The Moment of Truth

[Chuckanut]

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Originally Posted by pb4uski Who is Harry Trueman?

I think he was actually called Harry Truman.

[TromboneAl]

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Originally Posted by Gone4Good Certainly. They easily could have written the law to bump every tax bracket up 1%-2.5% (the size of the penalty), included a per-person tax deduction for everyone who buys health insurance equal to 1%-2.5% of AGI, dropped the word "mandate," and the word "penalty" and the whole thing would be constitutional. The ease with which we can achieve the same exact thing by slightly different means exposes the silliness of this whole debate.

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.

[ERD50]

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Originally Posted by Gone4Good Never is a very long time. But so too is the history of trying to get comprehensive health reform: ...

If it is cut down, maybe there is still more hope than you think.

Regardless of any shortcomings/negatives, there certainly were things in there that people want. I don't think any current Congress is going to be able to get away with doing nothing. People have had a taste of something they want. Congress will be attacked for taking away x,y,and z, and be painted as very bad people. I honestly think they will have to do something.

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... and almost another two decades for ACA to finally pass only to possibly fail at the hands of the Supreme Court.

Perhaps I'm being pedantic, but I'd say the failure was with the Congress that passed a law that was likely to be challenged. Saying the bill failed at the hands of the SC is like saying the murderer was executed by the hands of the jury. The murderer was the cause of the action, the jury did its job.

-ERD50

[ERD50]

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Originally Posted by TromboneAl 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.

I believe so, I can't vouch for the numbers, but the concept is what I'm talking about.

For me, the question is - why not take the less challenge-able route? There must be a reason.

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

I'm not sure JSP is even asking those questions.

-ERD50

[M Paquette]

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Originally Posted by ERD50 I believe so, I can't vouch for the numbers, but the concept is what I'm talking about. For me, the question is - why not take the less challenge-able route? There must be a reason.

It's a tax hike. Grover would be upset. When Grover gets upset, the Usual Suspects all get upset, and before you know it, every radio commentator and talking head is carrying on with the usual spiels.

Nothing will happen. Nothing will be done. Other than raising insurance rates, of course.

[samclem]

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Originally Posted by TromboneAl 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 think the challenge would have been much less serious if it had been structured as G4G suggested. The states still would have challenged the Medicaid expansion.
As written the mandate is relatively toothless anyway--the penalty would have maxed out at 2.5% of income (family limit: $2085) by 2016. So, a family of 4 earning $100K would have been fined $2085 or else buy an approx $11K insurance policy (no subsidy).

[harley]

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Originally Posted by ERD50 I believe so, I can't vouch for the numbers, but the concept is what I'm talking about. For me, the question is - why not take the less challenge-able route? There must be a reason. I'm not sure JSP is even asking those questions. -ERD50

The reasons for phrasing the law the way they did was because they couldn't get it passed using G4Gs terminology. It was barely passed anyway, using various parlimentary manuevers. And nobody had their head wrapped around the whole thing. As I remember, Nancy Pelosi said something along the lines of "lets get this thing passed so we can start finding out what's in it." Congress doesn't have the same make up as it did when the PPACA passed, so I do think it would all have to start over from scratch.

[samclem]

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Originally Posted by M Paquette It's a tax hike. Grover would be upset. When Grover gets upset, the Usual Suspects all get upset, and before you know it, every radio commentator and talking head is carrying on with the usual spiels.

Didn't anybody who cared about Grover vote against it anyway?

Anyway, folks shouldn't get out the black armbands yet, the whole thing might just pass Supreme Court muster.

It is interesting that proponents of the law insisted "this whole thing can only work if everyone is compelled to buy insurance." Then, on Wednesday, their lawyers are arguing that we should go ahead with this even if the individual mandate is struck down. Prominent supporters of the law are saying the same thing now. What was impossible before is suddenly preferable. I recognize that I do the same thing myself--the goalposts move and now half a loaf looks darn good.

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

[ERD50]

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Originally Posted by harley The reasons for phrasing the law the way they did was because they couldn't get it passed using G4Gs terminology. It was barely passed anyway, using various parlimentary manuevers. ....

Well, that's the obvious answer (and most likely correct) as to why it passed in that form. But I think that says a lot about the support the bill had, and IIRC, general polling didn't show support either.

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Originally Posted by M Paquette It's a tax hike. Grover would be upset. When Grover gets upset, the Usual Suspects all get upset, and before you know it, every radio commentator and talking head is carrying on with the usual spiels. Nothing will happen. Nothing will be done. Other than raising insurance rates, of course.

Well, I think we're drifting (running at full speed?) into porky-land here, so out of respect to those of us who want to see this thread stay open, I'll just say there are other pressures in play, and that I don't share your pessimism. And I'm in the camp that says Murphy was an optimist.

-ERD50

[NW-Bound]

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Originally Posted by haha I agree. Best to keep thinking and speaking to a minumum around here. Can't we just concentrate on cats, how wasteful other people are, and on detailed fantasies about simple living? Soon it will be spring; then we can also share photos of flowers in our gardens. Anything else is just a want, not a need. Ha

Eh, I have tried to minimize my involvement in threads like this. It's not that I do not care, but as I have stated on this forum before, I have proposed the Political Efficiency Hypothesis, which parallels the EMH. I just let other people slug it out. And right now, the Supreme Court Justices are deciding, and they are certainly no dummies.

Oh, and a lot of this health care stuff to me is "wants", not really "needs" anyway.

[pb4uski]

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Originally Posted by samclem ......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.

[Old Microbiologist]

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 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!!!!).

[Gone4Good]

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Originally Posted by TromboneAl 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.

[FinanceGeek]

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Originally Posted by TromboneAl 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.

[Bestwifeever]

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Originally Posted by borschelrh ,,,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?

[pb4uski]

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Originally Posted by Gone4Good ....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.

[ERD50]

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Originally Posted by Gone4Good ...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'.

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

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

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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.

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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:

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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.

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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

[MichaelB]

The thread needs to stay focused on health care to avoid an unnatural end.

[Texas Proud]

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Originally Posted by Chuckanut 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...

[ERD50]

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Originally Posted by MichaelB 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