Supreme Court rules on Obamacare

It sounds like they're going to rule tomorrow. This would be a good thread to talk about it.

For now, any predictions?

I predict they'll uphold it, but I'm not at all confident in that prediction.

Stephen Colbert yesterday said Justice Scalia confessed at a press conference that he is not now and never was a real human being but, in reality, he is four raccoons in a black garbage bag who pass themselves off as a single human being.

That revelation does not bode well for Obamacare.

Details at 11.

Fine with me. Three extra votes!

I have one thing to say. Roberts!?!?!

I can't get at the actual opinion. For some reason, I'm getting error messages when I try to get the .pdfs of any of today's three decisions.

Edited to add: if anyone else is having the same problem, the opinion is available on the Cornell Legal Information Institute site here.

Devastating loss on political grounds for Republicans. To have the the knife twisted into their backs by their golden boy and Federalist Society approved Chief Justice may even be worse. Let us see if they attack the Supreme Court for "judicial activism" this time.

The Tea Party also received the middle finger salute from the SCOTUS.

I have one thing to say. Roberts!?!?!

Trump is calling for his birth certificate.

>4 I have one thing to say. Roberts!?!?!

Curious, yes. No doubt we'll hear plenty of explanations shortly...

Rand Paul questions the constitutional legitimacy of the SCOTUS ruling:

“Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so. The whole thing remains unconstitutional,” the freshman lawmaker said in a statement. “While the court may have erroneously come to the conclusion that the law is allowable, it certainly does nothing to make this mandate or government takeover of our health care right.” http://www.politico.com/blogs/on-congress/2012/06/rand-paul-obamacare-is-still-u...

Well, I called it. :) I shall now revise my earlier claim that I wasn't sure. I was utterly positive! Uh-huh.

I should have said I figured—as I did—that if it was upheld, it would be upheld as part of the taxing power. That's better than continuing the expansion of the Commerce power as far as I'm concerned.

>7

There's always that question, though. Was the ruling upholding the internment of Japanese constitutional? By one logic, yes it was--the Supreme Court ruled. By another, the constitutionality of a law is a matter of appropriate and correct reasoning. Ultimately you can reduce it to an issue of language—"how did they rule" vs. "how should they have ruled."

We have, as a country, been headed toward bankruptcy for quite some time. This should push us over the brink. It should be interesting in a few years or perhaps longer, to live in a bankrupt, second-class country.

"Affordable Health Care Act" Yeah, right. If you believe that, can I interest you in buying this property I own at a real bargain price? It's a city called "Phoenix." You can have it for a million bucks and a trip to London for the Olympics.

I'm all for everyone getting health care, but this isn't the way. Starving people will need more than health care.

7, 8> Of course, at one time slavery and genocide were constitutional. "Constitutional" != "moral", "ethical" or "good policy"

Genocide was constitutional?

I heard that Roberts had stated somewhere that he didn't want to overturn a major law on a 5-4 decision, so maybe he was just looking for an out.

What's going to bankrupt the country is Social Security, Obamacare is just a blip.

#11 by theoria> Sure! It doesn't mean it was LEGAL. Those things aren't the same.

Perhaps Cherokee Nation v. Georgia.

This is largely a semantic issue—two different uses of "Constitutional," but indian removal was usually "legal." Legal is usually used to mean simply "what the law is." Lynching a man who deserves to be lynched is illegal. Executing an man who didn't do it can be legal.

Incidentally, the taxation argument is not a new one among conservatives. The Federal Society held a debate on the topic—available by Podcast. The "uphold" argument was largely on those grounds, not on the expansive Commerce Clause grounds many liberals assumed would fly. As Webster said, the power to tax is the power to destroy. But, with some exceptions, the federal government does have that power. The government was hobbled in this quarter by the fact that they went out of their way to avoid calling it a tax, for political reasons, and didn't write the law the way taxes are usually written.

I think the administration went with the commerce clause for political reasons - to avoid giving more ammunition to conservatives that they'd created more taxes.

I am a little surprised that SCOTUS squared the "it's a tax" argument with the law that says you can't sue over a tax unless it's already gone into effect. They usually love to punt.

(And when I was referring to genocide, I didn't mean just "indian removal" but the specific acts of murder towards the non-combatants. I'm not sure that was every legal.)

>8 Ultimately you can reduce it to an issue of language
>14 This is largely a semantic issue

The truth is out. Tim is a closet postmodernist...

Snort. No, I just hate it when people argue about something and they're really just arguing between two arbitrary definitions.

7: Rand Paul is an idiot. If a law is allowable, then it is Constitutional. Whether it is a good idea or not is an entirely separate question.

15> I am a little surprised that SCOTUS squared the "it's a tax" argument with the law that says you can't sue over a tax unless it's already gone into effect. They usually love to punt.

To answer my own question:

Under the Anti-Injuction Act, tax assessments cannot be challenged until the taxes are due. The majority ruled that the penalties under the health law, which do not start until 2014, were not intended by Congress to be “treated as a ‘tax’ for purposes of the Anti-Injunction Act,” and therefore it was not too early to consider the case.
http://www.nytimes.com/interactive/2012/06/28/us/how-the-justices-ruled-on-healt...

Though I'm still a little surprised they didn't punt.

I think Rand Paul can be excused on the basis of rhetorical hyperbole, as he does go on to say that even if the Court ruled the law constitutional, that didn't make it right. Which is an opinion, not a statement of (erroneous) fact.

And although the Court has held to stare decisis as a general policy, it has reversed prior rulings in the past.

As far as actually making a ruling, as opposed to punting; maybe there were too many powerful people demanding an answer?

#20 by BruceCoulson> As far as actually making a ruling, as opposed to punting; maybe there were too many powerful people demanding an answer?

The question is, was it the Illuminati or the Pentavirate?

The Anti-Injunction Act is itself constitutionally dubious, at least in the extreme. The Supreme Court is there to pass on the Constitutionality of laws. The Congress may not strip it of that power by saying that challenges to laws can't happen until the rocky mountains crumble to dust, pigs fly and Hell freezes over.

There's always that question, though. Was the ruling upholding the internment of Japanese constitutional? By one logic, yes it was--the Supreme Court ruled. By another, the constitutionality of a law is a matter of appropriate and correct reasoning. Ultimately you can reduce it to an issue of language—"how did they rule" vs. "how should they have ruled."

A) Some are balls and some are strikes, but not til the umpire calls them. "Constitutional" and "moral" are not always synonymous.

In the dissent, the writer refers to "Ginsberg's dissent," assuming that when it was written it was the majority opinion. Apparently Roberts changed his mind, and that was left in to show what kind of traitor he was.

#22 by timspalding> The Congress may not strip it of that power by saying that challenges to laws can't happen until the rocky mountains crumble to dust, pigs fly and Hell freezes over.

Well, except for this bit in the Constitution:
In all Cases affecting Ambassadors, other public Ministers and Consuls, and those in which a State shall be Party, the supreme Court shall have original Jurisdiction. In all the other Cases before mentioned, the supreme Court shall have appellate Jurisdiction, both as to Law and Fact, with such Exceptions, and under such Regulations as the Congress shall make.

It seems pretty explicit in allowing Congress to neuter the courts appellate jurisdiction. And this went through the appeals process. I think it wouldn't prevent the SC from taking on the case via original jurisdiction since the a state is a party, though.

Of course, it's probably yet another bit of debate on whether if it has original jurisdiction on a matter if that rule applies even if the matter went through the appeals process. But it doesn't seem nearly as cut and dried as you make it sound.

And if a state were not a party, Congress could strip strip strip away.

http://www.channel3000.com/news/Walker-state-won-t-implement-health-care-law-des...

>24
Walker at work. Guess he needs to reread the constitution ? The health care clinics, hospitals and insurance companies have been planning for this all along. Can't imagine the mess if Walker opts out.

I happened to be online when the decision was made and was confused by no immediate posts, then I read the following article:
=================================================​
Dewey Defeats Truman, again!

Moments after the 193-page ruling was released by the court, several media outlets--including CNN and Fox News--erroneously reported on-air that the mandate had been struck down.

"BREAKING NEWS: INDIVIDUAL MANDATE STRUCK DOWN," CNN's on-screen scroll blared. "Supreme Court finds measure unconstitutional.".....



PS SCOTUS looks too much like misspelled scrotum.

>24

That's interesting. I had not considered the jurisdictional stripping power before. It is broader than I understood. Thank you.

You're right, however, that the federal-vs.-state aspect of this would give them original jurisdiction here.

It would also be interesting to speculate on whether the Reconstruction Amendments prevents some outer limit of jurisdictional stripping, much as they have been understood to extend the (Federal) Bill of Rights to the states. It seems possible to argue that, if the Constitution requires free and republican government and due process of law, that the Congress may not strip the Supreme court of appellate jurisdiction over the parts of the Constitution that provide that--such as stripping the Supreme Courts' right to strike down Ex Post Facto laws, Bills of Attainder or violations of the First Amendment. I am just speculating, but this seems reasonable to me. I would like to believe that a Congressional bill cannot actually strip the Supreme Court of the appellate jurisdiction over cases arising from the Khmer Rouge Takeover Act of 2013. Anyway, I tremble for a future where every bill includes a final clause about the Supreme Court having no jurisdiction over it, and the Supreme Court is reduced to a case a year about ambassadors who didn't get properly reimbursed for a trip.

17 > Tim, the whole decision was total bullshit. They decided as they did because, had they voted to overturn, the law would have been thrown out and therefore dead as a campaign issue. By voting to let it stand, the Republican SCOTUS has allowed the Republican Party to keep beating the Democratic administration with the healthcare club for the remainder of the campaign and maybe throughout Obama's second administration. If the GOP play their cards right, they can use this healthcare gizmo to hamstring Obama's legislative agenda for the next four years. If they had thrown it out, on the other hand, they'd have deprived themselves of a useful tool.

So it was a conspiracy. Roberts acted on orders. If he'd refused no doubt Scalia would have changed sides. Ah. I see. Your hat, it's glinting.

Deke does raise an interesting question—how does this change the political landscape going forward? Many voters, including many swing voters, remain hostile to Obamacare. That it was saved as a tax may exacerbate that. At the same time, the SC's decision strips the anti-Obamacare argument of a key argument, and generally reduces the prominence of the issue, since there's nothing to keep it in the news except politics.

#28: They decided as they did because, had the voted to overturn, the law would have been thrown out and therefore dead as a campaign issue.

That's hard to say. But along the same track, if they had voted to overturn it, we would have heard no end from the Dems about how Republican "judicial activism" has "destroyed" healthcare or some other recycled neocon talking point.

538 did an interesting piece on the topic of how it could affect the election.

I love the conspiracy theory. One big problem, though (even apart from all the other little problems). Two alternative futures debates:

Situation 1:
Romney: ObamaCare is a terrible law.
Obama: But I patterned it after RomneyCare.
Romney: That was appropriate at a state level, but it's unconstitutional at a federal level. You can't force all the states to use the same solution by federal fiat.

Situation 2:
Romney: ObamaCare is a terrible law.
Obama: But I patterned it after RomneyCare. And the Supreme Court declared that it was well within the power of the federal government to take the same model you used and apply it to the country as a whole.

I think one of these two is a winner for Romney. Guess which one. :D

And honestly, the Republicans would much rather have had the ACA dead as a campaign issue, but with them holding the smoking gun. It would have been a notch on their belt and something they could just gesture to instead of spending a lot of time on it. Then they could move onto what poll after poll has shown is the issues that most influence voters decision - jobs and the economy. Any shifting of focus from that to any other topic - including the ACA - is bad for them.

>31

I think it's a good argument. You may be right. Adroitly presented, however, both Romney and Obama can link Obamacare to the economy—Romney that it is expensive and that regulation kills business, Obama that it protects people from financial ruin.

More generally too, it gets at the big "issue under the issues" when it comes to Republican and Democratic takes on the economy, namely the role and size of government.

In other words, I am not sure it's a distraction. It's not some silly issue of cultural politics, but gets at core economic and ideological concerns.

On the lighter side: http://affordablecarecat.com/

31> Romney loses on health care (he took a beating from Santorum already on this topic). He'd rather not talk about it since it detracts attention from his "job creator" bona fides with Bain Capital. The economy is his only plank (and he has to hope that the economic outlook worsens). Topics like foreign policy, immigration, marriage equality, "women's contraception," etc. do not help Romney outside the Republican base.

In contrast, "repeal ACA" is a winning topic for Congressional Republicans, who are stricken by Tea Party fever. These Republicans have much narrower constituencies than the one Romney must reach.

And to repeal, you actually win elections. If it had been ruled unconstitutional, that work would already been done.

29 > My hat is not glinting. It used to glint. Now I no longer vote in our sham elections. I used to vote Democrat. I started voting third-party in 1998. Obama never fooled me. I paid attention when he named Joe Biden his running mate, and voted third-party once again. In 2010, I didn't vote at all, and I'll never vote again while things remain as they are. It's simply a waste of time.

I know what you're thinking at this point: "Things will remain as they are for as long as people like Deacon don't vote." I couldn't disagree more. History records no instance in which fascists let go of power peacefully, once they've attained it. There are, therefore, only two ways out of the mess in which we find ourselves: 1) violent revolution; 2) defeat of the United States by a foreign military power.

I pick exit No. 2. It seems to me that things have to go that way because the American people have shown themselves intellectually incapable of revolt.

"Fascists." *chuckle*

I think it must be time for another world war to give people some perspective.

There have been other times in US history when the political process was controlled by the monied interests, Tamany Hall anyone?, and we managed to find our way through to more democratic times without revolution.

I wish everyone who called leaders of either party (and they've done it to Obama, Bush, Boehner, Pelosi, Reid, etc.) "fascists" or "dictators" or "Nazis" were required to sit down in a room with:

* A relative of the Slovene church choirmaster was was tortured by Mussolini's blackshirts because he didn't want Slovenian surnames changed to Italian ones
* A woman with a serial number inked on her forearm who managed to avoid the showers and the ovens simply because she was farther down in the queue
* The son of someone among the thousands that "disappeared" under Pinochet's reign simply because he was a member of the opposition party

I want them to look each of these three people in the face and lay out their argument for why their democratically elected leaders who come up for a vote every 2, 4, or 6 years in some of the most free and fair elections in the world are tyrants. I especially want to hear the rationale for why the president, who is up for election every four years and who is prevented from serving more than two terms is "just like Hitler."

Do we have problems that need fixing in this country? Definitely! But anyone spending their copious free time posting on the internet about how they basically live in a police state has only one kind of problems: first world problems.

38> Tammany Hall was actually the Democratic party machine which favored less well off immigrants.

OK, not controlled by monied interests but not small-d democratic either.

41> There are many ways to measure small-d democratic. Voter turnout was highest during the heyday of patronage politics.

#39--Regarding Pinochet's dictatorship--his coup would not have been possible without the assistance of the United States in a variety of forms. Our corporations played a part--our military played its part--some props as well to the School of the Americas, Ft. Benning Ga., our secret service CIA as well--and should not forget the POTUS--just happened that he was a conservative--who would have thunk? and his Secretary of State Henry Kissinger. They all were instrumental in the regime change that brought Pinochet to power.

*sigh*

42> Regardless of the aptness of my example, are you denying that there were periods in US history that were less democratic and that we managed to get through them to periods of greater democracy? I'm really thinking of the time of the great trusts and how they owned politicians rather openly I believe. Wasn't it Teddy Roosevelt and the progressives that broke them up?

39 > brightcopy: Hitler wasn't a fascist. Hitler was a Nazi. Your problem is you don't realize there's a difference. At the right end of the spectrum, you're the equivalent of the misinformed many who think Lenin and Stalin were socialists.

45> Money has always influenced US politics, so (for me) this can't be a definitive measure of the "democratic" (see Kennedy's election in 1960, long after trust-busting occurred). If the right to vote is a criterion, then the US survived very long periods of its history without full democratic rights for women and racial/ethnic minorities, rectified formally in 1920 and 1965, respectively. I'm more inclined to evaluate US "democraticness" (sic) along procedural rather than substantive lines, since the latter (substantive outcomes) are less controllable than the former. But aside from my nitpicking, I think we are in general agreement.

N.B. The "Progressive Era" is a mixed bag imho.

#46 by dekesolomon> WTF? I said:
I wish everyone who called leaders of either party ... "fascists" or "dictators" or "Nazis"

Where in there makes you think I don't know the difference? My point is that people throw around these terms, and not only do they not understand the difference between them, but they also don't understand the difference between e.g. actual fascism and their faux "I don't like them so they must be the worst thing ever" fascism.

Congratulations on not falling into the first group.

At the right end of the spectrum, you're the equivalent of the misinformed many who think Lenin and Stalin were socialists.

Not the same at all. Stalin and Lenin would have used the term themselves, in some contexts. Americans as a rule have shied away from it entirely, but socialist as a term has been used by everyone from the British Labour Party to Stalin and the Nazi Party. It's almost as wide as "democratic" or "republic." The appropriate application of the term is a matter of taste, or perhaps semantics, but obviously between very different things.

>39

Yes.

> 49 Stalin and Lenin might have hopped around in circles and called themselves kangaroos, but that wouldn't mean that they were actually kangaroos.

Wake me up when we find the true Scotsman.

Seems to me "socialist" is not like kangaroo.

Nice roundup of various crackpottery going around to "explain" how Roberts could have possibly voted in a clearly obviously idontunderstandhowwecouldpossiblylose way:

http://gawker.com/5922416/john-roberts-medication-made-him-stupid-and-other-righ...

If you prefer: anybody can call themselves anything they like but, in all such cases, wearing the label doesn't indicate the contents of the package.

Nobody who is truly "conservative" or "liberal" could support either George W. Bush OR Barack Hussein Obama. What kind of a conservative tears up the Constitution (Bush), and what kind of a liberal believes that he (or anybody else) has the power to order American citizens killed at whim? What kind of liberal or conservative could support either of those men?

What kind of an idiot -- in a nation that has openly torn up the rule of law (the U.S. Constitution) -- appeals to the legal system or the electoral system for redress of grievances?

There are no American patriots who support George W. Bush or Barack Obama. Both men are criminals and (if we had a government that works) would be arrested and tried for treason. None of their supporters truly believe in the U.S. Constitution.

About 4 months after I voted for Obama--which was about two months into his term I regretted not voting for Nader instead--as I had the two previous elections. Nader--or course--would not have won but I would have felt better. Taken for what that's worth for most people I suspect that would not be much--many of them persist in their lesser of two evils argument--but sometimes even a little is something. It took about two months of his presidency for me to realize I'd been conned. Well this system sucks is all I can say. I would like for it to work but my wanting and the realization of that happening are two quite different things and I can say I think I've quite given up on the electoral process altogether.

I don't know if I'd go quite as far as saying our only two ways out of the political kind of dilemma we as Americans are in is 1) violent revolution or 2) military defeat by another foreign power--both of which seem far fetched scenarios. Our Arab dawn of an Occupy movement has seemingly fizzled in this country anyway--but not necessarily everywhere. What it shows however is we're capable of reaching into our past and creating effective protest movements which can effect change--however that turns out and keeping in mind that our militarized police forces are more forces of the state than of the people and that our media is controlled by those with the most wealth and political power.

>39 Thank you brightcopy.

#52 by brightcopy> Wake me up when we find the true Scotsman.

#55 by dekesolomon> Nobody who is truly "conservative" or "liberal" could support either George W. Bush OR Barack Hussein Obama.

Huh, I never would have guessed "Solomon" was a Scottish name...

> dullcopy -- Maybe you ought to man up and say what you mean instead of trying to look smart by making reference to what is obviously an inside joke.

#56: our media is controlled by those with the most wealth and political power.

Agreed with most of what you said, but the problem of the media is not so conveniently a matter of the whims of a select few. They're just mirroring (and amplifying) the political climate as it exists. The political climate became a two-party system long before the media became what it is today. It's the natural result of vying for the top political offices in the land. The two-party system is the only kind of system that's viable under the US constituion and the populace has largely shaped itself accordingly. The media's just trying serve the politicized audience we happen to have. When third parties are not politically viable (again, for reasons that predate the current media environment), flirting with third-party ideas is ratings suicide.

#60--maybe not quite suicide but...Anyway I agree. More or less you fleshed out what I meant to imply.

I will say this--that from my perspective mainstream media in the USA absolutely can't be trusted to give you more than a version of what's going on at any given time and much of what it does give reads to my eyes like propaganda.

59> No thanks. You're already to the "silly name changes that were all the rage the playground" stage anyway. I'll pop back in when Mr Godwin shows up.

> 62 -- I didn't think you had any sand in your pockets.

Seven Consequences of the Health Care Ruling
--James A. Morone, a professor of political science at Brown, co-author of “The Heart of Power: Health and Politics in the Oval Office.”

Passing health reform has always been hard, but now it’s gotten a lot harder.
The biggest winner is the Roberts court.
The biggest losers are Medicaid and the poor.
For the Obama administration, the hard job begins now.
Big changes are ahead for health care.
For the Republicans, “no” is not enough.
But Democrats can’t rest easy.

http://campaignstops.blogs.nytimes.com/2012/06/28/seven-consequences-of-the-heal...

ETA: Re #1 ("the cost of drugs, devices and procedures continues to spiral"), a segment on NPR discussed a physician-staffed board that set prices (for Medicare?) that allowed individual charges for a sinus gizmo that could be used several times. NYT discussed strategy to charge more for anesthesia in colonoscopies (http://well.blogs.nytimes.com/2012/05/28/waking-up-to-major-colonoscopy-bills/?s...). A new technology allows cataracts to be removed more quickly, and Ontario for one is having devil of a fight to reduce opthalmologists' unchanged charges for that much expedited procedure. Ditto, MDs are pushing back against Ontario effort to get at MDs (with catscan equipment in-office) to charge for referrals to THEMSELVES--well above frequency for referrals to others! Ontario's centralized system is well-poised to detect such potential areas for savings, and it negotiates with physician associations on costs, for savings which it hopes to spend on community health services. Still, Ontario is challenged to control and prioritize health spending. However can we do it here in US with such a polarized political system, so vulnerable to lobbying??

>64
"The biggest losers are Medicaid and the poor. "

Though I agree with this it is a sad fact that Medicaid has been abused. Not just by those who are targeted most often by politicians and society in general. Medicaid needs some serious oversight....it is costing us far too much to pay for people who have learned how to use a system. Not suggesting that everyone does this, but enough. It will not upset me to see some of them have to actually pay for themselves. And I consider myself fairly liberal, just seen too much abuse.

> 64 & 65 -- you guys (gals?) are sniffing the right trail (abuse of the system) but before you start pointing fingers at individuals, think about all the insurance companies and drug companies and manufacturers of medical equipment who advertise on TV. "We guarantee we can get the government to pay for your scooter chair, or we'll give it to you for free." "We can have your diabetes supplies delivered to your door and get medicare to pay for it!" All the ads for supplemental insurance (medicare part B), etc. Start closing down all the scam operators who overcharge for goods, services, medicine, etc., and pretty soon the problem will start to get smaller.

Another thing to think about is the privatization of everything.

I once went to apply for a job teaching English to convicts in prison. It was advertised at $19.50/hour. I was interviewed by a Lutheran minister who told me that SHE gets $19.50/hour for every hour I work and she, in turn pays me $9.00/hour. The state, she said, used to hire and administer the teachers but she and her husband convinced the Dept. of Corrections that they could save the state money by taking over the operation themselves.

Making a long story short, the minister and her husband have put themselves (middlemen) between Corrections and the teachers. The cut the teachers' pay by 50 percent and put the savings in their own pockets. The state used to get decent teachers for $19.50/hour + benefits. Now the state still pays $19.50 per hour for teachers but gets whatever teachers the minister and her hubby can scrounge up for $9.00/hour + no benefits. The prisoners just get screwed.

It's the same way all over government. They've turned the administration of services over to money-grubbing middlemen who pocket half the money and hire second-or-third-class help. The same applies to Medicare, Medicaid, the U.S. Postal Service, Dept. of Agriculture and you name it. They're flushing billions away from taxpayers and into the pockets of "entrepreneurs," who in fact are a lot of freeloading hacks who pay for the privilege by paying kickback campaign contributions to legislators.

Nobody seems to notice that government started delivering mail and providing other services (ag inspectors, etc) because private enterprise couldn't do it for the same price and make a profit. Ergo: if we re-regulate govt. services and throw out all the money-grubbing middlemen, we can put more people back to work at better wages than the middlemen now pay them. Privatization of govt. is a loser. Everything they privatize gets ever and always more expensive while the taxpayer's dollar pays for fewer and fewer services.

#66: They've turned the administration of services over to money-grubbing middlemen who pocket half the money and hire second-or-third-class help.

You could just as easily be describing government bureaucracy. Anyway, if the government is flipping the bill, you don't get to call it "privatization." Whether the work on the ground is done by private businesses or by government bureaucracies, at the end of the day it's the government that's paying without any care about the results. Your government locks up vast numbers of people for violating its own vast number of laws, and then when the government pays for the education of these captive students and you don't get to take as big a bite out this scam as you'd like, somehow it's the middleman's fault?

Nobody seems to notice that government started delivering mail and providing other services (ag inspectors, etc) because private enterprise couldn't do it for the same price and make a profit.

Well, no. Government delivers the mail because they'll shut you down if you try to compete with them. They are a legally protected monopoly (they even say so in their own propaganda). So I would advise against drawing lessons from fabricated history.

> 67 -- I call it theft. THEY call it privatization. And no anarchist should ever talk about history. It's enough if they know how to spell it.

It is so cute when children try to join adult conversations.

Here's a suggestion from The Atlantic for bringing down the cost of healthcare: sell the Pill over the counter. I think morning after pill is already is available OTC for women seventeen and older--why not the birth control pill? OTC availability of the birth control pill would not only bring down cost, it might help ease the religious freedom issue.

"Reserving the pill as a reward for a regular checkup with a gynecologist is no longer just condescending—it’s also medically unsound."

http://www.theatlantic.com/magazine/archive/2012/07/sell-the-pill-over-the-count...


(Condescending = Peggy Olson's visit to OB-GYN in Mad Men episode.)

>70
Agree with you. We would, however, have to take an active role in our knowledge regarding healthcare. Which wouldn't be the worst thing. Need to know that smoking and taking birth control pills at the same time puts one at risk of a stroke. That sort of thing. As a society we are very uninformed about the consequences of our decisions when it comes to our physical well being. (among a few other things)

>70

Yipes. The "morning-after-pill" is different from RU-486. The former is basically a heavy dose of the birth control pill. It's sold under the name "Plan B," but many people just take 3-6 birth control pills to achieve the same effect. (I gather it varies between pills, and, please, nobody take this as medical advice.) There is some disagreement whether this regimen prevents implantation, fertilization, works in other ways or in multiple ways (see recent NYT article).

RU-486 is not the same thing. Rather than preventing fertilization or implantation, RU-486 interferes with the progesterone cycle necessary for the progress of pregnancy in humans. (I gather it binds to where progesterone normally would, but here someone else should take over!)

Mybad--it hadn't registered that RU-486 is not morning after pill--or somehow they became conflated. Thanks for correction (and link). I will remove reference to RU-486 in #70.

36>"History records no instance in which fascists let go of power peacefully"

Sigh, Allow me to quote Wikipedia.

With the death of Franco on 20 November 1975, Juan Carlos became the King of Spain. He immediately began the process of a transition to democracy, ending with Spain becoming a constitutional monarchy articulated by a parliamentary democracy.

now what was the purpose of that Non sequitor?

Just because I know this will be the eventual answer - Spain wasn't controlled by fascists. Franco wasn't a fascist. He started out allied with them and eventually co-opted and ditched them.

Of course, 36 also claimed the US was a fascist government, which is a far worse mistake than thinking Spain under Franco was one. It was a dictatorship, though. And the original statement seems more directed at that. Which makes it still wrong. Franco had set Juan Carlos up to take over as dictator upon his death. Luckily, the new King wanted no such thing.

The Falangists certainly attempted to differentiate themselves from the other fascist movements of the 30's.While it may be that by Francos death they were a long way from their roots, those roots remain in my opinion fascist.

#69: It is so cute when children try to join adult conversations.

I don't think there's anything "cute" about pining for the violent overthrow of the US. Maybe when he was complaining about privatization trying to move onto his turf as if he had some god-given right to the ill-gotten spoils of the prison-industrial complex. But not when he's scratching his itchy trigger finger as a way to solve problems. It's more like watching a drunkard lock himself into his bomb shelter which doubles as his wine cellar.

#76 by SimonW11> No, the Falange was definitely fascist to some degree, no argument. But it also had major differences. And that's who I was referring to when I said Franco allied with, co-opted and ditched them. Franco was never a member of the Falange. He simply used them and the other political parties for his own means.

WASHINGTON -- Republicans have said repeatedly that the landmark health care reform law, upheld as constitutional by the Supreme Court last week, must be repealed and replaced. But the GOP leader in the U.S. Senate gave a surprising answer on "Fox News Sunday" when asked how Republicans would provide health care coverage to 30 million uninsured Americans.

"That is not the issue," Sen. Mitch McConnell said. "The question is how to go step by step to improve the American health care system. It is already the finest health care system in the world."

"Fox News Sunday" host Chris Wallace interrupted, "You don't think 30 million uninsured is an issue?"

"We're not going to turn the American health care system into a western European system," McConnell said. "That's exactly what is at the heart of Obamacare. They want to ... have the federal government take over all American health care. The federal government can't handle Medicare or Medicaid."

If we have the finest system in the world, what must we do to improve it? And McConnell seems to know nothing about the relationship of the congress approved health care bill and the various systems in Europe.

>79
"It is already the finest health care system in the world."

This is why we are having problems. We do NOT have the finest system in the world.

http://www.examiner.com/article/world-studies-rank-u-s-health-care-before-court-...

Why improve on excellence ? What incentive do we have to do anything different in this country if we are the "Greatest County" in the world. No incentive....so we are behind on dang near everything except building weapons.

What is consistantly amazing to me is the fact that these guys McConnell say ANYTHING. It doesn't have to have any basis in reality what so ever. Drives me nuts and they do it all of the time. Who do they think they are that they can "make up" their own facts ? Basically they create their own reality. Why don't more people call them on this ?

Congressmen and rich people in America have the best health care system in the world. No one else matters to Republicans.

>79 "It is already the finest health care system in the world."

We might have finest health care system in the world, but certainly not by most important measure! Sen. McConnell once made disparaging remarks about Ontario's Kingston General Hospital. In response, papers there had much fun comparing life expectancy in Ontario and Kentucky. Kentucky has low life expectancy compared to other states as well. Many reasons, no doubt, but please spare us, Sen. McConnell!

http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/health26-eng.htm
http://www.cdc.gov/nchs/nvss/mortality_tables.htm
http://en.wikipedia.org/wiki/List_of_U.S._states_by_life_expectancy

Senator McConnell was remarkably honest (maybe because he was on Fox News). His non-answer is the Republican answer; for the Republicans, and those they represent, the lack of coverage for those 30 million isn't an issue. Those people can foad; after all, how much did THEY contribute to campaign coffers? Since these people are worthless financially to the party, their welfare is of no consequence.

foad?

Not nitpicking, but I'm trying hard to guess what word that's a typo for!

Ah, fuck-off-and-die? Got it.

Sorry; I prefer not to use profanities in most communication. I feel that this makes my rare use of them more effective.

81> "Congressmen and rich people in America have the best health care system in the world. No one else matters to Republicans."

Many of those Congressmen (Congresspersons?) and rich people are also liberals and Democrats. Why do you give them a pass?

Because they're not the ones saying that there isn't a problem with the health care system in this country.

>86

Political enemies do not hold their views honestly. They don't even have views per se. They are merely monsters.

87: Well, that would probably be because those rich liberals and Democrats support measures like the ACA which are intended to expand health care coverage to those who do not currently have it.

No word from our legal expert. Wonder why. He's probably off mocking conservatives or trying to convert Christians.

90> But, of course, they don't want to have the health care of the masses, they somehow deserve their top drawer health care. They're too good for the same as the poor folk.

92> Personally I think everyone deserves first class health care.

Under Obamacare Congress and Congressional staff will only be offered the same insurance offered to people in the insurance exchanges, rather than Federal Insurance.

By passing a law giving the poor and those already sick access to healthcare the Democrat congressmen have demonstrated that they do care about the health of others.
What recent law can the Republicans point to that demonstrates they still care about the health of others?

>92
http://factcheck.org/2010/01/congress-exempt-from-health-bill/

Are you talking about the Democrats or the Republicans ?

#93 by SimonW11> Under Obamacare Congress and Congressional staff will only be offered the same insurance offered to people in the insurance exchanges, rather than Federal Insurance.

Let's be honest here - this doesn't mean Congress will have the same health care we will. They'll still get their gold-plated expensive plans that are payed for with federal funds (aka taxes).

The plan they have likely already meets or exceeds most or all the exchange requirements. The only thing I can think of that might change it would be the ratio of premiums that must be spent on care and not eaten by the company.

What faceinbook's link shows is they aren't simply "exempted" from the law. But then CharlesBoyd never claimed that. But CB's claim was pretty foggy, since there isn't one single "health care for the masses" but a myriad selection of plans, just as there are today.

And this was all a diversionary strawman anyway. We can all admit politicians aren't our favorite people, no matter whether they have stars on their bellies or not. At the same time, some of us can recognize that one party as a whole has honestly done more to advance affordable health care than the other. The effort may have been flawed and we'll see if how much it actually improves things. But there was undeniably an effort.

>95
Thank you !
We will eventually have a single payer system no matter what gymnastics we go through to get there.

A growing "Profit margin" and "good health for the masses" are not two concepts that are compatible. Just not ! Other countries have figured this out. As much as we don't like the consequences of public healthcare we seem unable to curb the greed that has infused almost every part of our current system. SO......eventually we will have no choice.

#96 by faceinbook> As much as we don't like the consequences of public healthcare we seem unable to curb the greed that has infused almost every part of our current system.

Again, let's be fair and not fool ourselves. The problem with the American health care system is far more complicated than just "greed". Yes, that's one part of it, but there's LOTS of others. There's the fact that we have an employment-based health insurance system (gee, what's one of the things that's most likely too happen when you get sick enough that you can't do your job anymore?) There's the fact that we have an aging population, and end-of-life care is can be outrageously expensive because there are so much "stuff" you can do in such a short amount of time. Even though the tort issues are overblown, the fear of being sued does drive costs up as the default decision for doctors is to order every single test and damn the expense (they're not paying for it). People go to the ER instead of getting preventative care, thus adding in a multiplier for the cost. The government was hamstrung in being forbidden by law to negotiate for drug prices like it does in the VA system. And we're all getting fatter, on average, and that's not exactly a recipe for cheap health care.

SOMEWHERE in there are the insurance companies, but they're really not the driver of cost. I'm not even sure they make the top ten. And it's equally unrealistic to pretend you could replace a greedy insurance system with a perfect, efficient and humane bureaucracy as it is to pretend that insurance companies are just all nice, hardworking folks who just want you to get better.

I'm in favor of single-payer, but I don't want to pretend it's a magic wand. Similarly, I think the ACA is better than what we had and will certainly address many problems (primary care via ER, for one). But I think it's counter-productive to make it out to be too big of a solution, because then people will come back in a decade or two and want to scrap it because it didn't magically "fix" things all by itself.

I post all this because I'm just sick of "healthcare policy by sound bite". It's the same thing that poisoned the well by turning "having honest conversations of end of life care and whether you want to die quietly at home versus in a hospital with a thousand hoses shoved in you" into "death panels." It's the equivalent to going to the ER to get your diabetes treated. This is a complicated problem and there are no simple solutions.

Here's an article the goes a bit more into depth about the complex set of drivers for health care costs. It's not the most authoritative or exhaustive, but it's one of the first that came up on google that outlines a good chunk of the problem:
http://thehealthcareblog.com/blog/2012/03/07/what-is-the-cause-of-excess-costs-i...

This American Life & Planet Money also did an excellent pair of episodes on how we got here, what's wrong and possible ways to start digging ourselves out:
http://www.thisamericanlife.org/radio-archives/episode/391/more-is-less
http://www.thisamericanlife.org/radio-archives/episode/392/someone-elses-money

#97 Excellent post. I think you implied it, but I want to say it explicitly. One of the reasons for the high costs of health care is the large number of uninsured people who use the system. Many ERs are legally bound to accept anyone who shows up at their door, as are psychiatric hospitals. They are not billed, nor is their care free. The insured pay for it. Many people cannot afford the high cost of insurance. Others are free loading bums who want someone else to pay for their health care.

The only way around this is either single payer or individual mandate.

#98 by Arctic-Stranger> Thanks. Yeah, I touched on the ER point (and the links I gave to a much better job). But I just don't want to overplay the point because it's only ONE aspect of the high costs, and I'm not entirely sure how much things will improve under the ACA. There's a pattern that's been ingrained here and undoing it will take a lot more than a signature on a piece of paper. Plus there are plenty of people (the homeless, the mentally ill, the just generally very uneducated) that aren't going to change.

I'm also for single payer, but by itself that's not going to fix things, either. If you look at those drivers of cost, they could actually get worse under single payer. Take "defensive medicine", for example (where doctors send out for all sorts of unnecessary tests to CYA). One thing that might slightly dampen that effect right now is copays. But under single payer, there is literally no reason why a patient wouldn't say "I don't have to pay extra, so you run every damn test and scan you can think of!" Ditto with prescription drugs. Advertising drives a lot of that right now, and just slapping on single payer would just remove the one driver that might get people to actually take a look and decide that the fancy new drug that the drug company is pushing isn't really better than the old generic they have.

I know, I know, there are potential answers to these problems. Like doing analysis on diagnostics based on their usefulness and applicability. Or banning prescription drug advertising, negotiating for drug prices and putting in some sort of testing for when certain drugs are actually necessary (which if you do it wrong can be even worse than our current system).

But a lot of these answers also apply to the current system as well as single payer. We've just yet to make it a priority and tackle it in a coordinated fashion. Instead, we're* too busy trying to score political points.

(*"We" being the country as a whole. I know there's plenty of people out there who get it.)

The only way around this is either single payer or individual mandate.

Which is really the same thing when you come down to it. Either the gov't says you have to pay for it yourself, or you have to pay for it through taxes.

99> Why do you assume that single-payer wouldn't have co-pays?

The only way around this is either single payer or individual mandate.

Which is really the same thing when you come down to it. Either the gov't says you have to pay for it yourself, or you have to pay for it through taxes.

Throw in today's version that it is a cost of doing business that is passed on to the consumer. If I work for Company W, and they pay a part of my health care, that means that the widgets Company W sells are more expensive. If I work for the state, then tax payers are paying for my health care.

But under the current system health insurance is impossible to get for some, and we still pay for their care through higher rates.

Which is really the same thing when you come down to it. Either the gov't says you have to pay for it yourself, or you have to pay for it through taxes.

The difference is that a single payer changes the structure of provision, and gives the government an easier road to regulating who gets what, when. If we are required to have health insurance, we can buy the kind we want. If the government provides us with health insurance, a bunch of voters or, worse, bureaucrats decide.

Of course then insurance companies, who have a commitment to profit OVER your health, get to decide in the free market approach.

95> oh total not only i do I think I think everyone deserves first class health care. i also think people even congressmen are entitled to the best healthcare they can afford and congressmen can afford a lot.

But congressmen have not divorced themselves from this new market. as was implied and by removing spend limits on
cover and most ways of dening insurance, plus paying 95 percent of the insurance of the poorest. the gap between best and worst has been lowered considerably. Affordable healthcare looks to be living up to its name.

>104

Maybe. But why does this argument not apply to everything else? The government should take over the bread market or the bread companies get to decide what bread to make.

(One answer is that medicine is already a highly regulated market, so insurance companies are not really free-market actors, but a queer synergy between government and the free market, taking on some of the worst tendencies of both.)

>97
"Again, let's be fair and not fool ourselves. The problem with the American health care system is far more complicated than just "greed". Yes, that's one part of it, but there's LOTS of others. There's the fact that we have an employment-based health insurance system (gee, what's one of the things that's most likely too happen when you get sick enough that you can't do your job anymore?) There's the fact that we have an aging population, and end-of-life care is can be outrageously expensive because there are so much "stuff" you can do in such a short amount of time. Even though the tort issues are overblown, the fear of being sued does drive costs up as the default decision for doctors is to order every single test and damn the expense (they're not paying for it). People go to the ER instead of getting preventative care, thus adding in a multiplier for the cost. The government was hamstrung in being forbidden by law to negotiate for drug prices like it does in the VA system. And we're all getting fatter, on average, and that's not exactly a recipe for cheap health care."

What have you mentioned in here that doesn't have to do with "greed" ?

>106
Because healthcare is not bread. Health care stands alone. One will not be refused health care and when someone with out insurance or money to pay the bill is treated, those who still have money pay. It is not as simple as loafs of bread, it can not be compared to anything else really.....

#101 by jjwilson61> That's true. You can have single payer with co-pays and some countries do that (but not all). That's kind of my point by saying just "single payer" doesn't fix it. You're now talking "single payer with co-pays". You've added an embellishment. The more you add these kinds of things, the more it starts looking like the current insurance system in many aspects. That's good, but it's not always what people expect.

There's also the fact that said co-pays would likely need to be on a sliding scale, diminishing to nearly nothing at the lower end. The ER problem isn't caused by a bunch of middle-class folks who refuse to pay for insurance and/or go to the doctor for preventative/early-treatment care. It's increases the further you go down the income scale. You're not going to squeeze a lot of cash from these groups for co-pays.

Finally, an interesting note about France. They have single payer with co-pays. So a lot of people just by a private insurance policy on a yearly basis that pays all their co-pays. The cost to them is a fixed premium that they can plan for. This effectively means they don't have co-pays for the purposes of shaping their decision making.

#107 by faceinbook> What have you mentioned in here that doesn't have to do with "greed" ?

Is that an honest question or just a rhetorical jab? Because I don't see how any intellectually honest reading of the paragraph you've quoted wouldn't already answer your question.

#105 by SimonW11> i also think people even congressmen are entitled to the best healthcare they can afford and congressmen can afford a lot.

Of course, that's not really how it works, is it? Congress makes the laws that determine what kind of health insurance you and I will pay out of our pockets to give them.

Maybe. But why does this argument not apply to everything else? The government should take over the bread market or the bread companies get to decide what bread to make.

Because health care is a very specific and inelastic commodity. And the government does step in to supply in cases of need (food stamps).

Also, there's that cost thing. Just like with education, you either pay now for the uninsured to get health care; or you pay later. Or you try to make the uninsured pay. But you're not getting away from the cost, no matter what you decide.

111> Which suggests the Republican opposition is irrational.

Because health care is a very specific and inelastic commodity. And the government does step in to supply in cases of need (food stamps).

Inelastic demand? Supply?

Or you try to make the uninsured pay. But you're not getting away from the cost, no matter what you decide.

Actually, overall costs are lower. Uninsured people get emergency treatment, but they aren't entitled to chronic treatment, and a lot of medicine is chronic. They die earlier.

Obviously, I don't like these savings. But it's not accurate to say that denying insurance to people saves no money overall.

#113 by timspalding> They die earlier.

Fair point. Though I know end-of-life can be much more expensive than all the stuff that comes before it.

On the other hand, everybody has to die eventually, so you don't really get out of end-of-life care anyway. But does EOL care after a life chock with preventative care cost less than an early EOL after a chronic disease?

I wonder if some completely amoral bastard has actually crunched the numbers on a nationwide scale, actually modeling the differences in overall costs of the FOAD Model versus the PMNOPML* Model.

*Pay Me Now or Pay Me Later

>114

Plant money did a show recently on whether free care improved outcomes and whether it cost more. It did and it does.

http://www.npr.org/blogs/money/2012/06/15/155135781/episode-379-does-medicaid-ac...

When you crunch the numbers you get some unexpected, and gross, results. For example, cigarettes cause a lot of lung cancer, and that's terrible. But lung cancer kills you quickly and young, saving you from years of expensive care for chronic conditions, other cancers, etc. On balance cigarettes are bad for people, but good for healthcare spending. No doubt pancreatic cancer is an even bigger financial winner.

Of course, all that talk is bypassing a very real situation that happens every day. Middle-class working people get sick, lose their jobs, lose their insurance, can't pay for gap coverage or are too sick to deal with it, wrack up huge debts, go bankrupt, etc. It's a lot harder to quantify those costs. First, there's the passed on cost if they wind up never manage to dig back out of the hole and pay back those bills. Then there's the cost to society of that person no longer being the functional cog that makes the economy spin the way it does. And finally there's the personal cost - it becomes a moot point whether or not "the rest of society" saves money over all if any member can be yanked out of that society at any time and flushed down the toilet.

Middle-class working people get sick, lose their jobs, lose their insurance, can't pay for gap coverage or are too sick to deal with it, wrack up huge debts, go bankrupt, etc

Similarly, middle-class people don't change jobs, because they know their next insurance will consider them to have a "pre-existing condition." Pregnancy is a pre-existing condition! That's one aspect of the law almost nobody opposes changing.

#115 by timspalding> Thanks for the link. I should listen to "Plant money" more often. :D Normally I only catch them when they do a joint production with TAL.

But again with the point I made in 116, I wonder how much that factors in the cost of the economy losing that person. We tend to put a lot of resources into people up front in terms of schooling, etc. Do you know if they zoomed out that far, only only on the medical costs and benefits?

#117 by timspalding> Similarly, middle-class people don't change jobs, because they know their next insurance will consider them to have a "pre-existing condition.

Yeah, that's a big one. And not only their pre-existing condition, but any PEC their wife or children might have. The American worker is quite constrained in terms of job mobility due to this. It's an incredible hurdle to considering striking out on your own instead of working for an employer (as I'm sure you're very familiar with). I wonder how much our economy misses out on due to that. Or, who knows, maybe the economy likes it better that way?

Stupid economy.

>109
We have employment based health care premiums because the cost for individual premiums are often unaffordable, also in the past, if you have a pre-existing condition insurance companies can deny coverage. You are a liability to them and may cost more than it is worth them to collect your premium. The "Stuff" that doctors order at the end of life care is often not needed. They do this to inflate the bill. Unless you are medically savey, doctors often order tests that are unecessary....especially if they are "bonus" driven at their place of employement. I feel that tort reform is needed ,we must be very careful about that, however, the number of people who threaten doctors over things the doctor has no control over is pretty high. Like it or not....some people think they have millions coming to them if something goes wrong. Doctor's are not God's.....not that a doctor should be neglegent but errors can occur....are we then entitled to millions ? People go to the emergency room because they can not afford a clinic. My son had no insurance for a while, he needed to have $150 to get in the doors of a clinic. Drugs are shipped to Canada, sold from Canada and shipped back here for a third of the cost to the patient. The getting fatter thing may be a stretch as far as greed goes but has a lot to do with dependency on a system that profits from dependency. Just heard a mother of a 14 yr old girl who weighs 247 pounds, when it was suggested her daughter go on a diet say, "Oh she will eventually have her stomach stapled. It is too hard to put a teen ager on a diet"

What do you call all that ? I wasn't trying to make a JAB.....I do think that most of this as a form of personal and/or corporate greed. It is not exclusive to the system but to many who use the system as well. I am guessing that those who don't pay see the doctor far more than those who have hefty copays....why not ?

There are a lot of similar laws. Because of our stupid federal/state tax laws, every time LibraryThing hires an employee in another state, our tax bill goes up—as does that of our customers, since we don't have to collect taxes from states we don't have "nexus" in. It's why companies like Amazon don't hire outside states they have nexus in.

All told, if you really had a president serious about helping the economy, and doing so against this or that powerful but narrowly-focused lobby, there are quite a few regulatory and tax changes to be made.

Going to ask a question here just to see what thoughts you have on this.

My daughter does mammograms as well as other xrays but one day a week is dedicated to mammograms.
She does them on 95 yr. olds, older women who are crippled up with arthritis and often are in pain when the procedure is done, elderly Alzhiemer patients and some elderly women who have other terminal diagnosis'.
She has done this test on combative patients (they do not understand what is happening to them) Patients who have cried with pain when they try to position themselves and patients that are almost catatonic.

She will tell you that all of these are a waste of resources and money. Women who are that old, even if they are in fairly good shape most often will not have anything done should they find any breast cancer. Cancer in the elderly grows very slowly, once surgery is done, it speeds up the process. Most women who are that old will develope complications after surgery and the chemo treatments will most likely kill them before the cancer will.

Should they receive mammograms ?

In some cases, no.

>122

Right. Probably not. There's a lot of these arguments and recommendations now—to not scan for prostate cancer is another. The screening lobby is generally in favor of screening even if no health benefit can be established.

Part of this goes back to the CYA attitude of some docs, and part of it is the inefficiencies in the system.

I recently broke my finger dipnetting in the Copper River. The PA at the emergency care center recommended three x-rays of three fingers--a total of nine. I overheard the x-ray technician complaining that she only needed to x-ray my hand, not individual fingers, and so I requested that. I had to wait a half hour to get the order changed, but eventually they did, and I saved some money.

Throw in today's version that it is a cost of doing business that is passed on to the consumer. If I work for Company W, and they pay a part of my health care, that means that the widgets Company W sells are more expensive.

Haha. Then why doesn't Company W just increase their selling price a bit more, and make a bigger profit? :)

I am not sure what your point is. They do increase their price.

>124 & 125
Screening brings in revenue. Some of the bigger medical clinics and organizations give doctor's incentive bonuses. The amount of the bonus is based on how many dollars they generate for the institution. Drug companies do this as well, they will had out yearly bonuses to the docs depending on how many scripts they've written out.

Just a bad way to achieve a cost efficent system and a healthy society....it is in constant contradiction with itself. Not sure if there is a fix for this.....health care like many systems in this country has grown so big.

>127
It is one of the beefs I have with politicians who are saying that they are going to pave the way for more small businesses. Don't believe that we can fix the decrease of small business with out a fix in our health care system. Much like gasoline prices, the cost of this country's health care affects most everything we do.

127> why don't they increase their price more, to make a profit (you're suggesting they pass on costs, so the increase in price doesn't affect their income/profit...why wouldn't they want more profit)?

My point: If they're trying to make a profit, they already set their selling price at (what they believe is) the point that maximizes the income: at a higher price, they'll sell less and make less money -- so they can't put their price up (unless they're mistaken about where that point is) without making less money. A cost increase makes no difference: if they put their price up to cover the cost increase, they'll make even less than if they put their price up without a cost increase, which already losing! (The change will move the maximum-profit-point, of course, so the price will change over time, but whether it goes up or down (or whether it's worth staying in that business) is not something you can predict...)

Ultimately, their costs are determined by their selling price, not the other way around.

My point--the health insurance costs are not suddenly tacked on for people who already provide it. We, the people, are paying for the employees health cost currently.

And any company that sells a product for less than it costs to make deserves to go out of business.

Now, if you want to talk about new payments under ACA that is another animal. But that is not where I was.

#120 by faceinbook> The "Stuff" that doctors order at the end of life care is often not needed. They do this to inflate the bill.

Have you been around an end-of-life situation? I have, multiple times. What you're saying is just not the entire picture. Do some doctors/hospitals do it for a purely mercenary? I'm sure. There's always some percentage of any group that's pretty rotten. But I've also seen that families are often desperate to do anything other than give up and they don't often put a lot of thought into what that really means.

I also have a close personal friend from college who is a doctor, and I know that they often prescribe things directly due to fear of being sued. And I don't think that's down to a simple matter of greed on the part of the people who might sue them. Analysis show that most malpractice comes from the same doctors being sued over and over. Doctors fear being sued out of proportion to how likely they are to be sued. It's because everything is put on their judgement. We don't have a lot of good regulations/guidelines that would, for example, recommend against the mammograms like you mentioned in your later post. If there was actually a government guideline that says mammograms in those cases aren't really needed, then a doctor would be a bit less fearful about being sued.

But I'm also against tort reform that doesn't prevent doctors from rightly being worried about being incompetent or slipshod. So it's not just greed but also a necessary part of the system.

While you addressed my point about people going to the ER when they could have gotten preventative care long before that point, you didn't really show how that's a simple "greed" answer. It's a structural problem with the system. It's like saying mothers go on food stamps because of "greed". It's more complicated than that and people have a lot of different situations. The ACA will hopefully help address the ER problem, but as I outlined above I still have concerns that it may not be able to fix it.

And no, I don't think your response worked at all in addressing the obesity issue. Are people going to try to make a buck of it? Sure! That happens with everything. But again, to simply say people are fat because... uh... GREED. It just doesn't work.

And then there's the part you completely skipped about having an aging population. If you disagree on everything else, hopefully you can agree that the baby boomers aging isn't because of "greed". ;)

Now, let me reiterate that I never said greed wasn't inolved at a lot of levels and in a lot of different aspects. What I'm saying is that it simply isn't just about "greed."

And on another level, blaming it all on greed is simply giving up on finding a solution since greed will always be with us.

My point: If they're trying to make a profit, they already set their selling price at (what they believe is) the point that maximizes the income:

Yes, but if all your competitors also have to pay medical benefits for their employees (because they wouldn't be able to attract good employees otherwise) then they all will be able to raise their prices because there won't be any competitors able to undercut them (unless you're talking about foreign competitors but then you have shipping costs etc.)

I've always wondered why big US businesses haven't pushed for a single-payer solution to health care. What they pay in health benefits must put them at a disadvantage compared to countries that have gov't provided health care.

109> I do not understand your point.(and i don't pay for congressmens health care).

Perhaps my own postion was less than clear. I beileve that congressmen are entitled to act in their own best interest when their interest do not conflict with those of the people they represent. I further believe that it is in the best interest of the everyone that their congressman is healthy.

That the movement from the federal system to buying their insurance on the market, will note effect either their health or their bank account to any appreciable amount is I think more than just a given, it is both right and fair. I dont expect them to give up their healthcare because others lack it any more than I expect them to give up clean drinking water because millions lack it.

134

An argument could be made that congresspeople should be required to live at the standard of the average citizen, since that would encourage them to act in the best interests of the average citizen. This would be nice in terms of salaries as well, though perhaps somewhat irrelevant since it appears that one must be wealthy-ish in order to get elected to Congress.

>131
You are looking at it in the opposite way than I am. And yes, I worked for 14 years in an intensive care unit. I've seen end of life situations of all sorts. I've seen some situations that warrent all kinds of measures and I've seen some that have not. From my perspective, you are not looking at the picture as a whole. In regards to our personal health care we American's have developed a culture of irresponsibility.....many of us don't take care of ourselves...we depend on the system to fix us once something goes wrong. Rather than accepting the fact that some habits are harmful and changing them, we continue till we need medical intervention. Often those who need the most care are unable to work by the time they reach this point so they are often on disability of some sort....another cost to everyone. The system that provides this care makes a lot of money due to this attitude....what does it benefit the system to have a healthy society ? The act of changing our system would require a complete turn around in our way of thinking.....we can not expect the SYSTEM to do it.....American's as a whole, have to desire HEALTH. Unless we are able to get to that point, government will step in and start to do what it does when we do not govern ourselves, regulate.

My sister works at a clinic.....they are preparing for a boom in bariatric care. Wider doorways, bigger machines for tests, double wide wheel chairs and special lifts to move patients about. Extra doctors were hired. The profits for this venture are projected to go through the roof. Do you feel that the other doctors who are working at the same clinic, the orthopedic docs, the internal medicince or the obstitricians who all make money based on what the clinic takes in as revenue have a strong interest in treating their patients for over eating BEFORE those patients are candidates for the new bariatric center ?

As for end of life issues...that is a whole nother ball game. Again, unrealistic expectations and a cultural denial of death hikes up the cost to everyone. Watched a mother DEMAND that a special chemo nurse be called in at midnight, thousands of dollars worth of chemo drugs were wasted and the doctor had told her repeatedly that her daughter was beyond help. The DAUGHTER told her mom herself to "Let me go"........was a mess, an expensive mess. A "selfish" expensive mess. Caused by one woman's refusal to accept reality.

About the ER......the situation I gave was my son...he had a sinus infection...bad one. No insurance....the doctor who cared for him since he was born could not see him unless he had $150 to hand to the receptionist. Otherwise he had to find a free clinic or an emergency room. The doctor could not make the decision for himself...the clinic made it's own rules about that. Same clinic my sister works at and I assure you that the doctor's average pay, for that particular clinic, is a bit over one million per year. Not sure what you call that ?

Baby boomers ? Yes we are going to break the system. But this isn't something that hasn't been discussed and kicked down the road for sixty some years. We've had time to deal with, what ever it is called, that has corrupted our approach to our healthcare and/or eventual death. Greed may be too specific a term ? Irresponsibility, denial and greed ?

136> I think we're making progress. This was my whole point - it's a lot more complicated than a simple answer of "greed". I think most of your post just reinforces my point.

Tort reform was handled by Indiana years ago, under Governor Bowen. They set a cap on attorney fees. Not how much you could sue for; but how much the attorney could collect. Suddenly, multi-million dollar malpractice suits became a rarity, only sought when it was clear the damage inflicted justified that level of recompense.

As for paying later; the Republicans aren't being irrational, really. They're presuming that they won't be the ones bearing the cost, so it doesn't matter. The Republicans can see the immediate costs, and think that the cost of 30 million uninsured can be passed on to the little people. And like most insurance, until something catastrophic happens, the Republicans will be correct.

I think Americans fail to realise how significant the affordable care act is. President Obama could be caught in bed with a dead girl and a live boy tomorrow and in fifty years time he will be mentioned with respect because of his association with that act. While every republican standing for congress will declare that Universal Healthcare is safe in their hands.

#139 by SimonW11> And considering he's also the first president who actually went on record with saying, "Gay marriage isn't going to destroy America", he's in a really good position.

well i think him being caught in bed with a dead girl and a live boy would put that particular cause back 50 years.

I'm reminded of the libertarian club at Georgetown, where the British member said he wasn't sure he'd do away with their universal health care.

#139: I think Americans fail to realise how significant the affordable care act is.

Kind of like how Bush will fondly be remembered for the "Patriot" Act and the "No Child Left Behind" Act? Sorry, but a pretty name means jack squat.

#140: And considering he's also the first president who actually went on record with saying, "Gay marriage isn't going to destroy America", he's in a really good position.

You mean that PR stunt he pulled just two weeks after pissing off the gay community by refusing to sign a nondiscrimination order for businesses with government contracts? He even went so far as to claim that it was just a "state issue," which is clearly false due to the Full Faith and Credit Clause and the unconstitutional "Defense" of Marriage Act that the previous Dummycrat to inhabit the White House signed into law. Not that reality ever stopped the dumb pigeons on the Left from eating up the propaganda like the fools they are.

142> its not just Britain every country with universal health care has the same reaction. no one wants to go back. when have you ever encountered a european canadian or australian who did not compare their countries system favourable to the old american system, indeed I am sure you have noticed how many regarded the old system with horror. All the countries honour the person who is credited with it. no matter what their politics were, Clement Atlee might be a long way from Bismark but in this this they are both well respected.

135>nods here in the UK every now and then you hear of an MP who has limited their income to say that of a skilled manual worker.
but me i just think it would makes bribes more tempting.

#144: "no one wants to go back."

Is that really because it's so wonderful or because it doesn't matter how crappy the deal is so long as it's nominally free? In the US you'll get plenty of people on both sides of the aisle that wouldn't think twice about laying a hand on Social Security no matter what problems it has. But you don't hear anyone praise Ted Kennedy or Richard Nixon for shoving the HMOs down our throat. Obamneycare is much more the latter than the former.

And no country ever had the "old american system." That's just what propagandists like to say to perpetuate the myth that the decades of political screwage are a "free market" system. I guarantee you that Obamneycare will do nothing to stop the same retards on the left from complaining about "capitalism" in healthcare.

Actually, I would thank Ted and Dick for HMOs. I got affordable care that saved my life from my HMO. Without the HMO, I would have died because I wouldn't have been able to afford to go to the specialist or pay for the surgery or pay for the hospital. I had no assets to mortgage, no credit to run up, I was just plain poor and the HMO was the only insurance plan my employer offered that I could pay for and still make the rent.

In addition to life-saving treatment, I also got great care for chronic illness, great pain management advice, excellent primary care service and free parking. My current employer doesn't offer an HMO option, and I'm disappointed. I've now got to replace that great collection of medical providers one at a time, and some of them I won't be able to afford, even with the insurance I have - so hears hoping there's no relapses.

>146
""capitalism" in healthcare." Well, it is indeed a fact that our healthcare system does function as a capitalist system. It is also a fact that this will not be sustainable. "Obamney care" as you call it is only a bandaide. We will have a public health care system much like Medicare, which seems to work well for seniors. Most of the "fraud" in the Medicare system comes from "capitalists" outside the program. Just need more policing for fraud (unfortuantely).

what is an HMO?

Health Maintenance Organization
http://en.wikipedia.org/wiki/Hmo

>149
Compcare was one of the first HMOs in Wisconsin. They were great...covered everything. Problem was people then went and used them for lots of unnecessary things. Was working in a clinic at the time the first claims started coming in for Compcare subscribers....was unbelievable what people went to see the doctor for. Total bogus. Knew it was going to be an issue sooner or later.

i see so they are intended to provide intergrated medical care?

>152
Yes ! I don't think they anticipated the amount of abuse that patients and/or doctors could come up with.

#151 by faceinbook> In theory, that'd be made up for by the people they did catch earlier with real problems that would have been much more costly in the long term.

No idea if that really panned out. The wikipedia article says "some research indicates that private HMO plans don't achieve any significant cost savings over non-HMO plans", but they don't bother to cite that "some research".

Of course, there's also the hidden bias in that question - "But does it cost more?" It's not asking, "How healthy are people staying under the plan versus under others?" Even if the costs were exactly the same, the HMO might be better if people are staying more healthy. And even if the cost were more, it could still become a net win in terms of employee sick time. Not quite the same scenario, but here's an example of what I mean:

http://www.startribune.com/local/north/148460865.html?page=all&prepage=1&amp...

This Minnesota school district opened two "free" private on-site clinics for its employees. I put free in quotes because the it's free per-use by the employees but of course the money has to come from somewhere. Anyway, the district spent $180k/year to operate the clinics. So far, an increased cost to the employer. However, when they next went to negotiate their contract, instead of facing the projected 7% premium increase ($296k/year) which has been typical, they were actually able to negotiate for a 3% decrease (-$71k). By spending $180k/year to make their employees healthier, they saved $225k/year - a net saving of $71k/year.

As near as I can tell, there's no copay. I'm sure there were plenty of employees that use it for "unnecessary" care. But it seems like what I was talking about earlier about that being outweighed by those whose problems would cost a lot more money down the road. I know there are tons of times where I want to just ask my doctor "can you look at this ingrown toenail and tell me if there's any long-term fix for it?" or "for some reason my eye keeps twitching over and over this week". But I'm not making a doctor visit and paying a copay for something like that. And maybe it's just nothing. But I'm sure somewhere in there there's some things that are definitely not nothing. Doctors always want to see their patients more often when they're healthy or mostly-healthy because it's hard for them to get a big picture when all they see is the sick version.

Of course, this was a win for the school district but might not be as applicable to all business. Many of them would just fire the people when they got sick and not worry about maintaining a long-term healthy workforce.

My impression is that HMO plans are, as far as costs go, an obvious win. I don't have the evidence to hand, but I think that's the general belief, isn't it?

You realize that if Wilbur Mills had not crashed the car with Fanne Fox, and Nixon had not been bogged down with Watergate, we might have a single payer system now.

The Nixon plan was not a single-payer system. Although the American Medical Association called in socialized medicine, Nixon's plan involved employers buying health care, with employees paying 25%. Medicare, meanwhile--the closest thing we have to a single-payer system--would be dismantled and turned over to private insurers. The Kennedy-Mills compromise wasn't single-payer health care either.

>157
Guess Romney has come the closest ?

155> Really, whenever I've seen Kaiser Permanente, the HMO around here )and I believe it was the first HMO?), it's costs were higher than even the PPO plans.

#147: Actually, I would thank Ted and Dick for HMOs.

What? No love for Michael Moore? Then what have the lefties been bitching about all this time?

>159
Kaiser was much cheaper for me, both in my monthly contribution and in my overall costs. It probably partly depends on how much healthcare you need. The healthy young may not see a doctor for several years, while the middle-aged may need to see a doctor every other month as they begin to cope with chronic, time-related conditions such as arthritis. If you never go to the doctor a PPO makes sense, but if you need regular checks on things like your liver enzymes or need prescription drugs, then the PPO can be more expensive.