Judge in VA strikes down federal health care law

[samclem]

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Originally Posted by easysurfer 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]

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Originally Posted by FinanceDude 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]

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Originally Posted by ziggy29 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]

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Originally Posted by samclem 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]

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Originally Posted by samclem 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]

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Originally Posted by Gone4Good 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]

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Originally Posted by FinanceDude 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]

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Originally Posted by samclem 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]

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Originally Posted by ziggy29 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.

[ERD50]

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Originally Posted by Gone4Good Except to do this, you need to make sure everyone is in the pool.

Yes, of course.

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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.)

There is more than one way to accomplish this. Do the Swiss have an 'individual mandate' or do they just provide a voucher (funded through taxes) and you are an idiot not to use it for health care (as it is no good for anything else).

I understand it is all semantics, but the Constitution and our laws are made up of words, so words are important.

edit/add - sorry, there were about 20 posts between me starting and submitting, I apologize for any redundancy (beyond my normal level ), but by the time I edit this, that edit will need editing!

-ERD50

[Gone4Good]

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Originally Posted by ERD50 There is more than one way to accomplish this. Do the Swiss have an 'individual mandate' or do they just provide a voucher (funded through taxes) and you are an idiot not to use it for health care (as it is no good for anything else).

According to Wikipedia . . .

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Health insurance is compulsory for all persons residing in Switzerland (within three months of taking up residence or being born in the country).

[ziggy29]

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Originally Posted by samclem 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.

Both parties are bought and paid for by Big Business, and most hedge their bets and don't go "all in" with either party, not wanting to be left off the guest list for the party if the "other guys" take control.

Had the other party had control of Congress and the White House when this was passed, you'd see a lot of the same "winners" emerge, just in different ways. These lobbies (and yes, you can probably include unions and major trade organizations here, too, as they also won with special exemptions and such) pay big money and they expect results.

[ERD50]

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Originally Posted by samclem 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.

In general, I agree that the General Welfare clause has been stretched beyond where it should. But, I wrote this a year or so ago in all the debates, and I still feel strongly about it:

To have insurance 'work', we really do need everyone in the pool. And I can't see how we get everyone in the pool, with out either forcing it (mandate), or providing a voucher (paid out of taxes) to everyone. As long as we allow some to decide to go bare, and we aren't willing to kick them out of ERs, I'm paying twice. I can argue that getting everyone in the pool is actually good for the General Welfare of the country.

There are some bad ways and some less bad ways to do it. I think the current bill is very bad on many fronts. We could/should do better, and I hope that this court case is a catalyst for that, but I expect to be disappointed

-ERD50

[Midpack]

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Originally Posted by ziggy29 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.

+1

We are already spending much more than any other country [all with universal health care in some form], and we don't have better care to show for the expense if longevity and infant mortality are any indication.

While I generally don't believe government has a good record spending our money effectively/efficiently, health care seems to be an area where they could indeed make a difference. The current system is so out of whack on the cost side, it appears they'd have a hard time making it worse if they just follow the model of any other developed country. However, if they start from scratch and just institutionalize the current broken system, they could indeed make it worse.

And from what I read, the access to care and other issues are largely no longer valid. We won't be able to afford the current system, so it will change eventually...sooner vs later.

[samclem]

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Originally Posted by Midpack And from what I read, the access to care and other issues are largely no longer valid.

The wait times for many procedures are still very long by US standards in many countries with "government provided" health care. I'd be happy t find out differently.

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Originally Posted by Midpack We won't be able to afford the current system, so it will change eventually...sooner vs later.

Very true. I think folks of many viewpoints (proponents of single payer, private insurance purchased by individuals, etc) believe a "crash" will happen and they want to be positioned to take advantage of the anger and the crisis atmosphere to drive their preferred solution home. I'd rather take a deliberate approach to making things better now, but it seems we need a crisis to force actions on hard issues (debt/deficit, SS, health care, etc). That can lead to some bad results, and it certainly leads to a "force it through at all costs" mentality that results in a lot of disgruntled citizens and poisoned political waters.

[ERD50]

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Originally Posted by Midpack +1 We are already spending much more than any other country [all with universal health care in some form], and we don't have better ... While I generally don't believe government has a good record spending our money effectively/efficiently, health care seems to be an area where they could indeed make a difference. The current system is so out of whack on the cost side, it appears they'd have a hard time making it worse if they just follow the model of any other developed country...

Here is where your argument falls apart - substitute "public education" for "public health care" and where are we? The US spends more on public education than other countries and gets worse results. I think that tells us that switching private health care to public is not a slam dunk positive.

Though I agree we need to do 'something'.

-ERD50

[Martha]

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Originally Posted by samclem The wait times for many procedures are still very long by US standards in many countries with "government provided" health care. I'd be happy t find out differently.

I have posted on this issue before and the data is mixed, with some countries having shorter wait times than the US and others longer. It sort of depends what you are waiting for. Waiting in an emergency room? In many areas of the US this wait is terribly long. Waiting for non-emergency surgery, such as knee replacement? You may wait longer in some countries. Waiting to see you primary care doc? Waits can be long in the US. Again, depending where you are as we do not have a health care system in the US.

http://www.early-retirement.org/foru...tml#post458387

I note that wait times to see specialists in the US can be long. For example, I have a particular problem. I was referred to a specialist in November. My appointment is not until February. There isn't an emergency, but there is a strong inconvenience factor as it screws up my winter. And this is just the initial appointment, a procedure will be required later.

[samclem]

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Originally Posted by Martha Waiting to see you primary care doc? Waits can be long in the US. Again, depending where you are as we do not have a health care system in the US.

We sure don't. I can understand why the ER's are more crowded after MA's universal care law, it's apparently largely due to more people being put into Medicaid. My health insurance also comes through a govt program (TRICARE), and if I call with an urgent-but-non-emergency situation, I can't see a provider for, usually, two weeks. There is no urgent care option, so I go to the ER and wait, just like Medicaid patients and many others who are in systems with a scarcity of providers.

OT: I wonder if it really costs as much to provide care in ERs as some experts claim. I'm sure the bills hospitals submit are high because they can get away with it (since "everyone knows" it's the most expensive place to provide care), but the desk has to be staffed 24/7 anyway, and they know that 50%+ of the patients are non-emergency cases and can be handled by a PA or nurse practitioner. One exam room staffed by a PA authorized to write prescriptions could handle the workload effectively for these non-emergency cases, with the ER admissions desk handling the scheduling. The ER MD and staff is there if additional support is needed.

[Martha]

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Originally Posted by samclem OT: I wonder if it really costs as much to provide care in ERs as some experts claim. I'm sure the bills hospitals submit are high because they can get away with it (since "everyone knows" it's the most expensive place to provide care), but the desk has to be staffed 24/7 anyway, and they know that 50%+ of the patients are non-emergency cases and can be handled by a PA or nurse practitioner. One exam room staffed by a PA authorized to write prescriptions could handle the workload effectively for these non-emergency cases, with the ER admissions desk handling the scheduling. The ER MD and staff is there if additional support is needed.

Some places have combined an urgent care clinic with their ER, triaging people into one or another. It seems to help with wait times and cost. The urgent care staff can help out in the ER if things get really busy.