What is wrong with the Affordable Health Care Act?

[fred rosenberger]

I've heard it over and over..."ObabaCare is bad for america. It's costing us jobs. People don't like it. It's a train wreck..." etc.

But what are the concrete facts about why it is bad?

As I understand it:

1) Children can stay on their parents healthcare until they are 26 (and more likely able to afford their own)
2) You cannot be denied healthcare coverage for a pre-existing condition
3) There are no more lifetime caps on how much you can get in benefits
4) There will soon be markets where insurance companies compete for your business (this was originally a Republican idea), thus hopefully lowering costs as they compete.

ALL of these things seem like GOOD things.

Where is the bad? What isn't working? Why do so many people say this is the worst law we ever passed?

[Jayesh A Lalwani]

Criticism for Obamacare is coming from 2 sides, the liberal and the conservative. The liberal criticism which is not that vocal is that Obamacare doesn't go far enough. Rather than providing healthcare which they see as an universal right, it just forces everyone to buy insurance from the market, and is really designed to help insurance companies

The criticism from the right is much more vocal and nonsensical. It seems like the GOP is criticizing Obamacare mainly because they want to take digs against democrats. Obamacare is more or less a clone of romneycare. They designed it, more or less. They stalled and they stalled until democrats gave in and tailored the law to suit republican demands, and then the republicans didn't support it anyways.

[Joe Ess]

I'm not a fan. First, I'm supposed to trust the government with my medical records when they can't secure their facilities from the likes of Edward Snowden and Aaron Alexis? I'm not worried about a large scale leak, it's those little one-off leaks (IRS, anyone?). What about if one were to take a position that is not looked upon with favor by the regime in charge? Will those syphilis/drug addiction/depression (insert some condition that has a stigma attached) treatments suddenly come to light? Will it lead to a chilling effect where people are reluctant to seek out services? It boggles my mind that the "keep your laws off my body" crowd is begging for government intrusion in this instance.
Second, there is nothing "affordable" about the affordable care act. As soon as the mandate for pre-existing conditions/ children until 26/ lifetime caps went into effect, my insurance rates doubled. Most of the stipulations of the law have to do with the demand side (people must buy insurance, insurance companies can't refuse people) rather than the supply side (subsidizing doctor education, "reasonably priced" clinics, etc.). The intention of the law was to "bend the cost curve", to hopefully curtail the ever-increasing cost of health care. Focusing on the demand side to the exclusion of the supply side will lead to costs rising. Economics 101.
Third, I don't think medical care responds to rational market behavior. When Grandma is sick, we don't shop around for a good deal, we go straight to the best doctor at the best hospital and run all the most expensive tests. Obamacare will switch Medicaid/Medicare reimbursements to a local market-based approach, but I don't think that will do much good. Who's going to go from one place for an x-ray, another place across town to get a bone set, and a third place for meds?
I could go on, but work. Suffice to say, I have had few government interactions that left me with a great deal of confidence in government. Anyone who's spent an afternoon at the BMV should understand why I am not looking forward to Obamacare.

[fred rosenberger]

Joe,

How does the government get my medical records? If I sign up for <insert private insurance company name here> on the health insurance exchange, where exactly does the government see my records?

Next - do you really thing that BlueCrossBlueShield has better security? Do you think that if the government has my records, they will be LESS secure than some private company? From what I've seen, just about any sufficiently valuable target can be hacked, government or otherwise. Do you know that private health care companies don't have small leaks?

It boggles my mind that the "keep government out of healthcare" can be so vocal about forcing the government between a woman and her healthcare provider.

I'm sorry, but I just don't see the "government intrusion" into healthcare. I see them intruding by mandating I BUY insurance, but they do that for auto insurance too. After the law goes into effect (I am assuming it will), I don't see how the government will be any more involved - I still have my private health insurance, with no government.

As soon as all the healthy people are forced to sign up, your rates should go down. California recently announced that the rates on their exchange would be several hundred dollars LOWER than originally predicted.

An independent bookstore owner in St. Louis recently published a blog post (I can't find it right now). He currently pays the full premium for his 12 full time employees. From what his research has shown, his estimated costs should go DOWN by $100/employee/month once the HIE's go online.

Having more young, healthy people pay IN without making claims means the same expenses are now shared among more people meaning each person has to pay less. Also Economics 101.

I am seriously trying to understand the opposition. But it still doesn't make sense to me.

[Ernest Friedman-Hill]

Oh goody, a real disagreement

Most of the opposition seems to be driven by the Tea Party and by "small business owners", by which of course I mean CEOs of Papa John's, Walmart, etc, who currently treat their employees like slaves, and want to be able to continue doing so. The AHCA is an affront to the cult of the CEO and the Randian ethos of the Republican party, and to the underlying racism of the Tea Party, and that's why it's such a lightning rod. The only way to fix this country is to begin to deal with the class barriers and incredible wealth inequality; destroying the cult of the CEO and the myth of shareholder primacy is the only way we're going to do that. That anyone would have to nerve to say he'd rather have employees suffer from lack of proper health care than reduce profits by 15 cents per pizza is a psychopath, frankly, and doesn't deserve to be in charge of a small family let alone a large corporation.

Joe Ess wrote: Suffice to say, I have had few government interactions that left me with a great deal of confidence in government. Anyone who's spent an afternoon at the BMV should understand why I am not looking forward to Obamacare.

That's state government -- you know, those folks the Republicans think should run more stuff. As far as the Federal government: visit any national parks lately?

[Jayesh A Lalwani]

Joe Ess wrote:I'm not a fan. First, I'm supposed to trust the government with my medical records when they can't secure their facilities from the likes of Edward Snowden and Aaron Alexis? I'm not worried about a large scale leak, it's those little one-off leaks (IRS, anyone?). What about if one were to take a position that is not looked upon with favor by the regime in charge? Will those syphilis/drug addiction/depression (insert some condition that has a stigma attached) treatments suddenly come to light? Will it lead to a chilling effect where people are reluctant to seek out services? It boggles my mind that the "keep your laws off my body" crowd is begging for government intrusion in this instance.

.

Obamacare requires you to turn your medical records to the government? Where does it say that?

Second, there is nothing "affordable" about the affordable care act. As soon as the mandate for pre-existing conditions/ children until 26/ lifetime caps went into effect, my insurance rates doubled. Most of the stipulations of the law have to do with the demand side (people must buy insurance, insurance companies can't refuse people) rather than the supply side (subsidizing doctor education, "reasonably priced" clinics, etc.). The intention of the law was to "bend the cost curve", to hopefully curtail the ever-increasing cost of health care. Focusing on the demand side to the exclusion of the supply side will lead to costs rising. Economics 101.

You are right and that's primarily because the Republicans crippled the measures that did try to reduce the cost of medicine in the country. And now the same people tale about how it's not making healthcare affordable? That's like shooting the horse and then calling it lame!

Third, I don't think medical care responds to rational market behavior. When Grandma is sick, we don't shop around for a good deal, we go straight to the best doctor at the best hospital and run all the most expensive tests. Obamacare will switch Medicaid/Medicare reimbursements to a local market-based approach, but I don't think that will do much good. Who's going to go from one place for an x-ray, another place across town to get a bone set, and a third place for meds?

Yes, I agree with you there too. A free market based approach doesn't work. That's why we need a system in which either a central body either provides healthcare, or the central body negotiates the price of healthcare for everyone. The problem is when you bring this up, people start going lalalalalasocialismlalalaladeathpanellalalala

I could go on, but work. Suffice to say, I have had few government interactions that left me with a great deal of confidence in government. Anyone who's spent an afternoon at the BMV should understand why I am not looking forward to Obamacare.

I don;t know. I've spent time shuttling from one doctor to another, and the DMV works a lot better than the system we have right now. My wife and I were going through pregnancy loss, and there is not one place we can go to treat pregnancy loss. There is the OB/GYn that looks after general health of the female reproductive system. Then there are REs who specialize in the reproductive system. However, REs don;t know much about problematic pregnancies themselves. After the woman gets pregnant, you have to go to yet another doctor who specializes in problematic pregnancies. ANd then you have a fourth doctor who specializes in male reproductive system. So, you have problem pregnancies, you get shuttled around 4 different offices, and all 4 do the same tests, and give conflicting answers. It's not uncommon for a complicated fields to have hyperspecialization. I get that. But why can't these 4 people talk to each other better? Why are they in separate offices? Why are they running the same tests again and again? The reason is the free market system doesn't work here. They will make actually make less profit if they all get under the same roof. The DMV, OTH is way better. Atleast all the vehicle related services are under the same roof. I don;t need to go to one office to get my license, and another office to get my car registered, and another to show that it went through the inspections process.

[Jeanne Boyarsky]

Joe: I barely trust the HEALTH INSURANCE company to have my records. I've been uncomfortable with the system of insurance discounts for showing you are healthy in various ways. Technically, it is just for submitting the tests every year via your employer who keeps it "anonymous" and sends to the insurance company. But I think that is where it is going. I don't participate. This costs me $120 a year to not have the info passed along. I think it is worth it.

Jayesh: The government gets the fact that you have insurance and with whom. I don't know what else more. I suspect there are records from the insurance company showing that they are doing their part properly.

[fred rosenberger]

I work for a company that owns/runs 12 hospitals. We are self insured (although our plan is administrated by a 3rd party). All my family's health care is pretty much done by my employer.

My colleagues have access to my records. Believe me, they have better things to do than to look and see what my cholesterol level is.

Here is a post by the owner of a small, independent bookstore in St. Louis:

http://leftbankbooks.wordpress.com/2013/09/26/a-small-business-response-to-obamacare/

[fred rosenberger]

So something else I heard today, which I never really paid much attention to.

You don't want the federal government involved. The AHCA sets up these Health Information Exchanges (HIE). Each State has to have one. The state were given the option of setting up and running it themselves. If they didn't want to, the Federal government would run it for them.

So...if you don't want the Feds involved, and in your State they are, that is the fault of your State government. They CHOSE not to run one. In fact, I heard on the radio this morning that 29 States OPTED to let the Feds run their HIE. I don't think then that it is fair to say the Feds are INTRUDING into healthcare.

And that doesn't even begin to touch on the fact that all they are doing here is setting up a marketplace where private insurance companies have to compete for your business, not actually providing any healthcare.

[Joe Ess]

It seems like I am the sole voice of reason here...

Jayesh A Lalwani wrote:
Obamacare requires you to turn your medical records to the government? Where does it say that?

I'm going to back off this claim. I went looking for a reputable source and it seems like people are conflating the electronic medical record subsidy in the Recovery Act and the reporting requirements for that and the Affordable Health Care Act and that your health coverage information has to be transmitted to the IRS.

You are right and that's primarily because the Republicans crippled the measures that did try to reduce the cost of medicine in the country. And now the same people tale about how it's not making healthcare affordable? That's like shooting the horse and then calling it lame!

I though we were talking about what is wrong the AHCA as it stands now. Sounds like you have a partisan axe to grind.

Yes, I agree with you there too. A free market based approach doesn't work. That's why we need a system in which either a central body either provides healthcare, or the central body negotiates the price of healthcare for everyone. The problem is when you bring this up, people start going lalalalalasocialismlalalaladeathpanellalalala

Because centralized planning works so well.

I don;t know. I've spent time shuttling from one doctor to another, and the DMV works a lot better than the system we have right now.

There's nothing in ACTA about consolidating services. As I said, I think the pricing structure actually encourages the opposite behavior, exacerbating the problem you are detailing.

Atleast all the vehicle related services are under the same roof. I don;t need to go to one office to get my license, and another office to get my car registered, and another to show that it went through the inspections process.

You do in Ohio because the title agency is under the county and the BMV is a state agency.

[fred rosenberger]

Joe Ess wrote:I though we were talking about what is wrong the AHCA as it stands now.

But that's the thing, isn't it? The law isn't being implemented as written. People are trying to prevent the next steps from taking effect. So we've implemented the parts that cost money (no pre-existing conditions, no lifetime caps, kids stay on until age 26), but we're being told that we should delay the part that saves money (getting healthy people to sign up and pay into the pool).

Again...most of the ideas in this plan, as I understand it, were Republican ideas. Most of this was modeled off Mitt Romney's plan for Massachusetts (again, as I understand it).

Joe Ess wrote:I'm going to back off this claim.

Would you please tell the Koch brothers so they stop airing the ads they are running showing a creepy Uncle Sam character coming in the exam room?

[Martin Vashko]

Joe Ess wrote:Because centralized planning works so well.

Yeah. I can confirm that socialist countries find it surprisingly hard to make the right amount of toilet paper. Years ago happened in my country too.

[Joe Ess]

fred rosenberger wrote:

Joe Ess wrote:I though we were talking about what is wrong the AHCA as it stands now.

But that's the thing, isn't it? The law isn't being implemented as written. People are trying to prevent the next steps from taking effect. So we've implemented the parts that cost money (no pre-existing conditions, no lifetime caps, kids stay on until age 26), but we're being told that we should delay the part that saves money (getting healthy people to sign up and pay into the pool).

Your OP was "what is wrong with the act?". That's what I was addressing. I can't make heads or tails over the battle over implementation. Half of me wants it implemented so it can fail, half wants it delayed so they can implement it without a lot of problems, half wants it repealed and half wants it replaced with something better.

fred rosenberger wrote:
Again...most of the ideas in this plan, as I understand it, were Republican ideas. Most of this was modeled off Mitt Romney's plan for Massachusetts (again, as I understand it).

A Republican Massachusetts? That's Bizarro world talk! Their legislature is about 85% Democrat (sorry, don't have the 2006 figures). Romney even vetoed several sections when the law was given to him.
The Wiki page on the Massachusetts experience is interesting because it gives us some idea how the national system will work. Good: emergency room visits down as people go to doctors. Bad: Removing the restrictions on insurance encourages people to join insurance, get major work done, then drop insurance. So it's a mixed bag.

[Jeanne Boyarsky]

Joe Ess wrote:
Your OP was "what is wrong with the act?". That's what I was addressing. I can't make heads or tails over the battle over implementation. Half of me wants it implemented so it can fail, half wants it delayed so they can implement it without a lot of problems, half wants it repealed and half wants it replaced with something better

And I appreciate that you answered.

[Ulf Dittmer]

Joe Ess wrote:Bad: Removing the restrictions on insurance encourages people to join insurance, get major work done, then drop insurance.

But in the future everyone would be required to have health insurance, or pay fines, so this would no longer be a viable path, no?

[Jayesh A Lalwani]

Joe Ess wrote:

Because centralized planning works so well.

Well centralized planning at the federal government level works quite well Here. Obviously no one is asking for defunding the army because the federal government runs it, or to have each state run their own militaries, or to have a free market where you can buy military services. The argument that any program that is federally managed will lead to ruin is bunk

IMO, there are plenty of things wrong with the AHCA, but all the wrong things in AHCA are there because the current opponents of AHCA put them in there. AHCA is a compromise. It's a step towards true universal health care instead of patchwork healthcare that we have now.

[Joe Ess]

Ulf Dittmer wrote:

Joe Ess wrote:Bad: Removing the restrictions on insurance encourages people to join insurance, get major work done, then drop insurance.

But in the future everyone would be required to have health insurance, or pay fines, so this would no longer be a viable path, no?

Insurance is likely to be more expensive than the fines:

The fines start small - at $95 for an individual in 2014, or 1 percent of household income if that's higher - but escalate to $695 annually by 2016, or 2.5 percent of household income.

Why some will choose to opt out

and one can also get an exemption under certain circumstances (which appears to be a very popular FAQ entry on the healthcare.gov web site).

Jayesh A Lalwani wrote:Well centralized planning at the federal government level works quite well Here.

As an Army veteran, I can assure you that that is not true!

Seriously, though, there is a big difference between managing an organization that has a well-defined goal (kill people, break things) and managing a supposedly free society (do whatever the hell you want). In the army, the needs are fairly predictable (beans, bullets) and in society at large, needs are fairly chaotic. Want to go to war, need more beans and bullets. No war? get less. What central planner could have anticipated the Rainbow Loom?
Remember the restrictions on human stem cell research? Would you trust those guys to run healthcare? You'd better, because sooner or later, they'll be back in power!

[fred rosenberger]

Joe Ess wrote:Why some will choose to opt out

I stopped reading that when the author said "The real issue for me is to be required to buy insurance that doesn't cover the care I'm accustomed to and is found to be effective". There has been no valid scientific study that says prayer is effective. In fact, the few I've come across that were done under rigorous scientific procedures showed the people who were prayed for did WORSE than those who were not.

Healthcare should pay for things that have been shown to work, not for things that haven't.

Joe Ess wrote:Remember the on human stem cell research? Would you trust those guys to run healthcare?

Why are you saying the government will "run healthcare"? All the government is doing here is a) saying everyone needs to buy health insurance from either their employer or through private insurance companies, and b) setting up a place were you can easily see what all the private companies offer.

How is that in any way them "running healthcare"?

If my assumptions are wrong, please tell me how with a verifiable source.

[Jeanne Boyarsky]

There's a fee for prayer?

[Paul Clapham]

Joe Ess wrote:Why some will choose to opt out

That's an interesting propaganda technique. Choose an interesting-looking example. Ignore the fact that it is completely unrepresentative of the population as a whole and hope that other people won't notice that fact.

[Joe Ess]

Jeanne Boyarsky wrote:There's a fee for prayer?

No, certain religious groups can claim an exemption to the insurance mandate. I'm guessing those groups will find themselves with a lot more members than fill the pews on Sunday.
The problem with people getting exemptions or just paying the fine is they will likely be the more healthy people the law depends on to cover the obligations they've promised those who have previously existing conditions.

fred rosenberger wrote:Why are you saying the government will "run healthcare"?

The fed holds the purse strings. The fed can mandate requirements on the states and threaten to withhold funding like they did with the 21-year old drinking age. Remember the abortion-foreign aid restrictions? I already cited stem cell research. How examples do you need?

Paul Clapham wrote:That's an interesting propaganda technique.

Are you calling out the San Francisco Chronicle as a tool for the right? I think you're the first person to do that ever!

[fred rosenberger]

Joe Ess wrote:The fed holds the purse strings. The fed can mandate requirements on the states and threaten to withhold funding...

I thought the Supreme court found that withholding money from states who don't expand Medicaid was unconstitutionally coercive.

I don't see the connection with stem cell research. The government provides grants to various scientific institutions to do research. For whatever reason, a law was passed saying they would not grant money to fund certain initiatives. But I would not say the government RUNS stem cell research. Anyone who wants to can still do so.

The arguments I keep hearing is that Uncle Sam will be in the examination room. He will know that I have high cholesterol, or I'm fat, or that I used heroin or whatever. But I don't see that. The argument is that Uncle Sam will say "You can't have chemotherapy, because you are 90 and will die in 5 years anyway". But I don't see where that is in the law.

All I see in the arguments against the law is very vague statements like "this bad thing could happen", but that is true for any law passed ever.

Joe Ess wrote:The problem with people getting exemptions or just paying the fine is they will likely be the more healthy people the law depends on to cover the obligations they've promised those who have previously existing conditions.

So it sounds like you are arguing that nobody should get an exemption - that everyone should have to buy insurance. I think we finally agree on something!!!

[Paul Clapham]

Joe Ess wrote:

Paul Clapham wrote:That's an interesting propaganda technique.

Are you calling out the San Francisco Chronicle as a tool for the right? I think you're the first person to do that ever!

I don't have any preconceived notions about the Chronicle. It's just that for the last few years I've been noticing how documents and articles are written in various ways which lead the reader to believe things which aren't actually supported by those documents and articles. I use the general term "propaganda" for such articles whether or not they were deliberately written to deceive.

[Jeanne Boyarsky]

On the radio, a New Jersey politician has been running ads that his opponent supports Obamacare and raised taxes. On the Obamacare end of that, he accuses Obama of being a liar by saying people can keep their existing health care.

I looked online to see what that was all about and saw 10 states were Obamacare wipes out existing health plans.. The states are CA, CT, GA, IA, MD, MO, NJ, NY, SC and WI.

Reading further, these are states where major health insurers aren't participating in the Obamacare exchange for the subsidies. I don't recall anyone saying all insurers would be on the plan. I recall hearing that you wouldn't be forced to switch insurers. If you want to keep paying out of pocket or through your insurer, it doesn't matter if a provider is on the exchange.

This is how health insurance works in general. You pay more, you get more choices. For dental insurance, I have two choices through my employer. The one that costs less has very few dentists on it and the ones that are on it often restrict visits to weekdays. The one that costs more (and it's not that much more), has a lot more dentists including the ones I've visited in the last decade and weekend hours. This seems like the market at work. Something Republicans usually praise.

Am I missing something?

[fred rosenberger]

I do know that the article is wrong - at least about Missouri. Back on the 28th, there was talk that BJC (the hospital system that includes St. Louis Childrens Hospital (SLCH) and my employer) may not be on the HIE. However, on the 29th or 30th it was announced they would be on it after all. I don't know anything about Anthem BlueCross BlueShield.

And I'm not sure what they mean by "wipes out existing health care plans". My healthcare plan is certainly NOT being wiped out, and I can still take my daughter to SLCH.

[Jeanne Boyarsky]

In the first respect, it sounds old. Not wrong.

[fred rosenberger]

Jeanne Boyarsky wrote:In the first respect, it sounds old. Not wrong.

"Patients of the state’s largest hospital system...will not be covered by the largest insurer on Obamacare exchanges"
This was not even true at the time it was written. What they were saying in St. Louis was that that BJC would probably not be included, due to its high charges, but that nobody would know for sure until the 1st. When the 1st came around, BJC was indeed included.

The article makes it sound like it was a done, inked and signed deal, when in fact, it was still being discussed. Ultimately, it turned out to be not what happened at all.

[Ulf Dittmer]

fred rosenberger wrote:The article makes it sound like it was a done, inked and signed deal, when in fact, it was still being discussed. Ultimately, it turned out to be not what happened at all.

Not all that unusual for the political discourse around this topic. Of course, spreading FUD is not unique to political discussions.

[chris webster]

Well, our poor old National Health Service in the UK has serious problems of its own, partly as a result of efforts to privatise parts of it to make money for private healthcare companies at the taxpayer's expense, and partly for systemic problems that are proving hard to fix. Yet despite all that, and despite the fact that per capita spending on healthcare in the UK is far lower than in the USA, our infant mortality rates are lower and longevity higher than in the USA. Maybe centralised planning can work better thanthe "free" market after all, eh Joe? ;-)

It's up to Americans to decide how to manage their healthcare system, but if I were poor and sick I'd prefer a European/Canadian style "socialised" system to the current...uh..."antisocialised" US system.

[Jesper de Jong]

I know almost nothing on the health care system in the USA, so I won't comment on that.

In The Netherlands everybody has health care insurance, there has been mandatory basic health care insurance for a very long time (probably since before I was born).

Last year the government had a proposal to change how we pay for this system. They wanted to make it proportional to income, which means it would become cheaper for poor people and very expensive for richer people. In my case, it would have meant that I would probably have to pay four or five times as much for my health insurance.

There was so much protest over this idea that the government quickly backed out on the idea.

It's really strange that they came up with this idea, especially since the largest party is more on the right side than on the left side of the political spectrum.

[chris webster]

Jesper de Jong wrote:It's really strange that they came up with this idea, especially since the largest party is more on the right side than on the left side of the political spectrum.

One of the political tricks we've seen in the UK for more than 30 years is for governments to engineer a crisis in whichever public service they want to privatise, then insist the only solution is privatisation. One way to do this is to drive a wedge between rich people - who can afford to pay for privatised services - and less wealthy people who rely on the security and shared costs of public services.

Step 1: Push up prices for some people in the hope that they will voluntarily move into the private sector.

Step 2: Now claim the system isn't fair, because rich people are paying for the service but don't use it. So you allow rich people to opt out of paying for the service.

Step 3: Now there's not enough money coming into the service, so you insist the service has to be cut because poor people can't afford to support the full service on their own.

Step 4: Now you have a real crisis because nobody is getting a decent service any more, so you insist the only way to fix it is by privatisation.

Step 5: Privatise the service, usually at a loss to the public who still own it, because you want to ensure the sale goes through and your friends in business make a killing.

Step 6: As the former government minister in charge of the privatisation, you are soon rewarded with a well-paid directorship at the private company.

Step 7: Pretty soon, the private sector service becomes a virtual monopoly, and is usually more expensive than the public service was (because they have to pay profits to share-holders), but only poor people are suffering, so who cares?

Rinse and repeat with any publicly owned "greater good" until you've sold off and/or wrecked every public service in your country and made sure that as much wealth as possible is moved as swiftly as possible from the poor to a tiny corporate elite and their puppets in politics. And don't forget to take the taxpayer's money that's no longer being spent on public services and hand it over to your corporate chums in the state-subsidised banks - they need those fat bonuses more than Mrs Jones needs a new kidney, after all!

Just don't do play the same "small state" game with the police or the military - another massively subsidised and not always efficient public service - because you're going to need the men with guns sooner or later if you keep playing this game: there comes a point when the vast majority of people will begin to realise that democracy isn't working for them and resort to other methods.