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.
You have an odd way of expressing that underlying point (which I agree with). I wouldn't say eating a take-out box in a dingy back alley and a nice steak dinner both lead to similar outcomes. But that's by-the-by, your comment reminds me of another article I read which echoes your sentiments somewhat: http://www.newyorker.com/reporting/2012/04/02/120402fa_fact_sedaris
Maybe, being American, I want bigger names for things. I also expect a bit more gravity. “I’ve run some tests,” I’d like to hear, “and discovered that what you have is called a bilateral ganglial abasement, or, in layman’s terms, a cartoidal rupture of the venal septrumus. Dogs get these things all the time, and most often they die. That’s why I’d like us to proceed with the utmost caution.
For my fifty dollars, I want to leave the doctor’s office in tears, but instead I walk out feeling like a hypochondriac, which is one of the few things I’m actually not.
I didn't necessarily mean that a move to the NHS was a free lunch, but a move to a social health insurance system would be something super close to it, given the dire state of the status quo.
One thing that also strikes me about all this is just how partisan the supreme court is; is this a normal thing? Is it desirable?
I'm very disappointed and confused by the White House's insistence to call this a penalty rather than a tax. Why? So they can have the case heard before the law goes into effect?
The popular pro-Constitutionality arguments in favor of the individual mandate are simple, and they all boil down to one thing: it's a tax. Even if you call it a penalty, it's indistinguishable from a tax.
If it were a tax, they could justify it under the general welfare and necessary and proper clauses. But now that it's not a tax, according to the solicitor general, those clauses aren't relevant.
It's just retarded and makes me wonder if they want it to sink.
every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
I really can't even understand how anyone can argue with a straight face that the individual mandate doesn't easily fit under the Commerce Clause / Necessary and Proper Clause. The cost of healthcare is a huge drain on the national economy. A large part of that are the uninsured/uninsurable. The only possible way to remove this drain on the national economy (without completely dismantling the health insurance industry and instituting single-payer) is the individual mandate. If the SCOTUS wasn't just another detrimentally partisan branch of government, this case would have been laughed out of the court system a long time ago.
The unconstitutional case is trying to prove that the government is forcing people into the market, which is true on such a technicality that it needs an electron microscope. In reality, you are in the healthcare market the minute you're born. Ginsberg called this out yesterday.
While I agree with the latter statement, I'm not even sure if it matters. The Necessary and Proper Clause clearly gives Congress the power "To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof." The only way to address the economic drain that the uninsured/uninsurable put on the country is an individual mandate. There is no other way to address that problem (short of razing and salting the health insurance industry and instituting single-payer). It doesn't matter if you don't think you're part of the healthcare system. You're part of the national economy.
Wait, what? You're saying nobody wants lower medical bills?
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.
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.
Exactly. The cost savings of the ACA is founded in requiring young, healthy people who don't really need health insurance to pool with the old or infirm who do.
This isn't some insidious new scheme, it's just How Insurance Works. The whole system is reliant upon their paying premiums when they're healthy to cover costs for those who aren't, blissfully unaware that when the rubber meets the road and they someday need treatment themselves, their insurance companies, pre-ACA, would then rather scam them and preexisting condition their way out of paying on a claim. There are no steak dinners in private suites to be had, only bankruptcies and ruined families as somebody tries to fight off death or even just maintain a passing quality of life.
This is the main purpose of the law--to extend health care to Americans who either cannot afford it or have been turned down, and then to keep those Americans healthy and solvent once they do obtain coverage.
The issue with the Court potentially striking down the mandate is that they take away the machinery for making that possible, the means of making it affordable. Yes, for purely political reasons.
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Deebaseron my way to work in a suit and a tieAhhhh...come on fucking guyRegistered Userregular
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.
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.
Thing is, insurance companies know this as well.
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.
It can get even wonkier than that. Sometimes facilities don't get fee-for-service billing at all and just get paid based on the diagnosis code on the claim form.
Fee schedules are the worst things.
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syndalisGetting ClassyOn the WallRegistered User, Loves Apple Productsregular
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.
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.
Thing is, insurance companies know this as well.
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.
It can get even wonkier than that. Sometimes facilities don't get fee-for-service billing at all and just get paid based on the diagnosis code on the claim form.
Fee schedules are the worst things.
Trust me, I know.
Which is why medical software nowadays is designed to overcode visits, making sure each iota of time spent with the patient has its proper code(s), building justification for a level 4 or 5 visit when it really should have been a level 2 or 3, and tying every possible ICD-9 to a visit that it feasibly can. Oh, so the review of systems had someone say they had a few headaches since last visit? That's a code. Can;t sleep? Who cares if it is relevant to the visit! That's a fucking code.
It's awful.
SW-4158-3990-6116
Let's play Mario Kart or something...
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AtomikaLive fast and get fucked or whateverRegistered Userregular
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.
You have an odd way of expressing that underlying point (which I agree with). I wouldn't say eating a take-out box in a dingy back alley and a nice steak dinner both lead to similar outcomes. But that's by-the-by, your comment reminds me of another article I read which echoes your sentiments somewhat: http://www.newyorker.com/reporting/2012/04/02/120402fa_fact_sedaris
Maybe, being American, I want bigger names for things. I also expect a bit more gravity. “I’ve run some tests,” I’d like to hear, “and discovered that what you have is called a bilateral ganglial abasement, or, in layman’s terms, a cartoidal rupture of the venal septrumus. Dogs get these things all the time, and most often they die. That’s why I’d like us to proceed with the utmost caution.
For my fifty dollars, I want to leave the doctor’s office in tears, but instead I walk out feeling like a hypochondriac, which is one of the few things I’m actually not.
Well, the point I was making was that the box-dinner in the back alley and the steak dinner in the restaurant are both resulting in the same greater outcome: a person being successfully fed.
But yes, the fact that we charge money for people to be put to a doctor's judgment has a huge connection with the fact that people in the US treat healthcare as a potable commodity instead of a public resource. The exchange of money has this implied assumption of a tangible return, which is just not how medicine works.
I really can't even understand how anyone can argue with a straight face that the individual mandate doesn't easily fit under the Commerce Clause. The cost of healthcare is a huge drain on the national economy. A large part of that are the uninsured/uninsurable. The only possible way to remove this drain on the national economy (without completely dismantling the health insurance industry and instituting single-payer) is the individual mandate. If the SCOTUS wasn't just another detrimentally partisan branch of government, this case would have been laughed out of the court system a long time ago.
The unconstitutional case is trying to prove that the government is forcing people into the market, which is true on such a technicality that it needs an electron microscope. In reality, you are in the healthcare market the minute you're born. Ginsberg called this out yesterday.
You may be in the healthcare market, but the individual mandate attempts to regulate the health insurance market, and they are not the same thing. That's not a technicality at all!
You may not be in the health insurance market, but the cost of your care abso-fucking-lutely is. You can't separate health insurance from healthcare. They are inextricably linked.
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AManFromEarthLet's get to twerk!The King in the SwampRegistered Userregular
I really can't even understand how anyone can argue with a straight face that the individual mandate doesn't easily fit under the Commerce Clause / Necessary and Proper Clause. The cost of healthcare is a huge drain on the national economy. A large part of that are the uninsured/uninsurable. The only possible way to remove this drain on the national economy (without completely dismantling the health insurance industry and instituting single-payer) is the individual mandate. If the SCOTUS wasn't just another detrimentally partisan branch of government, this case would have been laughed out of the court system a long time ago.
The unconstitutional case is trying to prove that the government is forcing people into the market, which is true on such a technicality that it needs an electron microscope. In reality, you are in the healthcare market the minute you're born. Ginsberg called this out yesterday.
While I agree with the latter statement, I'm not even sure if it matters. The Necessary and Proper Clause clearly gives Congress the power "To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof." The only way to address the economic drain that the uninsured/uninsurable put on the country is an individual mandate. There is no other way to address that problem (short of razing and salting the health insurance industry and instituting single-payer). It doesn't matter if you don't think you're part of the healthcare system. You're part of the national economy.
Watching this from the other side of the Atlantic, where I'm protected by the NHS and all care (even prescriptions - I live in Wales) is free at the point of delivery, I honestly cannot describe how fucking backwards the US looks. Since this isn't about the economics of the ACA (because, economically, the case is pretty much untouchable), and is about your constitution and notions of equity, I'm not going to weigh in on whether the Supreme Court is right or wrong.
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!
But, of course, this case isn’t ultimately about the law—it is about politics. The four ultra-conservative justices on the court—Alito, Roberts, Scalia, and Thomas—are in the vanguard of a movement to roll back the federal government and undermine its authority to tackle market failures. The movement began in the nineteen-eighties, when the Federalist Society got its start and Ronald Reagan appointed one of its members, Scalia, to the court—and for thirty years it has been gathering strength.
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.
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".
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.
Well yeah if you measure the quality of a hospital by its architecture, meal quality and the number of atriums then UK hospitals will fall short (except for our private ones which probably do have all that shit). Personally I consider other things like how clean it is, how much time doctors and nurses spend with me, the quality of the medication I'm given and not contracting MRSA in my quality scale.
I get what you're trying to say but I still think your problem is not measuring like for like. Luton probably isn't that much worse (or better) than many older inner city hospitals in the US.
I would like someone who opposes health insurance regulation to tell me what the rational cost of a surgery to save the life of a 27-year-old single unmarried male with no dependents is.
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Deebaseron my way to work in a suit and a tieAhhhh...come on fucking guyRegistered Userregular
I would like someone who opposes health insurance regulation to tell me what the rational cost of a surgery to save the life of a 27-year-old single unmarried male with no dependents is.
I would like someone who opposes health insurance regulation to tell me what the rational cost of a surgery to save the life of a 27-year-old single unmarried male with no dependents is.
I would like someone who opposes health insurance regulation to tell me what the rational cost of a surgery to save the life of a 27-year-old single unmarried male with no dependents is.
is he a smoker?
If not
HARVEST HIS ORGANS
Sure, why not. But seriously: What's the appropriate charge? What should be the cost to keep you from dying?
Edit: The Ron Paul clip is related, but distinct - the question there is "presuming he cannot afford it, should we let him die or not." I'm asking how much we should charge for the procedure.
I would like someone who opposes health insurance regulation to tell me what the rational cost of a surgery to save the life of a 27-year-old single unmarried male with no dependents is.
I really can't even understand how anyone can argue with a straight face that the individual mandate doesn't easily fit under the Commerce Clause. The cost of healthcare is a huge drain on the national economy. A large part of that are the uninsured/uninsurable. The only possible way to remove this drain on the national economy (without completely dismantling the health insurance industry and instituting single-payer) is the individual mandate. If the SCOTUS wasn't just another detrimentally partisan branch of government, this case would have been laughed out of the court system a long time ago.
The unconstitutional case is trying to prove that the government is forcing people into the market, which is true on such a technicality that it needs an electron microscope. In reality, you are in the healthcare market the minute you're born. Ginsberg called this out yesterday.
You may be in the healthcare market, but the individual mandate attempts to regulate the health insurance market, and they are not the same thing. That's not a technicality at all!
Moved to the ACA thread, too, because this needs to be responded to.
@Spool32, TheCanMan moved this over here so I'll respond in this thread cause it exists now.
Here's the thing about the healthcare market and the health insurance market in the United States, they're the same thing. This is like saying that using a car doesn't put you in the fuel market as well.
You literally cannot get affordable healthcare in this country without insurance. Health insurance artificially inflates the price of medical care. If you wish to regulate healthcare, you must also regulate insurance. Without nationalizing the industry, this is literally the only way and it is incredibly necessary and incredibly proper.
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AManFromEarthLet's get to twerk!The King in the SwampRegistered Userregular
I would like someone who opposes health insurance regulation to tell me what the rational cost of a surgery to save the life of a 27-year-old single unmarried male with no dependents is.
I would like someone who opposes health insurance regulation to tell me what the rational cost of a surgery to save the life of a 27-year-old single unmarried male with no dependents is.
is he a smoker?
If not
HARVEST HIS ORGANS
Sure, why not. But seriously: What's the appropriate charge? What should be the cost to keep you from dying?
I don't understand the question. Do you mean "charge" as in why do they care or how much should they charge for the life saving services?
Because if it's the latter, they will charge you retail and will either negotiate it down to the point where it's a little "FUCK YOU" every month, or bankrupt you.
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Sir Landsharkresting shark faceRegistered Userregular
I'm very disappointed and confused by the White House's insistence to call this a penalty rather than a tax. Why? So they can have the case heard before the law goes into effect?
The popular pro-Constitutionality arguments in favor of the individual mandate are simple, and they all boil down to one thing: it's a tax. Even if you call it a penalty, it's indistinguishable from a tax.
If it were a tax, they could justify it under the general welfare and necessary and proper clauses. But now that it's not a tax, according to the solicitor general, those clauses aren't relevant.
It's just retarded and makes me wonder if they want it to sink.
If only the individual mandate gets struck we could have a pretty clear path to single-payer. Seems an awfully big gamble though.
Please consider the environment before printing this post.
I would like someone who opposes health insurance regulation to tell me what the rational cost of a surgery to save the life of a 27-year-old single unmarried male with no dependents is.
is he a smoker?
If not
HARVEST HIS ORGANS
Sure, why not. But seriously: What's the appropriate charge? What should be the cost to keep you from dying?
I don't understand the question. Do you mean "charge" as in why do they care or how much should they charge for the life saving services?
Because if it's the latter, they will charge you retail and will either negotiate it down to the point where it's a little "FUCK YOU" every month, or bankrupt you.
The latter. But "retail" isn't quite what I was shooting for.
The rational free-market cost for a life-saving procedure, presuming the patient values living, is "everything you have now and everything but subsistence living for the rest of your life."
A functional unregulated or lightly regulated free-market healthcare system is impossible. It cannot exist.
Well yeah if you measure the quality of a hospital by its architecture, meal quality and the number of atriums then UK hospitals will fall short (except for our private ones which probably do have all that shit). Personally I consider other things like how clean it is, how much time doctors and nurses spend with me, the quality of the medication I'm given and not contracting MRSA in my quality scale.
I get what you're trying to say but I still think your problem is not measuring like for like.
Yeah, that's what he's saying.
He's saying that the medical industry in the US relies heavily on customer feedback to assess the quality of its hospitals, which measures irrelevant shit. But that's what American citizens are used to, because they don't know any better, and won't be willing to give up such niceties so easily (even if it means better care).
He knows how absurd the situation is.
every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
I'm very disappointed and confused by the White House's insistence to call this a penalty rather than a tax. Why? So they can have the case heard before the law goes into effect?
The popular pro-Constitutionality arguments in favor of the individual mandate are simple, and they all boil down to one thing: it's a tax. Even if you call it a penalty, it's indistinguishable from a tax.
If it were a tax, they could justify it under the general welfare and necessary and proper clauses. But now that it's not a tax, according to the solicitor general, those clauses aren't relevant.
It's just retarded and makes me wonder if they want it to sink.
If only the individual mandate gets struck we could have a pretty clear path to single-payer. Seems an awfully big gamble though.
I'd like to believe that this is a savvy political gambit on the part of the White House, but I'm a bit too jaded for that. I think they just got overconfident.
every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
the "no true scotch man" fallacy.
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Sir Landsharkresting shark faceRegistered Userregular
I really can't even understand how anyone can argue with a straight face that the individual mandate doesn't easily fit under the Commerce Clause. The cost of healthcare is a huge drain on the national economy. A large part of that are the uninsured/uninsurable. The only possible way to remove this drain on the national economy (without completely dismantling the health insurance industry and instituting single-payer) is the individual mandate. If the SCOTUS wasn't just another detrimentally partisan branch of government, this case would have been laughed out of the court system a long time ago.
The unconstitutional case is trying to prove that the government is forcing people into the market, which is true on such a technicality that it needs an electron microscope. In reality, you are in the healthcare market the minute you're born. Ginsberg called this out yesterday.
You may be in the healthcare market, but the individual mandate attempts to regulate the health insurance market, and they are not the same thing. That's not a technicality at all!
Moved to the ACA thread, too, because this needs to be responded to.
@Spool32, TheCanMan moved this over here so I'll respond in this thread cause it exists now.
Here's the thing about the healthcare market and the health insurance market in the United States, they're the same thing. This is like saying that using a car doesn't put you in the fuel market as well.
You literally cannot get affordable healthcare in this country without insurance. Health insurance artificially inflates the price of medical care. If you wish to regulate healthcare, you must also regulate insurance. Without nationalizing the industry, this is literally the only way and it is incredibly necessary and incredibly proper.
That's a strong argument for single payer but the ACA doesn't nationalize the health insurance industry.
Please consider the environment before printing this post.
Necessary and Proper is a subordinate clause. If the thing you're trying to do is unconstitutional, you can't back into doing it with the Necessary & Proper clause. It gives the Congress the power to do (necessary and proper) things in the course of pursuing some Constitutional effort, and that's all.
If regulating insurance vial the individual mandate is an unconstitutional overreach not covered by the Commerce clause, that's the whole ballgame for the mandate.
I'm very disappointed and confused by the White House's insistence to call this a penalty rather than a tax. Why? So they can have the case heard before the law goes into effect?
The popular pro-Constitutionality arguments in favor of the individual mandate are simple, and they all boil down to one thing: it's a tax. Even if you call it a penalty, it's indistinguishable from a tax.
If it were a tax, they could justify it under the general welfare and necessary and proper clauses. But now that it's not a tax, according to the solicitor general, those clauses aren't relevant.
It's just retarded and makes me wonder if they want it to sink.
If only the individual mandate gets struck we could have a pretty clear path to single-payer. Seems an awfully big gamble though.
I'd like to believe that this is a savvy political gambit on the part of the White House, but I'm a bit too jaded for that. I think they just got overconfident.
I have been pointedly ignoring the consipracy theorist in my head, but he won't shut up suggesting that this whole effort was designed to explode from the beginning, leaving only single payer as a viable option.
I'm very disappointed and confused by the White House's insistence to call this a penalty rather than a tax. Why? So they can have the case heard before the law goes into effect?
The popular pro-Constitutionality arguments in favor of the individual mandate are simple, and they all boil down to one thing: it's a tax. Even if you call it a penalty, it's indistinguishable from a tax.
If it were a tax, they could justify it under the general welfare and necessary and proper clauses. But now that it's not a tax, according to the solicitor general, those clauses aren't relevant.
It's just retarded and makes me wonder if they want it to sink.
If only the individual mandate gets struck we could have a pretty clear path to single-payer. Seems an awfully big gamble though.
I'd like to believe that this is a savvy political gambit on the part of the White House, but I'm a bit too jaded for that. I think they just got overconfident.
I have been pointedly ignoring the consipracy theorist in my head, but he won't shut up suggesting that this whole effort was designed to explode from the beginning, leaving only single payer as a viable option.
It's too bad we won't see single payer because boomers are fucking idiots
If this gets struck down the insurance companies will just kick everyone back off the roles, we'll be back where we started, and idiot liberals won't vote for Obama because his healthcare plan failed and if he'd just done it this other way like we wanted him to everything would be okay
I really can't even understand how anyone can argue with a straight face that the individual mandate doesn't easily fit under the Commerce Clause. The cost of healthcare is a huge drain on the national economy. A large part of that are the uninsured/uninsurable. The only possible way to remove this drain on the national economy (without completely dismantling the health insurance industry and instituting single-payer) is the individual mandate. If the SCOTUS wasn't just another detrimentally partisan branch of government, this case would have been laughed out of the court system a long time ago.
The unconstitutional case is trying to prove that the government is forcing people into the market, which is true on such a technicality that it needs an electron microscope. In reality, you are in the healthcare market the minute you're born. Ginsberg called this out yesterday.
You may be in the healthcare market, but the individual mandate attempts to regulate the health insurance market, and they are not the same thing. That's not a technicality at all!
Moved to the ACA thread, too, because this needs to be responded to.
-Spool32, TheCanMan moved this over here so I'll respond in this thread cause it exists now.
Here's the thing about the healthcare market and the health insurance market in the United States, they're the same thing. This is like saying that using a car doesn't put you in the fuel market as well.
You literally cannot get affordable healthcare in this country without insurance. Health insurance artificially inflates the price of medical care. If you wish to regulate healthcare, you must also regulate insurance. Without nationalizing the industry, this is literally the only way and it is incredibly necessary and incredibly proper.
That's a strong argument for single payer but the ACA doesn't nationalize the health insurance industry.
No, but it regulates a market we're all involved in whether we want to be or not. If you have insurance, your involvement is obvious, if you don't you're driving up rates for people who do have it.
I'm very disappointed and confused by the White House's insistence to call this a penalty rather than a tax. Why? So they can have the case heard before the law goes into effect?
The popular pro-Constitutionality arguments in favor of the individual mandate are simple, and they all boil down to one thing: it's a tax. Even if you call it a penalty, it's indistinguishable from a tax.
If it were a tax, they could justify it under the general welfare and necessary and proper clauses. But now that it's not a tax, according to the solicitor general, those clauses aren't relevant.
It's just retarded and makes me wonder if they want it to sink.
I agree. From my layman's perspective that looks like a huge mistake that may well sink the ACA. If so, I'll be righteously pissed at the White House for fucking up the biggest healthcare reform this country has seen in decades.
Not only is the mandate as a tax argument much more solid, but it would have also delayed any decision until 2015 which would have made an existing benefit that much harder to take away from everyone whose life was being positively change by it. I just don't understand what the administration is doing here. Is it that important to have a SCOTUS decision before the election? Really? You'd risk it all because of that?
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AManFromEarthLet's get to twerk!The King in the SwampRegistered Userregular
I'm very disappointed and confused by the White House's insistence to call this a penalty rather than a tax. Why? So they can have the case heard before the law goes into effect?
The popular pro-Constitutionality arguments in favor of the individual mandate are simple, and they all boil down to one thing: it's a tax. Even if you call it a penalty, it's indistinguishable from a tax.
If it were a tax, they could justify it under the general welfare and necessary and proper clauses. But now that it's not a tax, according to the solicitor general, those clauses aren't relevant.
It's just retarded and makes me wonder if they want it to sink.
If only the individual mandate gets struck we could have a pretty clear path to single-payer. Seems an awfully big gamble though.
I'd like to believe that this is a savvy political gambit on the part of the White House, but I'm a bit too jaded for that. I think they just got overconfident.
I have been pointedly ignoring the consipracy theorist in my head, but he won't shut up suggesting that this whole effort was designed to explode from the beginning, leaving only single payer as a viable option.
Designed this way by the intransigence of the Republican party, yes.
I'm very disappointed and confused by the White House's insistence to call this a penalty rather than a tax. Why? So they can have the case heard before the law goes into effect?
The popular pro-Constitutionality arguments in favor of the individual mandate are simple, and they all boil down to one thing: it's a tax. Even if you call it a penalty, it's indistinguishable from a tax.
If it were a tax, they could justify it under the general welfare and necessary and proper clauses. But now that it's not a tax, according to the solicitor general, those clauses aren't relevant.
It's just retarded and makes me wonder if they want it to sink.
It could have to do with the fact that the IRS cannot forceably collect the "penalty". Maybe if they called it a 'tax", the IRS would be empowered to force people to pay it.
As I understand it, a person who does not have health insurance receives the penalty, but no government institution is empowered to collect the penalty.
Which is why I'm confused by SCOTUS being so worked up about it. If you don't have health insurance, the government enacts a penalty whereby you have to pay $50, but they never collect the $50.
Is there a reason why the "penalty" couldn't have been explicitly implemented as a tax, with write-offs for actually purchasing (or being provided) health insurance that allowed for the system to pretty much match the penalty structure?
Like, was making it a "penalty" a political thing, or a practical thing?
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AManFromEarthLet's get to twerk!The King in the SwampRegistered Userregular
Necessary and Proper is a subordinate clause. If the thing you're trying to do is unconstitutional, you can't back into doing it with the Necessary & Proper clause. It gives the Congress the power to do (necessary and proper) things in the course of pursuing some Constitutional effort, and that's all.
If regulating insurance vial the individual mandate is an unconstitutional overreach not covered by the Commerce clause, that's the whole ballgame for the mandate.
That's a pretty big if there, cowboy, and I argue that it isn't an overreach.
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AManFromEarthLet's get to twerk!The King in the SwampRegistered Userregular
Is there a reason why the "penalty" couldn't have been explicitly implemented as a tax, with write-offs for actually purchasing (or being provided) health insurance that allowed for the system to pretty much match the penalty structure?
Like, was making it a "penalty" a political thing, or a practical thing?
A political thing. No Republican would vote for a tax and neither would the Blue Dog Democrats who gave the DNC its super majority.
I'm very disappointed and confused by the White House's insistence to call this a penalty rather than a tax. Why? So they can have the case heard before the law goes into effect?
The popular pro-Constitutionality arguments in favor of the individual mandate are simple, and they all boil down to one thing: it's a tax. Even if you call it a penalty, it's indistinguishable from a tax.
If it were a tax, they could justify it under the general welfare and necessary and proper clauses. But now that it's not a tax, according to the solicitor general, those clauses aren't relevant.
It's just retarded and makes me wonder if they want it to sink.
If only the individual mandate gets struck we could have a pretty clear path to single-payer. Seems an awfully big gamble though.
I'd like to believe that this is a savvy political gambit on the part of the White House, but I'm a bit too jaded for that. I think they just got overconfident.
I have been pointedly ignoring the consipracy theorist in my head, but he won't shut up suggesting that this whole effort was designed to explode from the beginning, leaving only single payer as a viable option.
Considering it was a conservative idea from the start, that would be the Xanatos gambit of all time if true.
At any rate, I'm a little disheartened by how many people here are disheartened by the court looking at this case, or the state of american jurisprudence. We kind of have to go by what the constitution says, no matter how much people might find it inconvenient.
I do kind of wish they had just called it a tax though, or even just levy a general tax and give exemptions for having insurance, which would be almost completely unobjectionable on legal grounds.
At any rate, wait until the actual opinions come out, then rail on the justices for being idiots.
The General Welfare clause doesn't apply because that only gives Congress to levy taxes for the general welfare, and the mandate is not a tax!
It's Commerce clause or nothing for the mandate.
Exactly my point. The SG could have gone to SCOTUS and said, "It's a tax, and if that means you can't hear the case until 2014... well, see you in 2014," and he'd be on arguably much more solid ground.
Feral on
every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
I'm very disappointed and confused by the White House's insistence to call this a penalty rather than a tax. Why? So they can have the case heard before the law goes into effect?
The popular pro-Constitutionality arguments in favor of the individual mandate are simple, and they all boil down to one thing: it's a tax. Even if you call it a penalty, it's indistinguishable from a tax.
If it were a tax, they could justify it under the general welfare and necessary and proper clauses. But now that it's not a tax, according to the solicitor general, those clauses aren't relevant.
It's just retarded and makes me wonder if they want it to sink.
If only the individual mandate gets struck we could have a pretty clear path to single-payer. Seems an awfully big gamble though.
I'd like to believe that this is a savvy political gambit on the part of the White House, but I'm a bit too jaded for that. I think they just got overconfident.
Well, a lot of people seem to see this as an "No matter the outcome, the Republicans win" type situation.
1. If they strike down just the mandate, then the insurance industries will panic like you've never seen. The entire idea of health insurance will explode if everything in the ACA is allowed to reach implementation without the mandate in place. This creates a rallying cry for the Republican base. "Get Republicans into office so they can repeal Obamacare before you and everyone you've ever loved is killed". They'll also have the insurmountable cash dollars the insurance companies can pour into their ad campaigns.
2. If they strike down the entirety of the ACA, the narrative becomes one of Executive overreach, Democratic power-grabbing, and a willingness of Obama to ignore the constitution in an effort to take your money and give it to illegal immigrants.
3. If they find that it IS constitutional, the narrative becomes about activist judges legislating from the bench. Arguably the weakest narrative since, you know, keeping legislation in place as is isn't what most people consider activism. But the threat of Obamacare continues to loom and if it reaches implementation and people actually like it, then there is the simple method of claiming it was a Republican idea first. But a ruling like this would strengthen the powers that be behind Romney and create a united front going into the election which could prove much harder for Obama to win against than the current fractured GOP.
Delaying the hearing on a technicality wouldn't prevent any of those, it would just allow the narrative to continue.
Because the mandate was a compromise in the first place, Obama and the Justice Dept really had no good plays here.
Of course, the issue is complicated and nuanced enough that the Democrats should be able to spin any of the above outcomes to their favor as well.
1. The Republicans are going to come after medicare and medicaid and social security next!
2. The Republicans are literally stealing healthcare from children just to try and score political points.
3. Look how awesome we are, the Republican challenge failed.
Delaying on the "it's a tax, not a penalty" thing would've made Obama and the Justice Department look weasely and ineffectual and cowardly. It would've been played round the clock like when Clinton was on tape say "It depends on what the meaning of the word IS is."
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You have an odd way of expressing that underlying point (which I agree with). I wouldn't say eating a take-out box in a dingy back alley and a nice steak dinner both lead to similar outcomes. But that's by-the-by, your comment reminds me of another article I read which echoes your sentiments somewhat: http://www.newyorker.com/reporting/2012/04/02/120402fa_fact_sedaris
@Casual
I didn't necessarily mean that a move to the NHS was a free lunch, but a move to a social health insurance system would be something super close to it, given the dire state of the status quo.
One thing that also strikes me about all this is just how partisan the supreme court is; is this a normal thing? Is it desirable?
The popular pro-Constitutionality arguments in favor of the individual mandate are simple, and they all boil down to one thing: it's a tax. Even if you call it a penalty, it's indistinguishable from a tax.
If it were a tax, they could justify it under the general welfare and necessary and proper clauses. But now that it's not a tax, according to the solicitor general, those clauses aren't relevant.
It's just retarded and makes me wonder if they want it to sink.
the "no true scotch man" fallacy.
While I agree with the latter statement, I'm not even sure if it matters. The Necessary and Proper Clause clearly gives Congress the power "To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof." The only way to address the economic drain that the uninsured/uninsurable put on the country is an individual mandate. There is no other way to address that problem (short of razing and salting the health insurance industry and instituting single-payer). It doesn't matter if you don't think you're part of the healthcare system. You're part of the national economy.
Exactly. The cost savings of the ACA is founded in requiring young, healthy people who don't really need health insurance to pool with the old or infirm who do.
This isn't some insidious new scheme, it's just How Insurance Works. The whole system is reliant upon their paying premiums when they're healthy to cover costs for those who aren't, blissfully unaware that when the rubber meets the road and they someday need treatment themselves, their insurance companies, pre-ACA, would then rather scam them and preexisting condition their way out of paying on a claim. There are no steak dinners in private suites to be had, only bankruptcies and ruined families as somebody tries to fight off death or even just maintain a passing quality of life.
This is the main purpose of the law--to extend health care to Americans who either cannot afford it or have been turned down, and then to keep those Americans healthy and solvent once they do obtain coverage.
The issue with the Court potentially striking down the mandate is that they take away the machinery for making that possible, the means of making it affordable. Yes, for purely political reasons.
It can get even wonkier than that. Sometimes facilities don't get fee-for-service billing at all and just get paid based on the diagnosis code on the claim form.
Fee schedules are the worst things.
Trust me, I know.
Which is why medical software nowadays is designed to overcode visits, making sure each iota of time spent with the patient has its proper code(s), building justification for a level 4 or 5 visit when it really should have been a level 2 or 3, and tying every possible ICD-9 to a visit that it feasibly can. Oh, so the review of systems had someone say they had a few headaches since last visit? That's a code. Can;t sleep? Who cares if it is relevant to the visit! That's a fucking code.
It's awful.
Let's play Mario Kart or something...
Well, the point I was making was that the box-dinner in the back alley and the steak dinner in the restaurant are both resulting in the same greater outcome: a person being successfully fed.
But yes, the fact that we charge money for people to be put to a doctor's judgment has a huge connection with the fact that people in the US treat healthcare as a potable commodity instead of a public resource. The exchange of money has this implied assumption of a tangible return, which is just not how medicine works.
Pretty much the court has gotten more open so we can see behind the curtain.
The court is not immune to partisanship it tries to act like it is but it isn't.
You may not be in the health insurance market, but the cost of your care abso-fucking-lutely is. You can't separate health insurance from healthcare. They are inextricably linked.
I agree with this too.
Well yeah if you measure the quality of a hospital by its architecture, meal quality and the number of atriums then UK hospitals will fall short (except for our private ones which probably do have all that shit). Personally I consider other things like how clean it is, how much time doctors and nurses spend with me, the quality of the medication I'm given and not contracting MRSA in my quality scale.
I get what you're trying to say but I still think your problem is not measuring like for like. Luton probably isn't that much worse (or better) than many older inner city hospitals in the US.
is he a smoker?
If not
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Sure, why not. But seriously: What's the appropriate charge? What should be the cost to keep you from dying?
Edit: The Ron Paul clip is related, but distinct - the question there is "presuming he cannot afford it, should we let him die or not." I'm asking how much we should charge for the procedure.
That is barbaric. There's no other word for it.
@Spool32, TheCanMan moved this over here so I'll respond in this thread cause it exists now.
Here's the thing about the healthcare market and the health insurance market in the United States, they're the same thing. This is like saying that using a car doesn't put you in the fuel market as well.
You literally cannot get affordable healthcare in this country without insurance. Health insurance artificially inflates the price of medical care. If you wish to regulate healthcare, you must also regulate insurance. Without nationalizing the industry, this is literally the only way and it is incredibly necessary and incredibly proper.
It's also pretty representative of a substantial (not total though) portion of who is voting for Republicans now.
I don't understand the question. Do you mean "charge" as in why do they care or how much should they charge for the life saving services?
Because if it's the latter, they will charge you retail and will either negotiate it down to the point where it's a little "FUCK YOU" every month, or bankrupt you.
If only the individual mandate gets struck we could have a pretty clear path to single-payer. Seems an awfully big gamble though.
The latter. But "retail" isn't quite what I was shooting for.
A functional unregulated or lightly regulated free-market healthcare system is impossible. It cannot exist.
Yeah, that's what he's saying.
He's saying that the medical industry in the US relies heavily on customer feedback to assess the quality of its hospitals, which measures irrelevant shit. But that's what American citizens are used to, because they don't know any better, and won't be willing to give up such niceties so easily (even if it means better care).
He knows how absurd the situation is.
the "no true scotch man" fallacy.
I'd like to believe that this is a savvy political gambit on the part of the White House, but I'm a bit too jaded for that. I think they just got overconfident.
the "no true scotch man" fallacy.
That's a strong argument for single payer but the ACA doesn't nationalize the health insurance industry.
If regulating insurance vial the individual mandate is an unconstitutional overreach not covered by the Commerce clause, that's the whole ballgame for the mandate.
I have been pointedly ignoring the consipracy theorist in my head, but he won't shut up suggesting that this whole effort was designed to explode from the beginning, leaving only single payer as a viable option.
It's Commerce clause or nothing for the mandate.
It's too bad we won't see single payer because boomers are fucking idiots
If this gets struck down the insurance companies will just kick everyone back off the roles, we'll be back where we started, and idiot liberals won't vote for Obama because his healthcare plan failed and if he'd just done it this other way like we wanted him to everything would be okay
No, but it regulates a market we're all involved in whether we want to be or not. If you have insurance, your involvement is obvious, if you don't you're driving up rates for people who do have it.
I agree. From my layman's perspective that looks like a huge mistake that may well sink the ACA. If so, I'll be righteously pissed at the White House for fucking up the biggest healthcare reform this country has seen in decades.
Not only is the mandate as a tax argument much more solid, but it would have also delayed any decision until 2015 which would have made an existing benefit that much harder to take away from everyone whose life was being positively change by it. I just don't understand what the administration is doing here. Is it that important to have a SCOTUS decision before the election? Really? You'd risk it all because of that?
Designed this way by the intransigence of the Republican party, yes.
It could have to do with the fact that the IRS cannot forceably collect the "penalty". Maybe if they called it a 'tax", the IRS would be empowered to force people to pay it.
As I understand it, a person who does not have health insurance receives the penalty, but no government institution is empowered to collect the penalty.
Which is why I'm confused by SCOTUS being so worked up about it. If you don't have health insurance, the government enacts a penalty whereby you have to pay $50, but they never collect the $50.
Why is that scary?
Like, was making it a "penalty" a political thing, or a practical thing?
That's a pretty big if there, cowboy, and I argue that it isn't an overreach.
A political thing. No Republican would vote for a tax and neither would the Blue Dog Democrats who gave the DNC its super majority.
Considering it was a conservative idea from the start, that would be the Xanatos gambit of all time if true.
At any rate, I'm a little disheartened by how many people here are disheartened by the court looking at this case, or the state of american jurisprudence. We kind of have to go by what the constitution says, no matter how much people might find it inconvenient.
I do kind of wish they had just called it a tax though, or even just levy a general tax and give exemptions for having insurance, which would be almost completely unobjectionable on legal grounds.
At any rate, wait until the actual opinions come out, then rail on the justices for being idiots.
Exactly my point. The SG could have gone to SCOTUS and said, "It's a tax, and if that means you can't hear the case until 2014... well, see you in 2014," and he'd be on arguably much more solid ground.
the "no true scotch man" fallacy.
Well, a lot of people seem to see this as an "No matter the outcome, the Republicans win" type situation.
1. If they strike down just the mandate, then the insurance industries will panic like you've never seen. The entire idea of health insurance will explode if everything in the ACA is allowed to reach implementation without the mandate in place. This creates a rallying cry for the Republican base. "Get Republicans into office so they can repeal Obamacare before you and everyone you've ever loved is killed". They'll also have the insurmountable cash dollars the insurance companies can pour into their ad campaigns.
2. If they strike down the entirety of the ACA, the narrative becomes one of Executive overreach, Democratic power-grabbing, and a willingness of Obama to ignore the constitution in an effort to take your money and give it to illegal immigrants.
3. If they find that it IS constitutional, the narrative becomes about activist judges legislating from the bench. Arguably the weakest narrative since, you know, keeping legislation in place as is isn't what most people consider activism. But the threat of Obamacare continues to loom and if it reaches implementation and people actually like it, then there is the simple method of claiming it was a Republican idea first. But a ruling like this would strengthen the powers that be behind Romney and create a united front going into the election which could prove much harder for Obama to win against than the current fractured GOP.
Delaying the hearing on a technicality wouldn't prevent any of those, it would just allow the narrative to continue.
Because the mandate was a compromise in the first place, Obama and the Justice Dept really had no good plays here.
Of course, the issue is complicated and nuanced enough that the Democrats should be able to spin any of the above outcomes to their favor as well.
1. The Republicans are going to come after medicare and medicaid and social security next!
2. The Republicans are literally stealing healthcare from children just to try and score political points.
3. Look how awesome we are, the Republican challenge failed.
Delaying on the "it's a tax, not a penalty" thing would've made Obama and the Justice Department look weasely and ineffectual and cowardly. It would've been played round the clock like when Clinton was on tape say "It depends on what the meaning of the word IS is."
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