News Supreme Court upholds health care reform

[D H]

Including the mandate!

Chief Justice Roberts on the mandate:

Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.​

Everything I read/heard beforehand predicted either a split decision or a complete repudiation. I don't think anyone expected the Court to uphold the mandate. The oral arguments went so very, very badly. That's usually indicative of a problem.This is of course all over the news. Here's one:
http://www.cnn.com/2012/06/28/politics/supreme-court-health-ruling/index.html

 

[russ_watters]

I thought there was a chance it would be upheld, but based on the ICC. I'm shocked they used the power to tax as justification. Doesn't this mean Congress has the power to do absolutely anything they want as long as there is a tax attached to it?! Sheesh, the ICC trump card was bad enough!

(caveat: haven't read the decision yet)

 

[nitsuj]

I haven't read anything, but what was here, the cnn article & the video.


Russ_watters does the US not have required mandatory insurance for vehicle drivers?

I wonder how upset the health insurance companies are about the ruling, specifically the health "insurance profiteers".


Also sounds like allot of people already have coverage.

 

[D H]

I'm shocked they used the power to tax as justification.

That was shocking. Not the commerce clause, not the necessary and proper clause. The "Okay, maybe its a tax then" argument was a last minute ..., well, this sports video from 1984 says it best.

 

[jtbell]

Also sounds like allot of people already have coverage.

By the numbers: Health insurance

49.9 million -- The number of uninsured Americans in 2010. That's 16.3% of the total population.

 

[Angry Citizen]

This is certainly unusual. No one really expected Roberts to be the deciding vote. Kennedy, whom everyone thought would at least be slightly sympathetic to the government, ended up casting a vote to nullify the whole thing. I think Obama dodged a major bullet here.

FIGURATIVELY SPEAKING OF COURSE.

 

[D H]

This is certainly unusual. No one really expected Roberts to be the deciding vote. Kennedy, whom everyone thought would at least be slightly sympathetic to the government, ended up casting a vote to nullify the whole thing.

I've just started reading the decision itself. It appears to me that severability was the deciding issue to both Roberts and Kennedy. How much judicial intervention is acceptable? To Roberts, not much. To Kennedy, it's less of a problem.

To Roberts, that one couldn't just nullify the mandate without destroying the whole thing entailed too much judicial intervention. Perhaps he saw that last minute hail mary pass about the mandate as a tax as the way out? To Kennedy, that one couldn't just nullify the mandate without destroying the whole thing meant that the whole thing had to be tossed. Kennedy didn't buy that mandate as a tax argument. That's my take on this weird split (in other words, my opinion, not fact).

The court did reject a couple of items in this case. They rejected the commerce clause argument, and this rejection will have ramifications in completely unrelated future cases. They also rejected a mandate on the states to beef up their Medicaid programs.

 

[CAC1001]

I'm no expert, but how does the 16th Amendment prevent the government from being able to tax for whatever they want? I've always thought they could do that...

Regarding the Commerce Clause, some say this limits the powers of the Congress which uses the CC as a way to regulate so much. Some also say that, ironically, the concurrence was written as a dissent, and the dissent was written as a full opinion.

 

[Redbelly98]

I'm no expert, but how does the 16th Amendment prevent the government from being able to tax for whatever they want? I've always thought they could do that...

I would think the prospect of getting voted out of office if they "tax for whatever they want" should be enough.

 

[Vanadium 50]

I'm no expert, but how does the 16th Amendment prevent the government from being able to tax for whatever they want? I've always thought they could do that...

It does. However, one does not have standing to challenge a tax in the courts until one has paid it.

When the Left is done with their partying, they are going to have a terrific hangover when they realize what Roberts has done to them. With the help of the four reliably liberal justices, he managed to:

1. Shoot down the legal theory that the Commerce Clause and the Necessary and Proper Clause give Congress the ability to do whatever they feel is a good idea.

2. Reenergize the 10th Amendment and limit the federal government's ability to coerce states.

3. Allow the Republicans to portray ObamaCare, already deeply unpopular, as the largest tax increase in history, one that was sold as not being a tax, and one that needs to be even bigger to cover the costs. (Remember, 10 years of taxes goes to paying 6 years of benefits)

4. Allows opponents a second bite at the apple once this tax is paid and they have standing to challenge.

 

[D H]

With the help of the four reliably liberal justices[/I], he managed to:

1. Shoot down the legal theory that the Commerce Clause and the Necessary and Proper Clause give Congress the ability to do whatever they feel is a good idea.

2. Reenergize the 10th Amendment and limit the federal government's ability to coerce states.

3. Allow the Republicans to portray ObamaCare, already deeply unpopular, as the largest tax increase in history, one that was sold as not being a tax, and one that needs to be even bigger to cover the costs. (Remember, 10 years of taxes goes to paying 6 years of benefits)

4. Allows opponents a second bite at the apple once this tax is paid and they have standing to challenge.

Except for #3, I have to disagree with you. I agree that items #1 and #2 are key parts of the judgement, but the four liberal members did not play a supporting role here. They dissented. It was the four conservative members plus Kennedy who made this a reality. This part of the judgement will have future ramifications completely unrelated to health care.

Item #4, now the liberals have a judgement that strongly implies that the tax is constitutional -- and before anyone has paid a dime. This too will have some unexpected consequences.

Item #3 is a biggy (as are #1 and #2). The program was sold in part as not being a tax increase. Well, now it is a tax increase. And it's disproportionately a tax increase on people who overwhelmingly voted for Obama in 2008.

 

[CAC1001]

Except for #3, I have to disagree with you. I agree that items #1 and #2 are key parts of the judgement, but the four liberal members did not play a supporting role here. They dissented. It was the four conservative members plus Kennedy who made this a reality. This part of the judgement will have future ramifications completely unrelated to health care.

Item #4, now the liberals have a judgement that strongly implies that the tax is constitutional -- and before anyone has paid a dime. This too will have some unexpected consequences.

Item #3 is a biggy (as are #1 and #2). The program was sold in part as not being a tax increase. Well, now it is a tax increase. And it's disproportionately a tax increase on people who overwhelmingly voted for Obama in 2008.

#2 involved the liberal justices. The Court voted 7-2 to strike down the aspect of Obamacare that let's them threaten to cut off all Medicaid funding for states that opt out of the program's expanded Medicaid coverage.

 

[russ_watters]

I'm with you on all except this one (the political implications are vast and fascinating here - this is so multi-dimensional!):

2. Reenergize the 10th Amendment and limit the federal government's ability to coerce states.

If Congress can pass whatever law they want as long as there is a tax attached as the form of coercion (even if they call it a penalty!), then they have at best replaced one end-around the 10th Amendment (the commerce clause) with a new one.

It's a good thing Obama no longer has a filibuster proof majority anymore: otherwise, he could get a law passed that "taxes" voters for voting for Republicans!

Also:

5. "If the court had struck down Obamacare, you wouldn't have to vote for me to get it repealed. But since they didn't, the only way to get rid of Obamacare is to vote for me." [/Romney speech writer]

What disturbs me most so far is an excerpt from Roberts' decision I heard on the radio that appeared to say the Roberts voted to uphold because he wanted to defer to Congress and wanted us to sleep in the be we made (voting for Obama and a Democratic Congress) rather than overturn a law he believed to be unConstitutional. I can't imagine an action more damaging to the court than for them to shirk their most sacred responsibility.

That's also a different - worse, imo - take on Judicial Activism than I had heard before: essentially it says that judicial activism isn't about upholding laws they think are Right even if they are unConstitutional, but rather upholding laws because they don't wan't to go against Congress.

 

[russ_watters]

Cato Institute paraphrasing me:

In short, we have reaped the fruits of two poisonous trees of constitutional jurisprudence: On the one (liberal activist) hand, there are no judicially administrable limits on federal power. On the other (conservative pacifist) one, we must defer to Congress and presume (or construe) its legislation to be constitutional.

http://www.cnn.com/2012/06/28/opinion/shapiro-health-ruling/index.html?hpt=hp_bn7

 

[russ_watters]

Text of the decision: http://msnbcmedia.msn.com/i/msnbc/Sections/NEWS/scotus_opinion_on_ACA_from_msnbc.com.pdf

 

[QuarkCharmer]

This might be a bit off topic, but does anyone have a link to a place where I can figure out what exactly this means for me? All I can find are things describing the effect on the typical American, the poor, the rich etc..

What about us zero-income non-insured student types?

 

[Borek]

Can't say I understand much of the whole story (and your discussion) as legalese and details of US system are a Greek to me. What struck me was the fact that the decision - nominally taken by the court, so it should be taken solely on the legal ground - seems to be strictly political. At least according to CNN article linked to in the very first post those seen as liberal voted for, those seen as conservative against.

Perhaps I am surprised just because of my naivety and that's the way the system works, still, I am in stupor. First, 2:0 for Italy, now, 5:4 for Obamacare. What a day.

 

[Evo]

Can't say I understand much of the whole story (and your discussion) as legalese and details of US system are a Greek to me. What struck me was the fact that the decision - nominally taken by the court, so it should be taken solely on the legal ground - seems to be strictly political. At least according to CNN article linked to in the very first post those seen as liberal voted for, those seen as conservative against.

Perhaps I am surprised just because of my naivety and that's the way the system works, still, I am in stupor. First, 2:0 for Italy, now, 5:4 for Obamacare. What a day.

The health reform was badly needed. Now my kids can get medical care.

 

[Ryan_m_b]

My knowledge of this issue is limited and observing any healthcare topic from the east side of the Atlantic looking west is bound to have some cultural confusion* but I'd gathered from various sources that the expectation that the bill would be overturned was very hyped.

If someone could clarify something for me though, the individual mandate requires that everyone must buy healthcare but millions of people can't afford healthcare so what provisions are there to deal with this? I understand that there will be greater regulation on whether or not insurance companies can discriminate based on pre-existing conditions and an expansion of medicare but for your run of the mill lower income family how will this help?

*Though I am extremely happy about any move the US takes towards healthcare for all.

 

[Angry Citizen]

If someone could clarify something for me though, the individual mandate requires that everyone must buy healthcare but millions of people can't afford healthcare so what provisions are there to deal with this?

For one, anyone who makes less than 133% of the poverty line automatically qualifies for Medicaid, which is a government-ran health insurance program without a premium. For two, you are allowed to claim tax breaks and subsidies if you don't make very much money in order for you to afford the premium. In addition, any corporation with more than 50 employees must offer employer-subsidized health insurance, which itself will likely be subsidized for many small business owners. Plus premiums themselves are likely to decrease markedly given that at least 80% of the expenditures of a given health insurance company must be in the form of actual, honest-to-god medical care - and they must refund part of your premium if they don't meet that.

Those are just the parts I'm currently aware of.

 

[Angry Citizen]

Can't say I understand much of the whole story (and your discussion) as legalese and details of US system are a Greek to me. What struck me was the fact that the decision - nominally taken by the court, so it should be taken solely on the legal ground - seems to be strictly political. At least according to CNN article linked to in the very first post those seen as liberal voted for, those seen as conservative against.

Perhaps I am surprised just because of my naivety and that's the way the system works, still, I am in stupor. First, 2:0 for Italy, now, 5:4 for Obamacare. What a day.

It is clear that Justices Scalia, Thomas, Alito, Ginsberg, Kagan, Sotomayor, Kennedy, and Breyer all voted according to politics. Roberts seemed to have some measure of integrity after all, however, and voted completely against his politics.

As an ardent lefter-than-liberal, I can't say I agree with their decision, even though it was almost the best possible outcome for my side. Here in America, in order to challenge a law in court, you must have what's called "standing" - in other words, the law must have wronged you in some fashion. No one has been wronged by the mandate at this time, so SCOTUS should have punted this until 2015 when the first penalties began to be paid.

 

[Ryan_m_b]

For one, anyone who makes less than 133% of the poverty line automatically qualifies for Medicaid, which is a government-ran health insurance program without a premium.

In that case the pertinent question would be is earning more than 133% of the poverty line (a bit of googling places that at ~$30k/~€25k/~£20k) enough to afford health insurance after all other expenses (food, rent, utility bills, travel etc) are taken into account? Out of interest how much would the average American pay for health insurance?

 

[Vanadium 50]

Item #3 is a biggy (as are #1 and #2). The program was sold in part as not being a tax increase. Well, now it is a tax increase. And it's disproportionately a tax increase on people who overwhelmingly voted for Obama in 2008.

And those people who then-candidate Obama said he would not raise taxes on. This will surely be exploited by the Republicans: "They say they will only tax the rich - but look where they actually levied the most tax - on you!"

It is clear that Justices Scalia, Thomas, Alito, Ginsberg, Kagan, Sotomayor, Kennedy, and Breyer all voted according to politics

Politics? Or honest disagreements about jurisprudence and the roles played by the federal government?

 

[russ_watters]

Can't say I understand much of the whole story (and your discussion) as legalese and details of US system are a Greek to me. What struck me was the fact that the decision - nominally taken by the court, so it should be taken solely on the legal ground - seems to be strictly political. At least according to CNN article linked to in the very first post those seen as liberal voted for, those seen as conservative against.

Perhaps I am surprised just because of my naivety and that's the way the system works, still, I am in stupor. First, 2:0 for Italy, now, 5:4 for Obamacare. What a day.

The toughest part is probably that we are referencing specific clauses in the Constitution by name. Supreme court decisions are supposed to be based on [a] specific line in the Constitution that the law either fits with or violates. At issue:

1. The Interstate Commerce Clause (ICC): Congress has the power to regulate interstate commerce. This is what the lawyers for Obama argued the law fit and should be allowed under. That argument was rejected.
2. The Necessary and Proper Clause: Congress may pass laws necessary and proper for carrying-out its delineated powers. This is a little sticky/sloppy in that it is sometimes used as an attempted catch-all justificiation (I can do whatever I think is necessary).
3. Taxation and spending clause: Congress has the power to collect taxes and spend money to fund the execution of its laws.
4. 10th Amendment: This clarifies that the Constitution doesn't say what Congress can't do, only what it can and that that's the limit. Congress can't do anything that isn't specifically justifiable.

 

[CAC1001]

The health reform was badly needed. Now my kids can get medical care.

I don't think anyone disagrees that health reform was needed, but many disagree that this particular form of health reform was best. If this results in a single-payer style system, then while many people will get coverage, they will not necessarilly get care when they need it. They may instead be put onto a waiting list.

 

[CAC1001]

My knowledge of this issue is limited and observing any healthcare topic from the east side of the Atlantic looking west is bound to have some cultural confusion* but I'd gathered from various sources that the expectation that the bill would be overturned was very hyped.

If someone could clarify something for me though, the individual mandate requires that everyone must buy healthcare but millions of people can't afford healthcare so what provisions are there to deal with this? I understand that there will be greater regulation on whether or not insurance companies can discriminate based on pre-existing conditions and an expansion of medicare but for your run of the mill lower income family how will this help?

*Though I am extremely happy about any move the US takes towards healthcare for all.

Everyone who can afford health insurance but chooses not to purchase it, either must purchase it or pay the tax. There is a large number of such people. Those who outright cannot afford either the tax or to purchase health insurance will be subsidized.

 

[CAC1001]

And those people who then-candidate Obama said he would not raise taxes on. This will surely be exploited by the Republicans: "They say they will only tax the rich - but look where they actually levied the most tax - on you!"

One thing I wish the Republicans would point out is that European-style social democracy isn't funded primarily by taxing the rich, it's a good deal funded by taxing the poor and the middle-class. That's why gasoline costs around the equivalent of $10 a gallon in European countries and their cost of living is higher, because of the VATs they have (Value Added Tax). America has no VAT. Obamacare, to pay for itself, has the mandate, along with additional other taxes hidden within it that will kick in so as to theoretically make the systme sustainable.

 

[russ_watters]

Now my kids can get medical care.

What was stopping them before?

 

[D H]

1. The Interstate Commerce Clause (ICC): Congress has the power to regulate interstate commerce. This is what the lawyers for Obama argued the law fit and should be allowed under. That argument was rejected.
2. The Necessary and Proper Clause: Congress may pass laws necessary and proper for carrying-out its delineated powers. This is a little sticky/sloppy in that it is sometimes used as an attempted catch-all justificiation (I can do whatever I think is necessary).
3. Taxation and spending clause: Congress has the power to collect taxes and spend money to fund the execution of its laws.
4. 10th Amendment: This clarifies that the Constitution doesn't say what Congress can't do, only what it can and that that's the limit. Congress can't do anything that isn't specifically justifiable.

If I were a strict constructionist (which I am not), I would find myself worrying about the original intent of striking the word "expressly" from the 10th. I'm a broad constructionist, so the general fuzziness/vagueness of the Constitution, its intentionally weasel worded clauses such as the three you mentioned plus others, and the express deletion of the word "expressly" from original drafts of the 10th all give me comfort.

Just look at the utter mess of the California, Alabama, and Texas constitutions. California's is perfect example of what not to do. Alabama, 1/72 the size of the US, 1/64 the population, has a buttinski constitution that is 40 times as long as the US Constitution. Texas, we don't have weasel word clauses. Everything has to be spelled out. So we have a Railroad Commission that does not regulate railroads but does regulates the oil and gas industry. The most extreme of strict constructionist worry about the constitutionality of the Air Force, Marines, Coast Guard, NASA, etc. There would be no doubt (all unconstitutional!) were the US Constitution worded along the lines of the Texas State Constitution.

 

[ThinkToday]

I've just started reading the decision itself. It appears to me that severability was the deciding issue to both Roberts and Kennedy. How much judicial intervention is acceptable? To Roberts, not much. To Kennedy, it's less of a problem.

To Roberts, that one couldn't just nullify the mandate without destroying the whole thing entailed too much judicial intervention. Perhaps he saw that last minute hail mary pass about the mandate as a tax as the way out? To Kennedy, that one couldn't just nullify the mandate without destroying the whole thing meant that the whole thing had to be tossed. Kennedy didn't buy that mandate as a tax argument. That's my take on this weird split (in other words, my opinion, not fact).

The court did reject a couple of items in this case. They rejected the commerce clause argument, and this rejection will have ramifications in completely unrelated future cases. They also rejected a mandate on the states to beef up their Medicaid programs.

I think you pretty much got it correct. As some of the talking heads have noted, Roberts voted as a true conservative and not as a Republican. For a true conservative, it's about upholding limited powers of the court, judicial restraint, basically telling people you get what you vote for, and it's not the job of the courts to bend to the changing will of the people. In short, "we" (not me for sure) voted these guys in, and we live with our choices. I am disapointed with the outcome, but it was the right choice to base the determination on the taxing authority of Congress. In all honesty, IMO it was clear the democrats called it a penalty just for political consumption. Roberts saw through the polical calculation using the term "penalty" and saw it for the tax it is.

IMO, we are a long ways from the end of this, and I don't mean the election. For example "At companies with fewer than 50 workers, the employees must obtain insurance themselves." source http://www.cnn.com/2012/06/28/politics/obamacare-what-we-learned/index.html?iref=allsearch With the folks at the lowest income end that don't fall within the 110% of poverty line $11,170. Who pays for their REQUIRED health insurance? Here's the answer from the same source "Not obtaining insurance in 2014 will cost a person $95 or 1% of his or her income, whichever is higher. In 2015, it's $325, or 2% of income. For families, the penalty will be $285 per household or 1% of income, whichever is greater. By 2016, it goes up to $2,085 per family or 2.5% of income. Penalties will rise each year."

No folks, it ain't free health care.

 

[Ryan_m_b]

With the folks at the lowest income end that don't fall within the 110% of poverty line $11,170.

Do you have a source for the poverty line stat? I tried to find one earlier and found something very different. Otherwise I agree with you that the individual mandate seems to have a potential problem for the squeezed middle; if you have enough surplus income to afford it no problem, if you don't have enough money no problem, if you lie in between it will be a huge strain on your personal finances but you get no help.

No folks, it ain't free health care.

*No* healthcare is free, there are just various levels of social provision across the world.

 

[ThinkToday]

Do you have a source for the poverty line stat? I tried to find one earlier and found something very different. Otherwise I agree with you that the individual mandate seems to have a potential problem for the squeezed middle; if you have enough surplus income to afford it no problem, if you don't have enough money no problem, if you lie in between it will be a huge strain on your personal finances but you get no help.

*No* healthcare is free, there are just various levels of social provision across the world.

Same article from CNN.

"Cash-strapped entrepreneurs can buy insurance at state exchanges and can get tax credits if their annual individual income ranges between 100% and 400% of the poverty line, which this year translates to $11,170 and $44,680."

 

[Evo]

What was stopping them before?

The high cost. And my older daughter has a pre-existing condition, and was turned down by everyone.

 

[daveb]

The high cost. And my older daughter has a pre-existing condition, and was turned down by everyone.

The same applied to my girlfried. She has epilepsy, and she couldn't get any insurance until her recent disability approval.

 

[Angry Citizen]

Same applies to me. I found out I was a diabetic when I was twenty. No insurance company in the world would touch me without exorbitant fees, and none of them would've helped pay for my insulin for at least a year and only after I met my deductible.

Thankfully, the city has a program that helps people such as myself not die - it's much like how Medicaid will be in 2014.

 

[ThinkToday]

I've not had any issues with getting my wife and child with pre-existing conditions covered. Like yours, the pre-existing conditions were serious. It's been awhile, but as best I can remember, they weren't covered for 12months unless they were transitioning from one insurance to another without a significant break (e.g. typical job change situation). Even then, if they hadn't been treated for the condition within the past 12 months, that was ok too for getting coverage. My understanding was regardless of the outcome of the ACA, pre-existing conditions were being made a thing of the past. A very good thing for those whose illness is through no fault of their own.

 

[mheslep]

The high cost. And my older daughter has a pre-existing condition, and was turned down by everyone.

The cost of insurance has not come down but gone up significantly in the last two years. So you would agree what your daughter really needs from this law is the no pre-existing condition exclusion rule, and not necessarily 2700 pages of other things?

 

[mheslep]

Can't say I understand much of the whole story (and your discussion) as legalese and details of US system are a Greek to me. What struck me was the fact that the decision - nominally taken by the court, so it should be taken solely on the legal ground - seems to be strictly political. At least according to CNN article linked to in the very first post those seen as liberal voted for, those seen as conservative against.

One of the news worthy points of the story is that is not entirely the case here. The Chief Justice, Roberts, appointed by former President Bush, voted to uphold the health care law and for largely unanticipated legal reasoning. Also Justice Kennedy who votes both ways, voted with the minority to strike down the law.

 

[mheslep]

... and their cost of living is higher, because of the VATs they have (Value Added Tax). America has no VAT.

Eh, at the *federal* level America has no across the board VAT, though there are some on certain .. http://www.irs.gov/newsroom/article/0,,id=242812,00.html/ and they hit the poor/middle incomes just as you point out. America has ample State and local VATs, implemented as simple sales taxes.

 

[ThinkToday]

One of the news worthy points of the story is that is not entirely the case here. The Chief Justice, Roberts, appointed by former President Bush, voted to uphold the health care law and for largely unanticipated legal reasoning. Also Justice Kennedy who votes both ways, voted with the minority to strike down the law.

Yes, it doesn't always follow what's expected.

Roberts appointed by GWB
Scalia appointed by Reagan
Kennedy appointed by Reagan
Thomas appointed by GWB
Ginsberg appointed by Clinton
Breyer appointed by Clinton
Alito appointed by GWB
Sotomayor appointed by BO
Kagan appointed by BO

In general, they do tend to vote the way you'd expect, but I think Kennedy becoming a swinger and Roberts swing on this and the AZ immigration case stand out. I think people tend to forget O'Connor (Reagan) was a frequent swinger, and Souter (GWB) and Stevens (Ford) were mid-tending left on many votes, even though conservative republicans appointed them.

 

[CAC1001]

Eh, at the *federal* level America has no across the board VAT, though there are some on certain .. http://www.irs.gov/newsroom/article/0,,id=242812,00.html/ and they hit the poor/middle incomes just as you point out. America has ample State and local VATs, implemented as simple sales taxes.

From my (maybe incorrect) understanding, a sales tax is different from a VAT. A sales tax shows up on the receipt, whereas a VAT taxes each stage of the production and distribution of a good or service. It doesn't show up on the receipt and is thus hidden. You only know it's there by the higher prices for said particular goods and services it is applied to.

 

[mheslep]

From my (maybe incorrect) understanding, a sales tax is different from a VAT. A sales tax shows up on the receipt, whereas a VAT taxes each stage of the production and distribution of a good or service. It doesn't show up on the receipt and is thus hidden. You only know it's there by the higher prices for said particular goods and services it is applied to.

Yes, that's my understanding of how its done in the EU, though I think of notification as an aspect of implementation, and not a fundamental characteristic of the thing itself.

 

[nitsuj]

The cost of insurance has not come down but gone up significantly in the last two years. So you would agree what your daughter really needs from this law is the no pre-existing condition exclusion rule, and not necessarily 2700 pages of other things?

The restrictions on insurance companies looks awesome. I would love to know the income health insurance companies make. Exchanging those profits for more healthcare seems fair (for the greater good), for a business model of "House always wins".

As far as the subsidy side / "tax increase" ect it maybe just growing pains.

Come budget cuts for 2015+ maybe, just maybe citizen health will be put before military/philanthropy/NASA/...what budget expense could possibly force healthcare funding back onto the chopping block?

Oh right politicking.

 

[Borg]

The high cost. And my older daughter has a pre-existing condition, and was turned down by everyone.

This is one of the reasons that I am for health care reform in some form. The big problem is that this isn't fair to the insurance companies if only the sick had to get insurance.

If you don't buy car insurance and wreck your car, you're out a car. But, with the way health care is, you don't have to buy insurance and you can still be treated by going to a hospital that can't turn you away. Even if you gave people the ability to opt out (no pay, no coverage), the evening news would be full of sob stories of people who suddenly didn't think that it was fair once they became very ill. So, until someone comes up with a plan for something better and not just the desire to kill it, I think that this is a reasonable compromise to achieve the goal of universal health care.

I am curious though what happens to the money paid as 'tax'. Does that money go to the insurance companies or does the federal government keep it?

 

[Astronuc]

Some interesting commentary on the decision and Roberts's vote:

http://news.yahoo.com/blogs/power-p...ice-roberts-save-supreme-court-103301790.html

I think Roberts played his hand well. He established that tax for what it is, and basically left it to Congress to rescind it as they see fit. Now it's up to the people, as it should be, to elect officials that represent their collective will. If the majority want this healthcare program or not - let them elect their representatives accordingly. The next Congress will have a chance in 2013 to rescind the law. Whether or not, there will be another chance in 2015.

Meanwhile - neither presidential candidate, nor Congress, is addressing the chronic budget deficit or failing economic recovery.

 

[CAC1001]

From what I have researched of universal healthcare systems, single-payer is not the ideal form. Single-payer is the form the political left in the United States want, but that usually is more ideology-driven on their part. The best forms of universal healthcare, from what I've seen, are systems that are a combination of public and private elements.

 

[Jimmy Snyder]

Russ_watters does the US not have required mandatory insurance for vehicle drivers?

I'll step in for Russ. This is wrong on two points. First, the federal govt does not require insurance for vehicle drivers, only states do. Second, the states do not require you to own a vehicle and hence, they do not require you to have insurance.

 

[ThinkToday]

If you don't buy car insurance and wreck your car, you're out a car. But, with the way health care is, you don't have to buy insurance and you can still be treated by going to a hospital that can't turn you away.

Part of the problem is the people that wreck the car and want to buy the insurance after the wreck, expecting it to cover the wreck. IMO, there are important issues with ACA.

1) Clearly, the people that have medical issues by no fault of their own shouldn't be penalized with a higher rate. IMO, there should be a high risk subsidized pool for inherently high risk people that are victims of genetics, the environment, accident, war, crime, etc.

2) On the other hand, people that engage in risky activity should have to pay a premium for that behavior. If I have a stack of speeding tickets, should you (with a clean record) and I pay the same for car insurance? The ACA model says yes, no pre-existing conditions (tickets, accidents, drunk driving convictions), which is silly, IMO. If I engage in risky behavior, smoke, eat all high fat food, drink a lot, use drugs, sky dive, motocross, drag race, free climb, etc., should I pay the same for health care as someone that lives a relatively "normal" healthy lifestyle, gets plenty of safe exercise, and doesn't routinely engage in high risk activities? The ACA model says yes, no pre-existing conditions (drug convictions, gang leader in south LA, etc.), which is silly, IMO.

IMO, a serious problem with ACA is the lack of personal responsibility and accountability.

 

[Ryan_m_b]

From what I have researched of universal healthcare systems, single-payer is not the ideal form. Single-payer is the form the political left in the United States want, but that usually is more ideology-driven on their part. The best forms of universal healthcare, from what I've seen, are systems that are a combination of public and private elements.

Having single payer and private systems are not mutually exclusive. In the UK anyone can use a public NHS hospital/doctor/dentist but they also have the choice to go to private clinics paid for with private health insurance. There's little difference in the actual care but waiting times (a notorious problem for the NHS) are reduced.

 

[ThinkToday]

Having single payer and private systems are not mutually exclusive. In the UK anyone can use a public NHS hospital/doctor/dentist but they also have the choice to go to private clinics paid for with private health insurance. There's little difference in the actual care but waiting times (a notorious problem for the NHS) are reduced.

Years ago, I worked with a doctor that was trained in Great Britain. He commented the health care for someone with and emergency condition is very good (heart attack, stroke, MVA), but care for more chronic conditions wasn't very good, unless you had some private paying option to be treated outside the government system. How are things now? You commented about the waiting times. Do the people have a say about their care, as far as quality and timeliness with the government? Does the government adequately respond to the concerns of patients, or has it become something people just have to live with? Do you see change in the future of medicine in England or is the system pretty well locked down?

Is your health care like Canada? I had an acquaintance that worked for CP Railroad, and he had a brain tumor with an estimate of about 6-12 months to live, if untreated. They told him he had to wait 6 months to get an MRI to determine course of care! Apparently, there were very few MRI and they were booked. A friend of his is a US radiologist, and he flew him to the US and did a stat MRI on him to take back to his doctors in Canada. As a practical matter, what he had was going to kill him, treated or not, but not even scheduling critical tests ASAP is unheard of in the US health system. Perhaps he could have lived another 6-12 months, if treated early and aggressively.