Americans begging for money to pay for basic healthcare

Employers are required to submit a 1095-C  to the IRS, copy to the employee, that indicates if they were enrolled in an insurance plan and the dates they were covered. If you worked for several employers during the year then you'd receive multiple 1095-Cs. The instructions are not to file them with your return as the IRS computer system will have the data so the IRS knows the number of days you are covered by employment.
https://www.irs.gov/affordable-care-act/individuals-and-families/heres-what-you-need-to-do-with-your-form-1095c

Yes.  I had 2 employers last year, so I got 2 1095-C forms.  One of my forms was wrong, and it has become such a problem that the IRS is allowing us to file without a 1095-C.  Employers have until mid-April to fix them.  My botched form affects both my daughter and I, because she was on my insurance for 3 months last year.  I was uninsured for 2 months last year, so I'm not sure if any penalties may be prorated or not.

I agree, it does not sound at all like a scam to me.  What does sound like a scam is this:

Is he paying the tax penalty each year for not having Health Insurance under the ACA mandate?

Is he being employed illegally by hiding a medical condition, I certainly wouldn't like to think of, say, a pilot with a heart defect flying around.

I did not say his situation was a scam. I said I'd advise people to watch out on those kinds of sob stories asking for help cause you might be surprised how many of them are scams.

And no I'm not paying the penalty because I've been in law school with no significant income since phase in of the penalty. So, I do not get Medicaid, I do not qualify for a subsidy, and I do not pay a penalty.

Y'all will have to give me few to respond to all the traffic. I'm happy to engage in a reasonable conversation, just busy. Actually I've flown over to London now and I'm getting over some flu or something that knocked me down pretty hard.


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just busy.

Well if you are studying for the English bit:,  just remember:

Donahue v. Stevenson  - duty of care
Cahill V. Carbolic Smokeball -  unilateral offer
High trees - Promissory Estoppel
Ghosh - two-limbed  dishonesty test

Well if you are studying for the English bit:,  just remember:

Donahue v. Stevenson  - duty of care
Cahill V. Carbolic Smokeball -  unilateral offer
High trees - Promissory Estoppel
Ghosh - two-limbed  dishonesty test

Yeah I have 2nd stage of QLTS this summer.


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I don't know for sure, but my guess is Texas2uk is retired military, in which case he may get his health care through the system set up for retired military people rather than by having traditional insurance like a civilian would. Again, I don't know the dude; I'm guessing.

I can't speak for all military people, or for what it's like today, but when I was in the US Air Force most pilots avoided doctors at all costs, as they didn't want a doctor to discover something that would disqualify them from flying.*

It's hard to make out any detail in Texas2uk's profile pic, but it looks to me like he might have been a US Army officer, and I'm sure they have similar medical qualifications to avoid.

*Just to be perfectly clear, I wasn't a pilot. I know a few of them, though.

In fact I was an army pilot & we did avoid things that might take us off flight status, but my situation was a bit more complex. I messed up my back in a car wreck before deploying. Didn't report it because it'd stop me from deploying. Got hurt more while deployed. VA decided that was not service related cause they couldn't tell precisely how much was prior to versus during deployment, so nothing from them to speak of.

Most people in the military conceal injuries in order to continue doing their job because there is no doctor patient confidentiality. It is the Army's doctor, not your doctor. Flight surgeons or medics would often try to help you out on the DL, but a lot of people will go into their own pocket to see a civilian doctor if they're really worried about something & then only go back to the Mil side if they have to.


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I assume that if you are too poor and end up on Medicaid that you don't get fined.  However many Republican led States did not expand the income levels for Medicaid up to the bottom of the income level that qualified for ACA subsidies. So, many are in that dead zone where they can't afford insurance, but earn too much to get Medicaid so get fined for not having insurance.

Prescription coverage for the elderly on Medicare has a similar deadzone.  I have a friend whose wife has COPD and needs lots of meds each year. To begin with the prescriptions are subsidized then once past a certain $ amount he has to pay full price for a while until he hits a maximum $ amount and then they are subsidized again.  It's known as the "Part D Donut Hole" and there are calculators to try and figure it out

https://q1medicare.com/PartD-DonutHole-CoverageGap-Calculator.php



You couldn't make this stuff up...

It's the American way, the best government money can buy.

You don't pay a fine under ACA unless you're making enough to afford the lowest cost bronze plan. There's an exemption calculator. So, if you would get Medicaid but your state didn't expand, then you're exempt from the fine. If you make too much for Medicaid but still not enough to afford the lowest cost qualifying plan, no fine. You have to be able to afford insurance and opt not to have it in order to get the fine. We can debate if that's a good system or not. But the real issue for people is the formula saying people should contribute more than they actually can to healthcare. That's easier for them to adjust.


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Healthcare is a commodity in the USA, with profit being the bottom line for the most part. Story Time:

I know of someone who's child aged off of their employer's insurance at age 23. Let's call the kid Louise. Louise had significant health issues, but was not so disabled that she qualified as 'disabled' under Social Security regulations either as a child or as an adult.  One of her parents died and the other was struggling to raise Louise's siblings and could not offer Louise any financial assistance at all - in fact, Louise had been giving the family money when she could, to help out.

Louise's medical problems intensified after age 23, but again, were not constant or severe enough to trigger the two-year SSA vetting process.  She was able to work, but only found temporary jobs and the only insurance she could get was continuance in the COBRA program on one of her parents' employer's insurance - you can continue on the insurance you aged off of/had while employed for a set number of months. The COBRA premiums were astronomically high. As in Louise brought home from working basically 35 to 40 hours a week, when she had work placements, after taxes, about $1100 a month. After paying the COBRA premium, she had roughly $300 a month remaining. Fortunately, Louise was able to live with various family members.

Unfortunately, Louise became ill enough, intermittently over time, that she missed too much work and was let go from her one good, long-term job.  Because she had not worked the minimum number of hours in a given year she was not protected by the federal FMLA (Family Medical Leave) program, which only guarantees your job for a number of weeks if you are ill. (It doesn't provide any income.) No income meant she could not pay the COBRA premium.  Private insurance would not touch her, due to the pre-existing condition(s). She had a few days of temporary employment here and there, but not enough to cover her basic expenses. 

Louise lived in a state that had no Medicaid program for single adults, so she went without medical care and medications and became more ill. No doctor's office would even let her in the door without a substantial (and we're talking in the four-figures here) deposit in advance on any care that might be given. She didn't have it.  In a few crisis events she was seen at the local emergency room, where, after a 12 to 18 hour wait each time, they stabilized her and sent her home. And billed her  $10,000 to $14,000 per visit. The bills went into collection.

There was the "pre-existing condition" insurance pool offered by her state's government. Unfortunately, the rules of that program stated that you had to have exhausted your COBRA before you could qualify for the pool. If  you were eligible for COBRA, but you could not pay your COBRA and lost coverage, too bad. You did not qualify for immediate acceptance into the pool because you COULD have had COBRA and it was your choice to not buy it. There was a two year waiting period for coverage in the pool after that point. If Louise had gotten into this special pool the premiums were also quite high and there were caps on how much would be paid over any given year and over your lifetime.  (Louise's premiums would have been in the $600 to $700 a month range. That's the premiums. There would be co-pays and out-of-pocket expenses on top of it. And, not all doctors/hospitals accepted that insurance - you had to do a serious hunting/coordination job to find care. Great task to be undertaking, while ill.) The fact that Louise could only work when well was not a part of the equation - you don't pay the premium, you're out of the program.  If you can't afford the medication, you don't get the medication.

So, along comes Obamacare.  Louise was reinstated on her parents' health insurance for another two years until she again aged off at age 26.  She received top-flight care, recovered significantly (although this will be a life-long fight for her), enrolled in and finished an advanced degree, and was happy. Her condition stabilized with the correct care and medication. Of course, after receiving the degree Louise could not find work in her field and was forced back into doing temporary work. She was again able to COBRA, but after a time could not afford the premiums, which were several hundred dollars higher this time, as her surviving parent's employer had switched insurance providers - they charged more.

Because Louise only worked intermittently, she did not earn enough to qualify for any subsidies under Obamacare. She was basically too poor. So, she got Medicaid. Which is way better than nothing.

So, Louise had medical coverage. (Of a sort - no private doctor would still see Louise. They don't accept medicaid due to the fact that it reimburses a doctor roughly one tenth of the usual charges in Louise's hometown. The prescription formulary is extremely restricted on Medicaid, so you don't always get the drugs you actually need. However, the emergency room visits are free.)

Louise was assigned to a doctor 15 miles away who she never saw. Every year the Medicaid program reassigns her to some other doctor at some other location, as doctors withdraw from the program. She's never actually seen her "primary care" doctor, as the waiting time for a non-urgent appointment runs into several months.  If she's ill enough to need to see a doctor, she can use a local urgent-care facility contracted with the State or the emergency room.  As long as the medication prescribed is on the Medicaid formulary, Louise gets her medication, with a small co-payment. If a test is recommended that is not on the Medicaid list, the options are a multi-month bureaucratic appeal or not getting the test. (Unless she can find the cash to pay, in advance).

So, the coverage Louise has under Medicaid on Obamacare is actually worlds better than what she had before Obamacare, although it's horrifyingly bad.  And now Trump wants to dismantle Obamacare and give Louise something like $2,000 a year towards her medical coverage, wish her well, and be done with her. 

He must:
1) be completely clueless and never been truly poor a day in his life; or,
2) be completely heartless; and,
3) be going to that hot place when he passes on. Hopefully to one of the lower levels.

Healthcare is a commodity in the USA, with profit being the bottom line for the most part. Story Time:

I know of someone who's child aged off of their employer's insurance at age 23. Let's call the kid Louise. Louise had significant health issues, but was not so disabled that she qualified as 'disabled' under Social Security regulations either as a child or as an adult.  One of her parents died and the other was struggling to raise Louise's siblings and could not offer Louise any financial assistance at all - in fact, Louise had been giving the family money when she could, to help out.

Louise's medical problems intensified after age 23, but again, were not constant or severe enough to trigger the two-year SSA vetting process.  She was able to work, but only found temporary jobs and the only insurance she could get was continuance in the COBRA program on one of her parents' employer's insurance - you can continue on the insurance you aged off of/had while employed for a set number of months. The COBRA premiums were astronomically high. As in Louise brought home from working basically 35 to 40 hours a week, when she had work placements, after taxes, about $1100 a month. After paying the COBRA premium, she had roughly $300 a month remaining. Fortunately, Louise was able to live with various family members.

Unfortunately, Louise became ill enough, intermittently over time, that she missed too much work and was let go from her one good, long-term job.  Because she had not worked the minimum number of hours in a given year she was not protected by the federal FMLA (Family Medical Leave) program, which only guarantees your job for a number of weeks if you are ill. (It doesn't provide any income.) No income meant she could not pay the COBRA premium.  Private insurance would not touch her, due to the pre-existing condition(s). She had a few days of temporary employment here and there, but not enough to cover her basic expenses. 

Louise lived in a state that had no Medicaid program for single adults, so she went without medical care and medications and became more ill. No doctor's office would even let her in the door without a substantial (and we're talking in the four-figures here) deposit in advance on any care that might be given. She didn't have it.  In a few crisis events she was seen at the local emergency room, where, after a 12 to 18 hour wait each time, they stabilized her and sent her home. And billed her  $10,000 to $14,000 per visit. The bills went into collection.

There was the "pre-existing condition" insurance pool offered by her state's government. Unfortunately, the rules of that program stated that you had to have exhausted your COBRA before you could qualify for the pool. If  you were eligible for COBRA, but you could not pay your COBRA and lost coverage, too bad. You did not qualify for immediate acceptance into the pool because you COULD have had COBRA and it was your choice to not buy it. There was a two year waiting period for coverage in the pool after that point. If Louise had gotten into this special pool the premiums were also quite high and there were caps on how much would be paid over any given year and over your lifetime.  (Louise's premiums would have been in the $600 to $700 a month range. That's the premiums. There would be co-pays and out-of-pocket expenses on top of it. And, not all doctors/hospitals accepted that insurance - you had to do a serious hunting/coordination job to find care. Great task to be undertaking, while ill.) The fact that Louise could only work when well was not a part of the equation - you don't pay the premium, you're out of the program.  If you can't afford the medication, you don't get the medication.

So, along comes Obamacare.  Louise was reinstated on her parents' health insurance for another two years until she again aged off at age 26.  She received top-flight care, recovered significantly (although this will be a life-long fight for her), enrolled in and finished an advanced degree, and was happy. Her condition stabilized with the correct care and medication. Of course, after receiving the degree Louise could not find work in her field and was forced back into doing temporary work. She was again able to COBRA, but after a time could not afford the premiums, which were several hundred dollars higher this time, as her surviving parent's employer had switched insurance providers - they charged more.

Because Louise only worked intermittently, she did not earn enough to qualify for any subsidies under Obamacare. She was basically too poor. So, she got Medicaid. Which is way better than nothing.

So, Louise had medical coverage. (Of a sort - no private doctor would still see Louise. They don't accept medicaid due to the fact that it reimburses a doctor roughly one tenth of the usual charges in Louise's hometown. The prescription formulary is extremely restricted on Medicaid, so you don't always get the drugs you actually need. However, the emergency room visits are free.)

Louise was assigned to a doctor 15 miles away who she never saw. Every year the Medicaid program reassigns her to some other doctor at some other location, as doctors withdraw from the program. She's never actually seen her "primary care" doctor, as the waiting time for a non-urgent appointment runs into several months.  If she's ill enough to need to see a doctor, she can use a local urgent-care facility contracted with the State or the emergency room.  As long as the medication prescribed is on the Medicaid formulary, Louise gets her medication, with a small co-payment. If a test is recommended that is not on the Medicaid list, the options are a multi-month bureaucratic appeal or not getting the test. (Unless she can find the cash to pay, in advance).

So, the coverage Louise has under Medicaid on Obamacare is actually worlds better than what she had before Obamacare, although it's horrifyingly bad.  And now Trump wants to dismantle Obamacare and give Louise something like $2,000 a year towards her medical coverage, wish her well, and be done with her. 

He must:
1) be completely clueless and never been truly poor a day in his life; or,
2) be completely heartless; and,
3) be going to that hot place when he passes on. Hopefully to one of the lower levels.

Yeah and that's real sad and everything, but who should be responsible for paying Louise's medical bills? Louise? Her family? Or some rich person who has never met Louise and lives in a different city but is nonetheless is required to pay dollar for dollar full price for their own medical care plus also pay for all of Louise's care and that of several other people too?

It is always sad when people cannot afford the things they need, regardless if it's healthcare or housing, food, clothing, etc. there will always be tragic stories when some people don't have everything they need. But who is responsible for earning what it costs to pay for those needs?

It's easy to point the finger at a nameless faceless government and say they should pay, but government doesn't make any money. People do. Every penny given to someone we've decided doesn't have enough has to be taken by force from someone else.

Okay so that's fine to a point. But where is the limit? What is the limit on help that should be given? Who makes enough that they don't need to be supported by someone else? Who makes so much that their success should be punished? Who decides where those lines are drawn? And what is the result when we as a society punish success and reward failure?

I don't know anything about Louise, but she chose a major and then an advanced degree in some subject. That education had a cost in money and time. If she got a masters in art history and can't find a job, or if she got a law degree and isn't suited for whatever reason to practice law, then who should be responsible for paying for those mistakes in judgement?

I think we're all in favor of a program that does try to take care of everyone as best as we reasonably can, but it is largely a zero sum game in which someone must be harmed in order to help someone else.

What Obamacare did was shift the balance slightly so everyone in the country paid more to get worse access to care in order to give access to a relatively small segment of the population while still leaving millions more behind. It punishes the middle class to help the lower middle and upper-lower class. It drives some middle class people into poverty and lifts no one out.

Anecdotally, you can of course point out thousands of stories of people who benefited by getting coverage under Obamacare. It's much harder to show the same kind of visceral stories when you point at the other hundred million who have to pay more, the jobs not created, the greater limits on access to care, yet all of those things happened too. Louise would of course favor the arbitrary line in the sand that benefits her, but why is that line better than some other arbitrary point that may or may not benefit her?

A pivot point has to be picked that has massive consequences for society. No matter what point we pick, people will die because of it. There will be tragic stories, people will lose jobs, have food taken off their plate, and have overall less freedom and a lower quality of life. The only difference is which people will experience those punishments so that what other people will get some benefit. So, if we're to play god here and decide the fate of people by picking some arbitrary point, where should it be? Or should we refuse to make that choice as much as possible and leave it in the hands of the individual?

It's not as simple as poor Louise, don't we all feel sorry for her and anyone that would deny her help is obviously evil and heartless.


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But where is the limit? What is the limit on help that should be given? Who makes enough that they don't need to be supported by someone else? Who makes so much that their success should be punished? Who decides where those lines are drawn? And what is the result when we as a society punish success and reward failure?

The limit for how far I think we should do when it comes to our community's and our fellow citizens' health seems to be much further than yours. When we're talking about a human being able to live a healthy life, live a life full of illnesses (which are not by choice) or even to live AT ALL, I think it's our responsibility to take care of these people as much as can. Whether they are well off or living pay check to pay check, everyone deserves to live a healthy life and getting the treatment they need shouldn't put them in debt or in financial stress.

We're not talking about the whole country pitching in so everyone can have 55 inch TVs or gym memberships. Healthcare is not a luxury you can do without. I believe we should ensure everyone has access and if that means I chip in more than I take out, that's fine by me. It will be there for me whenever I need it.

I don't know anything about Louise, but she chose a major and then an advanced degree in some subject. That education had a cost in money and time. If she got a masters in art history and can't find a job, or if she got a law degree and isn't suited for whatever reason to practice law, then who should be responsible for paying for those mistakes in judgement?

I completely disagree with you on this (and so much else you've said). No one should be made to feel guilty about getting an education, regardless of their health, and it seems irrelevant to this discussion. To me, healthcare is about everyone pitching in to make a healthy community, not a country of healthy individuals who can afford healthcare and people sick and in debt because they can't. Education or how money is spent has nothing to do with that and no one is in a position to decide if someone else has spent their money in the 'right' way or the 'wrong' way.

Yeah and that's real sad and everything, but who should be responsible for paying Louise's medical bills? Louise? Her family? Or some rich person who has never met Louise and lives in a different city but is nonetheless is required to pay dollar for dollar full price for their own medical care plus also pay for all of Louise's care and that of several other people too?

And this is 100% why the US will never see universal healthcare. Too many people are focused on the fact that healthcare costs money and not that it's a right like having roads & a police force. When healthcare is not a commodity it actually costs less because of bargaining power & the focus on community health.

The limit for how far I think we should do when it comes to our community's and our fellow citizens' health seems to be much further than yours. When we're talking about a human being able to live a healthy life, live a life full of illnesses (which are not by choice) or even to live AT ALL, I think it's our responsibility to take care of these people as much as can. Whether they are well off or living pay check to pay check, everyone deserves to live a healthy life and getting the treatment they need shouldn't put them in debt or in financial stress.

We're not talking about the whole country pitching in so everyone can have 55 inch TVs or gym memberships. Healthcare is not a luxury you can do without. I believe we should ensure everyone has access and if that means I chip in more than I take out, that's fine by me. It will be there for me whenever I need it.

I completely disagree with you on this (and so much else you've said). No one should be made to feel guilty about getting an education, regardless of their health, and it seems irrelevant to this discussion. To me, healthcare is about everyone pitching in to make a healthy community, not a country of healthy individuals who can afford healthcare and people sick and in debt because they can't. Education or how money is spent has nothing to do with that and no one is in a position to decide if someone else has spent their money in the 'right' way or the 'wrong' way.

Again, no matter where you draw that line, it will cause the same amount of suffering. People will suffer, get sick, not get the treatment they need, and people will die because of the decision we make, no matter what that decision is.

If we extend coverage to more people it is at the cost of reducing quality and limiting access to hundreds of millions. Thousands of people have and will die as a consequence of those limitations on their coverage. Then there are the financial consequences. Millions who had coverage before now can only afford a lower level of coverage. Millions now mandated to buy health insurance cannot afford the same level of housing, food, school supplies, etc. Hundreds of thousands of jobs that would have existed now do not because the employers cannot afford the higher benefit costs for an additional employee. All of that causes death and suffering. It just causes it to a different group suffer than was suffering before.


As for education, maybe you didn't understand what I said. Education is highly important and valuable - that is economically viable education. If you get a degree in art history or anything you cannot convert into a job that pays enough to justify the opportunity cost, then that is by definition a luxury item.

Luxuries are fine, but their cost - both the actual cost and the consequence (here, not being able to get a job) - need to be borne by those who enjoy them. If we enable people to pursue flights of fancy on the public dime, then both they and society end up worse off for the experience.


We can talk about everyone pitching in, but that's simply not the truth. People at the bottom and the top are getting screwed in favor of about 15-20% of people in the middle. It's trying to pick winners and losers for purely political reasons and society as a whole ends up worse off all across the income spectrum.


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And this is 100% why the US will never see universal healthcare. Too many people are focused on the fact that healthcare costs money and not that it's a right like having roads & a police force. When healthcare is not a commodity it actually costs less because of bargaining power & the focus on community health.

The problem is it's not possible to provide universal healthcare to all citizens at a quality and access level that would allow people to survive.

It's like sitting in a lifeboat with limited supplies. If you share everything equally, it is not enough for anyone and everyone will die.

It would be more helpful to grow capacity so the supply exceeds the demand and cost goes down. When we try to pay doctors less and less, we get less doctors and costs go up.

You can call things a commodity or not all you want but everything including air and water has an economic cost that has to be paid. There is no way to escape that no matter what form of government or what policy they put in place.


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Louise's degree was in one of the computer sciences,  I think - I'm not sure, but I remember hearing that she took programming and business courses.  Just like the gazillion other kids with the same degree who graduate every year with a degree that they were told would qualify them for a decent career who end up working at Starbucks because the jobs aren't there.  My own daughter's friends got their degrees two or three years ago. One is now an assistant manager at Walmart, where she had been working since before she got her degree. The rest are in retail, because the jobs just aren't there.  We do have one that went into the armed services, and the service put her through school and Med School, and now she'll serve her country for the next 20 years trying to put servicemen with PTSD back together. Assuming there's enough funding directed to her program, rather than to developing new jet fighters.  She's a good kid, with a good heart. They need her.

But it doesn't matter, really, for Louise.  I learned just after the start of this year that young lady in question finally got a good job, with full health coverage last fall doing something entirely different than what her studies had prepared her to do. I'm told she was happy as a clam and that she loved her job - low pay, but good benefits. She died just before Christmas of complications that had been untreated for too long. She never made it to 30.  What a freaking waste.

And that is one of the main reasons I am leaving the USA. The mindset here is that it's ok to spend "taxpayer's money" to subsidize people being able to  buy homes when other people don't have homes at all; to build high-dollar sports complexes in upscale neighborhoods when there are people in the same county who still have to use cess pits because they are not connected to a sewer system; that it's ok to use tax dollars to subsidize the education of medical professionals who then make money hand-over-fist with absolutely no sense of duty to their fellow citizens; that it's "just bidness" when pharmaceutical companies can quintuple the cost of critically necessary drugs [like epi-pens] so their stockholders can get a good check... a country where "it's all about me".

"Bidness is good for the country" does not excuse greed. Because, regardless of that c--pola that they drilled into us in high school in Texas, it does NOT trickle-down. It goes straight into profits, and profits only very rarely get shared with employees. Employees have value only when they are economic assets to a business. When they cease to be, regardless of the reason, they're jettisoned like old socks with no benefits to speak of, for the most part. You can slap lipstick on a pig, but it's still greed.

When a culture condones having no sense of responsibility for one's fellows, you are one step up from being animals. I'll take my chances on the other side of the pond, as long as they'll let me stay. I'm happy to pay taxes into a system that doesn't let kids die simply due to lack of care, when the best care in the world is available just down the street - if you're not poor.

On the lifeboat with limited supplies: Canada seems to be managing ok.

Personally, I am of the opinion that government should do as close to nothing as reasonably possible. It's function is to do the absolute minimum necessary for society to exist without murdering each other to solve our disputes. AKA, the minimum necessary for rule of law to exist.

If subsidizing a sports stadium brings in enough additional sales tax to exceed the subsidy, then that makes sense. That is the justification when those things happen. Like any deal, some of them work out and some don't. Voters have to hold their representatives accountable to stand firm for good deals in those situations rather than caving to pressure and making a bad deal for taxpayers.

They subsidize home purchases and stadiums in the U.K. as well, and there are still homeless people. We have pretty good housing programs in the US - far from perfect but not bad. You'll find that a high percentage of US homeless are not in that condition because it is impossible for them to get public housing, but rather because there are other things going on like mental health problems. And you'll find as well that NHS does not have the greatest reputation for things like mental health care. If you're leaving because you think the grass is greener, well it's different but it isn't really better or worse.

There are problems with how pharma companies do business, but it largely is not to deliver massive profits to shareholders. Part of it is they have to pay the development & approval process for all their drugs (including those that fail) with the price of the few they end up being able to sell. And they only get 20yrs to make it back before generics hit the market. The bigger problem though is about foreign sales. That company has to make X dollars off a product line to cover their costs. When Canada or the UK or whomever either imposes a statutory price limit or negotiates a lower price, that company has to raise the price in the US to compensate. There are certainly cases where companies have abused a situation to gouge customers, and that's wrong, but for the most part those companies aren't getting rich and aren't abusing customers. There are some things we need to do to better regulate the industry, but they aren't evil.

I don't know what your issue is with profits, but without them everyone starves to death. There is no utopian world where everyone does their part out of duty to their fellow man and it somehow works out. Everyone from communist to conservative under any form of government will always act in their rational self-interest to fulfill their own hierarchy of needs. Profits are what result.

And by the way, you might google the stories about people denied or delayed treatment in places like Canada and the UK who absolutely do die despite good healthcare residing down the street. You might go to any major hospital in the US and see the thousands of people from universal healthcare countries paying out of pocket for treatment they can't get either in a timely manner or at all back home.

I understand your frustrations with the US system. Everyone including me is frustrated with what we have. But it is not a problem magically solved on the other side of an ocean. Their system is deeply troubled itself, and the economic cost of paying for what they have either forces or holds millions in poverty. It exacerbates the the problems with housing costs and limits available jobs and salaries.

You are demanding the impossible and then just rejecting any imperfect solution that might be the best we can do with what we got. Maybe you prefer a different and equally imperfect solution. Maybe you prefer to force the people to prioritize their healthcare over food or housing - cause their bad health impacts your cost while them starving or being homeless does not. I think that's a harsh position to take away their freedom in order to forcibly make them address the one of their needs that most impacts you rather than them, but i guess it is a logical position to take. I just happen to disagree.

Life is tough for everyone. Maybe instead of dictating to people big broad one size fits all solutions, maybe it'd be better if we let individuals figure out for themselves what is in their own personalized best interests. That seems more like freedom than a paternalistic government trying to run my life and mostly doing a very bad job of it.

Also maybe bring up a position on PTSD relative to defense funding is not most helpful when talking to a combat veteran.



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it does NOT trickle-down.

Well yes exactly. The problems with these free market ideas are that they don't work, and they can't exist.

Smith himself acknowledges certain damning problems with free markets....monopolies and externalities (though that term came later I think). Both demand some sort of governmental oversight.

But more to the point, there can be no such thing as a free market....you might as well believe in Santa. Our roads, our police, our military all exist as interference to free markets.  But how could business grow and prosper with out them? We would still be huddled in mud huts praying to Sol that the morning didn't bring a travelling band of marauders.

Too, as much as the monetarists evoke the language of freedom, what is lending rate but the absolute worst sort of interference? How can it possibly be justified? And how can we even begin to talk about any form of market regulation? Or heaven forbid....bailouts.

Like it or not, these ideas of free markets are more fairy tale than the most fanciful New Jerusalem utopia. 

But the real concern with free market ideology - and we can put morality aside - is that on a graph the down slope of the bubble looks innocuous. But what it really represents is revolution....mass death and chaos. The Great Depression, represented on a graph, is a purely logical cleansing of bad debt and risk....on the ground it created conditions for all the horror and instability that followed.

And if we admit, as we have to, that there can be no totally free market, then our conversation turns to how we can best use government to stabilise. Beveridge posited that health is one of the foundations of a peaceful, stable society. Education too. Peaceful, healthy people contribute. Sick, ignorant folk don't.

Well yes exactly. The problems with these free market ideas are that they don't work, and they can't exist.

Smith himself acknowledges certain damning problems with free markets....monopolies and externalities (though that term came later I think). Both demand some sort of governmental oversight.

But more to the point, there can be no such thing as a free market....you might as well believe in Santa. Our roads, our police, our military all exist as interference to free markets.  But how could business grow and prosper with out them? We would still be huddled in mud huts praying to Sol that the morning didn't bring a travelling band of marauders.

Too, as much as the monetarists evoke the language of freedom, what is lending rate but the absolute worst sort of interference? How can it possibly be justified? And how can we even begin to talk about any form of market regulation? Or heaven forbid....bailouts.

Like it or not, these ideas of free markets are more fairy tale than the most fanciful New Jerusalem utopia. 

But the real concern with free market ideology - and we can put morality aside - is that on a graph the down slope of the bubble looks innocuous. But what it really represents is revolution....mass death and chaos. The Great Depression, represented on a graph, is a purely logical cleansing of bad debt and risk....on the ground it created conditions for all the horror and instability that followed.

And if we admit, as we have to, that there can be no totally free market, then our conversation turns to how we can best use government to stabilise. Beveridge posited that health is one of the foundations of a peaceful, stable society. Education too. Peaceful, healthy people contribute. Sick, ignorant folk don't.

Government isn't actually in charge of society. Free markets aren't a consequence of policy. They are the natural state that exists between two packs of monkeys in the wild or two countries or anything in competition with anything. Free markets aren't created, they simply exist. There most certainly are positive and negative externalities to their existence, and there are problems when they are abused, but no force on earth can impose an alternative to a necessary condition of existence.

A communist system like the Soviet Union was, seeks to operate as something different than a free market, but it cannot be achieved because they still exist in a state of competition internally and externally. There is still profit motive and stratification of society. It is inescapable no matter what facade a human will attempts to impose atop it.

Bailouts by the way are the polar opposite of a free market philosophy (as are subsidies). A free enterprise economist would want those companies to fail and new stronger smarter ones to rise from the ashes. That's how natural selection works. When banks are rewarded for their bad behavior with a bailout, they rename the high risk behavior and make a couple tweaks then go back to doing it again. Which is exactly what happened.

I am a big advocate of education. Economically viable education that leads to better jobs and more productive societies continuously growing the bottom line for everyone. I am a big advocate for broad access to quality healthcare too. But that means it has to be paid for in a way that doesn't hamstring the country, decimate quality or access, and does not simply shift the suffering from one group to another. What we have right now in the US, as well as the proposed reforms, fails at all of that.

If you want to fix these problems, then the effective way for govt to help stabilize the system is not to dictate a reality it is incapable of achieving. The more effective way to engage with the system is to organically increase supply inputs so it lowers the price on the demand curve.




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