Healthcare reform's impact on Nashville

[fieldmarshaldj]

^Um, hate to break it to you, but this isn't a democracy.

[samsonh]

The best argument for progressive legislation is field marshal and mlbrumby. That's the beauty of current conservative thought, when it's adherents write down their beliefs it seems awful to all reasonable people

[fieldmarshaldj]

Y'know what's a hoot is that you guys think "progressive" is a positive political terminology. To political historians like me, I know that "Progressive" was a party founded to advance the ideals of Marxism... these were the folks being bankrolled by and with allegiance to the Soviet Union. Dupes like Vice-President Henry Wallace come to mind (and eventually, even he came back to reality). It's bad enough the left hijacked and destroyed the credibility of the term of liberalism, which is the polar opposite of the statist and totalitarian agenda those that still claim to be adherents to today.

 

Of course, trying to ask basic questions of your ideological groundings and where these utopias exist where these programs work (in contrast to the real world where they don't) when you can't (or won't) even answer the question, again, shows the fallacy of your arguments.

 

I know you can't come to terms with it, but this is a basic fact of life: Socialism doesn't work. It's been tried countless times and always ends up the same way... usually with a high body count. Yet the left still wants to implement it because it hasn't been done "right" (or by the right people, as Ted Kennedy said). The definition of insanity is doing something over and over again and expecting a different outcome. You fellas are textbook case here.

[ruraljuror]

"Y'know what's a hoot is that you guys think "progressive" is a positive political terminology. To political historians like me, I know that "Progressive" was a party founded to advance the ideals of Marxism... these were the folks being bankrolled by and with allegiance to the Soviet Union. Dupes like Vice-President Henry Wallace come to mind (and eventually, even he came back to reality). It's bad enough the left hijacked and destroyed the credibility of the term of liberalism, which is the polar opposite of the statist and totalitarian agenda those that still claim to be adherents to today."

 

There is nothing intrinsically wrong with the term 'progressive.'  You may not like the Marxist associations, but that's the beauty of progressivism--it progresses and adapts with experience and as more information becomes available.  The world changes, so do ideas.

 

Do you believe 'conservatism' is without unsavory associations (i.e. slavery, child labor, segregation, bank deregulation)? 

 

When you decry 'Marxism' it can come across feeling like McCarthyism.  It's clear that you believe progressivism, Marxism, and the modern incarnation of liberalism are all bad and evil, and obviously the wrong path for our country to take, but are you doing a good job of conveying your perspective in a way that might be relatable to people who don't already hold those same beliefs.  Are you preaching to the choir or are you standing on the curb in front of the mall screaming at passers-by, and is there a difference in terms of conversion rate?

 

 

"I know you can't come to terms with it, but this is a basic fact of life: Socialism doesn't work. It's been tried countless times and always ends up the same way... usually with a high body count. Yet the left still wants to implement it because it hasn't been done "right" (or by the right people, as Ted Kennedy said). The definition of insanity is doing something over and over again and expecting a different outcome. You fellas are textbook case here."

 

Starting a paragraph with a phrase like 'I know you can't come to terms with it' is a condescending way to introduce your point, and isn't likely to encourage receptiveness in your audience--especially when you follow it up with a platitude like 'it's a fact of life.'  Once upon a time it was a fact of life that you could be killed for speaking negatively of the emperor, or god, or your father, or whatever.  Facts of life have been known to get better as we've progressed through the ages.  

 

More importantly, you say socialism hasn't worked, but what socialist countries have failed?   What is a socialist country, for that matter?  What qualifies as failure?

 

If socialism doesn't work, then what's the better alternative?  Capitalism?  What capitalist countries have succeeded?  What qualifies as success?

 

We gave/are giving capitalism a shot, but it's not without it's flaws, right?  The robber barons exploited a worker or two in their day.  Insider trading wasn't outlawed until insiders were trading...at the expense of investors/the market/the economy.  The ADA still approves some drugs that turn out not to be so safe, but at least entire towns aren't getting sick after the wrong snake oil salesmen passes through.  It's nice to know that when I buy a carton of orange juice that there have been fewer then three flies stewing in that particular batch at the factory and Lake Eerie is no longer flammable! (though more than a few PA kitchen sink spigots are, not because of a lack of capitalistic motivation in the emerging natural gas industry). 

 

America wasn't created to be a Capitalism, or Socialism, or Communism.  It was created to be a place for freedom, equality, and opportunity.  This country wasn't perfect at the outset and it's still not perfect now, but we've been consistently making it better and that's what we'll continue doing.  It doesn't matter if the idea came from Marx or Locke, Jefferson or Madison--if there is any value to the perspective and it can lead us toward greater freedom, equality, and opportunity, the idea is worth pursuing. 

 

"Of course, trying to ask basic questions of your ideological groundings and where these utopias exist where these programs work (in contrast to the real world where they don't) when you can't (or won't) even answer the question, again, shows the fallacy of your arguments."

 

I for one am happy to answer any questions you have regarding my ideological groundings.  Also, I don't think any utopias exist, but I do think we can do better.

[UTgrad09]

Some of this discussion is good, but let's please be careful to not get personal or nasty with comments.

[Guest 5th & Main Urbanite]

If the government had declared healthcare a right back in 1776 and set up a government-run system, we'd still be treating the sick with barbers bleeding patients. Free markets drive innovation, encourage competition and drive costs down. Government heavy-handedness encourages dysfunction, drives up costs, drives down quality. If you love the smoothness and efficiency of the DMV, you'll love ObamaCare.

So you are against eliminating lifetime caps? What about children with illnesses? Do you want to cap their benefit as well, or do you want to eliminate their care altogether and bring back the pre-existing condition? What about seniors? When you reach 70, basically everything is a pre-existing condition!

 

The single payer option is the best, and the moral Judeo-Christian way is healthcare for everyone as a right and not a privilege. As soon as healthcare became for profit as it is now, it became the antithesis of the message of Christ. As a non religious person who tries to follow the example of a great man, as referenced in the bible, and who may or may not have existed, healthcare for profit is a sin. Pure and simple. Healthcare for profit is evil.

[dmillsphoto]

As long as insults stay to a minimum, this thread is exactly what NashUP needs. Keeps the conversations off the other threads.

 

Now, my two cents - some of ya'll are funny! Not saying which ones, but it's true!

[fieldmarshaldj]

So you are against eliminating lifetime caps? What about children with illnesses? Do you want to cap their benefit as well, or do you want to eliminate their care altogether and bring back the pre-existing condition? What about seniors? When you reach 70, basically everything is a pre-existing condition!

 

The single payer option is the best, and the moral Judeo-Christian way is healthcare for everyone as a right and not a privilege. As soon as healthcare became for profit as it is now, it became the antithesis of the message of Christ. As a non religious person who tries to follow the example of a great man, as referenced in the bible, and who may or may not have existed, healthcare for profit is a sin. Pure and simple. Healthcare for profit is evil.

 

What I am against, as I have stated repeatedly, is the federal government involving itself in healthcare. To nationalize it is an abomination and (to borrow your word) "evil." As for "profit", it is profit that drives innovation. Without it, we'd still be in the dark ages... and we all know how catastrophic that would be.

[fieldmarshaldj]

"Y'know what's a hoot is that you guys think "progressive" is a positive political terminology. To political historians like me, I know that "Progressive" was a party founded to advance the ideals of Marxism... these were the folks being bankrolled by and with allegiance to the Soviet Union. Dupes like Vice-President Henry Wallace come to mind (and eventually, even he came back to reality). It's bad enough the left hijacked and destroyed the credibility of the term of liberalism, which is the polar opposite of the statist and totalitarian agenda those that still claim to be adherents to today."

 

There is nothing intrinsically wrong with the term 'progressive.'  You may not like the Marxist associations, but that's the beauty of progressivism--it progresses and adapts with experience and as more information becomes available.  The world changes, so do ideas.

 

Do you believe 'conservatism' is without unsavory associations (i.e. slavery, child labor, segregation, bank deregulation)? 

 

When you decry 'Marxism' it can come across feeling like McCarthyism.  It's clear that you believe progressivism, Marxism, and the modern incarnation of liberalism are all bad and evil, and obviously the wrong path for our country to take, but are you doing a good job of conveying your perspective in a way that might be relatable to people who don't already hold those same beliefs.  Are you preaching to the choir or are you standing on the curb in front of the mall screaming at passers-by, and is there a difference in terms of conversion rate?

 

 

"I know you can't come to terms with it, but this is a basic fact of life: Socialism doesn't work. It's been tried countless times and always ends up the same way... usually with a high body count. Yet the left still wants to implement it because it hasn't been done "right" (or by the right people, as Ted Kennedy said). The definition of insanity is doing something over and over again and expecting a different outcome. You fellas are textbook case here."

 

Starting a paragraph with a phrase like 'I know you can't come to terms with it' is a condescending way to introduce your point, and isn't likely to encourage receptiveness in your audience--especially when you follow it up with a platitude like 'it's a fact of life.'  Once upon a time it was a fact of life that you could be killed for speaking negatively of the emperor, or god, or your father, or whatever.  Facts of life have been known to get better as we've progressed through the ages.  

 

More importantly, you say socialism hasn't worked, but what socialist countries have failed?   What is a socialist country, for that matter?  What qualifies as failure?

 

If socialism doesn't work, then what's the better alternative?  Capitalism?  What capitalist countries have succeeded?  What qualifies as success?

 

We gave/are giving capitalism a shot, but it's not without it's flaws, right?  The robber barons exploited a worker or two in their day.  Insider trading wasn't outlawed until insiders were trading...at the expense of investors/the market/the economy.  The ADA still approves some drugs that turn out not to be so safe, but at least entire towns aren't getting sick after the wrong snake oil salesmen passes through.  It's nice to know that when I buy a carton of orange juice that there have been fewer then three flies stewing in that particular batch at the factory and Lake Eerie is no longer flammable! (though more than a few PA kitchen sink spigots are, not because of a lack of capitalistic motivation in the emerging natural gas industry). 

 

America wasn't created to be a Capitalism, or Socialism, or Communism.  It was created to be a place for freedom, equality, and opportunity.  This country wasn't perfect at the outset and it's still not perfect now, but we've been consistently making it better and that's what we'll continue doing.  It doesn't matter if the idea came from Marx or Locke, Jefferson or Madison--if there is any value to the perspective and it can lead us toward greater freedom, equality, and opportunity, the idea is worth pursuing. 

 

"Of course, trying to ask basic questions of your ideological groundings and where these utopias exist where these programs work (in contrast to the real world where they don't) when you can't (or won't) even answer the question, again, shows the fallacy of your arguments."

 

I for one am happy to answer any questions you have regarding my ideological groundings.  Also, I don't think any utopias exist, but I do think we can do better.

 

Ruraljuror, I'd reply to your points, but this discussion is moving away from the subject of the thread (government in healthcare) to a broad dissection of ideology. That might be better off for another thread, but the mods (not dmillsphoto, the top mods) have apparently issued an edict that they don't want it discussed on this forum.

[bwithers1]

Y'know what's a hoot is that you guys think "progressive" is a positive political terminology. To political historians like me, I know that "Progressive" was a party founded to advance the ideals of Marxism... these were the folks being bankrolled by and with allegiance to the Soviet Union. Dupes like Vice-President Henry Wallace come to mind (and eventually, even he came back to reality). It's bad enough the left hijacked and destroyed the credibility of the term of liberalism, which is the polar opposite of the statist and totalitarian agenda those that still claim to be adherents to today.

 

I'm not trying to step into the left-v-right debate, particularly on healthcare, but my understanding is that in the United States, the Progressive Party was founded by Theodore Roosevelt when he split with the Republican Party after he had served his two terms and sort of operated as a "shadow" president during the Taft administration.  http://en.wikipedia.org/wiki/Progressive_Party_(United_States,_1912).  Teddy Roosevelt had many ideas that many today would consider to be leftist, and certainly his platform in 1912 was to the left of both the Democratic and Republican platforms at that time,but I'm not sure that Teddy Roosevelt was himself intellectually beholden to Marxist thought.  And this unsuccessful political run as a the Progressive Party presidential nominee was well before the Russian Revolution of 1917. 

 

My point is that "progressive" and "conservative" are faily wide terms and mean different things to different people.

[MLBrumby]

Cannot say I'm surprised, but I am disappointed nonetheless for the direction this discussion took.

 

Think about what you are saying 5&M: Doctors, nurses, techs should work for free.  Or would you argue that they don't (shouldn't) profit from their knowledge?  You can choose to get all  your health needs from charity hospitals!  Although, I commend your attempt to explain your positions.

 

And Ruraljuror... I'd love to have a puff of what you're smoking. Coherent much?!  Before you attempt to respond here, I encourage you to refresh your American history and review the part about which political party is associated with segregation and slavery. That's about the only thing you wrote that was understandable (albeit wrong).  When that cloud lifts, why don't you book a trip to Havana and discover first hand all the "benefits" Communism has done for healthcare. I am 43, but I'm just old enough to remember the lie that was still going strong (through the 1990s) that Cuba had the best healthcare in the world.

 

Samsonh and P2... you guys have not made any valid rebuttal to my original point. Instead, readers here are treated to some inane leftist fantasy depicted in a cartoon, er excuse me, a metaphor.  And then some snide comment about how when conservatives write down their points they are shown to be flawed, yet (not surprisingly) with no explanation as to why/where whatever point referenced is flawed.  These posts resemble a "drive by" like my lovely, but passive aggressive, wife will do occasionally.  Yet, she has the sense and decency to explain her points of disagreement. Someone made a comment about "Democracy at work", well guess what... the American people did not vote for Obamacare... Congress did, and that's not "Democracy"... that (as FMJ noted) is a Constitutional Republic... don't know why liberals always want to make that argument. And as of a CBS poll announced yesterday, two-thirds of Americans don't like Obamacare. Only 1/3 of Americans even like it.  And when did "passing a bill before knowing what's in it" become good "democracy" anyway?

 

Last week, I had a similar conversation with a young man who complained about this premium rising by 300%.  I happened to mention to him that it is because of health "reform"... but for some reason (emotional investment apparently) he refused to accept that.  He embarked on a "wild ride" of logic to attempt to explain it all away.. and boiled his argument down to gouging by greedy insurance companies, without acknowledging the slightest clue as to why his premium hike is happening this year and not ever before (We call that willfully clueless!!). 

 

In general... I am not surprised to see this discussion devolve into the usual name-calling and silly non sequiturs that we tend to see in the form of responses from the left. I understand... it's emotional. 

 

So boys, this "discussion" is neither stimulating nor revelatory...  it's devolved into the inane. Need I remind you of the original topic: Healthcare reform's impact on Nashville. 

 

Call me when you guys stop the angry emotional diatribes. 

[fieldmarshaldj]

I'm not trying to step into the left-v-right debate, particularly on healthcare, but my understanding is that in the United States, the Progressive Party was founded by Theodore Roosevelt when he split with the Republican Party after he had served his two terms and sort of operated as a "shadow" president during the Taft administration.  http://en.wikipedia.org/wiki/Progressive_Party_(United_States,_1912).  Teddy Roosevelt had many ideas that many today would consider to be leftist, and certainly his platform in 1912 was to the left of both the Democratic and Republican platforms at that time,but I'm not sure that Teddy Roosevelt was himself intellectually beholden to Marxist thought.  And this unsuccessful political run as a the Progressive Party presidential nominee was well before the Russian Revolution of 1917. 

 

My point is that "progressive" and "conservative" are faily wide terms and mean different things to different people.

 

I was referring to the 1940s incarnation, led by standard-bearer Henry Wallace (whose storied career saw him go from "Progressive" Republican to Democrat to Progressive back to Republican). The Bull Moose incarnation of the 1910s was the Republican split between the center-right Taft faction and the left-wing TR faction. I tend to point to 1896 as the election where essentially the ideologies that we recognize today could be effectively defined (and the point at which the Socialist faction of the Democrats largely took control of that party and have remained ever since, with the purge of the Conservative Bourbons of Grover Cleveland's ilk, the last non-leftist Democrat to serve as President. Although left-wing, William Jennings Bryan tried to marry social Christian fundamentalism with his fiscal ideology, which would be anathema and anachronistic today, and his role in the Scopes Trial would not have fallen on the "progressive" side).

[ruraljuror]

Which angry emotional diatribes?  The political cartoon?

 

M.L, since you addressed me directly, I'll just say that I wasn't being deliberately incoherent and I'm sorry for any part of what I wrote that may have been unclear.  Re: the history lesson that you brought up specifically, I wasn't referring to the political parties who supported/opposed segregation/slavery but to the political philosophies of those who supported/opposed those policies.  The Republicans were abolitionists, but they were progressives while the conservatives of the era championed 'state's rights' etc.  Similarly, Democrats were responsible for Jim Crowe and most of the segregation laws, but they were conservative democrats, while progressives were the ones who championed Civil Rights.  I hope that's more coherent than my last post.  No offense taken.

 

As has been noted, we've strayed pretty far from the Healthcare debate, which is only arguably relevant for an urban planning forum in the first place.

 

On that note, it has been said that the federal government should be out of health care entirely.  Let's see how that plays out.

 

No more Medicare and Medicaid.  Will hospitals and E.R.s just turn uninsured sick people away?

 

What about federal medial research funding?  Contrary to popular belief, for-profit drug companies are not the only ones making important medical breakthroughs. 

 

What about medical/pharmaceutical patents?  Will the Federal Government issue and defend them in Federal Court? 

 

What if Pfizer had invented the polio vaccine instead of Salk?  Would they have just given it away to the world at cost?  Would the Federal Government have subsidized whatever price Pfizer saw fit in order to distribute the vaccine to the entire population, and would every other country done the same?  Or would we still have polio in the world, but it's okay because an expensive and extremely effective vaccine would be available for those who can afford it?

[fieldmarshaldj]

Which angry emotional diatribes?  The political cartoon?

 

M.L, since you addressed me directly, I'll just say that I wasn't being deliberately incoherent and I'm sorry for any part of what I wrote that may have been unclear.  Re: the history lesson that you brought up specifically, I wasn't referring to the political parties who supported/opposed segregation/slavery but to the political philosophies of those who supported/opposed those policies.  The Republicans were abolitionists, but they were progressives while the conservatives of the era championed 'state's rights' etc.  Similarly, Democrats were responsible for Jim Crowe and most of the segregation laws, but they were conservative democrats, while progressives were the ones who championed Civil Rights.  I hope that's more coherent than my last post.  No offense taken.

 

Your attempt to attach labels to 19th century ideologies by our standards today is ridiculous. There was nothing "Conservative" about slavery. John Adams could've been defined as a Conservative to the point of being derided as a Royalist (the worst slur you could attach to a politician of that era), but his anti-slavery views were strident. Conversely, the more populist Thomas Jefferson was clearly anything but. As for the most vitriolic of racists in the Democrat party, it was not the Conservative Bourbons, but the left-wing Populists (Pitchfork Ben Tillman, as a premier example, and later the infamous Theodore Bilbo, a strong supporter of the New Deal). In Tennessee, ostensibly the most Conservative member of the Congressional delegation (1921-31; 1933-47; 1951-61), B. Carroll Reece, and the first Southerner to serve as chairman of the RNC, was decidedly pro-Civil Rights (while contrasting with the more liberal Democrat members of the rest of the delegation, including one Senator Albert Gore, Sr., who opposed and filibustered the 1964 CRA).

[producer2]

This was not during the current administration but continues to worsen: (from KFF.org)

 

"It is reasonably well known that the United States spends more per capita on health care than other countries. What may be less well known is that the United States still has one of the highest growth rates in health care spending. Health care spending around the world is generally rising faster than overall economic growth, so almost all countries have seen health care spending increase as a percentage of their gross domestic product (GDP) over time. In the United States, which has both a high level of health spending per capita and a relatively high rate of real growth in spending, the share of GDP devoted to health care spending grew from 9% of GDP in 1980 to 16% of GDP in 2008. This 7 percentage-point increase in health spending as a share of GDP is one of the largest across the OECD."

 

And then we get this: (from The Atlantic)

 

"We've known for years that Americans tend to be overweight and sedentary, and that our health care system, despite being the priciest in the world, produces some less-than-plum results. Health nerds who closely follow the news may even have known that we live shorter lives than people in other rich nations, and that infants in the U.S. die from various causes at far higher rates.

But a fresh report, out Wednesday, tapped vast stores of data to compare the health of affluent nations and delivered a worrisome new message: Americans' health is even worse than we thought, ranking below 16 other developed nations."

 

You can do a simple google search and you will keep finding the same statistics so whoever I am using for verbiage is not giving a slanted perspective. We spend too much to get too little, hence reform. We as a nation can do better and unfortunately we are now left with a program that is far less than it could have been. I think we all know why...

[Guest 5th & Main Urbanite]

Cannot say I'm surprised, but I am disappointed nonetheless for the direction this discussion took.

 

Think about what you are saying 5&M: Doctors, nurses, techs should work for free.  Or would you argue that they don't (shouldn't) profit from their knowledge?  You can choose to get all  your health needs from charity hospitals!  Although, I commend your attempt to explain your positions.

 

And Ruraljuror... I'd love to have a puff of what you're smoking. Coherent much?!  Before you attempt to respond here, I encourage you to refresh your American history and review the part about which political party is associated with segregation and slavery. That's about the only thing you wrote that was understandable (albeit wrong).  When that cloud lifts, why don't you book a trip to Havana and discover first hand all the "benefits" Communism has done for healthcare. I am 43, but I'm just old enough to remember the lie that was still going strong (through the 1990s) that Cuba had the best healthcare in the world.

 

Samsonh and P2... you guys have not made any valid rebuttal to my original point. Instead, readers here are treated to some inane leftist fantasy depicted in a cartoon, er excuse me, a metaphor.  And then some snide comment about how when conservatives write down their points they are shown to be flawed, yet (not surprisingly) with no explanation as to why/where whatever point referenced is flawed.  These posts resemble a "drive by" like my lovely, but passive aggressive, wife will do occasionally.  Yet, she has the sense and decency to explain her points of disagreement. Someone made a comment about "Democracy at work", well guess what... the American people did not vote for Obamacare... Congress did, and that's not "Democracy"... that (as FMJ noted) is a Constitutional Republic... don't know why liberals always want to make that argument. And as of a CBS poll announced yesterday, two-thirds of Americans don't like Obamacare. Only 1/3 of Americans even like it.  And when did "passing a bill before knowing what's in it" become good "democracy" anyway?

 

Last week, I had a similar conversation with a young man who complained about this premium rising by 300%.  I happened to mention to him that it is because of health "reform"... but for some reason (emotional investment apparently) he refused to accept that.  He embarked on a "wild ride" of logic to attempt to explain it all away.. and boiled his argument down to gouging by greedy insurance companies, without acknowledging the slightest clue as to why his premium hike is happening this year and not ever before (We call that willfully clueless!!). 

 

In general... I am not surprised to see this discussion devolve into the usual name-calling and silly non sequiturs that we tend to see in the form of responses from the left. I understand... it's emotional. 

 

So boys, this "discussion" is neither stimulating nor revelatory...  it's devolved into the inane. Need I remind you of the original topic: Healthcare reform's impact on Nashville. 

 

Call me when you guys stop the angry emotional diatribes. 

Health professionals do have the right and privilege to earn good, or even great salaries for their education and services, but compared to firefighters, police, teachers, social workers, and the US Military, they are already paid quite well.

 

The profit comes in play when Insurance companies make coverage decisions based on their profit margins. i.e. staisfying stockholders, rather than what is good for the patient. Our economy now is based more in healthcare and related industries that supply healthcare than most other industries combined. It is in our best interest to solve this crisis. Healthcare lobby groups are also a large part of the problem. If we cannot take care of our people, than our mere survival is at stake.

 

The industries that supply healthcare are the one's commanding the highest  profits because of their R&D expenses and subsequent stockholders. The bottom line is what Producer2 has stated. The populace has spoken. I have already received a check from my healthcare provider because they have been overcharging me for so long. When the majority start getting their rebate checks, you will find The Affordable Care Act will be as popular as beer and pizza.

 

The way all of this impacts out city is the fact healthcare is our number 2 employer behind tourism. This effects the built environment is ways that are innumerable.

[producer2]

Actually Tourism is #3 behind Healthcare and Government....

[Guest 5th & Main Urbanite]

Either way, it's in the top 5.

[Hey_Hey]

As a physician here are my thoughts on healthcare reform:

 

1. Healthcare is not a "right" in the truest sense of the word because no one can be forced to provide services without payment.  If healthcare is a "right" then the government could theoretically force physicians, nurses, and hospitals to provide care without any payment at all.  However, healthcare should be accessible by all, and all should be made to contribute toward their healthcare.

 

2. The ACA gets rid of the ability of third party payers to refuse coverage based on pre-existing conditions. This is a good thing, but it will pass costs around to the healthy. I'm okay with this because those with pre-existing conditions will actually be able to be covered.  I don't think it's right that people who lost in the genetic lottery be shunned by the system while those that won the genetic lottery get its benefits. 

 

3. The government regulations and attempts to control costs will fail and will lead to more inefficient healthcare.  The Center for Medicare/Medicaid Services (CMS) already imposes a litany of "quality" measures and standards that are not evidenced based and don't do a single thing to improve actual care.  They allow those healthcare systems that are good at playing the game look good.

 

4. Judging quality from an office at HCA headquarters or in Washington at CMS is a charade. As a provider I can meet every quality measure that is established and still be a horrible physician. Likewise, I can miss on a lot of the quality measures and still provide world class care in many circumstances. 

 

5. Universal coverage is a good thing.  While the ACA doesn't quite do this, it gets close, and I think we'll be better off for it.

 

6. I don't see payments decreasingly significantly to providers or physicians in the grand scheme of things.  The payments will be moved around a bit.....on a per patient basis the reimbursements will likely stay flat or decrease some, but we will have close to 100% coverage so we will keep total revenues roughly the same. As things stand now my group doesn't collect any money at all on ~25-30% of our patients. If we now suddenly get paid for seeing those patients we would be able to stomach some decreased payment in the 70-75%.  Ultimately, we provide a service that people are willing to pay for. If the government goes to a single payer system or dramatically reduces payments, physicians will simply leave the system by either retiring, changing jobs, or (more likely) going to a system that cuts out third party payers.  As things stand now there is a tremendous physician shortage and we hold a very enviable position when it comes to negotiations.

 

7. Mergers and acquisitions will increase as "Accountable Care Organizations" become more and more prominent. This is why you're seeing healthcare systems expand to become a one-stop shop for all your healthcare needs.  One of the ironies of the ACA is that attempts to control costs and improve quality will likely lead to no significant cost savings.  As healthcare systems become bigger (the ACA incentivizes mergers) they carry a much bigger stick in the negotiations with third party payers.

 

8.  Tennessee made a mistake in not expanding Medicaid. That is, in essence, free money from the federal government that would have gone into our economy.  That money is going to be spent anyway, because there will be people that are not covered will be subsidized by those who are covered and pay premiums.

 

9.  We need to get rid of the employee-based plans.  When the new reforms went into effect the individual and group policies have become very similar.  Everyone could be in the private market but still be provided premiums by their employer without it actually being an employer based policy. The ACA, and the administration's implementation of it, have confused employers to the point that it's been an drag on our economy.

 

On the whole, I think the ACA will improve the healthcare system in terms of coverage, but will make it more complex because of the top down approach to cut costs. Many of the cost containing measures will likely fail.  The best thing to do is encourage high deductible plans (which I think it will do) because this will actually decrease utilization for non-essential services.

 

I do have a plan to leave healthcare if things go south. I hope it doesn't come to that, and I don't think it will. However, in the event that it does I am more than qualified to pursue other endeavors that might pay less but come with a whole lot less stress and a better home life and schedule.

[MLBrumby]

I did not plan to click on this thread at all, but your post was the most recent (from the UP main page) and I saw it. 

 

Thank you!! Oh, thank you!! Hey Hey!!!  Great post... and I'm not going to attack you because you said some things that I disagree with because I am a thinking conservative (e.g. I am not emotionally invested in this law). Of course, I actually do disagree with one point... physicians will be getting paid a lot less in the long run.  Like you said, you have a backup plan to leave the practice (sad... and I hope not!!).  But I have experience and common sense.  Putting them together, it will not be good for Nashville in 20 years.  My good friends (I have several physicians with whom I play golf ... ranging in age from 45-60) in medicine are ready also to bail... because they expect that one big problem will result from O'care... less innovation and entrepreneurism.  That said, in a nutshell, you have summed up ACA:  Uncertainty!!  Of course, there is the universally acknowledged immediate impact of Obamacare depressing hiring.  As the bumper sticker I saw in Colorado last month (Colorado!!!) said:  "I'd rather have a job than "free" healthcare", with the iconic "O" in the word "Job".

[fieldmarshaldj]

^Why should "all" be forced to pay ? That is coercive. Secondly, why should the healthy be forced to pay for the sick ? I've had health problems for most of my life, but I have no business demanding complete strangers to foot my bills. This is plain wrong, and again, highly coercive. Mandating universal coverage, again, is coercive and not the purview of the federal government to impose. It should be entirely voluntary.

 

As for Haslam not accepting the "free money", let's get it straight that there is no such thing. We are rapidly increasing in debt (which will be at or above $20 trillion by the end of the current regime in DC). There isn't the money for DC to nationalize healthcare. Pretending we can continue on this course of fiscal insanity is sheer folly.

[Hey_Hey]

^Why should "all" be forced to pay ? That is coercive. Secondly, why should the healthy be forced to pay for the sick ? I've had health problems for most of my life, but I have no business demanding complete strangers to foot my bills. This is plain wrong, and again, highly coercive. Mandating universal coverage, again, is coercive and not the purview of the federal government to impose. It should be entirely voluntary.

 

As for Haslam not accepting the "free money", let's get it straight that there is no such thing. We are rapidly increasing in debt (which will be at or above $20 trillion by the end of the current regime in DC). There isn't the money for DC to nationalize healthcare. Pretending we can continue on this course of fiscal insanity is sheer folly.

 

Actually, I'm not a fan of the individual mandate from a theoretical basis.  We can "force" people to pay without actually them to.  I believe it is unreasonable and wrong to receive healthcare without paying for it. One way of going about doing that is the individual mandate.  The other option is to give people the option; if you don't buy insurance you cannot receive healthcare services unless you pay up front. Of course that's brings in some major, major ethical conundrums.  What do you do about the patient in cardiac arrest that didn't pay insurance premiums? Do we perform an appendectomy on the patient with appendicitis and then confiscate their condo because they don't carry insurance? In reality an individual mandate is probably the least painful way to go.

 

As far as having the healthy not pay for the sick....it just doesn't make financial sense any other way.  There are essentially no individuals that can fund the medical procedures and hospitalizations that come with almost any type of illness.  Healthcare is incredibly expensive, and even the most efficiently run healthcare systems in the world are incredibly expensive.  A single heart attack or even a severe pneumonia that results in hospitalization will yield a healthcare bill that is equal to half a year's salary.  If you're child developed Type I diabetes at the age of seven, there's not an insurance company in the country that's going to touch them, and if they did the annual premiums would be in the tens of thousands of dollars. I personally don't think we, as a society, can let a person die or languish due to an illness that they had no control over.  Ultimately, we will all have medical issues and we'll all find ourselves at the mercy of a system that has the healthy subsidize the cost for the sick.

[Hey_Hey]

I forgot to comment on the Medicaid issue.  You're absolutely correct that in the grand scheme of things there is no free money.  Right now society says to me that I must provide coverage for people without an insurance or the ability to pay, but society doesn't provide any way for me to be reimbursed for that care.  Expanding Medicaid is free money in the sense that Tennessee can either accept the money or not.  We're going to pay the same federal taxes either way, and if we don't accept the Medicaid money then we are sending a portion of our tax dollars to other states. 

 

You are also absolutely correct in regard to our financial situation.  The demographic change in our country is going to bankrupt us because of the aging population.  Medicare and Social Security are nearing insolvency largely because of increasing life expectancy.  I think we're going to have to increase retirement age and the age that people are covered under Medicare or we're going to lose both programs for the elderly.

[fieldmarshaldj]

^In the end, solutions to these problems are going to have to come from individuals themselves and the private sector. Federal government involvement is a recipe for taking a situation in need of attention and making it infinitely worse. Do we sit by idly and let the government spend trillions (for which it doesn't have) in its obsessive need to involve itself in every aspect of society ? It will take us ALL down.

 

Regarding Social Security, it should've been privatized and/or phased out a long time ago (by the Eisenhower Administration, which should've eliminated and rolled back virtually every program enacted after 1933). That's always been another example of a control mechanism by the federal government over the people... that they cannot be trusted with their own money.

[samsonh]

Ml,

Ill reply why I am back in town and not on my phone