You folks (by which I mostly mean, 'Ray') understand that "unaffordable" is a relative term, right? Something can be "unaffordable" for someone and affordable for someone else. It's perfectly legitimate to say that something is unaffordable for lots of people even though others can easily afford it.

Sigh. It's not helpful to define the meaning out of a word. The fact one person can't afford a pair of shoes does not mean that shoes are "unaffordable." This is a completely ridiculous usage of the word, and it's shameful that people here are stooping to this level of debate.

Merriam-Webster:

1. being within the financial means of most people <once those electronic devices became affordable, sales skyrocketed>

2. costing little <they've added some affordable options>

http://www.merriam-webster.com/thesaurus/affordable

Affordable has a general sense, which Ray has correctly pointed out. One can refer to something as generally "affordable" or "unaffordable", which has an implied "for most people".

Affordable also has a relative sense, which Ray is bizarrely keen on denying. A $3000 suit is affordable for a rich person, but unaffordable for a poor person. This is perfectly normal language use.

The "affordable care act" uses affordable in this perfectly normal relative sense. The goal is for health care and health insurance to be affordable for all people, relative to their wealth, income, and budget.

Affordable also has a relative sense, which Ray is bizarrely keen on denying. A $3000 suit is affordable for a rich person, but unaffordable for a poor person. This is perfectly normal language use.

But how is this helpful? The issue is whether health insurance is affordable. It is.

If you want to make it affordable for everyone (*), fine. But don't imply (with the usage of "Affordable care" or whatever) that the issue is the cost of health insurance when the issue is not the cost of health insurance, but is simply that some people, for whatever reason, don't have the means to support themselves.

(*) Though I fail to see how allowing people to get health insurance for free is providing "affordable" coverage to them. That isn't "affordable" either -- it's simply free. (Or, more accurately, paid for by others.) Giving something to someone for nothing is not making it "affordable" for them; that word is misplaced in that context.

My overall point - this is not semantics - is that people use language in order to distract from what is actually going on. If one supports doing X, one should be honest about what X is.

My overall point - this is not semantics - is that people use language in order to distract from what is actually going on. If one supports doing X, one should be honest about what X is.

No, the goal really is for health care to be affordable for all people. The fact that it already is affordable for most people is an irrelevancy. Your struggles with language use notwithstanding, the vast majority of people understand this perfectly well.

2. costing little <they've added some affordable options>

You do understand the first and second definitions aren't synonymous, right? One designates a group of people that cost is relative to, while the other doesn't. If you make something cost less in absolute terms (the second definition), it becomes affordable to more people.

The issue is whether health insurance is affordable. It is.

Again, is this by your decree, or do you have numbers to back up what counts as "affordable" and what constitutes "most people"? Are these open to review and discussion? Or are we all just an audience for your self-indulgent proclamations?

==
The "affordable care act" uses affordable in this perfectly normal relative sense. The goal is for health care and health insurance to be affordable for all people, relative to their wealth, income, and budget.

And it recognizes that rising insurance premiums and health care costs are making health care increasingly less affordable to more people. Which all serious people having the conversation seem to acknowledge as a problem. Unfortunately, "all serious people" no longer includes Republicans. And Ray.

My overall point - this is not semantics - is that people use language in order to distract from what is actually going on.

Like when people use the term "free rider" to describe anyone who benefits from a public service more than they contribute to it?

EDIT: Too many arguments. I'm going to eat dinner now.

No, Matt, your goal (I don't think you'll disagree with this) is to give health care to everyone, by making some people pay for those who can't pay. Please stop describing a situation where some people get health care for nothing as making it "affordable" to them.

If you force Andy to buy me season tickets for a luxury box at Yankee Stadium, the luxury box has not now become "affordable" to me. It has simply been given to me. This really is not a hard concept.

But objecting to "affordable" really is a surface complaint, right? If the act had been called the "A-1 Peachy Care Act," one could argue about that too, in the sense that it wouldn't have been peachy for absolutely everybody. I mean, the Grand Canyon must look tiny to a Martian, so we could object to that moniker as well on some ground. Everything still stays the same in real terms.

Please stop describing a situation where some people get health care for nothing as making it "affordable" to them.

The people who get fully subsidized care get it through Medicaid. This is paid for through taxes.

The other major reforms in the ACA aimed at making health insurance affordable are the regulation of the industry (to benefit those with pre-existing conditions) and the subsidies for people who aren't Medicaid eligible to purchase insurance. For these people, the ACA ensures that their health insurance will be affordable, and it still requires them to pay direct (but lower) costs for health insurance.

No, Matt, your goal (I don't think you'll disagree with this) is to give health care to everyone, by making some people pay for those who can't pay. Please stop describing a situation where some people get health care for nothing as making it "affordable" to them.

This has been explained many, many times, in exhausting detail. You're pretending it hasn't been. Part of the goal of increasing the pool is to drive down health insurance premiums in the aggregate, resulting in more

(wait for it)

Affordable

(health)

Care

(as a result of the)

Act

Is there anything else we can help you with? Any more semantics you want to waste bandwidth complaining about?

But objecting to "affordable" really is a surface complaint, right?

As I said, I object to casting the Act in this way, because I feel that it is an attempt to veil what is really going on.

Had they called the act the Let's Force Some People To Pay For Health Care For Others As A Further Redistribution Of Wealth Act, I wouldn't have complained about the name.

Ray,

Did you equally object to the "Clean Skies Act"?

As I said, I object to casting the Act in this way, because I feel that it is an attempt to veil what is really going on.

By describing it in precise terms? Do you disagree that one of the plan's main objectives is to lower premiums in the aggregate, making health care cheaper in absolute terms and therefore more affordable? Or is that just socialist propaganda carefully engineered by those thieving leftists? The title of the bill describes its aims pretty well, especially as bill titles go.

Please, for the love of Christ, please stop using BTF as your own personal b!tchfest. This happens in literally every thread you post in.

So they just choose the name as objectively as possible, with no branding effort being made? Is that peoples' position?

Some things are necessary to living a full life in this country, others are optional. Necessary items should be affordable to all. Optional items, not so much. Health care is a necessity, and should be easily affordable to all. If that means taking money from those of us more well-off, then so be it. I'll not lose any sleep.

Okay, here's a question I have for you. Should Insurers or the Government incentive's people with either a momentary payment or some other form of award to become organ donors? Thousand of people die each year waiting on some sort of list, and the care they receive in the meantime is expensive and time consuming. Plus, becoming an organ donor might be a way to provide 'affordable' insurance. Whatever that means.

Is this bill title more to your liking?

So they just choose the name as objectively as possible, with no branding effort being made? Is that peoples' position?

Only the strawman you're arguing with. It is my position that the title's a pretty accurate description of the bill's aims, not that it wasn't strategically titled. It can be both at the same time. And aren't you the one always telling us that marketing and advertising has no impact on behavior? (actually, stating it as a foregone conclusion) Have you reversed that position?

I'm starting to get rather surprised by the apparent unpreparedness of McConnell and Boehner (and Romney, but he's got so many problems over ACA this one sort of hides in the background) to have any lucid comments on what they'd offer up as 'replace' option post-repeal. I guess they must have figured that since the media hasn't had the competence to ask that question since the ACA's passage, they were in the clear.

Near as I can tell... McConnell's position is that health insurance isn't a problem and Boehner seems to favor some form of cross-state insurance shopping, but state-level pools for 'pre-existing conditions'. Romney's position is that the July 4th holiday couldn't get here soon enough.

And aren't you the one always telling us that marketing and advertising has no impact on behavior?

No.

You know Ray I've never felt you were trolling before. I think you are now.

Have you ever known true extended financial hardship? I have. I'm frankly unable to participate in this thread any longer. I am that upset.

Ray,

Is there any other bill you object to the name of? I mean really you are just reaching because you don't like the outcome. Hurry through the stages of grief man.

I will admit, I actually find the constant questions to Ray about who will pay for this and who will pay for that to be a little weird. Ray thinks whomever is getting something should be the one paying. If you don't volunteer to pay for something you're not getting, you shouldn't be paying.

Except that he's been given countless opportunities to apply this principle to paying for the Iraq war, and his silence on the subject is all the proof one needs of his utter hypocrisy. I may be the only person who will call out this evasiveness for what it is, but then his entire pretense of having some overriding principle behind his Ayn Randish preferences is little more than a sham to begin with.

Just to summarize our portrait of Ray, Man of Steadfast Principles, as he applies his Principle to different situations:

1. Health insurance: Pay for it yourself, and if you can't, then pass the hat among those who feel sorry for you, and leave me alone.

2. Emergency rooms: Ahhhh, just treat em and write it off as welfare.

3. Wars of option: Go away boy, you bother me.

----------------------------------------------------

And aren't you the one always telling us that marketing and advertising has no impact on behavior?

No.

No, that's David, who thinks that demand for anything other than a specific brand is the product of a virgin birth.

You know Ray I've never felt you were trolling before. I think you are now.

I am not trolling.

Yes, some people are in true financial hardship, and can't afford health insurance. But, as I've said, the real problem there is not the cost of the health insurance; it's that the people are in true financial hardship. The health insurance is affordable, by definition, because the vast majority of people can afford it. It may be good policy to provide people with coverage, but that doesn't mean that the issue was the cost of the coverage. And providing them with coverage did not make the coverage affordable.

But now I'm just repeating myself.

Dayn, thank you for reminding us all what a tool Eric Cantor is (in case we needed reminding).

That that joker has a position of influence in one of this country's two major political parties speaks volumes about the intellectual vacuity of that party.

2. Emergency rooms: Ahhhh, just treat em and write it off as welfare.

It genuinely boggles my mind that conservatives by and large seem to be just fine with that particular state of affairs, but would rather self-immolate than live in a world where the dread ObamaCare is the law of the land.

No, that's David, who thinks that demand for anything other than a specific brand is the product of a virgin birth.

Beautiful. I wish I had said that.

This is a completely ridiculous usage of the word, and it's shameful that people here are stooping to this level of debate.

But you're the one who's complaining about the name of the bill, so ...??????

The health insurance is affordable, by definition, because the vast majority of people can afford it.

I'm not sure this is really even true - lots and lots of people have health insurance because their employer pays for most or all of it, and those payments are subsidized by the government in the form of tax exemptions. If people all had to pay market rates for their own health insurance, it's not at all clear that it would be "affordable" for vast swathes of the population.

I don't often post here anymore, I just lurk. But you folks seem fairly smart. So tell me why I can't/shouldn't do the following:

1) Get licensed as a health insurance provider
2) Offer only one policy: $10/month health insurance, but with a $1,000,000 co-pay

I mean...it feels like I could make millions by saying "Pay the government $600, or pay me $120 and keep your whole refund."

Those so adamantly against the ACA can save themselves $500/year and be covered for the most catastrophic illnesses, all while maintaining their right to pay for every cent of their health care.

[11] This poem is more the way some people discuss larger questions:

The Sloth by Theodore Roethke

I'm partial to My Papa's Waltz

The whiskey on your breath
Could make a small boy dizzy;
But I hung on like death:
Such waltzing was not easy.

We romped until the pans
Slid from the kitchen shelf;
My mother's countenance
Could not unfrown itself.

The hand that held my wrist
Was battered on one knuckle;
At every step you missed
My right ear scraped a buckle.

You beat time on my head
With a palm caked hard by dirt,
Then waltzed me off to bed
Still clinging to your shirt.

But you folks seem fairly smart. So tell me why I can't/shouldn't do the following

I'm too lazy to do it myself, but my guess is that it would take you only a few minutes of serious Google research to find out that this would be illegal.

I don't think it's illegal under the ACA, but it would not qualify for the exchanges or for the purposes of the mandate.

It might be illegal as a form of fraud, not under the ACA. And if you marketed a non-qualified plan as being qualified, that would be fraudulent.

I don't think it's illegal under the ACA...

Right, I don't mean to imply that I think it would be illegal under the ACA - I'm guessing that it would be illegal under plain old insurance regulations.

Is this bill title more to your liking?

Hee. Thank you, Dayn.

I'm not sure this is really even true - lots and lots of people have health insurance because their employer pays for most or all of it, and those payments are subsidized by the government in the form of tax exemptions. If people all had to pay market rates for their own health insurance, it's not at all clear that it would be "affordable" for vast swathes of the population.

Yeah, taking it off the top in a combination of employer/employee/government works. A big problem is for the people who have to get individual policies. No one is helping them out, and there premiums aren't subject to the modulation of group policy. This people give up trying to keep up keeping up when premiums skyrocket as they age.

131:

Yeah, I have read and re-read that poem many times over about fifty years, and it still stabs each time in the heart with icicle. Just a great poem.

But how is this helpful? The issue is whether health insurance is affordable. It is.

I think this is sort of factually incorrect. The entire decade of the 2000's was stagnant for American wages, but it was actually negative (in real terms) in terms of take-home pay due to the cost of healthcare increasing so rapidly--155% from 1990 to 2008.

Due to health insurance costs, the average worker had less money than they did 10 years ago. That's a really big problem for a developing economy. ACA was an attempt to fix that, in order to improve the overall performance of the economy.*

*Yes, I know. Get back to me in a decade.

Just catching up on a couple of posts from the June thread:

1335:

Option A admits that all readings of constitutionality are textual interpretations. Now, I have no problem with that, nor does, say, Ruth Bader Ginsburg, but David and Ray and the "reality determines itself" brigades (inclusive of the Thomases and Scalias of the court) are violently opposed* to admitting that basic, obvious truth.

No, that's not remotely correct.

1370:

Yes, but the Court is the final arbiter of what is or is not constitutional. Feel free to argue the decision, but for now, the ACA is constitutional.

For now, the courts deem the ACA to be constitutional. When Ginsburg has to retire midway through Gary Johnson's first term as president, and she's replaced by someone who cares about freedom, then the Court will change its collective mind. And since the Constitution won't have changed in that time, one of those two Courts will have been wrong, by definition.


1378:

Nobody's saying that court decisions can't be subjectively "wrong", according to one's various premises.

This is gibberish. What on earth does "subjectively wrong" mean?

1393:

This sounds like the ACA, though. People are given a choice whether to (A) to invest a portion of one's money in a private account or (B) leave their tax dollars with Social Security, but one is not free to not save for retirement. It's not called a mandate, but it acts in exactly that manner, since it requires everyone to become actors in that particular market.

A tax is not a market. One is free to not save for retirement, simply by staying in social security. (Social security is not "saving for retirement"; it's just a tax.) One isn't free not to pay the tax, but then, that's pretty much the nature of taxes -- they're collected (altogether now) at gunpoint.

But how is this helpful? The issue is whether health insurance is affordable. It is.

I think this is sort of factually incorrect.

It can't be, if the vast majority of people were affording it.

It can't be, if the vast majority of people were affording it.

That's a tautology, though. I mean, you wouldn't say that housing in NYC is affordable, would you? And yet more people can afford to live there than any other city in the country.

I think if the cost of a good rises 8.6% per year for 18 years, it has stopped being affordable and starts to need structural changes.

For a point of comparison, the price of gas in 1990 was $2.24 (in 2008 dollars). If gas prices had risen at the same rate as healthcare, gas in 2008 would have cost $5.71 per gallon. Would you call that affordable?

The issue is that the government is well within its power to require people to purchase insurance. The collective maintenance of insurance for certain things (automobile insurance, home insurance) is taken for granted as an obvious and necessary thing.

Huh? First, the government does not require people to purchase homeowners' insurance -- only mortgage lenders do. Second, the government does not require anyone to purchase auto insurance. Only people who want to drive on public roads are required to have auto insurance. Moreover, there is no "the government"; there are different governments. It's the state governments who require auto insurance. Not the federal government. The federal government has different powers than state governments.

The comparison actually would be if you could opt out of say, service by the local fire department and because of whatever reason you refuse to pay the annual, and then your house catches on fire. You're pleading with the fire department, who shows on your doorstep and *they* refuse to do anything to stop the fire, and are only really there because they want to make sure the fire doesn't spread out to other houses who did pay the annual fee. You might think this is ridicoulious and it doesn't happen, but read this story.

Now, that's evil and cold blooded.

No, it isn't. It's reasonable and just.

Exactly. That's what I've been saying forever. Health outcomes don't function properly on a profit/loss, "free market" mechanism.

Of course they do. They don't function the way you want them to do, which is magical ponies for everyone. (98.7% of the time, when a liberal talks about market failure, what he means is that poor people can't buy something expensive. But that's not a market failure; that's market operation. That is "functioning properly.")

Well since 60% of bankruptcy is caused by medical bills, then yeah it just might here in the real world.

Uh, no.

Is this bill title more to your liking?

Missing the word "evil."

A longer version of this has been making the rounds, with wraparound prose and citations to the bill's text:

Already in effect:
It allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices)
It increases the rebates on drugs people get through Medicare (so drugs cost less)
It establishes a non-profit group that the government doesn't directly control, PCORI, to study different kinds of treatments to see what works better and is the best use of money.
It makes chain restaurants display how many calories are in all of their foods, so people can have an easier time making choices to eat healthy.
It makes a "high-risk pool" for people with pre-existing conditions. Basically, this is a way to slowly ease into getting rid of "pre-existing conditions" altogether. For now, people who already have health issues that would be considered "pre-existing conditions" can still get insurance, but at different rates than people without them.
It forbids insurance companies from discriminating based on a disability, or because they were the victim of domestic abuse in the past (yes, insurers really did deny coverage for that)
It renews some old policies, and calls for the appointment of various positions.
It creates a new 10% tax on indoor tanning booths.
It says that health insurance companies can no longer tell customers that they won't get any more coverage because they have hit a "lifetime limit". Basically, if someone has paid for health insurance, that company can't tell that person that he's used that insurance too much throughout his life so they won't cover him any more. They can't do this for lifetime spending, and they're limited in how much they can do this for yearly spending.
Kids can continue to be covered by their parents' health insurance until they're 26.
No more "pre-existing conditions" for kids under the age of 19.
Insurers have less ability to change the amount customers have to pay for their plans.
People in a "Medicare Gap" get a rebate to make up for the extra money they would otherwise have to spend.
Insurers can't just drop customers once they get sick.
Insurers have to tell customers what they're spending money on. (Instead of just "administrative fee", they have to be more specific.)
Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they're turned down.
Anti-fraud funding is increased and new ways to stop fraud are created.
Medicare extends to smaller hospitals.
Medicare patients with chronic illnesses must be monitored more thoroughly.
Reduces the costs for some companies that handle benefits for the elderly.
A new website is made to give people insurance and health information.
A credit program that will make it easier for business to invest in new ways to treat illness by paying half the cost of the investment. (Note - this program was temporary. It already ended.)
A limit is placed on just how much of a percentage of the money an insurer makes can be profit, to make sure they're not price-gouging customers.
A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. Basically, your insurer isn't paying for the aspirin you bought for that hangover.
Employers need to list the benefits they provided to employees on their tax forms.
Any new health plans must provide preventive care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge.

1/1/2013
If you make over $200,000 a year, your taxes go up 0.9%.

1/1/2014
This is when a lot of the really big changes happen.
No more "pre-existing conditions". At all. People will be charged the same regardless of their medical history.
If you can afford insurance but do not get it, you will be charged a fee. This is the "mandate" that people are talking about. Basically, it's a trade-off for the "pre-existing conditions" bit, saying that since insurers now have to cover you regardless of what you have, you can't just wait to buy insurance until you get sick. Otherwise no one would buy insurance until they needed it. You can opt not to get insurance, but you'll have to pay the fee instead, unless of course you're not buying insurance because you just can't afford it. (Question: What determines whether or not I can afford the mandate? Will I be forced to pay for insurance I can't afford? Answer: There are all kinds of checks in place to keep you from getting screwed. Kaiser has a webpage with a pretty good rundown on it, if you're worried about it.)
Medicaid can now be used by everyone up to 133% of the poverty line (basically, a lot more poor people can get insurance)
Small businesses get some tax credits for two years. (It looks like this is specifically for businesses with 25 or fewer employees.)
Businesses with over 50 employees must offer health insurance to full-time employees, or pay a penalty.
Insurers now can't do annual spending caps. Their customers can get as much health care in a given year as they need.
Limits how high of an annual deductible insurers can charge customers.
Cuts some Medicare spending
Place a $2500 limit on tax-free spending on FSAs (accounts for medical spending). Basically, people using these accounts now have to pay taxes on any money over $2500 they put into them.
Establish health insurance exchanges and rebates for the lower and middle-class, basically making it so they have an easier time getting affordable medical coverage.
Congress and Congressional staff will only be offered the same insurance offered to people in the insurance exchanges, rather than Federal Insurance. Basically, we won't be footing their health care bills any more than any other American citizen.
A new tax on pharmaceutical companies.
A new tax on the purchase of medical devices.
A new tax on insurance companies based on their market share. Basically, the more of the market they control, the more they'll get taxed.
The amount you can deduct from your taxes for medical expenses increases.

1/1/2015
Doctors' pay will be determined by the quality of their care, not how many people they treat.

1/1/2017
If any state can come up with their own plan, one which gives citizens the same level of care at the same price as the PPACA, they can ask the Secretary of Health and Human Resources for permission to do their plan instead of the PPACA. So if they can get the same results without, say, the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer (in simple terms, everyone is covered, and medical expenses are paid by taxpayers).

2018
All health care plans must now cover preventive care (not just the new ones).
A new tax on "Cadillac" health care plans (more expensive plans for rich people who want fancier coverage).

2020
The elimination of the "Medicare gap"

For a point of comparison, the price of gas in 1990 was $2.24 (in 2008 dollars). If gas prices had risen at the same rate as healthcare, gas in 2008 would have cost $5.71 per gallon. Would you call that affordable?

If most people could afford it, then yes.

My point is that you guys are identifying the wrong problem. The problem is not that the cost of health insurance is too high; the problem is that some people can't support themselves. It may be good policy to provide health care for them, but people should stop pretending that the core problem is the cost of the health insurance.

The problem is not that the cost of health insurance is too high; the problem is that some people can't support themselves. It may be good policy to provide health care for them, but people should stop pretending that the core problem is the cost of the health insurance.

The problem is these freeloaders want fancy medical care but don't have anything to offer in return. Th solution? Organ markets. Show up at the emergency room crying because you cracked your little noggin? Sign away a kidney and everybody wins. Blindsided by a heart attack? Well here's a fine opportunity for your familiar and friends to show how much they appreciate you being alive. A couple of kidneys, a nice chunk of liver, a few square centimeters of skin, there are myriad ways you and yours can contribute.

Being unable to pay your medical bills only means one thing - the free market has determined that you don't generate enough value to be worth keeping alive. Someone else can take your job, lowering unemployment. Your material possessions can be sold on the second-hand market. You're a good husband? Kids love you? Great, quantify that in dollars or GTFO hippie.

I'm sitting here, a fine upstanding small businessman brimming with entrepreneurship whose dream of a service-oriented organ brokerage is being crushed by the oppressive jackboot of Big Government and you want to whine about linguistic semantics like some elitist snob cloistered in their ivory tower. Shame on you. Shame on all of you.

No, it isn't. It's reasonable and just.

It's incredibly stupid to live in a city and say "Whether my neighbour's house burns down or not is none of my business". Even if you're maximally callous - fires don't work that way. If the fire department just lets houses burn, the city is going to burn down. And since they know the city is going to burn down, insurance companies won't offer you fire insurance.