Supreme Court Ruling on Health Care

[bellasbane]

Our system of government, the determination of Constitutionality of a law, does not hinge on whether some people think the law is good for the people.

No, millions of Americans now are required to have insurance, and it will be subsidized by people like me. Can you believe that a family of four making $91,000 a year will get an insurance subsidy? No, my best interest is not to pay for your health insurance. Not care, but insurance.

States are not the Federal government. States have powers that allow them to enact this kind of law. The Federal government does not.

A law can still be bad even if no one has an alternative.

You offer nothing but empty rhetoric. Living in a civil society is not without cost - you certainly do have an obligation to the common good and universal health care is for the common good. The Supreme Court decided that the Federal government DOES have the right to enact this law - so get over it. The states rights argument is dead.

I live in Massachusetts and thanks to Romneycare, 98% of the people in this state are covered by health insurance and everyone can afford it - even small business owners. So unless you want to be a freeloader on the system, at $91,000 a year you should pay for your own health insurance just like you are probably paying for it now.

Obamacare is the same as Romneycare, but on a national level and it works fine. Just look at the evidence. Health insurance is the mechanism used to fund health care in this nation - personally I’d prefer a single payer public option, but conservatives had to protect the “market” - so we got the individual mandate.

Your obsession with “my best interest” makes you sound like a follower of Ayn Rand. Maybe you should read a bit of Matthew Chapter 5 and see what is ultimately in your best interest and by which standard you will be judged.

 

[bellasbane]

People like you put me in despair that we will ever return this country to any kind of functionality again.

Same back at you.

 

[Jeanne_S]

If Romneycare was a succes in Ma.,that was due largely to the fact that it was a single state involved,with no mandatory enrollment. On a larger scale,such as Obamacare,it will become a tangled mess.Nothing but bureaucrats running the system…just what we need What the heck does the gov’t do well and effeciently,ouside of the military

 

[PaulinVA]

You offer nothing but empty rhetoric. Living in a civil society is not without cost - you certainly do have an obligation to the common good and universal health care is for the common good. The Supreme Court decided that the Federal government DOES have the right to enact this law - so get over it. The states rights argument is dead.

No. I do not have an obligation to pay for your health insurance. Sorry. It’s not empty rhetoric,

I live in Massachusetts and thanks to Romneycare, 98% of the people in this state are covered by health insurance and everyone can afford it - even small business owners. So unless you want to be a freeloader on the system, at $91,000 a year you should pay for your own health insurance just like you are probably paying for it now.

GREAT! I’m glad we agree that the subsidies in the Affordable Care Act are wrong! However, I suspect you don’t understand what I said. In the ACA, people making up to $92,000 get a subsidy to buy insurance on the exchanges. That comes from people who have to buy their own insurance and then buy other people’s insurance as well.

Your obsession with “my best interest” makes you sound like a follower of Ayn Rand. Maybe you should read a bit of Matthew Chapter 5 and see what is ultimately in your best interest and by which standard you will be judged.

I hate it when people try to justify government intervention in our lives by quoting scripture they don’t understand. I give generously to charitable causes. I am against the government taking my money and giving it to other people.

 

[wynnejj]

My personal experience with the health care system in Massachusetts has been phenomenal. Last month, I had a breast cancer scare.

Your personal experience highlights to me the non-negotiable “reproductive rights” issues with the Affordable Care Act. When I think of ACA, I think of ABC connection with breast cancer as the #1 cancer with women. ABC as in Abortion Breast Cancer . That’s the real breast cancer scare.

 

[MichaelTDoyle]

Mickey you base this complete fallacy on??? I have been in healthcare finance for 24 years so I’ve seen the days when Medicare paid approximately the same as regular insurance, followed the cuts for “overpriced procedures” to the point where we are now.

How 'bout this actual statistic:

Surgery payment by Medicare 1988 $5181.00
Surgery payment by Medicare 2012 $1785.00

Do you think the doctor is being greedy because he’d like to keep his office open with reimbursements a fraction of what they were twenty years ago? Are you making a fraction of what you made 20 years ago? Don’t know your age but simple inflation would indicate that prices for everything else have increased dramatically…except medical care.

The “skyrocketing costs” are not going to doctors and not to hospitals either but to huge administrative burdens, higher malpractice and insurance rates, various mandates that increase the cost of care.

The reality is that most doctors can help Medicare patients because they were “subsidized” by regular insurance patients. The more that go onto government programs the lower overall reimbursement rates.

Oh and there is Medicaid…even worse. We used to have a pediatric practice. We gave it up when the reimbursement for a $5000 surgery on a newborn went to $701…

I’m not kidding Mickey. People like you who know nothing about what doctors are facing with the dramatic increases in administrative costs (EMR, PQR) malpractice rates and the dramatic DECREASE in reimbursement really muddy the water.

This bill is a disaster for our medical care system. Just hope and pray it’s repealed by Congress or pray you never need a doctor.

Lisa

This really needed to be re-posted. One of the great things about the internet is you can actually find people comment who authentically have to deal with the issue at hand.

 

[PaulinVA]

Over the past few days I have been thinking about a special that Fareed Zakaria had on CNN about the problems in healthcare. One of the facts he advanced was that 5% of the people are spending 50% of the health care dollars in America. My take on that is that they have multiple conditions that are not being efficiently treated due to the fact they are on medicaid/Medicare and get a lot of their treatment in the Emergency Department. The ED is not an efficient setting to provide care for chronic diseases.

Why are these people going to the ED? There are several reasons, but one is the medicaid/Medicare reimbursement rate. Since many doctors do not accept Medicare/medicaid, the pool of possible doctors/groups to treat these patients is low. Also, these groups/doctors that do accept Medicare/medicaid might not be in the locations the highest users of services can get to.

So, to reduce the cost of these 5% who are spending half of the healthcare dollars, we need to efficiently treat their multiple conditions in the right setting. Increase Medicare/medicaid reimbursement rates to make it attractive (not neutral) to treat these patients. Make it easier to get Durable Medical Equipment for home treatment. Open clinics in public housing areas and other areas where transportation could be a factor.

If you can cut by half the amount of money these top 5% spend, you have saved 25% of the health care spending in America.

 

[MichaelTDoyle]

Take the blue pill and enjoy your serfdom.

As others have pointed out, this novel interpretation now allows congress to tax citizens lack of behavior. It is the final nail in the coffin of a once free people and the beginning of our serfdom. I know if you are reading this, you must think me a crank or a paranoid. I am not either, so my shrink tells me. History shows, that successful freemen were never taken over forcibly, and then gave up their rights in a single fell swoop or cout de gras, but a slow erosion over long period of time.

All the good things you point out in 10 years may be less will include the conversion of the medical profession into government bureaucrats, crippling taxes, medical care rationing to the productive members of society and a large swath of behavior moderating laws by congress with the associated tax for failure to comply.
Enjoy……

Actually, after the Reichstag fire, the NAZI party and the Gestapo fairly quickly instituted totalitarian rule over every aspect of public and private life from education, to hobbies, to taking vacations, the NAZIs decided for the citizenry. Yet, as long as there was chicken in the pot there was not great resistance.

There are a lot of people–maybe a majority–who would rather have a chicken in a pot than liberty. More who do not even understand what they are giving up for that chicken dinner.

It can happen here with the use of the IRS and taxation as the compelling forces.

If we do not turn socialism back in 2012, there may not be another chance. Future choices will be socialism with taxation powers or HARDER socialism with taxation powers.

The genii is out of the bottle. Persecution of tour holy Church is a canary in the coal mine.

vatican.va/holy_father/pius_xi/encyclicals/documents/hf_p-xi_enc_14031937_mit-brennender-sorge_en.html

 

[SamH]

You offer nothing but empty rhetoric. Living in a civil society is not without cost - you certainly do have an obligation to the common good and universal health care is for the common good. The Supreme Court decided that the Federal government DOES have the right to enact this law - so get over it. The states rights argument is dead.
.

Didn’t Karl Marx make that argument about the “common good”? The US is based on individual freedom - not the common good.

We’re going to take things away from you on behalf of the common good.
Hillary Clinton

Society does not consist of individuals, but expresses the sum of interrelations, the relations within which these individuals stand.

Marx, The Grundrisse (1857)

 

[_Abyssinia]

Justice Roberts did the right thing to uphold the law and this is truly a victory for the American people. Millions of American’s will now benefit from access to affordable health care unless voters are gullible enough to fall for the right-wing propaganda paid for by people like the Koch brothers, Rupert Murdoch, Sheldon Adelson or some shady member of the 1% who want nothing more than to get rid of a populist president. I for one refuse to buy into their propaganda of partial truths aimed at getting average people to vote against their own best interests.

The bottom line is that Obamacare is just Romneycare on a national level. There is no need to speculate about what it will mean to you or to the national economy - the experiment has been done and it is a success. It may not be perfect, but it works. You can read all about what a success it has been for Massachusetts here:

Massachusetts Health Care Law, Staple Of Mitt Romney Legacy, May Hold Good Signs For Obamacare

My personal experience with the health care system in Massachusetts has been phenomenal. Last month, I had a breast cancer scare. It was a stressful two weeks, but during that time I was able to see my doctor, have a mammogram & ultrasound, a core biopsy and two consultations with the surgeon & breast care specialist who was handling my case. The health care I received was top rate, fast, efficient, and compassionate - that is what we have here in Massachusetts. That is what every person in this nation deserves.

I thank God for what my experience has taught me. I don’t have cancer, but I do have greater compassion for those who fight against it every day. I just participated in the American Cancer Association Relay for Life - and it was an incredible experience. So many stories and lives - every one of them precious. I thank God that I live in a state where every person who suffers from cancer or any other health care issue is able to get the same quality of care that I received and are able to live their lives with dignity without the fear that it will bankrupt their family.

Think about that next time you hear someone say the Affordable Health Care law is bad public policy. What do the Republicans propose instead? The individual mandate is a constitutional, conservative solution to the health care crisis that was developed by the Heritage Foundation. The GOP is trashing their own best proposal out of pure malice and hatred for the president. They have nothing better to offer.

ObamaTax is not RomneyCare on a federal level. RomneyCare did not create many new taxes, like ObamaTax does. They are two different bills. People have provided evince for why RomneyCare has created is own problems. If it is so great why hasn’t it been copied in more states, not even by Democrats?

Republicans propose health care form, as described here

Stuart Butler of the Heritage Foundation has written a column in which he says it is a myth that Heritage invented the mandate and yet you and other Democrats are perpetuating a myth by saying it was created by Heritage - Republicans and conservatives

Mandate Heritage supported was in the 1990s, that was different time. Anyway, he describes ‘three critical features’ which distinguish the mandate from ObamaTax’s mandate

First, it was not primarily intended to push people to obtain protection for their own good, but to protect others. Like auto damage liability insurance required in most states, our requirement focused on “catastrophic” costs — so hospitals and taxpayers would not have to foot the bill for the expensive illness or accident of someone who did not buy insurance.

Second, we sought to induce people to buy coverage primarily through the carrot of a generous health credit or voucher, financed in part by a fundamental reform of the tax treatment of health coverage, rather than by a stick.

And third, in the legislation we helped craft that ultimately became a preferred alternative to ClintonCare, the “mandate” was actually the loss of certain tax breaks for those not choosing to buy coverage, not a legal requirement.

Stuart then says of the reasons they do not support the mandate now

First, health research and advances in economic analysis have convinced people like me that an insurance mandate isn’t needed to achieve stable, near-universal coverage. For example, the new field of behavioral economics taught me that default auto-enrollment in employer or nonemployer insurance plans can lead many people to buy coverage without a requirement.

Also, advances in “risk adjustment” tools are improving the stability of voluntary insurance. And Heritage-funded research on federal employees’ coverage — which has no mandate — caused me to conclude we had made a mistake in the 1990s. That’s why we believe that President Obama and others are dead wrong about the need for a mandate.

Additionally, the meaning of the individual mandate we are said to have “invented” has changed over time. Today it means the government makes people buy comprehensive benefits for their own good, rather than our original emphasis on protecting society from the heavy medical costs of free riders.

Moreover, I agree with my legal colleagues at Heritage that today’s version of a mandate exceeds the constitutional powers granted to the federal government. Forcing those Americans not in the insurance market to purchase comprehensive insurance for themselves goes beyond even the most expansive precedents of the courts.

Heritage Foundation alumnus, Peter Ferrara, takes credit for ‘killing’ the Heritage plan after he left the institution

I had been close friends up until then with Stuart Butler, even double dating a couple of times with our girlfriends and then wives. Before he became Director of Domestic Policy [at the Heritage Foundation], Heritage had offered the job to then another friend of mine, Tony Pellechio. But I wanted Stuart to get it, because I thought Stuart was more hard core. So I talked Tony out of taking the job when he came to me to ask what I thought he should do. Sure enough, Stuart was next in line. Stuart does not know about this history almost 30 years ago to this day.

Stuart had no response to my objections to the individual mandate. But he was passionately devoted to the brilliance of the Heritage health plan. I told him it was so close to the Hillary plan, and so poorly framed as an alternative, that I predicted that President Clinton would come to point to it as the GOP alternative plan, and seek to get the Hillary plan passed as a compromise just ironing out the differences (employer pays or worker pays, generous health insurance or cheap health insurance).

Sure enough, a year later, as the Hillary plan was about to go down to defeat, President Clinton arose to point to the Heritage plan as the true GOP alternative, and offer to pass health reform by just ironing out the differences. Fortunately by then, I had already killed the Heritage health plan.

townhall.com/columnists/peterferrara/2011/12/23/heritage_and_the_individual_mandate/page/full

Just because some conservatives supported a mandate does not mean all did, and the mandate in the 1990s or even the original mandate for RomneyCare was not like the ObamaTax mandate

Romneycare was passed by the Massachusetts legislature, having both an employer mandate and individual mandate which was not Heritage’s individual market plan. Romney vetoed the employer mandate, but the over 80% Democrat legislature overrode Romney’s veto. RomneyCare as it is today is not the plan that Heritage probably wanted or Romney, which is why he has said there would be things he would change and it is not suited to a federal level. Romney also vetoed employer penalty, but was overrode by a majority Democrat legislature

 

[SamH]

My personal experience with the health care system in Massachusetts has been phenomenal. Last month, I had a breast cancer scare. It was a stressful two weeks, but during that time I was able to see my doctor, have a mammogram & ultrasound, a core biopsy and two consultations with the surgeon & breast care specialist who was handling my case.

Just wondering - did you know that the HHS is wanting fewer mammograms and most likely recommendations that will provide fewer screening would be incorporated into Obama Tax?

healthfinder.gov/news/newsstory.aspx?docID=657900

 

[_Abyssinia]

Merrill Matthews insights on the 1990s

Newt’s Wrong, Most Conservatives Opposed Insurance Mandate

In 2006, shortly after the legislation passed, Haislmaier was speaking to a group of state legislators and policy experts where he defended the Massachusetts plan and boasted of a long list of state officials who had contacted him for more information about implementing a Massachusetts-style plan in their states.

The problem is that managed competition—which was also the model for the Clinton plan—doesn’t work very well, at least outside the confines of an employer. John Goodman and Gerald Musgrave published

in 1994 “A Primer on Managed Competition” explaining some of the perverse economic incentives inherent in that model—such as choosing a less expensive plan until major medical care is needed and then shifting to more comprehensive and more expensive coverage—and why the government must heavily manage it. They predicted some of the problems we’re now seeing in Massachusetts.

Some Republican politicians—Sen. Don Nickles of Oklahoma, Rep. Jim McCrery of Louisiana, former Vice President Dan Quayle, and of course Newt, among others—picked up on the Heritage proposal. But virtually every other conservative or libertarian think tank or policy organization opposed it, choosing the MSA model instead.

The true conservative alternative plan was born in March of 1993, when then-Texas Senator Phil Gramm held a meeting in his office that included two econometricians, his health policy staffer and me, representing the NCPA. Gramm resolved to take on Clintoncare and wanted as an alternative a comprehensive health care reform bill that focused on Medical Savings Accounts. His staffer would write the bill, and he needed the rest of us to provide policy advice regarding how to make it work. Once Gramm, accompanied by Texas Rep. Dick Armey, started preaching MSAs, they became the market-based alternative to the Clinton health plan—and they have been the key ingredient to every major Republican health care bill since.

Grace-Marie Turner of health policy think tank, Galen Institute, on the 1990s history of the individual mandate

Setting the record straight on the individual mandate

Former Speaker Newt Gingrich repeatedly insists that most conservatives once supported an individual mandate for health insurance.

I beg to differ, Mr. Speaker. The Galen Institute, and I in particular, along with many other colleagues, including the CATO Institute, NEVER have supported an individual mandate.

One of the key responsibilities of think tanks is to think through public policy initiatives and analyze their likely impact before they become law. We advise lawmakers all the time about the likely consequences of their policy ideas to help them develop good policy and avoid mistakes.

We knew from the beginning that an individual mandate was an affront to our Constitutional liberties and that it would lead to government determining what kind of health insurance we must buy, huge taxpayer-funded subsidies to help people purchase the expensive new government-mandated coverage, invasions of our privacy so the government can find out if we are complying, and a slew of mandates and regulations…

No, Newt, most conservatives never have supported an individual mandate. We thought this through and saw exactly where it would lead.

 

[TheRealJuliane]

Same back at you.

When was the last time you read the Federalist Papers, dear?

 

[stevegravy]

When was the last time you read the Federalist Papers, dear?

Better yet, when was the last time a Supreme Court Supreme read them?
Well my opinion on Obamatax is mute because of Roberts Court Order:
I would add one more crazy observation regardless if it is food, retirement income, or health care,
headlines last week about the record number of Americans getting free food from the government. Couple that with the signs in the national parks warning tourist to not feed the animals, they lose the ability to feed themselves. You can see what we are becoming and it ain’tr pretty.

 

[bellasbane]

No. I do not have an obligation to pay for your health insurance. Sorry. It’s not empty rhetoric,

GREAT! I’m glad we agree that the subsidies in the Affordable Care Act are wrong! However, I suspect you don’t understand what I said. In the ACA, people making up to $92,000 get a subsidy to buy insurance on the exchanges. That comes from people who have to buy their own insurance and then buy other people’s insurance as well.

I hate it when people try to justify government intervention in our lives by quoting scripture they don’t understand. I give generously to charitable causes. I am against the government taking my money and giving it to other people.

I hate it when people apply modern political theory to interpretations of scripture to justify the separation of church and state. That whole line of reasoning is a product of the Protestant Reformation. Since I’m a Catholic and know my Church history - that doesn’t really work with me.

The Catholic Church has always viewed government as a vehicle for doing God’s work on earth. Jesus said pay your taxes. He also said we should pray to God to “give us this day our daily bread”. Well, who distributed “daily bread” to the people of Rome? That would be the Roman government. Jesus knew this. I don’t recall any scriptures where he argues against this arrangement. Do you think he meant we should expect it fall down like manna from heaven?

If you are not getting insurance benefits from your employer and have to buy insurance on your own, then I can see how a person making $91,000 a year with a family of four would be hard pressed to pay for it without help. Having that albatross lifted would certainly free people up to spend more money in other areas of the economy, which is exactly what we need to get it moving again.

 

[bellasbane]

If Romneycare was a succes in Ma.,that was due largely to the fact that it was a single state involved,with no mandatory enrollment. On a larger scale,such as Obamacare,it will become a tangled mess.Nothing but bureaucrats running the system…just what we need What the heck does the gov’t do well and effeciently,ouside of the military

VA health care works pretty good.

 

[stevegravy]

I hate it when people apply modern political theory to interpretations of scripture to justify the separation of church and state. That whole line of reasoning is a product of the Protestant Reformation. Since I’m a Catholic and know my Church history - that doesn’t really work with me.

The Catholic Church has always viewed government as a vehicle for doing God’s work on earth. Jesus said pay your taxes. He also said we should pray to God to “give us this day our daily bread”. Well, who distributed “daily bread” to the people of Rome? That would be the Roman government. Jesus knew this. I don’t recall any scriptures where he argues against this arrangement. Do you think he meant we should expect it fall down like manna from heaven?

If you are not getting insurance benefits from your employer and have to buy insurance on your own, then I can see how a person making $91,000 a year with a family of four would be hard pressed to pay for it without help. Having that albatross lifted would certainly free people up to spend more money in other areas of the economy, which is exactly what we need to get it moving again.

Well it used to be freemen of Rome operating farms and bakeries until the empire settled in. It took a couple hundred years of one bad decision after another but it finally showed up. Besides, the prayer of Jesus is addressed to the Father not the emperor.
All we want is bread and circus.

 

[MichaelTDoyle]

“Our daily bread” was not an injunction for a government handout. Good grief. Working through the government is fine but that does not obviate the need for prudence and wisdom, which this plan does not have. Nor is it in any way amenable to the moral life of the Church, which is a higher calling than eating.

Seriously, how many trillions in waste and corruption do you have to see go down the hole before we all accept that Federal control of every aspect of our healthcare is both foolish and a recipe for belligerence and abuse. That is NOT the Catholic Way.

 

[Mickey_Finn]

Mickey you base this complete fallacy on??? I have been in healthcare finance for 24 years so I’ve seen the days when Medicare paid approximately the same as regular insurance, followed the cuts for “overpriced procedures” to the point where we are now.

How 'bout this actual statistic:

Surgery payment by Medicare 1988 $5181.00
Surgery payment by Medicare 2012 $1785.00

Do you think the doctor is being greedy because he’d like to keep his office open with reimbursements a fraction of what they were twenty years ago? Are you making a fraction of what you made 20 years ago? Don’t know your age but simple inflation would indicate that prices for everything else have increased dramatically…except medical care.

The “skyrocketing costs” are not going to doctors and not to hospitals either but to huge administrative burdens, higher malpractice and insurance rates, various mandates that increase the cost of care.

The reality is that most doctors can help Medicare patients because they were “subsidized” by regular insurance patients. The more that go onto government programs the lower overall reimbursement rates.

Oh and there is Medicaid…even worse. We used to have a pediatric practice. We gave it up when the reimbursement for a $5000 surgery on a newborn went to $701…

I’m not kidding Mickey. People like you who know nothing about what doctors are facing with the dramatic increases in administrative costs (EMR, PQR) malpractice rates and the dramatic DECREASE in reimbursement really muddy the water.

This bill is a disaster for our medical care system. Just hope and pray it’s repealed by Congress or pray you never need a doctor.

Lisa

*Hi Lisa, nice to hear from you again. Reference your, “Surgery payment by Medicare 1988 $5181.00”. What can I say. The eighties were a time of excesses.

Otherwise, from what I’ve seen of medicare payments. They have a fee schedule that they go by. If the charge is considered allowable. They’ll generally pay 80 percent of the allowable fee. My Dental insurance does the same thing. (Sadly, they don’t pay 80% though.)

As I’m sure you, as someone in the business, knows. Many organizations have fee schedules. Workers comp in most states is another example. So in short. It’s not revolutionary, it’s how things are done. I’ve not heard of any hospitals, or ambulance companies going out of business for it. Quite the opposite in fact. If they did not have medicare payments coming in, in a timely fashion. Then, they would go out of business.*

I’m sure you know this as well. Much in the medical profession has changed between 1988 and 2012. In general, procedures are much less invasive. Many surgeries are handled on an “out patient” basis. I would have to wonder about a physician who is performing the very same procedure today. That he did in 1988. Besides that, Surgeon/physician incomes rose drastically in the eighties. There was the advent of elective surguries. Most of which, I don’t believe deserve medicare reimbursment in the first place. But, they drove up costs non-the-less. Without some serious innovation on the part of our government. We might have seen physician fees cut entirely from medicare. GW, and his administration actually considered this. Where do you suppose we would be now, if they had?

ATB

 

[TheRealJuliane]

Better yet, when was the last time a Supreme Court Supreme read them?
Well my opinion on Obamatax is mute because of Roberts Court Order:
I would add one more crazy observation regardless if it is food, retirement income, or health care,
headlines last week about the record number of Americans getting free food from the government. Couple that with the signs in the national parks warning tourist to not feed the animals, they lose the ability to feed themselves. You can see what we are becoming and it ain’tr pretty.

Heard last night:

In 1984, 85% of Americans were paying federal income tax.

In 2012, 51% of Americans are paying federal income tax.

That statistic alone should make any American But we aren’t the nation we used to be. Most people either can’t understand the statistics at all, or if they grasp it, are

“So what, and what’s on American Idol tonight?”