OT - Affordable Care Act & The Supreme Court

Submitted by briansd1 on March 25, 2012 - 9:28pm
SCOTUS will uphold the Act
35% (8 votes)
SCOTUS will strike down the Act
4% (1 vote)
SCOTUS willl strike down part of the law
61% (14 votes)
Total votes: 23
Submitted by briansd1 on March 25, 2012 - 9:31pm.

Let's see how prescient Piggington readers are.

I'm predicting that John Robert and Anthony Kennedy still will side with the liberal wing of the Court. Perhaps Scalia will too.

Time will tell...

Submitted by Allan from Fallbrook on March 25, 2012 - 10:00pm.

Brian: Who's SOCTUS?

Submitted by briansd1 on March 25, 2012 - 11:11pm.

Opps... my fingers type faster than I can read.

Submitted by flu on March 26, 2012 - 7:18am.

It doesn't really matter.

Insurance companies have already used obamacare as an excuse for why insurance premiums need to rise for everyone.

And as a result, employers have already used obamacare and the increase in insurance premiums as an excuse for why employees must now pay more for insurance...

Even if they did reverse obamacare in whole or part, the insurance companies aren't going to be lowering premiums and even if insurance companies lower premiums, employers aren't going to be start picking up the tab more like it was before....

The damage has already been done... No point in undoing it.

Submitted by ocrenter on March 26, 2012 - 7:48am.

http://articles.latimes.com/1993-09-16/n...

"But where the White House puts the burden for providing health care on employers, the Republican plan places it on individuals, who would be required to purchase health insurance in the same manner that most states require motorists to carry automobile insurance."

Obamacare is essentially the Senate GOP plan from 20 years ago. But when implemented by a Kenyan Muslim, of course it is under attack.

The best thing to do is to get the plan repealed, elect Romney, have him implement the same plan again, the whole country will now be for the plan, and the country can heal.

Submitted by ninaprincess on March 26, 2012 - 7:54am.

I like parts of the law, especially the requirement that individuals need to have health insurance coverage. I know many of you don't like this. But if we don't require individuals to have coverage then I think we should allow hospitals to kick out patients with no money to pay which as a society we are not ready to do. I know many small business owners with income above $100,000 chose not to buy health insurance.

Submitted by briansd1 on March 26, 2012 - 9:17am.

BTW, you should answer this survey objectively based on what you think the Supreme Court will decide, not what you want it to do.

Wonkbook: Absolutely everything you need to know about health reform’s Supreme Court debut
http://www.washingtonpost.com/blogs/ezra...

Submitted by scaredyclassic on March 26, 2012 - 11:39am.

I have no idea what they'll do. But I really impressed my mom with my ability to recall wickard v filburn from law school. Sh heard about it on NPR ...

Submitted by sreeb on March 26, 2012 - 8:16pm.

ninaprincess wrote:
I like parts of the law, especially the requirement that individuals need to have health insurance coverage. I know many of you don't like this. But if we don't require individuals to have coverage then I think we should allow hospitals to kick out patients with no money to pay which as a society we are not ready to do. I know many small business owners with income above $100,000 chose not to buy health insurance.

There are plenty of young people who do have an IPhone but don't have insurance. If you are young, single, and healthy you can probably afford the insurance if you pass on the IPhone.

My read:

Requiring you to purchase health insurance or anything else - not constitutional

Refusing care if you didn't buy coverage and don't have the money - constitutional

Submitted by JohnAlt91941 on April 4, 2012 - 8:48pm.

sreeb wrote:

Refusing care if you didn't buy coverage and don't have the money - constitutional

But impractical. What happens if someone unconscious is taken to a trauma center? Is the hospital supposed to check insurance before treatment? This "opt out" idea for health insurance doesn't fly because even if it was known that the patient couldn't pay our society doesn't have the stomach for denying care. And the uninsured know it.

The fact is that everyone is covered in some way (insurance or safety net) and should contribute.

Submitted by jstoesz on April 4, 2012 - 10:04pm.

sounds like you are making an argument for taxing poor people...

Submitted by sdduuuude on April 5, 2012 - 8:15am.

JohnAlt91941 wrote:
sreeb wrote:

Refusing care if you didn't buy coverage and don't have the money - constitutional

But impractical. What happens if someone unconscious is taken to a trauma center? Is the hospital supposed to check insurance before treatment? This "opt out" idea for health insurance doesn't fly because even if it was known that the patient couldn't pay our society doesn't have the stomach for denying care. And the uninsured know it.

The fact is that everyone is covered in some way (insurance or safety net) and should contribute.

Insurance isn't the only way to pay for medial coverage. They could actually pay for the service. Why would it be OK to force them to pay for insurance but not OK to make someone pay the medical bill for services rendered to an uninsured trauma victim?

It isn't a tax. It's a fee for someone saving your ass.

The supreme court asked the right question - where does the government's power to force people to buy stuff stop ? Forcing poor people to buy insurance seems like a tax on poor people to me.

Submitted by UCGal on April 5, 2012 - 8:37am.

sdduuuude wrote:

The supreme court asked the right question - where does the government's power to force people to buy stuff stop ? Forcing poor people to buy insurance seems like a tax on poor people to me.

Poor people were considered in the law. There is a sliding scale of subsidy for the coverage - up to household incomes 4x the poverty level.

People below 133% of the poverty level get medicaid.

Submitted by no_such_reality on April 5, 2012 - 8:45am.

Healthcare is broken in the US.

My wife recently spent a evening in the ER being checked for internal injuries after a vehicle accident. Of the five people in the ER that night, she was the only one with insurance. Determined by listening to the people telling the ER nurses they didn't have insurance.

After determining no injuries beyond bruising, the bill arrived at over $10,000. She was there 4 hours.

Submitted by harvey on April 5, 2012 - 8:54am.

sdduuuude wrote:
The supreme court asked the right question - where does the government's power to force people to buy stuff stop ?

It is the right question. And there is a clear answer.

The government can control an area of commerce in which everyone participates. And everyone uses the healthcare system.

(There are a few obscure exceptions, but they are not significant enough to be relevant and the law provides for many of these exceptions anyway.)

The healthcare market is unique and distinct from any other market. Everyone has health. Everyone needs healthcare and uses the "system" in some way at some point.

It's not a "slippery-slope" when there is a clear boundary defining one side and the other.

Submitted by enron_by_the_sea on April 5, 2012 - 9:37am.

sreeb wrote:

Requiring you to purchase health insurance or anything else - not constitutional

Refusing care if you didn't buy coverage and don't have the money - constitutional

Charge anything (i.e. Rip off) to the person seeking healthcare in the name of free market - also constitutional!

Submitted by no_such_reality on April 5, 2012 - 9:49am.

Well when you all get don't arguing the constitution we can talk about the real issue

Should Dick Cheney, and others like him at 71, get a heart transplant at a cost of more than $700,000? This Is the difficult question which is further complicated by who pays for it and how that paying for it affects costs for insurance coverage and care.

Submitted by bearishgurl on April 5, 2012 - 10:01am.

Part of the reason for having health insurance is having negotiated rates for care. A self-pay would have to negotiate their own bill (I was successful in doing this once for a bill which encompassed a large deductible). I got it down from about a $2750 copay to <$800 by negotiating out frivolous charges. But to do this, I had to show up at a meeting at the billing office with my portion of the bill that I was responsible for and set up a payment plan for six months. If I fell off the plan, my bill would go back up to $2750 and be referred to collections.

I ended up paying it in full in four months.

Lots of self-payors just ignore the bills or give fake addresses to the ER when they're being seen. They don't care if their bills are reported to collections because they don't have any assets and some are homeless or don't even live in the US.

I don't see how paying for health insurance coverage is going to be successfully enforced on anyone. It's like auto insurance. In some parts of the county (San Ysidro, for one), 73% of drivers are "uninsured" and the common limit of liability in Mexico (for those that are insured there) is $3K per vehicle. Yet they still drive and still sue the insured for injuries. Thankfully, the uninsured in a motor vehicle accident within CA can now only get their actual medical bills covered (paid directly) and property damage paid for (as part of tort reform). They CANNOT recover any punitive damages, so it's not worth it anymore for them to "set up" an "accident" with a (presumed) insured driver.

Submitted by poorgradstudent on April 5, 2012 - 10:03am.

I honestly think the Supreme Court could go any of the three listed directions when they rule. It sounded like Kennedy wasn't very sympathetic to the mandate. Roberts is a conservative but also has ties to the insurance companies who LOVE the mandate. A 4-3-2 split of opinions is possible, and who knows how they might resolve that kind of split?

no_such_reality wrote:
Healthcare is broken in the US.

It really is. I'm not convinced the ACA is anything more than minor first aid on a deep, festering wound. It might help a little bit, but unfortunately real, better options like single payer were stripped out in order to compromise with moderates.

That said, what alternatives are Republicans and conservatives really offering? Their message seems to be "Let's repeal Obamacare and go back to the way it was before!" The trouble is, that system doesn't work. Privatizing Medicare isn't a real solution for anything other than cutting rich people's taxes. I'd be a lot more open to "Repeal and Replace" if they had any real plan for "Replace".

Submitted by sdduuuude on April 5, 2012 - 10:10am.

pri_dk wrote:
sdduuuude wrote:
The supreme court asked the right question - where does the government's power to force people to buy stuff stop ?

It is the right question. And there is a clear answer.

The government can control an area of commerce in which everyone participates. And everyone uses the healthcare system.

(There are a few obscure exceptions, but they are not significant enough to be relevant and the law provides for many of these exceptions anyway.)

The healthcare market is unique and distinct from any other market. Everyone has health. Everyone needs healthcare and uses the "system" in some way at some point.

It's not a "slippery-slope" when there is a clear boundary defining one side and the other.

The clear boundary is "any area of commerce in which everyone participates" ?

That isn't a slippery slope. That is the bottom of the hill.

Submitted by bearishgurl on April 5, 2012 - 10:13am.

no_such_reality wrote:
Well when you all get don't arguing the constitution we can talk about the real issue

Should Dick Cheney, and others like him at 71, get a heart transplant at a cost of more than $700,000? This Is the difficult question which is further complicated by who pays for it and how that paying for it affects costs for insurance coverage and care.

Mr Cheney was no doubt insured and his "deep-pocketed" carrier paid most or all of his transplant bill (over and above the pittance paid by Medicare). It was probably a "Cadillac Plan" that he retained from his former cabinet position. I'm not as concerned about this as I am undocumented immigrants and border-crossers receiving care (incl "emergency" maternity) that clog the hospital emergency rooms in this county. These are the cases that affect ALL of our rates as the money to keep these ER's open has to come from somewhere.

Submitted by sdduuuude on April 5, 2012 - 10:19am.

pri_dk wrote:
The government can control an area of commerce in which everyone participates. And everyone uses the healthcare system.

Let me get this straight. If the government can force everyone to participate in a particular area of commerce, and they can control any area of commerce in which everyone participates, then they can force anyone to do anything at any time and control everything? Sounds like a great vision for America.

This is such a disasterous abuse of power, I can hardly find the words to describe how stupid it is. There are so many things wrong with this concept, I can't believe anyone could support it.

Justifying this kind of control because "the healthcare system is broken" shows how much you all believe that you have the right to tell basically everyone in the country how to live their lives, as long as Congress says its OK.

The government needs to stay the hell out of people's personal decisions. Period.

Lets let people how make the right decisions for themselves. If you need the government to make this decision for you, you might as well just give them your whole paycheck and let them decide which house you should buy, where to live, what food to eat, and on and on and on.

Submitted by sdduuuude on April 5, 2012 - 10:31am.

Hey - I know. Lets force people to do it my way.
That always works.

Welcome to China.

Submitted by blahblahblah on April 5, 2012 - 10:31am.

ninaprincess wrote:
I like parts of the law, especially the requirement that individuals need to have health insurance coverage. I know many of you don't like this. But if we don't require individuals to have coverage then I think we should allow hospitals to kick out patients with no money to pay which as a society we are not ready to do. I know many small business owners with income above $100,000 chose not to buy health insurance.

Switzerland does this and will fine citizens who do not have health insurance. However, there is one huge difference between the US version and the Swiss. Because the Swiss have a real country run by the people rather than a fascist corporatocracy run by a tiny untouchable elite, the Swiss law also mandates exactly what a health insurance policy covers (basically everything, no pre-existing exclusions, etc...) AND how much profit the insurance companies are allowed to make (not much, like 5% or so). The insurance companies HATE the Swiss system. However they don't have a choice because the country is run by the people, not the corporations.

In the US system, you will be required to pay a bunch of money for a crappy policy that won't pay for anything. Premiums will go up every year, the insurance companies will get fatter and more profitable, and people will die younger and faster than ever before.

It's coming, it's not going away, get used to it. Bend over and prepare to pay. The only advice I can give is to keep yourself as healthy as possible. If it is advertised on TV or radio, don't eat it. Lower your stress level as much as possible. Fortunately here in SD we can always cross the border for excellent medical care at a reasonable price. The rest of the country won't be so lucky.

Submitted by bearishgurl on April 5, 2012 - 11:00am.

CONCHO wrote:
. . . In the US system, you will be required to pay a bunch of money for a crappy policy that won't pay for anything. Premiums will go up every year, the insurance companies will get fatter and more profitable, and people will die younger and faster than ever before.

It's coming, it's not going away, get used to it. Bend over and prepare to pay. The only advice I can give is to keep yourself as healthy as possible. If it is advertised on TV or radio, don't eat it. Lower your stress level as much as possible. Fortunately here in SD we can always cross the border for excellent medical care at a reasonable price. The rest of the country won't be so lucky.

CONCHO, I agree with this post except the first sentence. "Reputable" insurance companies DO pay and have $5M or unlimited life caps if the worst happens. One needs to be careful in their selection of a plan. If it looks too cheap or you've never heard of it, leave it alone.

I agree that MUCH more copay/coinsurance will be put on the consumer in the future. There is nothing wrong with this. MANY people currently abuse the $10/$15 co-pay system and see medical professionals several times per month over problems and "over-testing" that I would visit Rite Aid for an OTC remedy because I have an individual HDHP and they have a "comprehensive plan" (mostly or all paid for by the government or an employer). They do it because they never see the bill. All these visits are for naught when the patient is finally "prescribed" ibuprofen, "rest" or a common antibiotic cream.

Submitted by dumbrenter on April 5, 2012 - 11:39am.

CONCHO wrote:
Switzerland does this and will fine citizens who do not have health insurance. However, there is one huge difference between the US version and the Swiss. Because the Swiss have a real country run by the people rather than a fascist corporatocracy run by a tiny untouchable elite, the Swiss law also mandates exactly what a health insurance policy covers (basically everything, no pre-existing exclusions, etc...) AND how much profit the insurance companies are allowed to make (not much, like 5% or so). The insurance companies HATE the Swiss system. However they don't have a choice because the country is run by the people, not the corporations.

In the US system, you will be required to pay a bunch of money for a crappy policy that won't pay for anything. Premiums will go up every year, the insurance companies will get fatter and more profitable, and people will die younger and faster than ever before.

It's coming, it's not going away, get used to it. Bend over and prepare to pay. The only advice I can give is to keep yourself as healthy as possible. If it is advertised on TV or radio, don't eat it. Lower your stress level as much as possible. Fortunately here in SD we can always cross the border for excellent medical care at a reasonable price. The rest of the country won't be so lucky.

Among the partisan crap that swirls around the healthcare discussion, it is nuggets of information like these that make reading this page worthwhile.
Those of you on HDHP know exactly what CONCHO says here. the language of the insurance contract is so vague that these guys deny half the annual checkup costs that they are supposed to cover anyway. did you physician perform vision test? Nope, that is not considered part of an annual exam. did you get blood drawn for a cholesterol screening? It is considered lab work and not part of annual exam, so sorry, we do not cover that.
It would have been very helpful if they clearly identify what they cover and what they do not, but obviously it is against their and the doctor's interest to make this clear in the contract. And patients have no idea what their best interest is...most of them anyway.

Submitted by harvey on April 5, 2012 - 11:49am.

sdduuuude wrote:
If the government can force everyone to participate in a particular area of commerce, and they can control any area of commerce in which everyone participates [...]

Um...a bit circular in your logic there?

What industry is obligated, by law, to provide everyone goods or services regardless of your ability to pay?

Only one.

Now I suppose we could change that number to zero.

Would that be a step forward?

Submitted by harvey on April 5, 2012 - 11:57am.

dumbrenter wrote:
Those of you on HDHP know exactly what CONCHO says here. the language of the insurance contract is so vague that these guys deny half the annual checkup costs that they are supposed to cover anyway.

Yup.

I find it hilarious that all these folks with private insurance cry "I was able to get health insurance, what's the problem?"

They have no idea if the company will ever pay any claims.

If the insurance company doesn't pay for your car accident injuries, go ahead and sue them. Good luck!

There's the ol' saying: "You don't need insurance until you need it."

Regardless of the SCOTUS outcome, this is just a step the on long road to single payer. Someday we will catch up to the rest of the civilized word. The reason it is such a long road is one of our greatest national embarrassments.

Submitted by AN on April 5, 2012 - 12:04pm.

pri_dk wrote:
Regardless of the SCOTUS outcome, this is just a step the on long road to single payer. Someday we will catch up to the rest of the civilized word. The reason it is such a long road is one of our greatest national embarrassments.

If the ultimate goal is to be a single payer system, then why not just extend medicare to all those who are uninsured?

Submitted by harvey on April 5, 2012 - 12:41pm.

AN wrote:
If the ultimate goal is to be a single payer system, then why not just extend medicare to all those who are uninsured?

There are lots of alternatives. That may be a good one.

Before we can make any progress, we need a congress that is willing to have an adult conversation about the issues.

Saying "NO!" to every proposal in between temper-tantrums about "socialism" does not qualify as adult conversation.

Submitted by livinincali on April 5, 2012 - 12:51pm.

The fundamental problem with Healthcare is there's a virtual unlimited amount of demand for services especially if people don't have to pay for them. In essence America had the best treatments available and you don't have to wait to access them. Because of this the cost is incredibly high.

A single payer system lowers the cost but the effect is waiting for treatment. The reason it costs less is you have fewer doctors and hospitals providing that treatment so the cost is lower.

In pay to get treatment countries (Mexico, China, India, etc.) you have world class services available but you have to be wealthy enough to pay for them. You limit the demand for world class services through the cost. Low quality services are available for a lowered cost.

What system does America really want. Do you want to tax everybody at an incredibly high rate to provide world class services to everybody? Do you want to ration care with a waiting line? Do you want to determine available of services through success/wealth? Do you want to try something different like access determined by future contribution to society (i.e. otherwise health young 25 year old gets treatment before 80 year grandpa)?

Our current path bankrupts us so we have to determine the best way to balance cost, availability of services, and who has access to them. This isn't about what we wish we could do it's about what we can do.

Submitted by harvey on April 5, 2012 - 1:08pm.

livinincali,

Good post. You are asking the right questions and it's a horrible shame that our government cannot have a mature debate around these questions.

As far as what system we want, I would say America in general would be very happy with a hybrid system where the general public has access to basic healthcare, and premium services are available to those that want to pay more.

With this system Dick Cheney can still pay for his "Cadillac" insurance that gives him a $700K heart transplant but a poor kid who breaks his leg is not faced with the choice of bankrupting his family or walking with a limp for life.

Of course the tricky part comes into play is when someone in the single-payer system needs the $700K heart transplant, but extremely costly cases can be rationed by age and other humanitarian factors (yes I said rationed because, like you point out, allocation is an inescapable aspect of economics.)

Submitted by lookingagain on April 5, 2012 - 1:36pm.

AN wrote:
If the ultimate goal is to be a single payer system, then why not just extend medicare to all those who are uninsured?

Because Obama and congress do not have the stomach to raise the medicare taxes that would be required to do this. Since almost everyone pays into the medicare system, and all at the same percentage of earned income, I would love to hear them explain to the country that regressive taxation as "their fair share."

The system is indeed broken, and it cannot be fixed until everyone is aware of the true cost of healthcare. As long as someone else is paying, everyone involved has had every incentive to maximize benefits. Patients, doctors, hospitals, lawyers, pharmaceutical and device companies as well as the insurance companies, they all have spent the last 50 years milking the system.

Personally, I think that the only way out is to make the consumer aware of the true cost of care, and to regulate the providers (the industrial players, not just the doctors) much like we regulate utilities.

Submitted by AN on April 5, 2012 - 1:40pm.

pri_dk wrote:
[There are lots of alternatives. That may be a good one.

Before we can make any progress, we need a congress that is willing to have an adult conversation about the issues.

Saying "NO!" to every proposal in between temper-tantrums about "socialism" does not qualify as adult conversation.


Sorry, but I put blame on both side. Why can't both side come up with a solution that is bipartisan (i.e. both side would be OK w/ the solution). It's not an adult conversation when one side say, we're in control, we don't care what you say because your vote doesn't matter, so we'll do whatever we want. Then whine about it when the other side gain back some of the control and want to repeal it. This is more of a general statement than just healthcare. You can't possibly be surprised that the side that were basically casted aside as irrelevant in the passing of the bill want to repeal it when they gain back some of the power.

Submitted by harvey on April 5, 2012 - 2:08pm.

AN wrote:
Why can't both side come up with a solution that is bipartisan [...]

You must not have been following the same debate I was.

I was a Republican all my life, but the healthcare debate ended any loyalty I had.

"Socialism, death-panels, government takeover of health care..."

There was no sincere effort on the part of the Republicans to debate. They had no proposal then, and still have no plan now. They never attempted even the most modest compromise, they went "all in" hoping it would fail in order to score political points against Obama. And they are still playing that desperate hand.

Quote:
You can't possibly be surprised that the side that were basically casted aside as irrelevant in the passing of the bill want to repeal it when they gain back some of the power.

No I'm not surprised at all that the Republicans would want to do something out of spite and as an attempt to seize political power. That's all they are about these days. They don't even bother to propose ideas - all they do is attack the other side. "Repeal and replace" is not a solution - it's another term for "go back to square one."

The fact that much of the current legislation they brand as an abomination is basically the same as historical Republican plans (going all the way back to Nixon) is proof that the Republicans have no interest in progressing any agenda that will fix healthcare. All they care about is hurting Obama. It's a destructive fixation.

The Republican agenda is as transparent as it gets. It is obvious that has nothing to do with the health of the American people.

Submitted by AN on April 5, 2012 - 3:04pm.

pri_dk, funny, because I'm actually coming from the other side. I was a registered Democrat for most of my life until recently. Now, I'm an independent. I see both the D & R's agenda as transparent and neither side are really willing to talk about the real solution. They all are saying, it's my way or the highway.

Submitted by AN on April 5, 2012 - 3:05pm.

dup.

Submitted by bearishgurl on April 5, 2012 - 3:12pm.

dumbrenter wrote:
...Those of you on HDHP know exactly what CONCHO says here. the language of the insurance contract is so vague that these guys deny half the annual checkup costs that they are supposed to cover anyway. did you physician perform vision test? Nope, that is not considered part of an annual exam. did you get blood drawn for a cholesterol screening? It is considered lab work and not part of annual exam, so sorry, we do not cover that.
It would have been very helpful if they clearly identify what they cover and what they do not, but obviously it is against their and the doctor's interest to make this clear in the contract. And patients have no idea what their best interest is...most of them anyway.

dumbrenter, I've been on HDHP for 8 years. It IS spelled out what they cover and what will be applied to your (large) deductible when you sign up - that is - ALL x-rays, lab, special procedures and testing ordered by a doctor will be applied to your deductible UNLESS the carrier deems those x-rays, lab, special procedures or testing "preventative health." The term "preventative health" means different things depending on age and gender (and whether they have already paid for same or a similar procedure in the recent past.

Vison care is an add-on with most HDHP's. I have vision and discount dental thru other organizations so don't have them with my medical carrier.

EVERYTHING is spelled out in the plan from the beginning, the copays (PCP, specialist, urgent care, emergency room, generic drugs, brand-name drugs, etc). When your application is accepted and your policy is issued for an agreed-upon monthly premium, a formulary is sent with that policy showing what drugs they cover and don't cover. The policy also explains the procedure for signing up for clinical trials, getting surgery approved in advance, etc. The staffs of the vast majority of the GREAT doctors in SD who take the reputable HDHPs ALREADY KNOW exactly what these plans cover and how to go about getting advance approvals for surgery, lab work, special procedures and tests. In addition, they know how to bill appropriate "preventative care" properly so it will be covered 100% by the plan.

Most of the HDHPs cover at least $400 of "preventative care" per year without applying any of it to the patient's deductible. Some cover MUCH MORE, depending on the patient's age, gender and utilization.

HDHP medical bills are usually processed within one week and the patient can see the EOB's online and print them out if they wish. I'm very happy with the huge choice of providers and service of the carrier.

I like healthcare the way it is set up now but this could change in March 2014 when I feel that myself and many more thousands of the "healthiest" HDHP subscribers in CA will be subject to much larger rate hikes. At that time, the HCRA provision allowing carriers to charge premiums based upon initial underwriting and utilization will end and the relatively "healthy" subscribers will no doubt be charged enough premium to subsidize the HDHP premiums of our vast brethren "contemporaries" who didn't take such stellar care of themselves over the years.

If I didn't have access to a HDHP, I could NOT afford the monthly premiums and I am not alone. A comprehensive individual HMO or PPO plan can be VERY costly between the ages of 50 and 65.

Hopefully, I won't be priced out of coverage before I become eligible for Medicare (IF it's still available) :={

Submitted by sdduuuude on April 5, 2012 - 7:16pm.

pri_dk wrote:
What industry is obligated, by law, to provide everyone goods or services regardless of your ability to pay?

Only one.

Well, maybe that's the problem.

Submitted by sdduuuude on April 5, 2012 - 7:41pm.

I just wish we could separate the market from the charity.

In other words, let the health-care market work like a market, with competing providers, prices set based on costs, demand, competition, etc. Let 1000 different people try 1000 different business plans and let the best rise to the top.

Then, if it turns out everyone can't afford it, you provide money from a charity/welfare pool to give assistance to those who need the services and can't afford it. Limit the distribution of those funds so that costs don't go through the roof and you will find some sense of reasonability in the system.

Problem is, everyone tries to manipulate the market to include the charity within the market, which ruins the market, really for everyone, because you end up with no competition, individuals within government making decisions for millions of people and artificially high prices.

Submitted by sdduuuude on April 5, 2012 - 7:49pm.

Kind of like food stamps.

The government doesn't force bread-makers and farmers to make a certain kind of bread or to price the bread at certain levels, or to sell bread to anyone who wants it - even if they can't afford it.

And I think I can say, without fear of contradiction that EVERYONE participates in the food industry. Maybe we should make everyone buy only health food. Yeah. That's the way I want it, so lets just force everyone to do it. That works every time, says the government official.

Submitted by sdduuuude on April 5, 2012 - 7:49pm.

oops

Submitted by harvey on April 5, 2012 - 8:37pm.

sdduuuude wrote:
And I think I can say, without fear of contradiction that EVERYONE participates in the food industry.

Sorry, but you keep forcing an equivalence that just isn't there. Grocery stores are not required by law to give food to someone that walks in and is starving. Emergency rooms are required to provide services. That's the distinction. If you don't understand this key point you are being disingenuous.

Your suggestion that we eliminate this distinction by removing the requirement to provide care to all does have practical advantages. And it is consistent with everything else - if you can't afford it tough luck. But it would be hard to implement even if somehow we decided it was a good alternative. First, it's not just the law, doctors have ethical codes that are similar. Also, we often simply don't know if someone has the capacity to pay when they go to the hospital. They may be unconscious and, even if they have insurance, hospitals don't know all the details of coverage.

The reality is that healthcare is a very complicated economic problem. It is by far the most complicated product there is. Attempts to dumb it down and compare it to other goods and services just don't work.

Just a few characteristics that make healthcare unique (in addition to what I pointed out above):

- There are huge cost differences between applying preventative care early and treating problems later (save $80 and skip that checkup and you may end up with a $100,000 problem.)

- The benefits of the same treatment applied to two people can be drastically different (e.g. giving an 8 year old vs. an 80 year old a new heart.)

- The massive variability and unpredictability in costs (I myself haven't been to the doctor except for a checkup in over five years, but may get into a car accident tomorrow.)

- The influence of personal choices (e.g. smoking or skydiving) on risks.

- Our ethical obligation as a society to provide basic needs, especially for children who cannot provide for themselves. (Like you said, it's a combination of product and a charity some ways.)

This list could go on much longer. The point is that healthcare needs a comprehensive solution.

People working at corporations with insurance coverage think it's easy (I used to think it was easy too). It is not. Try starting a business when you have a family and you will quickly learn what a mess our healthcare system is. The idea that the cost and ability to access healthcare is primarily a function of who you work for is ridiculous. Yet, that's what we have in America today.

Submitted by ocrenter on April 5, 2012 - 9:54pm.

I was talking to someone who I consider to be very level headed and reasonable the other day. He said he was not in favor of the health care bill. I assumed it was the mandate. And he said no, in fact he thought it was quite logical. But then he mentioned there's a clause in which all Muslims will be exempt from the bill! I asked him did he actually read the bill?

Of course not, turned out theres been a lot of chain e-mails making the rounds. if you are registered Republican chances are you received one of these.

Here's what factcheck.org has to say about this one:

http://www.factcheck.org/2010/05/dhimmit...

Submitted by sdduuuude on April 5, 2012 - 11:43pm.

pri_dk wrote:
sdduuuude wrote:
And I think I can say, without fear of contradiction that EVERYONE participates in the food industry.

Sorry, but you keep forcing an equivalence that just isn't there. Grocery stores are not required by law to give food to someone that walks in and is starving. Emergency rooms are required to provide services. That's the distinction. If you don't understand this key point you are being disingenuous.

I understand your point. That this is the only market where providers are forced to provide. But note Just note - they are forced to provide by the government. So, gov creates this situation that you say justifies their right to force people to buy something they might not choose to buy.

What I hear you saying is that the gov only has the right to force consumers to buy insurance in markets where they have already made the bad decision to force the providers in that inudstry into providing a product for anyone even if they can't afford to pay for it?

So, if they chose to force bread providers to sell bread to anyone who asks for it, even if they can't afford it, then it would be OK to force all citizens to buy futures on bread? See my point? Perhaps the Supreme Court should focus on the providers' rights.

My point is this: That providers are forced to provide, even for free, is a major part of the problem. My comments about separating the charity from the market itself apply here - the gov gives food stamps so they don't have to interfere in the bread market. Beaurocrats don't have to create recipes, bake, ship, and distribute bread, thank god.

Similarly, we could let the healthcare market be a private market, but offer assistance for the needy to buy medical insurance from any number of competing businesses at market rates. I'm against the whole idea of such welfare, but if we insist on providing it, it is better to provide the welfare externally to the market rather than change the market to be more charitable. This way, people feel the true cost of healthcare - as someone said earlier.

Also note - it eliminates all the political discussions of providers, price, service, etc. It takes the gov out of the market. We would be left with the tax burden of providing for the free-riders, but it would be explicit, not hidden in a complete beaurocratic bastardization of a market.

Here's a guy that has an intersting viewpoint on the matter:
http://globaleconomicanalysis.blogspot.c...

His "let it be" comment rings true with me - as in, let the market be a market.

Submitted by sdduuuude on April 5, 2012 - 11:54pm.

I can simplify all this:

If you put together a plan and at some point you decide or realize that, due to the plan, it is necessary to force everyone in the country to buy something that they might otherwise not choose to buy, then there's probably something wrong with the plan.

Submitted by livinincali on April 6, 2012 - 6:56am.

I understand your point. That this is the only market where providers are forced to provide. But note Just note - they are forced to provide by the government. So, gov creates this situation that you say justifies their right to force people to buy something they might not choose to buy.

There is a loophole in the EMTALA that theoretically allows a hospital to exist that can refuse treatments to patients but they can't take a single cent from Medicare or Medicade. Therefore virtually no hospitals exist that don't treat patient regardless of their ability to pay.

It might not be a bad idea to think about a private medical Co-Op type arrangement. Could you get a couple thousand households together paying $5,000 per year to setup a $10 million dollar a year local clinic/hospital. It would be an interesting case study about how low you could make medical costs if you eliminate all the middle men and figure out what care would actually be available on that kind of budget.

Submitted by harvey on April 6, 2012 - 7:16am.

sdduuuude wrote:
I understand your point. That this is the only market where providers are forced to provide. But note Just note - they are forced to provide by the government. So, gov creates this situation that you say justifies their right to force people to buy something they might not choose to buy.

What I hear you saying is that the gov only has the right to force consumers to buy insurance in markets where they have already made the bad decision to force the providers in that inudstry into providing a product for anyone even if they can't afford to pay for it?

Both government and the medical industry have a requirement to provide care - it's part of their ethical standards. I can't say I know all the specifics, but I think it is not easy to separate the laws from the ethical codes.

Personally, I wouldn't so quickly dismiss this as a "bad decision" although there are no doubts limits to the feasibility.

Quote:
So, if they chose to force bread providers to sell bread to anyone who asks for it, even if they can't afford it, then it would be OK to force all citizens to buy futures on bread? See my point? Perhaps the Supreme Court should focus on the providers' rights.

Sorry but you are arguing the slippery slope again and there just isn't one. Plus there is no "providers rights" issue here at all. There are no healthcare providers that feel that their rights are being violated. They want to provide care - to everybody. It's what they do. Of course they need to do it in an economically feasible way. The healthcare industry is a mix of for profit and non-profit businesses (yet another reason it is different...)

Quote:
[...] the gov gives food stamps so they don't have to interfere in the bread market. Beaurocrats don't have to create recipes, bake, ship, and distribute bread, thank god.

Again, I think you are overreaching with your analogy. The new legislation does not tell providers how to provide care. It does nothing analogous to "create recipes, bake, ship, and distribute bread."

Quote:
Similarly, we could let the healthcare market be a private market, but offer assistance for the needy to buy medical insurance from any number of competing businesses at market rates. I'm against the whole idea of such welfare, but if we insist on providing it, it is better to provide the welfare externally to the market rather than change the market to be more charitable. This way, people feel the true cost of healthcare - as someone said earlier.

Well, that's basically what we have now and it doesn't work for many reasons.

Quote:
Here's a guy that has an intersting viewpoint on the matter:
http://globaleconomicanalysis.blogspot.com/2012/04/massachusetts-health-care-system-model.html[

His "let it be" comment rings true with me - as in, let the market be a market.

Sorry but that article is very flawed. The the most glaring issue is that he is comparing the US system with countries that are heavily government subsidized and he doesn't even realize it.

He's right that costs have to come down but "allowing consumers to purchase insurance across state lines" - although a good idea - is hardly going to solve the cost problem alone.

I think your goal of "taking government out of the market" is honestly a bit naive. Healthcare is incredibly complicated. Because of the risks and variability there have to be shared risk pools (i.e. insurance) and there is no way that 300 million people can manage it all themselves as individuals.

Like I said before, you can't "dumb down" healthcare economics to the level of grocery shopping. (In economics parlance it is a market with a massive amount of Information Asymmetry: http://en.wikipedia.org/wiki/Information...) One side (insurance companies) has all the information. They write the contracts, they know the costs, the treatments, etc. The other side (the consumer) cannot possibly keep up.

Markets with information asymmetry need government to referee. There are lots of examples where this works well (mortgages, insurance, stock market, ...)

Many people who are healthy or have decent employer-provided insurance have no idea how complicated it is. You go to the doctor, the bill gets paid. Anybody who has to get their own insurance quickly learns that it's a mess: You have no idea what you are really buying, no idea if the insurance company will honor claims, no idea how to dispute it if they don't...

I suppose one can just not get insurance and live in fear of bankruptcy. And if you have a spouse and a few kids, your risk of bankruptcy is five times higher...

Although the individual mandate may turn out to be technically unconstitutional (I really have no guess either way), I don't understand why people have such an issue with being required to buy something they'd be fools not to buy anyway.

Submitted by ocrenter on April 6, 2012 - 7:16am.

livinincali wrote:

I understand your point. That this is the only market where providers are forced to provide. But note Just note - they are forced to provide by the government. So, gov creates this situation that you say justifies their right to force people to buy something they might not choose to buy.

There is a loophole in the EMTALA that theoretically allows a hospital to exist that can refuse treatments to patients but they can't take a single cent from Medicare or Medicade. Therefore virtually no hospitals exist that don't treat patient regardless of their ability to pay.

It might not be a bad idea to think about a private medical Co-Op type arrangement. Could you get a couple thousand households together paying $5,000 per year to setup a $10 million dollar a year local clinic/hospital. It would be an interesting case study about how low you could make medical costs if you eliminate all the middle men and figure out what care would actually be available on that kind of budget.

Very good point on the role of Medicare in "making" hospitals take the uninsured.

The bottom line here is we as a society have already gone half way. And going half way is costing us dearly. Either we roll back to a China equivalent, which means getting rid of Medicare as well as EMTALA, or we take the next step, which is the mandate.

The fear with the repeal is we then do nothing for another couple more decades when the problem goes from bad to worse.

Submitted by ocrenter on April 6, 2012 - 7:49am.

Agree with pri-dk. +1

As for the republicans, after the last few years, this year I will take the extra effort to change to independent after being a republican since I started voting 2 decades ago.