The Moment of Truth

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......FWIW, 72% of the public thinks the individual mandate is unconstitutional (Gallup). Me, too. But only those nine justices really count now.

From what I read, the reality is only one or two really count because the others have already chosen sides. Probably realistic too. Sounds like it will come down to Justices Kennedy and Roberts.
 
Cynacism, snarkiness, and health care

I like your comment on how do we prevent it. Short answer is you can't as it is an outgrowth of the school of hard knocks. The more you get knocked the more cynical you get particularly in regard to politics and expectations from the government. Speaking of Medicare that whole system is what is to blame for how we got here in the first place. I used to manage a not-for profit laboratory in a small community hospital. We charged the actual costs for lab work. But, we were purchased by a large conglomerate which was strongly for-profit. I used to be a cost-center for accounting as everything performed in the lab was done as an expense. Well, the Medicare system has allowable maximum payments for things as part of the admission/discharge diagnosis. For example a dipstick urinalysis cost roughly 2 cents to perform but we were able to charge Medicare $18. A 20 test chemistry panel costs us 20 cents to run (routine not STAT) and I could charge $200. That was in the beginning and of course insurance companies began using the Medicare allowances as the basis. That all changed in the 80's as we once again went back to a cost center and only minimum costs were paid by Medicare. However, a certain minimum amount of test must be performed to qualify for full re-imbursement from Medicare. We formed a DRG (see:Diagnosis-related group - Wikipedia, the free encyclopedia) committee consisting of myself representing the Dept of Pathology, the Radiologist for Radiology, Pharmacist, Medical Records, Administration, and Head of Nursing. Daily we reviewed every chart of every inpatient to ensure that all required services and testing were performed so maximum payment was received from Medicare. We even would modify the diagnosis to maximize the claims thus gaming the system to the maximum profit. None of this is illegal but represents where the emphasis has been since 1982. Maximum profits for the minimum amount of service. If Medicare says you only need a certain amount of treatment then that is exactly what a patient gets and nothing more. Everything in excess of those minimums are considered expenses and take away from the bottom line. I received large bonuses for having high efficiency. I also expanded enormously the amount of out-patient testing we performed and our profits (and my bonuses) rose dramatically. Medicare loves outpatient stuff and pays very well and this is the real reason out-patient procedures are preferred and now done as a rule. This is why health care is in such big trouble and why I am so cynical.

I was recalled to active duty during this period (sadly as I was raking in the salary and bonuses) and was locked into the military for another 18 years unable to retire even though I tried 3 times and all rejected as I was too essential. I filed 3 Congressional request for assistance only to be told they don't mess with the military. Cynical:confused: You bet. Worse, I was drafted originally for the Viet Nam war but (stupidly) decided to stay and maximize my education. I re-enlisted in 1973 for 6 years and was promised free health care for life during which time I completed my BS. I got out to obtain my MS and did ROTC simultaneous to being in the National Guard into which I was commissioned as a helicopter pilot. I was recalled into the Army in 1984 as a microbiologist and got my PhD while on active duty and spent the rest of my career doing nasty things. After a long stressful career I retired and now live in Hungary. Free heath care had by then disappeared and now we have Tricare. We are now only eligible for Tricare overseas and they are rapidly changing the amount of deductibles and cost shares that the military will cover. At the moment we have a $150 a yer per individual ($300 for family) after which they cover 75% of "allowable" costs. It is an okay benefit although we must pay cash then submit a claim and eventually get it processed. That system was very damaged but is now more or less functional. They used to have a 400% error rate in claims but now it has dropped to "only" 100% errors. I spend quite a bit of time dealing with this. So, now we are nearing the Medicare time (at least my wife is as she turns 65 next year, I am only 59 so it is a ways off). The military has implemented "Tricare for Life" which mandates that we must use Medicare as the major provider BUT we must pay Part B out of pocket. Now here is the clincher. To stay enrolled in Tricare Overseas we must pay for Part B even though we can never use Medicare outside the United States. So, I am mandated to pay for services I cannot ever use and what I was promised I would never have to pay for. I get more cynical every day. Luckily, health care here in Hungary is excellent and very cheap as they don't get the concept of health care as a business (thank god!!!!).
 
This is profound. Does this argument really hold water? That is, if it had been written this way would there have been a challenge? We certainly have deductions and credits for things and this is no different.

Yes, not only is it profound, it lays waste to the high-minded notion that what we're arguing over in this case are Constitutional rights, or even limited government. In the case of Medicare (or more broadly, single payer) the more intrusive and coercive government program is deemed Constitutional where the less intrusive one is struck down.

But consider even the argument that somehow a "mandate," backed only by a threat of a limited financial penalty, to engage in a private transaction is unprecedented. It isn't. We have the same basic effect with the home mortgage interest deduction. People who choose not to take out a mortgage of sufficient size pay a financial penalty to the government in the form of higher taxes. In the health care law, people who choose not to obtain health insurance pay a financial penalty to the government. The mandate and the tax deductibillity of mortgage interest are identical programs. The only difference is terminology.

It's hard to imagine any other Constitutional right that can be infringed by a simple change in verbiage. But we're on the brink of declaring one.
 
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This is profound. Does this argument really hold water? That is, if it had been written this way would there have been a challenge? We certainly have deductions and credits for things and this is no different.

Could Joe sixpack recognize that the two systems (penalty or increase with deduction) are equivalent.

I believe the two systems would only be equivalent for people who owe Federal income taxes.
 
,,,To stay enrolled in Tricare Overseas we must pay for Part B even though we can never use Medicare outside the United States. So, I am mandated to pay for services I cannot ever use and what I was promised I would never have to pay for. I get more cynical every day. Luckily, health care here in Hungary is excellent and very cheap as they don't get the concept of health care as a business (thank god!!!!).

Can't you choose to drop Tricare Overseas if the Hungarian system is meeting your needs?
 
....We have the same basic effect with the home mortgage interest deduction. People who choose not to take out a mortgage of sufficient size pay a financial penalty to the government in the form of higher taxes.....

So Congress providing an incentive for citizens to own their own home by making mortgage interest tax deductible is a really a penalty on all citizens who do not carry a mortgage (even though those citizens who do not carry a mortgage get the standard deduction).

Using the same logic, the earned income credit isn't a benefit provided to the poor, but rather a penalty on everyone else for not being poor.

So I guess anything that the government does to incentivize certain behavior is really a penalty on everyone else. Thanks for the insight.
 
...it lays waste to the high-minded notion that what we're arguing over in this case are Constitutional rights, ...

I believe that there are a few 'high minded' men & women in black robes very seriously arguing over the Constitutional rights of this case at this very moment. Doing exactly what you say we are not doing. How can you deny that?

IMO, your defense has devolved into 'if I repeat it enough times, it must be true'.


We have the same basic effect with the home mortgage interest deduction. People who choose...

operative word being 'choose'. Important terminology, no?

The only difference is terminology.

Terminology is important. The Constitution is just a bunch of words. Interpreting the 'terminology' of those words is a big part of what the SC does, and they are now doing it.

It's hard to imagine any other Constitutional right that can be infringed by a simple change in verbiage. But we're on the brink of declaring one.

I believe the verbiage of this phrase has been questioned quite a bit:

A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.

Meaning of "the right of the People"
Justice Antonin Scalia, writing for the majority in Heller, stated:

Nowhere else in the Constitution does a “right” attributed to “the people” refer to anything other than an individual right. What is more, in all six other provisions of the Constitution that mention “the people,” the term unambiguously refers to all members of the political community, not an unspecified subset. This contrasts markedly with the phrase “the militia” in the prefatory clause. As we will describe below, the “militia” in colonial America consisted of a subset of “the people”— those who were male, able bodied, and within a certain age range. Reading the Second Amendment as protecting only the right to “keep and bear Arms” in an organized militia therefore fits poorly with the operative clause’s description of the holder of that right as “the people”.[115]

Let's see, just one sentence, and we have a number of 'terminology' decisions from just one judge in one paragraph. A 'right' here is defined as 'an individual right'. .. “the people,” “the militia”, all require specific terminology distinctions. I recall a (state) Supreme Court ruled on whether a tomato is a fruit or a vegetable. Yes, terminology matters in law. It appears to be an inconvenient truth for you.

-ERD50
 
The thread needs to stay focused on health care to avoid an unnatural end.
 
Quite well said! I agree. We have to follow the law as it is written.

What I find interesting is that the people who so energetically protest plan B, may end up with plan A, which gives them even less choice. I suspect this is the opposite of what they want. Just my 2 cents.

IMO, the people who voted for this knew they could not get plan A passed... so they did plan B... and are hoping it sticks...
 
The thread needs to stay focused on health care to avoid an unnatural end.

Some clarification please?

I thought the thread was about the Supreme Court's review of this law. not specifically about 'health care'. We have had numerous threads on health care. But this SC review is 'new news', we have the transcripts and reports, and I thought that was the topic of this thread. I thought re-hashing health care was what was going to get the thread closed. Sorry, I'm confused.

edit/add - looked back and indeed the OP is specific about the SC hearings of this week, not about HC in general. And your own post #50 provides positive feedback on a comment that was solely about the SC process, not a whiff of HC in it. So yes, I am very confused.

-ERD50
 
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Some clarification please?

-ERD50
I suspect what MichaelB is warning about is the fact this thread keeps drifting back fom "How will the Supremes rule on the ACA?" to "Let's debate the interpretation of the Constitution", which cannot be done in isolation of the current political divide. Since it appears difficult to do one without the other, and debating politics is off limits, I doubt this thread will last much longer.
 
While I hope the thread continues, it has lasted 5 times longer than many originally thought it would.
 
Not quoting the original post because it was back a page or two...

But the example of garbage is not quite the same as this bill...

First, almost everybody wants their garbage picked up... and they do not mind the local gvmt doing it...

Which leads me to the second point... it is not part of the federal gvmt to pick up my garbage.... heck, it is not even a gvmt entity that picks up mine... it is public utility district... (I guess you could argue that is one...)...



My point.... most laws that are very popular with a large majority of the people will get passed in a form that most will agree with... this law fails this test badly.... this does not mean it will be thrown out by the SC, as it might be written well enough to pass... but if it is not thrown out it will be picked at by Congress for a long time....
 
In our neck of the woods we are personally responsible for our trash. We are expected to separate trash from recycleables and bring both to local recycling centers in each community and pay for each bag of trash we generate. The cost is modest, $3-4 a bag depending on the size of the bag. No need for government involvement in collecting trash, although the towns sponsor the recycling centers.

Perhaps we could fashion a system of medical care on how we do trash - some government involvement, personal responsibility and affordability.

Too late methinks.
 
Not just "I'm outta here" but also "I'm changing jobs". Than could have a very positive effect on business and employment in the US.

It could also have a very negative effect as the federal govt will have to raise taxes significantly to fund it, and even that will not work over time.....;)

I agree the model is broken in many ways, but the Congress could have taken it a bite at a time instead of ramming a 2700 page bill that few understand down our throats. If the individual mandate is upheld, the govt will literally have the power to make us buy whatever they want us too, as the precedent would have been set by this case.

Call me old school but I think the Constitution still has merit, and I am not ready to tear it up just yet. Does the SCOTUS feel the same way? We'll see..........
 
The justices meet today:

Justices meet Friday to vote on health care case - Yahoo! News


The voting goes according to seniority. Interestingly, from the article...

"That's because Roberts speaks first, followed by Scalia, then Kennedy. If the three men hold a common view, the Obama health care overhaul probably is history. If they don't, it probably survives."
 
That sounds right. From what I have read, Kennedy and Roberts are the key swing votes. Scalia is expected to vote against the individual mandate.
 
Is anybody planning any concrete changes, or heard of strategies for this, based on this week's hearings? Of course, nothing has actually changed yet, but it's fair to say that the popular perception is that the law is in much more trouble than most people believed it would be. We'll obviously know more when the ruling is announced in Juine, or before then if information from deliberations becomes public, but maybe there's hedging or other practical steps that make more sense today than they did a week ago?

Me: The only way the ACA has affected me to date is that DD (23 YO) became eligible to stay on my (previous) employer's insurance plan. It's a big plan (TRICARE), so I'm watching for "what if" news on that.

Anyone else investigating options? Any value added in acting today?
 
Perhaps we could fashion a system of medical care on how we do trash - some government involvement, personal responsibility and affordability.
But, if you don't pay for your trash pickup, it doesn't impact me. Today, if you don't have health insurance and get injured and can't pay the $200K for MRIs, surgery, hospital stay, etc, then I and everyone else get the bill (through cost shifting to our private insurance or through higher taxes.) That's the case the government is making: The costs of treating the uninsured are already being paid by others, they want to codify it.
 
Is anybody planning any concrete changes, or heard of strategies for this, based on this week's hearings? Of course, nothing has actually changed yet, but it's fair to say that the popular perception is that the law is in much more trouble than most people believed it would be. We'll obviously know more when the ruling is announced in Juine, or before then if information from deliberations becomes public, but maybe there's hedging or other practical steps that make more sense today than they did a week ago?

Me: The only way the ACA has affected me to date is that DD (23 YO) became eligible to stay on my (previous) employer's insurance plan. It's a big plan (TRICARE), so I'm watching for "what if" news on that.

Anyone else investigating options? Any value added in acting today?

I posted elsewhere on this forum that I am thinking about stepping down from my j*b to take a sabbatical beginning this summer. The sabbatical would be ~2 yrs long to include a full time masters degree, and I was assuming/depending on using COBRA until Jan 1 2014 when the exchanges were to take effect (pre-existing conditions in my family).

Nothing I can do today, but if the ACA fails constitutional scrutiny I'll be taking a shorter sabbatical to make sure I complete my masters and get re-employed before COBRA runs out.
 
IMO, the people who voted for this knew they could not get plan A passed... so they did plan B... and are hoping it sticks...
As I recall, Plan B was what the Senate had already passed when its version of the bill had 60 votes. It was yet to be reconciled with the House version when the Senate lost its 60th vote for the bill so the House held its nose and passed the Senate bill as is. The law, then, really wasn't a "finished product". It was forced through like a "shotgun marriage" because there was no way the differences could have been reconciled in conference at that point.

I think the people who voted for this -- those in the House that passed a badly flawed Senate bill as is -- knew they were getting a flawed bill... but they recognized that the alternative was MANY more years of gridlock on Capitol Hill and thus they had to take whatever they could get.

IMO, it's a shame that not enough policy makers seem to understand how important it is to get employers out of the health insurance business, how many jobs that could be opened up because of many people who could retire except for the health insurance problem, and how much entrepreneurial spirit could be unleashed by people who could afford to leave Megacorp and pursue their own dreams because Megacorp no longer offered the health insurance "golden handcuffs".
 
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What I will say is the law had some good ideas in it, but the way in which it was passed in a partisan way with no compromise, has caused a lot of the polarization we see today.

Again, I fail to see why this had to be done some quickly, with so many "back-room" deals cut, and all the exemptions for politically tied unions, etc, etc, etc.

On top of all that, it's an entitlement the CBO says we can't afford...... the US has an "entitlement addiction", and that's no healthy for the future.........

What is the answer? Maybe figure out the pre-existing problem first, take on one problem at a time.
 
Some clarification please?

I thought the thread was about the Supreme Court's review of this law. not specifically about 'health care'. We have had numerous threads on health care. But this SC review is 'new news', we have the transcripts and reports, and I thought that was the topic of this thread. I thought re-hashing health care was what was going to get the thread closed. Sorry, I'm confused.

edit/add - looked back and indeed the OP is specific about the SC hearings of this week, not about HC in general. And your own post #50 provides positive feedback on a comment that was solely about the SC process, not a whiff of HC in it. So yes, I am very confused.

-ERD50
I am so very sorry for your confusion. This happens when one posts in a rush. Still, REW did get it and managed to correctly convey my intention.

I suspect what MichaelB is warning about is the fact this thread keeps drifting back fom "How will the Supremes rule on the ACA?" to "Let's debate the interpretation of the Constitution", which cannot be done in isolation of the current political divide. Since it appears difficult to do one without the other, and debating politics is off limits, I doubt this thread will last much longer.
 
But, if you don't pay for your trash pickup, it doesn't impact me. Today, if you don't have health insurance and get injured and can't pay the $200K for MRIs, surgery, hospital stay, etc, then I and everyone else get the bill (through cost shifting to our private insurance or through higher taxes.) That's the case the government is making: The costs of treating the uninsured are already being paid by others, they want to codify it.

I think we all agree the system is currently being abused by those who have no insurance. However, giving the uninsured insurance just so some can feel good about it is unlikely to lower costs, and is a fallacy of the legislation. It will lead to futher abuse of the system, and ERs will be even more overrun with people having an ER doctor treat their runny noses...........this already happens........:facepalm:
 
Is anybody planning any concrete changes, or heard of strategies for this, based on this week's hearings? Of course, nothing has actually changed yet, but it's fair to say that the popular perception is that the law is in much more trouble than most people believed it would be. We'll obviously know more when the ruling is announced in Juine, or before then if information from deliberations becomes public, but maybe there's hedging or other practical steps that make more sense today than they did a week ago?

Me: The only way the ACA has affected me to date is that DD (23 YO) became eligible to stay on my (previous) employer's insurance plan. It's a big plan (TRICARE), so I'm watching for "what if" news on that.

Anyone else investigating options? Any value added in acting today?
Options are so limited its not clear what most people could do. People with coverage look to make sure they keep it.
 
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