits from - like the education system - as I have already mentioned.

I am aware that the healthcare industry is made up of many pieces. I work for one of those pieces, and have experienced some of those pieces as a patient.
The discussion wasn’t about the industry as a whole, but has centered around the payers in the industry (unless we’re branching out from the discussion about insurance).
All provision of healthcare is limited by the paying entity - be that oneself, an insurer, or a government arm who pays an insurer and/or provider on the patient’s behalf.
"I realize you want him to touch you all over and give you babies, but his handling of the PR side really did screw the pooch." - Ivory Thumper
"He said sleepily: "Don't worry mom, my dick is like hot logs in the morning." - Apple

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Axtremus
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HOLY CARP!!!
Copper
 
Food is more necessary than healthcare. If you want the government to supply a necessity food would make a lot more sense than healthcare.
https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program-snap
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