Commenter Archive

I think this is a fantasy. Significant portions of the population will never be able to pay for routine health maintenance services without being subsidized. Relying on that takes us back to the uninsured problems pre-ACA where people went untreated until the problem was catastrophic and thus much more costly for whoever ended up footing the bill.

I agree that the employer model is outdated but there is a role in my opinion for private insurers and that is cost control. It's what Medicare Part C and Medicaid Managed Care are (very imperfectly) experimenting with. I could see a world where risk adjusted private insurers working with ACOs or similar provider organizations get us to full coverage and save money, which as much as it sucks to say, is important.

Of course we aren't anywhere close to that yet but it's that reason that I'm not sure a switch to fee for service single payor is really what we should be aiming for.

@stillwater I'm talking about the system as a whole. We've got Medicare covering individuals over 65 but it's really split into 3ish systems. Parts A and B are at heart fully socialized systems where claims go directly to the federal government for payment.

Parts C and D are programs administered by private entities. Part C will be your traditional insurers who get money from the federal government through the risk adjustment process and Part D is the prescription drug program. These entities are for profit, private entities but are also heavily regulated and depended on by the government for Medicare to work.

Next you have your for profit plans, traditionally provided by employers, versions of which are now commercially available for individuals via the exchanges. These plans are regulated primarily at the state level. They cover everyone under 65 or who don't qualify for Medicaid.

Lastly you have Medicaid (including CHIP, etc.) for people with sufficiently low income which is funded by the federal government but administered by the states. Like Medicare, some Medicaid benefits are paid by claims straight to the state agency but there are also Medicaid Managed Care plans administered by private insurance companies that look a lot like Medicare Part C.

All of these systems have their own interested parties, their pros and their cons. What we don't have is a fundamental coherence and it can be extremely challenging to understand how they all work together, including the gaps, perverse incentives, and cost hiding that goes on between them. These gaps and perverse incentives was how we ended up with the large number of uninsured (who were putting pressure on emergency providers which operate in regulatory ecosystems of their own) that the ACA was supposed to address. The problem with the ACA is that it looks to correct the problem of the uninsured which is really just a symptom of the fact that we've got all of these overlapping payors (public and private) with their own incentives and prerogatives, and subject to a variety of different regulations at every level of government. The uninsured were people who fell through the cracks under the old system but by insuring them we've created other unintended consequences.

My point is just that no one would create a system like this from scratch. However it's hard to fix at the margins because of the overlap and different levels of government involved and of course scrapping it and starting over probably isn't possible politically. Also for clarity my point isn't that we don't need regulation just that we need a system that covers everyone and isn't in perpetual conflict with itself.

The better question is why do we deliver healthcare through this insurance structure. Even if it was fully public it would probably still be an insurance type system where people are paying into it and someone is determining what's covered and what isn't. That's how single payor (and old school Medicare parts A and B) work, it's just financed through taxes of current or future beneficiaries, as applicable.

The fundamental flaw isn't so much that aspect of it, it's that in this country we've built an incoherent hybrid public-private system with its own entrenched interests and fiefdoms. Our system of government makes comprehensive reform (which I agree is what we would do in a perfect world) really hard to get to.

The problem with this theory is it assumes that the big private insurers have gotten good at navigating the system. They haven't and they probably never will because they're constantly under threat from different regulators with different agendas.

Even the state level CO-OPs that were treated with kid gloves are mostly collapsing right now.

Interesting thought but the federal government hasn't given any indication that it's financially prepared to insure the large numbers of people who don't qualify for Medicare or Medicaid but who can't be covered in a manner that's profitable for the commercial plans. Many of the populations that were falling through the cracks under the pre-ACA system are too expensive for the private sector to insure. This is compounded by the fact that insurers are subject to approval at the state level. You get situations where private insurers abandon a jurisdiction due to the cost of taking on too many sick people and there's no one there to pick up the slack.

I think theres a strong possibility that the ACA will fail due to the incoherence of the regulatory structure and as Will said, I do think it shows that the public option would have destroyed the private competition. Whether or not that's desirable I suppose depends on your politics.

Any acknowledgement of the hit squads is per se racist and xenophobic. Which is why AfD is going to make an even larger than expected entrance into the Bundestag next time the Germans have an election.

I think the government's ambiguous stance on joining anti-ISIS fighters is actually preferable. While it should not in any manner be encouraged, I don't like the idea of people being prosecuted for it. Granted I also think if something bad happens to someone who voluntarily travels into a war zone for combat they should be considered on their own as far as the government is concerned.

I thought it was a good point. Just constructive criticism to the moderators/editors but it might be helpful to get some guidance on where the line crossing occurred. Not saying name and shame or anything but I don't get the impression anyone was trying to run her off and I certainly don't want to contribute to harming the (much appreciated) efforts to get good writers.

The conversation didn't strike me as particularly intense compared to some I've seen/participated in here but it seems others disagree.

No disagreement from me.

I read it the same way Damon did. It's unfortunate it was pulled because I thought it was an interesting piece. I can of course also understand why the author might not want her family life to be the touch point of the discussion that ensued.

I am not yet a parent but there is a sufficiently large age gap between myself and my siblings that I was able to see my brothers going through their teenage years from a more or less adult perspective. Kids can be pretty creative at justifying their mayhem when discipline is in order. If theyre clever enough the excuse will be perfectly designed to pull their parents' strings.

I agree with your sentiment. Teenagers doing dumb teenager stuff probably doesn't merit serious analysis of the political implications. A reminder of the rules of being a good neighbor is probably sufficient.

I'd follow the advice from your friend from Virginia. My suspicion is that you've blown the potential reaction from the neighbor up into something in your mind that is much worse than its likely to be. Even if he is rude or doesn't accept the apology he will hopefully at least have a grudging respect for the mom who required her daughter to do the right thing. That might be important one day down the road.

Cr1, assuming there isn't more to the story, is particularly disturbing and I hope leads to more investigation.

I think the problem with either approach is that they rely on the idea that you can completely separate policy from values.

Maybe he will write in Jodie Foster.

I don't know. I think there's way too much evidence corroborating the FBI's malfeasance for it to be conspiracy theory. I think the FBI knows there isn't much they can do to stop the true lone wolf/self radicalized murderer but they also know they can never admit that. They go around agitating losers and crazy people into phony plots then patting themselves on the back for foiling them and making people feel safe that the authorities aren't completely impotent.

Now the idea that they might chose not to foil a plot they themselves engineered in order to further some agenda gets into some weird territory...

It's all well in the realm of wild speculation right now. Kind of ironic in a way but the scenario I think she most needs to avoid is George H.W Bush in 1992.

To me the 2020 election, even if way out, might offer even more intriguing and/or disturbing possibilities than this election. You have to figure even if Hilary is running (I think she will be and that she wins this election but only narrowly) she could be the weakest incumbent in a long time. If the GOP has gone full Trump it may be able to find someone able to tap into the same discontent Trump is riding but who is more disciplined and able to turn it into a victory.

Don't apologize for the joke that was hilarious!

Maybe we're talking passed each other but courts reach holdings based on policy arguments all the time. There is a large body of case law on when non-compete agreements are and aren't enforceable and different jurisdictions take different approaches. There's nothing radical about taking the position that courts shouldn't enforce non-compete agreements in circumstances like this which is all I'm arguing.

I have no objections to arrangements like that. As you note there's an exchange of value there.

That's not true unless the contract required the company to take some tangible action or pay for something. Maybe if there is a real quid pro quo (you don't quit and we pay for your college/masters/certification) that might be the case but that's a different discussion.

First no one is saying society should intervene. The question is should a court enforce it if asked. Second, if your opinion is that courts should prioritize enforcing non-compete agreements over all other considerations then fair enough but I'd say that's pretty myopic both about the realities of the world and how the law works.