That's the same old justification for the status quo. No, it's not, not in the least. I stated a problem with the status quo- that means I think that problem needs to be addressed. However, the current plans do not address it. I'm not justifying the status quo- the proponents of the current reform plans apparently are satisfied with the status quo in this regard because they're doing nothing to fix it.

As far as your math- I imagine the 3:1 ratio is probably about right for ER visit cost to PC visit fee.

So, for your argument to make sense, you have to be assuming that every uninsured person visits an ER more than 33% as often now as they would visit a PC or specialist if they were insured. I don't know where to find that data, but I'll bet that estimate is insanely high. How many uninsured people (what percentage) have visited an ER at all, and what percentage have visited at least once a year? Compare that to what percentage will use PC services or visit a specialist if they're insured.

And on top of that, some ER visits will happen whether people are insured or not- for true emergency illnesses and for trauma (which actually makes up a pretty high percentage of the current reimbursements that taxpayers fund for uninsured. Having access to primary care is not going to change that.)

“But currently our biggest public, govt run system spawns even more fraud and waste. So unless it can be reformed and prove it can do a better job at handling those, the public option is not going to be better at cost reduction than the private, profit driven model is.”

That's the same old justification for the status quo. The devil we know is better than the one we don't. The fact of the matter with fraud in medicare is that the vast majority is generated by private insurance, doctors, and hospitals. That's iike blaming the chickens for the foxes.
Additionally, I've demonstrated the simply economics that privates use to ever increase their profits. 3% of a hundred million is better than 3% of fifty million.
Lastly, we both know that every denied claim is worth money to private insurance. Armies of non-medical personnel are tasked with reducing claims.

:OK, so have you missed most of what I've been saying in this thread? That it actually doesn't cost less to provide more primary care than it does now to provide emergency care?”

No, I've read your opinion, but seen little data that proves it. Let's take a simple example of my present insurance. A regular doctor's office visit requires a $25 co-pay on my part. For an emergency room visit, my part is $75. Now either emergency room visits cost three times as much or the insurance company merely charges me three times more simply to lower their exposure.
Thus, either we could provide three times the number of doctor/patient interviews by providing office visits or else the current pricing structure is arbitrarily designed to maximize profit. As I said, we already pay for these uninsured visits, so if the pricing structure is profit driven, it confirms that reducing costs can be accomplished by removing private incentives.

Simply, we pay for emergency room visits today. Office visits cost less. Office visits curtail medical situations where medical problems spawn critical care costs, so fewer emergency first visits reduces the cost we pay today while increasing the care for those who even can contribute to their care.

Have you not been listening to the math?

You must work for an insurance company, otherwise why are you so worried
about their pocketbooks. They have and continue to rape the consumers with
their premiums all the while purging people from the insurance rolls to make
their bottom line look better for Wall Street.

The country is already in deep doo doo thanks to unfettered greed in
capitalism starting with Ronald Reagan.

Joe Scarborough couldn't respond period. He was silent and when Weiner
asked him what the insurance companies bring to the table, he could not
answer and never did answer.

But I'm pretty sure that statistical analysis doesn't take anecdotal evidence with the same weight as it does statistical analysis.

Your personal IQ doesn't adjust the average IQ being 100; regardless of how far from 100 it might be. And your personal story, while both moving and impressive; doesn't affect the average costs of lifetime health care for people with or without certain conditions.

You will live longer, happier, and healthier by losing weight; and in your specific case, you might save more than if you hadn't gotten healthier.

But speaking from a statistical average, a person could only reasonably expect a good chance at the “living longer, and healthier”. Happier would be hard to judge, and overall health care costs would be a wash, or higher by the peer reviewed statistical studies I've seen.

Now that does make it worthwhile, but it does not make it cost effective; much less an indicator that this would be a good plan for “bending the cost curve”.

If government controls this industry, it will do to it what it did to the mortgage industry, drive it over a financial cliff and then have to bail it out. Medicare is not a program to use as a role model; there is a lot it doesn't cover, there are shortages in service providers, and it is going bankrupt. If you are paying for health care coverage on a level playing field, medicare is one of the last programs you would select. If you get it for “free”, then sure its a good deal for you, but someone has to pay for it. So when they start taxing you another 2-7% for the gov's limited one-size-fits-all health care, just imagine the plan and options you could have bought on your own with that money.

Costs generally come down with increased competition and with easing the supply side. Right now there are governmental policies in place that aggravate those issues- decreasing competition and limiting supply. Fix those first, and see if we can get costs down, and a lot of the coverage problem resolves itself. If we have to also spend more by increasing the threshholds at which people qualify for our current 'public option', that's fine by me. Personally I'd cover that cost by shifting some of the rules for Medicare, but do it gradually so that people aren't blindsided by the changes (ie, shift age eligibility over time so that people have time to prepare.)

But currently our biggest public, govt run system spawns even more fraud and waste. So unless it can be reformed and prove it can do a better job at handling those, the public option is not going to be better at cost reduction than the private, profit driven model is.

As you well know, we already pay for these groups of people when they partake of the system without insurance. They add no funds currently, any funds would necessarily lessen the bill. The resources they draw from the current system already are factored into the current system. The major benefit of the change would be that there would be fewer emergency visits and more GP appointments.

OK, so have you missed most of what I've been saying in this thread? That it actually doesn't cost less to provide more primary care than it does now to provide emergency care?

As you well know, we already pay for these groups of people when they partake of the system without insurance. They add no funds currently, any funds would necessarily lessen the bill. The resources they draw from the current system already are factored into the current system. The major benefit of the change would be that there would be fewer emergency visits and more GP appointments.

“But having a history of providing some services (I'm not sure I'd agree with that choice of wording but I'll go with it for now) is not the justification for providing all kinds of other services.'

And that's why I started with Jefferson and Hamilton. They kind of demonstrate the “first cause” of this current debate. That natural right is at the very heart of the general welfare clause. The kinds of services have varied over time in direct relation to the changing needs of the populace.

Bad private banks spawned fraud, waste, and economic downturns. Hamilton's bank was the remedy to those failings.

Private health care spawns fraud, waste, and an incomplete coverage of Americans. My earlier actuarial argument goes to the heart of the economic distortion that private only health care provides. Cover the basically healthy and leave the less desirable in the care of the government. That's a great way to make a profit but a poor way to provide people with the reasonable expectation of life.
Understand fully, I am not saying private insurance has no place in this, I'm saying that the profit margin is the wrong criteria for the best solution.

OK, but think about this for a minute. 'Costs for all going down' under that scenario is only possible if the additional people that are added to the pool are paying their own way. There is a segment of our currently uninsured population who will be made to do that under the new mandates- these are the people, mainly young healthy adults, who make enough income that they won't qualify for subsidies but currently they choose not to spend their money on insurance.

But the rest of the uninsured- and of course everyone argues about what those actual numbers are- will switch from having healthcare services provided on the basis of emergency need, to having health insurance coverage which enables them to access primary and preventative care.

I don't think the numbers are such that group 1 will add enough money to the pot to cover the extra expenses of group 2. Plus, additional groups which don't even fall into those categories make the equation even more questionable- you have the people who currently qualify for Medicaid but haven't accessed it, and the illegal immigrants who currently get some care in ERs but will not have any change in their status due to any of the current bills.

Hamilton made my point for me 200 years ago.

You know as well as I that the cost of health care is on a climb destined to wipe us out. We don't have to do anything and all our incomes will be drained by the skyrocketing costs. For your part, I believe you have time and again stated ways to reduce these costs. The crux of our debates have centered on the fact that I believe the private interests have worked hard t keep cost reduction off the table.

I further believe the actuarial tables prove that cost for all go down when the largest group is used to spread out costs across all segments of the population. Health insurance by definition covers a group for a specific time period. Health care costs from cradle to grave removes both the artificial appearance being a good risk, and the absolute certainty that we all will someday be requiring care.

The current system is just gambling. And the house always wins, especially when it can dump those “lucky” enough to draw off resources.

Rationing is a term from the private industry. Everybody gets some form of treatment eventually.

But having a history of providing some services (I'm not sure I'd agree with that choice of wording but I'll go with it for now) is not the justification for providing all kinds of other services.

I think rational conservatives can arrive at conclusions that allow for the govt to involve itself in the distribution of some resources or the overseeing of certain industries to some extent- but we arrive at those conclusions only after deciding if that is the best or most efficient way of handling a problem regarding those resource allocations or market instabilities.

The fact is, that virtually no one on any point of the ideological spectrum argues that it should be all one way or all another- we don't have pure collectivists arguing that we should dispose of capitalism and nationalize all industries, and we don't have pure laissez faire advocates either. But people do tend to look at each case from one perspective or the other as the default position, and then decide how far along the scale they think we should move in one direction or the other.

That's why it is irritating for you to argue for THIS govt expansion based on the fact that we've allowed for other expansions. It's not that we can't interpret the general welfare clause to mean that we should cede some power and authority to the federal govt in order to accomplish healthcare goals- it's that we believe that we shouldn't. That's why the point about the meaning of 'rights' is relevant- if healthcare is conceptualized as a natural right, then there IS no other interpretation of the general welfare clause other than to say that the federal govt must take on this expanded role.

(I meant to respond to your earlier comment about only conservatives talking about natural rights…well, first off, maybe that's the problem- people on the other side of the debate are getting the concepts of negative and positive rights muddled. And second, it's actually more of a classical liberal / libertarian concept, but today's American liberal/progressives appear to have moved pretty far away from those underpinnings.)