Supreme Court upholds Affordable Care Act

[marcus]

SCOTUS decided 6-3 not to wreck the ACA
http://abcnews.go.com/Politics/supreme-court-upholds-obama-health-care-subsidies/story?id=31931412

 

[jtbell]

So now it's going to come down to the election next year. If the Republicans keep control of Congress, and win the White House, they'll surely do something, after years of fulminating against the ACA. Since taking over the House of Representatives, they've voted to repeal the ACA, what, fifty times already?

 

[StevieTNZ]

Just reading the judgement now: http://www.supremecourt.gov/opinions/14pdf/14-114_qol1.pdf

More good news for Americans.

The President's statement: https://www.whitehouse.gov/blog/201...me-court-upholds-key-part-affordable-care-act

 

[mheslep]

Now onto replacement proposals.

http://energycommerce.house.gov/press-release/burr-hatch-upton-unveil-obamacare-replacement-plan

 

[wolram]

IMHO ACA should be world wide, why is that that a great nation like the USA should not embrace it.

 

[mheslep]

"IMHO ACA should be world wide ..."

You think the US' ACA should replace the UK's NHS?

 

[Finny]

If you know a Canadian, chat with them about their national health care.

They are prohibited from paying out of their own pocket for a doctor of their own choice.
Hence many come to the US, especially the US Midwest, for care.

If you want to know what ACA will become over time, just look at the Veteran's Administration and
the lackluster care given to our military.

 

[Tobias Funke]

If you know a Canadian, chat with them about their national health care.

They're mostly satisfied with it and overwhemingly prefer it to the US system before ACA.

 

[jim hardy]

They are prohibited from paying out of their own pocket for a doctor of their own choice.

Is that something new ? The years i spent in Montreal wealthy people used private doctors and there was no shortage of either.

 

[mheslep]

I'm inclined to count how peoplehttp://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/articles/leaving-canada-for-medical-care-2011-ff0712.pdf when gauging opinion:

In 2011, an estimated 46,159 Canadians received nonemergency medical treatment outside Canada. In some cases, these patients needed to leave Canada due to a lack of available resources or a lack of appropriate procedure/technology. In others, their departure will have been driven by a desire to return more quickly to their lives, to seek out superior quality care, or perhaps to save their own lives or avoid the risk of disability. Clearly, the number of Canadians who ultimately receive their medical care in other countries is not insignificant.

 

[Tobias Funke]

And the population is 35 million so that's 0.13% of them. And they don't all go to the US. And Canada's health care system is ranked above the US's (but still low). And polls show that they're generally content and think they have it better than the US. And in 2007 over 150,000 US citizens sought medical care outside the country.

All I can think of is that Mean Girls quote: "Gretchen, stop trying to make fetch happen! It's not going to happen!"

 

[Evo]

And the population is 35 million so that's 0.13% of them. And they don't all go to the US. And Canada's health care system is ranked above the US's (but still low). And polls show that they're generally content and think they have it better than the US. And in 2007 over 150,000 US citizens sought medical care outside the country.

All I can think of is that Mean Girls quote: "Gretchen, stop trying to make fetch happen! It's not going to happen!"

Your statistics are from 2007, mine are from 2011. Oh wait, you didn't even post any statistics, you posted a tv show.

So many Canadians come over the border to get health care in the US due to the long wait times in Canada.

A Canadian study released Wednesday http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/articles/leaving-canada-for-medical-care-2011-ff0712.pdf that many provinces in our neighbor to the north have seen patients fleeing the country and opting for medical treatment in the United States.

The nonpartisan Fraser Institute reported that 46,159 Canadians sought medical treatment outside of Canada in 2011, as wait times increased 104 percent — more than double — compared with statistics from 1993.

Specialist physicians http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/publications/waiting-your-turn-2011.pdf across 12 specialties and 10 provinces reported an average total wait time of 19 weeks between the time a general practitioner refers a patient and the time a specialist provides elective treatment — the longest they have ever recorded.

http://dailycaller.com/2012/07/11/report-thousands-fled-canada-for-health-care-in-2011/

 

[Tobias Funke]

Your statistics are from 2007, mine are from 2011. Oh wait, you didn't even post any statistics, you posted a tv show.

Yes, I didn't post any statistics but they just happen to be from 2007. (Edit: I even misread the number: it was estimated at 750,000, not 150,000. That's 0.25% of the population.) They're all easy to find, and I notice that you didn't see fit to question Finny's bold statement---not presented as an opinion---about the future of ACA*, so at least try to be consistent.

So many Canadians come over the border to get health care in the US due to the long wait times in Canada.

So many, as in 0.13% of the population, or as the study claims, 1% of all patients? And, as I said above but you ignored so you could focus on my "post[ing] a tv show", it never says how many go to the US.

I have no idea what you're trying to prove here. That Canada's health care system is worse than the USA's?

*Namely, that it will turn into a health care system that has a...um...high...customer satisfaction rating!?

 

[mheslep]

The population of Canada is 35 million, but the relevant figure for this discussion is not the population but the fraction seeking non-trivial health care; that is, to obtain something like cancer treatment not wrap a sprained angle.

 

[Tobias Funke]

Ok, so find that fraction, find which countries they go to to get such treatments, and then compare that to the fraction of US residents who seek non-trivial treatment in other countries (for that matter, find out what fraction doesn't get treatment because they can't afford it). Then tell all those Canadians and all those experts who rank nations' health care systems that they're wrong and it's actually a bunch of guys on a physics forum who really know what they're talking about.

 

[mheslep]

Ok, so find that fraction, find which countries they go to to get such treatments, and then compare that to the fraction of US residents who seek non-trivial treatment in other countries (for that matter, find out what fraction doesn't get treatment because they can't afford it). Then tell all those Canadians and all those experts who rank nations' health care systems that they're wrong and it's actually a bunch of guys on a physics forum who really know what they're talking about.

Appeal to authority, appeal to emotion, strawmen in flames.

 

[Tobias Funke]

Appeal to authority, appeal to emotion, strawmen in flames.

Failure to say what the relevant fraction---which you presumably know---is.

My post is only a strawman if you're not actually trying to argue that the US's health care system (before ACA especially) is better than Canada's. Everything about your initial post suggests you are, but if you're not, then that's fine. If you are, then you've posted exactly one number, moved the goalposts when it completely backfired (see, I can look up lists of logical fallacies too), and then done nothing since.

 

[Locrian]

The very idea of comparing "Canada" and "United States" health systems is dangerous. Medical care in the US varies widely in effectiveness, cost and efficiency. Canada's population is 1/10th of the US, they have both different demographics and different health challenges. There is no doubt in my mind that a Kaiser or Geisinger represent an improvement over anything in Canada, but at the same time most people in the US aren't served by health systems running that efficiently..

Comparing health care in the US pre/post ACA makes more sense, though I'm not sure it will lead to much in this venue.

 

[Tobias Funke]

The very idea of comparing "Canada" and "United States" health systems is dangerous.

I agree, which is why I have no problem deferring to authorities who spend much more time thinking about it than (most likely) any of us.

Comparing health care in the US pre/post ACA makes more sense, though I'm not sure it will lead to much in this venue.

Isn't that how this all started? That after ACA, American health care will go down the drain and resemble the supposedly much worse Canadian system? I may have jumped the gun; maybe the post I first responded to was just warning us that our health care system will remain relatively poor, but will be improved overall with longer wait times to see a specialist*. I think it's more likely that it was just a repetition of an old talking point that, as even the statistics claiming to support it show, doesn't hold up. Either way, you're right that it won't lead anywhere.

*Which would be funny because maybe that is exactly what will happen.

 

[Derek Francis]

It's important to keep in mind that the Supreme Court doesn't exist to decide the merit of policy - just the legality. It's Congress' job to make (and repeal) laws. Not the Supreme Court.

The Supreme Court decided that ACA was constitutional, and I would agree with that decision. People are free to say that they don't like the law or that it is harmful to the country, but objectively speaking, ACA isn't doing anything unconstitutional.

Subsidized health insurance is not illegal. Otherwise Lyndon Johnson's Medicare and George W. Bush's Part D prescription drug program would have been struck down. Charging fees and taxes is not illegal. The government has done it on a wide variety of occasions. Mandates are not illegal. People are mandated to go to school, have car insurance, have fire insurance and so on.

Back in Franklin Roosevelt's time, it was decided that government programs were acceptable so long as the constitution did not prohibit it. If ACA were to be made unconstitutional, probably half of the government programs since 1930 would be made illegal too.

I myself personally don't think ACA is a great law, but it's constitutional.

Also, where were these "strict constitutionalists" when the Patriot Act was being signed?

 

[jim hardy]

Also, where were these "strict constitutionalists" when the Patriot Act was being signed?

I for one was expecting it to succeed then expire , being deemed both further unnecessary and dangerous.
Oh, the naivete of youth.

 

[mheslep]

... Mandates are not illegal. People are mandated to go to school, have car insurance, have fire insurance and so on.

At the *federal* level, yes commercial mandates in the strict sense are still unconstitutional. What the court has said is that the government can tax you if you don't buy health insurance. But the federal government can't apply a criminal sanction if you fail to buy heath insurance, fire insurance, educate juveniles, though a state government might do so.

 

[Derek Francis]

At the *federal* level, yes commercial mandates in the strict sense are still unconstitutional. What the court has said is that the government can tax you if you don't buy health insurance. But the federal government can't apply a criminal sanction if you fail to buy heath insurance, fire insurance, educate juveniles, though a state government might do so.

Thanks for correcting me. And yes, it's true. I can't be jailed for not having health care. But I can be fined for not having it.

 

[mheslep]

Thanks for correcting me. And yes, it's true. I can't be jailed for not having health care. But I can be fined for not having it.

Taxed, not fined. Sorry to be pedantic but the case hinged on the difference.

 

[Derek Francis]

A fine is a mandatory payment for an offense. A tax is just a general collecting of revenue. People not getting health insurance are technically not violating the law so it's not technically a fine. But this payment is more of a targeted tax, to dis-incentivize undesirable behavior (much like a sin tax on cigarettes, which is not contested).

The ACA is dangerously close to approaching something that would be a fine. A citizen is not breaking the law by not having health insurance. But they would be breaking the law by not paying their ACA tax.

However, making ACA unconstitutional would, by corollary, eliminate numerous other taxes.

 

[jim hardy]

It's worth the 12 hours or so it takes to read the USSC's opinions, both sides.
http://www.supremecourt.gov/opinions/14pdf/14-114_qol1.pdf

It gives one a sense of Scalia's eloquence and clarity of thought, not to mention sense of humor.

 

[Dembadon]

It's worth the 12 hours or so it takes to read the USSC's opinions, both sides.
http://www.supremecourt.gov/opinions/14pdf/14-114_qol1.pdf

It gives one a sense of Scalia's eloquence and clarity of thought, not to mention sense of humor.

Agreed. A couple snips of my favorite parts:

Words no longer have meaning if an Exchange that is not established by a State is “established by the State.” It is hard to come up with a clearer way to limit tax credits to state Exchanges than to use the words “established by the State.” And it is hard to come up with a reason to include the words “by the State” other than the purpose of limiting credits to state Exchanges.

Reading the rest of the Act also confirms that, as relevant here, there are only two ways to set up an Exchange in a State: establishment by a State and establishment by the Secretary. §§18031(b), 18041(c). So saying that an Exchange established by the Federal Government is “established by the State” goes beyond giving words bizarre meanings; it leaves the limiting phrase “by the State” with no operative effect at all. That is a stark violation of the elementary principle that requires an interpreter “to give effect, if possible, to every clause and word of a statute.” Montclair v. Ramsdell, 107 U. S. 147, 152 (1883). In weighing this argument, it is well to remember the difference between giving a term a meaning that duplicates another part of the law, and giving a term no meaning at all.

He really highlights the "cherry picking" of the Court's interpretation.

Making matters worse, the reader of the whole Act will come across a number of provisions beyond §36B that refer to the establishment of Exchanges by States. Adopting the Court’s interpretation means nullifying the term “by the State” not just once, but again and again throughout the Act.

 

[gjonesy]

IMHO the ACA is nothing its promoted to be. Its a law that's enforced by sanctions against your income tax, its not national health care. There is nothing affordable about being on a tight budget living paycheck to paycheck and being FORCED to BUY health insurance that you can't afford.

 

[Locrian]

IMHO the ACA is nothing its promoted to be. Its a law that's enforced by sanctions against your income tax, its not national health care.

I don't ever remember it being promoted as national health care. I remember it being promoted as a significant change to the individual health insurance market, combined with a medicaid expansion. It came with a lot more garbage than that, of course, but most people aren't aware of those changes.

There is nothing affordable about being on a tight budget living paycheck to paycheck and being FORCED to BUY health insurance that you can't afford.

If you're on a tight budget and buying in the individual market, the ACA probably pays for most, if not all your premium. It has definitely made health insurance affordable for many people. The actual health care, well, that's another matter.

 

[mheslep]

...If you're on a tight budget and buying in the individual market, the ACA probably pays for most, if not all your premium. It has definitely made health insurance affordable for many people. The actual health care, well, that's another matter.

Or not on a tight budget. I have a friend who's a building contractor, relatively well off, family of four with a second home on the water and a yacht. The nature of his business necessarily entails ebbs and flows, and it happens his income fell to near nothing for a year. He applied to an exchange, and the ACA paid for nearly all his health premium during the time. I was both bemused and irked, but he reminded me that his pre-ACA very reasonable health premiums had since doubled and tripled, with 5-figure deductibles, etc.