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Old 12-13-2010, 09:52 PM   #21
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Yes, several judges have also found no problem. Of something like 20 cases, 12 were dismissed. In two cases, federal judges upheld the law.

The law really should not be severable. If the requirement to buy insurance is removed then the rest is a big mess. Practically, you can't require insurers to ignore preexisting conditions unless you also require people to buy insurance.
I just find it amazing that it is not severable... if true...

Why Because any law that is 2,000 pages, written in the back rooms, will have something in it that will be found unconstitutional IMO...
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Old 12-13-2010, 09:57 PM   #22
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Old 12-13-2010, 10:05 PM   #23
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Due to state (not federal) laws that make insurance coverage (or bond) mandatory before you exercise the privilege (not the right) to drive your car on public (no impact on private) roads. There's zero applicability to the health care insurance situation, where people are being compelled to purchase something just because they are alive--not to exercise a privilege.
Heh. If you are a trucker, there is currently a Federal insurance requirement for liability and related goodies. You can avoid it if you never ever cross a state line.

I can't wait for that to be overturned. You know how much liability insurance costs for a 40 foot trailer full of dynamite? Damn, Skippy, that's gotta be unconstitutional.
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Old 12-13-2010, 10:14 PM   #24
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Is it then also not constitutional to require a hospital to accept an injured person to ER if they cannot provide payment? (I am actually not sure if they are required to provided emergency treatment, but I am at least under the impression they are). How can the federal government require a hospital to do this? Is it in the constitution? Why has it not been challenged in court?
That would be the Emergency Medical Treatment and Active Labor Act (EMTALA), also known as the only insurance older unemployed folks will be able to get when COBRA runs out.

The unconstitutional idea of having everyone have insurance was supposed to alleviate the crunch on ER doctors and facilities from EMTALA. Not any more...

Edit: I just ran across a little blurb from one of the Tenth Amendment groups. They're proposing to go after EMTALA next. Looks like some folks want to carve out a little slice of Paradise for themselves. For odd values of Paradise...
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Old 12-13-2010, 10:57 PM   #25
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Back on topic: I understand that this particular result was pretty widely expected from this particular court. There will be appeals, of course.

Since the insurance mandate wasn't to go into effect until 2014, there is no immediate effect from this decision.
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Old 12-13-2010, 11:19 PM   #26
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The unconstitutional idea of having everyone have insurance was supposed to alleviate the crunch on ER doctors and facilities from EMTALA. Not any more...
MA is the closest state to having something like this plan we're about to field nationwide. Their ER visits have not declined since they covered nearly all their population, ER visits have gone up. And, at least as of 2008, they'd gone up faster than the US as a whole.
AP item, reprinted here.
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Kellermann and other experts point to Massachusetts, the model for federal health overhaul where a 2006 law requires insurance for almost everyone. Reports from the state find ER visits continuing to rise since the law passed—contrary to hopes of its backers who reasoned that expanding coverage would give many people access to doctors offices.

Massachusetts reported a 7 percent increase in ER visits between 2005 and 2007. A more recent estimate drawn from Boston area hospitals showed an ER visit increase of 4 percent from 2006 to 2008 — not dramatic, but still a bit ahead of national trends.
The idea that this law is going to reduce costs by getting patients out of the expensive ER by giving them access to lower-cost family practice physicians, urgent care, etc doesn't seem to be working out in practice where it's been tried. But, the idea seemed logical and it helped sell the plan, so that's probably good enough.
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Old 12-14-2010, 05:32 AM   #27
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It would be a pity if we got to the point where you had to provide proof of insurance or a valid credit card before the ambulance team would pick you up.
FWIW, I would guess that 75% of Europeans probably believe that this is actually true about the United States.
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Old 12-14-2010, 07:26 AM   #28
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The idea that this law is going to reduce costs by getting patients out of the expensive ER by giving them access to lower-cost family practice physicians, urgent care, etc doesn't seem to be working out in practice where it's been tried. But, the idea seemed logical and it helped sell the plan, so that's probably good enough.
The problem with ER visits going up is a nationwide trend and seems to have less to with whether one is insured or not and more likely due to an overall shortage of primary care physicians. I know when I call my doctors office to set up an appointment his schedule is usually full for at least a 1-2 weeks out. It certainly isn't going to get any better when we add 50M uninsured into the pool.
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Old 12-14-2010, 07:37 AM   #29
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Yes, several judges have also found no problem. Of something like 20 cases, 12 were dismissed. In two cases, federal judges upheld the law.
Yes, but unfortunately this isn't a sports contest where victory is awarded to the side with the highest score. Ultimately only one opinion will matter here, and that opinion will probably be split 5-4.

This is yet another reason why single payer makes so much more sense then all of the alternatives. Why? Because in a nutshell, health insurance isn't really insurance at all; it's health care subsidization. Free enterprise doesn't do subsidization, government does. Forcing folks to buy products and forcing companies to provide them on a non-discriminatory basis is necessary to force free enterprise to do something that is unnatural for it to do . . . treat chronically sick people at a price below their cost of care. There is a far easier way.
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Old 12-14-2010, 08:01 AM   #30
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Heh. If you are a trucker, there is currently a Federal insurance requirement for liability and related goodies. You can avoid it if you never ever cross a state line.

I can't wait for that to be overturned. You know how much liability insurance costs for a 40 foot trailer full of dynamite? Damn, Skippy, that's gotta be unconstitutional.
I'd say anything related to driving is a different legal issue because it's widely considered "a privilege, not a right" -- and you have the right to forego such insurance -- but you can't drive.
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Old 12-14-2010, 08:17 AM   #31
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Because in a nutshell, health insurance isn't really insurance at all; it's health care subsidization.


I don't understand this distinction at all. Would we say that fire insurance on my house isn't insurance, it's just subsidizing rebuilding burned down houses?

And what about the kind of health insurance that would make the most sense for most of us - high deductible insurance? The vast majority don't have zero deductible policies on car and house, and there is a good reason why that is.



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Forcing folks to buy products and forcing companies to provide them on a non-discriminatory basis is necessary to force free enterprise to do something that is unnatural for it to do . . . treat chronically sick people at a price below their cost of care.
I'd be interested to hear samclem's comments on this regarding the Swiss model. And whether the Swiss model would be deemed unconstitutional here. I think not, the Swiss govt provides the voucher, rather than charging the individuals directly with paying for health care (though in the end it's all the same, they are paying from their taxes). Same argument of single provider though, it seems.

But I think your analysis is wrong. Free market insurance companies spread the risk across people buying insurance products. It's true that if they can, they try to match the risk premium to the person buying the product (bad drivers generally pay more than safe drivers), but it's also true that the govt could regulate this for health care and say 'one price for all in each of categories x, y, z'. Seems pretty simple.

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Old 12-14-2010, 08:53 AM   #32
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FWIW, I would guess that 75% of Europeans probably believe that this is actually true about the United States.
FWIW, I would guess that 75% of Americans probably believe that the national pastime in France is striking, rioting, and blocking traffic with farm machinery.
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Old 12-14-2010, 08:59 AM   #33
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It's a small victory, but the fight is not over by a long shot. Interesting what will happen in January when the House will vote NOT to fund certain aspects of the bill..........that could get ugly in a New York minute..........
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Old 12-14-2010, 09:03 AM   #34
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I don't understand this distinction at all. Would we say that fire insurance on my house isn't insurance, it's just subsidizing rebuilding burned down houses?

But I think your analysis is wrong. Free market insurance companies spread the risk across people buying insurance products.
Apples and oranges.

Insuring a house against fire is completely different from providing health insurance to a diabetic or a 70 year old. A more apt comparison is trying to buy fire insurance for a house already on fire. Can't be done at a price below the house's replacement cost.

Free market companies spread risk in a pool where loses are unpredictable. Insurance works when we know that 0.5% of all houses catch fire each year. It doesn't work when we know 212 Hawthorne St. catches fire every year.

The "subsidization" I'm referring to is the fact that we know the aged and chronically ill will require health care expenditures well in excess of affordable premiums. That isn't insurance.

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but it's also true that the govt could regulate this for health care and say 'one price for all in each of categories x, y, z'. Seems pretty simple.
Except to do this, you need to make sure everyone is in the pool. And the whole point of this thread is a Federal judge who ruled that forcing people to participate in the pool is unconstitutional. So no, not that simple. (and yes, the Swiss system has an individual mandate too.)
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Old 12-14-2010, 09:09 AM   #35
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FWIW, I would guess that 75% of Americans probably believe that the national pastime in France is striking, rioting, and blocking traffic with farm machinery.

So you're saying that Americans are smarter than we thought? They correctly understand the French and their national pastimes?
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Old 12-14-2010, 09:11 AM   #36
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Interesting what will happen in January when the House will vote NOT to fund certain aspects of the bill..........that could get ugly in a New York minute..........
Congresscritters will do something that will get ugly? Nooooooo....... I don't believe that......
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Old 12-14-2010, 09:16 AM   #37
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Due to state (not federal) laws that make insurance coverage (or bond) mandatory before you exercise the privilege (not the right) to drive your car on public (no impact on private) roads. There's zero applicability to the health care insurance situation, where people are being compelled to purchase something just because they are alive--not to exercise a privilege.

Ok..so being a devil's advocate, then why is a requirement for 'boys/men" of age to sign up for selective service?

Isn't that something which is forced by Uncle Sam? ..."Hey kids, sign up or be punishable by law. You're not old enough to drink beer, but sign up at 18 just in case Uncle Sam decides to have a military draft again .
The privilege to be drafted?
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Old 12-14-2010, 09:18 AM   #38
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I'd be interested to hear samclem's comments on this regarding the Swiss model. And whether the Swiss model would be deemed unconstitutional here.
It's well above my expertise level to offer an informed opinion. But my semi-informed opinion is that if the Supreme Court rules the present law unconstitutional, that they'd find the Swiss model unconstitutional, too. In both cases the law requires individuals to engage in private commerce (though the Swiss require the insurers to make no profit on sale of the sale of the most basic coverage). The Swiss require people to buy a mandated minimal level of coverage and they provide vouchers if the costs exceed 8% of the person's income. So, the Supreme Court would probably have the same problem with the Swiss system as with the proposed new US system. This would probably be avoided if the government took the money and re-doled it out as benefits.

I hope there's a serious challenge in the Supreme Court to the idea that the provision of health care is a role of the federal government as provided in the Constitution. IMO, the General Welfare clause is being stretched to unrecognizable limits. If we are going to spend 75%+ of tax money on social programs, it seems right to have that national debate and get this in writing via an amendment.
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Old 12-14-2010, 09:20 AM   #39
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The "subsidization" I'm referring to is the fact that we know the aged and chronically ill will require health care expenditures well in excess of affordable premiums. That isn't insurance. Except to do this, you need to make sure everyone is in the pool, which we're saying here, may be unconstitutional. So no, not that simple.
SO we should add ANOTHER huge unfunded liability on top of the OTHER unfunded liabilities we already have? The govt, after all, has done such a "good" job with Medicare, Medicaid, and SS, how could anything POSSIBLY go wrong with them controlling the healthcare process?
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Old 12-14-2010, 09:24 AM   #40
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Ok..so being a devil's advocate, then why is a requirement for 'boys/men" of age to sign up for selective service?

Isn't that something which is forced by Uncle Sam? ..."Hey kids, sign up or be punishable by law. You're not old enough to drink beer, but sign up at 18 just in case Uncle Sam decides to have a military draft again .
The privilege to be drafted?
I don't think that's a good analogy easy......

You'd have to say something like "what if Uncle Sam forced males to go work for a private security firm?".
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