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The rationale offered by the Supreme Court in upholding the insurance mandate provisions of the health care reform law known as Obamacare hinged on regarding the mandate, and its related penalties for not buying insurance, as functionally equivalent to a tax.
Photo: 401K 2012 / Flickr
The law does not depend on the mandate to contain health care costs. That can be done by liberalizing trade of prescription drugs and other measures. It does not depend on the mandate to avoid the problem of free-riders. That is already done by narrowing the window during which one can enter the insurance market every year.
The law depends on the mandate because a good chunk of the revenue to pay for subsidized private-label insurance comes from fines – or, as SCOTUS would have it, taxes – paid by those households too poor to pay for insurance under the new program.
How much are the mandate provisions expected to raise in federal revenue? According to the non-partisan CBO (see table 2 here) the mandate-related penalties for those too poor to afford insurance will amount to 54 billion dollars over the 2012-2022 period.
It is, in other words, a way of implementing a highly regressive tax to fund the coverage expansion. And it is, as such, a highly unfair way to pay for that program: it takes from low-income families who will be denied medical insurance to help other low-income families pay for theirs.
All of which leaves me perplexed as to why progressives, and democrats more generally, are celebrating the fact that SCOTUS ruled in favor of these provisions. Surely the 54 billion in revenues can be collected in some other, fairer, way.
(And just to put the new 54 billion dollar tax on low-income families in context: the tax on big banks implemented to recover TARP-related losses is estimated by Treasury to collect in all 41 billion dollars.
Surely bankers deserve to bear the burden of mitigating the poverty-inducing effects of their actions rather than low-income households whose financial troubles, and consequent lack of health insurance, are largely caused by the bankers’ malfeasance and fraud)
(Update: crossposted at kgblogz)
150 Comments
Short answer. Because it will pay for preventive care, medical care for folks with pre-existing conditions and reduce the use of emergency rooms for primary care.
Like I said, there are other ways to raise the money than from those least able to pay.
Like I said elsewhere, this is Baucuscare. It was written by the former VP-Government Relations (i.e. lobbyist) for Wellpoint. Of course it missed the obvious better ways of funding it (such as Medicare for All).
At the moment, the reason for celebration is (1) the Commerce clause itself was not struck down, (2) there is relief for those with pre-existing conditions, (3) the individual mandate will hit some folks with the ability to pay (especially younger ones) who are low-risk enough to think they are invulnerable, (4) cost-shifting affects those who can pay their bills but sacrifice lots of other things to pay off their debt, and that is reversed. In addition, there is an expansion of Medicaid for those with the lowest incomes (and least or no tax liability) and a subsidized high-risk pool — but only if the states opt in.
Yes, there are much better ways to finance healthcare. Medicare for All or a National Health Service (VA for all) are two proven examples.
The celebration is just the relief of not returning to the way the essentially unregulated insurance industry was operating prior to the ACA going into effect.
Lol. That they didn’t rip up the good provisions, sure. Great news! But you’ve got a pretty low bar there. These things have nothing to do with the mandate, which – in my understanding – serves no purpose other tahn to penalize those too poor to afford insurance under the new program.
On who it will hit, I disagree. I haven’t seen any numbers, so I’m obviously going by anecdotal evidence. But my 30-something friends who live in cities look at it and hate it. Not because they think they’re invulnerable, but because insurance won’t be affordable for them under the new regime.
As for passing the mandate and allowing states to opt out of the medicaid expansion, that seems to me to be the worst possible ruling.
This Supreme Court is the Tim Donaghy of referees with it comes to the law. These narcissists will not rule in favor of taking money out of their investment portfolios, nor will any sitting politician in this day and age will make legislation to that effect. Furthermore, the executive branch has proven to be impotent in enforcing any law that may damage their portfolios.
Health insurance is another Wall Street racket tossed on the American public so that some people can profit off the sickness and death of another person.
“Draw them in with prospect of gain, take them by confusion.” Sun Tzu, The Art of War
The health care fight morphed from universal to pubilic option to individual mandate where now the supposed “liberals” are defending a mandate to buy a defective product that creates profit through human suffering. The fascists are winning. Even if the mandate was struck down by itself, the majority of this industry friendly act will remain intact or the industry would have reverted back to what is was doing prior to the act.
The questions that should be before the court is whether health care is a human right or not and should an industry profit off the misfortunes of others? The ruling today just further entrenches a system built around human greed and extracts profits from dying bodies.
It’s like a football game for some of these so-called progressives and obamabots. Their guy and team won. Who cares about the immediate or long term implications and precedent.
Ya know, even if I don’t like this law, I still think it’s good that our legal challenges are being decided based on the Rule of Law, and not whatever Scalia’s dad did to him back in the day.
I’m so glad that the Supremes have decided that I should pay taxes to a private, for-profit entity in exchange for crappy service./s Woohoo.
Well I don’t think that’s the right reading of the situation. I’ve long predicted that, simply by looking at SCOTUS as an agent of the corporate agenda, they would (i) uphold the mandate – which the insurance industry loves – and (ii) hobble the expansion of government programs like Medicaid – which the insurance and provider industries hate.
Yup. I don’t like the precedent that Roberts seems to have been desperate to insert regarding limitations on expansion of federal programs.
Yes. It blocks expansion of government programs and entrenches subsidized private insurance. That’s a big problem for coverage and cost-control going forward…
Exactly obey. I have said many times before that the real decision for the court was deciding between corporate America or helping rethug politicians. Looks like they managed a 2-fer.
We can all agree that “Affordable Care Act” was never anything but a giveaway to the health insurance and pharmaceutical lobbies wrapped up as “health care reform”.
I originally wrote that comment back in April when no one knew how the Court was going to decide. But by applying logic, it was a forgone conclusion and others knew this as well. Defending the culture of greed has been the duty of the Supreme Court since its inception.
I didn’t set a low bar. I am still holding out for Medicare for All.
I was answering your rhetorical question about why are Progressives celebrating. And pointing out that the tax hike was only one side of the equation.
Some people whose coverage was at risk in this decision are also celebrating.
And there are still two years left before the tax takes effect to enact Medicare for All and reform the tax code to be more progressive in effect. Stuff like that doesn’t happen on its own.
Thank you for posting your outrage. I share your feelings and thoughts on this.
It does not block expansion of government programs. It blocks expansion of federal mandates to states about programs (even if the federal government provides 90% of the funds). The federal government can still do Medicare for All essentially by removing an age restriction, appropriating the funds for it, uncapping the payroll tax, and raising the Medicare tax rate. Folks who then have access to preventive and primary care will create cost savings in reduced utilization of hospitals and emergency rooms and specialists.
Awesome!
In the mean time, what do I do if my uninsured 10 year old breaks her arm?
What would you have done before this case was heard? What would you have done in 2007?
I confess that I am missing your point.
The solution is so simple, but the pretzel logic concocted to evade the common sense solution occupies the thoughts of all in government. How sad.
I’m sure “pay through the nose” is the answer no matter when/if an arm is broken.
In 2007 my monthly premium for the family of 4 was $344 per month. I also made more money that year than I do now.
My family is in the income area that will be covered by Medicaid expansion, yet we cannot afford private insurance. My contribution through my company is a little over $850 for our family (different company than ’07).
Seeing that I’m in Texas, if SCOTUS did indeed give states the right to opt out of the Medicaid expansion, then I’m screwed. I now HAVE to buy insurance that I CAN’T afford to buy, or pay a penalty that I can’t afford to pay on my taxes.
That was my point.
Or shorter, since I’m so fucking pissed off right now that I want to throw this computer through the window, so my above rant may have been incomprehensible –
I still can’t afford coverage, or qualify for government subsidized coverage, but now I have to pay a bunch of money anyway.
Oh, and my children still don’t have access to health care that I can afford.
God Bless America!
Perhaps Kris’ family qualifies for subsidies?
One of the reasons this bill is hard to fight is because there are some reasonable stop-gap measures that *will* help some people in the short run.
Exactly my point. You are in the same situation you were before of not being able to afford health care insurance. Period. Nothing changes until 2014. No penalties to the IRS or enforced purchase of healthcare coverage until then. But two years to organize and press for a real healthcare bill, which will also require a huge change in the political culture–especially in places like NC and TX.
@23 Nor does my wife. I am on Medicare, but my providers seem to miscode services so as to maximize my deductibles.
For a broken arm, folks go to the emergency room, get the bill, dodge the collection agencies, and let the hospital shift the costs. It’s the less drastic stuff that weighs you down financially, especially with chronic conditions.
But there are people who would have been seriously hurt had this decision gone the other way.
That sounds right. Good caveat. But I’m still waiting to see how legal experts parse the ruling on the medicaid expansion.
Great. So basically I’m just supposed to take on more debt and try to change the minds of all the neoconservative assholes in my state government. Cool.
Now we’re on the same page.
We need to stop fighting this bill and start fighting for Medicare for All.
The hurdle to overcome is the attitude among some seniors that they “earned” their Medicare coverage through the payroll deductions for Medicare tax, not realizing how much the government is subsidizing them. And this is a problem because some of them feel that younger people, people who didn’t work, and “them” (whoever “them” is) are going to horn in on what they worked so hard for.
It’s time to stop looking in the rearview mirror on this one and join with National Nurses United in moving the issue forward.
Like I said, that is going to be a hard fight because of the special interests involved and the fog of this corrupt political culture.
That sounds horrible Kris. What does happen to those who fall in this prospective donut hole created in states which forego the Medicaid expansion…?
Prety much it. Same as in 2007. Just more people working on it now. Yes, we are on the same page.
But those with the resources to afford insurance who were shut out because of pre-existing conditions and those with individual and employer policies are benefitting from the regulations and regulated medical loss ratios. And they are celebrating today.
To control costs, at the very least medicine should be subject to the Sherman Anti-trust Act and health insurance should be made available across state lines like any other industry. Medicare for all is the best, but this does not even satisfy a conservative looking for medicine to compete in a truly free market. Even worse, Obama and the democrats gave up everything from Renewable Energy Standards to the Bush Tax Cuts to get this monstrosity.
My point exactly. And why I’m so frustrated.
We had relief in sight with Medicaid expansion. For someone like me who would theoretically have to pay almost half my new income for coverage every year through my company (if we all used $2k of services or more), the Medicaid expansion was an answer. It made coverage possible.
It appears the SCOTUS took that away.
That’s why I’m pissed. Not necessarily about the mandate, but the option that states may have to back out.
Now, we may see a redefinition of this decision by the 11th Circuit in the next 30 days. At least that’s my vague understanding of the situation.
No, they gave them up for other monstrosities (Bowles-Simpson, for example), not this one. But greenhouse gas regulations were just upheld in appeals court, and to my mind those are more effective than any pseudo-market (carbon tax or cap-and-trade) would have been.
And the checks in the mail, and I promise not to come in your mouth. Tarheel, time to come out of the land of denial. Medicare for all is dead for the forseeable future. With this decision there is not only zero incentive to go that direction, it’s gone negative.
The time for the medicare for all implementation was when bo and the dems had control and fucked us back in 2009. They weren’t interested then and they sure as hell don’t give a fuck now.
You’ve missed my point above. It’s not the same as 2007. In 2007 wages were higher, insurance was cheaper, and coverage was better.
I had insurance that I could afford in 2007. My kids were covered.
I haven’t had insurance for over a year now. Under the law as it passed Congress we would be insured. Now that’s apparently been taken away.
The 11th Circuit, eh. Oh, joy! Alabama, Georgia, and Florida justices are going to make this decision.
This whole thing is just such a clusterfuck!
Correct on all counts.
I disagree.
Perhaps once people see that the mandate would be cheaper — and offer more bang for the buck — if it were paid as a tax to the government we may see movement toward single payer.
completely OT, but I hope Italy beats the living shit out of Germany in this UEFA match. Looking good so far.
You are right, I missed the point that you would fall under the Medicaid expansion. But it hadn’t taken effect yet. And yes, that hope has been taken away.
I lost my insurance for three years after I retired (after a stent operation) and only got on Medicare at 65. My wife has diabetes and she’s been uninsured since she lost her fulltime job two years ago.
And not only have wages and salaries been going down (or not rising as fast as costs), the medical systems around here have been using their oligopoly to jack up rates. And creative coding to up the amount of co-pays that are calculated on a percentage basis. For example, a lab test that had been $35 for unisured was changed so that an RN did it and they could charge $120 just by changing the billing code.
agreed. TD posts are odd. Not sure what planet TD is on but the one called earth is not doing anything suggested by TD so long as we have a fully co-opted political and legal system. working through the system is a waste of time and energy we need to develop a better way before we are all total serfs to a fascist state.
Thanks. I needed an excuse to keep sitting on my butt. No reason to do anything now. Maybe I’ll just take a snooze.
Lol. I’m with you!!
OK. Give me a proposal for a better way. BTW, I never said we needed to work through the system. Sometimes folks mistakes what I write in analysis as advocacy.
DDay’s got a post up about Medicaid expansion in red states.
On the plus side, I just read that the law provides premium subsidies for people whose employer offers insurance that costs more than 9.5% of their income.
So there’s that.
I don’t think it “blocks expansion of government programs” per se.
I think Congress wrote this provision as an option, and the option was for expansion, not medicare completely.
So since states were given the option to opt out, they get that option.
If Congress want’s to go back and write that it’s forced, that it’s no option, they probably can.
Not likely. This has nothing to do with what “people see”. It has to do with doing what the insurance and medical lobbies want versus what they don’t. There’s no way either party will give all of those dollars to the other over a “small” percentage of people falling through the hole.
If the government did what the people wanted things would be far different. There is no logical reason to believe this will change. Other than a psychological or a partisan need to put a happy spin on things.
Highly rcc’d.
Thank you for laying out the obvious purpose of the ACA, to funnel money to pHarma and the insurance companies on the backs of poor people.
Like Citizens v United bought our political system for the corporate rich, the Supremes have now legalized theft from we the people by the corporate fascists.
Sick.
We’ll see. Regular people are remarkably sane when it comes to financial matters. Paying more to, get less, especially after getting hammered in this economy, may become a tipping point.
Italy 2 – Germany 1.
Spain and Italy in the Championship Final. Fuck you Germany.
Let the Spaniards and the Italians have a little bit of fun before you drain them dry.
I’m trying to figure out how this affects me (because it is, after all, about
). The Affordable Care Act is neither affordable, nor care. I had employer-provided health insurance until I was downsized about 15 years ago. I did the COBRA thing for 18 months at a cost, if I remember correctly, of about $500 per month (way back then) for a family of three. When that ran out, we tried to get catastrophic coverage only (since we are not fans of Western medicine or pharma). No dice. Not for any price. And we were 15 years younger and healthier back then. The pretense for not covering us was my being slightly overweight and my husband having been referred to a dermatologist for a tiny spot on his face. So neither one of us had a drop of insurance since then. Periodically we attempt to get some, as self-employed 50-somethings, and we end up laughing (or crying) hysterically. Either we pay for what amounts to a discount on the cost of basic care and meds, or we pay more than our rent for what amounts to BS coverage. And I make a pretty decent amount of money – too much to fit into any Obamacare subsidies, I am sure. The idea of having to pay vast sums for health insurance that will not actually provide me with health care makes me sick and so far I have refused to do it. I expect I will continue to refuse. The IRS and I are good friends; they were just over at my house last summer. I’m sure they’d be happy to return and drag me kicking and screaming to jail – where I believe they will have to give me health care.
Well, that’s some nice formatting, right there ^^. An edit button would be so nice, along with Medicare for All.
Are you sure those privatized prisons have healthcare? Or are you expecting to go to Club Fed with those Martha Stewart tailored jumpsuits?
{Laugh to keep from crying}
Yep, that’s pretty much it unless a whole lot of ordinary people wake up.
Obey, yours is the best commentary on this issue I have read today.
“All of which leaves me perplexed as to why progressives, and democrats more generally, are celebrating the fact that SCOTUS ruled in favor of these provisions.”
I don’t get it either. As you mention, there are any number of ways of providing both universal coverage and cheaper health care. Obamacare is a way to advantage corporate profits at the expense of those on the low end of the socioeconomic ladder. It is one more program to move wealth upward with a few pretty words and maybe crumbs for the middle class. Or did I miss something here?
And those praising Obama I don’t get either. Anyone who had read his website prior to the 2008 election could have seen he didn’t give a shit about affordable, universal coverage by looking at what he had in mind for cutting hospital’s emergency room insurance. And then one of the first significant acts of his administration was to conduct a secret deal with the health care industry in the same fashion as Cheney did with energy companies!?
What the fuck do people think is going on here? And folks are surprised that anti-environment, corporate-friendly, military-tribunal-promoting Justice Roberts would come down on the side of legally enforcing corporate profits through the Orwellian trick of calling them taxes?!
The best I can guess is that most of those progressives praising the SCOTUS decision are middle class and are therefore exhibiting the typical middle class attitude of hitching their wagon to those above them while distancing themselves from those below. Or they are at least not appreciating what this decision will mean for those who can’t afford health care to begin with.
“In America everybody is of the opinion that he has no social superiors, since all men are equal, but he does not admit that he has no social inferiors, for, from the time of Jefferson onward, the doctrine that all men are equal applies only upwards, not downwards.”
― Bertrand Russell
I feel ya’ Kris. We’re going to get fined for not being able to afford insurance, too.
Yeah, Tarheel, shoulda put a snark tag on that. I don’t actually believe they’d give me health care in jail. But all snark aside, the lack of insurance is getting to be pretty scary the older we get. I will have to do my homework and see just how “affordable” it turns out to be in California, given the austerity budget that was just passed here.
My motto for a few years was “Just stay healthy until 65.” Now my wife’s motto. At least California is trying to end run in some additional provisions instead of trying to gut what’s there.
I’ve been hearing all kinds of California-specific stuff on the news but mostly tuned them out because I literally do get sick with stress when I attempt to find insurance.
I do need to respond to Obey’s general premise: if we were doing Medicare for All and it really did cost x or y to ensure that every last person was provided with health care (not just insurance), I’d be happy to subsidize that. Of course I am a socialist and not a progressive.
As someone without insurance right now…with a major pre existing condition, may I say that I felt my life was at stake. No one will take us, they just turn us down completely. This forces someone to take us. And if we can’t afford to pay it, we will now have some options. I was really afraid of not being able to get insurance at all. If they had tossed the whole thing!
This dreck (includes a video I cannae watch) just came to my Inbox from the WH, ottogrendell.
Note that the bullet points are all designed around ‘hard-working members of the middle class’, nauseating as some of the points are.
OTOH, Lambert Strether speaks of ‘Obamacare, the Market State, and Nudge Theory’ (a new one to me, Orwellian behavioral theory framing).
Yves’ intro says:
“One striking bit is that the Supreme Court left the penalties for not obtaining insurance in place by designating it a tax, but then struck down enforcement mechanisms against states who fail to offer expanded Medicare.
Lambert highlights the fact that this decision undercuts the ability of the Federal government to use tax as a tool to promote social goals. The irony is the Obama administration was already there as far as banks are concerned. “
Lambert:
“Oh, and all the yammering from career “progressives” about how ObamaCare is a step towards a greater reform, or even single payer/Medicare for All, obscures the central issue: The change in the constitutional order. That’s their job, of course; no harm done if you take no account of their policy decoys.”
Nice job, Obey, ottog.
“The health care fight morphed from universal to pubilic option to individual mandate where now the supposed “liberals” are defending a mandate to buy a defective product that creates profit through human suffering. The fascists are winning . . . [etc.]”
Nailed!
The delusion, as I see it, is that we imagine that the portfolio-holders are looking out for our interests. Why would they? They don’t work for us. The game seems to be to move as much wealth upward as possible without breaking the system. ACA looks to be just one more piece of this strategy.
That’s it in a nutshell, Otto, thanks so much. And a huge thank you to Obey for this perceptive diary. It’s understandable that people who are desperate for any kind of coverage cannot understand why the vast majority of citizens who are not represented in any way, shape or form by this health insurance profit program see the handwriting on the wall as Roberts ‘sides with the liberals’ and with Obama.
Recommended.
wavpeac, I sympathize with your terrible situation, but you cannot put your faith in corporations rather than government programs when the profit motive is what is destroying the world’s economy not to mention the environment. We have to take a unified stand against this, and healthcare is fundamentally not an area where corporations can be allowed to profit off your distress. They will do that because that is how they survive, and this current administration defers to them, not to you.
All our lives are at stake.
I wonder if they think the system won’t break until they’re dead and gone. Our workforce is getting dumber and sicker by the minute and the portfolio holders DO. NOT. CARE. And must not have grandchildren, or must have planned to transport them to Mars just as this planet completely self-destructs. Their “ride it till the wheels fall off” attitude doesn’t even boggle my mind any more. It’s just the way it is. At least until enough of us stop pretending that Obama or the Dems give a ratfuck whether our 10-year-olds have insurance.
“One striking bit is that the Supreme Court left the penalties for not obtaining insurance in place by designating it a tax, but then struck down enforcement mechanisms against states who fail to offer expanded Medicare.”
And there you go. This gives the whole game away. This issue of enforcement is the nut that exposes racket.
From your WH link: “Today, the Supreme Court’s decision to uphold the Affordable Care Act ensures hard-working, middle class families will get the security they deserve and protects every American from the worst insurance company abuses. The Court has issued a clear and final ruling on this law.”
Bullshit. Whatever political speech is uttered publicly, the opposite is true. This will expose most US citizens, especially the poor, to the “worst insurance company abuses.” Or how does one explain the private policy meetings between the industry and the White House that took place right off the bat? Note the authoritarian tenor of that last sentence.
“. . . as Roberts ‘sides with the liberals’ and with Obama.”
Good catch. In what parallel universe is Roberts siding with “liberals”? There are no “liberals” to side with because this is a corporate-friendly strategy for increasing the profits of the “health care” industry.
Thanks for the reference to Lambert Strether’s analysis. Good as it was, this comment in that thread sums up the nature of the Supreme Court decision:
From Wendy’s White House link:
Bwaaaaaaa hahahahahahahahaha. Dude, what is this “middle class” of which you speak?
Even if the .001% have plans to go to Mars, someone must build the space vehicles for them. Far be it for them to lift their infantile hands to do work.
Not unrelated to this was the Frontline program on dental care recently aired. I thought it was excellent, and I have been critical of Frontline in the past as I thought they had an underlying corporate message. What they showed is that when corporations ‘streamline’ dental care they offer procedures which are unnecessary but profitable for the corporation.
wavpeac, do you think that once this system is in place you will get fair professional treatment for your condition? Or will you be just as subject to the snakeoil sales techniques seen on the Frontline program? Who is going to monitor what the insurance companies decide for you? Won’t they offer (or deny) care based on profit to them not on what is best for you?
Haven’t we seen how wonderfully well the system works by now? Shouldn’t we all be aghast that they want to expand it to include poor people whose only crime has been that they have remained healthy?
Remaining healthy and not wishing to pay for having done so is now taxable. What on earth happened to the land of the free?
Dontcha know? Thems the suits who are not in the 1%. What do you call them? Ummm. What’s that word? Oh, yes. Compradors.
Indeed. They do not care. Not one bit. And they can afford to pay for the TV time that tells most of the citizenry what to think, especially the bit about how deference to “authority” and “experts” is not just beneficial, but also required.
“Let me tell you about the very rich. They are different from you and me. They possess and enjoy early, and it does something to them, makes them soft, where we are hard, cynical where we are trustful, in a way that, unless you were born rich, it is very difficult to understand.” –F. Scott Fitzgerald
If one is accustomed to possessing and enjoying early, why would they care if the wheels fall off of something that is constructed for their exploitive benefit? What would keep them from imagining that they can just go buy another. And as long as the rest of us keep giving them money (or are required to do so by law via things like ACA), they are probably right.
I’m not discouraged. Once the Teapartiers figure out it isn’t government but the corporatists in government who are the tyrants, we’ll have a movement. It is just a matter of time.
Are subsidies considered ‘income’ for the purposes of taxation?
No, government subsidies are not considered taxable income.
Because healthcare subsidies are paid directly to the provider or the insurer.
Desider, I think you’ve got this wrong. The Medicaid expansion wasn’t optional as written (the 17 million figure of new Medicaid recipients from the CBO assumed it was mandatory). The states sued precisely because it was mandatory. It is Roberts’ SCOTUS opinion that said it could not be mandatory. So Congress cannot just rewrite it since Roberts has stipulated it is unconstitutional to do so – on the basis of the notion that it amounts to impermissible ‘coercion’ of the states’ sovereignty.
One has to hope so, Juliania!!
Exactly. Chief Justice Roberts’ opinion is perfectly consistent. On the one hand, he comes up with an interpretation that will uphold the private insurance mandate, thereby benefiting health insurance corporations. On the other, he opens up a whole new can of worms by prohibiting the federal government from saying to the states, “You want the federal moo-lah? Then you must do THIS,” which was at the heart of everything from the original Medicaid to banning open alcohol containers in cars.
He opens the door for corporate interests to challenge federal regulations on all sorts of things that involve any federal funding going to the states.
In short, this ruling was completely corporatist.
Big ‘Bingo’; thanks, I hadn’t read the comments; still haven’t finished the Time piece on ‘Nudge’.
HFC: Ya read it wrong: “Right now in congress, what’s at stake is how to break the middle class
and screw the poor.Also, at the Cafe a woman wrote a diary about being refused insurance (maybe even a COBRA extension) for her ‘pre-existing condition’, which was….wait for it…Menopause!
Thanks for that, Wendy.
;0)
Yup. I think many would agree with you, Carol.
My point was more about the very regressive nature of the way they are deciding to fund it, and how very regressive the benefits are structured – 50 cents of value in health care services and 50 cents of corporate profits for every dollar spent in subsidies.
Universal health care is a laudable goal, but the ransom demanded by the corporate sector is extortionate.
Congress can rewrite it, but it has to be a completely federal program. They can’t mandate the states to put up 10% of the cost of expanded coverage under penalty of loss of other funds.
Another question: will this be the end/diminishment of employer paid health insurance? My brother in law owns a business with a dozen employees. He wanted to offer insurance but the paperwork would have required him to hire a full time person just to process everything. He gives his employees a set amount per month to defray their private family plans.
What’s to say that more companies won’t ditch the non-productive hassle of dealing with their employees’ insurance. let them shop for their own policy, minus the benefit of volume premium discounts, and reimburse them after they turn in premium receipts?
I am a faculty member at a major research University. Throughout my twenty years there, there have been many years of zero or negligee pay raises but we receive both a variety of choices and plans for individual and family insurance plans. not Cadillac plans, but good sustained coverage with no risk of being cut entirely. It’s one of the main reasons I have stayed in academia rather than leave for the private sector.
I could share some horror storie from my immediate family of being either self employed trying to buy a plan or being at the tender mercies of an industry that makes its profits by denying coverage not providing it
Long story short:
is one of the unintended consequences of ACA that employer paid plans will become less prevalent?
yellowsnapdragon, regular people are losing their homes and jobs and thus healthcare as we speak, and social programs which would have supported them are being cut while the defense budget is taken off the table. The number of people who are not affected by these things or who don’t know someone who is affected is shrinking hour by hour.
We as a functioning society got to that tipping point ages ago, as people increasingly fell through the cracks while Obama kept smiling at the supposed middle class. In truth, there is no middle class. There’s just folks scared stiff to lose what pretense of security they have left.
Pay no attention to that yawning chasm beyond which the fires of hell await the 60 mile an hour winds that will sweep down and engulf your homes. Pay no attention to the governor of Colorado aging visibly as he speaks and shakily attempts to answer the inane question ‘Why didn’t you stop the fire?’ with ‘It must have been arson.’ Pay no attention to 32,000 evacuees (some of them felt quite well off, too,) just, like the boll weevil suddenly, lookin’ for a home. A home? Since when has that mattered?
Nothing to see here as the corporate war machine marches on and we’ll find that arsonist culprit for sure and lock him away for a zillion years of solitary confinement in a private prison after a captivating public trial on tv that nobody watches any longer because that is too hard for even the undereducated, having to endure the ‘tell your doctor’ and clean coal and cheap natural gas commercials.
And the rich get richer. There’s no tipping point for them, just another scam to pull.
I think it’s not regular people who’ll reach a tipping point. It’s those who are already out there fuzzily protesting down this or that blind alley who will suddenly realize they have a common foe who has played them against each other. Then it’s going to be like a flash flood, all the disparate parts of the disenfranchised moiling and roiling together.
Unstoppable.
We might just get something done for the real people, the real, regular people.
That is pretty darn regressive. And I guess they get away with it because somehow they have tricked people into thinking that it’s a win if you get to keep – or can now buy – health insurance. People continue to equate health insurance with health care even though the whole point of the former is keep you from getting any of the latter.
Thanks Otto.
Yes, that, or they are middle class with good jobs with benefits and aren’t affected by the new measures.
I know a lot of uninsured young-ish urban professionals working freelance jobs without benefits who are horrified at what they are going to have to pay. Not because they want to be ‘free-riders’ or just feeling lucky. They’re uninsured because they just don’t have another 3-4000 extra dollars lying around to pay for insurance under the new regime.
I don’t think that people with employer-provided insurance really understand what it’s like on the other side. I think they just assume the good faith of the Obama administration, that the subsidies do in fact make it affordable. Though they manifestly don’t.
Yup they can create a brand-new federal program. To cover 17 million people. And then roll the existing Medicaid program participants into that.
EASY PEASY!!
;0P
Precisely.
Our system is horribly flawed. Trust me, I was half hoping it would be struck down in hopes of it all getting replaced with single payer. But, that was too much of an unknown. I am not stupid. I don’t think this solves all the problems but this does cap what they can charge for preexisting conditions. Right now, we have no health care. I am 50 years old with a mrsa infection in the prosthetic mesh in my stomach. I also have horrible arthritis and need knee replacement. I was told 5 years ago, that the doc would be impressed if I could make it five more years without getting it done. I didn’t…I am managing. I still feel better knowing that the costs of insurance have to come down, that there will be a cap, and that someone has to take us now. He’s an addict who has received treatment, his addiction and mental health meds cause same kind of problems mine do.
Make no mistake, the best option for us would be single payor. Our health care system is horribly flawed and I want us OUT of the health care for profit game. I really do believe we get inferior care in the US because profits make our medical decisions.
In the mean time though…I will be able to sleep tonight. I truly feel they would let me die without some kind of protection that they have to insure us. They will do the minimal care for me, if I get septic again.I believe it’s quite possible that I wouldn’t survive under the condition of not having insurance.
Employers were shedding health insurance plans for employees long before the ACA came along. One of the debates during passage was how to keep employers from a rush to the exits if there were federally subsidized healthcare in any form. That logic is why the public option was purportedly scuttled; my reading was that Baucus considered it a non-starter. And the fear that summoned for Republicans and Blue Dogs was that the public option was a backdoor opening for single-payer Medicare for All.
I think that employers dumping healthcare coverage will continue regardless of the bill. US employers cannot compete with overseas employers whose governments subsidize healthcare or have a single-payer plan or national health service. Public employees will probably be the last to feel this although the recent moves in the Midwest mean that GOP governors want to end employer-based care for public employees as well.
Anyone who is in an employee-based plan right now should not complacently assume that their situation will continue indefinitely.
Corporate interests and red state governors. I don’t know the legal niceties, but it does seem to apply to any new federal mandates directed at states with ‘new’ funding involved.
Now define ‘new’…
Technically easy. Legally easy. Politically almost impossible. But the technical and legal realities mean they have no excuses but corruption and just plan cussedness.
I keep waiting for that to happen, because *that* will be the moment of change.
I don’t think they “got away with it” in the sense that they tricked anyone into thinking it was awesome. It was so unpopular that dems in congress got thrown out. And it’s still unpopular.
The trick is that they can, to some extent, keep doing unpopular things because they’ve convinced people that the alternative, the GOP, will do even more unpopular things.
FUBAR…
Not quite “opened”, more like “cracked”. What could be attacked under this a precedent likely is limited to laws that force people to participate in markets where they otherwise would not. It didn’t quite get to threatening the New Deal uses of the Commerce clause quite yet, but no doubt some clever Federalist Society lawyers have a strategy of where to go from here.
I think there is a cult of “political toughness” in Congress, aided, abetted, and promoted by the President that maintains that doing unpopular things is a sign of political will. Without wondering whether some of those unpopular things might also be unwise as well.
Calling this a “tax” is just semantics… it is a penalty, and one imposed on those who can least afford it. It’s like telling the homeless guy sleeping in a cardboard box under an overpass that he will have to pay a “tax” to sleep there, or telling the homeless lady pushing all her worldly belongings down the sidewalk in a filched shopping cart that she is required to pay a toll to continue. DUH.
I am and will continue to be an Obama supporter, but this bill is just WRONG.
The problem isn’t lack of insurance coverage, the CORE of this issue which I hear NO-ONE addressing is what is costs to go to a “doctors” office or to a hospital. It is the cost of health CARE that is the root of this problem. If it was affordable to attain medical attention and care we wouldn’t need the vultures in the health insurance business.
Why are doctors allowed to rape us financially?
And before I hear a defense about their scholastic bills, let me ask you if you know a POOR doctor???? Medical students are in it for the MONEY honey, the
hypocritical, UM hippocratic oath went by the wayside eons ago.Doctors and hospitals and the outrageous amounts of money they charge for ~health care~ are soooo out of line and are the root of the un-affordable health care problem in this country.
EFF the ACA, put me in jail because I will not pay the “tax” penalty, I’ll get FREE “health care” in jail.
naaah. I think I’ll go with “corruption and cussedness” as a simpler explanation. If more depressing…
“Even worse, Obama and the democrats gave up everything from Renewable Energy Standards to the Bush Tax Cuts to get this monstrosity.”
“No, they gave them up for other monstrosities (Bowles-Simpson, for example), not this one. But greenhouse gas regulations were just upheld in appeals court, and to my mind those are more effective than any pseudo-market (carbon tax or cap-and-trade) would have been.” TarheelDem
No major disagreement. Certainly Bowles-Simpson qualifies as a monstrosity. I too like greenhouse gas regs better than setting up a pseudo-market. However, the Renewable Energy Standards (RES) were just requirements for power plants to have a minimal percentage of renewable energy. The republican leadership agreed to this before negotiations started. You know what the democrats did and continue to do.
Keep in mind, too, that all of Obama’s environmental activism are for after his first term. He has punted his first term to the point that his environmental record for less than four years is worse than that of Bush after eight years. For documentation see Environment – http://newprogs.org/blog/2011/11/08/environment-under-democraticrepublican-uni-party
HEAR HEAR!
You might care to check out this product for your MRSA bug, wavpeac; we use it often, and have found it seriously helpful.
Because they figure they went through 3-4 years of hell and work long hours and that gives them a license to do walletectomies.
You have too many warm fuzzies about jail.
I feel the same way today as I did in 2010 when the ACA was signed into law – the corporations won then and SCOTUS merely affirmed it today. We are still held hostage by the private health care insurance industry that will continue to screw us. We had a slim chance for the public option in 2010 and that won’t come around again for at least a generation. So, what’s to celebrate today? I’ll celebrate when we all have the same kind of health care as Chief Justice Roberts or Alan Simpson.
Here’s an interesting tell:
It’s being celebrated because it’s wrapped in the Obama/”Democrat” flag; nothing more, nothing less.
As I wrote on an, ahem, more free-wheeling forum: “Obama could implement a program for chopping off your [penises] and you [tribalists] would be ‘Yay, Obama! Romney wants our [testicles], too!”
TarheelDem, I trust you realize that, barring armed Communist revolution (which I’m certainly hoping for, but doesn’t seem terribly likely, tbqh), there is exactly 0% chance of Medicare for All being passed before 2014, no matter how much you argue that people should advocate for it? The “Republican” corporatists are against any “comprehensive” program, even HeritageFoundationRomneyObamaCare, and the “Democratic” corporatists will be wanting to let HFRomneyOCare go into effect before making any “improvements” (not that they are advocating for that, or will).
So the answer to KrisAInTX‘s question is that, right now she’s screwed because she can’t afford overpriced “insurance” and in 2014 she will be more screwed because HFRomneyOCare will force her to pay a tax penalty, and because the insurance rates will continue to rise.
On the plus side, given how fast unemployment is expanding (19.9% and rising! [not counting the BLS's number-fudging by declaring 9,000,000 Americans non-people]) there’s a good chance she’ll be unemployed by then, so yay, Medicare! (And, well, homelessness, but what do you want, a pony?)
(Do you even get to keep your Medicare when you’re homeless? I’m killing myself when I lose my UI/rent money, so I haven’t investigated, but I don’t want to mislead any who might chose otherwise. I’m sure sleeping under a bridge is perfectly lovely, it’s just not for me.)
Interesting indeed. Thanks.
Well, there is a hardship exemption. Which *should* (?) apply to anyone below 133% of FPL.
If only the revolution will change things, why ever would you Vote Socialist? Or vote at all?
Not just red state governors. Plenty of Democrats may jump on board as well. There’s no real difference, you know.
Thanks for this explanation. I have often made this argument as why *business*should lead the way for single payer. Why does a car made in Windsor cost $2k less to produce than one in Detroit? They don’t bear the employee health care expense their American counterparts are expected to pay.
And doesn’t this have the potential to crash the economy when it sets in? If People have to outlay 3-4k per year in premiums, that is less discretionary income for everything else
Oh dear; I hate to weigh in on this one, but…
We pay doctors too much, and especially surgeons, and even Most Especially, oncologists and heart transplant surgeons cuz we fear death sooo much. (Other nations pay doctors far less.)
But to say that payment to doctors is at the core of the problem seems wrong to me. There are such higher administrative costs with private insurance compared to Medicare, say…then high profits and costs added on from hospitals, not to mention that physician insurance is killing, and all those items are profiteering by entities that don’t even have health care considerations at the center, imo.
Yep, doctors and hospitals order all sorts of procedures to increase profits, but also to cover their asses. I have a friend who’s quit delivering babies for those reasons. I also worked with chiropractors who are able to, thus DO, charge the maximum for treatments and any modalities they use because workman’s comp sets the allowable amounts, and as we all know, the thinking gets to be: “If it’s legal, I would be a fool not to charge the maximums’.
Bugger; there was another point wanted to make, but it’s floated away like a dry leaf on the wind.
But in the end, Bmaz (and others) have it right: the core problem is that the ACA is a health insurance bill, not a health care bill. Totally different animals.
It’s a toll to the private-sector, disguised by the ACA (and the Supremes) as a tax. Actually, it’s worse than a toll, it’s a mandated toll. Wonder if there were any Dark Age laws against swimming around a toll ferry?
The average person doesn’t have any idea how fucked we are.
The high costs come from a lot of waste because of the games that insurance companies play with providers and the fact that employers have to hire people just to make sure their employees’ claims getting taken care of. So you have providers doing multiple billings to insurance companies in order to collect, disputing insurance company decisions, and then in some cases having to bill the patients for the difference. You have other folks who have to call insurance companies multiple times for pre-certification of major procedures and insurance company nurses who tell them yea or nay for a particular patient. You have folks who calculate the “usual and customary” fees for particular geographic areas. The insurance sales, marketing, and legal departments–and the call centers. And insurance executives and medical system executives who make big bucks. The salary of the CEO of Duke Med was $1 million last time I saw it published. And the salary of the CEO of NC Blue Cross/Blue Shield was $4 million.
And then you have all of the uncollectable charges that get spread into the calculation of billing rates.
Yes, specialists are overpaid. And primary care physicians in large medical systems can be underpaid (by physician standards) in exchange for the golden handcuffs of having their student loans paid off.
It’s not worth it for me to reargue the ACA. It is what it is. It is more worthwhile to push forward toward Medicare for All or a National Health Service (VA for All).
Interesting stuff from you and Wendy. I’ve always been surprised to see how many doctors are in favor of single-payer. Even though they are likely to suffer financially. Or is there some trick to it…?
I perfectly understand, wavpeac, and forgive me for sounding heartless. You are being held hostage by the Powers that Be and that, that is unforgivable. They know what they are doing.
I do take issue with you on one point: you said about single payer ‘that was too much of an unknown’. No, it wasn’t! Every other industrial country in the world has single payer! None of them expects its citizens to pay private companies for profit for healthcare. And in the very first citizen meeting right over the hill from where I live Obama held the microphone and told the first questioner that sure, singlepayer would be fine if we were going to remake the system – even as he knew darn well that all he needed to do was remove two words from the Medicare system, ‘over 65′ and we could transition to a system of singlepayer Medicare for all by means we were already using! Already using!
Single payer is not pie in the sky, but it does eliminate insurance companies – and darn it, they should be eliminated! Bravo to Margaret Flowers and Russell Mokhiber with fifty courageous dedicated doctors for coming right out and saying the whole thing should have been thrown out and we just do a full court press to get everyone covered under the Medicare Act.
We went to the moon. For crying out loud, get out of the Middle East and do this thing, idiots! Hire people to work on this thing, employ the unemployed! You all ought to be ashamed of yourselves (I am talking to our government) for pretending you have done something wonderful when you have just prolonged the suffering, and don’t pretend you are going to regulate when you’ve sat on your hands for nearly four years. Start acting like a government of the people!
Primary care docs tend to favor single payer. Specialists tend to oppose government-mandates in healthcare. It is not accident that Paul Broun, Tom Coburn, and John Barrasso are (or were) specialists. (Broun has let his license lapse.) And there are others in Congress, all Republicans, all opposed to government healthcare, all catalyzed in the 1960s and 1970s by the passage of and changes to Medicare and Medicaid.
Docs who have to hire people to track down multiple insurance companies are incentivized by single payer. You only have to deal with one insurer, and that one can be hammered by a Congressman if need-be where private companies are insulated from even their stockholders. Or that’s the logic.
got it. thanks.
“In short, this ruling was completely corporatist.”
Bang!
How is Obamacare going to reduce costs?
If it doesn’t reduce costs, Obamacare becomes a political sledgehammer that the Repugs and Demoncrats can use to bludgeon Social Security & Medicare.
Obamacare delivers more profits to our corporate masters, provides more ammunition for the Austerity wrecking crew, and serves a tidy propaganda purpose of killing the notion of health care for all.
“assume the good faith of the Obama administration”
And there’s the misstep
You’re right Not having intimate experience has much to do with it
Think of it as like the politician who has to fundraise ninety percent of the time. That’s what doctors have to do to convince insurance companies that a procedure they think is necessary is covered. Both systems are fatally flawed because money is the name of the game.
I kind of think your view of how the health care system functions sounds an awful lot like the view of economists who sold us the confidence fairy theory of austerity-based growth. Sounds great … but damn near entirely unhinged from functional reality.
For one, you are totally snowed on how billing works … or at least it’s impact on cost of outcomes. Yeah, some of ‘em suck but in my experience that is mostly a crappy adjuster (or claims manager) thing – rarely do/did we have anyone go beyond net-90 – and we’ve worked with a lot of ‘em over the years. Making that problem into “the problem” is kind of hype – comparatively speaking. Ironically, it’s the self-insureds that give us the most trouble collecting (and don’t get me started on the D.C. Government!) – all the big boys have it pretty well set up. Also, billing systems are already pretty well automated by this point too (thanks HIPPA) … so it’s not like it takes an additional employee for the system to produce e-billing. And it takes a pretty big liberty with the purpose of an HR department’s benefit’s manager to say the position exists to make sure employee’s claims are taken care of. I’d say it exists more for the purpose of re-negotiating a new corporate insurance policy every damn year because they won’t write more than a 12 month contract so it’s possible to re-rate you the moment any of your employees actually have to *use* their medical coverage for care.
A lot of the other stuff you are listing (@117) – like authorizations for procedures, actuarial duties such as determining appropriate fees for service, the general back-and-forth of claims handling, etc. – is a function of care delivery and would be a reality with a “Medicare for All” program just as it is in private insurance.
You hit on some of the big issues with executive salaries/marketing but low-ball the figure somewhat … private insurance CEO’s top $50 million these days with $10 million+ seeming to be standard. But you miss the huge drain that shareholder demands for profit (and growth) take from productivity.
One source of real costs come from the fact that there is corporate capture of both sides of the equation. The care providers and insurance companies are both owned by the same people. They are able to make money on both ends simply by adopting more expensive approaches at the insurance side, slashing service in the product line on the care delivery side, and instructing their adjusters to use the preferred providers regardless outcome or cost. I watched it happen with my own two eyes at Cigna when they acquired Inercorp. And it looks great on their medical/loss ratios too boot. And they control the market which lets them set the prices any potential competitor pays … so it’s not like the costs seem statistically out of line.
ACA sucked when they passed it. It still sucks. You are right – there is absolutely no point in discussing it. Either a person can do math or they can’t … and the math is terrible for most humans.
I guess it’s a consolation that America being forced to suffer through a policy nearly identical to Bob Dole’s wet dream of the 90′s is certainly going to come at a steep political price for Obama. Now Romney is the (laughably) only person that can undo a policy most folks hate and believe is both horrible and Un-American.
But I do believe that with this – now Democrats should finally just have to admit, while Republican policy may not be superior … Republican policies are certainly good enough for them.
Aaaaaannnnnd. Who. Exactly … you know, running for or holding office … is talking about pushing forward toward Medicare for All or a National Health Service? Last I heard if this got overturned, the opportunity was lost for a generation … how do you extract from that a belief that any of those people have a plan to do a damn thing – let alone something as comically implausible as that?
Waypeac, providing you have already been without insurance for 6 months, you should look at the federal high-risk plan NOW rather than waiting. Maybe you could get your joint replacement.
I do not know if this differs if your state has a plan or if you have to apply to that first, but I know of a Texan in her early 60s who got on it within 3 weeks (you have to get in the paperwork at mid-month for the following month) and it costs about $400-$450/month I think. (Unfortunately she had a crisis and borrowed about $35,000 cash from relatives to get urgent treatment before the federal plan could kick in, but it is now covering her costs, which is a help as her condition remains dire.) The high-risk plan is supposed to be an interim solution until the whole plan kicks in. It is cheaper now than it was initially.
I hate the bill too, but I was overjoyed that she can still be on the high-risk plan and the same applies to thousands of people needing medical help who are on it. Plus, my nephews who are under 26 can also continue having health insurance. If the whole thing had been invalidated, these people and many others could be hurt.
The bill is a big mess, but at least it pretends we need to have an interest in seeing people get healthcare rather than let them die on the streets or rely on churches and neighbors (ha, ha!).
So, I hate the bill, and am worried about the Medicaid part and other things in the decision, but I’m mightily relieved about all the people it means can keep their health insurance — today!
But check out the high-risk federal pool, waypeac.
In a time far away I knew some of this stuff, including the premise that an expensive experimental treatment’s (say, back in the day, a heart transplant) costs were not charged to Elitist Doe X, but spread among other patients.
In a related field, after decades of marginalization, midwives were accredited in some states, chopping the costs of birthin’ babies to a fraction of hospital births, including stays of several days, episiotomies, unnecessary C-sections, etc….and there was a trend toward patients choosing home births or midwifery clinics…many hospitals began to offer: Midwifery Services! My guess it wasn’t altogether to have a mum with problems near to emergency interventions, but to…incentivize that choice, which might make a couple feel ‘safer’.
I don’t go to docs, and if I have a say, never will again, but a decade ago, as a public service, I got involved in a health care project to be designated as ‘medically under-served’, which designation opened it up to being allied with a middle-man non-profit that did paperwork, maybe ‘bulk medical purchasing (don’t remember all the benefit parameters or names) ,etc….for all comers at a clinic that would be administered by the parent organization.
But as part of my contribution, I interviewed every doc in the county, especially with the primary question of which docs still took Medicare/Medicaid patients, who accepted new patients. Not many on the latter, cuz the rates they were paid were almost criminally low. But I will say that some of the docs did seem to care about serving patients more than making bigtime bucks.
My friend Doc (played a hot banjo in our pick-up bands) finally went GP and charged $20 a visit for as long as she could. Of course, her malpractice insurance rates plummeted, too.
Anyhoo, that’s all I got. ;o)
Here was the design for lowering costs on individuals and total costs (US healthcare is twice as expensive as most places in costs/person).
1. Expand the pool to include more healthy people through the individual mandate; this provides insurance companies more money to be able to cover folks with pre-existing conditions at lower cost.
2. Mandate the minimum medical loss ratios. This means that the insurance company can use only 15% or so for administration and profit. Payments to providers must account for 85% or so of the costs of premiums.
3. Subsidize state high-risk pools. This provides insurance coverage for folks with pre-existing conditions who cannot afford private insurance.
4. Benchmark costs to Medicare standard prices. This provides insurance companies with a measure to try to beat in order to claim that private insurance outperforms government plans.
5. Require preventive care to be without charge to the patient. This encourages patients to get preventive care, reducing the long-term cost by improving their health.
6. Cover primary care. This reduces the load on emergency rooms and uses less expensive procedures for treatment before conditions get out of hand.
7. Have a healthcare quality board that review medical research and reports on improvements to best practices so that physicians in one part of the country can benefit from improvements in other parts of the country.
8. Subsidize rural clinics to bring primary care closer to rural populations, reducing the incidences of catastrophic health problems.
Those are a few of the things that were built into the 2000-page bill.
If folks are going to wait around for politicians to leave their campaign contributors and fix healthcare, we will be doomed. We have a huge polticial culture issue to deal with first, one part of which is the indentures of politicians to all branches of the healthcare and insurance industry.
Thanks for adding some more detail about billing etc. Also, I forgot to mention the cartelization of medical supply companies and medical equipment companies. Real anti-trust investigations would probably turn up some interesting practices.
One of the things I’ve experienced is the radically different way healthcare in rural areas functions ask compared to healthcare dominated by large private, religious, or university healthcare systems that conglomerate hospitals, specialists, family practices, and so on. My youngest daughter was born in a rural county hospital and delivered by a GP who had one partner and a series of residents who rotated through for training after med school, funded by some federal program. Middle daughter was born in a county hospital that is now part of a huge medical system, that has essentially be privatized, and had an outpatient ob/gyn deliver her.
What will be interesting to track is the growth in integrative and functional medicine that focuses more on prevention and health and can prevent serious chronic problems — and on herbalists, chiropractors, and other alternative health practitioners. And how they get integrated into the healthcare system. Right now few plans exist that accept claims from them in the context of the way they manage health; they have to fit what they do into conventional medical categories in order to get paid or charge low enough rates that people can afford to pay for their services directly. And there is increasing research that shows the efficacy of some of the traditional and alternative practices.
I wouldn’t even go that deep. It’s extortion pain and simple. Not much different than paying protection money.
Dunno, THD. There have been several Congressional bills over the years to make supplements and herbs ‘prescription only’, starting back in the 1970′s. Dorgan and Waxman had one, the most recent I could find was McCain’s (2010). Yep, it would be nice to know that herbal capsules contain what they say they contain, and contain no ‘contaminants’, as some Congressional studies have allegedly shown.
But given that so many pharmeceuticals are even more dangerous, and get fast-tracked, or receive okey-dokeys, it’s crap to single out herbs and supplements as dangerous enough to have under the control of docs (who know zilch about either nutrition or herbs), imo.
Guess it will depend on lobbyists for different alternative care categories. But given that last I’d heard, about half the health care dollars in the US were spent on alternatives to AMA-ish care, you’d have to think that there will be some strange conversations about which ones to cover/not cover.
1) I didn’t say that armed Communist revolution was the only way to change anything ever; it’s entirely possible that other, slower progress can be made through electoral methods. I said that a revolution was IMO a prerequisite for getting Medicare for All (your goal) enacted before 2014 (your timetable). Other problems may be addressed by ballots. “Medicare for All before 2014″ would only happen through bullets, IMO.
“Power grows from the barrel of a gun.” —Mao
2) Even if voting is an exercise in futility, it only takes a few hours on a few various days. And it can serve a purpose even if you never “win”…anything from disseminating ideas to spur revolution, to being a convenient place to find recruits or conduct meetings, to being a useful cover against the authorities. “What, planning to gut Rahm Emanuel like a fish? Not me, general C.I.A. man…I’m working with in the system! Vote!”
3) Dude, I took the username almost a year ago. I’m far more bitter, far more depressed and far more radical than I was then. (Originally the idea was to move the Overton Window and the Dems by introducing leftist ideas into the debate. Then it was to actually enact socialist policies. Now I’m virtually a Leninist and the idea of voting does seem somewhat pointless, prosaic, and ritualistic, I agree. But there’s still more to be said for voting Socialist than voting for anyone else, I’d argue.)
Are we allowed to change our usernames? Then I can change mine to Suicide in about Six Weeks, I guess. (But I’m lazy. That’s another reason I should die. And it will be moot soon enough, I suppose.)
4) I’m pretty sure that if you refer to “the revolution”, using a definite article, that proper style requires capitalization: “The Revolution”.
I don’t know, though. Better check with Prince.
Wasn’t the mechanism in the “hardship exemption” actually a tax credit? I confess it’s been a while since I looked at the nuts and bolts, but I thought the idea was that you still had to pay $1000/month (or whatever the premium was) and then, if you could prove you were a broke-ass failure and a useless disgrace, in 12 months, you’d get 75% (or whatever) of all that out-of-pocket expense back.
So it’s not as though you don’t have to put up the money…but if you’re poor enough, have no pride, and can jump through all the hoops, you might get a portion of your money back. Someday. Yay?
I’d argue that the ultimate root of the problem is the treatment of human health as a commodity to begin with, the idea that “care” has a cost that must be paid for (“Old people have a responsibility to die and get out of the way”, to [probably] misquote Dick Lamm), rather than a healthy life being a human right.
But yes, if you’re going to treat health as something that must be paid for—”your money or your kidneys, bub! Pay or die!”—then the fact that it costs so much is the overarching problem, I’d agree.
Okey-doke. What’s the estimated savings from this list and when does it kick in?
I wonder how many people have to die in order to preserve the profit motive.
“I wonder how many people have to die in order to preserve the profit motive.”
As many as is necessary.
And your summation @ 123 sounds about right.
Pain and simple? typo, cursed Auto correct, or Freudian Slip?
With apologies to Randal, I want to take back the word “profit”. It isn’t a dirty word. Profit is what happens when two parties willing enter into trade, and both come out feeling like they got more than they gave up. No one gets hurt. I would like to suggest alternatives such as “theft”, “greed”, “fraud”, “larceny”, “duress”, etc. Wouldn’t “the
profitgreed motive is what is destroying the world’s economy…” not only sound better, but also convey more accurately the real problem? Some more examples from the comments:The rule of law and fair markets would fix health care costs (and so many other parts of the economy). The problem isn’t profits, but perversion of the law and crony capitalism. You don’t like to mow your lawn; my hair is too long. We trade, we’re both happy. We both profit.
I always heard that states could opt out of the Medicare expansion and forfeit the funds, long before Roberts got hold of this. So I assumed the ruling was “the new offer doesn’t affect the existing program”. I could be wrong of course – my level of apathy and distaste for all this stuff is by now enough to keep me from reading any details.
Hey, Des. I dunno about any of this, but you may be able to decipher this piece at Pro Publica. Mystery, they call some of the future implications.
Starts with this:
“Although the court upheld the law’s mandate requiring individuals to buy insurance, the justices said the act could not force states to expand Medicaid to millions by threatening to withhold federal funding.
Republican leaders of some states already are saying they are inclined to say thanks, but no thanks. [snip]
States that challenged the law argued that it was coercive to require them to either expand Medicaid or risk losing all Medicaid funding, a practical impossibility given the size of the program in most states. The court ruled that while it was constitutional for Congress to offer states money to expand Medicaid, it could not take away funding for their existing program if they declined, according to SCOTUSblog.
It all puts a knot in my forehead, but have at it.
Nice to see ya, dear. ;o)
The Obama Administration spent 3 1/2 years to give us this, now they’re going to give us 6 months of campaigning telling us why we should re-elect them because they gave us THIS.
Juliana…you need not convince me of the value of single payor. However my fear is that had we not moved forward on this bill months would go by with no help. I live in Nebraska. We don’t even have chips program anymore. And the scotus opinion just put the power in states hands. I fear there is still too much ignorance about single payor.
Best wishes to you, wavpeac, but in the meantime, do look into Celadrin and colloidal silver for MRSA.
Spot on. And that is why it is so easy to paint the uninsured as those who have or are choosing to be uninsured, or someone desiring a free ride, or some other version of a dead beat. And if you have yet to become ill, and have not run into the “deny care at all costs” attitude that our system has killed so many with, ya haven’t a clue its real, so its much easier to discount such stories and to paint a picture that those complaining are whackos… Rather than to consider that the system is broken – like Humpty Dumpty – its a shambles.
Sadly, wavpeac, it isn’t ignorance but greed. I do understand where you are coming from and I’ll be glad for your sake if you can get the care you so urgently need. I would have the same feeling of relief were I in your shoes. It doesn’t change the point that we could have had what many of us voted for – which was promised by Obama – if he had not huddled in secret with the lobbyists he was going to eliminate before he got himself elected on our votes, not on corporate money.
It was votes got him into office, votes from huge numbers of needy people. It doesn’t matter that they were wrong about Obama; they weren’t wrong about what they wanted. Those votes meant people wanted a government healthcare system, but they didn’t get what they voted for.
Not ignorance, wavpeac. Greed. Powerlust. This country is more than ready for universal health care; it is our so-called leaders who are not. Had they implemented it back when we all voted for it, you would not now be in the position you are in.
It’s a sad state of affairs when needs such as yours, which are real and urgent, are exploited by the rich and powerful, so that the less fortunate among us are forced to scramble for the crumbs which fall from the oligarchical table.
I agree that profit isn’t a dirty word in the right context, hellcat; but when it is part of the healthcare exchange and a company exists that is not offering a product in that exchange but is a middle man between the two entities which both deserve to profit in a good way, that extra and extraneous profit becomes ‘profiteering.’ And then you have a further complication in health insurance exchange markets, where the profiteers get to jostle one another about competitively and the financiers get into the act and stocks go up and down and somebody makes out like a bandit.
Whatever words you want to use to highlight the chicanery of that, go to it!
Is ‘rent-seeking’ applicable?
Look up the CBO analysis at the time of the bill. I provided you the analysis. That doesn’t mean that I’m an advocate of anything other than Medicare for All or a national health service.