User talk:Thomas Pain 67

A belated welcome!
Here's wishing you a belated welcome to Wikipedia, Thomas Pain 67. I see that you've already been around a while and wanted to thank you for your contributions. Though you seem to have been successful in finding your way around, you may benefit from following some of the links below, which help editors get the most out of Wikipedia: Also, when you post on talk pages you should sign your name on talk pages using four tildes ( ~ ); that should automatically produce your username and the date after your post.
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Again, welcome! S. Rich (talk) 03:18, 8 July 2012 (UTC)--S. Rich (talk) 03:18, 8 July 2012 (UTC)

Talk page
Hello. Your efforts to intersperse your comments at this talkpage thread have rendered it nearly incomprehensible. Could you try to fix this? If not, I'll take a look, but in the future please simply post at the bottom of each thread, per the talk page guidelines. MastCell Talk 17:20, 28 July 2012 (UTC)

Yes, I see the problem, and I apologize (again) I'll try to fix as best I can, but there may be residual spacing/alignment changes. Thomas Pain 67 (talk) 19:50, 29 July 2012 (UTC)

The fix is in!Thomas Pain 67 (talk) 00:04, 30 July 2012 (UTC)
 * Thanks; much appreciated. MastCell Talk 04:27, 30 July 2012 (UTC)

Thomas Pain 67's opinions on PPACA lead
Nstrauss wrote. ....I don't see anything wrong with simply saying that the Court "largely upheld" the constitutionality of PPACA, that is correct and sufficient for the purpose of the lead section of this article. Re the half-truths you have read, why don't you identify each on specifically and we can discuss them individually? --Nstrauss (talk) 03:42, 30 July 2012 (UTC)

This is my response to Nstrauss:

First, let me share my perspective on why the lead should be fundamentally transformed. I believe the most important reader of this article is the undecided voter. It appears you are a legal scholar, and I understand your efforts to have everything be up-to-snuff from a legal perspective, but I will venture to say that for every lawyer that reads this there will be 100 non-legal types just looking for basic understanding, and they need to be accomodated.

These readers want to understand what all the fuss is about. Obamacare must be important because the pundits are saying it could decide the 2012 elections, and they wants to vote for the right candidates. If this law sounds like a good thing, they will probably vote progressive to keep it from being repealed. If at the end of the lead, they are left with the impression that "there's no real problem here, other than a hyper-partisan political system" they probably won't bother to read any further. I think this is the likely outcome with the present lead. They deserve a lead that portrays, in a balanced manner, how devisive this bill is. Below are various excerpts from the current lead. The "take-aways" are what I believe many readers might interpret the excerpt to mean. They often resemble a "talking point" for the "pro" side. They are often "half-truths" (which wiki says are the accepted norm of political speech these days) The "Counterpoints:" are some of the possible counter-arguments, and can be viewed as "con" talking points/half-truths. Importantly, these ideas are not verified, or reliably sourced. I believe they are probably out there in kinder, gentler words, but I have not gone looking for them. I don't propose using opposing pairs of half-truths to describe PPACA. The pairs are presented to illustrate the presence of what I believe is a (not so) hidden bias. In my opinion, the Act should be described in factual terms (numbers are good) focusing on: Finally, I want to be clear that the comments below are not meant to criticize any editor. I'm sure the current lead is written in good faith based on RSs. Examples from the current lead: .... it represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965.[3] Take-away: They are going to make some significant improvements to the healthcare system, but not on the same scale as Medicare and Medicaid. It sounds like Medicare is going to be improved, and I already like Medicare. Great! Counterpoints: This is faint praise of PPACA. PPACA outweighs Medicare and Medicaid in many ways. One of the reasons some are against PPACA is the sheer size and reach of the bill. To say that it's less significant than Medicare/Medicaid is deceptive. Medicare/medicaid is a comparatively simple statute, It imposed a new employment tax (since shown to be woefully inadequate) to provide single-payer healthcare insurance to a clearly defined group of citizens, the elderly. With the PPACA, much of the authority to regulate the healthcare system is taken from the states and nationalized. Industry-specific taxes are levied, the mandate is (almost) novel. The funding is highly progressive/redistributionist, in direct contradicition of the "I payed for my Medicare, I'm entitled to it" mindset. PPACA is aimed primarily at decreasing the number of uninsured Americans and reducing the overall costs of health care. Take-away: That all sounds great. Nobody wants to be uninsured, and I can't wait until everybody's costs go down. Counterpoints: They are going to force people that presently choose to buy no insurance or minimal/catastrophic insurance to buy near-Cadillac insurance, and then lump everybody together in the same "pool" so the health-conscious, cost-conscious folks can help pay the premiums of the couch potatoes and the "its free so I might as well use it" crowd. (Have you ever been to a fancy restaurant with a group of ten or more and split the bill equally? How did that work out for you?) They claim they are going to "bend the cost curve" (reduce the rate of increase) using questionable assumptions and with substantial uncertainty in the "out years". Following the Supreme Court ruling, there is now uncertainty about how many states will implement the Medicaid Expansion. It provides a number of incentives, including subsidies, tax credits, and fees, to employers and uninsured individuals in order to increase insurance coverage.[4] Take-away: Ooooh, incentives are good. Too bad there aren't any "refundable tax credits" in there, I really like those. I'm a little confused about the "incentive...fee...to employers" though, but it's probably a good thing. Counterpoints: I'm pretty sure these tax credits are "refundable" for many of the recipients. (but it has such a negative connotation. Well perhaps not, because many don't even know that it means "free handout from the government"...) Most people think an incentive is the good thing that happens when you are compliant. The fee (tax) is the bad thing that doesn't happen when you are compliant. Call it a dis-incentive, an inducement, a penalty, or coersion (my favorite), but don't call it an incentive. This is the kind of obfuscation often found in the writings of biased RSs, on either side of an issue. Subtle but effective. PPACA requires insurance companies to cover all applicants and offer the same rates regardless of pre-existing conditions or gender.[5][6] Take-away: That is obviously the only fair way to do things. Counterpoints: What about the premium increases for people without pre-existing conditions and for every male? Pre-existing conditions is a serious problem, but is this the only way to fix it? On gender; great, now every male (gay, straight, married, single) gets to pay his "fair share" toward the potential fertility-related costs of every female (gay, straight, married, single). No more choosing the health plan that does, or does not, include maternity coverage. Odd how that choice is so easily dismissed, while the other somewhat related "choice" is so fiercely defended. One more blow against the institution of marriage. Actually, I suppose a lot of people see this for what it is, but don't speak out for fear of being labeled sexist or uncompassionate. These "selling points" should be labeled as what they are, "premium cost redistribution mechanisms". The Congressional Budget Office projected that PPACA will lower both future deficits[7] and Medicare spending.[8] Take-away: Great, this is going to reduce government spending, including Medicare. Now Medicare won't go broke so soon, and the national debt will be smaller. Counterpoints: Even though there is obviously massive new government spending, the mention of reduced deficits, in the absence of any mention of new revenues and offsets, easily leads to the erroneous conclusion that net spending is reduced. I believe the CBO also cites the net increase in Federal spending. That is the number that should be presented. I hesitate to mention the increase in the national debt, as that will open the "unified budget, intra-governmental debt" can of worms. (Yes, I know "going broke" is a Tea Party "meme". ~I love that word) ...the newly Republican-controlled House of Representatives has repeatedly voted to repeal PPACA.[11] Take-away: Why are those Republicans wasting their time by trying to repeal this law? They are just showboating. They should work on something more important like passing a budget or raising the debt ceiling. Counterpoints: Why doesn't Harry Reid just let one of these bills come to a vote in the Senate, get everyone on the record, and move on to something like passing a budget or raising the debt ceiling? Conservatives have also mounted a number of legal challenges against PPACA; after mixed success in lower courts, on June 28, 2012, the Supreme Court upheld the constitutionality of much of the Act in the case of National Federation of Independent Business v. Sebelius.[12][13] Take-away: After all that time and expense, caused by those litigious Conservatives and their shot-gun blast of lawsuits, the Supreme Court says the law is mostly constitutional, and there apparently aren't any problems worth mentioning. (This has been partially remedied by Nstrauss, thanks.) Counterpoints: This case was decided 5/4 and hinges on the mandate being constitutional only because the penalty can be construed to be a tax. Ironically, if it had been called a tax during the debate, it might not have passed. The Medicaid Expansion penalty was found to be coercive, and has been reduced, leading several states to say they will not participate. We may not have seen the end of court challenges to this legislation. Perhaps a carrot can be so big it is "entrapment" (or did they already rule on that?)
 * what it does for, and to, various groups of citizens
 * how it does it
 * what it costs, who pays for it, and how is the money obtained
 * the expected outcomes

In summary, this is what I think the lead should look like:

The first paragraph should introduce the controversial nature of the Act, and briefly list the various controversies. The matter of the ACA should be touched on briefly, along with Obamacare. The Supreme court ruling should conclude the first paragraph. This is how I would then describe the PPACA: (It's rough, but you get the idea.)

PPACA is a wide ranging bill not fully implemented until 2020. Some important features are summarized below. To reduce the number of uninsured; an additional X million citizens become eligible for Medicaid, y million become eligible for refundable tax credits for part or all(?)of their insurance expenditures, tax incentives for small businesses that provide insurance to their employees are provided, and most individuals and all larger businesses must purchase insurance or pay a substantial tax penalty. Z uninsured are expected to remain by 2020, including y million undocumented residents. To reduce or redistribute out-of-pocket expenditures (while necessarily increasing premium expenditures); establish national standards for minimum coverage, prohibit annual and lifetime insurance spending caps , eliminate the Part D (prescription drug) "doughnut hole", require certain preventive care to be free-of-charge (including contraception related drugs and procedures), prohibit rate-setting consideration of gender and pre-existing conditions and limit consideration of age. To provide partial funding for the Act; (10 year projected impact shown in [ ])reduce expenditures for Medicare Advantage [x million], reduce certain other Medicare expenditures [], collect higher Medicare insurance taxes on the wealthy[], tax "Cadillac" insurance policies[], tax insurance companies and suppliers of certain medical devices[], dictate prescription drug rebates for Medicaid [] and collect insurance mandate penalties[]. Remaining net expenditures will result in increased borrowing by the Federal government. The national debt is projected to increase by $x by 20xx. A list of projected results can then complete the story: e. g.
 * Reduce uncompensated emergency room cost shifting by $x by year 20xx
 * Reduce total uninsured (including undocumented persons) from x million to y million by 20xx.
 * Increase % of population in single-payer system from x to y by 20xx
 * Change total government spending from x to y by 20xx
 * Change private sector healthcare spending from x to y by 20xx
 * Change private sector insurance premiums by x %
 * Increase life expectance of poor people by x years (I don't recall seeing that detail reported on, but I sure hope it's a big number because we are spending a lot of money in the name of this result. That's dangerous territory though, because it has a nasty effect on the sustainability of SS and Medicare...)


 * Your critique is very detailed and I don't have time to respond to each of your points. But here are five general observations. First, I strenuously disagree with your premise that the target audience should be undecided voters. Wikipedia isn't designed to be an election guide, it's designed to be an encyclopedia and is targeted to readers at large. This includes plenty of folks from outside the U.S. Second, your premise is directly antithetical to WP:RECENTISM. If we're writing articles not for the long view but for the specific purpose of helping readers make a decision less than three months away then we're in flagrant violation of WP:10YT. Third, the lead should absolutely not be designed to show how divisive the subject is. That's an inherently biased viewpoint and over-politicizes the subject. You will not find anything even close to what you're proposing in the leads of other passed legislation. Fourth, your proposed lead is far too long and technical to comply with WP:LEAD. An introductory paragraph listing all of the controversies -- Can you find another article about anything that does that? Fifth, as soon as you start talking about biased RSs then you are exposing your own personal bias. Of course we all come to Wikipedia with our own perspectives and you're welcome to share yours, but RSs are the bedrock of this website and we must respect them. Between your unsourced view and the view of an RS, on this website, the RS always wins. --Nstrauss (talk) 07:15, 11 August 2012 (UTC)

Nstrauss, I'll use a condensed version of the wiki definition of the "lead" to make a few points: ... The lead serves as an introduction to the article and a summary of its most important aspects. The lead should be able to stand alone as a concise overview. It should define the topic, establish context, explain why the topic is notable, and summarize the most important points—including any prominent controversies. The emphasis given to material in the lead should roughly reflect its importance to the topic, according to reliable, published sources, and the notability of the article's subject is usually established in the first few sentences. Significant information should not appear in the lead if it is not covered in the remainder of the article. .... the lead should not "tease" the reader by hinting at—but not explaining—important facts that will appear later in the article. The lead should normally contain no more than four paragraphs, be carefully sourced as appropriate, and be written in a clear, accessible style with a neutral point of view... Define the topic: Who-what-when, including the ACA and "Obamacare" clarifications. Establish context, explain notability: US healthcare system is broken. Rising costs, emergency room problem, Medicare is unsustainable, Democrat goal since 1948(?), narrowly passed by partisan vote. Most important aspects, : Reduction of uninsured people, subsidies, coverage changes, preventive care, impact on premiums, cost to government/revenue enhancements/fiscal impact. prominent controversies: Constitutionality/legal challenges, efforts to repeal, Religious freedoms, size of government/States rights, Individual mandate, tax increases, single-payer vs private insurance, wealth redistribution, impact on Medicare Advantage, burden on small business/job creation....(pick a few from the list, source each separately if necessary...) Emphasis given: I think the "controversies" deserve at least 1/4 of the emphasis; I know it is supposed to be based on what the RSs are talking about, but I don't know how to guage that. A survey of the article's citations doesn't work for me, as they support what I consider to be a one-sided article... Also, the fiscal impact of the bill deserves a lot more emphasis than it now receives. Government spending and debt are central to the politics of the nation at this time, and this Act is a posterchild for that issue. lead should not "tease": This is why we need to list in general terms the controversies, rather that simply say PPACA is controversial. I continue to believe that the Supreme Court ruling needs to be described in some detail for the same reason. Neutral point of view:NPV cannot be achieved if the controversies are ignored. NPV cannot be achieved if the financial details of the Act are glossed over. NPV cannot be achieved if the Act is descibed in "pro" half-truths. Regarding RECENTISM and the 10YT: Excerts from the Wiki article:
 * ...After "recentist" articles have calmed down and the number of edits per day has dropped to a minimum, why not initiate comprehensive rewrites? Many articles can be condensed to keep only the most important information, the wider notable effects of an event, and links to related issues. Much of the timeline and the day-to-day updates collected in the "rough draft" stages can safely be excised....
 * Just wait and see. Remember, there is no deadline. Editors writing today do not have a historical perspective on today's events, and should not pretend to have a crystal ball.

In my opinion, as the number of edits has not dropped to a minimum, it makes sense to just wait and see, and then make a comprehensive edit when the dust has settled. To do otherwise suggest that a crystal ball is telling us that the controversy will imminently fade into oblivion. In closing; I am only asking that undecided voters be included in the audience, not that they are the exclusive audience, I don't propose that the article focus only on the controversy, and I think I have been very clear about my personal bias and that I respect the need for reliable sourcing of all content. Regarding the length of the lead, this is a major article with many facets. As such, some leeway may be required to do it justice. I will concede the list of outcomes at the end is excessively detailed. Perhaps some key outcomes can be woven into the descriptive narrative, for perspective. Regarding the use of numbers in the text, I don't view that as being technical. It creates accessibility for the reader trying to get his/her head around the trillions of dollars and millions of people affected by this Act. What I really want to know:
 * Do you agree that "controversy" must be addressed in the lead, and if not, then please defend that position in light of the LEAD discussion above.
 * Do you (and others that may read this) find merit in my argument that there is bias in the present lead and if there is, will you work with me to correct the problem, even to the extent of "writing for the other side"?

Thanks to all that have taken the time to consider this... Thomas Pain 67 (talk) 10:39, 11 August 2012 (UTC)


 * In response to your specific questions:
 * No, I don't agree that controversy should be addressed in the lead for any legislation. There's just not enough space to air out the full contours of the political debate without excluding an important viewpoint and thereby violating WP:NPV. If you can find a lead section for a comparable piece of legislation that has done this successfully then I might reconsider my position.
 * No, I don't think there is bias in the lead as currently written. I think the lead is somewhat on the bare side but I don't draw any of the inferences that you do about supposed half-truths. I understand you think the lead is missing certain points but IMO those points are talking points for a particular non-neutral viewpoint. They would have to be balanced by equally strong talking points for the opposing viewpoint. And then the lead section starts looking a lot more like an election guide than like the intro to an encyclopedia article.
 * Also, I think you're misunderstanding my point about WP:RECENTISM (and WP:10YT). I have nothing at all against a comprehensive re-write. What I have a problem with is writing an article with an eye toward voters in the 2012 election. As the policy suggests, the article should be written toward people who will be reading it in 2022. --Nstrauss (talk) 20:34, 11 August 2012 (UTC)