Obamacare ruled Unconstitutional!!

[mickeyd]

If ACA is eventually ruled illegal, I'll be looking for a big tax reduction. I am paying for the coverage of others, and I do not see any benefit to me and mine. Sounds selfish, but it is the truth in my case.

 

[aaronc879]

As you yourself say, mere peanuts in the overall cost structure.

You're outraged -- well, there's a case here in Wisconsin where a woman lost both arms and both legs because of medical negligence and was limited to $750,000 in non-economic damages under state law. I'm outraged by that.

If I understand correctly she was awarded the $750,000 maximum which is in addition to the costs of her health care. She doesn't pay for her health care related to the malpractice from that $750,000.

More on that case here: https://www.jsonline.com/story/news...lds-states-750-000-malpractice-cap/736673002/

 

[HGTVfan]

I'm surprised we are on page 4 of this thread w/o "That's all folks".

Shocked really.

If this thread is closed, there is a good discussion over at Bogelheads.

 

[travelover]

And politicians would never overstate a point to sell a bill, would they?

The facts are different. The penalty was very minor in the early years to make it less objectionable, but even when the penalty was minimal millions of people still bought health insurance... including those with no subsidy (including me!)... because they needed and wanted to have health insurance coverage to protect them from the financial calamity of an unexpected illness. And now in 2018, the penalty exists but is not being inforced by the administration yet millions of people are still buying health insurance even though there is effectively no penalty. The same will continue in 2019 once the penalty becomes $0.

It may end up to be true that the ACA can withstand people not taking out insurance until they need it, but it still is profoundly unfair and sure to generate resentment once the implications are publicized.

 

[Jerry1]

IMO, tort reform is a red herring in the health care equation, a talking point for some politicians that has little real bearing on expenses.

In my state, there already is a $750,000 cap on non-economic damages related to medical malpractice. It hasn't contained the cost of healthcare.

Yes but $100 million dollar plus awards still happen all the time.

This link shows a quick 1/2 a billion in added cost to the nations health insurance. MERE PEANUTS IN THE GRAND COST STRUCTURE, since it is easily offset by those states that already cap damages.

https://www.natlawreview.com/article/some-highest-medical-malpractice-settlements-recent-history

The real benefit of tort reform is not the reduction in large settlements. The cost is the extra care that is performed for defensive reasons. If you come into an ER with a bump on your head, you’re gonna get a CT scan. I can’t imagine all the extra testing that gets performed on pregnant women just in case. How many times have you heard a doctor say, I think you have X but let’s just do a couple tests. Defensive medicine. The cost is way more than the big settlements.

I remember arguing with my doctor about a test for strep throat. Given that she had already said she was giving me an antibiotic given the look of my throat, I asked, how would my treatment change if I did have strep. It wouldn’t. So why do it. I didn’t.

 

[pb4uski]

It may end up to be true that the ACA can withstand people not taking out insurance until they need it, but it still is profoundly unfair and sure to generate resentment once the implications are publicized.

I totally agree with you. There needs to be a mechanism to penalize free-loaders who don't buy health insurance until they are sick if we are to continue to prohibit medical underwriting.

Perhaps premium surcharges and increased deductibles and co-pays if you haven't had continuous coverage... with the premium surcharges and increased deductibles increasing the longer you have not had continuous coverage with a cap.

So for premiums, you pay a 20% premium surcharge for each year that you did not have coverage, up to 100% of premium (so if 5 years or more of no coverage you pay 200% of the premium that people with continuous coverae pay), and the same for deductibles and co-pays... that should be onerous enough to get the free-loaders to think twice about going without health insurance.

The premium subsidies would remain in place so affordability would not be a valid excuse.

Something like that anyway.

 

[Mr._Graybeard]

The real benefit of tort reform is not the reduction in large settlements. The cost is the extra care that is performed for defensive reasons. If you come into an ER with a bump on your head, you’re gonna get a CT scan. I can’t imagine all the extra testing that gets performed on pregnant women just in case. How many times have you heard a doctor say, I think you have X but let’s just do a couple tests. Defensive medicine. The cost is way more than the big settlements.

I remember arguing with my doctor about a test for strep throat. Given that she had already said she was giving me an antibiotic given the look of my throat, I asked, how would my treatment change if I did have strep. It wouldn’t. So why do it. I didn’t.

And the doc wouldn't possibly order up a CT scan because the CT machine is expensive and it has to keep running to turn a profit? Unnecessary tests are often performed because they're a revenue source.

My state, Wisconsin, has had a cap on non-medical damage awards related to malpractice on and off since the 1980s. It currently stands at $750,000.

The state insurance commissioner's office also maintains a fund to pay off large malpractice claims that exceed the maximum coverage the state requires doctors to carry -- $1 million per claim and $3 million aggregate. That state fund currently has a $1 billion surplus because state law has discouraged malpractice claims.

Here's a little summary on the malpractice climate in Wisconsin from Capson Physicians Insurance. It says Wisconsin has the third-lowest malpractice payout per capita in the nation. https://www.capson.com/medical-malpractice-insurance-by-state/wisconsin

Still, the cost of health insurance here is consistently above the national average.

 

[HFWR]

I’m sure glad I’ll be on Medicare soon, and won’t have to worry about socialized medicine... [emoji51]

 

[SecondCor521]

And the doc wouldn't possibly order up a CT scan because the CT machine is expensive and it has to keep running to turn a profit? Unnecessary tests are often performed because they're a revenue source.

I'm not 100% sure, but most of the time the CT scan is owned and operated by someone other than the doctor, so the doctor really has very little incentive to order a CT scan "to keep it running to turn a profit" as you suggest.

I'm fairly certain that if the doctor does have a financial interest in the CT scanner, they have to disclose that to the patient and make sure the patient knows they can get the CT scan done anywhere. Otherwise, it raises the appearance of impropriety. Google the Stark law and anti-kickback.

I have four doctors in my immediate family. I have heard many times that they do practice defensive medicine by ordering tests even when they're fairly certain that it isn't needed. The risk and cost of a malpractice lawsuit, which are real risks to the doctor, are high compared to the cost of a test which is born by the patient or the insurance company.

I don't know how to quantify the cost of defensive medicine but I think it is substantial. I'm sure someone has made estimates.

 

[Luck_Club]

As you yourself say, mere peanuts in the overall cost structure.

You're outraged -- well, there's a case here in Wisconsin where a woman lost both arms and both legs because of medical negligence and was limited to $750,000 in non-economic damages under state law. I'm outraged by that.

This case is a travesty in misdiagnosis. From what I read on the subject briefly she didn't get tested or have follow up, but had a run away infection that didn't get caught for several days after her elective hysterectomy.

She called her physician's office two days after discharge, reporting very little urination.

Not saying it is right, but accidents happen. This is the exact type of case where we have to ask ourselves how much should we punish for errors?

Imagine if every clerk that screwed up an order was responsible for 1000'S times the revenue generated from the order itself?

We have to say what is enough to compensate someone for there loss? If we say the moon and the stars then we all should be willing to pay through the nose with NO SUBSIDIES. at all.

 

[Independent]

I don't get it. The law was challenged to begin with because the mandate imposed an obligation on taxpayers. The mandate itself is what was viewed as the constitutional problem. It was held constitutional because all the mandate did was impose a tax. Done deal. Now Congress removes the mandate so it removed any constitutional problem the was ever in question.

+1

My daughter has a subsidized ACA policy (she is self employed). I'm sure that if she asked I'd say don't worry. I think this will be overturned.

 

[Independent]

If ACA is eventually ruled illegal, I'll be looking for a big tax reduction. I am paying for the coverage of others, and I do not see any benefit to me and mine. Sounds selfish, but it is the truth in my case.

Here's a list of the taxes used to fund ACA. The list is sorted by amount of money raised.

Our income is less than $250,000/yr. Given that, I don't see much tax impact for us. YMMV

https://jeffduncan.house.gov/full-list-obamacare-tax-hikes

 

[ERD50]

Insurers did not leave any marketplace in the US. They did stop offering individual policies, and that got a lot of attention, but in all those areas they continued to offer group and Medicare, and Managed Medicaid.

Cold comfort to individuals.

-ERD50

 

[Texas Proud]

I totally agree with you. There needs to be a mechanism to penalize free-loaders who don't buy health insurance until they are sick if we are to continue to prohibit medical underwriting.

Perhaps premium surcharges and increased deductibles and co-pays if you haven't had continuous coverage... with the premium surcharges and increased deductibles increasing the longer you have not had continuous coverage with a cap.

So for premiums, you pay a 20% premium surcharge for each year that you did not have coverage, up to 100% of premium (so if 5 years or more of no coverage you pay 200% of the premium that people with continuous coverae pay), and the same for deductibles and co-pays... that should be onerous enough to get the free-loaders to think twice about going without health insurance.

The premium subsidies would remain in place so affordability would not be a valid excuse.

Something like that anyway.

You and Travelover actually think that the freeloaders are going to buy insurance when they 'need' it I think they will continue to do what they have done and freeload on their healthcare... go to the emergency room and get treatment and not pay a dime...

 

[Montecfo]

You and Travelover actually think that the freeloaders are going to buy insurance when they 'need' it I think they will continue to do what they have done and freeload on their healthcare... go to the emergency room and get treatment and not pay a dime...

This is undoubtedly true. Even with the mandate in place millions who were subsidy eligible went uninsured as they continue to today.

"Insurance" that is optional and for which "coverage" cannot be denied is a welfare plan, plain and simple.

 

[explanade]

One ER visit could easily cost a years worth of premiums.

Of course they don’t have to pay, could declare bankruptcy, blow their credit for years.

 

[Jerry1]

"Insurance" that is optional and for which "coverage" cannot be denied is a welfare plan, plain and simple.

The other quirk is that coverage would not be denied. I mean seriously, are we really going to let someone die on the street? That’s why whether we like it or not, healthcare is a social(ist) endeavor. The pure capitalist model would say to let those who cannot pay, suffer, die, whatever. We don’t have that. We need to deal with what we have.

What frustrates me is that there’s all this talk about not having enough money to cover everyone. When in fact, we already absorb the cost of caring for everyone. If you don’t have money you get sick and use the emergency room. This already gets paid for by everyone. Worse, it’s more costly because you likely got sicker than you would have had you had the benefit of primary care.

Next, the administrative cost built into our system is beyond excessive. I’m not sure what it is today, but last I knew it exceeded 20%. 20% of a huge amount that provides no actual care.

Then the defensive medicine brought about by our litigious nature.

Seems like there is enough money. Just need to agree on the right path forward.

 

[mpeirce]

The real benefit of tort reform is not the reduction in large settlements. The cost is the extra care that is performed for defensive reasons. If you come into an ER with a bump on your head, you’re gonna get a CT scan. I can’t imagine all the extra testing that gets performed on pregnant women just in case. How many times have you heard a doctor say, I think you have X but let’s just do a couple tests. Defensive medicine. The cost is way more than the big settlements.

Exactly

 

[pb4uski]

You and Travelover actually think that the freeloaders are going to buy insurance when they 'need' it I think they will continue to do what they have done and freeload on their healthcare... go to the emergency room and get treatment and not pay a dime...

In short, yes.

My understanding is that the ER thing works for life threatening situtions... they are legally required to stabilize you... but then they can push you out the door.... it doesn't work for more chronic, serious illnesses (cancer treatment for instance).

So yes, I think that there will be some freeloaders who don't buy heallth insurance because they are cheap.. get a cancer diagnosis and then buy health insurance at the next open enrollment period.

Remember, there are a lot of stoopid, ignorant people out there.

 

[Montecfo]

Public hospitals cannot refuse care. No hospital can legally refuse emergency care.

 

[travelover]

In short, yes.

My understanding is that the ER thing works for life threatening situations... they are legally required to stabilize you... but then they can push you out the door.... it doesn't work for more chronic, serious illnesses (cancer treatment for instance).

So yes, I think that there will be some freeloaders who don't buy health insurance because they are cheap.. get a cancer diagnosis and then buy health insurance at the next open enrollment period.

Remember, there are a lot of stoopid, ignorant people out there.

Thanks, I was going to point out the fallacy of "just going to the ER for free care". That might work for a broken bone, but not for cancer or dialysis or other long term serious conditions.

 

[audreyh1]

You and Travelover actually think that the freeloaders are going to buy insurance when they 'need' it I think they will continue to do what they have done and freeload on their healthcare... go to the emergency room and get treatment and not pay a dime...

Well if they get cancer they won’t get the treatment they need from the emergency room.

 

[Katsmeow]

My understanding is that the ER thing works for life threatening situtions... they are legally required to stabilize you... but then they can push you out the door.... it doesn't work for more chronic, serious illnesses (cancer treatment for instance).

That might work for a broken bone, but not for cancer or dialysis or other long term serious conditions.

Yes, it also doesn't work for some acute problems that aren't life threatening. In fact, broken bones don't necessarily get set in the ER. Recently, my daughter went to the ER because she had fallen. She had broken her foot. Now -- she has ACA insurance. But she hasn't met the $6k deductible. Anyway, the ER wrapped her foot and sent her home telling her to go see an orthopedic surgeon. Of course, for most people, they could do that. DD has an issue with that though because she can't afford to pay the rest of the deductible. Still she made an appointment with a surgeon (couldn't get one for two weeks). She then fell again ended up back in the ER and they just rewrapped the foot....

 

[Jerry1]

Thanks, I was going to point out the fallacy of "just going to the ER for free care". That might work for a broken bone, but not for cancer or dialysis or other long term serious conditions.

Well if they get cancer they won’t get the treatment they need from the emergency room.

Sadly, they will go broke and end up on Medicaid. This is terrible from both a human and cost perspective. From the human side, likely by the time they are broke, they’ve been through hell emotionally and their illness has caused significantly more suffering than they might have otherwise experienced. From a cost perspective, the person comes into Medicaid so ill that more money is spent trying to save them than would have been necessary had they been treated properly in the first place. Ultimately, people get care. It may be too late and the whole ordeal is beyond sad, but ultimately we don’t turn people away.

 

[Texas Proud]

In short, yes.

My understanding is that the ER thing works for life threatening situtions... they are legally required to stabilize you... but then they can push you out the door.... it doesn't work for more chronic, serious illnesses (cancer treatment for instance).

So yes, I think that there will be some freeloaders who don't buy heallth insurance because they are cheap.. get a cancer diagnosis and then buy health insurance at the next open enrollment period.

Remember, there are a lot of stoopid, ignorant people out there.

I would agree that there are going to be some as you describe... but I also think that the number that would do it would not move the needle on the rates to everybody....


And you might have to wait up to a year to sign up... the person might not live that long with cancer...


But I do agree that having a premium penalty would be beneficial, but good luck with getting that through congress....