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» Hatrack River Forum » Active Forums » Books, Films, Food and Culture » President Obama and the Proposal for Health Care (Page 0)

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Author Topic: President Obama and the Proposal for Health Care
Darth_Mauve
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Why Free Markets won't work with Health System:

1) Supply and Demand. This is the basic of all Free Market ideals. However, when my wife or child are ill my demand for health care is infinite. As anyone who plays with math knows, dealing with infinite numbers messes up everything.

2) It is less expensive to deal with small things than large. Yet most small things can be ignored. So when I get a cough I don't spend my money going to the doctor--but if it leads to pneumonia, that gets expensive.

3) The majority of health insurance is paid for in whole or in majority not by the consumer, but by their employer. This means that the insurance company does not need to satisfy the needs of the individual consumer, but the needs of the human resource department of that person's employer. Cutting costs by denying coverage or limiting health options allows a lower cost to the employer, which looks good on the Human Resource people's efficiency report. If they can do a two tier system where upper management gets prime care and the rest get semi-adequate care--that is the best savings for the employer and the best option for the insurance company.

4) The provider of the services in question do not need to please their patients as much as they need to please the insurance companies who are paying them. This dissonance of who is the priority is not appreciated by the service providers, or the service consumers.

5) Companies provide health care for two reasons. Originally to cover work related injuries and keep their employees healthy enough to continue working. More recently its been as a employment motivator and perk. Work for us and get this great insurance.

However, the cost of insurance is increasing faster than the profits of almost all companies. This means they must spend more and more of their budget on this perk.

To slow this down they are forced to provide less and less services--adding co-pays and deductibles that actually create a lowering of their employees spendable income.

This demoralizes and dis-insents the workers. The companies are spending more money to create the opposite outcome than the one they desire.

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rivka
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quote:
Originally posted by katharina:
quote:
I imagine it is possible for a health insurance company to come up with plans that would favor preventative medicine, but right now, most plans do not.
Mine does. Annual checkups, teeth cleanings, routine lab work is all free to me, not even a copay. Maintenance pills, including birth control, is cheap - I pay $10 for a four-month supply. They track my health for me, allow me to track all my appointments and prescriptions online, and they harass me into getting a well being check up once year. There is a small subsidy for gym memberships and discounts on reputable diet plans.

There is a higher charge for emergency services and for other things, but as far as supporting preventative things to make me a cheaper patient for them in the long run, I think Kaiser does a pretty good job.

Kaiser is what I have as well, as they started in and are based in California. In many ways I think they are the future of American medicine, but comparing them to most health insurance is comparing apples to rutabagas -- they're not remotely comparable. Kaiser pays their doctors a salary, not a per-service charge. They own the labs, radiology departments, etc. -- they're not contracting with outside agencies (with few exceptions). In those cases (like emergencies) that Kaiser is paying outside people, they are a huge PITA.

That said, I think the Kaiser model is a good one, and I'm glad it is growing.

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AvidReader
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quote:
Originally posted by Darth_Mauve:
2) It is less expensive to deal with small things than large. Yet most small things can be ignored. So when I get a cough I don't spend my money going to the doctor--but if it leads to pneumonia, that gets expensive.

I think my issue with this one is that most of the time, an otherwise healthy adult is just going to have the cough. If they take it easy and eat right, it's going to go away never having been more than a cough. So why send everyone to the doctor with a cough if most of them just need to lie down and eat some soup? So that tiny percentage doesn't get pneumonia? Let's just send the folks with risk factors for pneumonia to the doctor with a cough.

The rest of your points are pretty valid, though I would balance the HR part against the benefit of having someone who gets paid to weed through insurance co. fine print all day figure out what the best value is on a plan doing it for me. Plus, we'll never be able to match individually the collective bargaining power of a large employer negotiating price. Even though I want to see at least one layer of government run care available to everyone, I still see a place for a good employer-provided option in the future.

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The Rabbit
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quote:
Kaiser is what I have as well, as they started in and are based in California. In many ways I think they are the future of American medicine, but comparing them to most health insurance is comparing apples to rutabagas -- they're not remotely comparable. Kaiser pays their doctors a salary, not a per-service charge. They own the labs, radiology departments, etc. -- they're not contracting with outside agencies (with few exceptions). In those cases (like emergencies) that Kaiser is paying outside people, they are a huge PITA.

That said, I think the Kaiser model is a good one, and I'm glad it is growing.

The Kaiser system is an excellent model. We were using them as the standard for care back in the late 70s when I was a debater. They are the exception to what I said about insurance companies looking only at minimizing short term costs. Not only do they cover preventative care, they have done a lot of research to determine what types of preventative have the biggest pay off and they do an excellent job of eliminating unnecessary and over treatment.

Unfortunately, Kaiser doesn't get the full pay back for their preventative approach because people change jobs and health coverage too often. Its also unfortunate that few if any of the HMOs that are supposedly modeled after Kaiser actually function nearly as well. I suspect thats because they overlook some critical aspect of the Kaiser system, but I won't speculate about what that aspect might be.

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sinflower
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I actually would consider a universal health care system. But this clunky behemoth that actually raises costs while not addressing some of the most pertinent problems? I'm not sure.
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DarkKnight
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quote:
No, I don't pity you, especially. You're ignorant because you want to be, which is despicable, and laughable considering what you are actually trying to argue (because you've gotta love an answer to a basic question about European systems being: "I don't know anything about them, but listen to what I have to say about why they won't work"). Your fault, completely. Still unfortunate though.
Let me clarify that for you. I have read extensively about universal care models in many different countries (ie Canada, Cuba, European, and even Massachusetts). To clarify even more for you, the statement I made, that I do not know how ALL (emphasis added) of the world's health care models work is still true. Neither do you. I made an absolute statement which was true for me and true for you as well.
Does that make it less despicable and laughable for you?

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katharina
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That's my point, Rivka - it is a completely different system. In answer to the question of how to put a premium on preventative care, then a completely different system needs to be devised. I think Kaiser has come up with a very good one.

I stumbled on it accidentally because I wanted a cheaper insurance. Kaiser is cheaper than what I had before and much, much better.

Rabbit, I would be very interested, for curiosity's sake, in learning WHY Kaiser is able to be so much better while charging me less. Do you have some sources on that?

The move away from medical practices being sole proprieterships to doctors being employees of larger medical systems is already happening, accelerated by the recession. I can see some problems with it, but many, many benefits, and I suspect patients are better off for it.

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Blayne Bradley
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I've heard some horror stories for Kaiser.
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katharina
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You gotta learn sometime that Michael Moore is not a credible source.
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rivka
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quote:
Originally posted by katharina:
I stumbled on it accidentally because I wanted a cheaper insurance. Kaiser is cheaper than what I had before and much, much better.

Which is the main reason I use them too. (OTOH, I prefer to keep my kids not on Kaiser, but that's mostly because I really like their pediatricians, and would rather not switch them.)
quote:
Originally posted by Blayne Bradley:
I've heard some horror stories for Kaiser.

Yup. I bet I can beat them: I knew someone who testified at his own wrongful death trial (two months before the cancer -- that could have been cured had his test results not been ignored for 6 months -- killed him) against them, and won.

But the vast majority of the horror stories took place 15 or more years ago, and that's the point at which they took stock and seriously changed a lot of their policies and procedures for the better. Kaiser is definitely not perfect. But they are pretty damn good, and they have worked hard to improve some of their deficiencies.

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Orincoro
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Learn the words: "work in progress."
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rivka
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Orin, to whom are you speaking?
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Orincoro
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quote:
Originally posted by DarkKnight:

Does that make it less despicable and laughable for you?

Maybe. You still deflected the challenge from a position of ignorance, which is the key thing. I'm well aware you know something about these systems- your claiming ignorance of them in order to bolster your own point, or avoid defending it properly, is still laughable. Because *anyone* can say they don't know *everything* about every other system- using that as a reason not to broach subjects that you can't handle well because they don't lend themselves to your position is not fair. Going further and accusing me of the same sin- well that just isn't cool.

All this revolves around the main problem with the conservative approach to this problem. Because it is approached either from a position of ignorance, or with an arsenal of superficial anecdotes. The conservatives come off, to me, as a pack of superstitious natives when they talk about health care, either too timid to engage with the core economic issue (because they lose that fight hands down) or shriekingly bombastic about superficial aspects of either our own fledgling plan, or those of existing systems. Those graphs and tables that demonstrate very, very clear correlations between social medicine and actual average health outcomes are worth nary a bother, apparently.

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Orincoro
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quote:
Originally posted by rivka:
Orin, to whom are you speaking?

Heh, last post of the previous page. Didn't see the 11 down there at the bottom. It's been a long day.
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rivka
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Ah, ok. That makes sense.
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Blayne Bradley
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quote:
Originally posted by katharina:
You gotta learn sometime that Michael Moore is not a credible source.

For his recent movies hes credible enough.
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katharina
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No.
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The White Whale
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Let's use this wonderful thing called "30 seconds on Google", shall we?

Factchecking Capitalism, A Love Story

His track record for some of the major claims in that movie: False, Barely True, True, Mostly True, False, and Mostly True.

His overall record on Politifact: 1 True, 4 Mostly True, 2 Barely True, 3 False

So, kat, he's not all hot air. I've learned a good deal from his movies. And Blayne, I don't think "credible enough" is a good description either, since he certainly doesn't distinguish very well between what is true and what is heavily spun.

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Blayne Bradley
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credible enough to me is a shorthand for 'take with a pint of salt', his movies I'ld generally consider as illuminating of the important issues and the kind of movies where "if even x% is true we're screwed".

The point is to make you aware of the issues.

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Katarain
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My mom told me today that her doctor is closing her doors at the end of April because she can't afford to stay open because of the new health care bill. She already charges very little, and what she gets is going to be cut by something around 22%.

I told my mom that I hadn't heard anything about price setting for doctors, although I thought I might have for medicare providers, but mom said she doesn't have a lot of medicare patients. She also said that doctors know more about the bill than we do, so many small providers are already being forced out of business.

Can someone explain to me how the health care bill would be forcing a small time provider out of business. It really is unfortunate that she is closing, since my mom really relied on her.

Oh, and evidently, part of the reason for closing is that her dad, who was another doctor in the practice, is retiring. But according to my mom, the letter the doctor sent out blamed the health care bill as the main reason that she can't afford to continue her practice alone.

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Orincoro
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I love that you're in favor of a capital market that mercilessly cuts out anyone from doing business or receiving care if they don't have the money, and your against the health care bill because it has put someone out of business in the interests of building an equitable system. The cry: "it ain't fair!" is so pathetic coming from your camp- what do you know about fairness, exactly?

It's sad that the current market has put that doctor in the position where reform is going to destroy her business. That sucks, majorly. Perhaps it's something we can, *gasp*, work on with new revisions of the bill.

So yeah, we're ready for the anecdotes. The system will be shaken, and the idea is to make it stronger. If you reacted with even half the interest to the myriad horror stories of the current system (a failure in progress) the way you obviously have to the one story you know about the new system (a *work* in progress), you'd be much more credible, and I might actually believe you are capable of empathy, and not cynical self-serving sympathy, a la carte.

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rivka
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quote:
Originally posted by Katarain:
She also said that doctors know more about the bill than we do

Nonsense.

Sounds like the doctor is either having issue with the primary insurance company (-ies) they deal with, or looking for an excuse and blaming something they are politically against. I have looked at a lot of analyses of the bill, and have seen NOTHING like price setting. Now, insurance carriers have been forcing prices for years, and some may be using the new bill as an excuse to lower their payment rates.

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Orincoro
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Sssshhhhhhocking.
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Katarain
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Orincoro, are you talking to me? I didn't say whether I was in favor of or against anything! I just wanted to know what my mother was talking about. She has this tendency to tell me things she hears without sources, so I was seeking more information.

And really, my camp?? What the hell? I ain't in no camp.

The more I read your reply the more I think you're a huge idiot. Get some reading comprehension before you start thinking you know what I stand for.

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Katarain
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quote:
Originally posted by rivka:
quote:
Originally posted by Katarain:
She also said that doctors know more about the bill than we do

Nonsense.

Sounds like the doctor is either having issue with the primary insurance company (-ies) they deal with, or looking for an excuse and blaming something they are politically against. I have looked at a lot of analyses of the bill, and have seen NOTHING like price setting. Now, insurance carriers have been forcing prices for years, and some may be using the new bill as an excuse to lower their payment rates.

I was wondering if the insurance company she deals with most often had cut her rates. I know that my doctor gets a lower rate when treating me because I'm in a PPO. If the insurance cut that rate (which I believe is negotiated with the doctor), he would be making even less, and that's bad for him.

I am trying to be neutral when I talk to my mom. We tend to get into big arguments when we talk politics. I am actually in favor of health care for all (chew on that, orincoro), but my hesitancy comes in from my belief that both political parties are two sides of the same coin, each side bringing forth legislation that destroys more of our constitutional rights. So when talking to my mom today, I said, you know, the Republicans don't care about you either. (In response to her comment about the democrats.) She said something about the Republicans doing more for us than the dems.... I just had to change the subject--that made my head want to explode. So yeah, we can't talk politics very often. I love her, though, and I am concerned about her losing her doctor. I just want to know what the health care bill has to do with it, whether allegedly or not.

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Orincoro
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quote:
Originally posted by Katarain:

The more I read your reply the more I think you're a huge idiot. Get some reading comprehension before you start thinking you know what I stand for.

To be honest I misread your username and thought you were someone else. I apologize. Again, long day.
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Katarain
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Now don't go and be all reasonable and apologize when I've worked up a good ire. ...

Ah well. Apology accepted.


Sorry I bit your head off.

I really do hope someone can answer my question. I'm often interested in whatever shred of truth lies beneath the rumors I hear. I'm tempted to call up the doctor's office and ask the receptionist what specifically it is about the bill that is causing them to close. I *gotta* know.

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katharina
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The health care bill lowers the payments for Medicare patients. It does not set prices for anything else, so if your doctor does not have Medicare patients, then it is not directly as a result of the health care bill.

It is possible that as insurance are required to take all children now and will be required to take all comers in 2014, the insurance company has chosen to lower now what they pay to doctors.

However, that's between them and the insurance company. Blaming the bill directly isn't accurate.

It reminds me of when American Express used the credit card bill as an excuse to raise interest on everyone to 17% minimum, which about doubled my previous rates, despite my perfect record. When I called to ask WTH, they blamed it on the credit card bill and said they were first, but all the other credit companies would follow. The other companies didn't, but I cancelled my American Express card and told them why.

The bill is an excuse and a cover. A useful one, apparently.

------

If I had to guess, I would guess that the doctor is closing her private practice and going to work for salary for a hospital or clinic. LOTS of doctors are doing this - if you look at the link I put up earlier, in the last five years the percentage of practices owned by doctors as opposed to hospitals has dropped from over 70% to less than half.

I'm not convinced this is a bad thing. For every sole proprietorship, that means all the overhead has to be absorbed by the patients of a single doctor. There are benefits to scale, and lower overhead per patient is one of them.

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dabbler
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American Psychiatric Association's take on the new bill. Gives you an overview, though it's primarily focused on the mental health issues (of course). What's particularly helpful is that it notes which provisions the APA was for and against.
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Katarain
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My mom said she didn't have a lot of medicare business, but I have to wonder, since she has a lot of elderly patients.
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rivka
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quote:
Originally posted by Katarain:
I was wondering if the insurance company she deals with most often had cut her rates. I know that my doctor gets a lower rate when treating me because I'm in a PPO. If the insurance cut that rate (which I believe is negotiated with the doctor), he would be making even less, and that's bad for him.

This is something my kids' pediatricians (among others) have been dealing with for years. The bill is not specifically to blame.
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DarkKnight
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quote:
You still deflected the challenge from a position of ignorance, which is the key thing. I'm well aware you know something about these systems- your claiming ignorance of them in order to bolster your own point, or avoid defending it properly, is still laughable.
Please cite for me the country with a free market health care system. Is there one? Now cite for me the countries that the government has control of the health care system. Well, that is much easier isn't it.
quote:
Because *anyone* can say they don't know *everything* about every other system- using that as a reason not to broach subjects that you can't handle well because they don't lend themselves to your position is not fair. Going further and accusing me of the same sin- well that just isn't cool.
Here is a subject I have broached....the high cost of health care is because we get too much testing and are 'overtreated'. We choose to get tested more or to test more for a variety of reasons. We, as a culture, are consumers and we 'consume' more whether it is food or health care. To bring down the 'cost' of health care must mean that we are going to deny tests being performed. No ignorance there, but nice that you latched onto that and are not letting it go even though I have explained it.
quote:
All this revolves around the main problem with the conservative approach to this problem. Because it is approached either from a position of ignorance, or with an arsenal of superficial anecdotes.
So all of the articles I have posted are just ignorant or superficial ancedotes? I will inform the AARP that they, among others, are ignorant or just giving superficial anecdotes.
quote:
The conservatives come off, to me, as a pack of superstitious natives when they talk about health care, either too timid to engage with the core economic issue (because they lose that fight hands down)
Nice insults, please keep them coming. Nothing like belitting anyone who disagrees with you. Allowing health care companies to compete across states lines AND removing some of the mandates (like I have cited before) will bring down costs. That fight is not lost.
quote:
or shriekingly bombastic about superficial aspects of either our own fledgling plan, or those of existing systems.
I have not been "shriekingly bombastic", not that it matters to you because you will just make claims using your big grown up words to come across as smarter somehow. (See, I can do what you do too. I think this is where you start asking questions again like "Do you beat your wife?" like you did on the other side.)
quote:
Those graphs and tables that demonstrate very, very clear correlations between social medicine and actual average health outcomes are worth nary a bother, apparently.
Unless of course someone puts out some issues with the graphs and the correlations, like differing live birth calculations, different culture health habits, and so on.
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katharina
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He's not worth the bother, DK.
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Blayne Bradley
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Uum no, the problem with high costs is people being under treated because they avoid seeing the doctor while the problem is small and only go when it is expensive and thus raises costs, a healthier society is a cheaper per capita healthcare system.
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Juxtapose
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Heh. Classy.
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theamazeeaz
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quote:
Originally posted by The White Whale:
Let's use this wonderful thing called "30 seconds on Google", shall we?

Factchecking Capitalism, A Love Story

His track record for some of the major claims in that movie: False, Barely True, True, Mostly True, False, and Mostly True.

His overall record on Politifact: 1 True, 4 Mostly True, 2 Barely True, 3 False

So, kat, he's not all hot air. I've learned a good deal from his movies. And Blayne, I don't think "credible enough" is a good description either, since he certainly doesn't distinguish very well between what is true and what is heavily spun.

Cute, but that site doesn't talk about "Sicko", you know, the movie Michael Moore made that actually talks about health care:
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The White Whale
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Thanks. I thought it was cute too.

I chose Capitalism, A Love Story because it was his most recent, and the conflict at the moment seemed to be "For his recent movies hes [sic] credible enough."

You want some Sicko analysis:

CNN

quote:
Moore covers a lot of ground. Our team investigated some of the claims put forth in his film. We found that his numbers were mostly right, but his arguments could use a little more context. As we dug deep to uncover the numbers, we found surprisingly few inaccuracies in the film. In fact, most pundits or health-care experts we spoke to spent more time on errors of omission rather than disputing the actual claims in the film.
But the 30 Seconds on Google tactic also brings up dozens of blog posts criticizing the CNN analysis. I don't like using blogs as sources, and I didn't see Sicko, so I don't really want to say more than that.
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theamazeeaz
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I saw Sicko a couple weeks ago. All the analyses I found on Google just focus on insurance and payment, and Canadian ER wait times.

There's really not much more blogs can say about accuracy or inaccuracy after that.

The bulk of the movie rests on anecdotal stories of people being screwed over by insurance companies (including Kaiser). What viewers don't know is how cherry-picked his subjects are: all American examples of health care are bad, and all the foreign examples are good. Of course, Moore's point is to find people who have slipped through the cracks, and there are very many. He highlights how the integration of payment has interfered with the concept of treatment, and the results are nothing short of criminal.

The main point isn't really a numbers game, it's to bring home the idea that the government should take over health care, and people should pay in the form of taxes, as a way to divorce profit and payment from care.

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Orincoro
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quote:
Originally posted by katharina:
He's not worth the bother, DK.

Hey there scrappy. Feel like being a part of the discussion? No? Didn't think so. Oh but not, give us another one liner, please.
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The Rabbit
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quote:
Originally posted by Orincoro:
quote:
Originally posted by katharina:
He's not worth the bother, DK.

Hey there scrappy. Feel like being a part of the discussion? No? Didn't think so. Oh but not, give us another one liner, please.
Orincoro, Please ignore katharina. You know she's not worth the bother and when you respond to her, you make yourself look like a 5 year old.
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katharina
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Rabbit, please ignore yourself. You know you're not worth any attention at all and you only post here so you can be a bully without real world consequences. Your posts are useless, ignorant posings.
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Lyrhawn
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I think you should all take a step back, breath easy, and refrain from personal attacks in this thread. Or more appropriately, an apology, but hey, I'm not expecting miracles. I'll settle for adult-adjacent behavior that doesn't get the thread locked.
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Raymond Arnold
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Wow, this is getting pretty silly.
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jebus202
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Hahaha, great stuff everyone.

How does someone ignore themself? I dunno, but a priceless comment none-the-less.

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malanthrop
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quote:
Originally posted by Mucus:
Mal jumps down many rabbit holes. It is not necessary for you to follow him. Especially when it appears that his main pattern is: bring up as many random anecdotes and tangents as possible to get a rise out of people and confuse the issue

It has been a fortunate week for my "anecdotes". How many companies this week have followed the law by making quarterly cost projections to their stockholders? It's unfortunate that ATT (and dozens of others) have announced the healthcare bill will cost them a Billion dollars. Which will result in either: layoffs, higher healthcare premiums or the cancellation of benefits for their employees and retirees. Of course, only anecdotal.

Major corporations are required by law to reveal these projections. For doing so, they are being subpoenad to testify before congress. Liberal politicians that have never ran a business know better than the CFO's of a corporation. The CFO will be thrown in prison for not stating the truth. Pelosi and Reid can say the healthcare bill will reduce the defecit???????? ATT CFO would end up in prison for such creative book-keeping. ATT is telling the truth. The bill will reduce coverage and increase the cost.

The witch-hunt trials are about to commence. How dare the Chief Financial Officers of dozens of corporations disagree with the financial projections of Nancy Pelosi and Barack Obama. A congressional peer of theirs argued against an Admiral this week, marines might capsize Guam.

Congress knows best. They can legislate the cost of a good.

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TomDavidson
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quote:
ATT is telling the truth.
No, not really. As I understand it, AT&T has truthfully said that a tax loophole has closed which will cost it a billion dollars over a couple decades. They have chosen to take that charge this year, possibly to magnify its impact.
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fugu13
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There was no option not to take the charge in the very near future; once the change became clear, accounting rules require it.

It is standard practice on such charges to overestimate, to avoid having to take repeated charges as the real cost changes.

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Blayne Bradley
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quote:
Originally posted by malanthrop:
quote:
Originally posted by Mucus:
Mal jumps down many rabbit holes. It is not necessary for you to follow him. Especially when it appears that his main pattern is: bring up as many random anecdotes and tangents as possible to get a rise out of people and confuse the issue

It has been a fortunate week for my "anecdotes". How many companies this week have followed the law by making quarterly cost projections to their stockholders? It's unfortunate that ATT (and dozens of others) have announced the healthcare bill will cost them a Billion dollars. Which will result in either: layoffs, higher healthcare premiums or the cancellation of benefits for their employees and retirees. Of course, only anecdotal.

Major corporations are required by law to reveal these projections. For doing so, they are being subpoenad to testify before congress. Liberal politicians that have never ran a business know better than the CFO's of a corporation. The CFO will be thrown in prison for not stating the truth. Pelosi and Reid can say the healthcare bill will reduce the defecit???????? ATT CFO would end up in prison for such creative book-keeping. ATT is telling the truth. The bill will reduce coverage and increase the cost.

The witch-hunt trials are about to commence. How dare the Chief Financial Officers of dozens of corporations disagree with the financial projections of Nancy Pelosi and Barack Obama. A congressional peer of theirs argued against an Admiral this week, marines might capsize Guam.

Congress knows best. They can legislate the cost of a good.

And in free market economics layoffs mean that those employees can go find new jobs, layoffs have never been that bad a thing.

Gross misspellings aside, health care will reduce the deficit by taking the load off of medicaid and by paving the way for more comprehensive reform, a healthier society is a cheaper society.

Also since when is liberal mutually exclusive with running a corporation?

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kmbboots
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I highly recommend watching this:

http://www.pbs.org/wgbh/pages/frontline/obamasdeal/?utm_campaign=homepage&utm_medium=bigimage&utm_source=bigimage

An excellent civics lesson.

Edited to fix link.

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Samprimary
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Outrage and promises of populist retaliation over the bill's passage has deflated even more rapidly than I anticipated. :/
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