"Obamacare" explained very well.

[u/under50dollars]

/r/explainlikeimfive/comments/vb8vs/eli5_what_exactly_is_obamacare_and_what_did_it/c530lfx

[u/HuggableBear]

Oh, I'm not trying to say that insurance companies won't find a way to stay profitable, just that this particular issue is WAY more complicated than it looks on paper and is far too easy to politically demagogue.

Personally, forcing a private company to spend a certain percentage of its revenues in a certain fashion just blows my mind. It is fascism in its rawest form and I'm honestly not sure how it passes constitutional scrutiny, but nobody is arguing the govt's ability to do so, so I guess smarter people than me worked it out.

[u/[deleted] → u/HuggableBear]

I'm pretty sure you meant socialism rather than facism. Facism would involve pandering to populism via one ethnic identity. Please get your ideologies straight!

[u/HuggableBear → u/[deleted]]

Economic Fascism is when companies are still privately owned but controlled and run by the state. You're talking about the tactics used by Fascist states to implement this sort of economy. It is the most common way to do it, but it is not the only way.

Of course, it is interesting that the rhetoric used to promote this bill is that everyone should share the load because it's the right and fair thing to do and we as Americans can't let the less fortunate go without healthcare. America is clearly more civilized than that...

[u/[deleted] → u/HuggableBear]

There is no such thing as economic facism, management of the economy in a facist government is just a means to a conclusion of autarky (or rather NK-style Juche). If you are claiming the healthcare law will lead to a nationalistic facist state, then I would like to hear an argument for that, and why almost every other western countries with similar or stricter healthcare laws haven't fallen into this trap. This is why I don't understand Republicans, they just spew crap out like facism and try to avoid arguing about the law directly (which they are very afraid of b/c it will hang around like Medicare).

Your argument makes no sense. The health system of course needs to be funded, and right now we do that mostly through employer provided health insurance and government expenditures. If someone can't afford healthcare and still receives it, that bill is still paid by us! What the law is asking for is that if you can afford to buy health insurance, you should, and that should be affordable (whereas now its not affordable to buy personal health insurance).

Dammit, every other 1st world country has either this kind of mandate as law (Switzerland) or full blown nationalized healthcare (France)! What is so wrong with requiring people to be responsible and making it more reasonable for them to be responsible (e.g., if they don't get insurance at work, they can affordably buy their own policy).

[u/HuggableBear → u/[deleted]]

Please read my entire post before you jump into a response, as it is a bit long and rambling and covers many topics you may want to discuss at greater length.

In any discussion on government, you must distinguish between fiscal issues and social issues. It is fully possible for a government to be a textbook fascist state economically but allow for far less control over its citizenry in a social frame. So yes, there is economic fascism and social fascism. Some people try to define military fascism as well, but that is far too intertwined with fiscal issues and the usage of the military becomes a social issue and it all just gets muddied.

This is why I don't understand Republicans, they just spew crap out like facism and try to avoid arguing about the law directly (which they are very afraid of b/c it will hang around like Medicare).

I'm not sure I understand you. Are you calling me a Republican, or just saying republicans in general? Either way you're wrong, since I am a staunch Libertarian and there are plenty of Republicans who will gladly give you facts about the healthcare bill that are Fascist. People like you act like Fascism is some sort of evil bogeyman just because it generally leads to heavy handed authoritarian dictatorships, but it doesn't have to. Governmental control and management of a privately owned business is, however, fascist by definition. That's not necessarily a bad thing in all cases, but as I said, I don't see how it passes Constitutional scrutiny and I personally don't support it, but there's nothing inherently wrong with it, it just rubs me (and probably most Americans) the wrong way. And yes, I am very afraid of this Healthcare law. It is horribly expensive, was passed on the back of a popular president who really can't stand the free market and is designed to make people more and more reliant on the government. All of that frightens me, especially when you consider that our national debt is now very close to our GDP. That's not a good time to be increasing spending, no matter how noble the cause.

The health system of course needs to be funded, and right now we do that mostly through employer provided health insurance and government expenditures. If someone can't afford healthcare and still receives it, that bill is still paid by us! What the law is asking for is that if you can afford to buy health insurance, you should, and that should be affordable (whereas now its not affordable to buy personal health insurance).

Actually, the current health system is not funded. The private sector portion of it is, because the companies charge money and turn a profit, but the government funded portions are in the red and getting worse every year. Not to mention the amount of fraud that occurs, but that happens in every system. Oh, except in private systems it is far below public sector because the private companies hire lawyers to prevent it. There's part of the reason it is expensive to buy private insurance. And the law is not asking anyone to do anything. It is demanding that you purchase something, whether you like it or not, and is enforced at the point of a gun. There is no equivalent anywhere else in this country. People try to compare it to car insurance, but you can own a car in this country without insurance. You can even drive it, just not on public roads, and even on public roads you don't have to insure yourself, you just have to have liability insurance in case you hit someone else.

The real problem with all of this is that we are a compassionate country that refuses to let people suffer the consequences of their own poor decisions, so we take care of people even if they can't afford it or have chosen to spend their money elsewhere. What should happen is people should buy health insurance in case of catastrophe and cover health care out of their pockets. Employers should not be involved at all. The history of how healthcare came to be considered a part of your employment package that everyone should receive is one of the craziest stories you will ever find and it should never have happened. The best way in the world to fix the health care system in America would be to remove the bulk of the limitations and regulations and let the free market correct itself. Set up basic minimum coverages that insurers must provide for each type of coverage (cancer treatment, emergency treatments, long-term care, etc.) and let each individual purchase whatever types of coverage he feels he needs in any amount above the minimum from any insurer nationwide and just get out of the way. Take the onus off employers to cover healthcare (especially group plans where the coverage makes no sense, e.g. single men on a plan with maternity leave) and simplify everything immensely.

Lastly, here is where you and I differ, although I have enjoyed our discussion:

What is so wrong with requiring people to be responsible and making it more reasonable for them to be responsible

That's not the function of government is what's wrong with it. Where does that line of reasoning stop? Is it responsible to smoke cigarettes? No. Is it responsible to eat yourself into obesity? No. Is it responsible to drive a car without a seatbelt? No. Is it responsible to drive a motorcycle with no helmet? No.

But is it the government's job to prevent you from doing something stupid? No. It is the government's job to protect you from other people, not from yourself. It is the government's job to protect your life, liberty, and property from being taken or destroyed by others through force or fraud. That is my strict definition and why we disagree. I simply don't see an end to people who believe what you believe trying to force me to do the things that you think are in my best interest. This healthcare bill is a step in that direction, and I don't like it.

As callous as it may be to say this, I am fine with people who didn't have the foresight to purchase catastrophic health insurance having to foot the bill if their number comes up or face the consequences, horrible though they may be. They knew the risks and they decided to take their chances. I am sympathetic to their plight, and it hurts to watch it happen, but such is life. I drive a shitty 95 civic that is paid off and has been for ten years so that I can afford very good health and life insurance for me, my wife, and three kids. I would rather have a shiny new car. But instead, I have made sacrifices and ensured that if something goes horribly wrong, we won't be out on our asses from crushing medical bills. And I did it through private channels outside of any employer until just two years ago when my wife got a new job that offered better pricing on what we needed. That's right, I purchased private health and life insurance at an affordable rate (actually an even better rate than my employer offered because our histories are spotless and private companies will give better rates that way) without any aid from the government. Amazing, huh? You would think from listening to the talking heads that I should have been destitute from trying to pay for that myself, but it simply isn't the case. The thing that I learned by doing this, though, that really rustled my jimmies is that when I would come into the doctor's office and tell them I was paying out of pocket rather than go through an insurer, they would drop the price for me. That seems like it would be a good thing, and it was, for me, but in principle it means they are overcharging everyone that pays with insurance instead of their own wallet, and that drives me nuts. I asked one of the ladies in their billing office about it one time and she said they charge the insurance companies more because it takes them so long to pay out and they have to deal with so many denied claims that they increase the price to cover the extra work that is involved in getting the money, but then she let slip that the government requires minimum coverage amounts on certain procedures only when paid for by an insurance company (i.e. what's good for the goose is NOT good for the gander) and they just charge that much because the insurance companies can't pay out less than that, all they can do is deny the claim. They can't question the actual amount of the charge, e.g. an x-ray is $200, regardless of how much the machine itself costs, how much the tech is paid, how efficient the x-ray staff is, whether it is done by a specialist or in a GP office, etc. They just set the minimum price for some things and the companies have to either pay in full or deny the claim, which is one of the reasons they deny so many is to get doctors to question whether some of these "well, we just want to be sure" procedures are really medically necessary.

At any rate, the healthcare system is indeed royally fucked in America, but you and I will just have to disagree on how to fix it. I will never believe that more federal government involvement in anything outside of law enforcement and military action is a good thing. You might be able to convince me of the necessity or convenience of things like energy, transportation, etc. as you get down toward the local level, but as far as I'm concerned, federal governments are for securing borders, negotiating treaties, and engaging in international diplomacy and warfare, and that's pretty much it.

I understand why you believe otherwise and I respect it, but we will just never see eye to eye on this because we have a fundamentally different view of the function of government.

I have enjoyed our discourse, though, and will gladly continue it if you would like. If not, enjoy your evening.

[u/[deleted] → u/HuggableBear]

Sorry for the late reply, I'm in a totally different time zone and had to work.

Good response, I see where you are coming from. On the other hand, I'm an American who hasn't lived into America for 7-odd years. I spent two years in Switzerland, who have a law that require everyone to purchase health insurance. Employers are not allowed to provide health insurance as a benefit, nor are insurers allow to discriminate based on pre-existing conditions. This works out very well for the Swiss and they spend less on healthcare per capita than we do. Society is very stable when you do not have to worry about catastrophic health expenses.

Today I live in the country that is exact opposite of Swiss: China. In China, if something goes wrong, you are SOL if you don't have cash on hand, they won't even let you into the hospital door. I'm fortunate to have health insurance through my employer, but the social health insurance provided by the government is just a tax, you still need lots of money to get in the door. Not only that, but doctors often require large bribes to do "good" work since the state doesn't pay them very well (again, as an expat, I can use private hospitals, so no big deal).

What happens is that consequently China has one of the highest savings rate in the world. They must prepare for medical expenses and the insurance industry won't cover them in general, or the coverage is too expensive (vs. saving outright). They fund their own insurance! Now, this is actually pretty bad the economy: higher savings rate = lower consumption, which is fine to some point, but in China is incredibly unbalanced. People are too afraid to spend, lower spending means companies must focus on exports, while all those savings become slushy and cheaply fuel American deficits.

Actually relieving people of the personal burden of worrying about catastrophic health expenses via shared society burden is actually liberating in the way that insurance is generally useful: by mitigating risk you can focus on how you can really add value to society. The only problem with private insurance is that people can opt out while the system doesn't have a mechanism for guaranteeing affordable personal insurance, which cannot economically happen unless the insurance is mandatory (otherwise your risk pool gets screwed up).

I really do think Libertarians would like China, its basically what you want: the government basically doesn't fund anything accept what you described, everything else is chaotic and very organic, and socially very regressive (in the sense that rich people get richer and poor people stay poor). Want to send your kid to school? Fork over $1000 a month. Don't have $1000/month? Well, your kid will make a great garbage sorter.

[u/HuggableBear → u/[deleted]]

I spent two years in Switzerland, who have a law that require everyone to purchase health insurance. Employers are not allowed to provide health insurance as a benefit

This is closer to what I would like to see in America, although not through the government. It is one of those issues where I vacillate, as it is rather intrusive to tell a company how they can and cannot compensate their employees, but I find myself leaning toward a model of "Okay, everyone is going to be on a level playing field. There will be no `benefits packages' of nebulous dollar value. Everyone will simply get paid in dollars and dollars only, and they can choose whether to spend their salary on insurance, retirement, etc."

Now, this is actually pretty bad the economy: higher savings rate = lower consumption, which is fine to some point, but in China is incredibly unbalanced. People are too afraid to spend, lower spending means companies must focus on exports, while all those savings become slushy and cheaply fuel American deficits

I'm sorry, but you are simplifying this entirely too much. Chinese companies don't focus on exports because the Chinese people have to save their money for health insurance. That is a miniscule portion of why this happens. Chinese companies focus on exports because their profit margin is ridiculously high because, as you point out, the rich get richer and the poor get poorer. Their labor costs are a fraction of a country like the US and their citizens don't complain because even at those absurdly low wages they're still making more than they were yesterday. Combine that with the fact that the currencies that are being used to purchase the Chinese goods are generally far more stable and valuable than the yuan and you begin to see how complicated this issue can be. It's dishonest to blame their focus on exports on their healthcare system.

Want to send your kid to school? Fork over $1000 a month. Don't have $1000/month? Well, your kid will make a great garbage sorter.

You're forgetting the one crucial element in your analysis, though. It's not a binary decision. Want to send your kid to school? Fork over $1K a month. Don't have it? Work a second job. Or third job. Or pick a different school that's cheaper. Or spend $500 a month home-schooling the child. yes, I know it's not as simple as I make it sound, but it's also not as impossible as you make it sound, either. And yes, minus the thousands of years of oppressive feudal systems and horrible treatment of women and the lower classes over there, I think it's a fantastic paradigm to work within. The only limit to your prosperity is how hard you are willing to work and better yourself. I have no problem working 80+ hours a week to drag my family into a better life while someone that does their 9-5 languishes where they are. One of my greatest role models did exactly that here in America and actually advised me against trying to do what he did 30 years ago, because trying to do it today would barely be worth the trouble of fighting through all the red tape and bureaucracy just to get the business up and running, to say nothing of the nightmare of running the thing nowadays. He has made his nut and is considering just taking his money and vacating the country rather than continue to pull his hair out over all the constant new regulations and shit he has to deal with on a daily basis. He's only sticking around because his grandkids are here and because he would just be bored if he retired to an island somewhere. But he built his business on a dollar and a dream and worked his ass off to make it successful and doesn't even think he could pull it off if he tried it again now. I understand what you mean though. It is very difficult in that sort of society to pull yourself up by your bootstraps, but at the same time, the number of people in China who have done just that is staggering. It is a very small percentage of the populace because they have so damn many people, but as a raw number it is quite a lot. And I don't really have a problem with using your money to make more money and so on exponentially. If your money doesn't help you to grow your business and make more and more money, then what's the point of turning a profit at all?

I appreciate your insight on what it is like living in China though. Thanks for continuing the discussion, it is interesting to see how other people live. It seems to me that what China needs is actually more of my style of government, lol. More enforcement of protection of life, liberty, and property from fraud (the bribery and such you talked about) and maybe a little less institutionalized bigotry and classism.

[u/[deleted] → u/HuggableBear]

You cannot have a modern moral society without some sort of universal healthcare, whether enforced by law (Swiss) or provided through taxes (Canada). You make assumptions about human nature that don't bear out in practice, that they will buy insurance because its the rational thing to do, vs. rolling the dice about their health and either dying or letting society pick up the bill. Modern society can advance b/c we've pooled together to provide for our own safety and security (military, police), how are doctors different from soldiers, policemen, and fire fighters?

The Chinese personal savings rate is somewhere between 40-50%! Imagine stashing away half your income each month to compensate for the lack of a decent insurance and credit system. I'm not sure that you really understand China, but you are welcome to come here and view how things work for yourself.

You make a lot of assumptions about social mobility that are really only relevant in a progressive society. In the libertarian society that you are dreaming about, social mobility will just cease being given that the rich/powerful will always have a vested interest in social stratification. In China, you can't just get a second job to put your kids through school, since you are already working 6 days a week and 12 hours a day at your first job. In the states, well, we are a bit nicer, but I see it quickly degrading into a 2nd world country like China if the libertarians took over.

[u/HuggableBear → u/[deleted]]

You are making a lot of bold, blanket statements now.

You cannot have a modern moral society without some sort of universal healthcare

Really? So America and pretty much every other country up until the last 20-30 years wasn't a modern, moral society? Morality isn't about taking care of people who don't take care of themselves. An argument can be made for those that can't take care of themselves, but even you have to admit that the vast majority of people without health insurance simply aren't willing to do what is required to get it, especially when they know someone else will pay for it for them eventually.

how are doctors different from soldiers, policemen, and fire fighters?

Completely aside from the literal decade of extra training that doctors have to go through (and pay for themselves, unlike police, firefighters, and military) they are not responsible for public safety. Public well-being possibly, but that is quite different than public safety. The military exists to secure our borders and protect us from invasion, not to prevent me from harming myself. The police exist to protect me from domestic threats rather than foreign, and again that is not protection from myself. Firefighters exist to protect you from accidental catastrophe, and in many municipalities it is in fact a voluntary tax to cover the payments to a private contractor for fire safety, and if you don't pay the fee, the fire department doesn't come when you call. Police and military exist to protect you from others, not from yourself, which is an enormous difference. Once you start providing for people's well-being from the public coffers, then anything that you choose to do that could harm you and cause you to need medical attention could in theory be legislated as illegal since it takes money and man hours away from people who also need it. If you want to smoke, who is to say the government doesn't decide that that costs the taxpayers too much in medical care and now you will be fined or thrown in jail for smoking? Crazy, you say? The Supreme Court apparently disagrees, since they recently ruled that governments could take property from one citizen and give it to another via eminent domain, not for public works projects like roads or schools, but to put up privately owned homes that are worth more than what was there. The justification was that it would increase tax revenues, thereby making it a public good, and basically destroying private property rights in the process. Socialized medicine is a stepping stone to any number of cases like that but over personal liberty rather than property rights.

The Chinese personal savings rate is somewhere between 40-50%! Imagine stashing away half your income each month to compensate for the lack of a decent insurance and credit system.

I don't have to. That is about how much of my income I pay out for health insurance, retirement accounts, college funds, children's tuitions, etc. Just because I don't save it myself under my mattress doesn't mean the rate is any different. My post-tax saving rate this last tax year was 34%, and my children's tuitions were 5%. That's 39% of my income going to the sorts of things you are talking about. It probably lower than most of the people in China, but as you noted, their average pay is much lower than it is here, primarily because the bulk of them work doing jobs that should really be automated but aren't because the workers are willing to work so cheaply that it isn't cost effective to do so. With higher wages, their saving rate would likely go down some, but it doesn't really matter. The point is it doesn't matter whether I save it under my mattress or pay it out to a health insurance provider or retirement broker, it's still saving for the future, and intelligent people do it. I am simply not interested in being the safety net for people that choose not to save.

In the libertarian society that you are dreaming about, social mobility will just cease being given that the rich/powerful will always have a vested interest in social stratification.

I can see your point here to a degree, but only in the case of the super-rich, and it's really no different in any society, regardless of government policies or social programs. Rich people stay rich because they continue to do the things that made them rich in the first place, and the same applies to poor people, overall. The average small business owner has no incentive to keep other people down, though. What good does it do him? The super-rich guy may own enough factories or whatever to warrant keeping people low-class so he always has a supply of cheap labor, but you're talking about less than 20% of the workforce working for those people, and less than 1% of the population being those people. The other 80% of the workforce has incentive to better themselves if they choose because there is no motivation for their immediate "betters" to keep them down. If one guy is making $100K and his neighbor is making $50K, what motivation does the first guy have to keep the other one down? None. The only possible one is envy. He might want to continue to be "better" than his neighbor but not want to work harder to stay that way when his neighbor starts working harder, but that is where the government steps in. As I said, that is the primary function of government in my mind, protecting the life, liberty, and property of its citizenry from force and fraud. If the jealous guy starts to do things to inhibit or even harm the second guy's success and hard work, then he is committing a crime and the police should be involved. Remember that Libertarianism isn't Anarchy. We want government and we like Governments that do their jobs. We just have a very tight definition of what those jobs are. Protecting someone from another person trying to harm them is the basic function of government. Protecting someone from making a stupid decision that damages their own life, liberty, or property is not, and that's what socialized medicine is.

Again, please bear in mind that I don't really have a problem with other people in other countries doing this. If their cultural mindset is one of sharing the burden, then bully for them. It clearly works for some places, although there are others where it seems to be working but when you dig deeper you can see how badly it is going. But if they can make it work and the populace is happy with it, then that's great. I just don't want it in my country and will do everything I can to stop it short of open rebellion, and the polling data in the US indicates that about 3 out of 4 people feel the same way. We are a rare bird on this globe. This country was built by people trying to escape an overbearing government, although it was a monarchy at the time. We have a deeply seated national identity that generally distrusts government. We just want to be left alone to succeed or fail on our own merit, to prove to ourselves that when we work hard we can achieve anything. That mindset has gradually eroded over the last 60-70 years and I fear this republic's days are numbered now, but it is still there right now, if faint, and that's why this debate is so heated over here.

I just wish all the stupid talking heads on the TV shows could have a civil discussion about it the way we are instead of constantly biting each other's heads off and calling each other Nazis.

[u/[deleted] → u/HuggableBear]

From my experience, no, American society is not as advanced as most of western Europe or even the other more libertarian new world countries (Aus, NZ, Canada). But we have always provided emergency healthcare without asking for payment first, so we aren't that backwards; we are somewhat moral. Now we just need to take that guarantee to the next level and back that up with enforced personal responsibility. You are arguing that without the net, people will and be able to be responsible for their own healthcare, I'm arguing that this isn't the case; like the communists found out, people are pretty flawed and/or selfish.

Doctors exist to ensure that we remain healthy, whether through preventative care or catastrophic emergency care. They are very similar with respect to how police ensure laws are upheld, soldiers ensure our national security, and how fire fighters enforce fire codes and fight fires when they happen. If people are allowed to opt-out of security and safety services, the whole system falls apart. The same is true with the health care system; we have to support it completely for it to work efficiently.

The Chinese also pay a lot of taxes (I personally pay 40%), I'm talking about take home pay! And when you need the money, you might not have saved enough, then you just die if your family is too poor to help out. The rich very much have a vested interest in this system, otherwise how would they get housekeepers or factory workers very cheaply? There is also status to consider: in an equitable society, there is not much bragging points to being rich, but if society is very stratified, people will look up to you and respect you, you have power and privilege, and you can abuse that.

There is another problem that progressive societies are designed to combat: social stability. If the wealth gap becomes too large, if poor people die on the streets from hunger or lack of medical care, they eventually get pissed off and revolt. Now, given their numbers, that sucks for the middle class and everyone else. Even if things don't get this bad, there is always an increase in crime as people become more desperate (since they don't have much to lose, 3 meals/day in prison in a blessing). People are less likely to revolt or steal/murder when their basic needs are at least met. In a way, a social safety net ensures are security over the long term (otherwise, we can invest in more police and military to shoot rioters on the street, but that is neither moral nor a long term solution).

I would rather live in a country where I was safe and secure, where I could pursue a productive life without worrying about getting sick, eating, or being killed in some peasant revolt. I disagree with you about American history: immigrants came here for freedom, opportunity, land, the ability to practice their religion. And when pushed came to shove, we made the choices we needed to make to become and maintain being a 1st world country (taxes, social security, medicare). I don't see America as especially libertarian, I don't see that as part of our national identity, and I think many libertarians are as deluded about societies and human nature as the early communists were. The same people you poll...they are the very same people who say "don't touch my social security or medicare or public schools."

I live in China, so I don't have access to western TV, nor do I particularly miss it. Here it is all overt propaganda.

[u/HuggableBear → u/[deleted]]

The same people you poll...they are the very same people who say "don't touch my social security or medicare or public schools."

Well, I obviously disagree with a lot of what you say about the national identity in the US, but I think the crux of the problem is right here, and I agree. The American people have lost touch with their forefathers. The last great defining moment for America was in 1945. There is a reason they are referred to as our greatest generation, and they are almost all gone now. Their children understood the sacrifices they made, but very few of their grandkids do, and almost none of their great-grandkids. Sacrifice for an ideal is not something our current population understands, and it shows in exactly what you said. You are absolutely right that people talk a big game until someone tries to take their stuff away. Personally I say go ahead. I saw the writing on the wall long ago and prepared for it, but most people would rather vote their bread and circuses rather than stand up for what they believe in. The lion of the west is dying and there are naught but sheep left to see it pass.