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CrowEpistemologist

What exactly is wrong with Obamacare?

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If the percentages are correct, how in the world could this work out for the Dems in the next elections? I dont see how such a burden would continue to be embraced.

I know quite a few people who are happy about Obamacare, even though they themselves will not be impacted for a while. They think it is the right thing to do. If it means the government has to run up some more debt, so be it (they will probably say "save the money by cutting the military"). Electorally, I imagine Obamacare is not going to have an impact either way, at least for the next presidential election. If anything, the GOP is taking the political risk by placing so much emphasis on something that people might consider to be over-reaction, and by getting the blame for being intransigent. Edited by softwareNerd

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I know quite a few people who are happy about Obamacare, even though they themselves will not be impacted for a while. They think it is the right thing to do. If it means the government has to run up some more debt, so be it (they will probably say "save the money by cutting the military"). Electorally, I imagine Obamacare is not going to have an impact either way, at least for the next presidential election. If anything, the GOP is taking the political risk by placing so much emphasis on something that people might consider to be over-reaction, and by getting the blame for being intransigent.

 

This is an aside, but I don't think the R's have a snowball's chance of getting anywhere near the Whitehouse while their immigration policy seems to be set by the Klu Klux Klan. Talk about an opportunity for Objectivists to have big impact by showing R's out what a principled immigration policy looks like. Unlike a lot of policies ("kill social security") that are poisonous to their reelection prospects, such a shift on immigration could actually put a Republican in the Whitehouse.

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Anyhow, with that aside, I'm still not seeing a big difference in the high-level "net-net" here. Somebody needs to pay for this mess, and according to the Prime Directive, that somebody is young, healthy, rich(er) people. That is essentially what is happening now with medicare, and what continues to happen with OC, right?

 

I guess the simplest way to ask this question is, is OC going to raise my taxes or not? (Assuming here I'm part of the so-called "rich" bla bla bla). I understand about hospitals who don't participate in Medicare, but that doesn't sound right to me: it sounds too easy. It sounds like the government wouldn't let some people skip out of taxes that easy.

 

What am I missing?

 

Sure, Medicare involves taxing the young to pay for the old, but it doesn't directly interfere with the ability of young people to get their own health insurance in order to accomplish its goal.  It's not just about how much money each system costs, but what each system does to the system of private health care.  A straight tax-and-redistribute system still leaves us with the ability to provide for our own unexpected health costs, at least.  When the private health insurance system itself is used as a redistributive tool like this, it has the potential to screw up the provision of private health insurance in addition to redistributing money.  It's not just the amount being redistributed, but the way it's being done.

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Sure, Medicare involves taxing the young to pay for the old, but it doesn't directly interfere with the ability of young people to get their own health insurance in order to accomplish its goal.  It's not just about how much money each system costs, but what each system does to the system of private health care.  A straight tax-and-redistribute system still leaves us with the ability to provide for our own unexpected health costs, at least.  When the private health insurance system itself is used as a redistributive tool like this, it has the potential to screw up the provision of private health insurance in addition to redistributing money.  It's not just the amount being redistributed, but the way it's being done.

 

Okay, I'll rephrase my question: is OC going to raise my taxes + my health care costs? I don't see how changing the structure is going to make any difference to the net-net equation. If the new money OC gets by forcing more (read: poorer) people to pay, and overall costs stay the same or less than the added revenue, then I pay less. If not, I pay more.

 

Our discussion here is thus far inconclusive as to which it will be, and we haven't discussed any factors that we could a priori prove it to be one or the other.

 

I guess what I feel like people here might be missing is that somebody is paying for all of this stuff right now. I'd have to presume that its us, the non-young, non-poor taxpayers / regulated medical insurance havers.

 

If OC is going to lower our taxes+heath care costs, then its a win--it's less socialized medicine than we had before.

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ObamaCare is worse than no ObamaCare for at least the following reasons:

 

1) It fascistly forces you to buy something expensive and important.

2) It fascistly and radically limits your options on this to what Big Brother approves of.

3) It coerces the hell out of the medical insurance companies, forcing them to accept customers and provide treatments they prefer not to.

4) It coerces the hell out of doctors and hospitals too.

5) It invades people's privacy on the grand scale. Gov't is sure to use this to massively blackmail and intimidate gov't critics via the FBI, NSA, CIA, etc. 

6) It significantly expands the IRS's gestapo-like powers.

7) It significantly shrinks health care options, such as limiting the variety of insurance plans and companies in existence. Over time this will become radical.

8) Lowers individual incomes, and impoverishes the economy generally, by giving a big incentive for companies to cut back hours to under 30 per week. Lowers company health care coverage too.

9) increases coercion generally.

10) Increases collectivism generally.

11) Increases regulation, bureaucracy, and red tape generally.

12) Increases the power, prestige, and authority of Big Brother generally.

13) It's based on the basically-loathsome moral ideals of "brother's keeper" (bible), and "greatest happiness of the greatest number" (Bentham), and "from each according to his ability, to each according to his need" (Marx).

14) It will massively sicken, maim, and kill people.

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This is what I was talking about on the 85/15 issue:

"I have long argued that the impact of the Affordable Care Act is not nearly as big of a deal as opponents would have you believe. At the end of the day, the law is – in the main – little more than a successful effort to put an end to some of the more egregious health insurer abuses while creating an environment that should bring more Americans into programs that will give them at least some of the health care coverage they need.

There is, however, one notable exception – and it’s one that should have a long lasting and powerful impact on the future of health care in our country.

That would be the provision of the law, called the medical loss ratio, that requires health insurance companies to spend 80% of the consumers’ premium dollars they collect—85% for large group insurers—on actual medical care rather than overhead, marketing expenses and profit. Failure on the part of insurers to meet this requirement will result in the insurers having to send their customers a rebate check representing the amount in which they underspend on actual medical care.

This is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Why? Because there is absolutely no way for-profit health insurers are going to be able to learn how to get by and still make a profit while being forced to spend at least 80 percent of their receipts providing their customers with the coverage for which they paid. If they could, we likely would never have seen the extraordinary efforts made by these companies to avoid paying benefits to their customers at the very moment they need it the most."

Rest here:

http://www.forbes.com/sites/rickungar/2011/12/02/the-bomb-buried-in-obamacare-explodes-today-halleluja/

And there's this response to the above article:

http://www.forbes.com/sites/theapothecary/2011/12/06/obamacares-mlr-bomb-will-create-private-insurance-monopolies-and-drive-premiums-skyward-hallelujah/

Edited by Plasmatic

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This is what I was talking about on the 85/15 issue:

"I have long argued that the impact of the Affordable Care Act is not nearly as big of a deal as opponents would have you believe. At the end of the day, the law is – in the main – little more than a successful effort to put an end to some of the more egregious health insurer abuses while creating an environment that should bring more Americans into programs that will give them at least some of the health care coverage they need.

[...]

Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Why? Because there is absolutely no way for-profit health insurers are going to be able to learn how to get by and still make a profit while being forced to spend at least 80 percent of their receipts providing their customers with the coverage for which they paid. If they could, we likely would never have seen the extraordinary efforts made by these companies to avoid paying benefits to their customers at the very moment they need it the most."

 

 

I certainly agree that such intrusion into private companies is a Very Bad Thing, but in this context we're talking about shades of Bad. So is even this rule that "bad" compared to the regulation of the insurance industry we had before?

 

Certainly there would be a million loopholes in this sort of thing as well. You can look forward to your share of the company's website costs mixed into your next doctor's bill, etc. etc. Yes, this makes this aspect of the law really stupid on every level (i.e. it won't even accomplish what the makers of the law wanted it to accomplish) but again, net-net, this is just going to add a bit more overhead to the system.

 

This might have an effect on My Taxes, but will this be as big of a factor as the primary plus and minus balance we've been talking about here? I seriously doubt it.

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So far you've argued that the ACA is better than what we had because it "optimizes" the actions the government takes to provide healthcare. We know that this is not a proper role of government, so I interpret your argument to be that it is better for the government to practice an illegitimate function consistently and completely rather than partially. For me to accept this, I'll need to see some practical benefit to the law. I'll then need to see an argument that justifies providing this benefit at the cost of cutting off all avenues of escape from the medicare system, from point of income to point of care.

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So far you've argued that the ACA is better than what we had because it "optimizes" the actions the government takes to provide healthcare. We know that this is not a proper role of government, so I interpret your argument to be that it is better for the government to practice an illegitimate function consistently and completely rather than partially. For me to accept this, I'll need to see some practical benefit to the law. I'll then need to see an argument that justifies providing this benefit at the cost of cutting off all avenues of escape from the medicare system, from point of income to point of care.

 

No, that's not my argument nor my conclusion.

 

First, as to my conclusion, I started this thread with a question, and my own theory about it, but I think I made it clear it was a theory and I requested more information. I got it.

 

From that, second, my current "argument" (what I believe to be true as of this moment) is that we don't know (we being the ones in this forum and the sources everybody's cited) as to whether OC will be a net-net gain or loss to those of us with the rights being violated the most (i.e. "rich" people). So as to the merits of OC, the current answer is, "don't know".

 

In particular, this is not my argument:

 

...that it is better for the government to practice an illegitimate function consistently and completely rather than partially.

 

I'm not exactly sure what that means, but suffice it to say that if I'm going to have my rights violated, I'd like it to have as little impact on me as possible. I would rather robbers steal my cheap watches and leave the expensive ones. Etc. If OC means I pay for less deadbeats--which was by all accounts the vision when the original idea was kicked off by Heritage--then its better. If this doesn't pan out and it's a wash, I don't care either way. If it costs me more, it's a bad thing.

 

From what I can tell so far, I don't see what the big fuss is all about...

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Ok, so you've assumed as much, but aren't arguing as much... Was I wrong to take your assumptions from the first post as an argument?

Either way, government activity should be evaluated by more things than simply what happens to you. A more comprehensive evaluation takes into account the increased impact on people already negatively affected (which includes you, I guess), alongside the greater extent to which people are being violated (which includes the new people captured by Medicare). As I've shown before, people such as yourself (and myself, as it happens) had avenues of escape that they chose not to take. Newly captured people are being violated afresh. I don't know how we could possibly convince them that saving the money of willing participants justifies taking change from their pockets. They'd probably want to start with evidence that we're saving money. Maybe we should start there, too. How much are you saving?

Edited by FeatherFall

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[...]

Maybe we should start there, too. How much are you saving?

 

Well, as I said, nobody here seems to know and neither do I. Based on the high-level, it seems like it will save me something, or perhaps be a wash.

 

Note that my actual insurance premiums are pretty much meaningless. What I'm talking about is taxes in order to support socialized health care. In the current system I'm paying for millions of deadbeats who show up in ERs through my taxes. What hospital I pick or what insurance won't change that. If more of these deadbeats start paying, then that will necessarily lower my tax burden modulo the extra goodies given out.

 

The broader context for me is this: is Obamacare a massive shift to socialized medicine worthy of drastic action including the disorderly take-down of our government, or is it just an attempt at a tweak to the current system that is going to have little or no effect on our overall level of economic freedom. I'm in essence asking about the Obamacare histrionics: where's the beef?

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Based on the high-level, it seems like it will save me something, or perhaps be a wash.

It has the potential of saving you a lot of money if it is rationed as is done with government-care already under Medicaid (and a bit under Medicare too), and as is also done in other countries in schemes like the NHS.

The broader context for me is this: is Obamacare a massive shift to socialized medicine worthy of drastic action including the disorderly take-down of our government, or is it just an attempt at a tweak to the current system that is going to have little or no effect on our overall level of economic freedom. I'm in essence asking about the Obamacare histrionics: where's the beef?

In a democracy like the U.S., most changes come in little steps. If you think of an axis of all the politically-possible systems, you will find that they all agree if one gets down to basic principles about the role of government. The government already has control of a a majority of healthcare spending in the U.S., so the increase in government-controlled share is obviously not a change in principle.

It is easy to laugh at GOP who are screaming so loudly at what is just another step. "One more step", let's just take it. The logical progression leads to a single-payer NHS-like system. To make things worse, a government single-payer system is something a fair number of people actively support. We're not talking about a small minority, but a significant number of people who lean Democrat even though they think of themselves as independents. They think government-run schools, for all their flaws, are the best system. They vote against vouchers, not because they think they will kill private schools, but because they think they will undermine government-run schools. Point is: Obamacare is a step toward increased government control, in a context where its advocates will then try to go to the next step.

Is there any wonder that people scream bloody murder as they are being dragged the next inch? Is it more healthy and more human to slide along in quiet acquiescence? For all the fret and the fury, I think Americans should be proud of the loud controversy all around. The kooks are embarrassing, but the overall spirit is admirable.

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Is there any wonder that people scream bloody murder as they are being dragged the next inch? Is it more healthy and more human to slide along in quiet acquiescence? For all the fret and the fury, I think Americans should be proud of the loud controversy all around. The kooks are embarrassing, but the overall spirit is admirable.

I was personally surprised at the volume of complaining against Obamacare during this, because it doesn't seem like the opponents are any more principled than the proponents. And then I have been further surprised at the sudden scared-like attention mainstream media are giving to the "Minority Tea Partiers." They'll attribute all of this to those "loons" but then they sound scared while they say it. ...Or maybe I'm just imagining their tone.

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Well, as I said, nobody here seems to know and neither do I. Based on the high-level, it seems like it will save me something, or perhaps be a wash.

 

Note that my actual insurance premiums are pretty much meaningless. What I'm talking about is taxes in order to support socialized health care. In the current system I'm paying for millions of deadbeats who show up in ERs through my taxes. What hospital I pick or what insurance won't change that. If more of these deadbeats start paying, then that will necessarily lower my tax burden modulo the extra goodies given out.

 

The broader context for me is this: is Obamacare a massive shift to socialized medicine worthy of drastic action including the disorderly take-down of our government, or is it just an attempt at a tweak to the current system that is going to have little or no effect on our overall level of economic freedom. I'm in essence asking about the Obamacare histrionics: where's the beef?

 

Explain to me exactly how you think this is happening; taxes going to making up for the cost of ER patients that don't pay, I mean.  Because it was my understanding that the hospital picks up that bill, and has to cover the costs with their other procedures.  This is one of the reasons that everything in a hospital is so expensive, which means that insurance companies face larger bills when they pay out, which means they have to charge higher premiums to everyone.  It seems to me that the effect you're most concerned about doesn't happen through taxes; it happens through the premiums that you want to ignore.

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Note that my actual insurance premiums are pretty much meaningless. What I'm talking about is taxes in order to support socialized health care. In the current system I'm paying for millions of deadbeats who show up in ERs through my taxes. What hospital I pick or what insurance won't change that. If more of these deadbeats start paying, then that will necessarily lower my tax burden modulo the extra goodies given out.

 

The broader context for me is this: is Obamacare a massive shift to socialized medicine worthy of drastic action including the disorderly take-down of our government, or is it just an attempt at a tweak to the current system that is going to have little or no effect on our overall level of economic freedom.

 

Dante already implied that we shouldn't ignore the cost implications "deadbeats" have on premiums and point of care. I also think it's worth pointing out that when you say, "what hospitals I pick or what insurance won't change [my taxes going to support socialized health care]," you are talking past another criticism of the law that speaks directly to the subject as you want to define it. That is, what hospital you pick or what insurance you have is precisely how the individual mandate determines if you are to be penalized. The only alternative is the additional insurance cost that is a direct result of avoiding the tax. To arrive at a broader context, we must not ignore the constituent parts that shape it.

Those two things mentioned above (increased taxes and insurance payments) both affect your ability to afford healthcare. But another relevant aspect of "socialized" (I think fascist is more accurate) healthcare is that it limits the procedures for which your higher bills will pay. That is the whole point of the mandated electronic medical records infrastructure. So, your point of care is also affected; with fewer medical procedures available, your insurance dollars pay for less. The also affects point of care by driving doctors out of medicine. You can't afford a doctor who doesn't practice. Fewer doctors and procedures are good things if the issue is framed the way you would have us frame it. But degrading point of care is monstrously evil; it can't be both a good thing and monstrously evil. So we have to check our premises, first and foremost we should make the broader context consists only of tax burdens.

Once we frame the issue in terms of all of the relevant constituent parts, I think we will find that Obamacare is a massive shift toward socialized medicine (by way of the calamity this fascistic law will create).

Edited by FeatherFall

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Dante said:

" It seems to me that the effect you're most concerned about doesn't happen through taxes; it happens through the premiums that you want to ignore."

Exactly, my thought as well. Expense is expense. IF premiums skyrocket to the percentages that are being tossed about, then that is something that I don't see 85% of Americans suffering lightly. Not only this, but what of the cost to quality of care that this system will affect?

Edited by Plasmatic

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Feather Fall said: " To arrive at a broader context, we must not ignore the constituent parts that shape it."

The extent to which this is ignored in general is difficult to overstate!

Edited by Plasmatic

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It has the potential of saving you a lot of money if it is rationed as is done with government-care already under Medicaid (and a bit under Medicare too), and as is also done in other countries in schemes like the NHS.

In a democracy like the U.S., most changes come in little steps. If you think of an axis of all the politically-possible systems, you will find that they all agree if one gets down to basic principles about the role of government. The government already has control of a a majority of healthcare spending in the U.S., so the increase in government-controlled share is obviously not a change in principle.

It is easy to laugh at GOP who are screaming so loudly at what is just another step. "One more step", let's just take it. The logical progression leads to a single-payer NHS-like system. To make things worse, a government single-payer system is something a fair number of people actively support. We're not talking about a small minority, but a significant number of people who lean Democrat even though they think of themselves as independents. They think government-run schools, for all their flaws, are the best system. They vote against vouchers, not because they think they will kill private schools, but because they think they will undermine government-run schools. Point is: Obamacare is a step toward increased government control, in a context where its advocates will then try to go to the next step.

Is there any wonder that people scream bloody murder as they are being dragged the next inch? Is it more healthy and more human to slide along in quiet acquiescence? For all the fret and the fury, I think Americans should be proud of the loud controversy all around. The kooks are embarrassing, but the overall spirit is admirable.

 

 

But is this a "step" in a good direction or a bad direction? Nobody's shown definitely here which it is. OC may save me from paying for deadbeats. It might not. If it does, it's a positive step, not a negative one.

 

And no, I don't see how OC leads to single payer anymore than the current system leads to single payer. This sounds like the "gateway drug" fallacies, which ignore the fact that every single new decision made by people is a new and unique act of volition. Put it another way, if OC is really a huge disaster, then it will push us away from single payer (and Jon Stewart utterly destroyed the HHS Secretary last night because he feared exactly that). Or maybe it won't. But we don't know and pretending to know is folly.

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Explain to me exactly how you think this is happening; taxes going to making up for the cost of ER patients that don't pay, I mean.  Because it was my understanding that the hospital picks up that bill, and has to cover the costs with their other procedures.  This is one of the reasons that everything in a hospital is so expensive, which means that insurance companies face larger bills when they pay out, which means they have to charge higher premiums to everyone.  It seems to me that the effect you're most concerned about doesn't happen through taxes; it happens through the premiums that you want to ignore.

 

This is definitely interesting--I'd love to hear more details. Are you saying that medicare/medicaid aren't paid for through normal income taxes? I've assumed that the money has to come from somewhere and I also assumed that money probably comes from me more than others based on a progressive taxation system.

 

You mentioned above that I can choose a hospital that doesn't take deadbeats, but clearly they exist in a competitive marketplace and clearly they can and do charge a lot more compared to a system that was totally free, so I'm getting hit that way regardless.

 

Dante already implied that we shouldn't ignore the cost implications "deadbeats" have on premiums and point of care. I also think it's worth pointing out that when you say, "what hospitals I pick or what insurance won't change [my taxes going to support socialized health care]," you are talking past another criticism of the law that speaks directly to the subject as you want to define it. That is, what hospital you pick or what insurance you have is precisely how the individual mandate determines if you are to be penalized. The only alternative is the additional insurance cost that is a direct result of avoiding the tax. To arrive at a broader context, we must not ignore the constituent parts that shape it.

 

 

I've never said we should ignore anything. I'm trying to get at the truth here. All I'm hearing so far is hand waving. Yes, the new money coming into the system may not make up for the extra money going out. Or it will. Until we prove otherwise, we just have to say we don't know and call it a wash.

 

All of this is sounding like a loophole hunt, and the question is, do I and others like me pay more or less for other people's health care at the end of it...

 

And also, again, context: I really don't care about what my insurance will and won't pay for per se. I'll get whatever procedure I need (and no, this isn't a "super-rich" sort of thing, lots of people in Europe have supplemental insurance that fills in the cracks of the government system to give them 100% coverage of everything they want). So I'm not afraid of not getting the procedure I need, etc.

Edited by CrowEpistemologist

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I was personally surprised at the volume of complaining against Obamacare during this,... ...

Yes, I didn't mean to suggest that one could have predicted this standoff and "shutdown". But, ... there is a lot of latent dislike of Obamacare; the majority of the country was not behind it originally; and, a good proportion of people still don't want it. If Cruz and a few others had not made it an issue, it would come quietly in the night. Since they did, they ignited hope and it is no surprise that it woke up people who were opposed, and even got Objectivists praising Cruz et al.

 

And then I have been further surprised at the sudden scared-like attention mainstream media are giving to the "Minority Tea Partiers." They'll attribute all of this to those "loons" but then they sound scared while they say it. ...Or maybe I'm just imagining their tone.

To most college-educated folk, libertarian-leaning ideas are "too extreme". Almost by definition, the "establishment" in a democratic system embrace the average status-quo. To them, outright communists and libertarians are both kooks.

For the future, the key is: will young people remain reliably Democrat-leaning, or will someone inspire them toward more libertarian ideas? The Democrats cannot inspire them via ideas, and they are turned off by religion and socially-traditional ideas, so where will they head?

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This is definitely interesting--I'd love to hear more details. Are you saying that medicare/medicaid aren't paid for through normal income taxes? I've assumed that the money has to come from somewhere and I also assumed that money probably comes from me more than others based on a progressive taxation system.

 

You mentioned above that I can choose a hospital that doesn't take deadbeats, but clearly they exist in a competitive marketplace and clearly they can and do charge a lot more compared to a system that was totally free, so I'm getting hit that way regardless.

 

 

Medicare and Medicaid are a separate issue from the medical costs of ERs.  ERs are required to provide care to anyone coming in, regardless of their ability to pay.  Thus, they treat many people that are ultimately unable to pay their medical bills, and are simply forced to take a loss on these people.  This inflates medical costs for other patients of that hospital.  This is a separate issue from Medicare and/or Medicaid, which are certainly paid for through taxes.

 

Also, that wasn't me that mentioned choosing hospitals that don't take Medicare/Medicaid.  You're confusing me with another poster.

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Crow:

Ayn rands essay on inflation, (compassion v. inflation?) applies directly to the effect this'll have on the medical market and insurance market. What monetary inflation does to the wealthy and the poor, alike, this will do to the healthy- and more to the sick.

People living on the border, who otherwise couldve barely afforded to live, will now die.

Yes, its only another step. Yes, its just more of the same. This doesn't make it less evil than the antecedent.

It's not some gateway mandate; that is invalid. It is quite literally armed robbery.

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