Now you disappoint me.

After more than one day of what I thought was a reasoned back-and-forth between you and me — no name calling, no accusations — that started like this:

Submitted on 2012/06/30 at 11:55 am | In reply to DaGoat.

Thanks for expanding DG.

On the rising costs of healthcare:

Like everything else we use, consume or destroy (wars) the costs of health care are rising — but we should also consider how much better health care and medicine are today.

Of course it is going to cost more to take care of the estimated 46 million uninsured and 25 million under-insured Americans (or the “30-35 million patients” you mention.) The question is, are the other Americans willing to pay some more to do so?

Obviously many aren’t

27 hours later, you suddenly decide to ask me:

Submitted on 2012/07/01 at 2:43 pm

Well let me ask it this way DDW. When you said “obviously, many aren’t” were you saying you felt I was against the ACA (and for letting this woman die) because I didn’t want to pay higher taxes?

How can you conclude, in the first place, when I make a general statement that many Americans aren’t willing to pay some more to “take care of the estimated 46 million uninsured and 25 million under-insured Americans” — which is a fact –that I have included you in this? Or that I have concluded that you are “against the ACA.” I have no idea of either with respect to you.

Then you take it even one step further and cross every boundary of decently dissecting a comment and belatedly accuse me of claiming that I said or implied that you are “for letting this woman die.” Where is even the remotest connection, the remotest implication?

I am sorry but you have just gone too far and instead of continuing to debate the subject you are now imputing and mischaracterizing my motives.

At first I thought that by “demonizing” you had Webster’s definition of “To make into or like a demon” in mind.

Thanks, I guess.

What I mean by “demonize” is separating people into angels and demons, into the deserving well-behaved versus the self-interested intransigents, into those who play by the rules versus those who game the system. One can do this categorization very politely, so
I don’t mean to say it’s impolite, though I can see how my choice of words might suggest that.

What I mean to say is categorizing people in this way strikes me (and doubtless other conservatives) as unhelpful for evaluating matters of public policy. It oversimplifies people’s motivations and encourages one-sided appraisals of policies. If I can satisfy myself that policy X has a net benefit to the angels, I won’t be too concerned with the cost borne by the demons and may not even factor it into my analysis. But in reality, angels and demons are not cleanly divided and interact, so costs imposed on the demons tend to end up back on the angels’ tab. It’s important to keep the whole system in view, and to acknowledge that there’s some angel and some demon in everyone.

If DG feels I demonized him/her with those comments, I offer my apologies to him/her.

Wow. You call this “demonizing DG”?

Yes, Dorian, that is how your “obviously some aren’t” comment came across to me.

I know your comment was meant for Zephyr, but since you mentioned me, I hope it is OK for me to jump in.

First, let me say, that your comments are reasoned “non-name calling” and the kind one can dispassionately debate. Thank you for that.

**You say, “For liberals (and I’m not using the term as a pejorative, just to describe the group) compassion and empathy are THE primary factors in decision-making and problem-solving, and other considerations are secondary.”

Is this merely an opinion or a statement of fact? And, if the latter, do you have any authoritative sources?

**”In DDW’s article I get the sense that he is saying because this woman was helped the primary factor of compassion was satisfied, and the ACA was justified.”

Close. What I was really intending to do was to give an example of how both Obamacare and the ACA have truly helped — and will help — a woman who, because of cancer, was at her wits’ (and finances’) end. While of course compassion comes into play (and I am not ashamed of that, nor do I apologize for it) compassion is not the primary factor, but rather the reality that our nation can and ought to do better with regards to its less affluent ones and that a healthier population is good for a society.

**”I consider myself a fiscal conservative, and for me the problems in the bill I laid out above are as important as the compassion factor. That this one woman was helped is great, but her story is just one aspect of judging the program as a whole.”

I — and I am sure many others — have no problem with that. I am sure that if “we” work together we can fine-tune Obamacare/ACA to be both “compassionate” and fiscally responsible.

**”The yahoos cheering ‘let him die’ during the question to Ron Paul about an uninsured patient come to mind, although I think in their heads they were cheering FOR personal responsibility and not so much against compassion.”

That is one way of looking at it, but I am sure you can understand how others can look at this in a completely different way.

**”Finally one reason conservatives might show a knee-jerk reaction against empathy is partisanship. Many Republicans will reflexively disagree with an idea coming from a Democrat (many Democrats behave the same way of course). In that situation conservatives are being contrary more than they are anti-empathy.”

Can’t argue with that, and I am sure Democrats have similar knee-jerk reactions against perceived lack of compassion on the part of Conservatives

Thanks, DG

What exactly is the origin of modern conservatism’s suspicion reflex with regard to empathy? I see evidence of it all the time and am genuinely curious.

Just my opinion, but I think what you are seeing as a reflex suspicion is really a difference in the way conservatives and liberals look at things in general. For liberals (and I’m not using the term as a pejorative, just to describe the group) compassion and empathy are THE primary factors in decision-making and problem-solving, and other considerations are secondary. In DDW’s article I get the sense that he is saying because this woman was helped the primary factor of compassion was satisfied, and the ACA was justified.

For conservatives empathy is one factor among several others. I consider myself a fiscal conservative, and for me the problems in the bill I laid out above are as important as the compassion factor. That this one woman was helped is great, but her story is just one aspect of judging the program as a whole. My observation is liberals might interpret that as heartless, uncaring, greedy, etc. since they are looking at the situation much differently.

Certainly some conservatives go way overboard. The yahoos cheering “let him die” during the question to Ron Paul about an uninsured patient come to mind, although I think in their heads they were cheering FOR personal responsibility and not so much against compassion.

Finally one reason conservatives might show a knee-jerk reaction against empathy is partisanship. Many Republicans will reflexively disagree with an idea coming from a Democrat (many Democrats behave the same way of course). In that situation conservatives are being contrary more than they are anti-empathy.

“To my eye, yes. Your comment “Obviously many aren’t” looks like a barb at DaGoat for questioning the net value of Obamacare. ”

This was my comment to DG:

“Thanks for expanding DG.

On the rising costs of healthcare:

Like everything else we use, consume or destroy (wars) the costs of health care are rising — but we should also consider how much better health care and medicine are today.

Of course it is going to cost more to take care of the estimated 46 million uninsured and 25 million under-insured Americans (or the “30-35 million patients” you mention.) The question is, are the other Americans willing to pay some more to do so?

Obviously many aren’t”

Wow. You call this “demonizing DG”?

Now, I do understand you had to really dig deep to try to justify your false accusation, but this is really ridiculous. Perhaps others can help you and dredge through all my past post and comments, I am sure they’ll find some better examples.

Then, you give another example of my “demonizing”:

“Your distinction between the woman in your post and others who will ‘game the system’ by not buying insurance demonizes the latter.”

Oh yes, you got me on this one .

Did I demonize you? Or others?

To my eye, yes. Your comment “Obviously many aren’t” looks like a barb at DaGoat for questioning the net value of Obamacare. Your distinction between the woman in your post and others who will “game the system” by not buying insurance demonizes the latter. You haven’t gone quite as far as SteveK’s explicit name-calling, but I’m picking up a similar sentiment. Am I wrong?

I definitely have not and will will not accuse you of having no compassion. In the same token, please resist the temptation to ridicule, scorn, use sarcasm against those who genuinely do not mind going the extra mile, pay that extra dollar for the sake of others and calling those who have suffered or are suffering horrible illnesses “colorful characters.”

Thank you.

And please resist the temptation to continue that trend and conclude that I must be out to destroy Obamacare and therefore have no compassion for anyone. It wasn’t the health care reform I wanted, but the pandemonium from reversing it at this point would have just made our situation worse.

Did I demonize you? Or others?

You are saying?

I simply cannot get my head around your tendency to simplify situations and demonize people who see more complexity in them than you do.

No, Dr. J. this not an “opera”. It is real life United States of America, and yes, I repeat what you seem to be so scornful about, “I am willing to pay some more,” to give some others a chance. If you find that “virtuous,” I don’t. It is just something we as human beings, should do instinctively.

Thanks Dorian… I’ll leave it at that because I can’t even begin to comprehend how a person can become so self-centered and uncaring as to… I’d better stop.

With all due respect, especially since, if I remember correctly, you have a young child with special medical needs, “the colorful character filling [my] writing” happens to be a real life American woman who was diagnosed with an aggressive form of breast cancer late last year and who recently had a double mastectomy after five months of chemotherapy, and who — had it not been for Obamacare and now ACA — would be in the poorhouse, or worse, and would not be able to continue to receive treatment for breast cancer.

I don’t find that “colorful” at all. I find it pathetic that had it not been for Obamacare it could have been otherwise in a country of so much wealth and supposed compassion and that we have millions and millions of uninsured and millions who have been financially ruined because of health care costs.

No, Dr. J. this not an “opera”. It is real life United States of America, and yes, I repeat what you seem to be so scornful about, “I am willing to pay some more,” to give some others a chance. If you find that “virtuous,” I don’t. It is just something we as human beings, should do instinctively.

No, Dr. J, this is no opera, this is real life in the United States. And now, you have a good night.

—Added:

As to your “gaming the system” commentary and as I responded to DDuck, yes it is a good idea “to design a system to minimize a foreseeable problem.”

The world I’m familiar with isn’t nearly so clear-cut. Suppose a healthy 28-year-old faces a choice between a $700 tax penalty and $5000 annual premium (padded above his actuarial baseline, because Obamacare requires him to be a net contributor to the pool). If he opts out, is he gaming the system or simply responding to his economic incentives just like the couple in your article?

All the players in your opera look to me to be in the latter category. There are no particular villains or heroes; everyone’s just trying to do the best they can given the way the system is set up.

And this adverse selection problem isn’t the only one, the docs are not happy with a potential of millions of new patients with the current payment schedule under Medicaid flooding their offices. Like what is happening in Medicare, many docs will choose to refuse new patients. So you will have a card but no where to go.

Sorry to harp, but the devil is in the details, and those details were created by congress.

I don’t know.

But as with any government program, there probably will be those who try to game the system.

“Q. I’ve heard that I’m required to have insurance. When does that go into effect? And what sort of penalties will I face if I don’t comply?

A. Starting in 2014, most Americans will be required to have health insurance and could face federal penalties if they do not. Taxpayers will be required to indicate on their tax returns whether they have health insurance that meets minimal benefits standards, according to the Commonwealth Fund. If consumers do not have insurance by 2014, they would owe $95, or 1 percent of taxable income, whichever is greater. The penalty rises to $325, or 2 percent of taxable income in 2015, and then $695, or 2.5 percent of taxable income in 2016, up to a maximum of $2,085 per family.

That does NOT MEAN I favor the PPACA. I’ve advocated for health care delivery changes for about 20 years now, and I have my own ideas that would not have turned the whole health care world upside down but would have taken care of the catastrophic scenarios of Ms. Ward, et.al., and of people who cannot afford routine care or insurance to cover it. It truly is NOT a very complicated thing, if you get rid of all the special interests, greedy leaches, sacred cows, and all the political hackism that has intruded.

My greatest fear is that this PPACA, because of the process by which it was designed and passed, and because of its scope and cost, will simply remain unpopular, be unworkable, become (after 2014) unsustainable financially, and fraught with ugly unintended consequences. Meanwhile the ship of state will be sailing toward an fiscal cliff (I guess that would be a waterfall, huh?). And thus it will have to be dismantled in large part if not wholly repealed.

If one is depending on the CBO for estimates of the net cost impact … please, just spare me. They, like the rest of us, have NO idea. Way too many variables, wild cards, and imponderables are in play. It’s a complete crap shoot and the odds seem to be stacked against, in my opinion.

Thank goodness I am 70 years old with an ailing spouse, and have nothing much left in the tank. No issues at all with simply checking out and leaving this mess behind.

On the rising costs of healthcare:

Like everything else we use, consume or destroy (wars) the costs of health care are rising — but we should also consider how much better health care and medicine are today.

Of course it is going to cost more to take care of the estimated 46 million uninsured and 25 million under-insured Americans (or the “30-35 million patients” you mention.) The question is, are the other Americans willing to pay some more to do so?

Obviously many aren’t

1. There is no bi-partisan legislation or leadership today. Everything is politicized. I am waiting for the bathrooms in the capital building to be marked “Democrat Mens Room”; “Republican Mens Room” and the same for the ladies.

2. Most do not know much about the ACA because it is more than 2500 pages and much of the regulations are not even in place yet. Some will be imposed by future regulations written by government agencies. We only know about the big parts, but its the small parts that will screw up the whole thing once lifers in the federal agencies get their hand on it.

The dishonesty I am referring to is assumption that the SGR will continue while at the same time working to end it, and “fixing” it on a year to year basis. This means the ACA is assuming a roughly 30% drop in provider reimbursements from the SGR, a drop that almost certainly won’t happen. The initial Pelosi plan actually did fix the SGR and in that sense was more honest, but in an effort to pretend the bill would balance the SGR was put back in. The CBO has admitted their numbers will not add up if the SGR does not continue. The CBO numbers in the NYT article are based on the assumptions provided them by the framers of the bill.

Many people still seem to be pretending 30-45 million patients can be brought into the system at no extra cost. It’s just not going to happen. Either taxes need to go up (and more than just the piddling amount on high earners) or the program will run at a deficit.

Compassion is not the only consideration though. If you believe as I do that the bill is fiscally dishonest, does little to control costs and panders to Big Pharma, hospitals and Insurance companies, then judging the bill is much more difficult. Does this woman’s life justify the passage of a heavily flawed, dishonest program? No easy answers there.”

I’ll let the commenter explain/justify his “dishonesty” claims. (added: on “compassion,” each person is different)

On costs, etc.:

http://www.nytimes.com/2012/06/30/us/health-care-act-questions-and-answers.html?ref=us

Q. My parents are screaming about higher taxes from the Affordable Care Act. Any figures for those who have health insurance through our employers already? What does this mean for us?

A. The law imposes tax changes that would affect some people who are covered through their employers, especially those in higher tax brackets. Beginning next year, the law increases the Medicare tax by 0.9 percent on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly. It also imposes a 3.8 percent tax on unearned income for high-income households.

Q. What does the law mean for retirees on Social Security and facing high drug costs?

A. The law shrinks the Medicare drug coverage gap known as the “doughnut hole” by requiring pharmaceutical companies to give a 50 percent discount on brand-name drugs. Federal subsidies will gradually fill in the rest of the gap until it is closed by 2020.

Q. Will my insurance premium go up?

A. The Congressional Budget Office estimates that private health insurance premiums will increase by 5.7 percent each year, on average, from 2012 until 2022. But premiums would be getting more expensive with or without the Affordable Care Act. The budget office has estimated that, relative to what would happen in the absence of the law, premiums in the individual insurance market will be a little higher, employer-sponsored insurance premiums for big companies will be a little lower and employer-sponsored insurance premiums for small companies will stay about the same.