Judge in VA strikes down federal health care law

[samclem]

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.

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.

 

[BigNick]

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.

 

[zinger1457]

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.

 

[Gone4Good]

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.

 

[ziggy29]

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.

 

[ERD50]

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.

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.

-ERD50

 

[Westernskies]

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.

 

[FinanceDude]

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..........

 

[Gone4Good]

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.

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.)

 

[youbet]

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?

 

[youbet]

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......

 

[easysurfer]

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?

 

[samclem]

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.

 

[FinanceDude]

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?

 

[youbet]

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?".

 

[samclem]

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?

?? There's no privilege involved. The Supreme Court has found that the government can direct citizens to do all kinds of business with the government--file tax returns, go to jury duty, obey a subpoena, register for selective service, etc. The present question (among a couple that will come up about the new law) is whether it is constitutional for the government to direct citizens to engage in a certain type of private commerce, and punish them if they don't.

Selective service can be attacked on several other grounds.

 

[ziggy29]

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?

I generally agree with the sentiment that government doesn't have a great record where cost controls are concerned. However, on *this* particular issue I also think faith in the "private sector" or the "marketplace" hasn't exactly been justified either.

The sad thing is that per-person Medicare costs aren't rising as quickly as individual health insurance premiums. That's not an endorsement of Medicare as the "answer" per se but a recognition that the private health insurance market is so horribly broken that even a government solution might look efficient in comparison.

 

[samclem]

The sad thing is that per-person Medicare costs aren't rising as quickly as individual health insurance premiums. That's not an endorsement of Medicare as the "answer" per se but a recognition that the private health insurance market is so horribly broken that even a government solution might look efficient in comparison.

Yes, and a sign that the cost of the government programs (e.g. reimbursement rates that are below the cost of providing care, etc) are being successfully transferred to private insurers and those paying cash for their medical services.

 

[Gone4Good]

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.

Yep.

As stated in another thread, the Swiss system is remarkably similar to what we're trying to do here.

 

[ziggy29]

Yes, and a sign that the cost of the government programs (e.g. reimbursement rates that are below the cost of providing care, etc) are being successfully transferred to private insurers and those paying cash for their medical services.

This is a factor, but frankly I think there's at least as much cost-shifting from Megacorp group plans to individual plans as there is from Medicare.

To me this indicates the issue is less "government versus private sector" than it is about all the different ways health insurance is delivered to people, and with different groups having different power to keep cost increases on *their* insurance lower as long as others bear the brunt of the cost increases. The private sector (even without Medicare in the picture) is proving very capable at producing a wildly uneven playing field depending on where and how you get your identical coverage.

 

[huusom]

They should have passed a public insurance option instead of this mess. The whole thing was a setup by the insurance companies in the beginning. Having a non-profit public option to compete with the private insurance companies will definitely force the current system to be more efficient.

 

[samclem]

As stated in another thread, the Swiss system is remarkably similar to what we're trying to do here.

The new law could probably be transformed into something beneficial. But the pain of making the changes (getting employers out of the game, assuring a competitive marketplace with customer incentives for cost control, etc) would be high, and it's probably best to start over. But, that's not the way we'll do it in the short term.

 

[Gone4Good]

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?

I'd love to hear the specific details of the alternative (I've asked several times and gotten responses that either look very much like the existing health care law or simply assume that sick folks will go into high risk pools without providing any specifics about how those pools would work).

It really isn't helpful to simply throw stones at an admittedly unperfect solution without offering any realistic alternatives that would work better.

 

[ziggy29]

The new law could probably be transformed into something beneficial. But the pain of making the changes (getting employers out of the game, assuring a competitive marketplace with customer incentives for cost control, etc) would probably be more efficiently accomplished through new legislation. But, that's not the way we'll probably do it in the short term.

There's nothing in it for corporate campaign contributors (to either party OR to both parties), which is the problem. The bottom line, IMO, is that as the nation is more and more run by corporations using Congress as a proxy, the health care law that passed gave almost all of these big corporate lobbies something on their wish list.

The health insurance lobby and the pharmaceutical industry got laws to make everyone buy their product.

The trial lawyer lobby got something with no tort reform.

Large employers still get to keep their "health insurance tied to employment" model that gives them a huge competitive advantage over small businesses who can't afford insurance or get the same large-group pricing as the Megacorps.

This is government of the corporation, by the corporation and for the corporation, as has been increasingly the status quo for decades. They got the best new law they could buy.

 

[samclem]

There's nothing in it for corporate campaign contributors (to either party OR to both parties), which is the problem.

I don't take issue with any of your points, except that we should include the very important role of unions and other donors (e.g. the AMA) to the list of clients who bought what they want. I sure don't feel like my interests and the interests of citizens were put first in the process that was used or the product we got. And, while I know it's important to keep parties out of this discussion, the oft-cited "friend of big business" party had almost nothing to do with getting this law passed, so there's little doubt who was in bed with the big donors and inserting their favored provisions when it came to crafting this thing. That needs to be widely understood.