quote:But, still, you're stuck in GOP = GWB mode. Bush is not the GOP and the GOP is not Bush.
Very true. Can you name something constructive the GOP has done at the federal level since the Bush Administration?
Has the Senate allowed passed anything the House has passed in the past 2 years? Remember that the GOP was the minority party from 2006-2010, and nothing they would have wanted would have gotten through after Bush left. But then, I admit that I haven't really paid a whole lot of attention to things in the past couple years. CSPAN isn't good for people with ADD (The only reason I am even on this site discussing things right now is because the ADD meds I just got started on a couple months ago are doing some weird stuff to my brain and its grabbing on to the strangest subjects that I normally don't care about and amphetamines!) and I trust news outlets about half as far as I can throw them.
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quote:How about the desire to curb run-away government spending? The desire to not have the government digging its nails into daily life? The desire to prevent the money we spend on taxes from being wasted on people who are gaming the system?
Does it need to be pointed out that these desires are not exclusive to Republicans and that, when in power, Republicans haven't necessarily done much better at addressing them than Democrats?
Posts: 3275 | Registered: May 2007
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I didn't want to bring it up, but it's hard to find a single speech Obama has made in the last three years that does not specifically point out that he shares and acknowledges the desire to restrain the growth and cost of government. One can argue that he's lying, just saying what he thinks people want to hear -- but even that would put paid to the argument that he doesn't understand what they want to hear. He quite clearly does.
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quote:I don't think he even acknowledges these as legitimate issues with modern government.
Now we've gone from the need to understand that some Republicans believe these are legitimate issues to believing -- and agreeing with them -- that they are issues which demand his attention. Are you suggesting that a good leader must believe the same things his opposition believes?
A good leader would at least acknowledge the fact that his opponents are also people with beliefs that are worth acknowledging as potentially legitimate. Heck, that's just basic rhetorical theory.
Were I to give an example of good leadership, I would point you to MLK Jr.'s Letter from Birmhingham Jail. If you read through that, note that his audience is a group of clergymen from different faiths. A Jewish Rabbi, some catholic priests and a bishop, and some protestant leaders. Throughout the letter he takes special care to appeal to the beliefs of each individual. He references Jewish History and stories from the Talmud. He speaks about the teachings of Jesus Christ. He also makes note of the actions of Martin Luther. He references beliefs he knows are held by each of the people who are attempting to distance themselves from the cause of civil rights out of public perception. By showing he knows what they believe and why they believe it, he is able to frame those beliefs into a convincing argument for why the civil rights movement was so important and have it firmly impact each of the people who were opposing him.
I have yet to see Obama acknowledge that conservatives are anything other than bitter old people who hate the world around them.
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quote:Originally posted by TomDavidson: I didn't want to bring it up, but it's hard to find a single speech Obama has made in the last three years that does not specifically point out that he shares and acknowledges the desire to restrain the growth and cost of government. One can argue that he's lying, just saying what he thinks people want to hear -- but even that would put paid to the argument that he doesn't understand what they want to hear. He quite clearly does.
Except that his actions belie a different view than he provides in those speeches. You can tell me a dog is a cat and I might believe you. Until it barks. And if you pull try to pull that on me more than once I'm not likely to pay attention to you. I was willing to believe that he cared about our spending problem, until he added 600 billion dollars to spending his first year in office. And only decreased that level of spending by about 15 percent the next year. And didn't drop at all the next. And it hasn't gone below a 1 trillion dollar shortfall since.
Also, it's important to point out that knowing what people want to hear is very different from understanding their reasons for wanting something. I can tell you the things I want clearly enough. Explaining why I want those things is much more difficult. Getting you to understand my views is even more difficult, because you aren't me.
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posted
Tom is giving an excellent clinic in Socratic questioning.
Boris is giving an excellent clinic in Republican obfuscation.
Carry on.
quote:I have yet to see Obama acknowledge that conservatives are anything other than bitter old people who hate the world around them.
Please tell me you're not really buying into the cartoon version of Obama. If this is really true, then you just aren't looking hard enough. Or really, you aren't looking at all. Even a little bit.
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quote:Originally posted by Lyrhawn: Tom is giving an excellent clinic in Socratic questioning.
Boris is giving an excellent clinic in Republican obfuscation.
Carry on.
And you've given a great example of why I quit visiting this forum. Being a dismissive jerk is a great way to clear the forum of all dissenting opinion, but it's a really lousy way of coming to some realistic solutions.
quote: Please tell me you're not really buying into the cartoon version of Obama. If this is really true, then you just aren't looking hard enough. Or really, you aren't looking at all. Even a little bit.
Patronizing people is a really fantastic way to convince them that you are correct. Oh wait, no it isn't. See my previous comment on snarky responses.
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posted
Reagan was a conservative. He says he admires Reagan. That's him acknowledging that conservatives are something other than bitter old people who hate the world around them.
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quote:Originally posted by Lyrhawn: Tom is giving an excellent clinic in Socratic questioning.
Boris is giving an excellent clinic in Republican obfuscation.
Carry on.
And you've given a great example of why I quit visiting this forum. Being a dismissive jerk is a great way to clear the forum of all dissenting opinion, but it's a really lousy way of coming to some realistic solutions.
quote: Please tell me you're not really buying into the cartoon version of Obama. If this is really true, then you just aren't looking hard enough. Or really, you aren't looking at all. Even a little bit.
Patronizing people is a really fantastic way to convince them that you are correct. Oh wait, no it isn't. See my previous comment on snarky responses.
Forgive me if I'm wrong, but the impression I've gotten from your posting in this thread that you're a right-wing troll. If you're actually arguing from an honest place of disbelief, then I apologize, but really, your statements leave me profoundly flummoxed if they're to be taken at face value.
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Hey, let's cool down a sec. Boris, you've acknowledged that Obama talks the talk; he knows what conservatives want to hear and says it. But you believe that his actions demonstrate that he does not understand the motivations that underlie those statements. By way of evidence, you cite a spending cycle on par with the previous president, at the bottom of a recession. Granted that Obama is a moderate Keynesian and can be expected to try to govern as a moderate Keynesian when given the opportunity, what else has he done that gives you this impression?
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Boris is not a troll. He is arguing from the very real and very depressingly common position of someone who can really say "I have yet to see Obama acknowledge that conservatives are anything other than bitter old people who hate the world around them". Because his media filters or personal filters succeeded in making sure he has not seen this over the narrative.
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Blayne Bradley
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posted
Boris do you understand what the Bretton-Woods framework is and how it pertains to the US Dollar as the world's reserve currency?
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Is anyone still arguing that Republicans have any credibility in the area of fiscal restraint?
Please. Republicans are only arguing for cutting spending because
1. Tea Partiers are up in arms about TARP and bank bailouts
2. Obama can't cut spending right now, because the economy is still too fragile.
It's as cynical a political ploy as I've ever seen. It's a bunch of scam artists trying to get re-elected.
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quote:Originally posted by Parkour: ... ... conservatives are anything other than bitter old people who hate the world around them". ...
To be fair, that IS the Republican base. Take away the votes of oldest, whitest, most racist, and most xenophobic 15% of the electorate, and almost no conservatives would get elected to national office.
Of course, most of the Intermountain West and the rural South would be completely removed from voting. However, I don't think that's a bad thing. They're fricking killing the rest of the country. They think they're electing mavericks and people with an individualistic spirit, when really they're just electing people who kowtow to the tobacco, firearms, and defense industries.
If we manage to survive as a species with no major debilitating wars or major acts of terrorism over the next 20 years, it will be largely because we enact the opposite of the policies these most conservative voters want most.
it's pretty messed-up that gun-toting racists hiding out in rural Idaho have as much power over the entire WORLD as they do, due to the Senate and the electoral college.
We don't need to encourage xenophobia ANYWHERE, nor give xenophobes a voice. In a globally-connected world like this, that's self-genocide.
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quote:Originally posted by Parkour: ... ... conservatives are anything other than bitter old people who hate the world around them". ...
To be fair, that IS the Republican base. Take away the votes of oldest, whitest, most racist, and most xenophobic 15% of the electorate, and almost no conservatives would get elected to national office.
It's a distressingly large part of the base, but it's not fair at all to say that IS the base. On top of that, I don't see what was added by using "oldest, whitest". What point were you trying to make? I'd assume that it wasn't "old white people suck."
Posts: 1069 | Registered: Feb 2005
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quote:Originally posted by Boris: So the democrats in congress were either incorrect in their estimates of what the plan would do, or they deliberately mislead the population.
False dichotomy. Two possible alternatives, just off the top of my head:
End user insurance costs are not the only costs associated with health care.
Not all provisions of the ACA are in force yet.
1. You're right. Bureaucracy costs money too. People have to fill out paperwork, file claims, enter data into databases, transcribe information, etc. All of that bureaucracy costs money. In fact, the majority of costs associated with medical care can be attributed to administrative costs incurred by bureaucracy. 2. Also correct. Unfortunately, the provisions most likely to increase the cost of insurance and medical care are the ones that haven't been implemented yet.
0. Most importantly: Congressional Democrats were not necessarily either wrong or deliberately lying about the ACA's cost implications. That was my main point: your two proposed explanations were not in fact the only two possibilities.
1. Yes, that's true. You have redundant bureaucracy in part as a consequence of having fifty hojillion different insurers doing more or less the same thing. That's one of the downsides of a market-based health care system.
2. Which provisions are those? Here's a summary timeline of ACA provision implementation. Some cost-related measures came into effect in 2012 -- in fact, I just spent the last several days playing with the outcome data mentioned in the first 2012 item as part of a course I'm taking in my spare time. Others take effect in 2013 or 2014.
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I'm still waiting to hear, as are others, what potential political strategies Obama could actually have employed to negotiate with people who had decided *before he was President* that they were committed to thoroughly disrupting any of his efforts and destroying him politically. What viable political strategy could Obama have employed, other than capitulation? Which incidentally if one actually asks the liberal Democrats Obama is supposedly a member of, he in fact *did* on quite a few occasions (Gitmo, immigration policy, deportations, wars, drone strikes, targeting Americans, fiscal cliff negotiations, debt ceiling negotiations, just for some of the biggest).
No. It's just a little twist on the old 'well this guy did something bad, but the other party...' argument of equivalence. No one can seriously claim that Republicans weren't committed to wrecking Obama's term for longer-term political gain because, well, more than a few are on record as saying exactly that. Hard to get equivalence there, so something else must be found. Hmmm. Wait! If Obama had been a better leader, Republicans would not have *started out* with the wish to utterly hamstring him and Congress in his first term-to ensure it was his only term. Equivalence!
Posts: 17164 | Registered: Jun 2001
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In trying to puzzle through Boris' response to the inaugural, I came across this article by CNN's David Gergen and it really left me quite puzzled.
Gergen attacks Obama for not issuing the normal blather about bi-partisanship and lambastes him for saying its his way or the highway. And I guess I'm just flummoxed as to what sort of amnesia you have to have if you don't think that's what we've had for the last 3 years on the Republican side. Compromise means caving as far as the GOP has been concerned for the last few years. Obama bent over backwards and was crushed every time.
I read another Op-Ed elsewhere that made a good point I think. First Term Obama believed that everyone was basically on his side, and that America really agreed on most issues, but politics got in the way. Second Term Obama believes we have radical divisions on major issues and we do not in fact agree, so he's decided to join the message war in trying to convince people he's right. I don't see the problem with that. If you aren't trying to convince people you're right, why bother?
I just can't fathom Gergen's response to the speech in the face of what the last few years have been like. I know Republicans love to say that Obama doesn't compromise, but it flies in the face of every major policy negotiation that's happened since he took office.
Posts: 21898 | Registered: Nov 2004
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posted
Did you people ever think that it was possible for two different people with different backgrounds to look at the same thing and have two different responses to it?
What I see from this thread is a lot of "This is what I see, and you're stupid for not seeing it. I can't be wrong because I'm a rational human being. You don't agree with me, therefore you are not a rational human being." You guys probably don't realize you're coming across like that, but trust me, you are.
Rakeesh, are you bullying people who disagree with you just to silence them, or do you actually think your attitude and debate tactics of snark and sarcasm are likely to convince people of your position's superiority?
steven...The Aryan nations were sued out of existence in Idaho in the late 90s. And you are also ignoring the fact that most White Supremacists can't vote to begin with because they are ex cons. The remainder are so far out there that they wouldn't vote for anyone that doesn't wear a swastika on their sleeves. Those aren't Republicans. And old white people? Are you a racist geriatrophobe? Because the attitude that you show in your posts is no different in substance than what you accuse Republicans of. My skin color has as much to do with how I and most other Republicans vote as my shoe size does to what kind of car I drive. But since we're considering racism and xenophobia as disqualifications for joining national political discourse...What do you suppose would happen if all the Hispanic and African American racists in this country couldn't vote? Which party do you think would come out ahead if all the racists (and by racists, I mean people who think members of other races are inferior or who just generally hate people of a different race, not the pseudo-intellectual social justice version of racism where every white person is racist and everyone else is a kindly little lamb of love and affection) in this country weren't allowed to vote?
Lyrhawn, I don't see how Obama has tried to compromise in a meaningful way. But I will admit that I haven't paid a lot of attention to him in the past few years, what with me working to improve my career. ACA was the last thing I really paid attention to outside of the election and his handling of that was horrendous. His campaign during the election did nothing to improve my opinion of him. Particularly since he sat behind a shield of journalists trying to spin him out of trouble at every step (funny that it was MSNBC that first announced what he really meant with his "You didn't build that" speech and not Obama himself). He spent the whole campaign shooting the messenger. If you want to ask me whether I buy into Cartoon Obama, didn't you buy into Cartoon Romney? I'll admit that Romney wasn't the best candidate, but I at least agree with him on Fiscal strategy. I'm not going into why, because that's another 5 page explanation. But I didn't get to vote anyway, since the Tucson election board waited until December to send my absentee ballot to my new address (moving to a new location across the state 1 month before election day is a pain in Arizona). I could go all conspiracy theory on the subject and say they held on to it because I was registered Republican and Tucson is a very liberal city...But I'd just be joking around if I did. Mostly. At any rate, rather than just saying I'm not looking hard enough for evidence that he's trying to cooperate and being a snarktard about it, why don't you consider that maybe other people don't have the same experiences as you and provide some evidence to support your claims and explain why it does so. The only evidence of Obama's supposed attempts at cooperation I've seen in this thread is the rant on the Heritage Foundation plan, which, as I've already explained, isn't exactly strong evidence of honest cooperation on his part. Particularly since adding the mandate to the plan was a suggestion from his side of the argument and not one provided by Republicans at the time. And the idea that Obama doesn't compromise only flies in the face of what you have perceived from every major policy negotiation since he took office. His actions might appear to be compromise to you and not appear to be honest attempts at compromise to someone else.
Twinky, Government bureaucracy is a wonder of inefficiency. 37 insurance companies with their own systems and ways of doing things can't *possibly* be as inefficient as the federal government. In addition, when the exchanges go into effect and millions of people who have no interest in taking care of themselves (and would normally be declined for insurance as a result) start getting insurance, or paying the fines and waiting until something on them blows up before they get insurance, you can expect the prices of care to begin skyrocketing. Not to mention the fact that the scarcity of healthcare providers caused by increased use will drive prices up as well. ACA does nothing to address the existing shortfall of Primary Care Providers. It will do a lot to exacerbate that problem, though.
Destineer, Obama's speeches about how he admires Reagan are short on specifics and long on vague references to the Reagan Mythos. There is very little substance in what Obama has said about Reagan that suggests Obama even knows what the man did in office, let alone truly admires him. Further, saying that he admires a prominent conservative does not mean that he doesn't see conservatives as anything other than frothing racist morons. Hell, it doesn't even mean he doesn't see *Reagan* as a frothing racist moron.
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posted
Wait, so you'll openly admit that you haven't been paying attention for 'the last few years' (put another way, almost his entire first term), and then you've got the nerve to whine about other people treating you in a snarky and unfair way? Your hypocrisy and entitlement is breathtaking.
In any event, I just listed quite a few major issues on which Obama compromised. Others have too of course, and they've been repeating themselves, but I expect you'll continue to speak as though they haven't, and spend as much time complaining about how you're spoken to as about the actual things you claim to wish to talk about.
Bullying. I never tire of that one, particularly since it so often comes from those with a strident, confrontational and angry tone themselves. You and I have precisely the same amount of power here. Please stop pretending to be a victim.
As to Romney's fiscal strategy...boy, I'm all ears on that. Would love to hear more.
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quote:37 insurance companies with their own systems and ways of doing things can't *possibly* be as inefficient as the federal government.
Cite please.
Though I suppose it may be article of faith for you.
Do you know how many bureaucrats that I, as a Canadian, have to deal when getting health care (except for the stuff not covered by the government)?
Posts: 185 | Registered: Apr 2009
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quote: Wait, so you'll openly admit that you haven't been paying attention for 'the last few years' (put another way, almost his entire first term)
What, beyond the midterm elections, has there been to pay attention to? Nothing actually happened from 2010 to 2012. I think I acknowledge earlier that I was happy he made concessions on the increased tax rate as to who it should apply to. Perhaps you ignored it. As for confrontational attitudes, let's go back to the reels and look to see that I didn't get confrontational until you felt like rearing your snarky head for a good baseless snipe. I am sick to death of snark masquerading as a debate tactic, so I'm sure as hell going to confront you on it when you use it against me. If you want to continue being snarky in response, that's just you being an arrogant ass. I don't care if I piss you off. Besides. I'm not coming back to this forum after this discussion. Being dogpiled with snark isn't my idea of a good time. I am not particularly good at explaining what I mean, and I'm sure people aren't understanding what I'm saying, but that isn't a reason to act the way you do here. As for romney's fiscal policy...Let's ask a question...If you had a business that could operate anywhere in the world...where would you open your doors? Personally, I'd go somewhere that let me keep the largest portion of my profits. Guess what. That isn't the US. Go look at the corporate tax code to see what's wrong with it. Obama has no intention of addressing its shortfalls.
quote: Do you know how many bureaucrats that I, as a Canadian, have to deal when getting health care (except for the stuff not covered by the government)?
How many people work in your doctor's office besides the doctor? Those are what we refer to as Bureaucrats. They do paperwork. They fill out forms. They submit reports. So you deal with them. But the work they have to do adds a massive cost to medical care. As for how I know that all the insurance company bureaucracy can't be as inefficient as the federal government, I worked for the federal government. I spent two months trying to get one network security report for *one laptop* through the bureaucracy. I got a new job before that report was accepted. If it was accepted. I don't know if it was.
By the way, I'm not responding anymore. I'm done with this crap. So go ahead and commence with the chest pounding and hooting over driving another conservative off so you can return to the circle jerk.
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I'll get to your larger paragraph addressed to me a bit later on, but this paragraph jumped out at me.
quote:Twinky, Government bureaucracy is a wonder of inefficiency. 37 insurance companies with their own systems and ways of doing things can't *possibly* be as inefficient as the federal government.
Every study I've ever seen comparing administrative costs between government and private sector insurance companies says that Medicare is vastly more efficient at administrative costs.
quote: In addition, when the exchanges go into effect and millions of people who have no interest in taking care of themselves (and would normally be declined for insurance as a result) start getting insurance, or paying the fines and waiting until something on them blows up before they get insurance, you can expect the prices of care to begin skyrocketing.
Well, first of all, a lot of those people don't have coverage because they can't afford it, not because they don't care about themselves. That's a little silly blanket statement to make. And you fail to recognize that what you're describing is the status quo. People already use the emergency room as a care provider when, as you note, things "blow up." It's the absolute most expensive form of care possible.
quote:Not to mention the fact that the scarcity of healthcare providers caused by increased use will drive prices up as well. ACA does nothing to address the existing shortfall of Primary Care Providers. It will do a lot to exacerbate that problem, though.
You're right, there is a problem with a scarcity of PCPs, one that probably won't be solved until the government meddles in the field to artificially create a draw to the profession. No one wants to be a PCP because the pay is too low for what you have to do, and specialty services pay two and three times as much. That's what happens in a free market, but it's not particularly helpful to people as a whole.
But what you seem to be suggesting is that care rationing, which we're already doing, is an absolutely necessary way of keeping costs down for the small majority who can afford care at all. Nothing about that strikes you as wrong? They have to suffer to keep prices lower for everyone else?
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quote:By the way, I'm not responding anymore. I'm done with this crap. So go ahead and commence with the chest pounding and hooting over driving another conservative off so you can return to the circle jerk.
I don't think that's what anyone here was trying to do. Now that I know you're serious, I'm more interested in hearing you explain your views.
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quote:If you had a business that could operate anywhere in the world...where would you open your doors? Personally, I'd go somewhere that let me keep the largest portion of my profits. Guess what. That isn't the US.
It's probably Equatorial Guinea, although there are some great Caribbean tax havens as long as you don't actually live there.
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quote:Originally posted by Boris: Did you people ever think that it was possible for two different people with different backgrounds to look at the same thing and have two different responses to it?
Yes. And in this case, only one of those responses is based on factually sound interpretations.
If someone today really thinks that the Republicans were the ones trying to compromise and Obama was the problem because he was inflexible, they're wrong. Nobody should care that it is a perspective "from a different background". It's wrong.
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quote:37 insurance companies with their own systems and ways of doing things can't *possibly* be as inefficient as the federal government.
Cite please.
Though I suppose it may be article of faith for you.
Do you know how many bureaucrats that I, as a Canadian, have to deal when getting health care (except for the stuff not covered by the government)?
Probably so many that it explains why your country gets better care than ours for less than a third of the cost per head, right? I assume you have to wade through bureaucrats. Whole rooms full. And plenty of paperwork, unlike Americans.
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quote:Originally posted by Parkour: ... ... conservatives are anything other than bitter old people who hate the world around them". ...
To be fair, that IS the Republican base. Take away the votes of oldest, whitest, most racist, and most xenophobic 15% of the electorate, and almost no conservatives would get elected to national office.
It's a distressingly large part of the base, but it's not fair at all to say that IS the base. On top of that, I don't see what was added by using "oldest, whitest". What point were you trying to make? I'd assume that it wasn't "old white people suck."
When I used to install TV/internet/phone service, some customers would annoy me by watching everything I did. The solution? Find their addiction, and give it to them fast. For elderly customers, 99 times out of a hundred, it was Fox News. No matter how irritating and micro-manage-y they were being, as soon as I'd put Fox News on, they'd leave me alone. It's like SpongeBob for the elderly.
Most of them just stopped thinking at some point in their lives. (My mom is a perfect example of this. In fact, it's so bad with my mom, I'm honestly not sure if she stopped thinking 30 years ago, or if she just doesn't really have much short-term memory left, due to aging-related mental decline.) They stopped examining their opinions/beliefs/assumptions, and Fox News plays to that. So do Rush Limbaugh, Michael Savage, etc..
So yeah, I have very little respect for people who refuse to examine their assumptions. They're screwing things up for the rest of us, and, because the US is so powerful, the rest of the world too, by extension.
Combine these voters with our Senate-dominated Congress, and you get a mess.
And as for the "whitest" part of my comment, it's not elderly black/Hispanic voters that are putting today's Jesse Helmses in office.
Posts: 3354 | Registered: May 2005
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quote:Originally posted by Boris: Twinky, Government bureaucracy is a wonder of inefficiency. 37 insurance companies with their own systems and ways of doing things can't *possibly* be as inefficient as the federal government.
Can't possibly be as inefficient as the federal government, because...?
That's just an assertion, not an argument. Can you support this claim in some way -- with logic, data, or both? Is the US federal government somehow uniquely inefficient among governments of industrialized countries, all of whom manage to deliver care for a fraction of the cost?
In fairness, I will note that since moving to the US from Canada and witnessing a state government shutdown as well as the federal debt ceiling and fiscal cliff debacles, I'm somewhat sympathetic to the argument that America is uniquely bad at governance. Nonetheless, I reject the argument that government is inherently less efficient than private enterprise. If you want to persuade me that this is true in all cases, you'll need to provide pretty compelling evidence.
quote:Originally posted by Boris: In addition, when the exchanges go into effect and millions of people who have no interest in taking care of themselves (and would normally be declined for insurance as a result)...
Do you have any evidence that a majority or significant minority of those who are currently uninsured are uninsured because they have no interest in taking care of themselves?
quote:Originally posted by Boris: ...start getting insurance, or paying the fines and waiting until something on them blows up before they get insurance, you can expect the prices of care to begin skyrocketing.
The price of care has already skyrocketed in the US, for a number of reasons. One of those reasons is that hospital ERs end up providing not just acute care to the uninsured, but non-acute care as well. For more detail, here's a CDC report.
The intended effect of expanded insurance is to shift people from the pool of uninsured people who go to the ER because they have no other option into the pool of insured people, who are much less likely to go to the ER first. While that will obviously increase expenditures on primary care, it will also obviously decrease expenditures on ER care, which is generally quite a bit more costly.
How well it works remains to be seen, but I don't think it's credible to argue that it will inherently increase cost.
quote:Originally posted by Boris: Not to mention the fact that the scarcity of healthcare providers caused by increased use will drive prices up as well. ACA does nothing to address the existing shortfall of Primary Care Providers. It will do a lot to exacerbate that problem, though.
The US already has a scarcity problem with health care providers, which is another part of why your pre-ACA system was already so much more expensive than all other systems in industrialized countries, both per capita and as a percentage of GDP. The solution there is to expand the number of care providers, not deny care to people. While that will cost money, it will also contribute to alleviating the overload on ERs by both uninsured and insured patients, which will save money.
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quote:Originally posted by steven: Most of them just stopped thinking at some point in their lives. (My mom is a perfect example of this. In fact, it's so bad with my mom, I'm honestly not sure if she stopped thinking 30 years ago, or if she just doesn't really have much short-term memory left, due to aging-related mental decline.) They stopped examining their opinions/beliefs/assumptions, and Fox News plays to that. So do Rush Limbaugh, Michael Savage, etc..
I'm not sure that most people, regardless of age or political orientation, really examine opinions/beliefs/assumptions. My experience is that it's rare.
As a conservative, though, I'd be glad to agree that the current Republican party has elevated such behavior to an art form.
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Blayne Bradley
unregistered
posted
quote:Originally posted by NobleHunter:
quote:37 insurance companies with their own systems and ways of doing things can't *possibly* be as inefficient as the federal government.
Cite please.
Though I suppose it may be article of faith for you.
Do you know how many bureaucrats that I, as a Canadian, have to deal when getting health care (except for the stuff not covered by the government)?
e: Actually I'm not sure what your saying.
quote: Twinky, Government bureaucracy is a wonder of inefficiency. 37 insurance companies with their own systems and ways of doing things can't *possibly* be as inefficient as the federal government.
But you trust the government to handle organizing and training a military more than contracting it out to the private sector?
quote: How many people work in your doctor's office besides the doctor? Those are what we refer to as Bureaucrats. They do paperwork. They fill out forms. They submit reports. So you deal with them. But the work they have to do adds a massive cost to medical care. As for how I know that all the insurance company bureaucracy can't be as inefficient as the federal government, I worked for the federal government. I spent two months trying to get one network security report for *one laptop* through the bureaucracy. I got a new job before that report was accepted. If it was accepted. I don't know if it was.
This is false, Canadian doctors deal with significantly less paper work as they don't have to go through various middlemen to give their patients care.
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quote:Originally posted by Boris: I have yet to see Obama acknowledge that conservatives are anything other than bitter old people who hate the world around them. [/QB]
Now now, based on my Facebook feed, they can also be bitter young people who hate the world around them.
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posted
Guys....look at Boris's argument on the big picture, and laugh.
Boris: Obama was the obstructionist. Republicans were not.
Most of us: That's not how we remember it. The Republicans obstructed the Healthcare laws while President Obama gave in and compromised.
Boris: Well, Obama care, and basically any change to our current health care system is WRONG and will result in terrible things.
Me: So, to stop those terrible things the Republicans did everything in there power to Stop it. That is the definition of obstruction.
If you have a reason or an excuse to obstruct everything that is going on--you are still the obstruction.
Posts: 1941 | Registered: Feb 2003
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quote:Do you know how many bureaucrats that I, as a Canadian, have to deal when getting health care (except for the stuff not covered by the government)?
How many people work in your doctor's office besides the doctor? Those are what we refer to as Bureaucrats. They do paperwork. They fill out forms. They submit reports. So you deal with them. But the work they have to do adds a massive cost to medical care.
As a side note, I have worked as a physician on both sides of the border. It is laughably insane how easy it is to bill in Canada.
quote:Originally posted by Blayne Bradley: This is false, Canadian doctors deal with significantly less paper work as they don't have to go through various middlemen to give their patients care.
Blayne is right. I have a sheet or two (or on busy days, three ) of paper with each patient's name, time of appointment, and two blanks: one for billing code (amount of complexity, which is essentially 1 of 3 numbers), and one for primary diagnosis. If I did any procedures like flushing ears or giving shots, I scribble that at the side of the diagnosis. Takes less than 10 seconds per patient.
My office manager converts that sheet into formal billing by spending about 15-30 seconds each patient typing in the complexity code and translating the diagnosis into ICD-9 (a formalized system of numbers, sorta/kinda like Dewey decimal system for medicine). She knows most of the ICD-9s we use by heart. If she doesn't, it takes an extra minute or so to look it up in the codebook. Billing for each procedure takes an extra 5-10 seconds each.
I've watched her do this -- she can fly through billing for 30 patients in less than 10-15 minutes.
Some bills get questioned or denied, but that's a very low percentage in Canada. Maybe 1% need any additional time to sort out. No fighting with documentation for coverage or sending multiple letters, as in the US. The office manager either recodes the entry or clicks to accept a lower rate. Maybe once or twice a month she makes a phone call.
Honest to god, that's it. And the bill is always paid like clockwork. It is flippin' dead easy to bill as a physician in Canada. In contrast, there have been a series of studies on the amount of time physicians spend on nonclinical paperwork in the US, averaging around 20-25%:
posted
Out of curiosity, are there any studies that suggest a benefit from all that paperwork? I mean, what exactly IS all that work? What is the stated purpose of the additional forms and paperwork you're required to submit?
I'm guessing it's all for insurance purposes, but why do they want it? What's in the way of streamlining it?
PS: Thanks for that second link CT. I'm browsing through the report and it's making for very interesting reading.
Posts: 21898 | Registered: Nov 2004
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quote:Originally posted by Boris: Twinky, Government bureaucracy is a wonder of inefficiency. 37 insurance companies with their own systems and ways of doing things can't *possibly* be as inefficient as the federal government.
Can't possibly be as inefficient as the federal government, because...?
... Is the US federal government somehow uniquely inefficient among governments of industrialized countries, all of whom manage to deliver care for a fraction of the cost?
In fairness, I will note that since moving to the US from Canada and witnessing a state government shutdown as well as the federal debt ceiling and fiscal cliff debacles, I'm somewhat sympathetic to the argument that America is uniquely bad at governance. ...
Reminds me of the gun control argument, where someone was arguing that the US can't have a low homicide rate because the US is culturally too much like a third world country (and not one of those low crime third world countries either).
Sometimes these days it seems like American conservatives have us actual foreigners beat in terms of disliking America.
Posts: 7593 | Registered: Sep 2006
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quote:Originally posted by Lyrhawn: Out of curiosity, are there any studies that suggest a benefit from all that paperwork? ...
I distinctly suspect that the paperwork helps in slowing down doctors and uncovering/manufacturing problems that can be used to deny coverage, and thus save money.
There's efficiency and then there's efficiency.
Posts: 7593 | Registered: Sep 2006
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posted
Partly what Mucus said, partly because negotiating different systems means fulfilling different requirements. When I worked in the US, that group served 5 different HMO/PPOs plus Medicaid. There was a large flowchart on the wall to explain what you needed to fulfill in the paperwork to bill for each provider.
For a level 2 care visit, one provider might require 3 elements of the acute medical history, 2 of the social history, 3 from physical exam, and 2 items of differential diagnosis. Those numbers might vary amongst all 5 of the providers.
If you billed as a level 2 but did not hit that particular provider's marks (say, you had only one element of social history), the bill could be flagged for audit. It was all electronic at that point.
Or, say you needed to use a particular drug because the patient hadn't tolerated other drug options for that condition. It might be on the formulary (approved list) for 2 of the HMO/PPOs, but not the other 3. So you'd have to spend time each visit figuring out what that person's insurance was (and it could change as their or their parents' jobs changed! and they might forget to tell you!), then figure out what needed to be in the documentation, then figure out which treatment from THAT formulary or approved list of procedures would be accepted, then deal with any bounceback.
That's part of it. Another part is maintaining the paperwork for being an accepted provider in all those networks, including reviewing the audits of your performance within their parameters (are you spending too much time per patient? ordering too many throat swabs by THOSE criteria? etc.)
posted
What would happen if Congress tried to pass legislation to standardize the paperwork apparatus? In other words, if it was mandated that everyone use the same system?
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posted
It would be called a Governmental Takeover of Healthcare. How dare the Government think that it knows better than the Insurance Companies what information they needed. Why, it must be the next step toward job killing communism
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posted
I know that's what would happen politically.
I'm wondering what would actually happen on the ground.
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Blayne Bradley
unregistered
posted
From SA:
quote: Since nobody answered your question yet, I guess I'll give it a shot even though I know little about Congress.
Congress is a big huge game full of the spergiest people who have ever lived, only with access to both power and money. There are two main factions, the Horde and the Alliance, and the only way that they can actually do battle is through legislation. Some people are on P2P servers, but that's mainly during election years, unless the player is really into griefing (Michele Bachmann, for example, is one of the more successful and hilarious congressional griefers). As such, while one might imagine that the two groups mostly spend their time engaging in massive, semi-scripted battles over big issues, they really spend most of their time grinding by spatting over bullshit for the sole purpose of gaining XP and leveling up.
Because legislation is the means of battle, this results in a lot of idiotic and repetitive legislation. Strategically, fighting in a way that forces your opponents to spend resources is equally as good as voting for something that actually benefits you. For example, a member of the Horde from Cooperstown, New York wants to look good, so he fires out a little proposal about commemorating his local baseball museum. Nobody but him really gives a shit about this, but half of the people don't want to appear like they hate baseball. The Alliance folks decide that they can't let this guy and the Horde have that tiny prize for free, so they pretend to be against it and force the Horde to invest a lot of political GP in a small battle that they don't really care about.
A good deal of taunting is involved throughout the process. In the battle itself, you usually have some high level players on both sides casting buffs on the newbies and drawing on large mana pools of public support to do so. Obama is a sorcerer, for example. This is similar to a mage or a wizard, but the sorcerer class permits a larger variety of races and skills, which is why President Obama does quite well as a bard Dunmer halfgiant sorcerer. There are also Tanks, like Bill Clinton, who can take a lot of damage but don't perform many attacks. Tanks generally serve to purposely annoy the enemy and draw aggro so that the rest of the team can secretly get away with a lot of bullshit. Usually, there are DPS characters standing right near the tanks. The DPS group serves to dish out political damage to the opposition as rapidly as possible. They are typically classes that can use AP/mana-based skills to sustain their rate of damage. Class types are not exclusive; Strom Thurmond was one of the most amazing combination Tank/DPS rogue characters ever to play the game. He could take 50 critical hits in a row, 10 being accidentally self-inflicted, and he would not ever die. This is because he had a surplus of buffers and a nearly-infinite mana pool. There was no way that Strom Thurmond would ever lose a reelection and leave the game. Eventually he just got bored and left, handing the mantle to Lindsey Graham, who plays one of the newer ninja DPS classes and favors using short-blade chain combos while being buffed by wealthy shamans.
Rangers, in my opinion, are assholes who take potshots and cheerlead from afar while never actually ever doing much of anything. They're also sometimes known as "pundits". Each team has a few rangers who focus on keeping their own team members in line. These guys are armed with giant whips.
In the game, there are guilds which are also known as "subcommittees" or "caucuses". Guilds, oddly enough, often contain characters of both factions. Sometimes a guild member who doesn't play very much has a sudden realization that he's about to get booted, so he quickly gets involved with a bunch of bullshit minor resolutions. That way, he can say that he took part in some raids. It's busywork, but you can also do this kind of raiding to earn political GP. Pro-Panamanian donors, to take an example from your post, will give valuable rare drops toward your guild's coffers if you take part in a Panama trade raid. This is why some players will do the same raid again and again, in slightly different ways, despite not giving a crap about Panama.
In public chat channels there's a lot of griefing, posturing, name-calling, and generally behaving like assholes. The game is designed to make players feel like they're important. Everybody perceives themselves to be a good guy on a team of good guys, just like in America's Army. You are always on the side of America. Nobody wants to play a game if they're not a big damn hero, so players take on these sorts of asshole personas and call other people names while simultaneously pretending to be greatly offended. Typically, they argue about ideas that neither side has any actual knowledge of. They are professional arguers, you see, not debaters, if you can understand the distinction. It's the difference between a town crier and a print journalist. The actual subject of the argument, be it tax reform or the Border Tunnel Prevention Act, doesn't matter because it's all just a battle on ****ing Hamburger Hill. There are a few GMs, however, but they are mainly for show. In theory, GMs like the Senate Pro Tem have a lot of power over the game, but the reality is that they can't actually use the power in unpopular ways or else they'll get accused of nerfing.
Every 2 or 4 years, there's a server reset that often accompanies an expansion, which adds new quest lines, events, and raids. A new race was added in 2008. The 2012 expansion was all about fixing the buggy trade system. Big expansions might include server-wide events such as hurricanes or entire wars with previously unheard-of nations, started for dubious reasons. The 2001 game expansion featured the fictional in-game nation of Afghanistan, and both the Horde and the Alliance had to temporarily join forces in fighting this new foe. It had fantastic sales (practically everyone bought it!) and was initially a critical success. It seemed well written at the time, but in retrospect, most people now think that this game expansion and the later Iraq sequel were idiotic. However, these areas of the game are still available as ongoing platforms for the occasional legislative quest or raid.
If you're new to the game but plan on sticking to it for a while, then a worthy goal is to get yourself an epic mount. This is when you get to co-sponsor a big, important bill and harp on a single issue for the rest of your career, even if it means riding it right into the ground every chance that you get. Generally, you'll see only high-level or wealthy players with epic mounts. A notable exception is Paul Ryan, who is low-level but rides a flying epic pro-life pig. By contrast, Joe Biden has no mount, but instead chooses to summon them depending on the situation. He's been riding a Gun Control Panda lately, but usually he summons a Flying ****, but only so he can not overtly give it to someone. Last week, it was a dead horse. You do need a mount, though, or you won't get anywhere very fast--Even if it's a level 4 Pesticide-Registration Mule, which you asked about. Everyone knows that this is a worthless mule that, as you pointed out, shouldn't even be in the game. But someone is riding it because they just need some sort of mount.
One final note: The legislation is both the means of execution and primary ammunition in this never ending war. However, the idea that the legislation actually affects non-player lives in meaningful ways does not matter or even occur to the majority of congressional players. They do not give a shit about us, the NPCs. If this idea matters, it does so only temporarily and in election years when they are busy questing. When questing, we NPCs can start to seem like we're real, live humans. Then they go right back to the game and we're all just cannon fodder--technically part of the game, but held as worthless.
Therefore, it's a common misconception that these players are acting unselfishly and in our best interests. Sometimes, you'll hear about a player poopsocking and hogging the battlefield waiting for something like a rare drop. This is known as a "filibuster." You might think that someone filibustering is nobly standing up for his beliefs. In reality, he's probably just poopsocking while ganking someone on the other team.
posted
I strongly believe that insurance bureaucracy is there to maximize profit. For example:
The HMO brand of my insurance panel automatically pays for the first 12 visits a year before requiring documentation to authorize more visits. However, my second session with the HMO carrying client gets rejected every time. Why? Because they create an internal authorization number after the first visit, before the 2nd visit. But their program isn't creating that number correctly. This means every week I check my payments to see which ones got rejected, call the insurance panel, and request them to fix these claims. If I don't tell them, they would never tell me they messed up. They would never pay me. Instead of fixing it, they get me to waste 20 mins a week hounding them. Ever since I joined 3 months ago, this has been broken.
It's cheaper for them to wait and "accidentally" not pay doctors than to fix the problem.
Posts: 1261 | Registered: Apr 2004
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posted
Having had my first pregnancy initially rejected as a preexisting condition by insurance because I saw my obgyn two years prior, I am convinced that the insurance company simply rejects everything. One of my friends was denied her food poisoning claim as a preexisting condition. I spent probably 6 months fighting that since I had insurance before, I had prior coverage and therefore my preexisting stuff should be covered. When I called the insurance company and read them the applicable parts in my insurance paperwork, as well as hippa, that proved I was in the right, they told me neither applied to my insurance policy. I was reading from the plan info they had sent me and was listed on their webpage and they told me no, you are confused. Only when I had my sister send the same info with her law firms header did they actually pay up. I imagine that a lot of people stop arguing at the first rejection or the second. Or after the letter and the first review.
Posts: 2223 | Registered: Mar 2008
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quote:Originally posted by dabbler: I strongly believe that insurance bureaucracy is there to maximize profit. For example:
The HMO brand of my insurance panel automatically pays for the first 12 visits a year before requiring documentation to authorize more visits. However, my second session with the HMO carrying client gets rejected every time. Why? Because they create an internal authorization number after the first visit, before the 2nd visit. But their program isn't creating that number correctly. This means every week I check my payments to see which ones got rejected, call the insurance panel, and request them to fix these claims. If I don't tell them, they would never tell me they messed up. They would never pay me. Instead of fixing it, they get me to waste 20 mins a week hounding them. Ever since I joined 3 months ago, this has been broken.
It's cheaper for them to wait and "accidentally" not pay doctors than to fix the problem.
What is being described here is also known as "fraud," and is a criminal offense, aside from being bad business.
Posts: 9912 | Registered: Nov 2005
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posted
I didn't realize until last night that insurance companies in the US are actually exempt from antitrust law -- i.e. they're free to collude, manipulate pricing, etc.
Posts: 10886 | Registered: Feb 2000
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posted
Doctors are not exempt. We cannot share information about how to negotiate with insurance companies, discuss how to set our rates, or agree to take/refuse particular insurance companies.
Posts: 1261 | Registered: Apr 2004
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) of paper with each patient's name, time of appointment, and two blanks: one for billing code (amount of complexity, which is essentially 1 of 3 numbers), and one for primary diagnosis. If I did any procedures like flushing ears or giving shots, I scribble that at the side of the diagnosis. Takes less than 10 seconds per patient.
