News Supreme Court upholds health care reform

[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.

 

[Ryan_m_b]

I don't think this thread is a great place to start a conversation about the National Health Service (don't want to detract from the actual conversation of the SCOTUS decision) but I'll quickly answer best I can.

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?

Of course the people have a say, we are a democracy you know. The NHS has to conform to various targets which are always political issues and is constantly under review (we've just enacted a big reform to shake up the organisation again). I'm not too clued up on the runnings of the NHS myself though I have a friend who is somewhat of an expert, we've had many conversations about the endless peer-reviewed studies that come out about how to better allocate resources, what organisational methods should be employed etc and that's all before you actually get down to the medicine itself. "Locked down" would imply a static organisation which is very much not the case.

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.

That wouldn't happen here and I'm very surprised that happened in Canada (I'm not doubting you but that sounds like one of those freak cases that gets reported on the media as though it was a widespread thing). Here you might have to wait weeks to months for a consultation/test/operation on a non-emergency illness which isn't ideal at all and is an issue constantly being tackled but for an emergency you would get it right away.

 

[CAC1001]

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.

Can you have both though? From what I have been read, if you start using the private-sector care in Britain, then you lose your ability to use the NHS, that they don't let you both use the NHS and then get additional private care on the side.

 

[Ryan_m_b]

Can you have both though? From what I have been read, if you start using the private-sector care in Britain, then you lose your ability to use the NHS, that they don't let you both use the NHS and then get additional private care on the side.

No that's not the case, you can use both and they often work together.

 

[jim hardy]

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 think the pemise is that legislative branch members would have to face tar & feathers at home.
Here in Arkansas we wrote Blanch Lincoln(our senator) telling her if she voted for Obamacare she'd get fired, and when she did anyway we fired her.


Roberts took it away from the bureaucrats and laid it right at congress's feet.
Now it's not some lame nameless bureaucrat assessing a fine for which yo have no recourse, it's your elected representative levying a tax . Give 'em hell.

 

[Evo]

Seems people are coming to their senses.

Support for Obama healthcare law rises after ruling


Among all registered voters, support for the law rose to 48 percent in the online survey conducted after Thursday's ruling, up from 43 percent before the court decision. Opposition slipped to 52 percent from 57 percent.

The survey showed increased backing from Republicans and, crucially, the political independents whose support will be essential to winning the November 6 presidential election.

And this is only after a few days. Looks like approval will keep growing, IMO.

http://news.yahoo.com/ruling-ups-support-obama-healthcare-still-unpopular-040755810.html

 

[Angry Citizen]

Don't jump the gun. This is just one poll. Wait to see an average of all poll data from several sources and over a few weeks before making claims. It's only prudent.

 

[Evo]

Don't jump the gun. This is just one poll. Wait to see an average of all poll data from several sources and over a few weeks before making claims. It's only prudent.

Very true, but I think people will see how it benefits society, IMO. I haven't completely lost faith in the human race yet. Close, but not completely.

 

[Angry Citizen]

Personally I think the poll data is misleading anyway. I'm technically against the PPACA, but only because it's not a single-payer system. I think it's a vast improvement over the status quo, but some people don't look at it that way. They want all-out, Waterloo-style victory, or nothing at all. And I think the poll data includes some of those people.

 

[Ryan_m_b]

I'm not sure who said it (will report back with name later) but I heard an opponent of the bill state that repealing it before it comes into full effect is a priority because once it's fully in place it will be nigh on impossible to get of. With so many people better off they aren't going to vote for someone to get rid of their healthcare.

Whilst this isn't universal healthcare as some people have lamented it is IMO a fantastic step in the right direction.

 

[BobG]

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

The ACA will mean a person can get insurance in spite of pre-existing conditions, but how will it lower the cost of insurance?

With having to choose between buying health insurance or paying a tax/penalty (whichever you want to call it), I could see insurance premiums dropping, since young, healthy people are chipping in money, as well. But insuring people with pre-existing conditions should push insurance costs higher, since people likely to use more health services are covered.

The only thing I see in the ACA related to the cost of health insurance is that some certain percentage of premiums (80% to 85%) has to be spent on medical care (and then requires companies to spend time and money reporting their performance) and the requirement for insurance companies to justify any increase in premiums of 10% or more.

I think it's just unclear what happens to insurance rates in the end and will it ever be clear when the cost of medical services is always increasing?