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The Supreme Court be master debatin' the [Patient Care and Affordability Act]
Heartlash
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As of currently, the Supreme Court is on day 3 of its marathon of debate surrounding the Patient Care and Affordability Act (dubbed "Obamacare" by its critics). Particular focus is being given to the individual mandate, which requires US citizens who are able to purchase healthcare coverage or be subject to fines, and whether or not it is Constitutional under the interstate commerce clause.
You can read more about it in some of these fine articles:
The latest NYTimes article on Day 3
Boston.com's Blog Coverage
Some interesting questions have been raised by the justices, painting an all-too typical partisan divide. These questions include:
“Can you create commerce in order to regulate it?” - Justice Kennedy
Justice Alito asked Mr. Verrilli to “express your limiting principle as succinctly as you possibly can.”
Justice Breyer asked whether people entered the health care market simply by being born.
Etc.
Solicitor General Donald B. Verrilli's handling of the questions has been described as muddy at best, convoluted at worst. Now there's discussion of which (if any) portions of the Law could survive without the mandate, a sign that does not bode well for its supporters.
What are your thoughts on some of these questions, and how the justices are interpreting the law and the Constitution?
You can read more about it in some of these fine articles:
The latest NYTimes article on Day 3
Boston.com's Blog Coverage
Some interesting questions have been raised by the justices, painting an all-too typical partisan divide. These questions include:
“Can you create commerce in order to regulate it?” - Justice Kennedy
Justice Alito asked Mr. Verrilli to “express your limiting principle as succinctly as you possibly can.”
Justice Breyer asked whether people entered the health care market simply by being born.
Etc.
Solicitor General Donald B. Verrilli's handling of the questions has been described as muddy at best, convoluted at worst. Now there's discussion of which (if any) portions of the Law could survive without the mandate, a sign that does not bode well for its supporters.
What are your thoughts on some of these questions, and how the justices are interpreting the law and the Constitution?
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I'll start with this one: Yes. You can't opt out of being treated when you're unconscious (and whatever widgets you have to decline treatment get removed/destroyed/damaged/etc.)
Just like the vast majority of decision making.
Governing this country with an eye to the future and current needs of its people is rapidly becoming an impossibility. It makes me want to just give up and move someplace where they realize that an individual's right to be stupid shouldn't take precedence over the greater welfare of the entire population.
I just try to get through the day without being fucked over by some new Republican regulation or mandate reducing my hours at work, wrack up too much time walking on my in need of surgery knee, or have some company fuck me over and overcharge me and cause me to get overdrawn or something. My aspiration is to not get fucked over every day, being successful is kind of a pipedream. I'm just lucky I'm white with a good honest christian name, or the shit I did as a teenager (from a poor family) would have landed me in jail (or shot, apparently) instead of "boys will be boys".
That's my American experience. It's apparently one the current court really thinks the constitution was based around.
I just need to convince my wife of the idea, which mostly means waiting for her parents to kick the bucket so there's nothing left holding us here. They are older, so I guess there's some (grim) hope.
Probably somewhere in northern europe
This is not the How Bad Do You Want to Flee the Country thread, duders.
In the other thread I asked about how the supreme court could find this unconstitutional but not Medicare/Medicaid/Unemployment/Social Security/everything else the 10th amendment was stretched to cover?
I can't wait to hear their mental gymnastics
Well, they are Republicans. They'd just overturn all the precedent and totally fuck the country.
Interesting in a "wouldn't a volley of chinese nukes launched at washington end interestingly" way
I find it amusing that the easiest way to avoid what the GOP bills as an unconstitutional power grab is to just nationalize the whole industry.
I... god dammit. A colleague said "Don't you know that jobs provide health care? Why do you care about the outcome here?"
Hahahah
Yeah, they totally do! Just not to anyone I or he knows. The only reason we get healthcare is a strong union, and also my parents were bankrupted at my age due to an unforeseen dental bill.
I'm sure in every case except every case I know it works great though
But it just strikes me as absurd that there are people flat out crying for a private market in health care, knowing full well that it can't and won't cover a crazy number of their fellow citizens, knowing that the cost of uncompensated care reflects back on them. It's surely a catastrophic moral horror when a nation willingly agrees to let a substantial proportion of its population risk dying or scraping by in destitution, all in the name of 'freedom' - further so, when existing institutions already violate that notion (Medicare, Medicaid) to a similar extent, and when there are numerous case studies of way more extreme systems (NHS) that haven't turned the parent country into the USSR 2. You guys could have it /so much better/ - it's practically a free lunch!
John Cassidy at the New Yorker wrote a really interesting article that I fully agree with - http://www.newyorker.com/online/blogs/johncassidy/2012/03/supreme-court-case-is-a-very-bad-joke.html :
Thus the creation of a new legal theory to sink Obamacare: the idea that while the federal government might well have the authority to regulate economic activity, it doesn’t have the right to regulate inactivity—such as sitting around and refusing to buy health insurance. Now, it is as plain as the spectacles on Antonin Scalia’s nose that opting out of the health-care market is about as realistic as opting out of dying. But necessity is the mother of invention. And, judging by his questions this morning, it is this invention that Kennedy has fastened on.
Well, the flipside to that is that the comparative experience of someone in the NHS and someone in the US who can afford healthcare (which is about 86% of the population or so) is vastly different.
The NHS is like eating take-out from a box in a dingy back-alley, where the US system is like eating a steak dinner at a nice restaurant. Both situations resolve in people being fed, but most people in the US just simply don't want cheaper care.
Many Americans hate and loathe other Americans
The notion that somebody might be getting help that is undeserving makes people fucking livid. Fuck in our PA SWTOR guild I was called an unrepentant thief for being alive because I got life saving medical care my mom couldn't afford as a child (the moral course of action would be for them to have let me die, and this guy wasn't trolling). It's really that the voting American public is largely made up of people that have barely constrained loathing or (sometimes) murderous rage for their fellow citizens.
This is nothing terribly new. As it relates to the court though, the supreme court historically has been above this "fuck you I got mine" mentality. They're generally able to more or less steer clear of naked political alignment. Our current court is unusually partisan (probably because they watch Fox), and I have zero faith in them making the right decision based on precedent though.
It's actually kind of scary.
Very succinctly put.
I would disagree though, I would say the average voting American feels that way, which is very different from the average American. In fact a shocking percentage of our voting base votes specifically to deny things that don't really affect them (gay marriage, birth control, etc).
I'm saying that the 86% of people WITH good coverage don't give two shits about what happens to people WITHOUT it, and those same 86% are generally pretty happy with paying three times as much as their European counterparts for care because US hospitals are fancy and shiny and you get nice steak dinners in your private suite.
That's really worth spending $4,000 for a quick in-office procedure
86% of people don't have good coverage. You don't get to find out if you have good coverage until you get a mid-5-figures-or-more disease/injury, and a lot of people never find out how quickly their insurance company would turn on them.
In my experience, the US system is closer to PAYING for a steak dinner at a nice restaurant, but receiving a Dollar Menu burger product where in a lot of cases, you have to pick up the actual burger at a different location for a $50 copay.
Nope.
And it is one of the biggest disservices you could ever do to perpetuate such a blatantly false argument.
http://www.commonwealthfund.org/Publications/Fund-Reports/2007/May/Mirror--Mirror-on-the-Wall--An-International-Update-on-the-Comparative-Performance-of-American-Healt.aspx
http://www.who.int/healthinfo/paper30.pdf
UK comes 18th in terms of overall efficiency, US comes 37th.
This argument that the US spends loads on care, therefore it gets good quality care is bullshit.
You want to know why the US spends a lot on healthcare? It's because the private market doesn't function, it's because of fundamental problems such as adverse selection ramping up premiums and perverse incentives in the system leading to an inefficient overuse of resources (see the third-party payer problem). To be sure, your absolute level of care isn't awful, but it's not staggering, and is awful in comparison with your spending.
Oh, and underinsurance! It's highly likely that those in cheaper insurance packages aren't getting an optimal level of insurance.
So, taking your frankly insulting and ill-advised analogue: The UK is like a decent chain restaurant where you get decent food, nothing special, and the US is like a pret-a-manger in the city; overpriced, and never really leaves you fully sated.
Oh, by the by - here's my dissertation on the ACA and health care economics, just in case you try spouting another inaccurate talking point at me: http://www.scribd.com/doc/75396623/Final-Final-Dissertation
But nobody with coverage knows that.
It's a game of Calvinball, and people with coverage like to crow about how awesome they are.
Also, part of the Obamacare mandate says that you can no longer be dropped from your insurance due to illness or pre-existing conditions.
Perfect case: My dad was slightly overweight and has diabetes, so wasn't able to get personal coverage. He thankfully was able to get in my mother's coverage, which is payed for by the government because my mother is a State employee as a college professor. He was diagnosed with lymphoma about 8 years ago, and without that insurance would have had to choose to either sell their farm and house for the medical bills or just die of cancer. He got great treatment from a cancer center, and has been in remission for 6 years, thanks to my mom's State-funded insurance.
My dad hates Obamacare and wants nothing more than to see it repealed.
No one is talking about efficiency or actual quality of care, you goose.
Studies on the findings of Press-Ganey surveys routinely show that people in the US with coverage do not care about their healthcare outcomes, they only care about the perceived quality of their amenities.
Meaning, they'd rather have a steak dinner in a private room and die of malpractice than be in a ward with other people and survive a heart attack. That's a kind of stupid that isn't fixed easily.
Yep.
God damn, I love that some decision models still act as though rationalism is the driving force.
You're both wrong. Living in Scotland (where we also get free prescriptions) I'd say it is very much NOT a free lunch, the current everything is free system is on borrowed time. It was pretty much only the SNP trying to get favor by spending money unsustainably.
As for the quality of the NHS if you believe certain tabloids then yeah, it's awful everywhere but the reality is quality varies a lot from one hospital to the next (same as the US). It really depends on the volume of people using it and the competence of the people they have running it (again same as the US). My personal experiences with the NHS have all been pretty good (or as good as a stay in hospital can be). Saying American hospitals are like steak and NHS hospitals are dingy takeaway is a gross oversimplification on the scale of saying "all Americans are better looking than British people".
This is so true. I know what some hospitals' bill-rates are for equipment and supplies and it's staggering. $250 for the same $16 crutches you can buy at Wal-Mart.
If you have insurance, the hospital sends a crazypants bill to them, sometimes upwards of $100,000 dollars. The insurance company pulls out its own price guide, which all hospitals that accept the insurance policy have to agree to, which usually takes that same bill down to 17-20,000 dollars. From there, they deduct their 80-90% and send the rest of the bill off to you or your gap insurance.
So keep in mind this: If you HAVE insurance, that back surgery only cost you 2-4 thousand dollars. Because the real cost before insurance was 17-20 grand.
If you didn't have insurance, the hospital has legal right to financially rape you with prices that have no basis in reality.
Let's play Mario Kart or something...
Granted, the only NHS hospital I've spent any long amount of time in was Luton General, but it was pretty shitty comparatively to even the shittiest of American hospitals.
American Hospitals are fucking glorious. Steel and glass monoliths that stretch high in the sky, many of them having huge cavernous foyers and even gardens and art installations. One hospital I worked with had a 10,000 sq ft manicured jungle with walking paths INSIDE THE HOSPITAL just for people to fuck around in.
Also, that's a ridiculous thing for a hospital to have.
If you are willing to accept $50 for an office visit, fucking charge $50.
The markets are completely intertwined. Not having insurance distorts the rates for people who do, and vice versa.