Missouri’s Blow Against Obamacare

August 10th, 2010 at 10:47 am | 47 Comments |

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What’s the matter with Missouri?

Last week, voters there approved Proposition C, annulling the “individual mandate” – that is, the requirement that everyone in Missouri buy health insurance or pay a fine. The final result was lopsided, with 71.1% favoring the proposition.

Much conservative ink has been spilled touting the vote as proof that Obamacare isn’t a winner at the ballot box. The Wall Street Journal, for example, declared it: “another resounding health-care rebuke to the White House and Democrats.”

FF Contributor Andrew Pavelyev argues that the Missouri results may be overhyped: “The Proposition C vote in Missouri may be a classic case of there being less than meets the eye.” This analysis is echoed by others, such as Jonathan Chait at TNR, who notes that the victory was colored by a “massively disproportionate Republican electorate.”

While I generally agree with Pavelyev’s thoughtful posts, we’re going to agree to disagree here.

My friend Henry Olsen summarizes the results in a concise blog:

While some commentators have suggested this was fueled by high Republican turnout, the results suggest otherwise. The measure passed in every county save one, heavily Democratic St. Louis City. It was approved by over 70 percent in virtually every county, and by 60-62 percent even in strongly Democratic counties such as Jackson, which includes Kansas City, Boone, which includes the University of Missouri, and St. Louis and St. Genevieve counties.

I ran by Olsen the various arguments that the Show-Me State didn’t really show much of anything.

He responds:

The author’s argument is based on an incorrect understanding of Missouri election law. Since all Missourians have the right to vote in any party’s primary under Missouri’s open primary law, the fact that 65% of the ballots were cast in the Republican primary does not prove that turnout was tilted toward the GOP base. The primary election results should be understood as a solid representation of what Missouri voters think of the individual mandate.

The general point is not that Obamacare is doomed because of one proposition – but it’s striking that the legislation remains unpopular and aspects of it are incredibly unpopular.

The Missouri result, in fact, can be seen in the larger context of polling results over the last number of months. Take a look at the RealClearPolitics rolling average – the poll of polls. Since passage, Obamacare has failed to capture the public’s imagination.  The most recent polling, as calculated by that publication, has the “against” up by 14.8%.

And while we can always quibble about the merits and demerits of polls, it’s interesting to note that the people in the business who, literally, have their jobs on the line, aren’t exactly extolling the merits of Obamacare.

This. Debate. Isn’t. Over.

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47 Comments so far ↓

  • rbottoms

    Missouri’s Blow Against Obamacare

    Missouri Blows, Against Obamacare

    Fixed.

  • Chris

    I live in Missouri. True, many people (mostly conservatives, my part of the state is very red-titled) are anti Obama’s proposal. At the same time, most of those same people think people should not be discriminated against in terms of pre-existing conditions, and they also think that if you show up to an ER in need of medical help, you should be assisted, regardless of whether you have insurance.

    When you put all that together, you get a more complicated picture.

  • rbottoms

    When you put all that together, you get a more complicated picture.

    No, what you get is the usual Conservative hypocrisy of: “Keep the government out of my Medicare”, “Don’t touch my Social Security, you socialist bastard”, and “Waaah, make the insurance companies cover pre-existing conditions” but you better not raise my taxes one penny.

  • easton

    And are these people aware that when the uninsured get treatment at the ER the costs gets of this uncompensated care, in the end, is just pushed onto the premium payers? So people in Missouri are in favor of free riders or deadbeats? Ok, then since the Republican party is so in favor on now mandate, perhaps they can pay for the uncompensated care, or they can put forward a law that no hospital shall treat any patient unless they can prove beforehand that they can pay 100% of the care that they might receive.

    This. Debate. Isn’t. Over.

    What debate is this? We already know the teabaggers are idiots and fools.

    So seriously, lets have this debate. Who shall pay for care, the patient who takes responsibility for his health by purchasing insurance, or others who will pay for it for him or her? Or will Republicans then mandate no treatment at hospitals unless the patient has insurance? Which is it?
    Answer this, or otherwise you are a freaking idiot.

  • Chris

    rbottoms:

    That’s what I meant, actually.

    easton:

    That’s why I don’t trust these propositions. If people want to require hospitals to reject the uninsured sick and injured, then let’s talk about how individual mandates are evil.

  • LFC

    The Republican Party should be renamed the Sumfin’ for Nuffin’ Party. They whine about “tax and spend Democrats”, but at least the Dems have made efforts to pay for their spending. If Clinton hadn’t been in office, Newt and crew would have slashed taxes to make sure we never got away from deficit spending. But that was OK, because Bush and Congress’s merry band of boneheads made sure they saddled us with massive and never-ending debt.

    Republicans spend, spend, spend but never want to pay, pay, pay. And why is that? Because they are so utterly moronic that they believe tax CUTS bring in more revenue than tax hikes. Any party that can’t figure out the difference between a + and a – on a calculator is unfit to govern.

    “Teh stupid! It burns!!!”

  • Watusie

    Here is a snapshot of one of Missouri’s finest:

    Missouri farmer David Jungerman has raised the hackles of local residents with a politically-charged sign he’s placed on his “45-foot-long, semi-truck box trailer” on his farm. The trailer reads: “Are you a Producer or Parasite Democrats – Party of the Parasites.” Now, the Kansas City Star reveals that Jungerman has been the recipient of over a million dollars of federal farm subsidies since 1995.
    http://thinkprogress.org/2010/06/23/farmer-democrats-parasites-subsidies/

  • DeepSouthPopulist

    The states need to stay aggressive with Obama by using law suits, referendums and any other legal means to turn back his agenda. Meanwhile, the Republicans in Congress should use obstruction.

    Repealing the health care mandate should be the first order of business when the new Congress is seated. Let Obama veto it with the whole world watching.

    The Republican strategy both in the short term and in the run up to 2012 needs to be forcing this man to expose himself.

    Make him veto the repeal even though most people hate health care mandates, and make his lawyers go to court in every state to argue, as they did in Virginia, that mandates are Constitutional because the federal government has the power impose taxes. By drawing attention to this argument by Obama’s own lawyers, the GOP can expose his lie that no one making under 250 would see any form of a tax increase under his presidency.

    The US federal government created the health care free rider problem first place and now wants to solve it with more government. Surely there are other ways to keep people from being turned out of ERs.

  • forgetn

    How can anyone be surprised by Missouri’s position: Do you want to have to buy medical insurance? Who would say yes to that question, no one likes “taxes” at the same time they still want to services. BTW Watusie: love the snapshot comment, sounds about right: I’m against government subsidies, just leave mine alone.

    the only people who are for tax increases are (a) those who benefits directly from the increase in taxes, (b) those who don’t have to pay the tax increase.

  • Chris

    LFC

    “Because they are so utterly moronic that they believe tax CUTS bring in more revenue than tax hikes. ”

    I agree with your overall point here. Still, I agree with Reps that at some point higher up on the taxation scale cuts do bring in more revenue than hikes. Any sensible Dem must agree. The problem with Reps is that they take “cuts=revenue” to be an a priori truth — they don’t seem to agree that there’s a diminishing (or negative) return point lower in the tax scale. If taxes are 30, more revenue at 20. And more at 10. And more at 1. That’s insanity, in my opinion.

    What we need to figure out is (a) what services do we want and then (b) at what level given that spending can we cut or raise taxes to increase revenue while at the same time pay for (a). Republicans don’t want to talk about (a), and they only want to talk “Cuts” for (b).

  • LFC

    …the GOP can expose his lie that no one making under 250 would see any form of a tax increase under his presidency.

    Tax increase on people making $250K? Good. We don’t have enough money to pay for our government spending, and we sure as heck know that the Republicans haven’t made a serious effort to cut spending in over 30 years. Time for the nation’s whiny little bitches to grow up and realize that they can’t have everything for nothing.

  • LFC

    Still, I agree with Reps that at some point higher up on the taxation scale cuts do bring in more revenue than hikes.

    I do agree with that, Chris, and supported Reagan in getting rid of the 90% income tax rate. The problem with Republicans is that they are acolytes of just one half of the Laffer Curve. They’ll never admit that it has a second half.

  • DeepSouthPopulist

    Out of curiosity, other than older people who rely on entitlements, what are these mythical federal government services that middle class people who pay most of the taxes supposedly “want”?

    Few middle class people receive large farm subsidies or any direct subsidies for that matter, maybe with the exception of low interest student loans subsides.

    I myself use roads, bridges, public utilities, sewage, water and other basic infrastructure, police, fire and the court/legal system. A lot of that is paid for by state and local rather than federal taxes.

  • DeepSouthPopulist

    “Tax increase on people making $250K? Good. We don’t have enough money to pay for our government spending, and we sure as heck know that the Republicans haven’t made a serious effort to cut spending in over 30 years. Time for the nation’s whiny little bitches to grow up and realize that they can’t have everything for nothing.”

    When is the last time a Democrat proposed meaningful spending cuts, or even keeping spending at current levels rather increasing spending?

    Neither side proposes spending cuts, and neither side ever will. That’s why a line has to be drawn on taxes. Raising taxes will do nothing because the gov will just increase spending regardless of who is in power.

  • easton

    what are these mythical federal government services that middle class people who pay most of the taxes supposedly “want”?

    What do you mean mythical? Take a look at spending some time. Social Security is 21% and certainly Americans want that. Medicare and medicaid 33%, again, most Americans want that as well out of self interest if nothing else. Defense and Security, lord knows how much is really being spent but according to the Government 20%, that leaves interest and discretionary spending.
    From wiki:
    # $78.7 billion (−1.7%) – Department of Health and Human Services
    # $72.5 billion (+2.8%) – Department of Transportation
    # $52.5 billion (+10.3%) – Department of Veterans Affairs
    # $51.7 billion (+40.9%) – Department of State and Other International Programs
    # $47.5 billion (+18.5%) – Department of Housing and Urban Development
    # $46.7 billion (+12.8%) – Department of Education
    # $42.7 billion (+1.2%) – Department of Homeland Security
    # $26.3 billion (−0.4%) – Department of Energy
    # $26.0 billion (+8.8%) – Department of Agriculture
    # $23.9 billion (−6.3%) – Department of Justice
    # $18.7 billion (+5.1%) – National Aeronautics and Space Administration
    # $13.8 billion (+48.4%) – Department of Commerce
    # $13.3 billion (+4.7%) – Department of Labor
    # $13.3 billion (+4.7%) – Department of the Treasury
    # $12.0 billion (+6.2%) – Department of the Interior
    # $10.5 billion (+34.6%) – Environmental Protection Agency
    # $9.7 billion (+10.2%) – Social Security Administration
    # $7.0 billion (+1.4%) – National Science Foundation
    # $5.1 billion (−3.8%) – Corps of Engineers
    # $5.0 billion (+100%) – National Infrastructure Bank
    # $1.1 billion (+22.2%) – Corporation for National and Community Service
    # $0.7 billion (0.0%) – Small Business Administration
    # $0.6 billion (−14.3%) – General Services Administration
    # $19.8 billion (+3.7%) – Other Agencies

    Defense is at least 663 Billion. Do Americans want clean air and water, my guess is. The same with parks, or should we sell Yellowstone? We can argue about farm subsidies all day, but lets be honest that the pork is bi partisan.

    By the way DSP “Raising taxes will do nothing because the gov will just increase spending regardless of who is in power.” um…Clinton Surpluses…remember…and pretty much full employment and increase across the board of income. According to your theory surpluses are impossible.

    Surely there are other ways to keep people from being turned out of ERs.

    So tell me what is the private sector solution to this? How do you get physicians to voluntarily treat patients without any costs being passed on to anyone who does not want to pay. My guess is many, many people would die on the streets outside the ER since the people who don’t have insurance tend to live in inner cities. On the plus side, the wealthy need never see that as they go to their own hospitals since it would be a shame for them to have to drive over the dead bodies of the poor.

  • easton

    When is the last time a Democrat proposed meaningful spending cuts, or even keeping spending at current levels rather increasing spending?

    Again, Clinton cut defense by hundreds of billions of dollars, and did the same to welfare. Why do you refuse to acknowledge the existence of the Clinton presidency?

  • DeepSouthPopulist

    Clinton left office almost a decade ago, although I have admit what you say is true — he is a good example of a Democrat who proposed and pushed through meaningful cuts. At the same time, every bill he signed into law after the ’94 midterms was passed by the Republican controlled Congress, so the Republicans probably deserve some credit for those cuts as well.

    More recently, no one on either side that I know of with the exception of Ron Paul has proposed much less fought for meaningful spending cuts. So this canard that people keep repeating about the Republicans not wanting to specify cuts is just that, a canard, because the other side doesn’t do it either and the only one is specific is a Republican.

    We would have to drill into each one of those federal agencies to identify who benefits from what. There is undoubtedly a lot of pork coming out of those agencies that benefit very narrow constituencies, as opposed the middle class in general.

  • TerryF98

    DSP Said

    “When is the last time a Democrat proposed meaningful spending cuts, or even keeping spending at current levels rather increasing spending?”

    Obama proposed going back to paygo. The GOP opposed it. The Dems wanted a bi-partisan deficit commission to see where the deficit could be reduced and how to get there. The GOP Opposed it.

    So who is serious about a balanced budget?

    Again not one GOP president since WW2 has reduced the deficit as a % of GDP.

    Every Democrat one has. Who is serious about spending again?

  • LFC

    And again, spending cuts are only half of the equation. Reagan went overboard on the tax cuts, and it took tax hikes by the administrations of Reagan, George HW, and Clinton to get it back on track. And when you look at actual federal debt put on by tax and spending policies, there’s no recent history of a fiscally responsible Republican. (Under Reagan I thought that the tax rates definitely needed flattening, but I’ve never forgiven Reagan for the fact that he never tried to put the brakes on spending.)

    And now the current crop of Republicans is calling for what? Yet more tax cuts! They have even made the completely moronic statement that any and all spending must be paid for, but tax cuts don’t have to be paid for because they bring in more money than they lose. It must be great living in a world where reality doesn’t get in the way of what you “know”.

    Even if the right-wingers are corret and the Dems are “tax and spend”, that still makes them a vastly more fiscally conservative choice than the Republican “borrow and spend” mantra that they are still defending.

    At the same time, every bill he signed into law after the ‘94 midterms was passed by the Republican controlled Congress, so the Republicans probably deserve some credit for those cuts as well.

    First, that took a lot of fighting and a gov’t shutdown by Newt Gingrich to keep them in line. Second, the Republicans were demanding the same massive tax cuts that Bush put into place for years under Clinton. Third, compared to Reagan and HW, spending was slowed in Clinton’s first two budgets, before Republicans controlled Congress.

    There’s really very little evidence that Republicans did much to get debt under control in the 1990s. Much (most? all?) of it was due to a booming economy, the Dem tax hike (and previous Reagan and HW hikes), and Clinton holding the line on spending and tax cuts we couldn’t afford.

  • rectonoverso

    “Some aspects remain incredibly unpopular”

    Give me a break! Site one single major piece of legislation which didn’t have some unpopular aspect.

    Health care reform was a major topic of the presidential campaign. The ultimate goal is to ensure everyone in this country gets access to good health care like in all other industrialized countries.

    It’s a process, it’s here to stay. Deal with it.

  • DeepSouthPopulist

    Terry

    I wasn’t aware that Obama proposed returning to paygo, but if that’s true can I ask what meaningful, large and specific cuts did he propose that might result from any return to paygo?

    Has Obama done what people claim only the Republicans do and gotten specific about meaningful cuts?

    Obama probably wants to return to paygo to have a convenient excuse to raise taxes. The same is likely true for the deficit commission; some conservatives have charged that the purpose of the deficit commission is to provide cover for tax increases, without cutting spending, which might explain some GOP opposition.

    The Democrats are also less serious about spending overall both today and historically. The Democrats were responsible for creating the two biggest budget busters of them all, Social Security and Medicare, and also I believe for making them non-discretionary (I might be wrong about that).

    But both were signed into law by Democrat presidents with Democrat majorities, as was health care a few months ago.

    LFC

    You make a very good point about tax/spend versus borrow/spend. The GOP is definitely guilty of the latter, which is irresponsible and definitely undercuts their credibility on fiscal matters.

    Where you and I probably differ is that I don’t believe the Dems are any more responsible or credible for opposing tax cuts and/or suggesting increases. Until contemporary Democrats get specific about their proposed spending cuts (like Bill Clinton), there is no reason to believe that any additional taxes will be used for debt/deficit reduction as opposed to more spending on things like their latest gigantic entitlement (health care).

  • easton

    Obama probably wants to return to paygo to have a convenient excuse to raise taxes.

    He doesn’t need any, the Bush tax cuts are going to expire next year, all the Democrats have to do is nothing, they can even prevent Republicans from bringing anything about it up for a vote.

    And starting next month as more and more troops come back from Iraq that money bleed will go down.

  • easton

    and the thread is about mandates, I am still waiting for a Conservative solution to uncompensated care provided by emergency rooms.

    and waiting

    and waiting.

  • LFC

    I wasn’t aware that Obama proposed returning to paygo, but if that’s true can I ask what meaningful, large and specific cuts did he propose that might result from any return to paygo?

    HCR was written so that it would pass PayGo, even if it wasn’t required.

    Has Obama done what people claim only the Republicans do and gotten specific about meaningful cuts?

    PayGo doesn’t necessarily mean cuts. It can also mean an increased revenue. Obama has already said what he’d do for increased revenue, and that’s allow part of the reckless Bush tax cuts expire. (I personally would let the whole thing expire. We’re effing broke.)

    Obama also created a debt reduction commission much like the base closing commission. Their recommendation is supposed to get an up or down vote. No politicking. No adjusting. No riders. Just “yes” or “no”, and forcing our cowardly Congress to take the popular along with the bad tasting medicine. And the Republicans almost immediately said they wouldn’t have anything to do with it.

  • PracticalGirl

    LFC says

    “Republicans spend, spend, spend but never want to pay, pay, pay. And why is that? Because they are so utterly moronic that they believe tax CUTS bring in more revenue than tax hikes. ”

    That’s the whole ball of wax. American conservatives have bought the bull, hook line and sinker. I know DeepSouth would rather forget this, but under Clinton (before the Bush tax cuts) the top tax bracket was 39% and we had a captial gains tax of 20%. How’d we do in jobs creation under that system vs. the Bush cuts? It’s completely obvious, but the GOP does a much better job of selling “stupid” to the masses than the Democrats do selling “reason” to them. Go figure.

  • Fairy Hardcastle

    Missouri has spoken the hearts and minds of the country.

  • DeepSouthPopulist

    “and the thread is about mandates, I am still waiting for a Conservative solution to uncompensated care provided by emergency rooms.”

    People abuse ER’s to obtain treatment for non-life threatening, non-emergency conditions. This is why uncompensated ER care is such an expensive free rider problem. If ERs were only forced to save people who would otherwise die, this problem would not be nearly so costly. A good first step would be amending the law to allow ERs to politely turn away anyone who shows up without a real emergency.

  • DeepSouthPopulist

    “I know DeepSouth would rather forget this, but under Clinton (before the Bush tax cuts) the top tax bracket was 39% and we had a captial gains tax of 20%. How’d we do in jobs creation under that system vs. the Bush cuts?”

    I am not convinced the economy was weak under Bush solely because of tax cuts. That proposition is as simple-minded as “tax cuts always increase tax revenue.” Reagan and Kennedy both cut taxes and the result both times was a boom period.

    The Bush tax cuts overlapped and correlated with a poor economy; it doesn’t mean they caused all these problems.

    Furthermore, we can’t go back and replay the Bush years without tax cuts to see how the economy would have done without them. The economy might very well have done worse without them.

    What we do know is that there is evidence of boom times following both tax cuts and tax increases. The impact of tax cuts is not a simple issue.

  • jg bennet

    fairy
    all this talk about the hearts and minds of the american people and the majority against obamacare

    some math

    the 20 states against obamacare combined population is
    116,787,916

    the US population
    309,957,232

    38% if every person in all 20 states were against it

    mandate?

    the 20 states

    Florida
    South Carolina
    Nebraska
    Texas
    Utah
    Louisiana
    Alabama
    Colorado
    Michigan
    Pennsylvania
    Washington
    Idaho
    South Dakota
    Indiana
    North Dakota
    Mississippi
    Nevada
    Arizona
    Georgia
    Alaska

  • Rabiner

    I really don’t care what voters think about the mandate. Ask them about the benefits of having the mandate such as: end to rescission and pre-existing condition denial of coverage. Let them vote on ending those insurance practices AND having a mandate or allowing such practices to continue and having no mandate. I’m sure people would change their tune when presented with the entire picture.

  • easton

    A good first step would be amending the law to allow ERs to politely turn away anyone who shows up without a real emergency.

    And what qualifies as a real emergency? A baby with a fever of 102, maybe, maybe not. And what doctor in their right mind is going to take that risk of denying care and then the person goes home and dies? And, of course, it is the case of the flu that turns into pnuemonia that can run into big bucks, or the guy who maybe has heart burn, but maybe is also having a heart attack.

    Isn’t it just easier to see that everyone has insurance via a mandate and subsidies for low income people. You can have co pays, etc. so that low income people do not abuse the system.

  • Chris

    “A good first step would be amending the law to allow ERs to politely turn away anyone who shows up without a real emergency.”

    That’s what I’ve been saying. Prop C, without these sorts of details, is a joke. If MO voters are “rejecting big government” then they will also want to have a new law that allows ERs to do just that. My guess: they would say no, which would alter the position that this is all about reducing big government’s role.

  • Watusie

    DSP A good first step would be amending the law to allow ERs to politely turn away anyone who shows up without a real emergency.

    Like “buying insurance across state lines”, this is pure fantasy. The person has to be seen by a doctor for the assessment of whether or not it is a real emergency, so you have achieved exactly nothing. So, I say – go ahead and make the rule. It won’t make a jot of difference.

  • Ruminant

    easton // Aug 10, 2010 at 4:22 pm
    and the thread is about mandates, I am still waiting for a Conservative solution to uncompensated care provided by emergency rooms.
    What about the answer they proposed in 1993? Why don’t we try that solution?

    On a non-sarcastic note, don’t forget that the individual mandate is also necessary to prohibit insurers from discriminating against people with pre-existing conditions. Have any conservatives proposed a serious alternative for achieving this goal? As far as I can tell, Alan Grayson was right when he said their solution was for people to “die quickly”. That’s a pretty cruel solution, especially coming from people who almost certainly oppose euthanasia!

  • SFTor1

    So deepsouth wants ERs to turn away people who do not have life-threatening conditions..

    Let’s see:

    A severed finger? Not life-threatening.

    A broken arm? Neither.

    Food poisoning? Ditto. (Unless of course it is salmonella, E. coli, or other nasty bugs that you can catch from eating a hamburger.)

    What if it’s a 10 year old kid? Turn him/her away?

    Let’s see how many doctors you get to play that game.

    One day deepsouth will think before he puts his fingers to the keyboard.

  • Ruminant

    Assuming that Proposition C isn’t repealed by another proposition at some point in the next few years, how will/should Obama and his successor respond? Assume that his successor supports the healthcare reform law.

    Should the federal goverment attempt to force compliance from Missouri? Should it instead exempt Missouri from any portions of the law that require the individual mandate (for example, the prohibition on discriminating against people with pre-existing conditions)?

  • DeepSouthPopulist

    Broken bones and those other things are emergencies. I am talking about non-emergency conditions. Refusing to treat non-emergency conditions that can wait until office hours when treatment can be obtained for much less than in the ER is not unreasonable, immoral, or even impractical.

    Everyone knows when they have a real emergency or a possible emergency on their hands and when they don’t. It’s common sense. Yet you guys write as if every uninsured person who shows up at the ER’s doorstep genuinely believes he has a real emergency on his hands when that is almost certainly not true.

    If the uninsured only showed up for legitimate emergencies then the ER free rider cost problem would not exist. The only reason the problem exists is because the uninsured use the ER for non-emergency care.

    So the reason this idea isn’t practical isn’t because of possible emergency situations going untreated; it’s because fear mongering about people dying on the doorsteps would make it impossible to implement.

    This fear mongering technique actually gets used a lot in the illegal immigration debate. We are always hearing how ERs shouldn’t be allowed to let illegals die on the doorstep even though most illegals show up for treatment for non-emergency conditions, not to have their lives saved.

    But anyway, I doubt anyone who supports mandates wants solutions to free rider costs that do not involve mandates.

  • Rabiner

    DeepSouthPopulist:

    “If the uninsured only showed up for legitimate emergencies then the ER free rider cost problem would not exist. The only reason the problem exists is because the uninsured use the ER for non-emergency care. ”

    Actually people use the ER because they can’t afford preventative care which can cost roughly the same but produce far better outcomes since things are caught early and treated before they become emergencies. Unless you want to make preventative care affordable for the poor then you’re going to have to accept the ER being used for ‘non-emergency’ issues from time to time.

    “But anyway, I doubt anyone who supports mandates wants solutions to free rider costs that do not involve mandates.”

    You realize that the only way to end ‘free rider’ issues associated with a public good is to force everyone to pay. Sounds like taxes to me but I’m sure that wasn’t what you were getting at. I just find this conservative mindset that public services are only good if I need them but when others need them fuck paying taxes for them, its redistribution! I’m happy to pay taxes for ER rooms to provide health care to anyone and everyone because I may need it someday and I’m sure going to want it to be properly funded.

    Also I find it humorous that you blame only the ‘uninsured’ for coming to the ER for non-emergencies. I know many people who have used the ER and they have insurance and the issue was somewhat minor or ended up being minor. The reason the ER is utilized is that its an unexpected calamity and your family practitioner is unavailable.

  • Watusie

    DSP Broken bones and those other things are emergencies. I am talking about non-emergency conditions. Refusing to treat non-emergency conditions that can wait until office hours when treatment can be obtained for much less than in the ER is not unreasonable, immoral, or even impractical.

    You have to have a doctor see the patient in order to determine what is emergency and what is not. So there goes 90% of your “savings” right there. And if you know any doctors, you know they didn’t go to medical school in order to play bureaucrat lording it over sick folk in the middle of the night.

    I’ll agree that your suggestion isn’t immoral, but it certainly is unreasonable and impractical.

    Also ineffective.

  • easton

    not long ago my infant son broke out with spots all over his body, he would not stop crying or go to sleep and he had a fever so I took him to the ER, the rash was a reaction to the fever and in the end was not serious, but as I am not a doctor and will not diagnose I thought it prudent to take him to the ER.

    Look, do people go to ER’s who have a cold, I am sure they do, but you really can’t tell me the 1 or 2 minutes the Doctor sees them is all that expensive, nurses do assessments anyhow so the doctor won’t see these people until there is a down time.

    And where is the evidence that an ER doctor seeing a non er type person is that much more expensive than a Doctors office. The billables might be more, but is it so in actuality? After all, after the expense of building a hospital is factored out (and it would be built regardless) isn’t it just a question of time? An ER doctor would be far more likely to dispose of these cases quicker. I know when I go to my children’s pediatrician I ask far more questions and take much more time than the few cases I have gone to the ER. In fact, when I took my infant to the ER after we saw the Doctor we were out in mere minutes since I just wanted to know it was nothing deadly serious.

  • Rob_654

    Yeah – let’s take our direction from states like Missouri…

    The people out front who support health care reform have never even gone on the attack on the realities of the Far Right rhetoric and are current health care system.

    If someone is injured and rushes to the emergency room and can’t pay – guess what – the taxpayers pay. Where is the “personal responsibility” here? Why not tell people – you can opt out of health care – but if you are injured and go to an emergency room its between you and the hospital (and the hospital will no longer be under any obligation to treat anyone who cannot show ability to pay or provide proof of insurance) – and if you can’t pay and they don’t want to treat you for free they can wheel your butt out to the sidewalk – because there is no more government paid-for emergency room visits for those free loaders who want to go without health care.

  • bubba11

    I don’t think the Missouri vote can change the federal law, so it was, at most, a straw vote put on the ballot by republicans just to voice their dismay at having a democratic president. A lot of people in Missouri already have government health care; the seniors and the children. People who cannot afford the insurance will receive credits to help pay for their insurance; so, until this goes into practice, I think everyone is just frightened of change.

  • armstp

    That vote was pure BS.

    > most of the voters were Republican, so all it said was Republicans are against the healthcare bill. what a surprise.

    > Republicans spent $100,000s on a media campaign for Prop C and there was no opposition campaign because the vote legally means nothing.

    > the question was very little one sided and confusing. as one political operative who worked on Prop C said; there are likely many who voted for it that were confused and thought they were voting in support of the healthcare bill

    I would be more worried about the 30% of Republicans who opposed Prop C, if I were a conservative.

  • armstp

    jg bennet,

    Your math is a bit twisted. So you are saying that because some idiot Attorney General, who is a Republican, is against the healthcare bill then the whole population of that state is against the bill. You need to go back to school and learn a little more with your logic.

  • easton

    armstp

    so what is your solution? As I said, I am still waiting and waiting. No offense to DSP but how do you politely turn people away without an informed assessment, and if you are going that far might as well finish the job.

    Even if it is 90% the logic just ain’t there. Either people are responsible or not. A mandate ensures responsibility.

  • jg bennet

    armstp

    i was responding to Fairy Hardcastle’s post

    “Missouri has spoken the hearts and minds of the country.”

    my point was that the best case scenario of 100% of the 20 states population being against obama care is just 38% of the US population. minus those for obama care, children who are too young to tell the difference, illegals etc. the percent is even less.

    how is 38% speaking the hearts and minds of the country? the other states didn’t sue, why?

  • drdredel

    @JG
    Firstly I agree with you.

    However, we live in a republic, and like it or not, we simply don’t tally up individual voter’s opinions to decide what the nation wants (except for when we do polls and really, who gives a shit about those).

    The voters who are voicing this point of view are misinformed and scared. They have been mislead into believing that the current system is one that is sustainable (it isn’t) and that the new system is wildly different and will bankrupt the nation (of course it isn’t very different at all and subsequently maybe it will bankrupt us, but while that is a “maybe” the current system WILL bankrupt the nation, that is a fact).

    Sadly, because we live in an era of Palin and Beck, rational discourse on the merits and weaknesses of various options is no longer permissible. Instead, what we do is take every possibility, extrapolate the worst possible outcome, assume that this outcome is fated and unavoidable and scream that the end is nigh.

    The reality is that ER visits are extremely lucrative to hospitals. We all have anecdotal experience that amounts to “I thought something was wrong, I went to the ER, nothing was wrong, I went home.” Did you happen to look at your bill afterwords? I bet it was in excess of $1000. Since your insurance company was picking up the tab, you don’t care. If YOU had to pay this you’d be back there the next day shouting “WTF is this?! you poked me with your finger, gave me a suppository and told me not to hit myself in the head with a hammer… how is that a $1000 bucks?!”

    So, if a hospital doesn’t get its $1000 it puts it on a balance sheet as lost income and gets to write it off at the end of the year, but the fact is that it’s only actually “losing” what it cost to do the examination, which is very little and made up for in spades by all the paying ER customers. This is true of ALL business! There’s no need to grant hospitals special exceptions for these sorts of situations.