The Moment of Truth

[easysurfer]

I think that if there was a hard stance, to those who can afford insurance, "No insurance, no treatment" then folks would get the message and be more than willing to get coverage.

Think about car insurance. If Mr. Risk-taker had no insurance but got in a wreck, could he go say, "Well, I really meant to be insured, but couldn't because of <excuse>" and get away with that? I don't think so.

Of course, than the question becomes are we willing to take that extreme and stick to the hard line?

 

[Gone4Good]

Intrade has shown some accuracy at forecasting outcomes of popular votes, but only a day or two ahead of elections.

In this case, there won't really be any new news coming out, so I think what we have here is about as accurate an estimate as we're going to get.

I like the comment about the Supremes deciding things in a way that satisfies nobody but themselves. It doesn't seem like striking down the whole law is necessary. Nor does it seem like even striking down the guaranteed issue provisions are necessary. If the states don't like what is happening to their insurance companies without a mandate, they can certainly institute one.

Seems like just deserts for the states bringing the suit in the first place.

 

[easysurfer]

You mean the insurance that most states require you to purchase?

I meant to say, if you have no car insurance, but is found liable, or need want to file a claim, good luck saying "well, I have no insurance but cover me anyhow."

If folks who forgo any health insurance see that to have insurance or don't expect any coverage, I'd think folks would sign up. I guess it'll be a game of who blinks first. The ones who think no insurance whatsover is needed vs 'do we treat them anyhow?"

But as I think about it, the hard stance wouldn't fly anyhow. For example, if someone needed emergency treatment. Will the first question be "Insured or not?" or treatment. I'm sure treatment comes first.

 

[TromboneAl]

You can't tell how the justices will vote based on what they say, and you certainly can't tell based on the sound bites on the news.

 

[Gone4Good]

You can't tell how the justices will vote based on what they say, and you certainly can't tell based on the sound bites on the news.

Agreed. And I think today's arguments are biased toward giving the impression that the judges will vote to strike down the mandate. The whole "severability" discussion presuposes that outcome. Intrade is probably a good sell today. Maybe we can get this discussion moved to the Stock Picking board.

 

[M Paquette]

The one problem I see is that Mr. Leach decides not to buy insurance for his family and himself. A few months later, his 6 year old daughter, Linda Leach, gets ill. Do we really want to deny her care because her father is a leach?

The Emergency Medical Treatment and Active Labor Act of 1986 guarantees care in an emergency.
http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

One could self insure for minor care, and rely on the Act for emergency treatment for accidents, injuries, and illness, including chronic life threatening diseases. Millions of Americans currently rely on this mechanism. Funding for the extremely expensive ER care is derived from a combination of Medicaid when available, state and county taxes for public facilities, and very high un-negotiated or retail rate hospital charges and padding on negotiated rates charged for those who have insurance.

I've talked with folks who have philosophical issues with insurance. There is some sentiment that if they are in good health, their insurance payments are going to cover the expenses of some sick people or malingerers because of insurance risk pooling, and they object to this. It's an interesting concern, even if it does miss the whole way insurance works, as a mechanism for risk pooling.

Given this concern, and the whole per-existing conditions problem with people gaming insurance, I have a modest proposal. Reduce the size of the risk pool to an individual, or a family as a single covered entity. Now the insured doesn't have to fear paying for some stranger. Further, to prevent gaming the system, limit the lifetime payment from the insurance to 80% of the total payments made by the insured. (The 20% reserve is to cover administrative costs, expenses, and bonuses for the insurance company.). Now they can't possibly game the system.

 

[M Paquette]

I think that if there was a hard stance, to those who can afford insurance, "No insurance, no treatment" then folks would get the message and be more than willing to get coverage.

Think about car insurance. If Mr. Risk-taker had no insurance but got in a wreck, could he go say, "Well, I really meant to be insured, but couldn't because of <excuse>" and get away with that? I don't think so.

Of course, than the question becomes are we willing to take that extreme and stick to the hard line?

This sounds like a nice formula to return to the good old days of emergency medical care, where the first procedure done was the traditional walletectomy.

http://www.ncbi.nlm.nih.gov/pubmed/21421951

Folks didn't seem willing to stick with that extreme a century ago. Perhaps with modern medical costs they'd be more open to this today.

 

[M Paquette]

The Emergency Medical Treatment and Active Labor Act of 1986 guarantees care in an emergency.
http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

One could self insure for minor care, and rely on the Act for emergency treatment for accidents, injuries, and illness, including chronic life threatening diseases. Millions of Americans currently rely on this mechanism. Funding for the extremely expensive ER care is derived from a combination of Medicaid when available, state and county taxes for public facilities, and very high un-negotiated or retail rate hospital charges and padding on negotiated rates charged for those who have insurance.

I've talked with folks who have philosophical issues with insurance. There is some sentiment that if they are in good health, their insurance payments are going to cover the expenses of some sick people or malingerers because of insurance risk pooling, and they object to this. It's an interesting concern, even if it does miss the whole way insurance works, as a mechanism for risk pooling.

Given this concern, and the whole per-existing conditions problem with people gaming insurance, I have a modest proposal. Reduce the size of the risk pool to an individual, or a family as a single covered entity. Now the insured doesn't have to fear paying for some stranger. Further, to prevent gaming the system, limit the lifetime payment from the insurance to 80% of the total payments made by the insured. (The 20% reserve is to cover administrative costs, expenses, and bonuses for the insurance company.). Now they can't possibly game the system.

(note that this look a lot like a medical savings account, with a fee to gain access to the insurers negotiated rates. It will be a bit harsh on the insured for the first decade or two on their plan, but over the entire population it will probably work out. On average. Except for the sickies...)

 

[Gone4Good]

Given this concern, and the whole per-existing conditions problem with people gaming insurance, I have a modest proposal. Reduce the size of the risk pool to an individual, or a family as a single covered entity. Now the insured doesn't have to fear paying for some stranger. Further, to prevent gaming the system, limit the lifetime payment from the insurance to 80% of the total payments made by the insured. (The 20% reserve is to cover administrative costs, expenses, and bonuses for the insurance company.). Now they can't possibly game the system.

Nice!

 

[easysurfer]

This sounds like a nice formula to return to the good old days of emergency medical care, where the first procedure done was the traditional walletectomy.

Patient dumping in New York City, 1877-1917. [Am J Public Health. 2011] - PubMed - NCBI

Folks didn't seem willing to stick with that extreme a century ago. Perhaps with modern medical costs they'd be more open to this today.

Thanks for the link.

Yeah..on second thought...I guess dumping won't work.

 

[Major Tom]

You can't tell how the justices will vote based on what they say, and you certainly can't tell based on the sound bites on the news.

Most definitely. I saw a local newspaper in a vending machine this morning with a headline that read something like "Supreme Court Justices extremely critical of proposed healthcare law."

Well of course they're being critical. It would be very worrying if our Supreme Court Justices weren't thinking that way.

 

[FinanceGeek]

It seems that every controversial decision in US society comes down to a 5-4 partisan vote. I therefore suspect that the oral arguments before the supreme court have more theatrical than predictive value.

Still its very significant to me that the intrade contract value swung 20 points in one day.

Intrade has shown some accuracy at forecasting outcomes of popular votes, but only a day or two ahead of elections. This is not a public vote and the outcome is not limited to "keep or revoke". The US Supreme Court is expert at ruling in a way that satisfies no one but itself.

I thought this was well-said.

Actually, the outcome of the intrade contract is indeed limited to the fate of the mandate provision and not to other parts of the law. So its market price should accurately reflect the perceived probability of just that portion of the law being struck down.

Agreed. And I think today's arguments are biased toward giving the impression that the judges will vote to strike down the mandate. The whole "severability" discussion presuposes that outcome. Intrade is probably a good sell today. Maybe we can get this discussion moved to the Stock Picking board.

On the subject of pricing, there is presently an excellent arbitrage opportunity on the intrade contracts related to healthcare reform - the one that expires 12/31/2012 is priced *higher* than the same contract which expires a year later. Negative relative time premium!

 

[ziggy29]

I wonder how much Justice Kennedy feels like Joe Mantegna's character on First Monday...

 

[Gatordoc50]

Allow all to buy into Medicare and charge a premium for Medicaid, based on income for those not covered by Medicare or Private insurance. I know, I know, where was I when all this was being drafted.

 

[REWahoo]

Here he comes...

 

[MichaelB]

Lets try to keep the thread on topic and related to early retirement and financial independence, and not get sidetracked into arguing about freeloaders, leeches and socialism.

 

[pb4uski]

Lets try to keep the thread on topic and related to early retirement and financial independence, and not get sidetracked into arguing about freeloaders, leeches and socialism.

This is silly. The thread has to do with the SCOTUS review of the health care law, which is an admittedly political topic in a politically titled thread. If the dialogue is censored to be only related to ER & FI, there isn't much to be said.

 

[youbet]

So, don't say much.

If mean spirited, politically orientated digs are desired, there are a number of forums specializing in that sort of thing.

 

[ziggy29]

This is silly. The thread has to do with the SCOTUS review of the health care law, which is an admittedly political topic in a politically titled thread. If the dialogue is censored to be only related to ER & FI, there isn't much to be said.

One can discuss the review without using charged labels such as freeloaders, socialism and other emotionally-charged words intended to stir up acrimony and which generate defensive, emotional responses. The issue itself IS central to FI and RE and can thus be discussed provided the rhetoric is more carefully chosen and don't use language that invites "full contact politics."

This is your absolute final warning shot across the bow. Any more questioning of moderator decisions in public here WILL result in thread closure and possibly additional action -- period, full stop.

 

[Sarah in SC]

So, don't say much.

If mean spirited, politically orientated digs are desired, there are a number of forums specializing in that sort of thing.

 

[ERD50]

One can discuss the review without using charged labels ...

Thanks - I'd like to see the thread continue. I think we can learn from it.

At this point I'm most interested in the mechanics of the SC decision. We've debated the HC stuff many times, so now I'd just like to discuss how this SC process works.

As was mentioned, it seems that some judges are talking about what would be good or bad, or what Congress intended. I'm surprised by that - I would think they would look at it in strict Constitutional terms, almost in a vacuum. Each branch should do their own thing.

In that light, if they decide it is unconstitutional, I think the whole thing should go. I don't think it is reasonable for those judges to decide what would should stay and what shouldn't. In some cases, issue X,Y or Z was added to get a State to go along with the mandate - but can the judges 'know' this - should they try to fathom that? I don't think so. Make it all or nothing, and let Congress put the pieces back together again, and make it Constitutional this time - that was their job.

True, we now have a different Congress than we had. But whose 'fault' is that? The questions on Constitutionality were there from the start, so this is the price they pay for taking that risk.


-ERD50

 

[easysurfer]

Whichever way SCOTUS eventually decides, it's gonna be a historic decision.

In the back of my mind, I've wondered if SCOTUS decides if the mandate is constitutional, then would more folks say "I'm outta here" and FIRE as it seems for many, not finding individual insurance because of pre-existing conditions is the biggest hurdle to FIRE.

 

[pb4uski]

.....As was mentioned, it seems that some judges are talking about what would be good or bad, or what Congress intended. I'm surprised by that - I would think they would look at it in strict Constitutional terms, almost in a vacuum.......-ERD50

I was surprised that many of their comments/ruminations had to do with the detriments and benefits of the law rather than the constitutionality. Though I suppose the constitutionality is covered ad nauseum in each sides legal briefs.

It was amusing where Scalia questioned whether having to pore through all 2,700 pages of the law might be cruel and unusual punishment.

 

[MichaelB]

Whichever way SCOTUS eventually decides, it's gonna be a historic decision.

In the back of my mind, I've wondered if SCOTUS decides if the mandate is constitutional, then would more folks say "I'm outta here" and FIRE as it seems for many, not finding individual insurance because of pre-existing conditions is the biggest hurdle to FIRE.

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.

 

[brewer12345]

Whichever way SCOTUS eventually decides, it's gonna be a historic decision.

In the back of my mind, I've wondered if SCOTUS decides if the mandate is constitutional, then would more folks say "I'm outta here" and FIRE as it seems for many, not finding individual insurance because of pre-existing conditions is the biggest hurdle to FIRE.

How many would-be entrepreneurs choose not to pursue their dream and stay at teh day job just to keep the health benefits? That is one major reason I have not seriously considered any such ventures.