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Old 03-22-2010, 01:19 AM   #241 (permalink)
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David Frum... a Canadian that most of us would be happy to forget is a Canadian. That said, what he had to say was some of the most pragmatic utterances I've heard from *any* Republicans in this debate. Interesting to hear it now that the voting is over. I wonder if this form of spin will get any traction given the new paradigm or will Beck, Hannity, Limbaugh and company continue to push their tired agenda on America?

How long can the sort of hysteria that I am seeing (and even reading in this thread) be maintained? How long before it (needlessly) boils over?

Hopefully calmer heads prevail.
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Old 03-22-2010, 01:43 AM   #242 (permalink)
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Originally Posted by Idyllic View Post
I have always been disappointed with Obama, from the first moment he decided it would be o.k. to acknowledge a withdrawal date, like a sucker punch to our kids over there. Just lost all respect for the man.
This is something of a threadjack, but every "kid" "over there" that I know (and, having graduated college in the last 10 years, I know a lot of them), wants desperately to come back or desperately not to ever go there again, having already been once before.

I can't imagine what "kids" you know who think being able to come home from a hostile country is a sucker punch, but hey.

This isn't what I wanted, but, as an independent contractor, I'll sure as heck take it over the alternative.
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Old 03-22-2010, 03:12 AM   #243 (permalink)
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Originally Posted by Charlatan View Post
David Frum... a Canadian that most of us would be happy to forget is a Canadian. That said, what he had to say was some of the most pragmatic utterances I've heard from *any* Republicans in this debate. Interesting to hear it now that the voting is over. I wonder if this form of spin will get any traction given the new paradigm or will Beck, Hannity, Limbaugh and company continue to push their tired agenda on America?

How long can the sort of hysteria that I am seeing (and even reading in this thread) be maintained? How long before it (needlessly) boils over?

Hopefully calmer heads prevail.
I'm sure their push will only get stronger. They will put on the fake outrage and do their best to influence elections in november.
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Old 03-22-2010, 03:58 AM   #244 (permalink)
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Originally Posted by Charlatan View Post
Smeth... I just read the article to which you linked. I can't believe that such a prominent GOP leader would actually say, "we think this is the beginning of the end for America."

America really is a mess. I can't imagine a politician, in such a high position, in any other Western nation, spewing forth such hyperbole. Wow.
I could never get this sentiment. If the passing of a health care bill such as this can destroy America, what does that say about America? Is it really that weak? That fragile?
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Old 03-22-2010, 04:28 AM   #245 (permalink)
 
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the astonishing thing about this logic, such as it is, remains for me that the right is now saying effectively that "the american way" is defined by a health care arrangement that is a permanent expression of class warfare in the context of which over 30 million people do not have access to insurance and so do not have access to basic health care.

of course, you can't say that because the correlates of the argument are really ugly--you know, that these 30 million are extraneous people, or that they're not "real americans" or whatever---so instead the right's meme-machine shifts to matters of abstract "individual" rights as if "individuals" exist outside of society. so then social goals, like raising american capitalism from the barbaric conditions it allows to exist insofar as health care is concerned for the uninsured---become read as some kind of Imposition on the individual. which sets up the conservative Individual as wholly infantile, unable to distinguish itself from the world. the conservative individual is the world until Bad Reminders Come that maybe conservative individuals are not the world. these Bad Reminders typically come from the Persecuting State which is always bad unless it is being used to fund conservative-friendly constituencies like the military. then it is good. conservative Individuals, it seems, like diverting resources to systems that kill people but not so much to resources that make living easier or better for all. whatever.

it'd be amazing were it not so prevalent. read this thread. geez.

depressing stuff.
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Old 03-22-2010, 07:08 AM   #246 (permalink)
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From the hysterical accusations from the Republicans one would think that this healthcare bill was some kind of radical change like single payer or something. Instead it is a middle of the road proposal similar to Mitt Romney’s Massachusetts plan or the Republican counter-proposals to Clintoncare in 1993-1994. You can only cry "the sky is falling" so many times before you loose all credibility.

I don't think this bill will hurt the Democrats nearly as much as the Republicans think once people realize that life goes on and no one is pulling the plug on grandma.
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Old 03-22-2010, 07:46 AM   #247 (permalink)
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The dangerous thing is that most of the benefits won't go into affect for a few years, so the republicans have plenty of time to ramp up the propoganda machine saying "see we told you it wouldn't work, what has this done for you so far?" Even though they know full well it's not going to do a whole lot until 2014.
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Old 03-22-2010, 08:36 AM   #248 (permalink)
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Originally Posted by Charlatan View Post
Smeth... I just read the article to which you linked. I can't believe that such a prominent GOP leader would actually say, "we think this is the beginning of the end for America."

America really is a mess. I can't imagine a politician, in such a high position, in any other Western nation, spewing forth such hyperbole. Wow.
I'm surprised the guy who said 'Behave like grown-ups' if healthcare bill is passed' in Smeths article is the same guy I saw on CN last night while flipping through the channels say 'The next 24 hours are "armageddon" because the health care bill proposed by Democrats will "ruin our country".
Boehner: It's 'Armageddon,' Health Care Bill Will Ruin Country | The FOX Nation

Quite amusing to be watching from the outside though, especially in this thread, I mean we've had it all, factual errors, people saying politicians said things when they didn't, some laughs, yep pretty amusing.
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Old 03-22-2010, 10:16 AM   #249 (permalink)
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Originally Posted by pan6467 View Post

Wonder when the markets crash tomorrow, what's going to be your spin??????
Markets are up. What is your spin?
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Old 03-22-2010, 10:24 AM   #250 (permalink)
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Originally Posted by dippin View Post
Markets are up. What is your spin?
Yeah, not only are health-care stocks surging, but even U.S. bonds are ticking upward, suggesting that the bond markets aren't overly concerned about the implications of health care.
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Old 03-22-2010, 12:24 PM   #251 (permalink)
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Quote:
Originally Posted by rahl View Post
The dangerous thing is that most of the benefits won't go into affect for a few years, so the republicans have plenty of time to ramp up the propoganda machine saying "see we told you it wouldn't work, what has this done for you so far?" Even though they know full well it's not going to do a whole lot until 2014.
The Top Ten Immediate Benefits You?ll Get When Health Care Reform Passes | House Democrats
Quote:
The Top Ten Immediate Benefits You’ll Get When Health Care Reform Passes

As soon as health care passes, the American people will see immediate benefits. The legislation will:
  • Prohibit pre-existing condition exclusions for children in all new plans;
  • Provide immediate access to insurance for uninsured Americans who are uninsured because of a pre-existing condition through a temporary high-risk pool;
  • Prohibit dropping people from coverage when they get sick in all individual plans;
  • Lower seniors prescription drug prices by beginning to close the donut hole;
  • Offer tax credits to small businesses to purchase coverage;
  • Eliminate lifetime limits and restrictive annual limits on benefits in all plans;
  • Require plans to cover an enrollee’s dependent children until age 26;
  • Require new plans to cover preventive services and immunizations without cost-sharing;
  • Ensure consumers have access to an effective internal and external appeals process to appeal new insurance plan decisions;
  • Require premium rebates to enrollees from insurers with high administrative expenditures and require public disclosure of the percent of premiums applied to overhead costs.
By enacting these provisions right away, and others over time, we will be able to lower costs for everyone and give all Americans and small businesses more control over their health care choices.
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Old 03-22-2010, 05:20 PM   #252 (permalink)
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HuffPo has compiled a list of the top 18 immediate effects of the health care bill as well as some that will take effect in the first year of implementation:

Health Reform Bill Summary: The Top 18 Immediate Effects

Quote:
  • An End To Pre-Existing Conditions: Health Insurers cannot deny children health insurance because of pre-existing conditions. A ban on the discrimination in adults will take effect in 2014.
  • Small Business Tax Credits: Businesses with fewer than 50 employees will get tax credits covering up to 50% of employee premiums.
  • Seniors Get 'Donut Hole' Rebate: Seniors will get a rebate to fill the so-called "donut hole" in Medicare drug coverage, which severely limits prescription medication coverage expenditures over $2,700. As of next year, 50 percent of the donut hole will be filled.
  • More Young Adults Covered On Parents' Plans: The cut-off age for young adults to continue to be covered by their parents' health insurance rises to the age 27.
  • No Lifetime Caps: Lifetime caps on the amount of insurance an individual can have will be banned. Annual caps will be limited, and banned in 2014.
  • Adults With Pre-Existing Conditions Covered: A temporary high-risk pool will be set up to cover adults with pre-existing conditions. Health care exchanges will eliminate the program in 2014.
  • New Insurance Plans Must Include Preventative Care: New plans must cover checkups and other preventative care without co-pays. All plans will be affected by 2018
  • The End Of 'Recissions': Insurance companies can no longer cut someone when he or she gets sick.
  • Transparency In Insurance Companies: Insurers must now reveal how much money is spent on overhead.
  • Customer Appeals Process: Any new plan must now implement an appeals process for coverage determinations and claims.
  • Indoor Tanning Services Tax: This tax will impose a ten percent tax on indoor tanning services. This tax, which replaced the proposed tax on cosmetic surgery, would be effective for services on or after July 1, 2010.
  • Enhanced Fraud Abuse Checks: New screening procedures will be implemented to help eliminate health insurance fraud and waste.
  • Medicare Expansion To Rural Areas: Medicare payment protections will be extended to small rural hospitals and other health care facilities that have a small number of Medicare patients.
  • Deductions For Blue Cross Blue Shield: Non-profit Blue Cross organizations will be required to maintain a medical loss ratio -- money spent on procedures over money incoming -- of 85 percent or higher to take advantage of IRS tax benefits.
  • Nutrient Content Disclosure: Chain restaurants will be required to provide a "nutrient content disclosure statement" alongside their items. Expect to see calories listed both on in-store and drive-through menus of fast-food restaurants sometime soon.
  • Better Coverage For Early Retirees: The bill establishes a temporary program for companies that provide early retiree health benefits for those ages 55‐64 in order to help reduce the often-expensive cost of that coverage.
  • Better Consumer Information On The Web: The Secretary of Health and Human Services will set up a new Web site to make it easy for Americans in any state to seek out affordable health insurance options The site will also include helpful information for small businesses.
  • Encouraging Investment in New Therapies: A two‐year temporary credit (up to a maximum of $1 billion) is in the bill to encourage investment in new therapies for the prevention and treatement of diseases.
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Old 03-23-2010, 09:57 AM   #253 (permalink)
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Opinions turn favorable on health care plan - USATODAY.com

Quote:
Opinions turn favorable on health care plan

By Susan Page, USA TODAY
WASHINGTON — Americans by 9 percentage points have a favorable view of the health care overhaul that President Obama signed into law Tuesday, a USA TODAY/Gallup Poll finds, a notable turnaround from surveys before the vote that showed a plurality against it.
By 49%-40% those surveyed say it was "a good thing" rather than a bad one that Congress passed the bill. Half describe their reaction in positive terms, as "enthusiastic" or "pleased," while about four in 10 describe it in negative ways, as "disappointed" or "angry."

The largest single group, 48%, calls the bill "a good first step" that should be followed by more action on health care. An additional 4% also have a favorable view, saying the bill makes the most important changes needed in the nation's health care system.

To be sure, the nation remains divided about the massive legislation that narrowly passed the House late Sunday and was signed by Obama in an emotional East Room ceremony Tuesday morning. The Senate began debate Tuesday afternoon on a package of "fixes" demanded by the House.

The findings are encouraging for the White House and congressional Democrats, who get higher ratings than congressional Republicans for their work on the issue. The poll shows receptive terrain as the White House and advocacy groups launch efforts to sell the plan, including a trip by Obama to Iowa on Thursday.

No one gets overwhelmingly positive ratings on the issue, but Obama fares the best: 46% say his work has been excellent or good; 31% call it poor. Congressional Democrats get an even split: 32% call their efforts good or excellent; 33% poor.

The standing of congressional Republicans is more negative. While 26% rate their work on health care as good or excellent, a larger group, 34%, say it has been poor.

For more results and a look at the demographic breakdown of the poll findings, see Wednesday's USA TODAY.
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Old 03-23-2010, 04:59 PM   #254 (permalink)
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I know you can't actually hear the defeat in his voice when you read the article, but here's a bit more on Kucinich. Click the link for the full article.

Dennis Kucinich on Health Care Bill - What Obama Didn't Say by Dennis Kucinich - Esquire

Quote:
The meeting that took place on Air Force One was the fourth in a series of meetings that I had attended with the president in the last few months. There was a meeting on March 4 where the president called nine members to the Roosevelt Room at the White House, and eight of the members had voted for the bill when it passed the House last fall. I was the only one who voted against the bill. I thanked the president for inviting me even though I was a "no" vote. And in the more than hour-long meeting, the president covered a lot of territory about what he thought was important to consider. I sat quietly and listened carefully and took some notes. And at the end of the meeting, you know, we thanked each other, and I left.

I think that once people stop irrationally assuming the worst about this bill, we'll all be a great deal better off. Nobody thinks it's perfect, and nobody is completely satisfied. Unfortunately, there seems to be an entire political party that exists purely to feed irrational fear of the bill.

This isn't the end of the United States. It isn't the end of the economy. It isn't the cause of a crippling deficit that will crush the will of our grandchildren. My prediction is that most of the doomsaying that is currently occurring will fail to be borne out in reality and that most of the folks currently predicting doom won't even realize that they were wrong (much less publicly acknowledge the fact that they were wrong).
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Old 03-25-2010, 01:31 PM   #255 (permalink)
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The GOP's Dirty Health-Care Secret - The Daily Beast

The GOP has a really short memory, eh?
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Old 03-29-2010, 11:07 AM   #256 (permalink)
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Originally Posted by filtherton View Post
I think that once people stop irrationally assuming the worst about this bill, we'll all be a great deal better off. Nobody thinks it's perfect, and nobody is completely satisfied. Unfortunately, there seems to be an entire political party that exists purely to feed irrational fear of the bill.
In this thread post #50 I wrote:

Quote:
If pre-existing conditions are an issue an insurance company can simply stop accepting new applicants forcing those people to go into the exchanges. This adverse selection will force costs up in the exchanges or coverage will have to be sacrificed. Kucinich was right at first, this bill is a win for insurance companies. We either need to go all in with a single payer public option or go "free market", this hybrid is for the birds.
I have been constantly writing about the consequences (how market participants will respond) and there is constant pretense that there will be no unintended consequences. Market responses are not irrational, to the contrary it is very rational and predictable:

Quote:
Just days after President Barack Obama signed the health care law, insurance companies are arguing that, at least for now, they don't have to provide one of the benefits the president calls a centerpiece of the law: coverage for certain sick children.

At issue is how the industry has to treat children with pre-existing medical conditions.

Obama, speaking at a health care rally in Northern Virginia on March 19, said, "Starting this year, insurance companies will be banned forever from denying coverage to children with pre-existing conditions."

The law's authors say they meant to ban all forms of discrimination against children with pre-existing conditions like asthma, diabetes, birth defects, orthopedic problems, leukemia, cystic fibrosis and sickle cell disease. The goal, they say, was to provide them access to insurance and to a full range of benefits once they are in a health plan.

To insurance companies, the language of the law is not so clear.

Insurers agree that if they provide insurance for a child, they must cover pre-existing conditions. But, they say, the law does not require them to write insurance for the child and it does not guarantee the "availability of coverage" for all until 2014.

William Schiffbauer, a lawyer whose clients include employers and insurance companies, said: "The fine print differs from the larger political message. If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost."
Read more: When will children be covered? - CharlotteObserver.com

I suggest we keep our eyes open and ask questions, demand answers and try to get politicians off of their talking points. This should be truly embarrassing to Obama, I wonder if he read the legislation?
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Old 03-29-2010, 11:22 AM   #257 (permalink)
 
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good that you've got your shit straight and are asking the important questions, ace--how will the insurance companies react?
it's a bit mysterious that you don't seem to pay any attention to any of the....um....medical situations in the states that call out for the reforms, no matter how watered down they may be by the obama administrations mistaken approach that had them taking seriously what conservatives said. stuff like this:

http://www.amnesty.org/en/library/as...10192010en.pdf

maternal mortality rates have gone from 6.6/100k in 1987 to 13.3/100k in 2008. the problem, as this report makes clear, is really the radically unequal quality of care afforded different populations in the united states under the system that's being changed.

so these are people dying in childbirth. there's lots of other examples. but clearly the question is how the insurance companies will react.
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Old 03-29-2010, 11:27 AM   #258 (permalink)
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Originally Posted by Derwood View Post
The GOP's Dirty Health-Care Secret - The Daily Beast

The GOP has a really short memory, eh?
Wow, so the left has to go to Nixon to make a point? Wasn't Nixon the guy who imposed wage and price freezes? Certainly not a free market concept.

But, there are two types of mandates regarding health care, there is the type like with medicare were everyone is required to participate through taxation and there is the type like in Obama's bill and like in Massachusetts. No matter who proposes the latter, odds are that the Constitutionality will be challenged.

If a low income person is living pay check to pay check on average I understand they will pay about 10% of their income on health insurance - fro people living pay check to pay check this is a big deal. Some will face paying their heat bill or pay for health insurance and would rather pay the heat bill - but they are going to get hit with a fine so they may not have a choice. Welcome to the new America.
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Old 03-29-2010, 11:29 AM   #259 (permalink)
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Insurance companies will no longer be able to turn away those with pre-ex's. They can't deny them, so there won't be a flood of people going into the exchange.
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Old 03-29-2010, 11:35 AM   #260 (permalink)
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good that you've got your shit straight and are asking the important questions, ace--how will the insurance companies react?
The point is that there needed to be a real open debate on the subject, there was not. Obama's approach to this complicated issue, was his way or no way.
Quote:
it's a bit mysterious that you don't seem to pay any attention to any of the....um....medical situations in the states that call out for the reforms,
This comment assumes there was not a better way to address reform, I think there is.

Quote:
no matter how watered down they may be by the obama administrations mistaken approach that had them taking seriously what conservatives said. stuff like this:

http://www.amnesty.org/en/library/as...10192010en.pdf

maternal mortality rates have gone from 6.6/100k in 1987 to 13.3/100k in 2008. the problem, as this report makes clear, is really the radically unequal quality of care afforded different populations in the united states under the system that's being changed.

so these are people dying in childbirth. there's lots of other examples. but clearly the question is how the insurance companies will react.
It is frustrating reading reports like this when from the start they make it clear there is a political agenda. In the first paragraph they make this statement which is false:

Quote:
Approximately half of these deaths could be prevented
if maternal health care were available, accessible and
of good quality for all women in the USA.
There are almost no women in this country who can not get access to good prenatal care. How is the report to have any credibility?
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Old 03-29-2010, 11:40 AM   #261 (permalink)
 
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because of the documentation behind it ace.
i don't think researchers are calling you up to see if their results are ok with you.
so it's really not important whether you like the information or not.

class stratification of access to medical care is a basic reality.
i hardly expect you to see that because i don't expect you acknowledge the existence of economic classes.

there is a debate in here somewhere that will come---not here---about whether medical care should be understood as a business---whether any of it should be for profit---whether that is ethical at all.

but for the moment of course, what's important are conservative bromides about rational markets and dismissing information about actual problems of access to medical care.

way to go.
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Old 03-29-2010, 11:50 AM   #262 (permalink)
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Originally Posted by rahl View Post
Insurance companies will no longer be able to turn away those with pre-ex's. They can't deny them, so there won't be a flood of people going into the exchange.
Do you wanna make a wager? If this is not an issue, I will make a charitable donation to your charity of choice, if it is you make a donation to Big Brothers Big Sisters, on the honor system.

An insurance company can simply stop taking new applicants if the "pre-existing" condition issue is expected to be a problem. So, in 2013 they write as much "profitable" business as possible and basically close their doors in 2014. The rush begins, all the people without insurance with pre-existing conditions go into exchanges. 2015, insurance companies start accepting new clients, or perhaps they don't - because the costs for their pool will be significantly lower and so will the premiums. Perhaps, they start a separate company with separate books - oh, you must get it - insurance companies will have people actually read the law, find the holes, and use them as they see fit. The insurance companies know the battle is not over. Insurance companies know the business better than the folks in Washington.

---------- Post added at 07:50 PM ---------- Previous post was at 07:45 PM ----------

Quote:
Originally Posted by roachboy View Post
because of the documentation behind it ace.
i don't think researchers are calling you up to see if their results are ok with you.
so it's really not important whether you like the information or not.

class stratification of access to medical care is a basic reality.
i hardly expect you to see that because i don't expect you acknowledge the existence of economic classes.

there is a debate in here somewhere that will come---not here---about whether medical care should be understood as a business---whether any of it should be for profit---whether that is ethical at all.

but for the moment of course, what's important are conservative bromides about rational markets and dismissing information about actual problems of access to medical care.

way to go.
I understand the issues, my point was pretty clear. I started reading the report and right from the start they make a b.s. statement. They could have worded the statement in a manner to make the point and be truthful without the actual implication they made. As the reader, I made an assumption, which is my right, I believe they have a political agenda and truth is secondary.
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Old 03-29-2010, 11:53 AM   #263 (permalink)
 
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....There are almost no women in this country who can not get access to good prenatal care. How is the report to have any credibility?
ace...the average cost of prenatal care and delivery in the US is nearly $8,000.

Is that affordable and accessible if you are a working family making $30-50K and have no insurance?
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Old 03-29-2010, 12:03 PM   #264 (permalink)
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Originally Posted by aceventura3 View Post
Do you wanna make a wager? If this is not an issue, I will make a charitable donation to your charity of choice, if it is you make a donation to Big Brothers Big Sisters, on the honor system.

An insurance company can simply stop taking new applicants if the "pre-existing" condition issue is expected to be a problem. So, in 2013 they write as much "profitable" business as possible and basically close their doors in 2014. The rush begins, all the people without insurance with pre-existing conditions go into exchanges. 2015, insurance companies start accepting new clients, or perhaps they don't - because the costs for their pool will be significantly lower and so will the premiums. Perhaps, they start a separate company with separate books - oh, you must get it - insurance companies will have people actually read the law, find the holes, and use them as they see fit. The insurance companies know the battle is not over. Insurance companies know the business better than the folks in Washington.
The vast majority of people with insurance have it through their employer. Beginning immediatly all children under 19 can not be excluded. Beginning in 2014 no one can be excluded. Your scenario could hypothetically happen to people buying individual policies, but it won't affect employer sponsored plans, which is what most americans have.

I don't doubt that insurance companies will follow only the letter of the law and no more. They will in all likelyhood try to exploit any and all loopholes, but the language is very specific in terms of group health insurance.
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Old 03-29-2010, 12:13 PM   #265 (permalink)
 
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by chance i just saw this post from the mit press blog. i'll paste up the relevant paragraphs:

Quote:
Apart from the political debate, we wanted to know what was next for the nation's health care system. So we turned to Tom Lee, who's CEO of Partners Health Care in Boston and coauthor with James Mongan of Chaos & Organization in Health Care, which analyzes the prospects of reform from the standpoint of the delivery of care. He sent us the following thoughts on the changes just enacted, the challenges that lie ahead, and why reform matters.

Now that the health care reform legislation has passed, the real work begins. There are three types of “reform” related to health care, and the U.S. has just made huge progress on the first – financing reform (i.e., coming up with the money to pay for health care).

The second type of reform is payment reform – i.e., how providers are paid. Will they continue to be paid fee-for-service, by the test, by the procedure? Or will the funds made available through the new legislation be used in some different way, such as bundled payments for episodes of care or capitated payments to providers for care for an entire population?

If the payment system does not change, we can expect slow progress on the third and most important type of reform – delivery system reform. Delivery system reform means real change in the way care is delivered. It means providers getting more organized, and implementing systems that make care more efficient and higher quality.

Ultimately, delivery system reform is the real goal – it is the end, for which payment reform is just the means. It is our best hope for truly improving the efficiency and quality of care.

A reasonable question is – why weren’t all these issues addressed together? The reason is that it is too complicated. Meaningful efforts to change the payment system and the delivery system would create too many losers who would do their best to sabotage the change.

I strongly believe that the way we took on health care reform in Massachusetts makes sense – first get everyone covered, then take on costs and other tough issues. Once you have everyone covered, then the gun is held to our heads to get down to the ugly work of changing how we do things in health care. If you don’t have that commitment to full coverage in place, then it is all too easy to squirm out of short term financial challenges by un-insuring or under-insuring people.

I hope we really do have a much broader national commitment to covering most Americans now. And I know that the challenges in making that commitment work will be brutal. But for the faint of heart, let me give one glimpse of the reward within our reach.

In my practice at the teaching clinic at Brigham and Women’s Hospital, my population is very mixed socioeconomically, racially, and medically – but they are all alike in one way. Every single patient now has insurance. My last uninsured patient got coverage last fall through the Massachusetts Connector. He is a 62 year old self-employed electrician with diabetes. He really needs insurance, and it is a lot easier for me to take care of him now.

That’s why slogging away at the second and third types of health care reform is work worth doing.
MITPressLog: After reform...what's next?

do you think mongan provides a useful orientation for thinking about the process that's underway with this legislation?
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Old 03-29-2010, 02:00 PM   #266 (permalink)
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Originally Posted by roachboy View Post
do you think mongan provides a useful orientation for thinking about the process that's underway with this legislation?
Yes, however I think the first type of reform "financing" will be modified by the addition of a public option before much progress is made on the others.
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Old 03-30-2010, 01:11 PM   #267 (permalink)
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Originally Posted by dc_dux View Post
ace...the average cost of prenatal care and delivery in the US is nearly $8,000.

Is that affordable and accessible if you are a working family making $30-50K and have no insurance?
There is a difference between the average cost and what a low income woman would pay, if anything. There are many reasons why prenatal care is at unacceptable levels in this country for some women but to suggest the issue is one of availability is untrue. That is my only comment on this issue at this time.

---------- Post added at 09:04 PM ---------- Previous post was at 08:45 PM ----------

Quote:
Originally Posted by rahl View Post
The vast majority of people with insurance have it through their employer. Beginning immediatly all children under 19 can not be excluded. Beginning in 2014 no one can be excluded. Your scenario could hypothetically happen to people buying individual policies, but it won't affect employer sponsored plans, which is what most americans have.
We already have business owners who have gone on record saying that if they pay a penalty for not offering coverage their costs would be lower. At some point some of those people may very well drop the benefit to their employees. This is important - the costs of those plans will go up because of the preexisting conditions issue, not go down, increasing the probability the benefit will be dropped by some employers. Those employees will most likely go into the exchanges. As the cycle continues, employers who want to maintain the benefit may find themselves at a competitive disadvantage and either face declining market share, profitability, or going out of business. they may be forced into dropping the benefit, putting more in the exchanges. And, even if insurance companies simply take new insured's with preexisting conditions, costs will go up and passed on to all insured's. Insurance companies have a mandated medical pay-out ratio, but on the other-hand this is a guaranteed profit margin once the get a handle on their non-medical costs.

This is not going to hurt insurance companies or business owners, ultimately these cost will be incurred by the American public one way or the other.

My preference with children is to have a system where we simply cover the medical costs for all children in this country period, no questions asked. If a child is being treated for a condition upon obtaining the age of majority, we should continue that treatment for the remainder of their lives, otherwise they buy a policy on their own. That and a free market approach for adults, up to qualifying for Medicare is what I would do - short of a true single payer system with individuals having the option of buying supplemental coverages.

Quote:
I don't doubt that insurance companies will follow only the letter of the law and no more. They will in all likelyhood try to exploit any and all loopholes, but the language is very specific in terms of group health insurance.
But, that is the point. Perhaps, the stop offering group coverage and focus on individual policies. Or perhaps they do the opposite. Perhaps, the write coverage in Arizona but not Michigan, etc, etc, etc., They are not going to go out of business over preexisting conditions - they will make a profit or not participate. the legislation does not have simple little loop-holes, it has major problems that contradict the broad promises made.

---------- Post added at 09:11 PM ---------- Previous post was at 09:04 PM ----------

Quote:
Originally Posted by roachboy View Post
do you think mongan provides a useful orientation for thinking about the process that's underway with this legislation?
It is a convoluted way to get to single payer. If government thinks it can control real costs and control market behaviors including delivery systems, it has to control the system from A to Z. I think there are simpler more efficient ways to incrementally get to full single payer system, including what I stated above, taking the next step with children.
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Old 03-30-2010, 01:35 PM   #268 (permalink)
 
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Originally Posted by aceventura3 View Post
There is a difference between the average cost and what a low income woman would pay, if anything. There are many reasons why prenatal care is at unacceptable levels in this country for some women but to suggest the issue is one of availability is untrue. That is my only comment on this issue at this time.
ace...it may be your only comment, but you are wrong.

There are millions of women in working families above the Medicaid level and w/o insurance. Unlike women (or a spouse) with employer-based health coverage where 85% the cost, on average, is covered by insurance, the cost of pre-natal care and delivery for these women is beyond their means....in the range of $7,000-$8,000.

So I guess they shouldnt have children, huh? Or maybe they should just skimp and skip the pre-natal and save about $1,500-$2,000 of that total.
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Old 03-30-2010, 01:52 PM   #269 (permalink)
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Originally Posted by aceventura3 View Post


But, that is the point. Perhaps, the stop offering group coverage and focus on individual policies. Or perhaps they do the opposite. Perhaps, the write coverage in Arizona but not Michigan, etc, etc, etc., They are not going to go out of business over preexisting conditions - they will make a profit or not participate. the legislation does not have simple little loop-holes, it has major problems that contradict the broad promises made..
The language in the bill is specific. They can no longer choose to deny a person be it group or individual. As far as not participating in certain states, that won't work either because those with pre-ex's are spread out over the entire country.
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Old 03-30-2010, 02:05 PM   #270 (permalink)
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Originally Posted by dc_dux View Post
ace...it may be your only comment, but you are wrong.

There are millions of women in working families above the Medicaid level and w/o insurance. Unlike women (or a spouse) with employer-based health coverage where 85% the cost, on average, is covered by insurance, the cost of pre-natal care and delivery for these women is beyond their means....in the range of $7,000-$8,000.

So I guess they shouldnt have children, huh? Or maybe they should just skimp and skip the pre-natal and save about $1,500-$2,000 of that total.
I can not believe I am doing a search on prenatal care access...

But for example New York, they have a PCAP/MOMS program:

A healthy baby starts with a healthy pregnancy.

If you look at their guidlines manual there is a presumption of qualification and the qualification for the program is up to 200% of the poverty level:

Quote:
Expanded Medicaid Eligibility is Medicaid coverage for pregnant women with incomes at 0-200% of the federal poverty level (FPL) who would otherwise be ineligible for Medicaid.
Medicaid eligibility is guaranteed until the end of the month in which the 60th day postpartum occurs.
A Medicaid-eligible woman can receive care at PCAP sites throughout New York State, or from other Medicaid enrolled providers.
Presumptive Eligibility
Presumptive Eligibility (PE) is the process whereby a preliminary financial screen for a pregnant woman is conducted at the PCAP site by a qualified provider (QP) to determine if the woman would be financially eligible for Medicaid (income at 0-200% of the FPL).
If the pregnant woman is found to be presumptively eligible for Medicaid by the QP, the PCAP is able to begin the woman’s care, and is guaranteed to be paid for services rendered until the Medicaid application is processed and a full determination of Medicaid eligibility is made by the Local Department of Social Services (LDSS), even if the final determination is a denial.
The QP at the PCAP is required to assist the woman in assembling the necessary paperwork for a full Medicaid application and convey the information to the LDSS’ Medicaid office. This process eliminates the need for the woman to make a separate trip to the LDSS to complete the Medicaid application.
Even if they don't qualify, don't have insurance, nor enough income, I am pretty sure there are other programs or even some doctors or clinic who would provide prenatal care a little or no cost, or even allow payments over time. The resources are out there and available.

---------- Post added at 10:05 PM ---------- Previous post was at 10:03 PM ----------

Quote:
Originally Posted by rahl View Post
The language in the bill is specific. They can no longer choose to deny a person be it group or individual. As far as not participating in certain states, that won't work either because those with pre-ex's are spread out over the entire country.
O.k., I throw up the white flag. You don't think it will be an issue, I do. Time will tell.

{added}

DC, here is more infor for you, if you need it:

Quote:
Financial Help During Pregnancy

For many women, the extra expenses of prenatal care and preparing for the new baby are overwhelming. You and your baby deserve to be healthy and have consistent care. Financial, medical and and other programs are available for you and your baby.
Financial Aid

Every state in the United States has programs to give financial, medical and other information, advice and other services important for a healthy pregnancy.

The links Medical Help for Pregnant Women, Mothers and Children and Financial Assistance for Pregnant Women, Mothers and Children will put you in touch with many valuable resources.

You may find clicking on the following resources and links helpful:

Child welfare agency for each state,

Department of Health can provide nutrition information and help as well as help with pregnancy and post-pregnancy concerns.

Medicaid in each state can help you with answers about free services offered to you and your child.

State Breast and Cervical Cancer Early Detection Program provides free or low-cost mammogram and Pap test.

Women, Infants and Children (WIC) Program provides help with food, nutritional counseling, and access to health services for women, infants and children.

Food Banks and Food Stamp programs are available.



Free and Low-cost Health Insurance

Your children may be eligible for free or low-cost health insurance. Your state and every state in the nation has a health insurance program for infants, children and teens. For little or no cost, this insurance pays for doctor visits, prescription medicines, hospitalizations, and much more. Children that do not currently have health insurance are likely to be eligible, even if you are working. The states have different eligibility rules, but in most states, uninsured children 18 years old and younger, whose families earn up to $34,100 a year (for a family of four) are eligible.

Please visit the links Health Insurance and Women and Insure Kids Now.






Financial Help Publications and Organizations

Local hospitals or social service agencies may also be good resources that can put you in touch with free clinics or clinics that provide free care.

The following has been adapted from the National Women's Health Information Center website:

1. Child Support Enforcement Steps - This publication lists the steps for applying for and collecting child support.
2. Finding Help to Pay for Child Care - This fact sheet provides information on Federal and private assistance for child care. It also provides information on child care tax credits.
3. Frequently Asked Questions About the Women, Infants and Children (WIC) Program - Food, nutrition counseling, and access to health services are provided to low-income women, infants, and children under the Special Supplemental Nutrition Program for Women, Infants, and Children, popularly known as WIC. This fact sheet provides information about the program and its benefits.
4. Search for a Headstart Program - Head Start Programs are those profit- and non-profit organizations, which receive funds from the Head Start Bureau. Use the search tool on this site to locate specific types of Head Start Programs, or those in specific geographical locations.
5. Vaccines for Children Program (VFC) - VFC helps families by providing free vaccines to doctors who serve eligible children and is administered at the national level by the CDC through the National Immunization Program. CDC contracts with vaccine manufacturers to buy vaccines at reduced rates. States and eligible U.S. projects enroll physicians who serve eligible patients up to and including age 18 years, providing routine immunizations with little to no out-of-pocket costs.
6. Who Gets WIC and How to Apply - Information about the Women, Infants and Children Program - This fact sheet provides information about WIC's eligibility requirements, length of participation and application procedures.
7. WIC Contacts: State Agencies, Nutrition Coordinators & Breastfeeding Coordinators - This directory provides contact information for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), organized by each state. You may view alphabetically (by state), by region, or using a listing of just the Toll-free numbers.
8. Financial Management During Crisis (Copyright © The Nemours Foundation) - This article provides information on managing your health care payments during a financial crisis. It provides information on the cost of health care, the health care system, the warning signs of financial trouble, paying for health care costs, finding help paying for health care, and other financial tips.

The Office of Family Assistance (OFA) in the United States Department of Health and Human Services, Administration for Children and Families and oversees the Temporary Assistance for Needy Families (TANF) Program which was created by the Welfare Reform Law of 1996. TANF became effective July 1, 1997, and replaced what was then commonly known as welfare: Aid to Families with Dependent Children (AFDC) and the Job Opportunities and Basic Skills Training (JOBS) programs.
http://www.pregnancyandchildren.com/...ncial_help.htm

So, far I have only done three searches.
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Old 03-30-2010, 02:06 PM   #271 (permalink)
 
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The average cost...from pre-natal to deliver is $7,600

Healthcare 411: Audio Feature

And you are sure that women w/o health insurance and above the Medcaid threshold will find someone to cover the majority, or a significant portion, of that cost?

200% of the poverty level, ace? Thats $28K (ave) for a husband/wife. Above that and w/o insurance, you are sol.
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Old 03-30-2010, 02:45 PM   #272 (permalink)
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Originally Posted by dc_dux View Post
The average cost...from pre-natal to deliver is $7,600

Healthcare 411: Audio Feature

And you are sure that women w/o health insurance and above the Medcaid threshold will find someone to cover the majority, or a significant portion, of that cost?

200% of the poverty level, ace? Thats $28K (ave) for a husband/wife. Above that and w/o insurance, you are sol.
I throw up the white flag here too. Hell, if I knew a pregnant woman I would help her pay for care if she needed help and I would help her connect to resources.

---------- Post added at 10:45 PM ---------- Previous post was at 10:21 PM ----------

Quote:
Originally Posted by dc_dux View Post
200% of the poverty level, ace? Thats $28K (ave) for a husband/wife. Above that and w/o insurance, you are sol.
Sorry, but I need to add one more thing, thinking about unintended consequences.

One of the reasons the out-of-wedlock birth rate is so high is because of arbitrary cut-offs like this. If the man has a good job paying over $28,000, it would be in his and her interests not to get married and incur the costs, but to have her go through the government subsidized care saving about $8k. People are not dumb. And, I don't suggest we don't help people, but some programs are set up to make people act in dishonest ways and have negative consequences. Once the guy knows the government is going to do his job, his connection gets weakened. A better way is simply to get the costs lower and not "penalize" people for making a little too much money in a all or nothing approach.
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Old 03-30-2010, 02:50 PM   #273 (permalink)
 
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Sorry, but I need to add one more thing, thinking about unintended consequences.

One of the reasons the out-of-wedlock birth rate is so high is because of arbitrary cut-offs like this. If the man has a good job paying over $28,000, it would be in his and her interests not to get married and incur the costs, but to have her go through the the government subsidized care saving about $8k. People are not dumb. And, I don't suggest we don't help people, but some programs are set up to make people act in dishonest way and have negative consequences. Once the guy knows the government is going to do his job, his connection gets weakened.
So now you are suggesting that a couple making $35-50K will seek a lesser page job under $28k to qualify for medicaid and save $7 - 8K?
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Old 03-30-2010, 04:39 PM   #274 (permalink)
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So now you are suggesting that a couple making $35-50K will seek a lesser page job under $28k to qualify for medicaid and save $7 - 8K?
Come on, read what I wrote. Are you really pretending that the issue I presented is not real or are you just being argumentative? If you are serious, I do strongly suggest getting out and interacting with low income people.
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Old 03-30-2010, 06:15 PM   #275 (permalink)
 
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Come on, read what I wrote. Are you really pretending that the issue I presented is not real or are you just being argumentative? If you are serious, I do strongly suggest getting out and interacting with low income people.
You have data to prove the issue is real...that people take a cut in pay in order to get govt. assistance?

I dont doubt you can find a few anecdotal examples....but it far from the norm.
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Old 03-31-2010, 07:30 AM   #276 (permalink)
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You have data to prove the issue is real...that people take a cut in pay in order to get govt. assistance?

I dont doubt you can find a few anecdotal examples....but it far from the norm.
What is the unwed birth rate for those in poverty?
What was that rate before the "war on poverty"?
What do you think are the top 10 contributors to the trend of unwed births in low income areas?
How does the trend in unwed birth in low income areas compare to middle and upper class income areas? Why are the trend lines different?

I can not persuade you, I know that, but if you honestly looked at this issue, the way that I have, your conclusions would be very similar to mine.

the fundamental issue I have with the liberal approach to issues like this is the presumption that poor people are not rational. What is common or not, here is what you want to believe:

Example: Joe 22 years old, with a job paying $27,000 per year, and a girl friend, who is 18. He loves her, and he just got good news on two fronts. First he was offered a promotion to be a crew chief, it offers $1,100 dollars more per year. His girl friend tells him she is pregnant. He is on cloud nine, and says let's get married.

His girl friend already did some research and knows that she can get free prenatal care, free delivery, free post natal care, coverage for her child, food and diapers. Adding all that up over two years it comes to a value of let's say $12,000.

If they get married they are looking at his income of $28,100, or $100 over the cut-off. So, marriage will cost them $12,000.

You think they are not rational, I do.

They don't get married - his connection to his family is weakened. What may have been the beginnings of a wonderful family has been hurt by government policy. I say rather than these arbitrary cut-off and high "marginal tax" (or loss of benefit) situations, let's come up with a better solution.

I don't get it, why do you keep playing pretend with these real world issues?
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Old 03-31-2010, 10:31 AM   #277 (permalink)
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What is the unwed birth rate for those in poverty?
What was that rate before the "war on poverty"?
What do you think are the top 10 contributors to the trend of unwed births in low income areas?
How does the trend in unwed birth in low income areas compare to middle and upper class income areas? Why are the trend lines different?
Do you actually have your analysis available, or is this just another one of those "I'm Ace and this is what seems plausible to me and so now you must argue with me about it as though it is fact" things?

Quote:
Example: Joe 22 years old, with a job paying $27,000 per year, and a girl friend, who is 18. He loves her, and he just got good news on two fronts. First he was offered a promotion to be a crew chief, it offers $1,100 dollars more per year. His girl friend tells him she is pregnant. He is on cloud nine, and says let's get married.

His girl friend already did some research and knows that she can get free prenatal care, free delivery, free post natal care, coverage for her child, food and diapers. Adding all that up over two years it comes to a value of let's say $12,000.

If they get married they are looking at his income of $28,100, or $100 over the cut-off. So, marriage will cost them $12,000.

You think they are not rational, I do.

They don't get married - his connection to his family is weakened. What may have been the beginnings of a wonderful family has been hurt by government policy. I say rather than these arbitrary cut-off and high "marginal tax" (or loss of benefit) situations, let's come up with a better solution.

I don't get it, why do you keep playing pretend with these real world issues?
I can vouch for this situation because I am in a similar one. The reason I'm not married to my lady is that we don't think marriage necessary. It isn't for financial reasons, though if we did decide to get married, financial considerations might present an obstacle. It isn't our fault we live in a society intent on overemphasizing the importance of marriage by tying finances to marriage status.

I get good financial aid benefits for school and our family benefits from having one stellar credit rating and one poor credit rating. If we got married we'd get to suffer with one shitty credit rating, and we'd end up in more debt because I'd likely get considerably less college money.

As far as connections with families being weakened, I think you're overstating the power of a marriage license here. A father's (or mother's) connection to their family exists completely independently of whether or not they are in a legally recognized marriage with the other biological parent.

*edit: in any case, just because you can fathom a scenario where it may be beneficial with respect to a specific program for a couple to not marry, you still can't plausibly assume that this scenario is significantly prevalent among the beneficiaries of said program to warrant consideration.

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Old 03-31-2010, 02:56 PM   #278 (permalink)
 
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Originally Posted by aceventura3 View Post
What is the unwed birth rate for those in poverty?
What was that rate before the "war on poverty"?
What do you think are the top 10 contributors to the trend of unwed births in low income areas?
How does the trend in unwed birth in low income areas compare to middle and upper class income areas? Why are the trend lines different?

I can not persuade you, I know that, but if you honestly looked at this issue, the way that I have, your conclusions would be very similar to mine.

the fundamental issue I have with the liberal approach to issues like this is the presumption that poor people are not rational. What is common or not, here is what you want to believe:
ace...IMO, what is rational is that most people want to do better for themselves and and their families and view federal assistance programs as a temporary safety net in times of need rather than a way of life.

Anecdotes and undocumented assumptions, based on a pre-conceived ideology that those "scamming the system" represent anything more than a very small minority, are not very convincing.

And the fact remains that most of those use benefit from federal assistance do so for relatively short, transitional periods of time.

So, no, my views would not be similar to yours.
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Old 04-02-2010, 01:27 PM   #279 (permalink)
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Originally Posted by filtherton View Post
Do you actually have your analysis available, or is this just another one of those "I'm Ace and this is what seems plausible to me and so now you must argue with me about it as though it is fact" things?
I will be 50 years old this year, I have been poor, what some consider "rich", back down and on the way up again. In high school and college I did research papers on the subject, in the 70's and 80's it was a major topic of discussion. I intimately know poor people, "rich" people, people who were once poor and now "rich", etc. I have been in public debates and have given civic speeches and presentations on the subject. I had a corporate job where they supported my outside activities in this area. And I still devour volumes of data on the subject. Other than a pure and simple appeal for an understanding of the rational nature (either consciously applied or not) of decision making by "poor" people, I don't know where to start, given my belief that nothing I present will make a difference at this point.

So, I ask the question directly and simply, do you believe "poor" people tend to make rational decisions? If you think they do, does apply to economic decisions? It is very possible for you or others to believe that "poor" people are poor because they make irrational economic decisions, but in my experience that is less often true than the opposite. Actually, in my experience "poor" people on a whole may be more rational with money than "rich" people. In my view this question is at the core of what one's expectation of the role of government is in helping "poor" people, it also defines what one will accept and reject on what they will accept as evidence. Reading the postings on how this has progressed it is pretty clear to me that there is an element of not wanting to believe or pretending not to believe what is pretty obvious. And given that, there is nothing I can do.

---------- Post added at 09:13 PM ---------- Previous post was at 09:07 PM ----------

Quote:
Originally Posted by filtherton View Post
As far as connections with families being weakened, I think you're overstating the power of a marriage license here. A father's (or mother's) connection to their family exists completely independently of whether or not they are in a legally recognized marriage with the other biological parent.
Look at this from a big picture point of view - the things that connect a family include many factors, one being the financial connection of willing to work and sacrifice for one's family. Another factor is the connection being reinforced by daily contact. If we take both of these away, it has a big impact, especially on males in the ages up to about 35.

---------- Post added at 09:27 PM ---------- Previous post was at 09:13 PM ----------

Quote:
Originally Posted by dc_dux View Post
ace...IMO, what is rational is that most people want to do better for themselves and and their families and view federal assistance programs as a temporary safety net in times of need rather than a way of life.
I don't disagree. Nothing I said is consistent with your point about "a way of life", however, using an example not necessarily involving "poor", you have the phenomenon of something like subsidized housing in New York. You use "way of life" however, why would a person give up highly subsidized housing? They generally won't, unless there is a compelling reason. You are barking up the wrong tree if you think I am one of those people who say, "well they get pregnant to get more welfare". I am not - the the issue is a bit more complicated than that, but not so complicated that it can not be understood, modeled and predicted..

Quote:
Anecdotes and undocumented assumptions, based on a pre-conceived ideology that those "scamming the system" represent anything more than a very small minority, are not very convincing.

And the fact remains that most of those use benefit from federal assistance do so for relatively short, transitional periods of time.
Prenatal care lasts about 9 months.

Quote:
So, no, my views would not be similar to yours.
You have not clearly presented your views.
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Old 04-02-2010, 01:30 PM   #280 (permalink)
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Quote:
Originally Posted by aceventura3 View Post
So, I ask the question directly and simply, do you believe "poor" people tend to make rational decisions? If you think they do, does apply to economic decisions? It is very possible for you or others to believe that "poor" people are poor because they make irrational economic decisions, but in my experience that is less often true than the opposite. Actually, in my experience "poor" people on a whole may be more rational with money than "rich" people. In my view this question is at the core of what one's expectation of the role of government is in helping "poor" people, it also defines what one will accept and reject on what they will accept as evidence. Reading the postings on how this has progressed it is pretty clear to me that there is an element of not wanting to believe or pretending not to believe what is pretty obvious. And given that, there is nothing I can do.
I don't think one's ability to make rational decisions is determined by class and I'm not sure how you could have come to the conclusion that I did. I also don't think that you're working with an objective definition of the word rational, but that's just my opinion.

Quote:
Look at this from a big picture point of view - the things that connect a family include many factors, one being the financial connection of willing to work and sacrifice for one's family. Another factor is the connection being reinforced by daily contact. If we take both of these away, it has a big impact, especially on males in the ages up to about 35.
So you're saying that without a marriage license it is more difficult to work and sacrifice for one's family? Or maintain daily contact? Did you know that unmarried couples with children can live together and collaborate on household finances?
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