Judge in VA strikes down federal health care law

[ERD50]

Except to do this, you need to make sure everyone is in the pool.

Yes, of course.

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]

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 . . .

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

 

[ziggy29]

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]

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]

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]

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.

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]

+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]

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/forums/f38/wheres-the-good-data-24678.html#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]

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]

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.

 

[Gone4Good]

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.

Maybe, maybe not. With education we're comparing public education here with public education elsewhere. The fact that we get worse results, then, has to derive from some other source. I think a lot of it is cultural (we laugh at the "nerds" and admire the jocks. We scorn the "educated elite" as "not real Americans" while admiring the hard working manual laborer. It's tough to expect kids to work to educate themselves in a country that often times looks down on the educated, or, at the very least sees, "street smarts" and "common sense" as an equivalent).

With health care at least a case can be made that having a quasi private system instead of a public one is a driver of our worse results. Many studies show a large divergence between the health outcomes of the rich and the poor, the insured and uninsured in the U.S. That latter group tends to pull the average results down, suggesting our uneven system of providing care is a large contributing factor to our worse results.

 

[Martha]

More contributions to our uneven system of providing care: Medicaid services slashed to save $

Some states have cut or are in the process of severely cutting medicaid benefits, leaving people without necessary care or with care that makes no sense. For example, not paying for drugs, such as antipsychotic drugs, blood thinners, insulin, antibiotics, etc resulting in more hospitalizations at a far greater cost than the drugs. Not paying for hospice services. Not paying for dental care, except to relieve pain.
Medicaid services slashed to save $

Medicaid prescription drug cuts not smart - Columnists | Tri-City Herald : Mid-Columbia news

 

[M Paquette]

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.

"Congressman? There's a gentleman here from the Soylent Corporation who has an interesting proposal to rein in Medicare costs."

 

[Texas Proud]

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.

Just a question... isn't Blue Cross/Blue Shield a non-profit... it still does not prevent premiums from going up sky high...

 

[chinaco]

I don't see too much to cheer about.

Our health care system has major problems in multiple areas. Anyone that thinks that doing nothing is a victory must be lulled into some false sense of security... thinking that their situation (or their family members situations) cannot change for the worse.

I was not pleased with certain parts of that bill or the way the whole thing played out with no compromise or collaboration on either side.

But at least there was some sort of progress.

For some reason there is a group of politicians that are content leaving us with the problems we face.

Something about that seems wrong to me.

 

[Texas Proud]

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.

One problem is that we have a fundamental difference... (and I might be reading your posts wrong, so forgive me if I do).... I will try and make it no personal...


There is one big camp who thinks everybody should have insurance and get medical care... this can be in the form of single payor or everybody has to have insurance and we can help out with tax money... think of this as universal coverage...

The other big camp is that health care is not a right... but there should be rules and regulations covering what an insurance company can and can not do... think of this as universal access...

Now, since I am in the camp of universal access and not universal coverage... why should I make up rules that make everybody have insurance That means I am in the universal coverage camp and I do not want to be there... I also do not want the gvmt paying insurance premiums (or any part of it) for people who make $70K... heck, even $50K...

If we can get over the theory that everybody should have the same level of health care then we can design a plan that covers the poor, a plan that covers the lower income people... and one that covers the higher income people...

I make more than average... I live in a house that is more than average... I can have a car that is more than average.... etc. etc.. so why should I have average insurance....

(BTW, I do not have a great plan... and I can not get one because I am tied to the company since I get a tax deduction... so even if I could go out on my own.. it does not pay to do so)...

 

[Midpack]

But at least there was some sort of progress.

For some reason there is a group of politicians that are content leaving us with the problems we face.

I agree that some sort of progress is better than the status quo, and I rarely see the government as a solution but they could be in the case of health care IMO. I say that because the fact remains we pay way more per capita than any other country on earth, including all developed countries - and don't get superior results overall by any measure I've seen. Yes we could make it worse, but clearly that's not a given (as evidenced by every other country).

But I don't think we can hang this on politicians alone. The uninsured is a problem, but they are still the minority. The insured majority squawks about the increasing cost of employee contributions, but most have no idea how much corporations and others are paying on their behalf. In the end, they don't want their "benefit" touched by their politician. Even though they complain, subconsciously or consciously they realize it's a bargain in what they pay out of pocket. And it's easy to convince them universal care would be "expensive" because they're unaware of what the US system actually costs them - most of it hidden in the products & services and taxes they pay.


The problems for the US include:

• lifestyle (obesity, smoking, drugs)
• high cost and profit for intermediaries (insurance)
• excessive profit for some product and service providers
• administrative burden (millions of microplans)
• high charges for specialized services
• forced use of expensive specialized facilities for routine medical needs (emergency room)
• multiple regulations around the country
• punitive legal awards
• diagnostic overuse (expensive tests even for routine matters)
• treatment overuse (especially end of life)
• excessive unproductive labor vs technology
• plus significantly/ironically, excessive usage

It's no easy issue...

 

[ERD50]

The problems for the US include:

• lifestyle (obesity, smoking, drugs)
• high cost and profit for intermediaries (insurance)
• excessive profit for some product and service providers
• administrative burden (millions of microplans)
• high charges for specialized services
• forced use of expensive specialized facilities for routine medical needs (emergency room)
• multiple regulations around the country
• punitive legal awards
• diagnostic overuse (expensive tests even for routine matters)
• treatment overuse (especially end of life)
• excessive unproductive labor vs technology
• plus significantly/ironically, excessive usage

It's no easy issue...

You forgot:

The US Govt gave tax breaks to companies to provide health coverage. This led to higher costs for those outside of companies that supplied coverage. It meant people lost coverage if they lost their jobs. It meant that during good times, companies competed for talent by offering "good" benefits. For the employee, "good" meant low deductibles and low co-pays, which led to no one knowing or caring what their health care really costs. And that became a downward spiral.

So the history of Govt involvement is not good. They don't consider the consequences. They need to tread carefully, and they haven't demonstrated that quality.

... Anyone that thinks that doing nothing is a victory must be lulled into some false sense of security... thinking that their situation (or their family members situations) cannot change for the worse.

I don't want this to come across as confrontational, I'm just playing off your own phrasing, but anyone who thinks that doing anything is a victory must be lulled into some false sense of security. Or that action is justified just because it is doing 'something'. We need good, thoughtful actions. Not just 'actions'.

-ERD50

 

[winger]

The current insurance we have allows you to look online to see what a medical provider charges, and what the insurance pays. It is an eye-opener. Nearly always 1/3, and sometimes less.

I'm a retiree in a mega-corp group. Can't imagine how smaller groups and individuals get by.

 

[easysurfer]

?? 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.

The government forcing citizens to do all kinds of things, private or not is a little George Orwell. (I was being sarcastic about the privlege of being drafted).

But what if the government had, cough.."a public option"? That way they won't be forcing citizens in private commerce.

At the other extreme, I bet if the governement said we have to right to say "no insurance" no treatment" that might change the whole dynamic
of things.

 

[samclem]

But what if the government had, cough.."a public option"? That way they won't be forcing citizens in private commerce.

I don't think a "public option" would face any significant constitutional hurdle of the type this law faces. Depending on how things are structured, there might be some problems with implementation (e.g. in some foreign plans, the intrusiveness of the government medical system into people's lives goes well beyond what Americans have been comfortable with. But, we're gradually becoming desensitized to this, so maybe it won't be a problem. Once we strap on the government diaper and suckle from the government bottle, I think we understand that Uncle Sam will need to peek in our nappies occasionally to assure himself that all is well. )

Regarding the taxation level needed to support it: As far as I can tell, according to the present "sense of the public" there seems to be no inherent constitutional limit to how much the government is allowed to seize from one citizen to give to another. There is a practical limit, however. Unfortunately, there's no elegant feedback mechanism that keeps that "taking" in check, things just decay when people can't keep the product of their labor.

From an abstract "which is a bigger affront to freedom" POV, we should realize that taking our private property is very much like taking a part of our lives from us. We traded our time to get that property, it is time we can't get back, and when the property (earnings, savings, etc) is taken it's like losing a portion of our life. So, I'm not as concerned with the government directing me to buy a product from a private company as I am with minimizing the amount of this "taking", and also having some control over it (how much, what for, who gets my money, etc). If the government directs me to buy insurance from a private company (on the exchanges), at least I have the choice of who gets the money and maybe how much I spend. If history is a guide, and if the field is level, this privately-provided service may cost less, overall, and be of higher quality than the same service run by the government. On the other hand, with single payer, I'll be taxed without any say in how much is taken, and I'll live with whatever Uncle Sam chooses to provide. Neither is what the framers of the Constitution would have envisioned, but I know which I'll pick if given the choice.

 

[Nords]

"Congressman? There's a gentleman here from the Soylent Corporation who has an interesting proposal to rein in Medicare costs."

"Make room! Make room!"

I guess those lines are too old & niche for this crowd...

 

[keegs]

I enjoyed this piece from David Leonhart in today's NY Times. He describes a national debate very much reflected in this thread.

http://www.nytimes.com/2010/12/15/business/economy/15leonhardt.html?_r=1&hp

 

[lets-retire]

I don't see too much to cheer about.

I see a lot to cheer about. This judge said that government can not force a person to buy something simply because they are alive. That is huge. I do think a single payer system would be found to be constitutional, but I also think a single payer system would be highly inefficient and more expensive than what we currently have.

 

[ziggy29]

but I also think a single payer system would be highly inefficient and more expensive than what we currently have.

It may well be, but that's a really scary thought -- that something could actually be worse than the "system" currently in place. Hard to imagine anything less efficient, more costly and more of a headache to deal with in terms of bureaucracy.