Health Care SCOTUS Ruling Reaction Thread

By now you know that the US Supreme Court has largely upheld “ObamaCare,” on a 5-4 vote. Here is the complete ruling.

I am traveling today so I won’t have much to say on follow-up, but my immediate reaction is: Interesting ruling, surprising grounds for upholding the law, the long-term political ramifications are probably even more interesting than the short-term electoral ramifications, and also, on a personal note, I’m glad to see the law ruled constitutional because I think lack of reasonable health care for everyone in this country has been a horrible state of affairs, and this is the first step in dealing with that.

Go ahead and leave your comments below. As a general rule, may I remind people of two things: One, treat other respondents in the thread with dignity and respect, two, actually try to discuss the ruling and its ramifications, rather than address it from a sports team point of view (i.e., “My side won!” “My side lost!”). And three, even though I will be traveling today, I will still be wielding the Mallet. So, you know. Keep it smart, keep it civil.

Got it? Then the floor is now yours.

344 thoughts on “Health Care SCOTUS Ruling Reaction Thread

  1. I still would have preferred a true Universal Health Care act, but as a first step this isn’t awful. I was most surprised that Roberts was the one who crossed the line, that was completely unexpected.

  2. I am happy that this passed. Having family that has worked hard and ended up not being able to afford insurance and that have prexisting conditions has given me a totally different perspective than I had 10 years ago. However, I do not even pretend to understand all the ins and outs. I just think that we need affordable healthcare for all.

  3. Yes, Roberts crossing the line to vote to uphold the Act is what I found most surprising as well.

  4. I agree with Luke, completely, on all points.

    Some are calling this a tax hike. In all actuality it’s a reduction in healthcare costs since we won’t have people going to the very expensive and unhealthy ER rooms for minor concerns, not being able to pay those bills (even some middle class folks stick us with their bills), and laying it on others to pay for it. I only wish it would be implemented today, not a year and a half from now.

  5. “In 1790, the very first Congress—which incidentally included 20 framers—passed a law that included a mandate: namely, a requirement that ship owners buy medical insurance for their seamen. This law was then signed by another framer: President George Washington. That’s right, the father of our country had no difficulty imposing a health insurance mandate.[…]

    Six years later, in 1798, Congress addressed the problem that the employer mandate to buy medical insurance for seamen covered drugs and physician services but not hospital stays. And you know what this Congress, with five framers serving in it, did? It enacted a federal law requiring the seamen to buy hospital insurance for themselves. That’s right, Congress enacted an individual mandate requiring the purchase of health insurance. And this act was signed by another founder, President John Adams.”

    That’s from Einer Elhauge, a professor at Harvard Law, via Ezra Klein’s Wonkblog at the WASHINGTON POST. Elhauge continues “not only did most framers support these federal mandates to buy firearms and health insurance, but there is no evidence that any of the few framers who voted against these mandates ever objected on constitutional grounds. Presumably one would have done so if there was some unstated original understanding that such federal mandates were unconstitutional.”

  6. It’s going to be an interesting decision (and dissent) to read. I had thought the taxing power was more appropriate than the commerce clause to apply the mandate (since Congress can’t force people into commerce), and it seems what I read in the syllabus follows that line.
    This combined with the Arizona decision makes Roberts perhaps more of an enigma. I wonder where Kennedy comes from in this.

  7. My concern is how they plan on “collecting” this tax. I’m about to make some huge sweeping generalizations, which I know will not apply to everyone, but hear me out.

    Let’s assume that the people who will not have health insurance are generally “poor”. Let’s also assume that this tax will be collected by the IRS as an additional line item on income tax. The “poor” already generally do not pay any income tax since their AGI is below a threshold… so how will this fine be collected from them?

    I must admit I’m woefully ignorant about the details of “ObamaCare” in general, so I’m hoping someone can enlighten me.

  8. Seems like sensible grounds to uphold the “mandate” on to me. I’ve heard people talk about how “dangerous” it is to tax people for not doing something, but I personally don’t see a strong distinction between this and social engineering using tax breaks. My wife and I choose not to have kids and have higher taxes as a result. Others can choose to not buy health insurance and they too will have higher taxes as a result. I don’t see the big problem with either of them.

  9. @Geoff IIRC the tax penalty scales with income so it is always less than you would pay for health care under the subsidies provided by other sections of the ACA. So it’s not a fraction of your income, though it scales with it. Presumably people making too little money to owe federal income tax would qualify for large subsidies and probably not pay much if anything under the penalty.

  10. @Geoff here you go: from Ezra Klein:

    “The individual mandate is a requirement that all individuals who can afford health-care insurance purchase some minimally comprehensive policy. For the purposes of the law, “individuals who can afford health-care insurance” is defined as people for whom the minimum policy will not cost more than 8 percent of their monthly income, and who make more than the poverty line. So if coverage would cost more than 8 percent of your monthly income, or you’re making very little, you’re not on the hook to buy insurance (and, because of other provisions in the law, you’re getting subsidies that make insurance virtually costless anyway).”

  11. First, I’m personally happy with the decision. That it was upheld 5-4 with Roberts joining and writing the decision is surprising. But declaring this constitutional on tax grounds (which the Obama administration went out of its way to avoid arguing on those merits) is pretzel logic. Then again, I like pretzels.

  12. That Roberts pulled a Souter is the most interesting part of the opinion. Especially when considering that Kennedy was solidly with the more conservative justices. That said, the libertarian in me can take consolation that the court at least found that the mandate was unconstitutional under the commerce clause and the necessary and proper clause.

  13. The Supreme Court declared it constitutional as a tax because that’s what it is, a tax. The largest tax hike on the middle class in history. Hundreds of new IRS agents have been hired. Not doctors, IRS agents.

  14. Hey Geoff,

    The fine will be “collected” in two possible ways, as I understand it (the quotations will relate to the second way, bear with me):
    1. The tax will be calculated into their overall tax burden as a percentage of their income and based on where they are in relation to the poverty level. This means if a person was going to get a refund on their withheld taxes, the penalty will take a bite out of that refund.
    2. If the language of the ACA isn’t altered, there is no enforcement for the penalty, meaning if the individual doesn’t pay, the IRS has no power to issue a lien, garnish wages, file an action, or do anything else to compel payment. This being a tax may change that, but for now there is, in effect, no penalty.

  15. Here’s a basic take on what the opinion actually says:

    All Justices kind of agree that the mandate is unconstitutional under the commerce clause and under the proper and necessary clause.

    Everybody agrees that the Congress could do something like the mandate as a tax.

    The conservatives say: However, since it isn’t a tax, obamacare is unconstitutional.

    The liberals and Roberts say: Well, we have an obligation to resort to any construction possible to save a status from unconstitutionality, so we’re gonna say it’s allowable as a tax.

    As a libertarian/conservative I hate it. I would prefer Roberts sided with the conservatives, and say you had a choice to make it a tax, you didn’t, so you loose. But I can’t honestly say I disagree. Prior cases say they have to jump through any possible hoops to let it survive.

  16. @oye: Look into the ruling a little deeper: 4 of the 5 in the majority found that the mandate is constitutional under the commerce clause and as a tax. Only Roberts rejected it under commerce clause but accepted it as a tax.

  17. This opens an interesting opportunity as to what the government can force you to do so long as the penalize the non-action with a reasonable tax.

    For example, lets assume the republicans want you to own a gun for personal protection and the money spent purchasing the guns will stimulate the economy, they could charge you a $500 tax if you don’t. Please don’t criticize this idea as dumb, I accept that it is, the point is that the government COULD “force” you to do this based on this ruling.

  18. mattmarovicht, it didn’t take the DNC Executive Director Patrick Gaspard long to tweet “It’s constitutional. Bitches!”

    Real classy.

  19. But Obama said it wasn’t a tax, and as a Law Professor who taught ConLaw, he knows what he’s talking about, right?

    ;-)

    All the arguments I heard from the left side of the aisle said it wasn’t a tax, but now the highest court in the land rules it’s Constitutional because it is a tax? I don’t think either side got what they hoped for, and in the long run, this will hurt Obama’s chances at another term. I’d be interested in seeing what the opinion of the Roberts Opinion is.

    Dav

  20. the point is that the government COULD “force” you to do this based on this ruling.

    No, the government could force you to do this based on Wickard (1942). The whole inactivity/activity thing is a spurious argument that was invented to go after health care.

  21. Geoff-

    Since this is based on the Mass law, I’m guessing implementation will be similar. You get a form to file with your tax return from your health insurance company. On the tax form there is a line for health insurance penalties. Otherwise you fill out the form HC and enter the penalty just like you would any tax you owe.

    Here’s a link to the form if you are curious: Form HC (pdf)

  22. I’m an EMT, and I “work” for a volunteer ambulance company, about 1000 hours a year, plus training. That’s ignoring my volunteer fire time.

    This means that when I go to a person’s house, they won’t be panicking over the bill they’re going to receive from me. It will make breathing easier, and may reduce their chest pain. At the very least, they will not have that Damocles sword over their heads, which means it will make my job easier.

    It means that if they need to get a doctor to look at them, and write a prescription because they have strep, they won’t be going to the ER, they’ll be going to a Doc-in-the-box.

    It means that they will be contributing to their health care, even if it’s by the tax, rather than dumping the expense for the homeless/insurance-less on those who can pay. Hospitals charge more for care because they have to eat the cost of caring for someone who can’t afford their care.

    On a personal side, it means that because I’m a diabetic with a heart condition there will not be a lifetime spending cap on my meds. I’m working with my doctors to do what they think I need to do to ameliorate my diseases. I don’t smoke, and rarely drink, and I don’t do recreational drugs.

    It may not be perfect, but if there’s a problem with it, we can fix it, one at a time.

  23. Matt: If that was the law, and the Republicans were to invoke an income-assessed tax on me because I don’t own a gun currently, I’d SKIP, SKIP, SKIP all the way to the gun store, and GLEEFULLY select the right firearm for my needs.

  24. I, for one, am selfishly happy about this. My family depends on MassHealth, Massachusetts state sponsored health care. Not how you might think. We depend on MassHealth because my private, employer-sponsored health insurance has an issue with adequately covering my daughter, who has multiple serious disabilities. Had Obama’s plan been struck down, MassHealth would have been in trouble (this according to my local NPR affiliate). This is not a guarantee since if Romney wins, he has promised to take it out, which in turn will take out MassHealth. If that happens, it will be a rather interesting set of circumstances since Romney created MassHealth (and Obama’s plan was modeled after it). In a way, it’s a legislative close parenthesis which would be more satisfying if the text between it wasn’t “and be prepared to either give up physical therapy or say goodbye to your retirement”.

  25. @Billy Quiet

    No, “t” in my last name but thanks.

    *shrug* “Classiness” knows no political affiliation.

  26. There are actually 2 big wins and one posible future one in this for conservatives:

    1) The Commerce Clause now has limits. This was previously the uber-clause that trumped every other limit on Congressional power. This limitation is, as they say, not nothing. I doubt anyone here honestly thinks the ACA would have passed if it had been billed as a tax increase from the beginning.

    2) Congressional power to take away state money is also limited. This has been a favored way of getting the states to fall in line over the years.

    3) Obama now has to run on a tax increase as part of his signature accomplishment. We’ll have to see how that works out for him.

  27. What is incredible to me is the lack of understanding that HEALTH care is not provided by Obama’s plan. Insurance is something that pays to fix things after they’re broken – car insurance pays to fix a broken car; homeowner’s insurance pays to repair or replace a damaged house; Obama’s plan pays to fix people who are sick or injured. Where is the *health* in that? I would be impressed with a plan that you paid into that provided a minimal level of nutritional supplements, that provided a minimal level of gym time. Stuff that contributed to *health*. But paying for insurance or paying a tax penalty? How exactly does this make for a healthier population?

    What Obama’s plan does is deal with some of the public financial consequences of bad health, it does NOT deal with creating health. So please – can we stop calling this plan a *health care plan*?

  28. @ZBBMcFate: It is only a tax increase if you choose not to buy health insurance or do not get it through your employer. Also, given the previous discussions in the thread, it will be a very slim margin of people in the middle class who would even be in the position of having to choose tax or insurance.

  29. @Lif – Your lack of understanding of health insurance is showing. Health insurance gives access, at a reduced cost, to various things as preventative health programs, immunizations, and medicine to treat on-going, chronic issues in general. Health insurance is not just for “Oh, I just got the cold, time to go down and grab some antibiotics.”

  30. I would have been very disappointed by a SCOTUS finding that the law was unconstitutional. Not because I’m a rabid leftist socialist running dog, but because I think the President invested every single bit of his “mandate for change” and political capital into the law. Frankly, I thought there were other, more pressing, issues to address, but that’s the choice he made. And so I would have hated to see all that political capital investment go to waste.

  31. I was surprised by Chief Justice John Glover Roberts, Jr. (born 27 January 1955), the 17th Chief Justice of the United States siding with the 4 Liberal Justices, and by the argument which he found dispositive. I owe an apology to a friend of Jerry Pournelle’s who’d vigorously defended Roberts when I expressed my concern for his partisanship. It seems that Roberts has taken an objective, nuanced, narrow position on Constitutional foundations. From Barry Goldwater to Barry Obama, Conservatism has kept reinventing itself.

  32. @matt

    “Someone didn’t pass high school civics.”

    It’s not taught that much anymore…a different argument for a different thread though.

    Dav

  33. I find it sad that so many people believe they will be able to keep the coverage they have now. That is one of the two big lies in the healthcare bill. The Supreme Court just exposed the other one. The president said in no uncertain terms, over and over that it wasn’t a tax. Just like he says, over and over that you can keep your existing coverage.

    Employers are going to be forced to move employees to the government plan because it will be the only way they can stay competitive. You will not be able to keep your plan because your employer will no longer offer it. Obama knows this, just as he knew that the healthcare law was actually a tax.

  34. Robert,

    While you are narrowly correct, I believe that politically, you are mistaken. “Mandate is constitutional as a tax” is the one sentence sumation of the ruling. You may not agree, but expect to hear a lot of campaign ads targeting Obama’s broken promise of no middle class tax increase.

    Also, by placing this in the “tax” realm, the SCOTUS may have lowered the bar to repeal, or at least neutering. As a tax, it is being reported that it can now be modified through reconciliation if Republicans win in November (50 votes in Senate, no filibuster),

    While I would have rather seen Roberts side with the 4 justices who dissented, at the very least this is a costly victory for Obama.

  35. @Billy Quiets: There is no government plan. There are exchanges which you can participate in to get private insurance at a group rate. The only thing the government provides is medicare and medicaid which existed long before the ACA came out. And in order to qualify for those plans you have to be below the poverty line. Companies will not be able to participate in Medicare or Medicaid.

  36. @Lif – you also misunderstand what ACA provides — like preventive care mandated for all insurance policies at no additional cost to the insured; this includes routine physicals, blood work, age defined necessary testing such as mammograms and colonoscopies. Those parts of t he healthcare act are already rolling out – with the idea being that if people resist going to the doctor for testings because of the cost, they are also missing out on early indications of disease in early stages. Diabetes is diagnosable with a simple blood test — but if you have no insurance, then the doctor visit and the lab cost while not enormous in terms of people with a moderate income (around $250 out of pocket in my area) if you have limited income that’s the difference between health and food for a month for your family. Diabetes that’s already progressed can be a lot costlier. The other provisions of ACA (not all of which are in play, including the individual manadate) also focus primarily on getting health care and diagnostics to people early, and regularly and in treatment or lifestyle change educations earlier. The latter of which insurance companies have been trying to get people to participate in for years.

  37. Did not expect this outcome, even though I consider myself a reluctant supporter of the Act. My first choice would have been single payer, my second the Public Option. Compared to those, this is a distant third, but I’ll take it. I personally know at least 3 people who will benefit from not being discriminated against due to pre-existing conditions (all would be life threatening without treatment and insurance). On that grounds alone, I’m pleased.

  38. @Andrew/Dav

    Saddly, I know this to be true, and agreed with you on moving it to a different thread.

  39. @Billy Quiets
    “Employers are going to be forced to move employees to the government plan because…”
    Gonna stop you right there. Which government plan is that?

  40. ZBBMcFate,

    I totally agree with you that there will be a lot of targeted ads about it being the largest middle class tax hike. However, I would like to think that since we aren’t having a political discussion about who is right or wrong here but an intelligent discussion about the salient points.

    Yes, it is a tax increase. Yes, the middle class will be the ones who will have to choose between a tax hike and insurance. But the number of people who are put in that position will be relatively small.

    And, I think choosing to not purchase even a basic policy is actually very poor long term financial planning and those who choose that path are asking the rest of us to pay for it. This I think balances the scales.

  41. Matt_Reader @12:02 pm: As far as I’m concerned, that’s functionally equivalent to a tax credit for owning a gun. And I don’t see the problem, given there are federal tax credits for all manner of other things, such as buying an electric car, paying for higher education, etc.

  42. Congress has required citizens to purchase weapons.

    “That every citizen, so enrolled and notified, shall, within six months thereafter, provide himself with a good musket or firelock, a sufficient bayonet and belt, two spare flints, and a knapsack, a pouch, with a box therein, to contain not less than twenty four cartridges, suited to the bore of his musket or firelock, each cartridge to contain a proper quantity of powder and ball; or with a good rifle, knapsack, shot-pouch, and powder-horn, twenty balls suited to the bore of his rifle, and a quarter of a pound of powder; and shall appear so armed, accoutred and provided, when called out to exercise or into service, except, that when called out on company days to exercise only, he may appear without a knapsack” http://www.constitution.org/mil/mil_act_1792.htm

  43. Robert, Employers are going to dump healthcare plans and their employees will be forced to go to the “exchange” to pick a plan. The “exchange” is the government plan. How is that allowing you to keep your current coverage? It is not.

    Even if a company wants to provide coverage, most of them won’t because it will cost so much more than simply opting out. If I’m making widgets and selling them for $10 while providing healthcare and my competitor can sell widgets for $7 because he does not provide health care, I’m going out of business.

  44. @Billy Quiets: The ACA isn’t a Tax. The Mandate isn’t a tax. The failure to buy base level insurance under the mandate invokes a penalty that is levied as a tax.

    As for companies — this will affect large companies not at all.Certain classes of business will be required to provide insurance or pay a penalty. Small Businesses (under 50 employees), as I work for, may redirect the monies they already offer employees toward group insurance and opt-in to pay the penalty toward not providing group coverage simply because it’s more cost effective to do so, *reducing* their costs rather than increasing them, and enable their employees to get *better* coverage than what the business can provide because group rates for small business aren’t cheap and the smaller you are the more expensive it gets since the risk to the insurance company is spread over the entire eligible pool, and in a pool of less than 50 people, one person with medication managed diabetes or heart disease can drive everyone’s rates up by 57% a *year*.

    Our company has been hoping and waiting for this because we were fast approaching the point where we would be unable to offer insurance to our employees at all — and thus lose that competitive advantage you are talking about. In our case, the group plans were getting so expensive fewer people are participating — which drives up the cost yet again — and insurance companies require a minimum participation in group plans among eligible employees. Fall short of that percentage and they aren’t required to offer you anything.

  45. maygra, If this will affect large companies not at all why are so many of them (like McDonalds) asking for exemptions? That is simply not true.

    As for your own company you are proving my point. You will opt out and tell your employees that the will get a “better” policy that way. But I thought that your employees could keep their current coverage. Nope.

  46. @Billy Quiets,

    Medium to large companies are not going to dump there insurance plans. They would be giving up a large tax break. Further, employees would leave in mass droves if the company started dumping their insurance plans. Losing talent and a tax break would increase their costs above their competitors.

    The exchange is not a government plan. It does not pay in whole or in part any of the coverage for the plan. It provides people who have to buy insurance on a personal level a group rate.

    And the cost of insurance for a company is relatively small compared to the overhead expenses and would not appreciably affect the price of the widget by more than a cent or two.

  47. Robert, Medium to large companies ARE going to dump their insurance plans. Bear with me and I will find a link to some comments from some CEO’s for you.

  48. I have no real problem with a government plan burying private plans. I live in a country that very closely resembles what the US would look like it the government provided a single-payer plan – an expansive government plan that every citizen and permanent resident qualifies for, with private companies offering more comprehensive plans.

    What happens in practice is that the private plans are competing with the government plan, and have to provide a service over and above the government plan in order to be attractive. This has lead to a bunch of services like optical and dental being covered by default, along with innovations like no-claim bonuses and the like. They tend to be much nimbler than the government plan in covering newer treatments, and the care you get is generally better, but for some things like pregnancies the government plan is usually superior. It’s well within the capabilities of HMOs to offer such services, but they don’t because they’re only competing against each other and not against an entity that’s setting the minimum standard to the market.

  49. @Everyone who answered my questions: Thank you, that clears things up. I have health insurance through my employer, but I understand that there are many people who don’t, and “forcing” them to (or tax them otherwise) will certainly help fund a universal system. Of course, this also makes me curious why they didn’t effectively accomplish the same thing by raising taxes in general, and giving anyone with insurance a “credit”. It seems like functionally it is identical, and doing that would allow those in favour of the plan to couch it in much prettier language.

    Of course, I suppose then you’d have to deal with the fallout of raising taxes.

  50. Wow. I did not expect this. I figured republicans willingness to burn the nation to the ground just to get Obama out of the white house would see a straight-party vote in the Supreme Court decision on this case.

    First, America hates failure. Second, America is a little fuzzy on the whole concept of causation. Put them together and I think if ObamaCare had been overturned, enough Americans would have seen it as Obama’s failure, rather than realizing that, just like the Republican’s willingness to play chicken with the American economy over the whole manufactured crisis called the “Debt Ceiling” last year (.), they’re also willing to destroy any improvement made to health care reform just so Obama fails.

    I did not expect this at all.

    The parts that prohibit denying coverage because of preexisting conditions are good. The parts that prohibit insurance companies from rescinding people who get sick is good. I think only a Ayn Rand acolyte would say they’re bad. I just wish they had gotten a real “public option” in the bill. With the individual mandate, but no public option, the overall result is still an improvement over what we had before, but not as good as it could be.

    Billy Quiets: “Employers are going to be forced to move employees to the government plan because it will be the only way they can stay competitive. You will not be able to keep your plan because your employer will no longer offer it.”

    Human sacrifice, dogs and cats living together… mass hysteria!

    Well, right wing hysteria anyways…

    You forgot to mention that Health Care Reform will bring about human sacrifice, Billy. You know… Death Panels

  51. ZBBMcFate,
    this is not the first time the Supreme Court has set limits on the Commerce Clause.United States v. Lopez did that. That was the one that struck down the federal law against having guns near a school. Similar rulings after that, according to Wikipedia, include United States v. Morrison,

  52. Billy Quiets says:
    The largest tax hike on the middle class in history.

    There’s never been a time in history when taxes on the middle class were raised by 1%?

  53. Speaking just for myself, I’m not buying into any “slippery slope” arguments about being required to buy broccoli or whatever until I actually see people doing it. Possibility doesn’t equal probability.

  54. @BillyQuiets: “The “exchange” is the government plan.”

    Uhm, no, the exchange is a marketplace for Commercial Insurers to trot out their best individual and faamily policies to provide open competition between Insurance Companies on rates and coverage option levels. The only “government” portion of the exchnage is an exchange set up (in a technical fashion) by the fed government on behalf of those states (like mine) who dug their heels in and said they didn’t want to play. The Fed Exchange will still consist of Commercial, private insurers who operate on a profit driven business model, competing for the business of those american seeking private, personal policy’s rather than Group policies sponsored by their employers.

    Also, it would help if you actually read my comment. We are not opting out, we are being forced out of providing benefits to our employees because the group rates have increased in the past five years. We are no longer getting better rates as a company than individuals can receive in some cases. This is happening without ACA. This is not a result of ACA, these are rate increases enacted by the insurance companies and allowed to do ridiculous year to year increases on renewal rates by the state of Georgia. “Keeping their plans” in our case was never an issue, since we’ve changed insurers every year trying to keep premiums and coverage somewhat reasonable. (Initial year quotes are always better.) Regardless of ACA, we would have been forced probably in the next two years to stop offering group insurance and instead offer a cash equivalent to our employees to assist them in getting their own policies – . not out of choice but because we would have been as a company, costed out of the threshold percentage insurers are willing to take on a small business for.

    As a company however, we are perfectly happy to give that cash equivalent, or as our current insurer has indicated, allowing our employees to roll their current plans over to individual plans at the end of the plan year and keep their same coverage. However, with guaranteed issue no long a problem by 2015, we may now be able to sail merrily along, something that wasn’t possible before ACA.

  55. I’ve been calling this the “My mom doesn’t have to die if she loses her job” act. Because under the previous rules that’s basically exactly what would have happened.

    Shit’s personal for me. I’m glad it was upheld.

  56. Here is a link to a study on how many companies will be dropping health coverage.

    http://www.mckinseyquarterly.com/Health_Care/Strategy_Analysis/How_US_health_care_reform_will_affect_employee_benefits_2813

    Even the Washington Post has said that employers could save $422 billion by dumping their health plans. http://www.washingtonpost.com/blogs/ezra-klein/post/employers-save-422-billion-if-they-dump-health-coverage-will-they/2012/05/01/gIQAZiCyuT_blog.html

    Greg, mocking me does nothing to refute what I’m saying, it just shows how immature you are.

  57. “The decision on the constitutionality of the mandate was 5-4 for the government on the tax power issue, but 5-4 against the government on the commerce clause issue.”

    This is getting lost in the noise for the moment, and understandably so, but IMO this is the one issue that will resonate over time with the ruling, and affect other cases down the line.

    The quote is from http://lsolum.typepad.com/legaltheory/

    Dav

  58. “Even the Washington Post has said that employers could save $422 billion by dumping their health plans.”

    Really? Doesn’t that kind of indicate that private insurers are providing a pretty poor value?

  59. Mocking you, Billy? Are you saying that the right wing party was NOT going ape shit over “Death Panels” and “Killing Grandma” when Obama was trying to pass Health Care Reform?

    I’m sure “Be Afraid! Death Panels!” is something the right wingers would like everyone to forget at this point in time. But the thing of it is very simple:

    Most of the folks who are now trying to present “facts” about the cost of Health Care Reform, those were the exact same folks who were screaming about Death Panels when the law was being negotiated.

    Has anyone seen any death panels?

    No? Well, that kind of makes a person wonder just how factual those right wing “facts” really are, doesn’t it?

  60. @Billy Quiets: Did you actually read the articles? They don’t say what you think they are saying. Also, anytime one political group or another says oh look this is going to happen, I pull out my industrial size salt shaker.

  61. Hey Billy, even your Washington Post link says it probably wont happen:

    “But the best experience we have suggests that employers won’t drop coverage. That comes from Massachusetts’ experience under Romneycare, which, like the federal law, provided subsidized insurance for low-income Americans. There, employers have continued to offer coverage at the same level they did prior to the reform law.

    What gives? To start, all those benefits of offering insurance — the competitive, financial and wellness aspects — don’t disappear in 2014. Companies can still get more bang for their buck offering compensation as health insurance rather than wages. “

  62. Robert, yes I read the articles. The Washington Post article said that employers could save $422 billion but concluded that they would choose not to. I think their conclusion is wrong, but found it interesting that they would even admit that opting out was a possible scenario, given their liberal bias.

  63. Lots of interesting opinions in here, and kudos to everyone for keeping it basically civil

    I would just like to point out (as there’s been a few “voted against his own party” comments) that the Supreme Court is NOT a political institution (or at least it’s not supposed to be). The justices are not republican or democrat, they were just appointed by presidents who held those designations (it IS fair to assume that they were appointed because they generally agreed with said president’s point of view). So Roberts did not “vote against his party”, he voted as he felt was constitutionally mandated.

    Also, for a laugh, here are a bunch of people who are going to move to Canada because the US is adopting universal health care.

    http://www.buzzfeed.com/daves4/people-moving-to-canada-because-of-obamacare

  64. Oh, and Billy, your link from McKinsey Quarterly?

    http://en.wikipedia.org/wiki/McKinsey_%26_Company#Criticism

    In June 2011 McKinsey & Company created some controversy by releasing a study on the effects on small businesses of the US Administration’s health care bill.[37] The study’s findings contradicted most previous estimates made by renowned research institutes and the independent Congressional Budget Office.[38] McKinsey’s initial decision not to disclose any information regarding its methodology, the questionnaire used and the target group that was polled, caused widespread criticism. This lack of transparency led to accusations of partisanship and cast serious doubts upon the company’s claim to independence and objectivity.[39] McKinsey finally bowed to the pressure by the media and the White House and released the questionable survey, arguing that “[t]he survey was not intended as a predictive economic analysis of the impact of the Affordable Care Act”. They furthermore admitted having used suggestive language by saying “[w]e understand how the language in the article could lead the reader to think the research was a prediction, but it is not.”[40],[41] The company’s decision to stand by the findings was met with additional criticism. The New York Times quoted the chairman of the Senate Finance Committee as saying that “[t]his report is filled with cherry-picked facts and slanted questions. […] It did not provide employers with enough information for them to make honest choices and fair evaluations. Rather than correct the major deficiencies in their report, McKinsey has chosen to again stand by their faulty analysis and misguided conclusions.”[38]

    What was that about “refuting” what you are saying?

  65. I am happy that SCOTUS did the right thing. On the other hand I sort of feel like this. “Of course you have the right to have to buy insurance in our corporate dystopia. You’re going to need it because of the poisons our attempts to deregulate all things profitable are going to put into the Land, Sea, and Air.

  66. Competition does not stop at state lines. In Massachusetts the companies were competing with companies in other states. In a national health care system they are all on a level playing field, and it will be much cheaper for all of them to opt out.

  67. @ MBL: “I’ve been calling this the “My mom doesn’t have to die if she loses her job” act. Because under the previous rules that’s basically exactly what would have happened.”

    That’s a good name for it.

    Having been self-employed my entire adult life, and working longer hours than my friends who have corporate jobs, corporate salaries, corporate paid days off, and corporate HEALTHCARE plans, I’ve been calling it the, “I can seek medical help if I fall down two flights of stairs and break both legs” act. (Whereas, under current conditions in this country–when I slip in the shower or see something heavy flying at my head, I don’t think, “Ouch!” or “Yikes!” No, what I ALWAYS think, as I feel myself falling or feel myself nearly passing out is, “Oh, no, I CAN’T PAY FOR THIS! What’ll I do? I can’t afford the medical bills! I can’t afford doctors and X-rays! can’t pay for this injury!”)

  68. Technically the mandate didn’t receive a “vote” of 5-4 against on Commerce grounds. Roberts made it obvious that he was against it in that instance, but voted as part of the 5-4 majority for the mandate under Congress’ taxing power. This made the question moot under Commerce since it was upheld on other grounds. They didn’t vote twice in the opinion, it was just upheld.

  69. I think it’s become pretty obvious that precedent doesn’t really matter anymore anyway. Replace one justice and the tenor of the entire court will swing back the other way. The “New Federalism” argument will slowly fade and the power that has seemingly been sapped from the Commerce Clause and Congress’ Spending Power will be back in full force. Kind of sad that it works that way, but it really, always has.

  70. Billy: “The Washington Post article said that employers could save $422 billion but concluded that they would choose not to. I think their conclusion is wrong, “

    Hey, Billy, you do know that these very same companies could also save $442 billion dollars just by implementing salary cuts on all their employees, right???

    Gee, I wonder why they don’t save all that money and cut those salaries….

    It’s an enigma wrapped in a riddle surrounded by mystery.

  71. Competition does not stop at state lines. In Massachusetts the companies were competing with companies in other states. In a national health care system they are all on a level playing field, and it will be much cheaper for all of them to opt out.

    So then all commerce should be within state lines? That’s…odd.

  72. @ Billy Quiets “Competition does not stop at state lines. In Massachusetts the companies were competing with companies in other states. In a national health care system they are all on a level playing field, and it will be much cheaper for all of them to opt out.”

    If a company decided to dump health care for its workers, it would (1) piss off the workers and (2) increase its tax liability. Since workers aren’t generally stupid, they would want a good portion of the savings to be returned to them by way of an increased salary. So the company would have to pay out more cash to its workers and would lose the tax advantage of paying a portion of their salary via health benefits. So please explain why a rational company would do that.

  73. Dragoness,

    Given that there was a 4 vote block to affirm the mandate under the Commerce Clause, I think the fact that this expansion of the CC was rejected is good news. The limiting factor of “health care is special” seemed pretty flimsy, and I’m glad it was not upheld.

  74. Billy:
    Billy: In Massachusetts the companies were competing with companies in other states.

    Hm, that’s interesting. If your point is true, then Massachusetts should have higher unemployment than states with more lax state health care laws.

    Oh, wait. No.

    http://www.bls.gov/web/laus/laumstrk.htm/

    Looks like Massachusetts unemployment is 11th lowest in the nation.

    Hm.

    I think the operative word here is “refute”, yes?

    Remember folks, these people giving you “facts” about how Health Care Reform is going to ruin the economy are the same folks who told you HCR was going to kill grandma with Death Panels. It’s nothing but right wing hysteria.

  75. Honestly, CEOs threatening to dump health insurance for employees because of ACA is about as credible as the “we’ll just pack up our toys and move elsewhere” threats from Wall Street about regulations.

    Which is to say it’s about as credible as left-leaning people claiming they’d move to Canada if Bush was elected a second term, or right-leaning people claiming the same this morning with ACA being upheld.

  76. @ Dave

    But wasn’t the government arguing that this was a Commerce Clause issue, not a tax issue? Therefore the 5-4 “vote” against the Commerce Clause invalidates the governments argument? The act was recognized as legal because it’s a tax, the one thing the administration went to great lengths to deny it was when trying to pass the bill.

    Dav

  77. Jon M, it is going to be far cheaper for companies to drop health care, even with the tax implications. It’s just a fact. If you don’t like my links google it yourself.

    You will not be able to keep your current plan if your company drops the coverage. Do you really think that a government mandated exchange is going to offer you better coverage than the free market? Good luck.

  78. A comment on my Facebook Timeline by a smart member of OldFen (Robin Postal White): I am not a Conservative and have never been one but it is nice when a reasonable sense of being conservative prevails, the one in which the Constitution is mostly upheld. That I can and do respect, as any thinking person should! :)

  79. Billy: “it is going to be far cheaper for companies to drop health care”

    Dude. You’re not doing the math.

    Lets say HCR got struck down today. Companies could still save $422 billion dollars if they simply implemented a straight salary cut of all their non-manager employees.

    They could save money by cutting benefits.

    Your say a company will take any savings available, and so they will punt insurance benefits. But if there was no ObamaCare, they could still save money just by cutting salaries. So why don’t they cut salaries?

    By your argument, they could save the most money if they just lay everyone off. Cut all their expenses.

    Yet, for some strange, mysterious, inexplicable reason, companies don’t do that.

    You’re argument fails the most basic test.

    i.e. you have been refuted, yet you keep pushing the same right wing hysteria dogma.

  80. Do you really think that a government mandated exchange is going to offer you better coverage than the free market?

    Yes, and if you think the current health system is anything close to a free market, you’re deluded.

  81. I retain serious doubts about any plan based on the “insurance” model. Insurance is suited to cases where risks are small but enormous. “House burned down” is an insurance issue. “Want to see doctor” really shouldn’t be, and I think the insurance model is a big part of our insane costs; we’re funding multiple highly trained professionals on both sides of the insurance/clinic divide whose sole purpose is to make statements that both parties know are false. It’s haggling. “Oh, I could never perform this service for less than $100.” “Then we cannot do business, for I cannot pay you more than $25.” Five letters later, they agree that the clinic will send a bill for $80, the insurer will send a check for $40, both will send scary-looking letters to the patient referring to the other $40, and if the patient doesn’t pay it they’ll never mention it again. The cost of the time spent by skilled professionals (who of course have full health coverage)? Probably $10-20 of that.

    I did find the reasoning surprising. And I’m still not sure whether I’d rather have this law, or a more fundamental attempt to fix the underlying problem. I don’t really like the way in which this ensures that the people who have created much of our current problem get even more business.

  82. Yeah, sorry Billy, but both of those articles don’t really sell your case. Greg already posted about the McKinsey report before I could, but here’s a quote from the methodology explanation linked on the page you posted: “Comparing the McKinsey survey to economic estimates, such as the CBO’s, is comparing apples to oranges. While the McKinsey Quarterly article about the survey cited CBO estimates, any comparison is not apt. We understand how the language in the article could lead the reader to think the research was a prediction, but it is not.

    And the Washington Post article puts this tidbit right at the beginning: “A new report, out Tuesday from Republicans on the House Ways and Means Committee, estimates that America’s 100 largest companies could save a collective $422 billion over a decade.”

    Not the House and Ways Means Committee…but the H&WMC Majority Staff. In other words, it’s a pretty partisan document, in which the chairman says he got info from 71 of the Fortune 100 and then did some math and decided that it would be less expensive to cut healthcare for all employees and pay the $2000 fine per employee, instead. Which assumes that’s the only equation that went into healthcare benefits and employees have no input, consideration or analysis. That argument lacks a lot of sense, to me. Even assuming major corporations COULD just drop coverage, there’s no reason to believe they WOULD. Employer health benefits are a part of compensation: simply dropping benefits for hundreds of thousands of workers with no reimbursement? Not conducive to a productive enterprise.

  83. Billy Quiets @ 2:06 PM —

    The problem with general statements, such as those you have been making, is that there are plenty of demonstrable exceptions to them. I suspect you would see better success with your line of reasoning here if you acknowledge them.

    For example, I’m 99% sure that my primary employer will NOT be dropping healthcare coverage, for a variety of reasons I’m not at liberty to go into here. Nor will many companies in the industry I focus on. Why? Because (in general) the costs are already factored into long-term pricing structures and undoing those structures to any signficant degree would cause a host of business issues that might well be more costly in the long-run. Both top and bottom-lines would likely experience degradation.

    So your “it’s just a fact” isn’t, not really. And that’s a fact.

  84. I know it is early, but I am pretty disappointed with the press coverage. The most interesting part of this ruling is that John Roberts sided with the liberal block and he ruled based on tax law and not based on commerce law. The analysis of his ruling has been flippant at best. The Wall Street Journal talked about how Roberts made a brilliant right wing ploy with this ruling that will allow conservatives to get many other laws over thrown. Huh? This tells me that any outcome would have been spun as pro-conservatives. The democrats are doing the same thing. This is a victory for women and people with out health insurance. Yeah whatever. The Supreme Court rules on whether something is constitutional or not and not whether they would vote for it. Hopefully by tomorrow the newspapers will have detailed stories explaining exactly what Roberts said and without the spin. I am very curious about this.

    I can really do without all the crap from politicians. The republicans going this is huge for our campaign cause you need us to throw out this legislation. You need 60 votes in the senate to pass anything. I doubt the Republicans have any chance of getting to a 60 seat majority even if they take the Senate. They won’t get a single democrat to vote for it. So it is not going to be revoked if republicans win. The democrats are going to spin this as proving that Obama should be re-elected. It was a 5-4 decision. One guy in the whole country changes his mind, this is gone. The economy is still lousy. Bush has been out of office for 4 years. So going we suck, cause Bush sucked may still appeal to your base it won’t get you to 50.01%.

    That being said, I am generally in favor of the health care legislation and I am not a liberal. I think the bill is implemented horribly and has all kinds of bloated garbage. It is not a very good bill. It is going to be expensive. However, I feel for people who are sick and can’t get health care.

    One other thing. Check out NOVA on PBS. They just did an episode about corporate dental practices fleecing Medicaid. They basically over prescribe so they can charge more. This is going to be a major issue going forward and these businesses need to be heavily regulated.

  85. Some things a few people in this thread are missing:

    1. There is NO “government plan.” Republicans killed any possibility of a public option when the bill was being written, in negotiations to try to get some Republicans to vote for it (much to the chagrin, I might add, of many in the Democratic base).

    2. A big part of the ACA is tax BREAKS for businesses, especially small businesses, who provide their employees with health insurance.

    3. Nate Silver of fivethirtyeight has a good analysis on his blog of how the ruling helps Obama, and how saying otherwise—that it helps Romney, or that an opposite ruling would have helped Obama—is wishful thinking. I don’t have the link handy (writing on my phone) but Google is your friend.

  86. Bush has been out of office for 4 years. So going we suck, cause Bush sucked may still appeal to your base it won’t get you to 50.01%.

    And pluralities or majorities of Americans (including independents) still think Bush is responsible for most or all of it.

  87. Ok, that’s fine. If you want to believe that corporations won’t act in their own self interest to generate greater profit by pushing employees to the government mandated health exchange then more power to you.

    It’s not a tax and you can keep your coverage. Really.

  88. Greg,

    While I don’t necessarily agree with Billy, what you are saying is a straw man. Companies could save 422 billion by doing any number of things. Cutting insurance is *one* of them (according to his source, which may or may not be valid). You did not refute anything, you simply pointed out there are alternatives.

    If you want to throw down with formal logic, look at it this way. He’s not making an “if and only if” statement. And note that the logical validity of an argument has nothing to do with its “truth”. I can say “If I eat moon pies, I will win the lottery” and its a logically valid statement. Does it make sense in reality, no.

  89. It may NOT be perfect and there welll MAY be a lot of “gotchas” that’ll pop up as this gets going, but a lot of the same arguments made by the wild-eyed Right about this law were made about Social Security and Medicare when they were first proposed and those are the very things very few, even in the wild-eyed Right, would propose doing away with now.

    Frankly, all things being equal, I’d rather have a nameless, faceless government bureaucrat making decisions about my healthcare based on a national proposal that is supposed to be in my best interest rather than a nameless, faceless bureaucrat from an insurance company doing it with the mandate of his CEO and Board to make money by figuring out how to screw me over the easiest way as soon as I start sneezing.

    Teddy Roosevelt is smiling somewhere about this mess.

  90. Ok, that’s fine. If you want to believe that corporations won’t act in their own self interest to generate greater profit by pushing employees to the government mandated health exchange then more power to you.

    Then why haven’t they already done that by, y’know, not hiring or paying people more?

  91. @ Jesse,

    Silver is right in saying that the courts vote will help him from the Public Policy standpoint, but they way the Court upheld the law is a ton of political ammunition for Romney, a point which Silver misses.

    The argument made by the administration was that the law did not constitute a tax (and honestly, it never would have passed had it been framed as a tax), and today’s ruling says “this bill is legal because it’s a tax”. Right? That doesn’t exactly help Obama out.

    Dav

  92. Doug from Tally,

    Are Medicare and Social Security really the examples of successful government programs you want to be using right now?

  93. Jesse “Then why haven’t they already done that by, y’know, not hiring or paying people more?”

    Seriously? Have you seen the unemployment and underemployment figures? They have.

  94. Seriously? Have you seen the unemployment and underemployment figures? They have.

    Aaaaand thanks for falling into the FREE MARKET IS TEH AWSUM hypocrisy trap.

  95. Hey Billy,

    This will be the last thing I have to say on this particular topic. I think that some companies will choose to give up providing insurance either by further compensating their employees or doing some sort of share plan. This trend was going on long before ACA and I suspect it will continue although not at the level that you are suggesting.

    I agree that companies will act in their own self-interest. However, there is more at play with insurance as a benefit than the cost of the policy. The other factors pointed out by the Washington Post article will play a factor in determining whether a company drops it’s insurance. It will weigh those factors and assign values (costs) to them and then make a decision. In the end, I believe that the companies will see the value in keeping the benefit.

  96. “Are Medicare and Social Security really the examples of successful government programs you want to be using right now?”

    May as well use them now…in what, twenty or so years you won;t be able too. ;-)

    Dav

  97. This may not be as good as it could/should be, but it’s a step in the right direction. DH couldn’t get medical insurance without a prohibitive cost because of a pre-existing medical condition, and so has to rely on me and my job for coverage. I have friends who ended up at the emergency room because they had no insurance and couldn’t afford the doctor bill if they had their ailment treated on an outpatient basis. For both those reasons, I will happily kick in an extra few tax dollars if mandated. This particular thing falls under the ‘good of the people’.

  98. On a personal note, I am relieved that my son will be able to stay on my health insurance longer. On a professional note, I hope this means we will see more people living longer (and better) lives because they won’t have waited until it was too late to seek medical care due to the financial burden that medical care would put on them.

  99. billy quiets @11:53
    Having dealt with payroll stuff in the past, I suspect most of burden will be placed on the businesses’ bookkeepers and accountants. It’s a basic decision tree thereafter.

    Do you offer your employees health insurance yes/no? If yes, did they opt in yes/no? If no do they have insurance through a spouse or parent yes/no? Do they pay for a private policy yes/no? If all answers are no… figure Insurance Rate X from Table Z based on gross income. List the amount as a payroll deduction on the pay stub.

    Do you offer your employees health insurance yes/no? If no do they have insurance through a spouse or parent yes/no? Do they pay for a private policy yes/no? If all answers are no… figure Rate X from Table Z based on gross income. List the amount as a payroll deduction on the pay stub.

    Do you offer your employees health insurance yes/no? If yes, did they opt in yes/no? If yes, proceed to your standard payroll deduction process.

    When it comes time for private citizens to file taxes, the decision tree may have a couple more limbs, but it will still be simple enough for the DIY filers to report to the Feebs the information needed to keep track of things. Whatever happens, the Federal side can and probably will be programmed into the tax software and an additional line will be added to the 1040-___ paper forms and instruction manual. The rest is just educating the current IRS employees in changes to the tax law.

  100. “This particular thing falls under the ‘good of the people’.”

    Well, that was the principle reasoning behind the Eighteenth Amendment as well…just saying…

    There are some good parts of the bill that make sense, and I would bet if were brought up and voted on individually, in a Compromise of 1850 manner, most of the bill could remain in place. The “all or nothing” approach though…not sure that was the best way to go about it.

    In any event, I doubt the vote resolves the issue for all time, there will be further challenges…

    Dav

  101. For those who like to trot out the argument, “employers will drop coverage because it’ll be cheaper to pay the penalty,” I have just one question. Why aren’t those companies dropping health care now while there isn’t any fiscal penalty at all? Because health care is an attractive benefit which makes up for slightly lower wages. With a good health care plan, they attract the better employees. That saves them even more money.

  102. I’m seeing a couple of different lines of reasoning here about why national health care is going to be great and they are at odds with each other. On the one hand, it’s going to be great because a “nameless faceless government bureaucrat” will be making your health care decisions instead of a nameless, faceless insurance company bureaucrat. On the other hand, the insurance “exchange” will offer a beautiful buffet of private insurance plans for happy, healthy employees to choose from, all run by the same insurance companies we have now, only without all the evilness of the free market.

    So which is it?

  103. Even before ObamaCare, there was no free market for heath care, not just because of Medicare and Medicaid, or because the government provides tax incentives for employers to provide insurance, but also because of the legal requirement that hospitals provide emergency treatment to people without regard to ability to pay. Not wanting people to die in the street, there’s no way we’ll ever have a “free market” in health care, and so comparing ObamaCare to some “free market” baseline is useless.

    Indeed, it’s worth noting that, according to the OECD,

    Even if the private sector in the United States continues to play the dominant role in financing, public spending on health per capita is still greater than that in most other OECD countries (with the exception of Norway, Luxembourg and the Netherlands), because overall spending on health is much higher than in other countries. [Emphasis mine.]

    Erica @ 1:37 pm:

    Also, for a laugh, here are a bunch of people who are going to move to Canada because the US is adopting universal health care.

    To prevent my head from exploding, I’m going to pretend these people are joking.

    That said, it’s certainly possible for someone to be opposed to the mandate and be in favor of a single-payer system, and indeed have seem a number of liberals express that view. For such people—admittedly not the people quoted on that page—a move to Canada is not absurd.

  104. No, a national health care system (and that’s not what we’re getting, actually) will not be great. What we are aiming for is something better — something that sucks somewhat less than the present Charlie Foxtrot that emerged over the last 70 years or so. And that is basically how progress is measured. Getting things a bit better than they were, little by little, year by year, decade by decade. If you think that’s impossible, then you have given up.

  105. ZBBMcFate: “Are Medicare and Social Security really the examples of successful government programs you want to be using right now?”

    Are you seriously suggesting that they’ve been the absolute failures it sounds like you’re making them out to be? Both my parents lived longer lives because they had surgeries paid for through Medicare that they would never have been able to afford in the “do it yourself” world of private medicine (my father was an automobile mechanic, so you can imagine they didn’t exactly have gold faucets in their home) and Social Security has been a lifeline for many over the years.

    Did I say that either program doesn’t have their faults? Of course not. Both need substantial work to stay effective over the next few years–I don’t think anyone really disagrees with that; however, privatizing Social Security would be a massive joke and doing away with Medicare would be a disaster. All government programs have issues, but I’d rather have something out there than nothing, or worse, a system that is totally profit-run where the CEO and Board run their own “death-panels” to make sure they keep getting bonuses.

  106. I have a few honest questions about the ACA because I just don’t understand certain things and I’m hoping some of you would be willing to help me out here.

    1. What in the ACA actually brings healthcare costs down? I’m currently employed and have good medical insurance. I’m grateful for that because 3 of my 4 kids were born prematurely and spent 3-6 weeks in the NICU. Even after the insurance paid (and they paid a TON) I was left with bills that made life tough for a little while. With the ACA in place, will that situation for other parents be better? We’ve had other medical issues in my family too (chronic neck and back issues, among others). Will those bills be lowered somehow?

    2. What happens to those people that currently do not have insurance because they can’t afford it, but would be hard-pressed to handle even a 1% tax hike? What sort of coverage do they have access to, and where is the money for that coverage coming from?

    These are things that I genuinely don’t understand, and I’d like to know what aspects of the ACA address them directly.

    Thanks for any help and feedback you can offer.

  107. So wait, if companies are not fined and not required to offer insurance now, why exactly would they start doing so once there was a penalty for it? What’s your reasoning there?

  108. @ Doug from Talley

    “privatizing Social Security would be a massive joke”

    Depending on how it was done, yes. But several countries have privatized their version of Social Security with success. Chile for example.

    Dav

  109. Robert @ 12:26
    I don’t know about you, but every employer that I’ve had that has paid for my health insurance has required me to pay a percentage of my health care insurance out of my gross earnings. Its shows up on my pay stub in the category of “payroll deductions.” As a result, I still have to report to the government about it at tax time. In essence, I’ve been reporting to the Feebs about my health insurance as long as I’ve had health insurance.

    Whether I pay my employer or the federal government for my share of the tax, I still get less take home pay. Only now I get to say if it’s a private expense, a voluntary payroll deduction, or a federal tax witholding done in the same way that social security and medicare/medicaid are handled.

    On the number crunching side… the larger the pool of people contributing to the pool, the cheaper each person’s contribution is thanks to this thing called “group discount.” A lot of poor people are healthy, they just don’t have the spare money to pay for a one-only supported insurance rate. A lot of middle class people are healthy and still can’t afford private health care. With universal access to health insurance, doctors, hospitals and labs are willing to accept new patients all the time on an as needed basis instead of the worst case scenario that lands them in the ER because all other options were priced out of reach. (I think ERs are required by law to turn no patient away. Ever. For any reason.)

    Why does this matter to me and others like me? I didn’t luck out on the genetic lottery. I have the genetic predisposition for three of the most expensive chronic illnesses. Access to health insurance means the labs that runs the tests that I need to keep doing preventative health care maintenance will let me walk in the door, no questions asked. Because the longer I can put off paying for prescriptions that cost $100 a pill, the better I like it.

  110. We’re starved for something other than sound bites and labels these days, so I’m trying to appreciate this opinion on that level.

    The politicians and the press will distill it into a bunch of catch phrases, but that doesn’t change the fact that the judicial analysis exists and appears to be based on solid constitutional principles influenced by philosophical – as opposed to purely political – divides.

    I don’t agree with some of the reasoning (although I think they nailed the results), but it seems they’re trying to find ways to stay above the fray, so it’s a win for the Court as an institution. And since both sides of the Congressional aisle have proclaimed themselves the champions of the Constitution, they ought to take a few hours to appreciate this guidance. And maybe even start putting a bit more thought into designing their agendas and drafting their bills to withstand constitutional challenges… (just kidding)

    Oh and even though the tax/commerce/mandate stuff is getting a lot of attention, the Medicaid issue is a States-rights issue, which probably makes it the sexiest piece of this opinion, constitutionally-speaking, in the long run.

  111. Billy Quiets at 2:26 PM.

    No. What I’m saying is that, for a significant portion of the US economy, curtailing or terminating the current health care employee benefit will result in reduced sales and lower shareholder profits.

    I expect that corporations will act in their own self-interest to maximize shareholder returns, which is why a significant portion of them will not immediately “push” employees into alternate coverage.

    I’m going to go out on a limb here and guess that you are not especially knowledgeable about how employer “self-insurance” plans work. If you already know all about how companies control expenses and (often) make money from their self-insurance plans from the difference between the actuarily determined projected average loss and their actual claims experience, then I apologize in advance. Otherwise, you may want to do some reading in that area before you simply accept the conventional wisdom.

  112. @Victoria @ 3:31

    I’m not sure I understand what part of my post you were disagreeing with. The point that I was trying to make in that post is that the mandate will only be accessed to those people who do not have insurance. I further went on to suggest that the number of people who fall in that region who have to think really hard about choosing insurance or paying the tax is relatively small. And by relatively small I mean roughly 5% of the population.

    I think that by setting up the exchanges, more people will be able to afford at least some form of health insurance. This will in theory reduce the costs imposed on health care institutions such as hospitals which should help reduce costs. Again, I’m talking theory here.

  113. Nick, I’m sure it’s just my ignorance showing again, but when you state that
    “a significant portion of them will not immediately “push” employees into alternate coverage.” do you mean that only some of the employers will immediately push employees into alternate coverage? In other words, some percentage of the workforce (something less than 50% perhaps) will lose their current coverage even if they want to keep it? And when you say “immediately” do you mean that a significant portion will EVENTUALLY be dumped onto the exchange?

  114. The great Marconi, Premier Prestidigitator and Prophet Plenipotentary, has had a vision!

    In the FUUUUUUUUUUUUUUUture, persons who do not purchase health insurance will either not have to pay the tax, because it is essentially unenforceable, or will not have to pay it because they do not make enough money or have some other tax out, or will pay the tax because it is cheaper than health insurance.

    They will continue to go to ER’s for all medical needs and bugger up the system in multiple ways.

    The hospitals will continue to pass the costs to the insured and cash payers.

    *sags in his chair*

    The vision passes…

  115. Andrew/Dav: I will stipulate that it is “for the good of the people” in the same way as clean water, sewers, firefighters that will put out your house when it is on fire, and roads in good repair are “for the good of the people”. I see it along the same lines as Social Security and Medicare, which at least in principle help those with need for them. Whether or not it is implemented effectively remains to be seen.

  116. Bill Quiets @ 4:20 PM.

    I do not know how many employers will curtail or terminate their existing healthcare plans. But I’m very confident it will be less than 100%. Similarly, I can’t say whether or not companies will eventually migrate over to alternate plans, but I can say with confidence that, in the industry I follow (which is a fairly big portion of the GDP), it won’t happen overnight. It can’t.

    Please remember that I’m responding to your prior posts that made flat declarative generalizations into “facts”. I’m providing informed counter-facts for your consideration. What I’m trying to tell you is that no corporation is going to push employees into alternate healthcare plans simply because those plans are cheaper. You need to look deeper into the financial reporting to see how much revenue and how much after-tax profit is tied to the healthcare plans. No sane corporation is going to walk away from a plan that’s making money for it.

  117. Doug from Tally,

    I am suggesting that the programs:

    1) Cost more than was predicted at the time of thier creation
    2) Anwser an undeniable need, but at great and increasing cost and inefficiency
    3) Are growing at unsustainable rates.

    If you are saying you think Social Security and Medicare are examples of what we could expect with the ACA, well, we agree.

  118. Nick, I’m sure you are absolutely correct that something less than 100% of employers will terminate or curtail healthcare coverage immediately. My point is that it will be something a lot greater than 0% which is what Obama is claiming. Many, many companies will have to drop coverage to stay competitive, and those employees will not be able to keep their current plan.

    Why did McDonalds and dozens of other large companies lobby for exemptions?

    Obama lied about it being a tax, and he’s lying about everyone keeping their plan.

  119. I’ve read many online posts about the SCOTUS decision today and I feel done now.

    I prefer the tweets from the idiots who say that America is dead or officially socialist and that they are moving to Canada. heehee

  120. A couple of people have quoted that remark about something not being constitutional just because the Supreme Court says so.
    Question for y’all. Laws against gay sex. Were they actually constitutional from about 1987 to 2003? Was the 2004 court (Lawrence v. Texas) wrong to claim that they were not? Was the 1986 court wrong to claim that they were? Did whether or not they were constitutional change?
    I ask because I have no idea. I lean towards the view that only one of those courts was right, and the other was wrong, and that the constitution didn’t change, but the court’s view of it did.

  121. Librarian,

    “Whether or not it is implemented effectively remains to be seen.”

    It’s a government run program…do you think it will be effectively implemented?

  122. “I do not know how many employers will curtail or terminate their existing healthcare plans.”

    And -I- don’t CARE how many employers will terminate their existing healthcares plans, precisely because I think that tying HEALTH CARE to an EMPLOYER is a -terrible- system which has worked out badly. When you lose your employer, you lose your healthcare. If you want to change employers, you face health care questions and problems. If your employer cuts health care, or if your employer doesn’t offer health care, then in a national system BASED ON getting your health care THROUGH your employer, you’re screwed.

    And if–like -=ME= and like millions of other Americans–you are SELF-employed, then you’re completely and effectively locked out of any sort of EMPLOYER-BASED health care system and an insurance system based entirely on benefitting large corporations rather than on providing adequate health insurance or health care to tax-paying, hard-working individuals.

    I think the notion that more than a handful of employers will eliminate employee coverage because of ACA is just the usual partisan hysteria, equivalent to claiming President Obama’s birth certificate is “suspect.” But I also don’t see what the problem is if employers DO cut health care, since I think it is INSANE to have a system where your health coverage is tied to a specific employer rather than being a right of every tax paying citizen and a service which self-employed people can access and use every bit as easily as someone who works for a large corporation/

  123. Ian@99: While I don’t necessarily agree with Billy, what you are saying is a straw man. Companies could save 422 billion by doing any number of things. Cutting insurance is *one* of them

    I don’t have to provide a logical proof. All I have to do is show the fallacy in Billy’s “argument”. And it’s exactly as you just said. Companies could save money doing a lot of things. But they don’t. Because if they actually did some of them, it would destroy the company. Getting rid of health benefits would cause a huge employee upset and probably cause the loss of lots of good people. So would a blanket cut in salaries for no reason. So would a lot of “savings” initiatives. Billy never proved that because the companies could save money cutting insurance that they had any realistic incetive that they would cut insurance. All he did was hop up and down and say “insurance costs businesses a lot of money, they could save a lot of money if they cut insurance”. And then he linked to a horrendously biased article to outsource his argument.

    Andrew@102: The argument made by the administration was that the law did not constitute a tax (and honestly, it never would have passed had it been framed as a tax), and today’s ruling says “this bill is legal because it’s a tax”. Right? That doesn’t exactly help Obama out.

    Meh. I think the only people who will care about that are people who already don’t like Obama. It’s like the recent silliness over Mitt Romney’s website misspelling it “Amercia”. The only people who made a “thing” over the spelling issue were people who never liked Romney anyway.

    Billy@103: Seriously? Have you seen the unemployment and underemployment figures? They have.

    Hey, Ian, here’s an example of what I was talking about. Billy doesn’t actually prove anything here. All I have to do is point out that his entire argument rests on a huge, massive, totally questionable non-causa-pro-causa fallacy: That the unemployment is due to the rising costs of health insurance.

    I pointed out in an earlier post that Massachusetts has one of the lowest unemployment rates in the country. And Massachusetts has all the stuff that Billy says is bad Health Care Reform law, too many restrictions and regulations and mandates and all that stuff. All I have to do is point out one real world example that contradicts Billy’s assertion, and that disproves his assertion.

    If Billy says “all swans are white”, all I have to do is show just one example of a black swan and that completely disproves his argument.

    In this case, Billy says that HCR will cause higher unemployment and underemployment. But Massachusetts is a real world example that shows him wrong.

    Jesse@104: Aaaaand thanks for falling into the FREE MARKET IS TEH AWSUM hypocrisy trap.

    …. where is the “like” button on this damn thing???

    ZBBMcFate: “Are Medicare and Social Security really the examples of successful government programs you want to be using right now?”

    There are two types of people who think Social Security is a bust. The first type are the people who have an “The Ants and the Grasshopper” view of the world, they’re the hardworking ants and all these lazy, no good grasshoppers are getting fat off their hardwork via social security. They don’t really care if the math works or not. They don’t like Social Security, so they like any narrative that attacks it. The second type of people who think SS is a bust are the folks who want to get their dirty stock trading mitts on all that social security money. They want to privatize social security, not because it doesn’t work, but because it works well and would give them a huge lump of money to make short term profits with gambling on the stock market. After they make their money, they get out and don’t care. But social security shouldn’t be made some junk stock trader’s grease money, it shouldn’t be how Gordon Gecko gets rich and retires in 10 or 20 years, and takes short term risks because it isn’t really his money. Social security has been designed to work for generation after generation. It needs to work on the long term and shouldn’t be gambling huge short term risks with people’s futures just because AIG or some other financial institution wants to play with someone else’s money.

  124. Laura, you are so right. Our system is a joke. However, this law takes us a tiny bit closer to acting like an actual civilized country so I’m for it, even though what I really want is universal nationalized health care. I have no dog in this fight, being upper-middle class and healthy with awesome insurance, but it’s sick and sad that s many people in this country don’t have the same

  125. Billy Quiets @ 11:53
    “The Supreme Court declared it constitutional as a tax because that’s what it is, a tax. The largest tax hike on the middle class in history.”

    The costs need to be viewed on net. As a hypothetical example, if your taxes were to go up by $1000 while at the same time your health insurance costs went down $2000 I’d say overall you got a decent deal.

    Billy Quiets @ 12:31:
    “Employers are going to be forced to move employees to the government plan because it will be the only way they can stay competitive. You will not be able to keep your plan because your employer will no longer offer it. Obama knows this, just as he knew that the healthcare law was actually a tax.”

    Tying insurance to employment is a fundamentally dumb way to structure a healthcare system, so I don’t see a problem with transitioning away from it. If people are still able to get decent coverage I’m not going to fret about it not coming from the employer. And I agree that Obama knew it was a tax, but saying otherwise the Blue Dogs happy and got the thing passed.

    ZBBMcFate @ 2:37:
    “Are Medicare and Social Security really the examples of successful government programs you want to be using right now?”

    Long-term funding of Social Security can be dealt with by using some combination of benefit cuts and tax increase, and given recent financial history it doesn’t seem certain I can count on having a 401(k) in 30 years. The main problem with Medicare is the general problem of the high cost of American healthcare. The ACA is in part supposed to reign in those costs.

  126. Billy: , many companies will have to drop coverage to stay competitive

    Competitive with whom?

    You’re not even trying ot make sense anymore. If its federal law, every company in America they compete with will have the same expense of Health Care Reform. It’s not like Massachusetts has regulated health insurance and Massachusetts has to compete with companies in states that DON”T have health insurance regulations. It applies to every corporation in every state.

    The only competition American companies would have to deal with who don’t have health insurnace regulations like this would be overseas companies, in countries that don’t have health insurance regulation like we do.

    And again, you’re argument is already proven wrong because Massachusetts has one of the more regulated health insurance industries but also has one of the lowest levels of unemployment in the nation. So, could you at least try to address the facts when you repeat one of these right wing talking points?

  127. heckblazer,

    And all that is required for weight loss is eating less and exercising more.

    Color me skeptical.

  128. Greg,
    “If Billy says “all swans are white”, all I have to do is show just one example of a black swan and that completely disproves his argument”

    You had to go and bring race into it, didn’t you?

    Just kidding. Actually, I try and ignore your shrill rants, but this one was just too amusing.

  129. Nom Nom Nom the popcorn is good today….

    Those who feel that the Government can’t force things like this on the citizenry need to sit down with a Veteran who was drafted for military service and ask them about what the Government can and can’t do to its citizens.

    No, the US hasn’t had a draft in a long time but every single male above the age of 18 is required to register with the Selective Service System. Talk about sexual discrimination that has consequences…

    Anywho…. Yea, nice win for those who need health services and don’t have them now! And Yea for Veterans!

  130. Billy Quiets–you seem really bothered by the concept that “if you like your current health care plan you can keep it”, because of the possibility that employers will change what they offer. Employers change the health plans they offer all the time, and too bad if the change is to one that you don’t like–and the change will probably not be to the employee’s liking, since the majority of changes are to reduce costs through cutting benefits, increasing co-pays, etc. Do you really think that Obama should be prepared to guarantee that as of a specific date NO employer will change their health plan? Otherwise, there’s no difference between now and the future under the PPAHCA.

    I think you’re expecting something that is conceptually impossible–the President guaranteeing that an individual’s health care plan will not change if they don’t want it to under any circumstances.

  131. So….

    1) People being free to chose their insurance options from a range of competing options is *worse* that being forced into whatever their employer has… right…

    2) If only we could look at other countries with single payer AND private insurance and see if the existence of single payer government healthcare destroyed the private insurance and employer insurance systems as perks for employees… oh? what’s that? There are such countries? Say it ain’t so!

  132. FLTransplant. Exactly.
    The president HAS guaranteed the conceptually impossible. Don’t chide me. He stood up there today and guaranfreakingteed that if you like your plan you could keep it. Period. Just like he said your healthcare cost would go down. Just like he guaranteed it wouldn’t add trillions to the deficit. Just like he said it wasn’t a tax. It’s just another lie, on a plan that is built on lies. That is my point.

  133. It’s nice to see the States working towards catching up with the rest of the civilized world in regards to healthcare, especially considering how much poorer and smaller countries seem to manage universal healthcare just fine.

  134. Andrew, I have no idea. It may go swimmingly, it may be hijacked by special interests, it may be infiltrated by aliens (unlikely, but a great story!) Yes, a number of current government programs have problems, but that doesn’t mean this one is doomed to fail immediately. It may be the exception that proves the rule, but give it the chance.

  135. Other than a tantrum because an arrow in the “elect Romney” quiver got a little warped, I don’t understand the fiscal-conservative complaints about this ruling.

    1) The free market will insure that *good* insurance companies thrive. Insurance companies that want to make money through better service and not, you know, gambling premiums on Wall Street while practicing frivolous recission, will be able to offer lower premiums (because they’ll be underwriting properly and not trying to offset investment losses), offer better service and thus attract more customers. This, in turn, will force other insurance companies to behave better to stay competitive. Isn’t this exactly what market-as-karma is supposed to be about?

    2) Health insurance becomes just one more form of infrastructure (like roads, ports, courts, a police force) that businesses don’t pay right out of their own pockets, but that they rely on and which are subsidized in large part by the government. This means that smaller businesses can be competitive with bigger, less-efficient companies, because they no longer have to lose talent to “I’m sorry, but you guys don’t offer health insurance”. More competition in the marketplace is good. More small businesses and start-ups enable average folks to improve their lot by starting businesses.

    3) Health care costs go down when the ER doesn’t become the uninsured person’s clinic of necessity.

    Also, really don’t understand the “death of liberty” nonsense. Taxation is an enumerated power, and isn’t overbroad and fuzzy like the Commerce Clause. I am still nostalgic for the days when “judicial activism” was an actual principle, and not a buzzword meaning “this decision was too politically liberal for my tastes”.

  136. FTLTransplant: Billy Quiets–you seem really bothered by the concept that “if you like your current health care plan you can keep it”,

    No. I’m pretty sure he’s bothered by Obama being president. And anything that might help make Obama lose is a good thing. The “keep your current health plan” hysteria is just a whipping post for him. a year or two ago, it was Death Panels. None of these things bother him per se. It much simpler than that:

    He does NOT want it because Obama DOES want it. Whatever it is.

    FTLTransplant: because of the possibility that employers will change what they offer.

    Well, that’s giving Billy quite a lot of credit I don’t think he deserves. He’s not saying there is a possibility that employers will change their insurance. He’s saying it’s for a certainty.

    i.e. Billy@38: “Employers are going to be forced to move employees to the government plan”

    FORCED. My god!

    Billy’s math doesn’t even make sense:

    Billy@55: If I’m making widgets and selling them for $10 while providing healthcare and my competitor can sell widgets for $7 because he does not provide health care, I’m going out of business.

    This was true before health care reform. This was true when Shrub was President. But now that Health Care Reform is here and Obama is president, that changes everything and the right wing talking points start flying with complete disregard for the facts.

    Billy@65: (posts a link to a laughably biased right wing article to “prove” his argument. See my link at June 28, 2012 at 1:37 pm which totally refutes pretty much everything in his link.)

    Billy@75: Competition does not stop at state lines. In Massachusetts the companies were competing with companies in other states.

    See my link at #84 “June 28, 2012 at 1:59 pm” which shows that while Massachusetts has Romneycare, it still has one of the lowest levels of unemployment in the nation. If Billy’s assertion were correct, Massachusett’s health care regulations should push unemployment through the roof as companies move out of state.

    Billy@88: Do you really think that a government mandated exchange is going to offer you better coverage than the free market? Good luck.

    Apparently, Billy doens’t know what insurance recission, preexisting conditions, or lifetime limits mean. These are several insurance coverage problems that were rampant in the unregulated market and are being regulated and removed with health care reform. So, yeah, I’d say you get better coverage with a regulated insurance.

    Billy@104: Seriously? Have you seen the unemployment and underemployment figures? They have.

    Right. According to Billy, the current unemployment was caused by Health Care Reform, not the economic crash brought on by Wall Street speculators creating a mortgage bubble that burst in 2009. Now we’re rewriting history.

    According to this link:

    http://data.bls.gov/timeseries/LNS14000000

    unemployment spiked starting in Jan 2008 through June 2009

    but has been going down ever since.

    For those playing along, Health Care Reform was passed in March of 2010, but don’t expect the chronological order of things stop right wingers from saying 2010 caused 2008.

    Billy@132: My point is that it will be something a lot greater than 0% which is what Obama is claiming.

    Ah, well, See? That’s your problem. Your problem is you’re completely strawmanning Obama. Which can be fun, I suppose, for an extreme right winger, but your strawman doesn’t have to make sense, because its something you made up.

    Obama didn’t say no one will change their insurance coverage. He said you can keep your insurance because the government isn’t going to FORCE you to get on the PUBLIC OPTION which is run by DEATH PANELS. He said you can keep your insurance, assuming your company keeps it for you.

    Maybe what Obama should have done to make you happy is have HCR include a requirement that from this day forward, no employer can ever change their health insurance plan… ever. But that would just be something else for the right wingers to bitch about hysterically. He’s FORCING us to KEEP OUR INSURANCE!!!! But I was going to CHANGE next enrollment cycle!!! WWWWWWWAAAAAAHHHHHHH!!!!!

    Many, many companies will have to drop coverage to stay competitive

    Bullshit.

    Pure and simple Fox News, right wing talking point, bullshit.

    Why did McDonalds and dozens of other large companies lobby for exemptions?

    Why did power companies lobby for exmptions for the amount of mercury they can release when they burn coal?

    Because it cut into their profits. That’s why.

    Do the power plant corporations care that they’re poisoning the water with mercury?

    No. They only care about profit.

    Why did McDonalds lobby for examptions from HCR? Because it *might* eat into their profits due to insurance costs.

    Do they care if the nation is better off overall with HCR?

    No. They only care about profit.

    Here’s the thing about your right wing, Greed For Lack of a Better Word Is Good mentality:

    It has no morality or sense of justice other than money.

    It has no sense of something in the US Constitution that you seem to have forgotten is there: promote the general Welfare

    America as a whole is much better off with a regulated insurance industry that can’t drop patients as soon as they get sick, who can’t refuse to cover people with preexisting conditions.

    Does that mean your precious McDonalds might have to pay more for its insurance? If McDonalds had really crappy insurance that liked rescinding sick patients and refusing to accept people with preexisting conditions, YES, McDonalds will probably have ot pay more for insurance. And that would be a good thing.

    Just like your coal power plant would have to spend money to keep mercury out of the atmosphere. AND THAT WOULD BE A GOOD THING.

    Implicit in EVERY ONE OF YOUR POSTS, is the Gordon Gecko talking points that Free Market capitalism will find the BEST solution for everyone. No, not always. Sometimes companies just find the solution that maximizes their profits, has child labor, 80 hour work weeks, no worker safety laws, no pollution restrictions, company towns, indentured servitude. And its up to we the people to form a more perfect union and promote the general welfare and regulate the Gordon Gecko’s of the world.

    It’s funny how all the right wingers will quote the shit out of the second ammendment but can’t seem to remember other stuff in the constitution like “promote the general welfare” or “congress shall have the power to … collect taxes …. (and) … regulate Commerce”.

    Geebus.

  137. I completely agree with you that the long-term ramifications are the most staggering. I’m really struggling with the idea that Congress has the power to tax a negative, i.e. inaction or the choice to not purchase. And yes, I did read the ruling and I know that they specifically say that inaction does not excuse one from a tax. But I’ve been wracking my brain trying to think of any other tax that is based on someone’s choice to NOT consume, and I can’t come up with anything.

  138. Billy: Just like he said your healthcare cost would go down.

    It will.

    Just like he guaranteed it wouldn’t add trillions to the deficit.

    DEBT CEILINGS!!!!

    Just like he said it wasn’t a tax.

    Taxation is constitutional, so I’m not sure what the problem is.

    It’s just another lie, on a plan that is built on lies. That is my point.

    If it is really just about “lying”, were you this upset when Bush said we’d be out of Iraq in 6 months? Welcomed as libertors? Did the pentagon propaganda effort around Jessica Lynch’s “rescue” bother as much? That Pat Tillman was reported as being killed by enemy fire?

    Or, surprise, surprise, is it just Democrat lying that bothers you?

  139. christy – the Congress has the power to levy taxes. We already have taxes designed to do things other than purely raise revenue – taxes on cigarettes, for example, are intended not only to discourage smoking but to offset the public-health costs of tobacco use (and yes, I know that there is a gap between ‘intent’ and ‘actually does’).

  140. The distinction between it passing under the Commerce Clause and it passing as a tax is potentially huge. Some commenters have linked to longer discussions as to why, but here are what I think are the salient points:

    1) Taxes aren’t subject to filibuster, so only 51 votes in the Senate are needed for a repeal, not 60.
    2) It is within a President’s powers to instruct the IRS not to collect the penalty/tax, which would render the “mandate” toothless. (I don’t know what the ramifications of that for the rest of the ACA would be.)
    3) The court rejected the argument that the Commerce Clause meant Congress could make someone purchase something they didn’t want to, which the laws backers thought it could/should. The limitations which Roberts put on the Commerce Clause in the majority decision, if held up as precedent, could have opened up a huge can of worms which Democrats/liberals may not be happy with going forward.

    I think the best outcome of the decision is that (1) and (2) put the issue back in front of the voters for the November election. With 51 votes being all that is required for a repeal, Senatorial races just got a lot more interesting. It also opens up another front in the Presidential election, for better or worse.

  141. any other tax that is based on someone’s choice to NOT consume,
    But it’s not a choice- you can’t guarantee that your house won’t burn down in a fire, and you certainly can’t guarantee that you will never need access to the health care system, so paying to have a fire station and a health care system is a wise choice.

  142. JB – I don’t think the Commerce Clause issue (which conservatives should be happy with, yo) is that different than the general rollback of expansive Commerce Clause jurisdprudence, which has been going on for a while now.

  143. Christy, if you don’t buy a house (and the mortgage to go with it) you are potentially taxed more because you don’t get the benefit of the mortgage interest and property tax deductions. So, in a sense, that’s being taxed more for not doing something.

    Yes, it’s a stretch.

  144. Mythago–I agree, but before today the thinking was that the ACA was going to live or die under the Commerce Clause. I brought it up because the decision seems “liberal” on its surface (and it’s largely being reported that way) but the rationale for passing it actually paves the way for more “conservative” rollbacks of Commerce Clause jurisprudence.

  145. As an American with an employer-provided benefit plan, I am glad that people who aren’t in my very comfortable shoes will have better access to the healthcare that I now take for granted. As a person who has lived with very low income in America, England and India, I am happy to know that America may no longer rank lowest on the list of places I wanted to have a minor injury. In England I had the necessary stitches for no fee, in India I paid a very low fee to have them done in a government hospital (I’m not arguing that their system is perfect- I would not have wanted a major illness or injury there), and in America… well, there wasn’t a clinic near enough, so I carried debt for a few months to pay off the ER visit. And yes, I should probably stop causing myself stitch-needing wounds.

    That said, I hope the ACA has the time it needs to shake out- and that Congress is able to amend it should it become obvious that certain parts are less functional (wishful thinking, I’m sure). I really wish we were less prone, politically, to baby-bathwater-hell-the-whole-house thinking. Or overblown assertions as to the TOTAL DISASTER or WONDERFUL MIRACLE of what are often temporary solutions which need to grow and change with us (ahem, Social Security). Right, fine, I’m in daydreamland…

  146. JB – no disagreement here. I think it’s just part of the same trend and not particularly a game-changer. Though I do think that it’s getting missed because right-wingers are so damn angry that Roberts actually relied on an enumerated power, instead of giving them an excuse to handwave about liberal expansionism.

  147. mythago: I get (and even support) the idea of sin taxes, but those are still based on a purchase that you make. If the taxes do dissuade people from say, smoking, then ex-smokers stop paying the taxes when they stop buying the tobacco.

    Pam Adams: I completely agree, having insurance IS a wise choice. But if I own my home free and clear, I’m free to make a really lousy choice and not buy homeowners’ insurance and then face the consequences if my home burns. And in areas where fire service is provided by subscription rather than as via tax dollars, fire departments do indeed let homes burn. I suppose the difference is that for indigent health care, tax payers don’t “let the house burn”, as it were. And I’m not even saying that increasing existing or imposing a new tax isn’t necessary – but that would be taxing something and again, I’m trying to think of something else that is taxed for being a nothing.

    Steve C: I take your point, but I agree that it’s a stretch. I may pay more income taxes because I have fewer deductions, but I’m still not directly taxed on my decision to not buy a home. I would see it as more analogous to paying a tax directly for the decision not to buy a home, i.e. buy a home or pay a flat $700/year extra for not having done so. I saw someone mention earlier that he saw no difference between tax breaks that encourage (like the homestead exemption or deductions for dependants) and taxing a negative, but I’m just not sure I buy that. If there is a standard tax rate, say rate X, that everyone pays, but then if you have deductions y and z you get to knock some off of rate X, that doesn’t to me be quite the same thing as saying that you are “paying” for not doing y or z. Not reaping a benefit doesn’t seem to be exactly the same as paying a penalty…

    Not trying to be difficult, just very disturbed by the non-healthcare implications.

  148. Sigh: agreed, and hope that you (and I) aren’t in daydreamland…but fear that we are. Congress doesn’t really seem to be very skilled at going back and smoothing the rough patches…

  149. ZBBMcFate: “The whole business about Social Security and Medicare…”.

    Actually, if your argument is that those programs are “bad” because they either need lots of tweaking to run “right” (whatever the heck that is) or modernization or whatever, I doubt you can find any program, private or public, that doesn’t fall into that category at one time or another. The idea of Social Security is a good one and yes, it IS probably in need of changes and modifications to make it work better and more efficiently–but that isn’t a good argument for just bumping it off and letting everyone fend for themselves.

    The same for Medicare; it’s beginning to sag under the weight of greedy hospitals, pharmas, doctors, suppliers, unions, crooks, etc., but that isn’t necessarily an excuse to do without it, given the benefits it has provided over the years to people who really needed it (including a good proportion of Tea Party-types, who kept saying “Keep your hands off MY Medicare” a couple of years ago).

    Why can’t we modernize or update the programs to make them more efficient? Yup, there are plenty of folks who don’t want any changes, but they are just as out of touch as the folks who want to abolish the programs outright. The Health Care law doesn’t have to stay exactly the same as it is now once it takes effect and people figure out where the problems are; doesn’t mean the idea to make sure everyone in the most prosperous nation on earth has access to affordable health care should be tossed.

  150. The court upheld the individual mandate based on the taxing power of the constitution, not the commerce clause. So when it came to deciding if the commerce clause meant the government could do anything, they punted. So rather than ignoring the constitution, they merely ignored the text of the law. That’s a far better situation than if the court had decided to not recognize any limits to the commerce clause. This is no Kelo. This is a political decision that was only about this particular law. It didn’t set a legal precedent.

  151. Did anyone read the dissenting opinion by Sotomeyor? In it she posits that it is not a case where people are taxed for doing nothing. Healthcare in whatever form is inevitable. Everyone participates in the market and having health insurance can and should be regulated under the commerce act. Interesting argument. I find myself agreeing with it.

  152. christy, if you don’t have children, you still pay taxes that go toward public schools. Taxes aren’t required to be on something you buy; they’re a revenue mechanism.

    Mike, the issue before the Court was whether the law was constitutional, not “What are the parameters of the Commerce Clause? Show your work.” Maybe I’m missing something, but I’m not sure how that’s ignoring the text of the law.

  153. Billy Q @ 6:10–and that’s where I go tilt. If you truly, literally believed that under the HCA no company would change it’s health insurance, and everyone who liked their insurance could keep it you have stretched a child-like faith beyond belief. If I like my insurance, but get laid off, fired, bought out by Bain, outsourced/offshored do I still get to keep it? If my employer changes plans or changes the details of the plan I’m in (drug formulary, co-pays, participating physicians so my long-time friendly family doctor is no longer covered) do I still get to keep it unchanged? I find it incredible that you would expect that everyone, everywhere, under any and all conditions would be able to keep their health insurance plan if they liked it.

    And would you compare the situation under the HCA which you feel is unacceptable with the situation without it? What happens if I get laid off, fired, etc without the HCA? My employer changes my plan? What if I’m over 55, a walking pre-existing condition, and lose my job–how do I “keep the plan I like” under those circumstances–or get any other plan for that matter? Looking ahead, I’m much happier with my chances under the HCA than not under it.

    Your unhappiness may have made sense a half-century ago, during a time when one could realistically spend a career working for the same firm which would only change their health insurance plan for the better during that career. Your unhappiness does not seem to bear any relationship to the reality we live in today.

  154. mythago: not quite right: I pay property taxes, which are based on the value and quantity of the property that I own. My county government then uses those property taxes to fund the county schools. My taxes are based on whether or not I have children (a valueless asset – and any parent can agree that that is a positive or negative statement depending on how your child is at the moment!), but on whether or not I have property.

    I completely understand that taxes are revenue – that’s the way government gets its money, we’re all agreed. I’m just trying to think of a way that they get my money for NOT doing/having/buying something, and I just can’t. All of the examples that people have given so far either trace back to government expenditure of the revenue rather than the means of collecting it. Or are based on the assumption that not being able to claim a benefit (i.e. a specific sort of tax deduction) is the same thing as being penalized, which I don’t agree with.

    I know that this may seem like I’m splitting hairs, but the ramifications beyond just heath care make my head spin. What else can/will the Congress tax us for not doing/buying now that that door is open?

  155. Sorry, make the second sentence of my last post read “My taxes are NOT based on whether or not I have children…”

  156. BBC radio’s “The World” today asked people in other countries, such as Germany, and Arab nations, what they do or don’t get about American healthcare. To oversimplify, Western Europeans are baffled that the richest country in the world does not have healthcare coverage for all citizens. Egyptians said that the Muslim Brotherhood was elected in part for providing free Islamic-based health services to the poorest people in the country, whom the old regime seemed to have ignored.

  157. rickg17: I saw that, and the idea that employers were mandated to buy insurance for their employees didn’t seem like such a big deal – employers are mandated to do/buy many things for their employees, and that is a business function.

    The idea that seamen were required by law to purchase their own insurance is interesting. What the poster doesn’t say is what the penalty was if they didn’t do so – ? And was that penalty framed as a tax?

    I’ve never argued that there are penalties for not doing things that the law requires. But most of those are positive things – we are required to take a positive action by paying taxes. And we are penalized financially if we don’t do that in the timeframe and manner which is prescribed by law. Orange Mike talks about the law requiring people to buy something, but he doesn’t say whether or not there was a financial penalty associated with not doing so, and he doesn’t discuss whether an relevant financial penalty was described as a tax.

    I’m thinking that it isn’t quite apples to apples.

  158. I’m getting a bit of schadenfreude from the taxes=theft=slavery crowd’s hyperventilating and foam.

    The above is not a caricature: I know actual people who think that way.

  159. christy: I’m just trying to think of a way that they get my money for NOT doing/having/buying something, and I just can’t.

    If you tax everyone the amount people with no insurance have to pay ($600 a year I think?), then offer people a deduction equal to the amount they or their employer spends on health insurance, up to that $600 limit, then you get the same numerical result.

    So, if you dont like “taxing a negative”, I think you can look at it as a tax for everyone with a deduction for those who get insurance such that the deduction cancels out the tax.

  160. Not sure how up to date this is, but….

    http://files.dfa.gethifi.com/resources/handouts-ppt-slides-videos/hcrfaq.pdf

    Companies with fewer than 50 workers won’t face any penalties if they don’t didn’t offer insurance

    Companies can get tax credits to help buy insurance if they have 25 or fewer employees and a workforce with an average wage of up to $50,000. Tax credits of up to 35 percent of the cost of premiums will be available this year and will reach 50 percent in 2014.

    Firms with more than 50 employees that do not offer coverage will have to pay a fee of up to $2,000 per full-time employee if any of their workers get government-subsidized insurance coverage in the exchanges. The first 30 workers will be excluded from the assessment.

    This? This is the end of the world that Billy Quiets is going on about????

    Oh, and as far as this being the largest tax hike on the middle class in history:

    individuals with earnings over $200,000 and married couples earning more than $250,000 will pay a Medicare payroll tax of 2.35 percent, up from the current 1.45 percent. In addition, highincome
    taxpayers will face a 3.8 percent tax on unearned income such as dividends and interest over the threshold

    Be still my heart….

  161. Many philosophical and political views. Mostly well thought out. But can I suggest a simple fiscal reality check? Affordable health care sounds great; go to the massachusetts exchange site, put in a mass. zip code and some basic personal information, and see how affordable it is likely to be. For myself, self-employed professional, making good money, family of five – $1,100 per month. With a $4,000 deductible. That is the CHEAPEST coverage, with co-pays. Where exactly is that money going to come from? Even with a pretax payment of premiums my effective tax rate – dollars out of pocket -will go up over ten percent if you include the deductible I have to spend before ever touching the coverage. Yes I understand Mass may not reflect my state. Still going to be hideously expensive and frankly, not at all affordable. So we’ll put off buying the new car (the newest is a 2004); will be able to save nothing for college; and discretionary spending will go to zero. All so I can enrich a private insurance company for coverage I will likely never need or use since my family is generally healthy. Every part of the economy not affiliated with the health care industry is going to take a huge hit and I would be curious to see what the stock of the large health insurance providers did today. I ask all considering this issue, consider your current personal economic status, estimate what even the cheapest coverage will cost you on a monthly basis, and say ” if this was effective today, how would I pay for it?”

  162. Jonathan Vos Post, I was almost in bed when I read your comment:
    “BBC radio’s “The World” today asked people in other countries, such as Germany, and Arab nations, what they do or don’t get about American healthcare. Egyptians said that the Muslim Brotherhood was elected in part for providing free Islamic-based health services to the poorest people in the country, whom the old regime seemed to have ignored.”

    Let’s muse for a moment about the “Islamic-based health services” soon to be provided by the Muslim Brotherhood.

    Do you figure womens’ reproductive health concerns are pretty well covered under that plan?

  163. This just in from Fox News: Chief Justice Roberts’ family is being held hostage by Muslim Kenyan terrorists believed to be cousins of President Obama. More to come on this fast breaking story as we make it up……
    OR
    The Council of Shadows told Roberts in no uncertain, and rather gross, terms what would happen if he didn’t follow their orders (whatever their reasons for those orders might be).

    There are other possible reasons for the Chief Justice’s actions, of course, but this morning these were the first two that occurred to me.

  164. @coolstar: This post was my reward for reading (okay, partly reading, mostly skimming) this entire thread. *applauds*

  165. Also, to stay on topic… I was also quite surprised by the ruling this morning. Surprised and pleased. I won’t go into it more than that since it’s already been discussed far more eloquently and intelligently than what I would contribute. Great comment thread, everyone.

  166. I was put onto this blog by Wired.com which stated that John Scalzi runs a tight forum-ship and I’m glad to find it’s pretty much true. The timing is also quite nice given this most recent development in the High Court ruling over the ACA. Hopefully “Obama/Romney-care” is a mild/moderate success so that people can *experience* the benefits of a universal healthcare system and look beyond to even greater possibilities.

    I understand some of the reservations expressed about being able to afford mandatory health insurance too, but given the socio-political situation in the States attempting to create or start anything more progressive would’ve immediately been shut down through the usual Socialist/Communist libel. It astounds me that the one true super power of the 20th Century, with all its wealth and power, has been unable to protect all its citizens from unnecessary disease and death because of a highly individualistic paradigm which dismantles any attempt to do so (be it idealistic, political, or economic reasons).

    There are plenty of examples of overseas systems which operate extremely well, cover everyone, and don’t cost the earth or a fraction of it. Hopefully those in opposition to progress can lift their beaks from the ground and stop scratching the earth to find a threat which isn’t there. Perhaps then too they’ll see the less fortunate who can’t stand by themselves.

  167. One reference point in the costs debate is the UK system – the UK health statistics are roughly those of the US – UK infant mortality is lower, cancer survival times shorter – but the UK pays about 9% of GDP and the US about 14-18% of GDP. (There seems to have been a recent jump in US costs.) That means US healthcare could be cheaper – on the other hand, no-one, but no-one, lets 5% of US GDP walk away from them with a light laugh and a sweet smile. I can’t see the US health-care system becoming “Socialist” any time soon.

    Will

  168. @Billy Quiets
    Let’s muse for a moment about the “Islamic-based health services” soon to be provided by the Muslim Brotherhood.

    Do you figure womens’ reproductive health concerns are pretty well covered under that plan?

    This thread is not about the current political system in Egypt OR about the specifics of women’s reproductive health care… But I can’t resist pointing out that if you’re going to claim to be concerned about the latter you’re going to get laughed out of the room.

  169. ZBBMcFate @ 5:06:
    “And all that is required for weight loss is eating less and exercising more.

    Color me skeptical.”

    Hey, it’s not my fault that the party I don’t belong to doesn’t sensibly give in on all of it’s demands. :)

    More seriously, the alternatives seem to be changing to private accounts and doing nothing. Private accounts wouldn’t be any less of a bloody political knife-fight than just tweaking things, plus design and implementation would be much, much hairier. Based on the most recent trustee’s report, doing nothing means that in 2033 the fund will be exhausted. Once that happens the Social Security Administration would be forced to cut benefits to 75% of the scheduled amount, whereupon Social Security would be able to run off collected taxes through 2086.

  170. Universal Health Care for everyone. I dig it.

    The bit that makes it against the law not to have health insurance: No sir. I do not like it.
    Offer me the health care without a penalty for not having it and I will be right behind it. But the second you make it against the law to not have it, fuck that shit. And don’t EVEN try to compare that shit to car insurance. There is no mandate to own a car, the same cannot be said about having a body.

    If anyone would like to tell me I am wrong, and there is no legal or monetary penalty for not having health insurance in this bill, I would be happy to be wrong. It has been known to happen.

  171. Billy: “Muslim Brotherhood. Do you figure womens’ reproductive health concerns are pretty well covered under that plan?”

    Ah…. I love the smell of Islamophobia in the morning…

  172. Martin said: “I don’t really think a 5-4 ruling is going to be that ‘sticky.'”

    You may think that, but history doesn’t agree. According to a paper published by Cornell University: “Since 1946, 17 percent of all Supreme Court cases have been decided by one vote. Furthermore, of the cases classified as “landmark decisions” by Congressional Quarterly, 37
    percent were decided by a margin of one. If we examine the last two decades, roughly half
    of the Court’s most politically salient and controversial cases have been decided with a mere
    five justices in the majority coalition. In the 2009 term alone, the Court issued opinions with
    a five-justice majority on such important issues as the incorporation of a Second-Amendment
    right to gun possession (McDonald v. Chicago (2010)), limitations on individual Miranda
    rights (Berghuis v. Thompkins (2010)), and the constitutionality of corporate- and unionfunded campaign activities (Citizens United v. Federal Election Commission (2010)).

    Things like minimum wage, abortion rights (roe v. wade, planned parenthood v. casey BOTH), the definition of pornography, flag-burning as protected speech, eminent domain and more were all decided by a 5-4 vote. Any members of congress have been complaining for a very long time about this…in the 1930s one congressman referred to it as being one justice effectively being an umpire who got to make the call, since all the other justices voted along ideological lines….and somehow that wasn’t fair. Apparently Rand Paul isn’t the first congressman who doesn’t understand how the US government works.

  173. Billy, you’re faux concern for people’s welfare yesterday is actually making me chuckle this morning.

    “The largest tax hike on the middle class in history.”

    Yesterday, I just sort of went along with the implied concern attached to this statement: The concern for the working people. The concern for the middle class. The concern for real live human beings.

    But this morning, I realized I was projecting my concern on to you. You don’t actually give a damn about the people. You don’t really care if workers are getting rescinded by insurance companies, denied coverage because of preexisting conditions, or going bankrupt because of medical bills. What you really care about, through this entire thread, is quite obvious:

    If this will affect large companies not at all why are so many of them (like McDonalds) asking for exemptions?

    Employers are going to be forced to move employees to the government plan because it will be the only way they can stay competitive.

    If I’m making widgets and selling them for $10 while providing healthcare and my competitor can sell widgets for $7 because he does not provide health care, I’m going out of business.

    I will find a link to some comments from some CEO’s for you.

    Will no one weep for the megacorporations? Will no one think of the poor, unfortunate, unappreciated CEO’s of the world?

    And I finally figured out why watching someone who was poor or middle class dance themselves into a knot to defend someone who is rich had such a familiar ring to it. It’s exactly like Chester, who is weak, tying himself in a knot to please Spike, who is strong.

    http://www.youtube.com/watch?v=UVNHcob3oJg

    Every time I see a Libertarian who makes $40k a year argue in defense of Exxon Corporation, I will always see Chester sucking up to Spike.

    Oh, and I almost forgot….

    DEATH PANELS!!!!

  174. Wizardru @ 9:14
    *”Things like minimum wage, abortion rights (roe v. wade, planned parenthood v. casey BOTH), the definition of pornography, flag-burning as protected speech, eminent domain and more were all decided by a 5-4 vote. Any members of congress have been complaining for a very long time about this…in the 1930s one congressman referred to it as being one justice effectively being an umpire who got to make the call, since all the other justices voted along ideological lines”*

    What worries me is that it seems like it just takes one appointment to reverse the decision. Yes, on one hand, the constitutionality of the whole thing is clear, because Supreme Court decisions are to some extent definitional. On the other hand, 44% of the supreme court justices have a different opinion of that constitutionality [1].

    Still, you have a point. The current Conservative supreme court has not reversed RvW, even though it would make many many conservatives dance merrily in the streets if they did so.

    [1] Actually, I am strongly suspicious that several of these justices (both side) did not decide based on constitutionality at all.

  175. This point is stolen from NPR, but I think it is a good one:

    For all of you who are deeply opposed to there being a tax for not having health insurance, what do you think about the existing tax for not having a child?

  176. @Martin: I agree it’s possible. Thing is, judges have to derive their authority from somewhere. In theory, they are impartial and wise. While I know that, in practice, this doesn’t always happen*, it helps courts to have the appearance of neutrality. The basic point is that courts prevent feuds by being arbitrators. If one side feels it cannot get a fair hearing in a case, then what’s the point of going to court? Better to fight it out, possibly with weapons, and let might make right. One good way for a court panel to appear neutral in controversial rulings is to have a close decision. Because of this, I’m not surprised that Roberts chose to be the tie-breaker in this case.

    *See for example the newly elected, irresistibly named Judge Kreep (http://www.ocregister.com/news/kreep-361257-diego-taitz.html), who got elected by downplaying the fact that he is an active “birther.”

  177. “Will no one weep for the megacorporations?”

    While not all of them are “Megacorporations”, 1200+ “businesses” have been exempted from participating until 2014, including McDonald’s. However, the largest single exemption (in terms of number of members) was given to a Teachers Welfare fund. But companies of all sizes are going to running the numbers and doing whats best for their bottom line, right?

    “Will no one think of the poor, unfortunate, unappreciated CEO’s of the world?”

    Are CEO’s not “real live human beings”? The decisions they make, or don’t make, have far reaching consequences for millions (if not billions) of people. When they make a wrong one, they are excoriated for it, when they make the right one, and god forbid make money off that decision, they are equally excoriated. I know more than a few people wouldn’t mind the perks and money that come with someone like Jamie Dimon’s office…what they don’t want is the desk that comes in the office, and all the work associated with getting to and using it…that however, is another thread in and off itself.

    I’ve no doubt that megacorporations like Berkshire Hathaway (I for one find it very funny that someone like Warren Buffet will say “Tax me more” yet his company is fighting with the IRS over how much it should pay going back almost 10 plus years) and GE will continue to use every legal loophole they can to avoid paying in to the system. They’ve got the legal power to do so.

    However, if you’ll notice it was mostly small businesses that opposed the bill.

    “We employed 24 seasonal part-time employees and 5 seasonal full-time employees as well, for a total of 38 full-time employees to whom we would be required to offer coverage under the new law as a large applicable employer. Should all 38 employees opt-in to the coverage, we would see a 282% cost increase to the business over current premiums. Today, we insure 7 employees at a cost of $2,067 monthly/$24,808 annually. This would jump to $7,892 per month or $94,669 per year, if all 38 full-time employees opted into our coverage.”

    ““It seems that there is one way for me to avoid paying these fines – I can either get (and stay) under 50 employees, or I can start forcing employees to part-time status, making them independent contractors, outsourcing certain services, and taking similar efforts to negate the fines. … I hope I don’t have to do any of this, but the healthcare law may force my hand, as well as that of many other small business people. I do not want to lose anyone on my payroll, but if it comes down to laying off a few employees or being saddled with these fines, I won’t have a choice.”

    “The mandate will basically punish businesses that have 50 or more employees by fining them if they don’t offer a certain level of coverage. Even if a business does offer a ‘qualified plan,’ it still might be fined just as much. Ironically, the fine for businesses that don’t offer coverage is $2,000 per employee… and the fine for a business that does offer coverage is $3,000 per employee, plus the cost they’re paying for coverage. In other words, it may be more cost-effective for Comanche to drop its coverage under the new mandate. Considering that Comanche’s profits are about 1 percent, I am not sure how we could afford to pay these fines.”

    Those are just some small business owners. An d large businesses are going to be doing the same sort of math.

    So, lets say MegaCorporation A runs the numbers, and realizes that by moving its employees to the government plan, it will make save money and increase shareholder value, even though the government plan doesn’t offer (in terms of coverage and cost) what the private plan they are currently paying for does.
    Why would they stay with the private plan? Why should they? Why Would they? Because it’s the “right thing” to do?

    Dav

  178. I see the comments on how much this is going to cost and whether or not there will be long term multi-billion savings. The cost of health care under the AFA is subject to so many variables that any estimate – even in the near term is nothing more than a SWAG. Estimates in the long term are nothing but speculation based on guesses and hopes. If there is to be savings there need not be “death panels” but there will need to be prioritization of care.

  179. @Andrew

    So, lets say MegaCorporation A runs the numbers, and realizes that by moving its employees to the government plan, it will make save money and increase shareholder value, even though the government plan doesn’t offer (in terms of coverage and cost) what the private plan they are currently paying for does.

    There isn’t any ‘government plan’.

  180. Rochrist, you’re right, there isn’t. There used to be plans for one but it was removed in the process of creating the final bill, right?

    Thanks for pointing out the error,

    Dav

  181. tl:dr, so this point may have been made before… AFAIK, the mandates part was included to bring Republicans on board, by providing the insurance companies with a big-enough pool of people to draw on that they could make money providing insurance. After all, they would lose money if they were forced to cover only sick people.

    That said, the stupidest thing about this whole system is that we’re paying for health care with insurance. After all, people get born, get immunizations, have a few fairly predictable medical needs and crises (wisdom teeth extraction, child birth, weight control, blood pressure issues, etc), and ultimately die. Much of this is totally predictable, and the fact that we use insurance to pay for it at all is nuts, if you stop to think about it.

    Imagine what your auto insurance premiums would be if you paid for gas and routine maintenance with insurance, and especially if you didn’t get the bill for months, because the price of each good was negotiated between the service station and your insurance company after you got your stuff. Yes, this would mean gas at $10/gallon, and thousand dollar tires for the uninsured. Unfortunately, that’s precisely what we’re doing with traditional health care. Idiotic, isn’t it? One of the few things I agree with Bush II about was that we really need something like health savings accounts for routine medical expenses, and to save the insurance not for our pre-death decline, but for the unforeseen emergencies. That’s what insurance is about, after all.

    Of course, universal health care really would be cheaper and better. One under-reported problem is that a good chunk of the insurance industry is based in (democratic) northern Ohio, and laying off thousands of democratic voters/insurance workers in the name of making health care cheaper for all Americans seems to be one of those things that recent Democratic white houses can’t quite swallow. Perhaps, if Ohio stops being a swing state, we’ll see some movement towards universal care. Or not.

  182. Andrew: CEO’s …. The decisions they make, or don’t make, have far reaching consequences for millions (if not billions) of people.

    You do realize that you sound just like Chester talking about how big and strong Spike is, don’t you?

    What’s hilarious is the implicit and yet amazingly blatant Argumentum ad Crumenam that you’re pulling here. Why, yes, CEO’s make decisions that affect billions of people. Just not always the decision that is best for those billions of people, but rather what is best for the CEO. That’s why the constitution says Congress shall have the power to regulate commerce. Because Commerce doesn’t always do what’s in the best interest of the Public Good.

    god forbid make money off that decision, they are equally excoriated

    This is weapon’s grade Objectivist bullshit. CEO’s aren’t excorciated just for making money. They get excorciated for making money unfairly. Making money by pushing some unfair cost and burden onto the public (pollution) or onto its employees (unfair wages) or on to its customers (unsafe products).

    Sometimes when a Laissez Faire capitalist tries to present a billion dollar corporate CEO as the poor, never-did-nothing-wrong-ever, picked on victim, it just boggles my mind when I realize that on some level, they actually believe this absolute nonsense.

    But boggling can be fun. By all means, please continue to plead for the hapless MegaCorporation CEO.

  183. Late entry to the discussion. For those who reference the historical requirements for health care for seamen and the purchase of firearms, there is separate express authority in the constitution for that, under the admiralty powers and the defense powers. Those powers don’t apply here.

  184. I think the President needs to send Chief Justice Roberts a fruit basket and a thank-you note. After voting against his appointment to the bench and insulting him in a State of the Union Address, President Obama should step up now.

  185. Greg: In response to your response to Billy, I have a response of my own.

    The middle class cannot survive without the mega-corporations. Corporations EMPLOY the middle class. You might say that these businesses will suffer only a slight loss if they have to spend more on their employee’s health care coverage or switch them over to a different plan to remain competitive, but that its worth it. That slight (or great) loss to a company equates to a fired employee, or a reduced wage, or even a layoff. Lost profits have to be recouped somewhere, and guess what? That often means someone loses their job. This is the unseen results of intervention in the market.

    You do not have a right to be healthy. Health insurance is absolutely no different from any other kind of insurance. You represent a certain risk to your insurance company, and they accordingly set your premiums and put you in a pool with people of similar risk-levels. The reason that people with preexisting conditions currently cannot get adequate coverage is because of government intervention, the health insurance market is already drowning in regulations that are preventing insurers from providing the products consumers want.

    There’s absolutely no reason that on the free market if someone wants health insurance, no matter the state of their health, a plan can’t be packaged to fit their needs. If there is a demand for a certain kind of health care coverage (those with preexisting conditions, low income), it will be met with a supply and a mutually beneficial exchange will take place. This process is so confused at the moment that health insurance has become some sort of holy grail, absolute right, NEED, when really people should be setting aside money for future health problems and paying out of pocket for regular, predictable expenses like check-ups, teeth cleanings, etc.

    The thing people keep latching onto with ACA is that currently, thousands of people go uninsured and just show up at the ER when they need to, passing the bill onto the “rest of us”. Is the solution to that problem really just to regulate the entire health insurance industry even further? Why doesn’t that person have to work off the debt they’ve accrued in using the ER? More questions: Why is the ER bill so high? Isn’t the health care industry highly regulated as well? Shouldn’t people pay for their own health care?

  186. Leatherneck: “If there is to be savings there need not be “death panels” but there will need to be prioritization of care.”

    So, mini-death-panels? That’s what “prioritization of care” is code for, right?

    The bigger issue with your statement is that it brings along the implicit right wing assumption that Capitalism will always find the best and most efficient answer and regulation can only make things inefficient. According to you, there are no inefficiencies in the Health Care economy, and the only way there will be “savings” through regulations is if regulations cut, reduce, or outlaw services, i.e. “prioritization of care”.

    This is probably the biggest failure of the Obama administration as far as Health Care Reform goes. They didn’t get it through right winger’s heads that, no, markets don’t always find the most efficient solution, and health care is a blatant example of that. No, really. For a simple example, an unregulated market tends towards monopolies and once those monopolies squeeze out the competition they no longer feel market pressure to keep prices down and provide good products and services. Anti-trust regulations stop monopolies and keep the market healthy, which makes things better for everyone (except of course, the poor picked on railroad baron who couldn’t own all the railroads. Poor baron.)

    Granted, right wingers don’t want to stop worshipping at the feet of Mammon, so trying to explain to them that health care reform will bring down how much the nation spends on healthcare will likely fall on deaf ears. But still, the administration seems to have made a point to pussyfoot around the Laissez Faire dogmas that fill the health care reform discussion.

    But the short of it is, for there to be savings, there won’t ahve to be mini-death-panels. Costs will go down with regulation because unregulated health care markets have ended up in inefficient outcomes. For a right winger to get this, they’d have to take a chance at their head exploding as their entire worldview collapsed and was replaced with reality, so more likely, they’ll just insist the only way for there to be savings is if the regulated market cuts services and outlaws treatments.

    mini-death-panels for short.

  187. voldemeg: The middle class cannot survive without the mega-corporations.

    Wow. The fear is wafting off your pores. Better suck up to the megacorporations and give them anything they want or they’ll “go Galt” on us all.

    Anything they want.

    If there is a demand for a certain kind of health care coverage (those with preexisting conditions, low income), it will be met with a supply and a mutually beneficial exchange will take place.

    Wow. You’re a total Laissez Faire Capatilist fantasy guy? You guys are entertaining. This should be fun. Ok. Let’s start with some facts. In 2009, about 1.5 million people declared bankruptcy. 60 percent of them were due to medical expenses. And yet, 60 percent of the bankruptcies caused by medical expenses were individuals who had medical insurance. That’s half a million people who had medical insurance who ended up declaring bankruptcy due to medical expenses. In one year.

    So, riddle me this, Mr. Laissez Faire capitalist, why didn’t your perfect Free Market system come up with a mutually beneficial exchange for these half million people?

  188. “So, riddle me this, Mr. Laissez Faire capitalist, why didn’t your perfect Free Market system come up with a mutually beneficial exchange for these half million people?”

    At a guess, I would say many of those 1.5 million people declared bankruptcy because they worked at one of the 89,402 companies that went bankrupt, meaning they no longer had an income with which to pay those bills off.

    Why those companies couldn’t be smart and do things that not only kept themselves in the black but did right by their employees we’ll never really know, will we?

    I for one certainly won’t make any claims that system is the free market system is perfect. Having
    seen and experienced several other types of systems though, I think its certainly the best option out there.

    That said, the medical insurance system in America is not truly free market.

    Dav

  189. It’s interesting, I think, where communication about healthcare and health insurance breaks down. Anecdote isn’t data, I know. But in all the social media circus that’s been going on since the decision broke I have noticed somewhat of a pattern.

    People who approve of the ACA = People that agree healthcare is a basic human right.
    People who disapprove of the ACA = People who think healthcare is a privilege.

    There are exceptions obviously – people who think it’s a right, but disagree with the implementation for various reason. Both liberals and conservatives. That kind of difference can be worked around since both want the same end result.

    For me, I find it useless to argue with those who just think it’s a privilege. Technically, however, the U.S. did adopt the Universal Declaration of Human Rights which our very own Eleanor Roosevelt helped draft. Provision 25 of it states:

    Article 25.
    •(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
    •(2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.
    ^ Top

    Now obviously it doesn’t say that medical care should be free (And even under universal care it’s not). But if medical care is a basic human right, then it needs to be accessible and affordable to every one. A universal healthcare system like Canada and the U.K. are one model, but there are also others out there. And for it to work, everyone needs to be a part of it; whether through taxes or through purchasing mandates. It’s the only way to be sure that people with insurance aren’t paying for the emergency expenses of those who show up at the E.R. and cannot be turned away (and they shouldn’t be turned away).

    A big problem we have, I think, is that it’s INSURANCE – as others have pointed out above. And no, it really isn’t the same as any other kind of insurance. With Car Insurance, or Home Insurance you’re paying in to a pool based on risk factors… in the hopes that you will NEVER NEED to use it, but it’s there if you have to. Everyone is going to need healthcare at some point! Everyone! So it’s not really insurance. It’s a monthly fee for access to services, that we pay in the hopes that we don’t put in much more then we take out for those services. Whereas the ‘Insurance’ companies we pay are hoping the opposite. That we pay for more services then we use. They are not interested in whether we receive good care, or adequate care, or even good service. They’re interested in making sure that they pay the least amount of money for as little care as they can get away with so that they can make the biggest possible profit. That, to me, has NO place in a healthcare system. I know that some of you disagree, but this is a moral issue for me. Not just a financial one, though that plays a big part of it when I see that people are going into bankruptcy in order to survive a medical problem.

  190. In it’s own way, Justice Roberts’ opinion is as brilliant a political move for the right as Obama’s administrative directive to allow the minor children of illegal immigrants a path to legal residency and citizenship.

    Roberts was able to provide a ruling that a) is consistent with historic precedent (a ruling against such a federal mandate would probably result in dismantling Medicare as well), b) restores an appearance of non-partisan impartiality to the court, while c) by calling the penalty fee for the uninsured a tax – opens the door for the Republicans to attack Obama for raising taxes to support a “wasteful government handout”.

  191. Andrew: free market system is perfect. Having seen and experienced several other types of systems though, I think its certainly the best option out there.

    Wow. So, you avoid answering the question as to why the market failed half a million insured people and yet manage to squeeze in a “Yay Capitalism!” cheerleading bit to boot.

    Nice.

    Like I said, you laisezz faire folks are fun.

    marismae: People who approve of the ACA = People that agree healthcare is a basic human right.
    People who disapprove of the ACA = People who think healthcare is a privilege.

    I approve of ACA, but I don’t think of healthcare as a right. I think that the fact that half a million people with healthcare insurance declaring bankruptcy due to medical expenses in a single year shows that the market isn’t working by itself and needs regulating. If private insurance companies were offering services that produced a good outcome, I’d be all for continuing private insurance with the minimal regulations it had up to this point. But they’re not producing a good outcome.

    The main thing I see about HCR is I view it as “Truth In Advertising”. If you want to sell a product and call it “health insurance”, then you have to meet a bunch of requirements. If you don’t meet those requirements, then whatever it is you’re selling isn’t “health” and isn’t “insurance”. It’s something else.

  192. Thank you for the different perspective, Greg. I agree that the current system is obviously not working, and hadn’t really thought of ACA approval from that particular POV.

  193. @voldemeg “The middle class cannot survive without the mega-corporations. Corporations EMPLOY the middle class. ”

    And corporations can’t survive without their customers, many of which are the middle class. See Henry Ford paying his workers enough so they could purchase his product. Not to mention there was a middle class before we had mega-corporations.

  194. @greg and marismae: This is where I come down on the ACA as well. And I think that we have framed the conversation with a bit of skew – the bill seems less to address a person’s access to health care and more to address access to insurance and/or payment assistance. And what we call health insurance isn’t really insurance in the sense that we understand insurance for most other things we insure, i.e. auto and home that covers major unforeseen damage but not routine maintenance, as marismae and others have pointed out. And the point that people with insurance are routinely forced into bankruptcy by major medical situations makes it clear that the current system of health care service payment via insurance plans isn’t working well. So I’m not completely sure that forcing more people into a clearly broken payment system is going to yield the outcome that we all hope for.

    Health care pricing and payment is completely out of whack, and the price of anything medical is never the price of anything. If I need a new part for my car, I can go to different mechanics and get price quotes that, barring unforeseen other problems, will be about what it would cost me to make the needed repair at that shop. However, if I need non-emergent care from a doctor or hospital and call to ask how much procedure X will cost me, the answer is ALWAYS contingent. I can’t think of any other major area of our lives where we are forced to receive a service before we know what that service will cost us. And unfortunately, as far as I’ve been able to tell, the ACA doesn’t do much to help clarify a muddy and confusing system of charges and payment (other than for some of the routine preventative care, which is a great thing – an ounce of prevention and all that.)

    I applaud the ideas. I just fear that this isn’t the solution for the problems. And I know that many people argue that even something broken is better than nothing…I’m more of a “take the necessary time to do it right the first time” kinda girl, and it impacts so many that the implications of getting it wrong are pretty alarming. But that isn’t what happened here so that’s not the law that we have. and we have to work with the law we have.

    But maybe Congress will act out of character and actually start going in and fine-tuning the law…and maybe pigs will grow wings…

  195. marismae: People who approve of the ACA = People that agree healthcare is a basic human right.
    People who disapprove of the ACA = People who think healthcare is a privilege.

    I have a hard time nailing down what should be human rights, or even what human rights are, exactly. There’s a lot of Murk there, and a lot of monkeys flinging poo at anything they don’t like.

    However, “socialized medicine” is clearly cheaper and just as or more effective than the current American system. The evidence is massive.

  196. marismae: hadn’t really thought of ACA approval from that particular POV

    Well, just to elaborate, I don’t think we have a basic human right to have a highway system either. But I think publicly created, publicly owned, publicly managed roads are a far better system than letting Exxon own I45 and Shell Oil own I60, and have to deal with insane tolls and the fact that neither company wants their highway to have exit ramps to the competition, so I have to drive 5 extra miles to get to work. A privately owned Free Market highway system would be a disaster. I’m sure Andrew would want to tell you otherwise, since he’s seen and experienced several other types of systems, so he’ll tell you its certainly the best option out there.

    And it seems that the healthcare industry is running into similar disaster territory. It’s not so much about having a right to insurance anymore than it is about having a right to public highways. It’s just that the market doesn’t produce the best solution for every problem. And it appears that healthcare is one of those problems.

    So, what we have right now in healthcare is as if we had a privately owned highway system and America started to wake up and realize they’re paying too much in tolls, the roads have gigantic potholes, and they have to drive miles out of their way because companies don’t want their roads to connect with competitors’s roads. And people are realizing that the private industry solution sucks. So, we’re transistioning to a regulated market. If you want to own a highway, you’ve got to fill the potholes, you can’t charge too much for tolls, you can’t prohibit people from entering your roads for arbitrary reasons, you’ve got to work with your competition and make connecting ramps to their highways.

    And that’s brought people like Andrew and voldemeg and other laissez faire capitalists out of the woodwork, trying to tell us the only reason its bad having Exxon own I30 and Shell Oil own I60 is because the few regulations we did have are the only reason the system is bad.

    According to them, never, never, ever, could it be that the corporations opperating in their own short term intersts could be producing the problem. According to them, the invisible hand of capitalism is all knowing, good, just, and wise, and never makes a mistake. You know, just like God.

  197. As a conservatively raised physician who works in an underserved area I do not feel that healthcare is a right, but rather a blessing to those who receive it, and a duty to those who can provide it for others to provide it. You may say that the result will be the same as what the ACA will provide, but I am always skeptical when the power of the government to tax, fine and punish is expanded.

    It is also important to understand that resources are limited. We are choosing a much different form of healthcare that will likely result in better general care and more life-years saved, but will also result in less extraordinary care, less private research and development, increased wait times for specialized services and occassional shortages of medication and supplies.

  198. Yes, I realize I am in the minority :) But I really do believe that reasonable access to many things is a basic human right. Healthcare, food, clothing, shelter, and education. Simply by virtue of being born. So, for example, I obviously disagree with Steven that it’s a ‘blessing’ and not a right. And probably with you too, Greg, to an extent. Or maybe I’m just having a hard time likening healthcare to highways, despite it being a pretty good illustrative example of why the system isn’t working well.

    But, I can agree with other parts of what you’re saying about how broken the industry is, and with Christina about how the framing is really kind of wrong here. And now that the law has been challenged and the SC has deemed it the law, I wish that our Congress could have the same kind of civil discussion we’re having here now about how to make ita better law and/or how to improve on the system further to address concerns about resources, r&d, and other costs. Instead, as christina noted with pigs and flying (which made me lol – thank you!) — I doubt that will happen. Cantor has already said they plant to put through a repeal vote. And if Obama loses the election they will repeal the law through reconciliation (assuming they win the Senate as well).

  199. I’m going to go waaaaaaay back up in the thread and say that I’d really enjoy a mandated-weapons-purchase law. Because, given the nature of the Second Amendment, they’d have to be weapons that would be useful in combat. Mortars. Shoulder-fired anti-aircraft missiles. Heavy machine guns. Get everybody on the block to chip in, and we could keep a neighborhood attack helicopter, keep it over by the community center. It would be awesome.

  200. marismae: But I really do believe that reasonable access to many things is a basic human right. Healthcare, food, clothing, shelter, and education.

    Well, I’m not exactly against the idea either. I definitely like the idea of every individual having the innate right to life, liberty, and the pursuit of happiness. And healthcare kind of falls into the “life” part, yes?

    But its like “pursuit of happiness” might be a right, but it doesn’t have to be managed by the government if private industry can make it work well. Healthcare might be a “right”, but it could be privately provided if the megacorporations running it actually did a good job. Thing is, they’re not, so we the people need to step in to make it work.

    As mentioned earlier, the second ammendment says we have the right to bear arms. Doesn’t mean the government has to issue everyone an assault rifle. I’m sure it would be quite fun, in a “Disaster Movie Waiting To Happen” kind of way, to have completely untrained folks getting heavy machine guns issued to them by the government. But a “right” doesn’t mean it has to be “government issue”.

    Winchester, Remington, Smith and Wesson, and other private corporations are doing a fine job of making sure people are armed to the hilt regardless of their training level. The government doesn’t need to step in and issue arms.

    Blue Cross, Aetna, and Unicare, haven’t been doing exactly a standup job of getting people insurance that actually insures them. The government needs to regulate that market.

  201. Christy:

    and not buy homeowners’ insurance and then face the consequences if my home burns.

    Except when your house burns down and takes the neighbours with it, who have to use their insurance to clean up your mess.

    Healthcare is like that. Sooner or later you’ll need it, and you’ll use it and if you can’t pay then your neighbours will. It’s why insurance is a lousy model for healthcare. You cannot insure against things that will happen.

    Voldemeg:

    Health insurance is absolutely no different from any other kind of insurance.

    NO, NO IT BLOODY WELL ISN’T. I really wish people would think about this for a second. You don’t have to drive, you don’t have to own a house, you don’t have to do those things. You will, however, need to see a Doctor. As you age, the probability of you needing a medical procedure approaches 1.

    If you are unlucky enough to get cancer, you become effectively uninsurable – or, rather, under an insurance model you should be because you can’t insure against things that have happened. Or your premiums would approach the likely cost of treatment because that’s how insurance works.

    Healthcare is a risk pool. It’s, generally, cheaper to pool the risk of healthcare across an entire population than to try and deal with individual risks.

    That deals with the other problem of free riders which is what is crippling US healthcare. It’s actually not all that expensive to treat a lot of chronic conditions like diabetes and hypertension through primary care access – probably a few hundred a year. Whereas treating the person arriving at ER with chest pains for untreated hyptertension which has led to Kidney Damage is a high six figure event.

    People aren’t responsible. Live with it and set up things that deal with reality not the warm and fluffy Heinleinian world you want to live.

    Very few of us can actually afford to save up for and pay for healthcare coverage because the potential cost v. consequences are so enormous.

  202. @Greg – Actually yes, I would agree with most of that. I think the only place we actually differ is that with something like Healthcare I tend to prefer government involvement from the beginning, since I think they (usually) have more purchasing power and would therefore be able to negotiate better rates. I don’t really object to private industry filling the need though. If, as you say, they’re able to do it well. (Which you point out they aren’t.)

  203. marismae, I think I would also have preferred to have government involvement of healthcare from the beginning as well. To me, its sort of like the Highway System. It’s pretty obvious to me that laissez faire highways would be about as horrendous as laissez faire healthcare. It’s something we could have predicted, given the system parameters. I think it’s just the laissez faire dogmatics keep steering us into near oblivion.

    veldemeg: “The reason that people with preexisting conditions currently cannot get adequate coverage is because of government intervention”

    Somehow I missed this the first time. Thanks for the chuckle.

    Like I said, you laissez faire folks and the way you worship the invisible hand of capitalism like an invisible, all knowing, all wise, perfect God, and how any kind of regulation is just the Devil trying to muck up perfection out of spite or pride or some other nonsensical reason, is just hilarious.

    You guys are funny.

    It’s like a wise man once said, ““Hokey religions and ancient weapons are no match for a good blaster at your side”.

  204. @Steven: Those are good points. However, the nature of medical R&D right now is another fraught area. Even now, according to the Chemical and Engineering News (sorry, it’s behind a pay wall), basic pharmaceutical R&D is financed largely by the government and large charities (such as the Gates Foundation), because big pharma worldwide. There’s a phenomenon called “the valley of death” between where basic research finds potential drugs, and where such drugs enter human trials. It’s called the valley of death because most potential drugs (>99%) don’t make it through the animal trials, cheap synthesis issues, ad nauseum, and because there’s relatively little money to see them through. It currently costs over a billion dollars to bring a drug to market (about 80% of that is salaries, according to a friend in the industry).

    In any case, big pharma no longer funds much novel research,because it can’t make it pay, even for the next lifestyle drug (erectile dysfunction, blood pressure, depression, etc). Most research right now is performed by universities and start-ups, funded by non-profits, and the companies that take drugs through “the valley of death” are typically bought up by big pharma if they emerge with a drug candidate on the other side. This also appears to be a worldwide phenomenon. They’ve outsourced some drug development to India (human trials, even basic research) in an attempt to bring costs down, but there are still huge issues.

    While I agree that extraordinary care is useful, we desperately need ordinary care as well. I’d love to see more targeted antibiotics and vaccines on the market, but basically, non-profits or the government, is going to have to pony up a billion dollars for each new drug they want to bring to market.

    This, incidentally, is the free market at work, coupled with our desire to have demonstrably safe drugs.

    Sorry for the lecture if you knew this already. It was news to me when I read it, and I thought I was well informed.

  205. @Greg,

    In the future, if you’re going to quote me, please use the whole quote. CNN already has the market cornered on rewriting the evidence to fit the narrative it wants to present…

    @Daveon

    “People aren’t responsible. Live with it and set up things that deal with reality not the warm and fluffy Heinleinian world you want to live.”

    If People aren’t responsible, they are choosing to be irresponsible. We should protect them from the bad choices they choose to make because its the right thing to do?

    But when people want to make a responsible choice, like choosing what school their kids should go to, or who their primary health care provider should be, we shouldn’t let them because they might make the wrong choice? Or the choice they might make may not be “fair” as defined by someone else?

    “Blue Cross, Aetna, and Unicare, haven’t been doing exactly a standup job of getting people insurance that actually insures them. The government needs to regulate that market.”

    Medical Insurance is already regulated to a fare thee well at the state level. Actually, State mandates and regulations are some of the reasons health care is so wonky in the US. Each state has its own mandates that insurance companies have to cover, and no two states are alike. A policy that costs a person $1000 in Kentucky costs upwards of $6,000 in New York. Heck, if your a double leg amputee living in New York, any policy you get is going to force you to pay for podiatry, because the State of New York mandates that every policy sold have podiatry coverage in it.

    And to be honest, selling across state lines would be a whole new set of problems, it looks good on paper and in theory…

    Can the Federal government do better. In some cases it certainly couldn’t do worse. But then I am more in the Sam Broder camp when it comes to the government being able to do things.

    @Marismae

    There’s a whole new can of worms with yesterdays ruling. As a tax, a bill can’t originate in the Senate (if I am remembering correctly). I think that sort of challenge will fail though. If they can’t repeal the law or go through reconciliation, as the mandate is now a tax, Romney if elected could order the IRS not to collect it.

    After a days reflection, almost everbody is unhappy with the ruling in one form or another, which leads me to believe it was the right one. :-)

    Dav

  206. If People aren’t responsible, they are choosing to be irresponsible.

    Whoops. Straw man there.

    Some might be choosing. Some might be just plain thick. Or others might have irresonsibility thrust upon them. As has been pointed out, a lot of people going bankrupt, losing homes and their lives were responsible right up until the point they ran out of money and options.

    We should protect them from the bad choices they choose to make because its the right thing to do?

    Yes we should. Because, they’re human beings and it’s the right thing to do.

    How HARD is that to comprehend?

    We do all sorts of things to protect people from their incompetence, this is just a really big one that should be done.

    It has nothing to do with your other strawmen about fairness and somehow it being unfair to people who make the right choices. People are not perfect, they are not in position of all the facts. Those two points alone mean the market just can’t function in healthcare.

  207. Andrew: ” if you’re going to quote me, please use the whole quote. ”

    You made clear that Laissez Faire is “certainly the best option out there”.

    As you said: “If there is a demand … it will be met with a supply and a mutually beneficial exchange will take place.”

    Note that this system specification describes a perfect, limitless system. It does not produce errors. It does not produce problems. It does not produce inefficiencies. Any demand will be met with a supply.

    So, I asked you, how is it possible that this infallible system of your, the best possible system of any other possible system, could cause half a million Americans with health insurance to end up declaring bankruptcy due to medical expenses in a single year.

    But rather than discuss, you know, actual living breathing human beings, you attempted to reframe the issue by trying to make us feel sorry for companies that went out of business.

    “At a guess, I would say many of those 1.5 million people declared bankruptcy because they worked at one of the 89,402 companies that went bankrupt”

    I point out that you failed to address the actual question and I point out that you try shifting the conversation back to “Yay! Capitalism!” and then your concern shifts from actual living breathing human beings with medical insurance going bankrupt from medical bills to being unfairly quoted.

    In other words, anything to avoid showing concering for those living breathing human beings that your perfect Free Market system let fall into bankruptcy even though they paid for insurance. In other words, anything to avoid even the most simple and rudimentary, yet massively overwhelming fact that shows your any-demand-will-be-met-with-a-supply-for-a-mutually-beneficially-exchange is nothing but the hot air of a Laissez Faire talking point.

    You laissez faire folks are definitely slippery types. Well, you have to be, right? What else can you do when facts completely refute your religion but misdirect and show faux indignation and other slight of hand to distract from those facts?

    So, I’ll ask again: Given that in one year, half a million Americans with health insurance ended up declaring bankruptcy due to medical expenses, how exactly do you define this as “the best system possible”? How exactly does that fit your “mutually beneficial exchange”?

    How does that possibly meet any definition of a good outcome?

  208. Andrew: “If People aren’t responsible, they are choosing to be irresponsible.”

    God, I forget how beautifully simple the world is when viewed in black and white.

    It’s complete nonsense of course. But beautifully simple.

    Again, Andrew, those half a million Americans who had health insurance but ended up declaring bankruptcy due to medical expenses? Remember those?

    yes, they completely destroy your beautifully simple black and white world. They render it to rubble.

    But it might explain why you can’t answer my question. Because when a partisan sees the world in black and white, people trapped in the gray areas aren’t even visible to them.

  209. There is a lot to cover here, so I’m going to try and pick away at the things I can.

    Greg: “It’s pretty obvious to me that laissez faire highways would be about as horrendous as laissez faire healthcare. It’s something we could have predicted, given the system parameters. I think it’s just the laissez faire dogmatics keep steering us into near oblivion.”

    The past 100+ years of American history should be evidence enough that us “laissez faire dogmatics” have not gotten our way when it comes to economic policy-making. Stack up the list of programs that expanded government power with the list of those that privatized and deregulated and it’s obvious who has had the steering wheel as we careen into oblivion.

    Greg: “Healthcare might be a “right”, but it could be privately provided if the megacorporations running it actually did a good job. Thing is, they’re not, so we the people need to step in to make it work.”

    Who runs corporations? People, right? Do you really think the people in the government are so much smarter than the ones who manage to keep multimillion dollar companies running? That career politicians know enough about health care to make sweeping decisions that affect millions of lives?

    Greg: “And it seems that the healthcare industry is running into similar disaster territory. It’s not so much about having a right to insurance anymore than it is about having a right to public highways. It’s just that the market doesn’t produce the best solution for every problem. And it appears that healthcare is one of those problems.”

    Greg: “So, what we have right now in healthcare is as if we had a privately owned highway system and America started to wake up and realize they’re paying too much in tolls, the roads have gigantic potholes, and they have to drive miles out of their way because companies don’t want their roads to connect with competitors’s roads. And people are realizing that the private industry solution sucks. So, we’re transistioning to a regulated market. If you want to own a highway, you’ve got to fill the potholes, you can’t charge too much for tolls, you can’t prohibit people from entering your roads for arbitrary reasons, you’ve got to work with your competition and make connecting ramps to their highways.”

    Have you done any research on privately owned roads? You’re using this is as an example and it’s really weak, there is quite a lot of evidence that the government has done an increasingly terrible job in building and maintaining the road system, with NO competition. You’re projecting your own opinions of what a private road system would be like when in fact, you have no idea what it would be like because we haven’t had anything even close to it for over a hundred years. Businesses do not succeed by inconveniencing, harming, or overcharging their customers in the long run! Roads are no different from fast food chains or department stores, the superior product and service will win out and just like everything else, toll road prices (if that is indeed how private highways would be run) would find an equilibrium that made both consumers and companies happy. The firms that cannot compete will close, unless they are kept alive by government protection (see anti-trust laws). Recommended reading: The Privatization of Roads and Highways by Walter Block.

    Also, “transitioning to a regulated market”? You really are kidding yourself if you think we’ve been enjoying an unregulated anything in this country, now you’re making me chuckle.

    Greg: “I think that the fact that half a million people with healthcare insurance declaring bankruptcy due to medical expenses in a single year shows that the market isn’t working by itself and needs regulating. If private insurance companies were offering services that produced a good outcome, I’d be all for continuing private insurance with the minimal regulations it had up to this point. But they’re not producing a good outcome. ”

    Again, the market isn’t working by itself? We’ve got the FDA, the AMA, the HHS, and myriad other regulating, interfering, coercive agencies keeping the market from working by itself. Minimal regulations? What exactly is your idea of non-minimal regulations, soviet medicine?

    You are making the fatal mistake of assuming that prior to the ACA, as recently as 2009 (by your quote about bankruptcies in 2009 as a result of health care costs) America had a free market, unregulated health care market. This is completely insane and wholly untrue.

    Greg: “Wow. You’re a total Laissez Faire Capatilist fantasy guy? You guys are entertaining. This should be fun. Ok. Let’s start with some facts. In 2009, about 1.5 million people declared bankruptcy. 60 percent of them were due to medical expenses. And yet, 60 percent of the bankruptcies caused by medical expenses were individuals who had medical insurance. That’s half a million people who had medical insurance who ended up declaring bankruptcy due to medical expenses. In one year.”

    Check the name, it’s voldeMEG, therefore I am not a guy. I’m seeing a trend in your level of observance here…

    I’m absolutely not claiming that the health insurance market was functioning and serving people ideally as it was. However, I believe the root of the problem was government intervention and not a lack thereof. Increased government involvement, without fail, leads to diminished utility, higher prices, confused market signals, and most importantly: violations of property rights.

  210. “Some might be choosing. Some might be just plain thick. Or others might have irresponsibility thrust upon them. As has been pointed out, a lot of people going bankrupt, losing homes and their lives were responsible right up until the point they ran out of money and options.”

    And having been a residential real estate appraiser in the past, I can tell you more than a few people were irresponsible because they didn’t do their homework on the loans they were getting and the penalties entailed when their ARM moved. Some didn’t do their homework on the companies giving them that money. Some people just signed without reading the papers in front of them. There are some horror stories out there, that will just boggle the mind.

    “We should protect them from the bad choices they choose to make because its the right thing to do?
    Yes we should. Because, they’re human beings and it’s the right thing to do.
    How HARD is that to comprehend?”

    So, what car do you drive?

    Dav

  211. voldemeg, you said:

    “I’m absolutely not claiming that the health insurance market was functioning and serving people ideally as it was. However, I believe the root of the problem was government intervention and not a lack thereof. Increased government involvement, without fail, leads to diminished utility, higher prices, confused market signals, and most importantly: violations of property rights.”

    Absolutely spot on. I haven’t seen it expressed better anywhere. Well said.

  212. There hasn’t been a totally free market in health care since about 1930. Of course, there wasn’t much real health care back then. And the nature of health care precludes a free market because the major players do not want competition and transparency. In fact, the health care biz today evolved around those conditions where costs are hidden and competition is constrained.

  213. “I’m absolutely not claiming that the health insurance market was functioning and serving people ideally as it was. However, I believe the root of the problem was government intervention and not a lack thereof. Increased government involvement, without fail, leads to diminished utility, higher prices, confused market signals, and most importantly: violations of property rights.”

    This is contra-factual in many cases, and, I believe it is contra-factual in the issue of health care.

    Markets are inherently distorted in health care; there is little freedom to opt out and choice in quite often limited by time and information is mostly certainly not perfect. Issues of recession is most certainly not an effect of government involvement, nor are life time caps on healthcare. In addition, much of the higher prices in prescription drugs stems from the ability of foreign countries to bargain as a unit for the entire country and the unwillingness of American governments to do so (which is, by nature, a lack of government involvement).

  214. voldeMEG: “I believe the root of the problem was government intervention and not a lack thereof. Increased government involvement, without fail, leads to diminished utility, higher prices, confused market signals, and most importantly: violations of property rights.”

    Preach it, sister!

  215. On responsibility:

    The thing is, everyone is irresponsible at some point, and it’s not uncommon for responsibility to crossover with OTHER responsibilities. You come from a genuinely middle class background, go to college and graduate and then….can’t find a job. Or the job you find is some crap work while you look for a real job?

    Where is the irresponsibility there, exactly? Or if you’re a twenty something and you are making enough to get by, but not enough for rent plus food plus insurance.

    Or you do buy insurance but it’s next to worthless when you come to really need it.

    Or you have healthcare through your job but you get canned because of downsizing after twenty years and can’t pay the COBRA for it.

    Right, irresponsible.

    But even if you do assume people are irresponsible, the next assumption is that because they didn’t make the right decision, the penalty should be ill health, ruination, and a life of debt? Because it’s not your problem?

    Shockingly, places where people actually work together to help make sure that when people make bad decisions that the fallout is minimized do better than this lone wolf crap. If you are in America, you are not some independent person being held back by everyone else. You are the beneficiary of a lot of good people working together for a couple of hundred years. So whether or not we have a duty to make sure people aren’t crippled by their irresponsibility, we’re better off if they are.

  216. “Increased government involvement, without fail, leads to diminished utility, higher prices, confused market signals, and most importantly: violations of property rights.”

    I find your “most importantly” point most telling, as I do the “without fail” slightly ahead of it.

  217. Andrew,
    I believe that Daveon was saying that that people were not responsible for the illnesses that they come down with or the inuries that are inflicted on them, not that they were acting irresponsibily. I agree with him generally. There are of course exceptions such as STDs and injuries from falls while rock climbing.

    I really like Greg’s analogy with the highway system and think I will use it in conversation with some people I know.

  218. Increased government involvement, without fail, leads to diminished utility, higher prices, confused market signals, and most importantly: violations of property rights.

    And this is the heart of the disagreement. Some of you put private property above human life in importance. You’re fine letting people suffer and die because of a lack of health coverage and would rather than adopt a system that works to prevent that.

  219. rickg17, your comment is silly and insulting. No one here is “fine letting people suffer and die because of a lack of health coverage”

  220. Greg,

    “Again, Andrew, those half a million Americans who had health insurance but ended up declaring bankruptcy due to medical expenses? Remember those?”

    Actually, I am (almost) one of them. As I said above I was a Residential real estate appraiser until 2009, and believe me, I can tell you some horror stories about people who got into homes they never should have. But the company I was with was small, and most of our clients went under when the defaults started. I did foreclosure appraisal for a bit, which was not fun, but then those jobs dried up as well.

    I went back to school, borrowed money from my parents to do so. Went through my savings, sold a lot of things. Robbed Peter to pay Paul, then mugged the rest of the apostles to keep a fair roof over the families head and good food on the table. Then five months later my son was born with a hole in his heart and a lung condition. The ambulance bill to transport him the 10 miles from the hospital he was born at to the Childrens Hospital specializing in his sort of problems was 12,000 dollars. The three weeks he spent in ICU was quite a bit more, and my wife’s insurance (and she was a part time federal employee mind you) covered only some of that.

    I’ve collected unemployment for an amount of time, Then I had a steady job that paid more than minimum wage, but not much more, but had insurance and let me go to school. We weren’t getting ahead, but we weren’t falling behind either. I could have been on my wife’s insurance. Her take home would have been about $100 each check, but that’s better than nothing, right? But we couldn’t afford to keep all of the family on just her insurance, so we kept the kids on it.

    Then one day in 2010 I woke up with a buzz in my head and swimming vision. Called my GP and she said it could be a stroke, go to the hospital ER, as in NOW. A stroke at 36 is odd, but better safe than sorry. An overnight stay at the hospital, a CAT scan, 2 MRI’s (because “something” went wrong with the first one) and a $14 dollar aspirin later,I walked out with another 30K in bills and a case of Bell’s Palsey that flares up from time to time.
    Anyways, I had my job at that for about 18 months, and I paid about 400 a month for coverage, so I paid in $7200. My insurance company paid out less than $3000, and left me with the rest of the bill.

    My credit rating is a mess, any sort of savings/college fund/vacation is a best a wish, the newest vehicle I have is 10 years old and forget about buying a house, even in this market. We looked at declaring bankruptcy, but then my wife got hired on full time, and I found a good contract job in the field I went back to school for, so that’s good. And were doing our best to pay off that debt, a little bit at a time.

    So, do I have any sympathy for those other folks? Sure, I do. That and a buck will get them a cup of bad coffee. Maybe.

    Were my actions with regards to my not going on my wifes insurance irresponsible? Perhaps, but if they were, why is covering for that mistake now someone else’s problem? It’s my debt, I incurred it, i am responsible for it. I am paying it off, slowly but surely. I’m not sitting in my room looking at all those participation trophies I received whilst playing kids soccer whining to my mom that “It’s just not fair”. What good would that do me? And I wasn’t even part of that generation

    I’ve spent a decent amount of time in Europe, I’ve seen their systems at work. They’ve got their own horror stories of government efficiency and accountability, and if we want that here, I am sure the government will oblige us.

    So , yeah…spare me the faux rage Clover.

    Dav

  221. Ah private property. The its my property and I can do anything I want with it crowd. As far as I have been able to determine that exclusive right has never existed. Every gouvernment has had the right of eminent domain, clear back to any king who wanted the local barons castle. I have never understood how property rights advocates could keep a straight face.

    My answer to any of them has always been – I own the property next to yours and intend to put a hazardous waste storage facility on it will you now defend my right to use the property as I desire?

  222. Billy – First, I wasn’t talking specifically to you. Second, when someone opposes full health care coverage because they’re worried about private property rights the consequences of that is PRECISELY that people have to live with ailments that cause suffering and some of them die. From your reaction, I take it you are thus in favor of national health care. Glad to see that.

  223. @Justin:

    “The thing is, everyone is irresponsible at some point, and it’s not uncommon for responsibility to crossover with OTHER responsibilities. You come from a genuinely middle class background, go to college and graduate and then….can’t find a job. Or the job you find is some crap work while you look for a real job?

    Where is the irresponsibility there, exactly?”

    Good question. The argument I’ve heard to this is:
    Did you major in an in demand field such as Civil Engineering, or something like 18th Century French Lit? Or Woman’s Studies? None of those choices are irresponsible, especially if something like 18th Century French Lit is your passion, but then a person choosing to major in it should know that lifetime of financial security and gainful employment isn’t a given. Ignoring that could be irresponsible.

    Dav

  224. rickg17, you can’t even state your own position without resorting to blanket generalizations and ridiculous pronouncements. Please don’t presume to tell me what I believe.

  225. @Mike

    “My answer to any of them has always been – I own the property next to yours and intend to put a hazardous waste storage facility on it will you now defend my right to use the property as I desire?”\

    I want to see how long your survive the process in turning that land into such a facility. County rules alone will have you pulling your hair out. And that’s before the EPA steps in…
    Maybe in a different thread one of these days

    :-)

    Dav

  226. Andrew,
    I agree – off topic so we will hold off till it becomes germain sometime. Thanks

  227. Andrew @7:20:
    “Major in something lucrative” is a really poor argument. It’s very easy to major in something that seems lucrative and then have the market change as you’re graduating. Where is the irresponsibility if you graduate with a degree that should set you up for life, and the market collapses next August? People sometime suffer misfortune through no fault of their own, and your argument seems to be trying to pretend that doesn’t happen.

  228. rickg17: “And this is the heart of the disagreement. Some of you put private property above human life in importance. You’re fine letting people suffer and die because of a lack of health coverage and would rather than adopt a system that works to prevent that.”

    I would agree that this is at the heart of our disagreement, but I believe it’s because we do not have a consensus on what “property” means. My definition of rightful property is: your body and the goods you have gained through peaceful exchange. You own your body, the money you earn represents hours of your life, thus taxation is theft of your life. By telling me what I can or cannot do with my own property the government violates my rights. I’m not sure what about this argument puts private property above human life, I value human life above everything else, including government intervention.

    I am absolutely not fine with letting people suffer and die, but I think saying anything like that is a bit melodramatic. It’s actually remarkably hard, in spite of our crippled health care system, to die on a waiting list or of inadequate health care in this country. I would also very much like to debate whether the ACA is a system that would work to prevent anything. Anytime government subsidizes a product or service you can count on higher prices and lower quality, which will indeed lead to people suffering and dying.

    mikegamer: “Ah private property. The its my property and I can do anything I want with it crowd. As far as I have been able to determine that exclusive right has never existed. Every gouvernment has had the right of eminent domain, clear back to any king who wanted the local barons castle. I have never understood how property rights advocates could keep a straight face. My answer to any of them has always been – I own the property next to yours and intend to put a hazardous waste storage facility on it will you now defend my right to use the property as I desire?”

    If that’s your end-all, be-all answer to private property proponents then you have some reading to do, son. I will repeat: You own your body. You own your rightfully gained property. The government does not, has not, and never will have the RIGHT to any of these things. Government is coercive, and government is made up of humans who have no more natural rights than you or me. If the government (or anyone else) takes your property without your express permission they are violating your natural rights.

    The argument is not “I can do anything I want with it”, the argument is “I can do anything I want with it so long as it does not violate another person’s rights”. If you paid me enough money I probably would let you put a hazardous waste storage facility next to my house, thus proving that peaceful exchange can solve all problems.

    There’s a nice, simple comic called “How An Economy Grows and Why It Doesn’t” that spells out a lot of information about property, economics, etc.

  229. Marc Moskowitz: “Major in something lucrative” is a really poor argument. It’s very easy to major in something that seems lucrative and then have the market change as you’re graduating. Where is the irresponsibility if you graduate with a degree that should set you up for life, and the market collapses next August? People sometime suffer misfortune through no fault of their own, and your argument seems to be trying to pretend that doesn’t happen.”

    No one ever intends to suffer misfortune, but obviously it does happen, is it my responsibility to pay for someone else’s inadequate planning, lack of savings, or even just bad luck? I may want to help them through charity, but I just don’t see how anyone can justify forced charity at the point of a gun (which is taxation). It ceases to be charity and becomes theft.

    Your example of someone getting what they thought would be a lucrative degree and then having the market collapse, again, is that my responsibility? Absolutely any career (besides public employee) has risk associated with it. Your company could close, you could be layed off, this is classic “buggy whip industry” stuff. Should the makers of buggy whips have had their industry subsidized by the government because they were no longer useful after the automobile took off? Of course not! If a product or skill is no longer desired by the consumer, make a new product, learn a new skill!

    A college degree is not a guaranteed lifetime meal ticket, it’s an investment and investments are risky, some more so than others. Of course people should pursue their passions, but they have to accept that their passions may or may not be profitable. This is why the college bubble is so dangerous, I do feel sorry for these *cough*idiots*cough* graduating with $300k+ of debt and possibly no career to follow, but I didn’t make them fill out the application.

  230. @ Marc

    I didn’t say Major in something Lucrative, I said Major in something in demand. There is a difference, although the earnings potential with some of the in demand jobs can be quite high after a few years.

    As an example, the last job I had was for an oil and gas company. We sent a team of engineers over to help implement a new program. Their interpreter was a young Qatari man who was constantly bemoaning the fact that he was working as an interpreter, it wasn’t what he went to school for. In an area that’s looking for engineers of all sorts, he chose to major in Islamic studies, a field with few openings over there. But its what he wanted to do.

    If something esoteric is your passion, and you want to major in it, you should. You should also know that the probable future financial realities of having a degree in 18th Century French Lit or Ceramics are not the same as having a Civil Engineering degree, and prepare accordingly.

    Heck, in this day and age I’d tell anyone to look at Engineering first and premed second. Failing that tie your sons right arm to his chest and teach him to pitch left handed. :-)

    Dav

  231. And this is the heart of the disagreement.

    No, not exactly. The statement about the government screwing everything up “without fail” is a statement of belief, not of observed fact. It’s like saying “I believe in the power of love to triumph over all”. Pointing out specific instances where love doesn’t, in fact, defeat all odds won’t change such a person’s mind; they’re not really saying that the world is, observably, a certain way, as they are making a statement of what they want the world to be like.

    Because in the real world, the private property argument is a red herring. The US has regulation of insurance and has government oversight of the insurance business. (Which is a good thing, unless you really think that the best way to manage insurance companies is on the back end, with bad-faith lawsuits. Then, you’re probably a lawyer.)

    Andrew, the problem is really not people blowing off insurance so they can spend their bucks on sushi and then complaining later. It’s that we have an insurance market that is built on stalling payments that are owed and denying care wherever possible; where “post-underwriting recission” is a business model, and not a response to actual fraud; and where purchasing health insurance is bound up in employment, not something you can easily and reliably do on the free market, as with auto insurance. “That’s my debt” – and when you have that debt because your insurance company tried to pretend you weren’t covered? Or you were charged more because you’re being squeezed to make up for deep discounts to people with gold-plated insurance?

    Marc: “Major in something lucrative” is throwing an economic gloss on the old liberal arts vs. gearhead taunting people engaged in back in college.

  232. “No one ever intends to suffer misfortune, but obviously it does happen, is it my responsibility to pay for someone else’s inadequate planning, lack of savings, or even just bad luck?”

    The short answer to this question is “yes”, it’s a moral imperative that you do so. If you disagree, you’re welcome to move to some other society which is organized around moral principles that are more to your liking.

  233. “Major in something in demand.” Let me see…
    Caltech, originally (1968) Physics major. There was demand for Physics majors then. Got a lot of knowledge from that, and loads of Hard Science Fiction, then switched.
    Caltech (1969) switched to Astronomy major. Probably helped me talk my way into some of my Space Program jobs years later, but at Caltech this required ALL the Physics prerequisites PLUS all the Astronomy, serious overload problem. Got a lot of Hard Science Fiction out of it. Dropped out for a while to car for my dying mother.
    Caltech (1970) started second Sophomore year. This time asked “What degree has the fewest required courses? Math you say?” earned B.S. in Math (1973), which eventually got me 5 semesters of Adjunct Professorship in Math, and many secondary school teaching gigs, mostly as substitute teacher, until laid off as a secondary school teacher.
    Simultaneously, B.S. in English Literature (1973). Never got me a job. Nobody at Amazing, Analog, Nebula Award Anthology ever bought something from me because of that degree. In applying for professorships in English Lit, told: “Your transcript lacks credits in Black Literature, Asian-American Literature, Critical Theory.” I replied “They didn’t have those at Caltech 1968-1973.” Got me into MFA in Poetry, but never earned that degree, because I would not have sex with the Department Chair, and which degree only qualifies you to teach Poetry.
    M.S., Computer & Information Science, UMass-Amherst (1974). I’d already been programming since 1966, so was it the degree or the experience that got me Software Engineering jobs?
    Ph.D. (All But Degree), UMass-Amherst (1977) all requirements completed but Thesis Committee could not reach consensus on whether this stuff I pioneered (now called Nanotechnology, Artificial Life, and Synthetic Biology) was real or mere Science Fiction. Helped get K. Erik Drexler into the field. He didn’t get his Ph.D. in that for many years, until Marvin Minsky shamed MIT into it.
    Secondary School Teaching Certificate (Math) Cal State L.A. (took 3.5 years of night classes), laid off from Pasadena Unified School District, laid off from Los Angeles Uniified School District, seriously injured by student whose gang told him to cripple me for my reporting his sexually harassing a female in the class. Bottom line: good thing I’m covered by my WIFE’s medical insurance, which she has as (badabing!) Physics Professor.
    “Major in something in demand.” — I can’t be sure. But Medical Insurance before Obama-Roberts, via employer, has kept me in danger most of my adult life.

  234. now that we have had a health insurrance debate and court ruling, when do we start debating health care?

  235. @ Daveon: a quick clarification:TThere are quite a few rural areas near me that do fire service by subscription rather than as a tax-based service, and as far as I know, if an uncovered home is burning the fire department will attend to assure that nearby covered homes are saved. So while I take what I believe to be your point (i.e. that better preventative health leads to better overall health outcomes and so fewer high-cost “fires” to be addressed), and actually expressed my support for preventative healthcare in my post. But the anaology isn’t quite right.

    @ David: true. The law is now the law. Now what will it mean to actual health care, not just to health insurance?

  236. If you can accurately predict what majors will be in demand in five years, you don’t need to get a job in that field because you could make more money as a market analyst. While there are certain fields that are safer than others, nothing is guaranteed. Things change quickly; often in less than four years.

  237. Meanwhile, several Republican governors have already stated outright they’re going to refuse to implement it.

    Didn’t we last have this discussion back during Brown v. Board of Education?

  238. voldemeg: us “laissez faire dogmatics” have not gotten our way when it comes to economic policy-making.

    I know, right? Laissez Faire purists such as yourself are such a small minority compared to the overwhelming majority of stupid, lazy, uninformed, ignorant voters who are the majority of the American public. If only this vast majority would realize that yours is a superior intellect, we could be living in Laissez Faire paradise.

    voldemeg: “Stack up the list of programs that expanded government power with the list of those that privatized and deregulated and it’s obvious who has had the steering wheel as we careen into oblivion.”

    Outnumbered by the majority of stupid people again. It’s like you’re Cassandra, able to predict the future, but no one listens to you.

    Oh! If only the vast majority of Americans would listen to you!

    But they’re too stupid to listen!

    “Have you done any research on privately owned roads?”

    Raubriter refers to miedieval lords who charged tolls to pass through their territory without adding any value to justify the toll. The term is the root word for “robber baron” in English. So, yeah, I’ve done some research.

    , there is quite a lot of evidence that the government has done an increasingly terrible job in building and maintaining the road system,

    Well, as right wingers and Laissez Faire capitalists vote to cut taxes that would go to road maintenance, yeah, road maintenance goes down.

    The firms that cannot compete will close, unless they are kept alive by government protection (see anti-trust laws).

    Right. If we get rid of the anti-monopoly laws, ONLY THEN will we see true competition.

    How did I and the vast majority of Americans not see this before??? We’re such fools!

    Recommended reading: The Privatization of Roads and Highways by Walter Block.

    Never heard of him. Probably because according to wikipedia, Walter Block is an Austrian School of economics economist and anarcho-capitalist. Clearly, his is also a superior intellect compared to the vast majority of people.

    Andrew: Were my actions with regards to my not going on my wifes insurance irresponsible? Perhaps, but if they were, why is covering for that mistake now someone else’s problem?

    Did you notice how the question was “If the free market is so great, if every demand will create a supply for a mutually beneficial exchange, then why would half a million people with insurance end up in bankruptcy in a single year?”

    And the anecdotal answer you gave was “I didn’t have insurance” Followed by a rhetorical question “Why is it someone else’s problem to cover my mistake?”

    Did you notice how once again you change the subject or answer a different question?

    Europe… They’ve got their own horror stories of government efficiency

    Except they generally pay less but have better overall health.

    and accountability,

    Yes, I know. Death Panels. Roving band of bureaucrats creating Kafkaesqueian nightmares. I saw a group of them go after a little old lady when I was in England. I tried to save her, but it was too late.

  239. voldemeg: “I will repeat: You own your body. You own your rightfully gained property. The government does not, has not, and never will have the RIGHT to any of these things.”

    Wait. Wait. Wait. You’re telling me a government has NO RIGHT to TAX? Because a tax is nothing but taking some of your property, usually in the form of money. You’re saying Never? Under no circumstances? Income tax? Sales tax? Property tax? None of it?

    Oh, please, please, pretty please, tell me you’re a “no tax, no, no never, never, nuh uh ah” proponent. I haven’t had that kind of fun in ages.

  240. With all the talk about McDonalds lobbying for waivers, and speculation about how it showed how bad the bill is, I thought I’d research the situation a bit.

    According to the numbers I found about the plans, they are not great deals. The plan caps mean that you would most often be better off paying cash for small medical events, and you wouldn’t be covered for most large medical events. And McDonalds complained that they couldn’t possibly match the bill’s requirement of payout ratios because the administration costs of their plans are so high, due to frequent turnover.

    That’s not really going very far in convincing me that the big corporations complaining about the bill have reached the most efficient solution, except in terms of what’s most efficient for their own profits. And there are a lot of historical examples of how what is most efficient for the profits of companies is not always the best thing for a country’s health.

  241. Greg,
    I agree with you completely. In addition you have no untrammeled right to your own body all societies have reserved the right to restrain (jail, banish) or eliminate you(death penalty) as a danger to that society. All gouvernments have reserved the right to seize property (i.e. seizure of any property gained through drug profits.) you have gained so again you have no intrinsic right to personal property.

    Please show me one example where this is not the case an I will cease flogging this horse.

  242. On a phone traveling so this will be brief.

    In short: I can’t argue the point about there being no examples of government working because my irony meter exploded.

    That’s an opinion not backed up in fact. The current poster children for good economic and fiscally conservative responsibility are Germany and Sweden. About 56% of the Swedish economy is under direct government control.

    They spend less as a proportion of GDP on healthcare and have, I can assure you, amazing roads on which the poor serfs typically drive new Volvos. They also have a disproportionately large military for their size.

    Property rights of any kind are meaningless outside of a well ordered civil society which protects them.

    Or put another way. When told that the natural state of man is to be free, the Patrician of Ankh Morpork replies it is also the natural state of man to hide in trees from the wolves….

    I think Pratchett summed it up nicely.

  243. Greatly enjoy your work, usually laughing aloud. Also quite surprised at the SCOTUS decision but can follow the logic. My problem is that this law, at 2,000+ pages, is unworkable and will not correct the defects in our system it is purported to address. Yes, the system is flawed but this will exacerbate it, not fix it. I speak as a retired benefit plan administrator with over 40 years experience as an independent consultant working for municipalities, corporations and unions to design and administer plans. Having an insurance company pay claims and control access to care is bad, having the government do it is worse. The HSA is probably the most effective and patient centric development of the past 20 years. It works because it reduces the reach of the claim payer and reinforces the role of the patient. Unfortunately we have become a people who want DADDY to take care of us. My personal view is hope that PPACA will be repealed and that some semblance of logic will emerge. But, given the track record of both Democrats and Republicans for thinking and acting logically, I am not optimistic.

  244. we have become a people who want DADDY to take care of us.

    Balderdash.

    Sorry, but wanting a fiscally responsible way to ensure a healthy population has nothing to do with wanting Daddy to take care of anything.

    I sometimes actually do feel that the libertarians are just like kids who live at home. They labour under the impression that all the stuff they think they pay their parents for in ‘rent’ actually covers the true cost to their parents of providing it. I used to have this when I first started work as a graduate. There were a lot of apprentices who were roughly my age who couldn’t understand why I was poorer than them, even though I earned about 10% more. The difference was while we both paid about 20 quid a week in rent. Theirs included their bills, property taxes, phone, laundry service (mum), food and cleaning (again, usually mum) – they couldn’t comprehend that all that *other* stuff actually cost money and didn’t come as part of what they thought they were paying for.

    Police, fire, health, social insurance, courts and education are just the same. You can’t live well without them, but you have to pay for them and most people, frankly, just don’t earn remotely enough to be able to provide them for themselves.

    I live, relatively happy, in the knowledge that if I had something serious, a Business Class flight home would be less than our insurance co-pays. Assuming I could wait. If not, I do pay for a LOT for insurance which provides us with a, frankly, inferior service to what I had in the UK.

  245. You own your rightfully gained property..

    Did you just say that? Without Irony?

    Damn, there goes another irony meter. The residents of any former British colony claiming that one really really amuses me. But that’s veering wayyyy off the reservation.

  246. “people who want DADDY”???? thats a libertarian code phrase that roughly translates to “any government service I approve of is OK, everything else is LAZINESS!”

  247. With regards to Sweden are we talking about the Sweden of the 70’s or the Sweden of today where medical care is more rationed? There are some good things about the Swedish model (the Brazilian model is pretty interesting too)
    but they also have their horror stories too and those see what critics will point out and proponents will ignore.

    Andrew

  248. With regards to Sweden are we talking about the Sweden of the 70’s or the Sweden of today where medical care is more rationed? There are some good things about the Swedish model (the Brazilian model is pretty interesting too)
    but they also have their horror stories too and those see what critics will point out and proponents will ignore because “nothing like that will happen here.”

    Andrew

  249. Sweden of today, of course, and ‘rationed’ – really? Specifically what are you thinking of, apart from, no you can’t have this stupidily risking procedure that might buy you a couple more months… or no, your 90 year old mother(*) can’t have the new kidney because really we should give it to the 20 year old.

    Every system has horror stories, I know of a few from the UK too. BUT nowhere in Europe have I seen thousands of citizens having to turn up to volunteer run clinics because they don’t have access to primary healthcare. Good grief, how is that not the most embarrassing thing in the world to you guys?

    http://religion.blogs.cnn.com/2012/06/27/a-health-care-judas-recounts-his-conversion/

    To be more specific I was referring to Sweden as a fiscally conservative and well run country, often pointed out by US fiscal conservatives, where the state is almost twice the size as in the US and yet they seem to be getting by.

    (*) a case a Doctor friend in the US actually dealt with, finally talking the family into NOT demanding they tie up a kidney to buy their mother a few more months.

  250. Daveon,

    Firstly, apologies for the long post.

    In my last Econ course (When the ACA was being debated) we compared Sweden to a few other countries including the US as part of a class excercise. These numbers are two years old, I don’t believe they’ve changed much though.

    The VAT in Sweden is 25%. Everything you buy, with a few exceptions, is taxed at 25%. If you earn more than $50,000, your tax rate (total state and federal), is 50% to 60%, depending where you live. If you earn less than $50,000, its around 30%. It is not progressive. If you are a working at a McJob, you’re paying 30%. If your managing that McStore, your paying %50. If you own the McFranchise, you pay 60%. There are a few exceptions and credits available, but the average tax rate in Sweden hovers around 47%.

    In 1950 the tax rate in Sweden was 27%, and it spent a greater share of those taxes on education and health care then than it did in 2010 (where my econ notes are from). From 1950 to 2010, Sweden went from 7 million population to 9 million. Taxes in 1950 were raised to an average of 57% in the 80’s, (with a high near 70% in the 70’s), and cut to an average of 47% in the 90’s. At the same time, Public Bureaucracy spending (as in “The bureaucracy is expanding to meet the needs of the expanding bureaucracy”) increased threefold. Sweden spends four times as much today on welfare and other social insurance programs as it did when the tax rate was 27%. Yet in 2010, of the 210 municipalities in Sweden (similar to US Counties, Sweden is small after all), 105 had populations in which more than 50% of the people living there lived off welfare. And in the 2000’s, Swede’s took more sick days than any other nation in Europe. In fact, there was quite the scandal at the time because young (healthy) Swedish workers were gaming the system to get their mandatory four weeks of vacation and 30 days of sick leave. As an interesting side note, in the 80’s the median Swedish Tax rate was 57%. It the 90’s was lowered it to 47% and some services and programs were eliminated, and Swedish growth rates increased. Go figure…

    “They spend less as a proportion of GDP on healthcare and have, I can assure you, amazing roads on which the poor serfs typically drive new Volvos.”

    OECD.org had Sweden spending 13.6% of its government revenue spent on health. The US Spends 18.5%. But Sweden (actually a lot of countries) are beating the US in several areas. Honestly, I don’t think a Universal health care system s going to be an instant cure all for that.

    And the average age of a car in Sweden and America is the same, 9 years. The Bureau of Transportation Statistics is your friend. :-) I spend a decent amount of time on that site for my current job, vehicle age is something we looked at not to long ago. A friend of mine in College was from Sweden, he told us all about it. The roads are great, but you only get a permit at 16, a license at 18, and have to pass 13 driving tests, 8 theoretical tests, and it costs about $1,200. They teach you how to powerslide in Swedish Drivers Ed. How freaking cool is that?

    “Sweden of today, of course, and ‘rationed’ – really? Specifically what are you thinking of, apart from, no you can’t have this stupidily risking procedure that might buy you a couple more months… or no, your 90 year old mother(*) can’t have the new kidney because really we should give it to the 20 year old.”

    Well, as to the first, its been argued here in the comments that preventing a person from making a bad choice is the right thing to do. So, If a person is going to die in four weeks, it’s better for them to live those four weeks and not have an operation that if it doesn’t kill them, could give them an additional twelve weeks of life? Am I interpreting that wrong?

    Sweden’s a single payer system. It has a Pharmaceutical Benefits Board. It decides whether a drug is included in the benefits scheme and sets the price. The primary factor that the Board considers when approving a drug is cost effectiveness. If it doesn’t approve a drug, then people who use it won’t be reimbursed by the government. No exceptions. On the other hand, patients pay no more than 200 kronas ($30) annually. Payment for prescription drugs is set on a sliding scale, in which patients pay 100 percent of the first 100 kronas charged, 50 percent of the next 89 kronas, 25 percent of the next 178 kronas, and 10 percent of the next 111 kronas. After that, the state pays 100 percent of the cost for drugs. So, for that $1,000 dollar prescription of insulin, you pay a pittance out of pocket, but your taxes cover the rest. The number of private practice Doctors is controlled by City Councils. They regulate the number of patients those doctors can see per year. Only 20% of the doctors in Sweden are in private practice, the rest work in hospitals.
    Waiting Lists are a rationing measure. In the late 80’s, it was pretty bad. 10 months for an angiogram, bypass surgery could be a 2 year wait, and that was for preventative care. It got better in the 90’s.
    The government promises you won’t wait longer than three months for an operation, yet there is only a 50% chance of having an operation within three months. Some operations occurred more often than others, Angioplasties an an example took place 90% of the time within three months. Knee replacement, 30% of the time. My friend in college was a forestry major, he was in an accident and lost 80% of his hearing in both ears. It took him four months to get hearing aids. That was in 98, maybe 99.

    Heck, In 2003/4 Gorann Persson waited 8 months for a hip replacement, and near the end was so heavily medicated for pain he could barely do his job.

    And he was the Prime Minister of Sweden at the time.

    “They also have a disproportionately large military for their size.”

    They have 30,000 members on active duty, 23,000 reservists, and 38,000 in their militia. That’s .01% of their population (Unless I fat fingered a key). Oddly enough, the US has 1.4 million active duty and 1.4 million Reservists in the Armed Forces, also .01% of it’s population. But Sweden has also marched to a different military drumbeat for quite a long time, it’s policy of non alignment was the key factor in that.

    Now, the German system, that’s something to look at.

    Dav

  251. Mike Whitney @ June 30, 2:21–I considered a HSA plan instead of my Blue Cross/Shield the last open season my employer offered, and decided against it for a very practical reason. BC/BS, as do all of the major plans I’m aware of, negotiates much lower rates for procedures/treatments with providers. The BC/BS negotiated “price” is generally no more than half, and quite often a third, of the “list price”. I’m willing to pay for my routine treatment–yearly visit to the opthamologist and family doctor for a physical, couple of visits a year to a specialist who prescribes some drugs I need on a routine basis, occasional colonscopy or other test when I hit that point, routine lab blood tests, etc. But with BC/BS those prices are reasonable; with a HSA they are not.

    If as a private individual I could pay the BC/BS price instead of the list price I’d happily move to a catastrophic plan, and cover my routine health care expenses myself through a HSA. But I don’t have that option, so I stayed with BC/BS. Prehaps I would come out ahead financially some years, but the risk is too high for me to make the change.

  252. Andrew. I think you pretty much made my points for me thanks. I know you don’t think you did. But, as a kinda fiscal conservative myself, I think one really really sticks out. And that is that Sweden is paying, as is EVERY SINGLE other industrial country LESS on covering 100% of their population.

    People might wait for treatment, depends on the country and the procedure but clinical rationing is, in my book, a tad more ethical than economic rationing.

    I pointed to Sweden because they’re the current poster child for many on the right as an example of how to run an economy. Germany is the other one. I find it ironic that they’re both really REALLY socialist in comparison to the US. They also have another thing in common which you pointed out, I think as a bad thing, in that they pay a lot more in taxes.

    Who’d have thought it eh?

    As I said before and I’ll say it again. It was easier to see a Doctor when I lived in the UK under the NHS. My CTO’s dad had a heart attack last year (UK again) and had had his triple bypass within 6 weeks – most of the delay caused by him catching a cold when they were about to do it after they’d stabalized him after the coronary. Total cost to him? Oh yes, zero – all covered under tax and for a lot less as a percentage of GDP. Yes, the NHS has bad areas and there are horror stories.

    You don’t hear about tens of thousands of British citizens turning up at football stadia in the hope that they can see a bloody doctor.

    As I said, that should make every American who is against universal healthcare hang their heads in mortified shame. If the richest nation on the planet can’t look after it’s sick, or for that matter be able to pave all it’s roads in 2012, then it’s doing something wrong.

  253. Oh, another thing. Most countries still let you pay for your own treatment privately if you don’t want to wait. Yes, even in completely socialist England (ironically most European countries are actually not socialist) there’s a thriving private insurance market.

    I do not accept that the US is incapable of doing something the rest of the industrial world has been doing AND doing for less for decades.

  254. People might wait for treatment

    Nobody who has tried to schedule an appointment with a doctor – particularly a specialist – would think this differentiates the US from any other developed nation.

  255. When you get cancer, and your insurance company drops you like a hot potato no matter how faithfully you’ve paid your dues, is that you being irresponsible?

    When you are born with a congenital heart problem that makes it impossible for you to get health insurance, is that you being irresponsible?

    When you lose your job and your employer-provided health insurance because of Wall Street’s greed and mismanagement, cannot find a new job in the middle of the worst economy since the Great Depression, and can’t afford health insurance that’s worth anything, is that you being irresponsible?

    It’s comforting to think that only the irresponsible, unworthy people are bankrupted by health care costs, because it allows you to believe that such a thing can’t happen to you. But it can. Most Americans are just one major health crisis away from bankruptcy, no matter how responsible they have been.

    Everyone else in the First World pays less and gets more bang for their buck when it comes to health care. This is a fact. The ACA, by extending health coverage to tens of millions of Americans who’ve been excluded due to pre-existing conditions (or dropped by their provider the instant they get sick, because paying for their customers health care costs would cut into the all-mighty profits), and by establishing several different approaches that are intended to cut costs, is very likely the best thing you Americans have had happen in years, if not decades.

    And the Republicans, of course, are enraged by this. Because they know that once people start noticing the difference; when people who under the old model would have died or lived in misery and poverty now survive and thrive; when people are more free to take risks, innovate, and enterprise because they don’t have to cling to their employer-provided health care; when the sky does not fall and Obama’s liberal stormtroopers don’t drag the American people in front of the death panels… Then it will be a political suicide to try and repeal it all. And it will be yet another nail in the coffin of their fundamental ideological claim: that the Free Market is always good, and the Government is always bad.

  256. Daveon,
    I’m trying to reconcile 25% VAT and 47% medium Income tax with “Fiscal Conservative”. :-)

    My Dad had a heart attack last year and had triple bypass within 48 hours.
    My Grandmother needed a hip replacement last year and waited less than a week.
    Heck, I had 2 MRI’s in under 24 hours. Yet waiting for just one in some countries with Universal Health Care is upwards of months. On Average.

    “Yes, even in completely socialist England (ironically most European countries are actually not socialist) there’s a thriving private insurance market.”

    And much of that market is related to the slow service in those National Health Care Systems. In fact, studies have shown that the majority of Private Insurance purchased in Britain is used to cover things that are already freely available in the NHS, because having private insurance allows them faster access and faster service. The NHS has started selling off under-performing Hospitals to private corporations in the hope that Privatizing them would make them better, and there was a bill proposed by Cameron that, if enacted, would partially privatize the NHS. If National healthcare is so good, why would privatization be happening?

    There was a story about a Canadian couple living in Calgary who had quadruplets. This couple had to be airlifted to Great Falls because none of the hospitals in Calgary (population 1 million) had enough ICU beds for the infants. So they had to go to Great Falls Montana. Population 58,000. Because it had a hospital with more NICU beds. How could that be possible under an efficiently run government service?

    Germany has a nice health care system, as does Brazil, but they all also have their problems, and hand waving those away with a “Those can’t/won’t happen here” is folly.
    There’s already a shortage of doctors here in the US. ACA just added, what 33 million plus more to the system? And quality of care is going to improve? It’s possible, but then I tend towards skepticism. YMMV.

    Dav

  257. Andrew at 10.41: “My Dad had a heart attack last year and had triple bypass within 48 hours.
    My Grandmother needed a hip replacement last year and waited less than a week.
    Heck, I had 2 MRI’s in under 24 hours. Yet waiting for just one in some countries with Universal Health Care is upwards of months. On Average.”

    A few weeks back, my dad (here in Canada) was concerned about a lump on his upper arm. Got in to see his GP here in our small (pop. 1500, 200 miles from Vancouver) town in two days. Was sent for a scan in our closest major centre (Kamloops, pop. 80,000, 55 miles away) within a week. They needed to do an MRI, he was told (this was early May). Two days later he was given a date: two weeks later. Unfortunately, that was the day he and Mom were booked to leave on a cruise. He was asked what day he got back, and his MRI was scheduled for the day after that.

    “There was a story about a Canadian couple living in Calgary who had quadruplets. This couple had to be airlifted to Great Falls because none of the hospitals in Calgary (population 1 million) had enough ICU beds for the infants. So they had to go to Great Falls Montana. Population 58,000. Because it had a hospital with more NICU beds. How could that be possible under an efficiently run government service?”

    From the Toronto “Star”, 3 September 2007: “An official with the Calgary Health Region defends the move to send the Jepps to Great Falls. ‘We did not have the capacity to take four new Level 3 babies, so the call goes to Edmonton and to Vancouver and across Western Canada to find out if there is bed space,’ explained Don Stewart. ‘We had found across Canada there were not four Level 3 beds available [in the same hospital, presumably], so that’s when we looked to Montana, which is the closest facility to us with reasonable care and within a reasonable distance. That was only done after exhausting the options here at home. They (American critics) don’t have all the facts and information, obviously,’ he added. Stewart said there are 21 Level 3 incubators in Calgary, but a staffing shortage meant only 16 were in use when the Jepps were giving birth. Staffing levels will be increased by this fall [2007], he added.”

    Here’s my own story: June 2008, my husband has chest pains one Sunday morning. I drive him to our local hospital in our small town (same one my dad lives in). Within ten minutes he’s hooked up to machines and having $1000 in clot-busting drugs injected because yes, he’s having a heart attack. Cardiac ambulance comes 55 miles from Kamloops, takes him there, and he spends five nights in hospital there being monitored. On the Friday he’s transported the 200 miles to Vancouver by air ambulance for an angiogram; an angioplasty or bypass would have been performed immediately if necessary (it wasn’t). Total cost to us: $0.

    So please, don’t trot out the old “it takes months to get anything done” argument as if it’s a hard and fast fact of life for everyone. Yes, it can – CAN – take weeks or months to get, say, a hip replacement. But what’s better: 100% of the population being able to get a hip replacement eventually without bankrupting themselves, or 40% of the population not being able to get one at all? Instant access to state of the art medicine and surgery is great, if you’ve got insurance, or can afford to pay out of pocket; not so great if you can’t get it, or getting it will bankrupt you.

  258. I’m trying to reconcile 25% VAT and 47% medium Income tax with “Fiscal Conservative”. :-)

    Why? They’re raising the taxes necessary to run their economy without debt. That sounds like how I run my household and business. If my revenues/income aren’t sufficient to run the business and grow I first work on raising revenue.

    In fact, studies have shown that the majority of Private Insurance purchased in Britain is used to cover things that are already freely available in the NHS,

    And? Not sure what you think that means. People would like not to wait for treatment, or they want a private room in hospital. When my father had cancer his insurance paid him a 4 fogure amount because ALL his treatment for Oesophogial Cancer was covered under the NHS. Within 2 weeks of diagnosis he was under the knife, a week of the delay was a set of surgical evaluations on the tumor to see if they could handle it without chemo. They did. He surived 4 years post operative eventually dying of something unrelated.

    That’s the point of insurance, to cover you for things that you couldn’t afford to cover yourself. Not everybody can afford it. Cry me a river, I’m a capitalist, not everybody can have a Porsche. But even that left Henry Ford worked out that making sure your employees could afford your product was good for him.

    And don’t come to me with anecdotes about X couple being airlifted to Y hospital …

    I don’t see the health service in any other Western Industrial nation having to run free clinics in football fields because people can’t see a Doctor.

    Frankly, as I understand the numbers, the French probably have the best system in the world which is largely single payer private medicine.

    There are LOTS of models the US could pick but they all start with one basic rule – everybody has to pay.

  259. If we’re swapping anecdotes. A few years ago.., actually, many years ago, I woke up at 3am with horrific abdominal pain. My parents made me wait until about 3pm when they called our GP. This being a Sunday he came out to see us straight away. Not happy with where the pain was centered he asked us to go to the local hospital where I arrived about 4pm. At about 5pm they called the on-call surgical team in and by 7:30pm I was back in my bed sans my appendix.

    Total cost to my family $0…. actually, like with his cancer treatment, Dad’s private insurance gave him a cheque because I had been completely treated by the NHS.

    All systems have flaws. But the flaw should not be responsible people going bankrupt for doing the right thing nor should it be a non-trivial percentage of the population of the RICHEST country on Earth not having access to medical services.

    Yes, people have to wait. As I said, cry me a river. Assessments will be based on clinical need and they will get treated. You don’t like that. Then pay for extra insurance and go private and scoff at the poor people waiting in line.

    Like with many things, I find that US ‘market based’ services focus on the wrong part of the market. In Healthcare, it’s trying to get the market to function for everything when people can’t possibly make informed decisions. You guys did it with Cellphone systems. Rather than pick a standard and have the carriers compete on service, you picked technologies and left the country fragmented and behind until… well… actually, it still is.

  260. Barbara,

    “So please, don’t trot out the old “it takes months to get anything done” argument as if it’s a hard and fast fact of life for everyone.”

    When a countries own government admits that it can take a long time to get things done, I’m not suppose to believe them? The averages I quoted above in the post about Sweden’s health care are from the OECD and were not disputed by any of the countries involved. So yeah, when your dad was seen and had an within a month, someone else in that same health care system had to wait 5 months, for whatever reason. The question you could be asking is why your dad wasn’t given an MRI the same day (or even the next day) he went to Kamloops. Or is waiting upwards of weeks (if not months in some cases) for any sort of non life threatening procedure just normal and expected?

    “Yes, it can – CAN – take weeks or months to get, say, a hip replacement. But what’s better: 100% of the population being able to get a hip replacement eventually without bankrupting themselves, or 40% of the population not being able to get one at all?

    I’d say the answer depends on what side of that hip replacement you’re on. If you need one, it’s been six months, and you still have to wait another three months before the surgery, your answer could be different.

    @Daveon

    “And don’t come to me with anecdotes about X couple being airlifted to Y hospital …”

    An anecdote is a short and amusing.

    I don’t find waiting 4 months for a hearing aid amusing, do you?
    An NHS hospital paying $20,000 to a private practice to treat its own doctors and staff because it’s waiting times to treat them at the hospital they workat were to long is funny?
    Or how about this: In Sweden a multiple sclerosis patient was prescribed a new drug. His doctor’s request was denied because the drug was 33 percent more expensive than the other available medicines that did not work for him. The patient offered to pay for the medicine himself but was prevented from doing so. The bureaucrats said it would set a bad precedent and lead to unequal access to medicine. That’s a riot, isn’t it?
    In Toronto, you have to to sign a legal release accepting that while delays in treatment may jeopardize your health the hospital and the system is blameless should anything happen before your seen. Meanwhile the Canadian government is paying 1 Billion a year to reimburse citizens who go to America for treatment.

    “There are LOTS of models the US could pick but they all start with one basic rule – everybody has to pay.”

    Which is why none of those models will ever be effectively instituted here in the US, any sort of tax proposal that has everybody paying something in would never make it out of the committee. Any congressmen who proposed something along the lines of the Swedish model would be run out of town on a rail, and even if it was accepted, would be so amended and changed and fixed to make it “fair” the final size of the bill would cause any standard desk to buckle under its weight. It would make the 1800 pages of the ACA look like a breadcrumb.

    “All systems have flaws. But the flaw should not be responsible people going bankrupt for doing the right thing nor should it be a non-trivial percentage of the population of the RICHEST country on Earth not having access to medical services.”

    20% of the population in the US is responsible for 80% of the medical costs in this country. Think about that for a moment. Then you have to realize that those percentages are going to grow on both sides as baby boomers transition into retirement. And everyone in America has access to medical services. You can walk into any ER in the US and get treated, its part of the EMTALA bill of 1986. No, it’s not efficient, or cost effective in many cases, but its not denied.

    Personally I think transparency in not only how much a hospital is charging you what it charges and why it charges that amount could go a long way in reconciling some of the cost discrepancies we have here in the US. Heck, it’s been three years and I’ve still never gotten an itemized bill for my sons transport from the hospital he was born in in to the NICU 10 miles away. The bill just said
    “Neo Natal Transport: $11,986.57″

    Anyways, I’ve appreciated this discussion. I think the ruling is going to have influence beyond the ACA for several years. I am off on vacation for the 4th, as much as three days in a car with a 6 and 3 year can be considered starting a vacation…

    Thanks,

    Dav

  261. “Or is waiting upwards of weeks (if not months in some cases) for any sort of non life threatening procedure just normal and expected?”

    Uh, that’s normal here in the US. I’m not sure what sort of awesome healthcare you’d have to have here to not experience it, but I’ve seen it enough to know it’s not just me.

  262. I’d say the answer depends on what side of that hip replacement you’re on. If you need one, it’s been six months, and you still have to wait another three months before the surgery, your answer could be different.

    And I’d say if you don’t want to wait for it for free, then pay for your own insurance or pay for it out of pocket to get it done.

    People are always free to pay for services above and beyond the baseline.

    I don’t find waiting 4 months for a hearing aid amusing, do you?

    I don’t find people not getting a hearing aid at all because they have crap insurance or no insurance even less amusing. How about you?

    We’re talking about people getting access to a basic level of service versus not getting any service or making you and I tack it onto our insurance payments by turning up at ER.

    An NHS hospital paying $20,000 to a private practice to treat its own doctors and staff because it’s waiting times to treat them at the hospital they workat were to long is funny?

    And even with paying private hospitals to do these procedures, the overall cost to the British economy (NHS and Private insurance spend) for the ENTIRE nation is about half of the US spend. Go figure.

    Which is why none of those models will ever be effectively instituted here in the US, any sort of tax proposal that has everybody paying something in would never make it out of the committee

    So you’re saying that Americans are just too stupid to understand basic economics? or do you mean something else by this?

    20% of the population in the US is responsible for 80% of the medical costs in this country. Think about that for a moment. Then you have to realize that those percentages are going to grow on both sides as baby boomers transition into retirement. And everyone in America has access to medical services. You can walk into any ER in the US and get treated

    Which is a LARGE part of the problem right there. Nobody is paying for those people they’re free riders, that’s why the Conservatives used to think a mandate was a good idea. It’s not ideal but it’s better than just living with the reality of not wanting people to die.

    No, it’s not efficient, or cost effective in many cases, but its not denied.

    No it’s just inefficient and plain stupid.

    I’ve still never gotten an itemized bill

    Do you think that having itemized billing remotely makes sense?

    One of the things I see as being a problem for the US is how much overhead it takes to run even a small doctor’s office.

    My Doctor in the UK had 3 GPs, 2 practise nurses, a receptionist and a part time admin.

    The one here has 4 GPs, 5 nurses, 2 receptionists, a Business manager and 2 full time admins!

    It’s bonkers. It’s inefficient and it’s wasting all of our money.

    American Conservatives should be mad as hell about the lack of a single payer national system not fighting it.

  263. By the way Andrew… like with other American Conservatives and Libertarians I’ve seen discuss this issue a lot of your arguments boil down to ‘can you imagine how hard it would be to do/get through government’ – and I’ll be honest, that’s the weakest argument EVAR for not doing something.

    I refuse to believe that the USA cannot do something that every other Western Industrial country has been doing for decades. If you can’t that’s just a damning inditement of what is wrong with the USA.

    I’ll also, again, point out that, for the most part(*) I think people should be free to pay for all the extra services they want, just that there should be a basic level of service for all. Frankly, I think the sanest thing would be Medicare for All with the private insurance companies fighting to offer top up services above and beyond that.

    Would that be 2 tier? Probably. Do I care? No, because it would still be better than what tens of millions of Americans currently have.

  264. Uh, that’s normal here in the US. I’m not sure what sort of awesome healthcare you’d have to have here to not experience it, but I’ve seen it enough to know it’s not just me.

    No, it’s not just you. But the freemousketeers will pretend you didn’t say that no matter how many times you repeat it; it’s just not a convenient fact. They also assume that health care is like any other good – that if you have a heart attack, say, you’ll have carefully planned out which ER is the most efficient use of your funds, so that’s where you’ll go in an emergency, rather than wherever is closest regardless of how “good” or cheap it is.

  265. Health care is expensive. Please stop calling it free health care. It is free to some, and super expensive to others and anywhere in between for others. To all the people who are happy to have health care when they lose their job, or for their ill children, parents, etc, please realize someone is paying the bill. It is not free. And the fact that you cannot afford health care on your own, means it is not even affordable.

    Calling it free is an ungrateful way to think about it, and demeans the sacrifice of others. Just because the government has created a program by which people may attain health insurance, does not give people an excuse to be ungrateful or forget the sacrifice that others. Nor does it give people an excuse to berate employers, companies (big and small), and individuals who are footing the bill for other people’s social services. Health care is not an inalienable right. People are not entitled to it just because they exist.

    This comment is not a comment on the rightness or wrongness of the Patient Protection and Affordable Care Act or the Supreme Court’s ruling. This is merely a reminder that health care is expensive. If you are not paying for it (or contributing more than you take out), then someone else is and you are enjoying benefits at the expense of another. Please be grateful and not demanding or feel entitled.

  266. P.S. Purchasing Health Insurance is not necessarily a good idea. When someone purchases any insurance, it is a gamble. Both the person and the insurance company hopes that they don’t need to use the insurance. Depending on how much the insurance is needed, either the person or the insurance company nets money. As with all gambles, the house (the insurance companies) always wins. That is how insurance companies stay in business.

    Note: I am not saying that everyone should drop their insurance. Some people can afford to take the gamble or prefer to take different gambles. There are several instances where this is the case. The most obvious is if you happen to be rich enough to cover yourself (self-insured; this happens more than you might think).

    Purchasing insurance is not always an absolute “good idea”. In fact, it generally is an unprofitable venture. We generally do it anyway because the stakes are so high. However, in most cases, there are several other ways to take advantage of the situation so that it is more in your favor. Forcing everyone to have health care limits these options and tips the scales in favor of insurance companies.

  267. “Health care is not an inalienable right. People are not entitled to it just because they exist.”

    Well, yes, this is the core of the issue. Right now health care definitely a privilege. Not a question. The question is whether or not this should continue to be the case.

  268. As to whether the ACA will make healthcare “cheaper”: The most basic economic principle is a supply and demand curve. To wit: Increase the demand for a product without simultaneously increasing the demand and prices go up.

    The premise of the ACA is that there are millions of people in the US who are currently not accessing health care because they cannot afford it. These people will now be consuming [“demanding”] health care. I’m unaware of any provisions in the ACA that will serve to increase the supply of available health care provision. [In fact, anecdotally there are surveys showing a significant proportion of primary care providers intending to leave the industry within the next few years]

    Therefore…

  269. Dang – that should of course be “increase the demand for a product without simultaneously increasing the SUPPLY…”

  270. Jeff @10:47 pm.

    No. Your “most basic economic principle” assumes an efficient market with perfect competition. That’s not the healthcare market. Your premise is incorrect.

    And your strawman re: “the premise of ACA …” is similarly incorrect.

    And your more “people will now be consuming healthcare” is similarly incorrect.

    The fact of the matter is that there is an inherent demand for healthcare. The demand won’t increase. What might be affected are certain barriers that make the market inefficient.

    I don’t know. It’s been 30 years since I got my Econ degree. Maybe you have a Ph.D. in Econ and you have a full command of the myriad economic theories, both Micro and Macro. But I don’t think so. What I think is that you’re taking the first theory from the first month of Micro, and trying to use it to describe a very complex market and to predict behavior in that market. And I’m not buying it.

  271. The most basic economic principle is a supply and demand curve. To wit: Increase the demand for a product without simultaneously increasing the supply (fixed) and prices go up.

    So how come all the other Western Industrial Countries have lower over all costs than the US? By your economic principles they’d be paying more.

    OTOH – it might be that the elasticity of demand for medical services isn’t quite as price dependent as you think?

    One might even think that, in general, something else gated medical service access… like… say… that demand is based on requirement for the product rather than a “hmmm… I think I’ll pop along to the doctor and have a new hip because damn, it’s cheap…”

    Seriously. Are you people even thinking a LITTLE bit about this stuff?

  272. Health care is not an inalienable right. People are not entitled to it just because they exist.

    Yes. Yes, it really is.

    We seem to be at a philosophical impasse.

    At some point in your life you’ll need medical help. I’d have died at 14 without a surgical procedure myself.

    How about you?

  273. @Thorton: Wait, what? You mean every time the government makes me pay taxes, they don’t just stuff all that money in a vault under Fort Knox somewhere? They use it to pay for public services, like food inspection, military forces, schools, fire departments and scientific research that I’m not writing a check for on my own?

    Sarcasm aside, you make a weird (if common) disconnect between people who pay and people who receive, as if nobody who pays taxes ever receives public services.

    Re insurance, health insurance is not like all other insurance in that it sets the prices of goods. Health insurance doesn’t simply step in when you get sick; health insurers determine which providers and services you can visit and the prices of those services.

  274. Daveon,

    Could you clarify if there are any other “positive” rights which are inalienable? By this I mean.”rights” which require action on the part of others to be actuated, as opposed to the “negative” rights (“Congress shall make no law…etc.”). Also, please explain the limiting principle to “positive” rights. Is it floating, based on the politics of the day? Or is there some fixed amount of another person’s property to which you are entitled in order to have such rights?

    As you can tell by the way I’m wording this, I disagree. However, I also am genuinely curious as to how you view this.

  275. @ZBBMcFate: The “right” to property, which you so tacitly assume, would be a such a right, if it were a right.

  276. Could you clarify if there are any other “positive” rights which are inalienable?

    Besides the positive inalienable right to “Life”, I would also say there is “Liberty, and the pursuit of Happiness”, at a bare minimum. I’m also a firm believer that congress has the power to regulate commerce, as well as having the power to levy taxes.

    Crazy, radical, left wing ideas, I know, but then I’m kinda crazy….

    I am suggesting that the programs: 1) Cost more than was predicted at the time of thier creation 2) Anwser an undeniable need, but at great and increasing cost and inefficiency 3) Are growing at unsustainable rates.”

    Those aren’t suggestions. They’re not facts either. They ARE talking points, though. So you’ve got that going for you.

  277. If you prefer to look this in terms of my life, liberty and pursuit of happiness, how does a right to health care exist without impinging on these? It seems to me that property is tacitly assumes to be owned in the 4th amendment, but I know of no affirmative right to property one does not already own.

    Unless you are suggesting that all persons have a “right” to property, your analogy does not seem to fit my question very well. Again, I’m not trying to score points here, just curious as to how those who disagree with me view this issue.

  278. ZMMBMcFate, don’t tell me you’re one of those squishy interpretationists who finds “implied” rights (like privacy or property) in the Constitution instead of a strict constructionist who sticks to the plain wording. ;)

  279. mythago,

    I’m actually big on the penumbral rights. For values of penumbral that include explicitly spelled out in the text.

    “The right of the people to be secure in their persons, houses, papers, and effects…”

  280. <No. Your “most basic economic principle” assumes an efficient market with perfect competition. <That’s not the healthcare market. Your premise is incorrect.

    My premise is imperfect, not incorrect. Even in an imperfect market, increased demand without increased supply raises prices [or causes shortages]. Can you provide a counter-example?

    <And your strawman re: “the premise of ACA …” is similarly incorrect.

    <And your more “people will now be consuming healthcare” is similarly incorrect.

    Umm…what? Did you read this comment thread, and all of the people talking about how they'll now be able to afford care they previously couldn't thanks to the ACA?

  281. I’m actually big on the penumbral rights. For values of penumbral that include explicitly spelled out in the text.

    Is this like “states’ rights, when they’re right”? I’m poking you a little bit, admittedly, but I assume you’d also find privacy to be one of the penumbral rights for the same reason as you find property there.

  282. ZBBM: If you prefer to look this in terms of my life, liberty and pursuit of happiness, how does a right to health care exist without impinging on these?

    The constitution which you so readily cherry pick also gives congress the right to regulate commerce and gives congress the power to levy taxes. I mentioned it in the very same post I mentioned life, liberty, happiness. I was giving 80-20 odds that you wouldn’t even mention either one of them, cause, you know… cherry picking the constitituion… Should have bet some money on it.

    For example, you cherry picked the fourth ammendment. If one includes just a little more text, we find it is no where near advocating the Libertarian Utopia you present it as:

    The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures

    Never mind that the fourth ammendment is geared towards the requirement for a Warrant for a search or arrest and doesn’t have much to do with taxation. But, hey, that’s what happens when people start cherry picking the constitution.

  283. I think property is a bit more clearly spelled out. As you might guess, I think the privacy right has proven to be more elastic than I would have guessed from my reading of the text.

  284. Greg,

    Sorry for the confusion. I was responding to John in the post just before yours.

  285. Jeff: Even in an imperfect market, increased demand without increased supply raises prices [or causes shortages]. Can you provide a counter-example?

    The dogma that is Supply-and-Demand should have Ron Burgundy as its Pope: 60% of the time it works every time.

    it doesn’t work when a corporation monpolizes a market. It doesn’t work when a corporation destroys a commons like the atmosphere, the ocean, our drinking water, and so on. It doesn’t work when the stock market crashes so badly that you get a depression. It doesn’t work in any scenario that can only be described by prisoner’s dillemma game theory.

    But if you ignore all that, then pure, simple, supply and demand is perfect.

    Kind of makes me wonder if this was how Galileo and others felt when they tried to convince the church that the earth went around the sun. A geocentric view of the universe is probably fine 60% of the time.

  286. Daveon said:
    “One might even think that, in general, something else gated medical service access… like… say… that demand is based on requirement for the product rather than a “hmmm… I think I’ll pop along to the doctor and have a new hip because damn, it’s cheap…””

    For something like a hip replacement, which is in some large measure “elective” surgery (as opposed to life-saving treatment you’d get at an Emergency room even without insurance), that demand is certainly based at least in part on “it’s cheap” as much as “requirement”.

    Unless in your opinion there are zero people who currently meet the following criteria
    a: No health insurance
    b: A bad hip
    c: Inadequate financial resources to pay for a hip replacement themselves

    Previously, they would have “toughed it out” [or more preferentially, “suffered with it”]. Now, under the ACA, they’ll have access to insurance they didn’t have previously, which will reduce the cost of that hip replacement, which means that in fact there will be some non-zero number of people who will “pop along to the doctor and have a new hip because damn, it’s cheap”, or at least cheaper than it was and thus now a realistic option for them.

  287. Greg said:
    “it doesn’t work when a corporation monpolizes a market. It doesn’t work when a corporation destroys a commons like the atmosphere, the ocean, our drinking water, and so on. It doesn’t work when the stock market crashes so badly that you get a depression. It doesn’t work in any scenario that can only be described by prisoner’s dillemma game theory.”

    Except that none of what you say is true.

    First example: If a monopolistic provider raises prices, demand will be supressed to the extent that there is any potential elasticity of demand. I have a monopoly provider of electric power to my house. As rates increase, I take steps to decrease my electrical usage. I purchase lower-wattage bulbs. I raise the temperature on my AC.

    I don’t think any serious person would claim there’s no elasticity of demand in medical services. Yeah, if you’re having a heart attack you’re going to the Emergency room NOW. But there’s already no price signal for uninsured people at the ER, since their care is “free” already. But there are certainly people who say to themselves “yeah, I’m sick but am I sick enough to want to pay the $X deductible on my insurance”?

    As to to “commons” argument, that also validates the supply/demand curve – the whole POINT of the commons is that the “demand” is unconstrained because of the $0 price – raise the price, and the demand for consumption of the commons will decrease.

    Stock market crash also validates my argument – it’s a fundamental mismatch between demand and supply – demand decreases, prices go down. The internet and housing bubbles are the best evidence – Demand increases while supply stays the same (or increases too slowly), prices explode.

    So again, I’ll ask for a SPECIFIC counter-example of inverted supply/demand curves.

  288. @greg wrote:
    “Kind of makes me wonder if this was how Galileo and others felt when they tried to convince the church that the earth went around the sun. A geocentric view of the universe is probably fine 60% of the time.”
    Thank you! I’m stealing this. Mostly for people who are convinced as to the “rightness” or “naturalness” of things because that’s the “way they are,” and use circular logic to justify their arguments. Of course the “market” usually works in a “market-based” economy. But when unusual things happen, we have to entertain the fact that maybe, just maybe, the Earth was round all along…

  289. Jeff: there will be some non-zero number of people who will “pop along to the doctor and have a new hip because damn, it’s cheap”,

    So, which is it: (A) Death Panels and rationing of care or (B) people getting their hip replaced who couldn’t have done so before???

    What we’re starting to see here is the right-wing-Goldilocks approach to healthcare. It’s simultaneously too hot and too cold at the same time.

  290. “If you prefer to look this in terms of my life, liberty and pursuit of happiness, how does a right to health care exist without impinging on these?”

    They do. Just as the right for people not to get shot in the head infringes on the life, liberty and happiness of people who would like to shoot other people in the head.

    I’ve rambled on this at great length elsewhere, but I believe that everything the government does should be weighed against the notions of life, liberty and pursuit of happiness. It’s a decent if fuzzy metric to ask why you’re doing what you’re doing.

    However, there is a substanial difference between theoretical freedom and actual freedom to pursue those things. Telling people that they need to educate their children is an infringement of those things BUT it clearly allows people to be more able to pursue their happiness. It’s a net gain in the life, liberty and happiness department.

    Likewise, it can surely be argued that being able to have access to healthcare does more to make able to have life (pretty damn directly), liberty, and the pursuit of happiness than the infringement takes away.

  291. “But there are certainly people who say to themselves “yeah, I’m sick but am I sick enough to want to pay the $X deductible on my insurance”?”

    Yup. But this isn’t entirely straightforward in terms of supply and demand. Some of those people, at least, when they have the chance to actually get healthcare will get treated for, say, heart disease or diabetes when it’s easy to treat and requires a few minutes with the doctor rather than when it becomes a crisis and they need hundreds of man hours to survive.

    So saying we’re adding more people therefor demand will rise therefore costs will rise isn’t necessarily true. Actual demand – the amount of manhours and money needed – may decrease, increase or stay the same because all this is, you know, complex.

  292. Jeff: I have a monopoly provider of electric power to my house. As rates increase, I take steps to decrease my electrical usage. I purchase lower-wattage bulbs. I raise the temperature on my AC.

    OK, great. Now, change that to a monopoly of health insurance and then you get cancer. What exactly are you going to do?

    You’ve been paying premiums for years, then you get sick and your provider rescinds coverage to protect their bottom line. And no other insurance company will touch you with a ten foot pole because they don’t cover anyone with preexisting conditions.

    Health care reform outlaws these practices because an unregulated market actually likes them.

    Sure, if the electricity costs go up, you can try to reduce your electricity consumption. Go to Home Depot and buy some of those LED lights or low energy appliances. But they don’t sell a Do-It-Yourself Kidney Replacement at HomeDepot for cripes sake.

    As to to “commons” argument, that also validates the supply/demand curve – the whole POINT of the commons is that the “demand” is unconstrained because of the $0 price – raise the price, and the demand for consumption of the commons will decrease.

    How do you raise the price of a commons??? It’s a fricken commons. How do you raise the price of using the atmosphere? Or using the ocean? Or using the underground water table?

    The only way you can reasonably attempt to put a “price” on any commons is through government regulation. Supply and Demand fails because to someone like Exxon Corporation, the “supply” of atmosphere in which to pollute is infinite, so the cost to them to pollute is zero.

    Stock market crash also validates my argument – it’s a fundamental mismatch between demand and supply – demand decreases, prices go down.

    First of all, you can prevent stock market crashes and bank runs with regulations. FDIC is government regulation that has prevented a run on banks since the Great Depression. Stock regulations like the uptick-short-sale-rule prevent pileons from forcing a valuable stock into the shitter just so some Gordon Gecko types can make a profit. The Glass Steagall Act of 1933 prevented another Great Depression until it got the legs taken out from under it, which in part gave us the speculative crash of 2009.

    And Supply-and-Demand didn’t solve the Great Depression. It was government spending, i.e. stimulus, from WW2 that got the economy going again.

    Like I said, Supply-and-Demand: 60% of the time, it works all the time.

  293. Justin,

    I don’t think the logic of your example works.

    Person X’s right to healthcare is person Y’s right to property as person W’s right to not get shot is to person Z’s right to shoot. One is a positive “right” (x gets y’s property) and one a negative (w has a right to not get shot).

    I’m just trying to get a feel for how the readers of this blog would place limits on the positive rights, other than political, i.e. it would be politically very difficult to raise taxes to very high levels in order to fund a very high levels of positive rights.

  294. “I don’t think the logic of your example works. ”

    It’s not, I think, that the logic doesn’t work as much as it is that it’s a different paradigm. If you want couch “I exist in a society and have to pay for it” as an infringment of your life, liberty and pursuit of happiness, that’s fine. But I maintain this is not merely simplistic but wrong. You get more of those three things by being a part of a well organized society than you do by not. Which is rather than point of the Declaration of Independence, and certainly the point of the constitution.

    But my point in the orginal post is that your ability to pursue life, liberty and the pursuit of happiness is not some unlimited thing, only infringed by the government. If you are marooned on a hypothetical island which is (for the purposes of this example) is a sovreign nation containing you. You have perfect uninfringed freedom, which is utterly useless in any practical way because you have no opportunities to do any with it.

    Which is why acting as if any infringement on life, liberty and the pursuit of happiness is always a negative is a worldview that doesn’t work. More people are more free having a police force than they are without it. More people are more free having to have educational standards than they are without it. See also the military etc.

    As to postive rights, well it depends. I personally don’t have a cookie cutter answer. I do think that for the level of taxes we currently pay in the US, we don’t get as much benefit from them as we could – for one thing, our military budget is bloated more than it needs, and even then, not in the places where I’d prefer to see it.

    But in fact, I believe we already have positive rights. We certainly have a de facto right to our national defense, for instance.

  295. ZBBM, positive/negative rights are smoke and mirrors. They don’t mean anything. I could take just about any right and frame it as either a positive or negative right. Which is perfect for a right winger because that means every thing the government does that he likes and approves of, he’ll say is founded in some “negative” right. And anything the govenrment does that he doesn’t like, he will say is trying to force some “positive” right.

  296. Andrew at 5.27 yesterday: “When a countries own government admits that it can take a long time to get things done, I’m not suppose to believe them? The averages I quoted above in the post about Sweden’s health care are from the OECD and were not disputed by any of the countries involved. So yeah, when your dad was seen and had an within a month, someone else in that same health care system had to wait 5 months, for whatever reason. The question you could be asking is why your dad wasn’t given an MRI the same day (or even the next day) he went to Kamloops. Or is waiting upwards of weeks (if not months in some cases) for any sort of non life threatening procedure just normal and expected?”

    Yes, it CAN take a long time to get things done. I suspect the same’s true in parts of America (or does every American who needs and can afford healthcare get everything done immediately?). What annoys is when foreign critics of Canadian healthcare leave the impression that it takes months for everything, all the time. As for your final sentence above: I think the key is ‘non life threatening’. Dad’s MRI, done almost immediately after he’d gone to see his GP, indicated it was a fatty, benign mass, nothing more. I don’t think anyone should expect that a more onerous and costly procedure for something that’s an inconvenience, and not life-threatening, should be done immediately, at the possible expense of people who are in more pressing need of that procedure (which kind of refutes your ‘someone else had to wait five months’ argument. I believe in medical circles it’s called triage).

    I remember watching a documentary on PBS more than 20 years ago, looking at healthcare here and in the States. They showed a hospital in Vancouver (I think), and indicated that yes, of course there were admin offices and administrators, but that the vast majority of the building was a space to help/treat sick people. Then they showed a hospital in (again, I think) Seattle. Half of the (very large) building was for sick people; the other half was for administrators and (most importantly) the billing department. There’s something wrong with that, in my opinion.

  297. Greg said “First of all, you can prevent stock market crashes and bank runs with regulations.”

    The mind boggles.

    Regulation – there’s NOTHING it can’t do!

  298. Could you clarify if there are any other “positive” rights which are inalienable? By this I mean.”rights” which require action on the part of others to be actuated,

    Inalienable rights, its an interesting concept, even when the framers of your consitution were writing about them, because, by and large, they really only meant, white, property owning men…

    So, I’ll come and out and say, that outside of a civilised commonly agreed framework of rules and laws I think rights pretty meaningless.

    You might well have an inalienable right to life, but if you’re stuck on a dersert island with no fresh water that right might not mean all that much.

    So, I think, the best we can generally do is try to ensure that we have a common agreement on what constitutes rights and ensure that we enforce them, messy as that often is.

    Taking the ‘right’ to property, for example, I would feel less inclined to laugh about that one if most British colonists hadn’t felt that the right to property only extended as far as the property ‘rights’ they could take by force from people who were, in their opinion, executing them properly.

    If such rights are inalienable, i.e. they cannot be taken away by others, then I assume all the non-native residents of the US, Australia and a few other countries will be heading home? No? Really… then how can property be inalienable if a force a few generations ago can remove it. Unless, actually, it’s an extention of the commonly agreed rule of law?

    Jeff:
    So how come the cost of a private hip replacement in socialist Britain is less than the cost in market driven America? Unless there is some other factor than straight supply and demand at work?

    When you collapse at Barnes and Nobel with chest pains and shortness of breath – how do you make your decision on which ER to go to? Have you picked out the right mix of cardiologists to treat your heart attack? What if it’s just anxiety? Have you got a diagnostic team on speed dial? Can you self diagnose so you can make a decision while your chest is pounding?

    Or do you go to the ER and hope they know what the hell it is?

    If it’s the last option, then you’re not actually working as a rational actor in a free market.

    Even in an imperfect market, increased demand without increased supply raises prices [or causes shortages]. Can you provide a counter-example?

    Ah! I see what you did there – that ’causes shortages’ rider.

    Because the short version is healthcare and money, both operate atypically to what you are suggesting. Not to mention that the Wikipedia page on Supply and Demand has a lot of discussion of the various problems with classical Supply/Demand curves.

    Paul Krugman would argue, convincingly, that currently the supply/demand curve for money is inverted as we are in a liquidity trap.

    There is no shortage of money, companies are sitting on record profits, but that’s not leading to increased demand for services. Under classical theories that much money supply should be leading to runaway inflation and need higher interest rates to control.

    Like with the healthcare elsewhere this is notable by the fact it isn’t happening.

  299. The mind boggles. Regulation – there’s NOTHING it can’t do!

    So Glass – Stegal wouldn’t have avoided the Bond Market lunacy that led to a market being created in fictional entities that were cross insured for amounts that exceed many multiples of GLOBAL GDP then?

    That was a rhetorical question btw…

  300. Daveon:

    “So Glass – Stegal wouldn’t have avoided the Bond Market lunacy that led to a market being created in fictional entities that were cross insured for amounts that exceed many multiples of GLOBAL GDP then?”

    A particular regulation MAY (or may not) have prevented a particular market crash. Of course, those very same regulations may also cause distortions which throw other factors off-kilter to cause other bubbles and crashes. For example, wage and price regulations during WWII lead directly to the US employer-based health insurance system. Tax policy regulations (employers get to deduct “medical costs”, private citizens do not) reinforced the move to 3rd-party payer models (i.e. end-consumer price-insensitive medical care consumption] that have driven the cost of health insurance and health care into a byzantine price-muddled world where we “need” something like the ACA.

  301. So, Jeff, in that case – I agree with you. Regulation. There is nothing it can’t do.

    Sometimes it gets things wrong and should be changed – by, say, a bill like the ACA.

    Sometimes, like with Glass Stegal, it’s there for a bloody good reason.

  302. Jeff: Tax policy regulations (employers get to deduct “medical costs”, private citizens do not) reinforced the move to 3rd-party payer models (i.e. end-consumer price-insensitive medical care consumption] that have driven the cost of health insurance and health care into a byzantine price-muddled world where we “need” something like the ACA.

    This is complete and utter bullshit. There is no government regulation that forces a health insurance company to rescind policy holders, or refuse to take a new customer due to preexisting conditions. That’s just plain old fashioned Corporate Greed, through and through.

  303. Daveon, Justin

    Your examples of the imperfect application to the concept of rights seem to me to be better understood as imperfect application of the concept of personhood. As that concept has expanded from property owning men to its current definition, the application of rights has expanded apace.

    Your answer and Justin’s seem to suggest that “rights” are just polite fictions of the moment which we maintain as it suits us. In the examples you cite I don’t see a distinction between a right to life, a right to property, and a right to healthcare, other than that which is politically achievable. If it is all politics, and there is no moral stopping point where one citizen’s right to medical care is trumped by another’s right to property, life, or liberty, then I don’t see the point of a constitution of ennumerated powers. Rights are what the majority says.

    I’ll grant you that this has been the case for the vast bulk of human history, but then again, the vast bulk of human history was summed up by Hobbes. Thank you for discussing your vies on tis with me.

    Regards,

    ZBBM

  304. ZBBM: Rights are what the majority says.

    How do you ammend the constitution but by a large majority? Three-fourths of the State’s legislatures are needed to ratify an ammendment to the constitution.

    Which reminds me of how to be a professional Libertarian:

    Step 1
    Take any statement about any progressive program created at any point in the last hundred years:

    *”State run health care takes healthy people to provide care for the sick.”
    *”Affirmative action means to give racial minorities social advantage.”
    *”Women are trying to be paid equally with men.”

    Step 2
    Add an exclamation point:

    *”State run health care takes healthy people to provide care for the sick!”
    *”Affirmative action means to give racial minorities social advantage!”
    *”Women! Are trying to be paid equally with men!”

    My GOD, our RIGHTS can be AMMENDED by whatever the MAJORITY SAYS!!!!!

    GARGLEBLARGLEGLARGLE!!!!

  305. As a note, I think we’re beginning to drift into more general areas of political philosophy, so let’s try to tighten things up, please, and come back around to the main topic.

  306. “Justin’s seem to suggest that “rights” are just polite fictions ”

    I’ll flat out say it, actually. I’d argue over the of the moment bit, which I excluded, but barring believing that those rights are guaranteed by god, of course they’re polite fictions. The point of inalienable rights is that we act as if people have those rights. If, in fact, rights were not a polite fiction, then we wouldn’t need to discuss them and build laws around them. They would simply exist.

    On the other hand, you’ve lost me with:
    “If it is all politics, and there is no moral stopping point where one citizen’s right to medical care is trumped by another’s right to property, life, or liberty”

    For one thing, there’s no guarantee of property in the constitution. Oh, certainly, it’s implied. And of course, life, liberty and pursuit of happiness isn’t there either. But why should property right supercede the right to healthcare.

    I am not actually making a moral argument. If you believe that is morally wrong for the government to take away whatever, I won’t argue with you, because that’s an opinion. If, though, you say that it’s the best way to accomplish the goal of allowing people life, liberty, and the pursuit of happiness, that might be worth discussing.

    You’re also strawmanning a bit. For one, no one has said there isn’t a “moral stopping point” like you’re implying. I personally don’t consider it a moral issue – there is certainly a point where it would tip over into diminishing people’s life, liberty and pursuit of happiness.

    To use an example in this thread, I think on the whole, Swedan has tipped over that point. But loads of Swedes and other folks would disagree.

  307. Pulling it back into the topic at hand.

    Yes, I think rights are, generally speaking, a polite fiction and what is and isn’t will evolve over time. Consequently, I think there is a right to healthcare, just as I think we should have a right to clean air to breathe, clean water, drugs that won’t kill you and a bunch of other things.

    I hope that as we evolve as a society and a species, we’ll move to a point where all the basics are provided as a ‘right’ because I believe that is the correct thing to do morally.

    As money and wealth are also abstract concepts created by consensus I don’t necessarily buy the idea that the things you earn/own are necessarily completely yours, hence taxation for the general good is acceptable morally.

    I’d rather see a single payer system, as all the emperical evidence shows that’s the most cost effective way to deliver healthcare. The ACA is at least a start in righting a terribly wrong though.

  308. While I prefer a single-payer system as well, getting from where we are now to there is a slow process. Doing it as a single drop-dead changeover would cause problems.

    Much as I hate the healthcare insurance industry, the economic consequences of having the whole industry go “poof” are not to be taken lightly. And SP being more cost effective means, among other things, that it will employ fewer people.

    Now, there are also no slave overseers, hangmen, or (less loadedly) scriveners or buggy-whip manufacturers left in the America. But we don’t want to do this change too fast.

  309. I did a word search, and I find it interesting that “Veterans affairs”, “VA”, and “military” (at least regarding military healthcare) do not appear in this thread. I have practiced medicine in both VA and DoD hospitals. These are the best examples we have of smaller single payer systems nestled in the larger overall US system. My experience is that there is a tendency in these hospitals for a high percentage of time and cost to be spent on non-clinical activities, difficulty in maintaining provider/patient continuity, longer wait times than civilian counterparts, and many other ways in which the reality does not meet the image projected here of single payer as the best overall solution. I’m curious as to how many on this thread (which, admittedly at this point is about 5 people) have experience in one of these two systems, and also as to how you think such challenges will be overcome by committing a larger percentage of our healthcare to such systems.

  310. . But there’s already no price signal for uninsured people at the ER, since their care is “free” already.

    If it’s actually free, why the scare quotes? Perhaps because it’s not actually free; it’s merely obligatory. The ER is happy to bill you even if it can’t force you to pay before treatment. Sometimes ER personnel will try and bill you during emergency treatment, apparently.

    The real reason there’s no price signal is that it’s an emergency room. People going to the ER generally don’t have time to compare prices and attempt to negotiate the cost of care.

    @ZBBMMcfate, from a totally anecdotal sampling, I hear more horror stories about care from for-profit Kaiser than I do from government-run VA.

  311. ZBBM: “Veterans affairs”, “VA”, and “military” … My experience is that there is a tendency in these hospitals for a high percentage of time and cost to be spent on non-clinical activities, difficulty in maintaining provider/patient continuity, longer wait times than civilian counterparts, and many other ways in which the reality does not meet the image projected here of single payer

    I see your anecdotal data and raise you a number of studies:

    http://en.wikipedia.org/wiki/Veterans_Health_Administration#Overall_Evaluation

    2008: patients rank VA above alternatives for customer satisfaction. Got “satisfied” rating for 85% of inpatient treatment compares to 77% for private hospitals. 3% higher for outpatient care.

    2004: a RAND Corporation study showed VHA outperform ALL OTHER SECTORS of american health care in 294 measures of quality.

    2009: CBO report showed VHA care favorably with that provided to non-VHA patients.

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