Healthcare and the Supreme Court

[sukeban]

Greetings all.

 

The Supreme Court recently heard the government's closing arguments with respect to the Affordable Care Act of 2010 and will render its verdict later on this year. It appears likely that the Court, lead by its five Republican Justices, will rule against the Individual Mandate, the centerpiece of the bill. Without going too far into the weeds about it, such a ruling would likely nullify nearly the entire bill, leaving us with essentially the same healthcare system that we had prior to 2010.

 

My question is this: Do you agree with this ruling? And if so, why? On legal grounds because you dispute such a wide reading of the Commerce Clause of the Constitution, on philosophical/political grounds because you dislike perceived government overreach, on practical terms because the healthcare system was working fine for you or maybe because you dislike President Obama and want him to fail whenever it is possible.

 

Additionally, most Americans believe that our present healthcare system is failing; what would you, the anti-Affordable Care Act respondent, replace it with? If you do happen to agree with the Act, will you be happy if it is upheld? Or would you rather have seen something else passed by Democrats in 2010, something more expansive, something better?"

 

NOTE: Please don't call it "Obamacare"--that's not it's real name.

Edited March 29, 2012 by sukeban

[Aurielius]

I think that it is premature to read the tea leaves with the Supreme Court in terms of which way it will rule. The court may only strike down the mandate which is the weakest part of the governments case because it does violate the commerce clause and they (the government) are arguing one day it's not a tax but a penalty and the day next the opposite. The Medicare provisions may well stand the test of constitutionality but without the underpinnings of funding will be a stranded whale piece of legislation. Though it was more than a year or so ago there was a contentious debate here about it's passage and I will not back away from my prior opposition to the bill. The largest burden of this bill still falls on small companies and it is still my beleif that it will inhibit and stagnate economic growth with small firms, the provisions have made us (as owners of a small company) rethink new hirings as cost prohibitive.The consensus among colleagues in our industry is much the same, so where does the economic recovery come from when retrenchment is more viable than expansion?

 

It will be little surprise that I oppose it on philosophical grounds as well, it is an intrusion into the rights of the individual and exceeds the authority granted to the federal government granted in the Constitution. This bill of the Obama administration (see how I avoided calling it Obamacare..) was crafted behind closed doors and rammed down our throats without diligent inspection of it's provisions. Pelosi and her minions claimed that it would only cost 1.56 Billion which is now proved fallacious, the estimated cost is closer to 1.76 Trillion dollars (GAO estimates). Aside from the fact that it is not universal health care considering the various deal brokered exemptions to gain passage. For the record I am not against true Universal Health Care but having experienced both Canadian and UK health care which are appalling in actual functioning practice, this is not a model that I would wish on anyone. I have great respect for our northern neighbor and anyone who knows me, knows that I am even more fond of the UK, so this is not intended as a slight to either nation, but the socialistic path that both have taken is a recipe for economic decline. I have lived in both countries so my experience is not secondarily anecdotal.

 

As per usual I await with droll amusement and anticipation the rebuttals from it's advocates...

Edited March 29, 2012 by Aurielius

[marharth]

I am going to leave my response pretty short.

 

Obama is a corporate robot as much as any other politician is. It is silly to think he passed the bill to help everyday people. I wouldn't trust Bush with any kind of healthcare bill, I see no reason to trust Obama with any kind of healthcare bill.

 

The bill should be repealed and replaced with a form of universal healthcare.

Edited March 29, 2012 by marharth

[pseudobio]

I am not opposed to the idea of a universal system, however, this particular attempt to reform the health care system leaves me a little disturbed. As one of those 30-50 million uninsured it proposes to help, I might find myself financially hurt by the requirement to buy. There are high risk insurance pools set up under the law in many states to cover disabled people like me, but, if my status as a family of one making about $25,000 a year disqualifies me for that high risk pool, I'll be stuck having to buy health insurance that is about half my monthly income. I think that most people would agree that paying one of your two monthy paychecks to an insurance company is a bit much, but that is how much they jack up the insurance rate to discourage those of us with disabilities from getting insurance. That $750 per month would require me to do one of three things: 1) divert my food budget to cover paying the insurance (a complete non-starter), 2) default on my student loans to cover paying for it, or 3) fail to buy and pay about $2000 a year as additional income tax. The fail to buy and pay $2000 is my best choice, though it isn't in the interests of my fellow citizens. I certainly pray that I can qualify for my state's high risk pool, for without it, I'm screwed.

[sukeban]

I am of two minds regarding this issue, actually.

 

The first views it as a threat, the second as an opportunity. The first is easy enough. Though I dislike the bill as it is written, it is at least a small step toward reform--really, the only progress made in the realm of healthcare since LBJ and the Great Society. In that sense, I would be dismayed to see it struck down (as, as per Aurielius--if the Mandate is struck, the Act no longer has a revenue stream--rendering it essentially void). Sadly, it might be another forty years before the issue was ever revisited.

 

However, part of me almost wants the Act to be stuck down--as a (likely naive) challenge to our nation to pass something better. Marharth is totally correct in saying that the Act was a lobbyist-concocted windfall for the insurance companies, whose coffers would be lavishly padded by the millions of Americans uniquely compelled to purchase their products. Plus, with the insurance companies still the primary brokers of insurance--and continuing to pay doctors on a fee-for-service basis--I would have severe reservations that the Act would actually succeed in stabilizing the cost of healthcare in the country.

 

As a younger person this is very important to me. I lament the increasingly large percent of GDP and federal budget spent on healthcare--and Medicare in particular--while premiums, drug, and procedure costs continue to rise unabated. All this because of the rapacious demands for healthcare by a large and aging segment of the population (Boomers, and their parents before them) and the pricing of said healthcare on a per-service basis rather than taking into account positive health outcomes or procedure efficacy. What this amounts to is a massive transfer of wealth from the young and middle-aged to the elderly, from two demographics that are under-using healthcare (preventative care) to another that is over-using it (ludicrously expensive end-of-life and palliative care).

 

I don't want to sound mercenary, but perhaps it can't be helped. I suppose that I view this as absolutely not a rational allocation of scarce public dollars. Which is why cost control--and yes, rationing--is needed to bend the cost curve downward. Taiwan is widely considered to have one of the dollar-for-dollar best healthcare systems in the world. Taiwan also does not provide chemotherapy to citizens over 90. Why? Because it is not a rational use of public resources. Not when there are children to be educated and hungry mouths to feed.

 

Hrmm. This is getting long and I haven't really even addressed what it was that I started out to say. Another post, I suppose.

Edited March 29, 2012 by sukeban

[HeyYou]

I think it is unconstitutional. This opens the door to the slippery slope of the government trying to legislate the economy. Not to mention, calling the entire thing "Healthcare Reform", when it has little to do health CARE, and everything to do with health INSURANCE. And it isn't "reform" by any stretch of the imagination either. The whole thing is a pie in the sky farce, which the dems wanted to pass, so they would have something to point at come election time and say "See what we did? We reigned in insurance companies." When that isn't true either. (and I find it MOST amusing that here we are in an election cycle, and NONE of the dems that passed this clusterfork are touting it as a feather in their cap.)

 

Congress needs to start over again, treat the PROBLEM, not just poke at symptoms.

[sukeban]

I think it is unconstitutional. This opens the door to the slippery slope of the government trying to legislate the economy. Not to mention, calling the entire thing "Healthcare Reform", when it has little to do health CARE, and everything to do with health INSURANCE. And it isn't "reform" by any stretch of the imagination either. The whole thing is a pie in the sky farce, which the dems wanted to pass, so they would have something to point at come election time and say "See what we did? We reigned in insurance companies." When that isn't true either. (and I find it MOST amusing that here we are in an election cycle, and NONE of the dems that passed this clusterfork are touting it as a feather in their cap.)

 

Congress needs to start over again, treat the PROBLEM, not just poke at symptoms.

I would find myself agreeing with you, HY. The Mandate likely is unconstitutional. However, the same could have been said about the 1964 Civil Rights Act as well. I would wonder, if he were available for comment now, what Earl Warren would say about upholding the Act, and whether or not he did so on its legal merits or merely because it was politically expedient at the time--as well as being the morally correct thing to do. Now, upholding the Mandate may or may not be the politically expedient thing to do this time around (especially for Republican Justices...), it may also not be the morally correct thing to do either. My larger point is that, IMO, the Supreme Court has long ago ceased to be a purely judicial body, and has now morphed into an extension of our Congress, complete with the petty partisan bickering and deployment of party-generated talking points during hearings.

 

Which brings me back to what I was talking about before--that this might be an opportunity. I am no particular fan of Obama, nor the Democrats, but I would vote for them wholeheartedly if, after being reprimanded by the Court, they adopted single-payer as their signature initiative for 2012. I would vote for them and I would volunteer for them, doing whatever I could do re-elect a Democratic House and help the Democrats hold 50 seats in the Senate (51 votes counting Joe Biden), all so that they could pass--via budget Reconciliation--a single-payer healthcare reform.

 

Additionally, if the law is struck down, I view that as more beneficial to Democrats than it will be to Republicans. Republicans will likely accuse Obama of being some sort of quasi-dictatorial Constitutional usurper, but, with "Obamacare" nullified, there isn't really any other obvious symbol of his Presidency remaining, apart from the man--and the demographic changes that his achievement represents--himself. Meanwhile, Democrats and independents will have witnessed yet another example of conservatives discarding attempts at needed reform whilst proposing nothing of their own as an alternative. That could be enough--when coupled with Mr. Romney's seriously flagging approval rating--to drive independents back into the Obama fold, as well as rally dispirited liberals who might have considered staying home. In any case, the Senate will be an extremely difficult body to hold (check the link and weep in despair), but holding onto 50 seats is not an impossible outcome.

 

Senate Election Prognostication--

 

Democrats will slam-dunk lose seats in North Dakota, Montana and Nebraska, bringing them to a rump 50. They have even-odds or lower to lose seats in Missouri, Virginia, Florida, Ohio, West Virginia, Pennsylvania, and New Mexico. Likely all of these will be contingent upon Obama winning the states in the general election (and having the Senate candidates ride on his coattails). If I had to assign states now, I'd say that Obama wins Ohio, Pennsylvania, New Mexico, and Virginia. This would also give him the election. He will likely lose Missouri and West Virginia. Florida will truly come down to the wire, but I think it will break for Mr. Obama against Mr. Romney. Even if this is the case, however, the Democrats are still down to 48 seats in the Senate.

 

But--there are some pickup opportunities. I am going to say that I believe the Democrats will pick up Massachusetts, getting them to 49. They may now pick between Indiana, Nevada, and Maine for the remaining seat. I would lean toward Maine as being the most likely, but I haven't seen any polls to corroborate that seeing as how Ms. Snowe has only recently announced her retirement. Nevada could also be a distinct possibility, and might be necessary if the Democrats lose in Florida or Virginia. Indiana has been trending increasingly red the last few election cycles, so I think that it will probably stay in the Republican fold. There are not, barring a ridiculous scandal, any other real possibilities. However, if Obama wins on election night, I would predict that it would be more likely than not that Democrats would still have a 50+Joe majority in the Senate. Their chances of picking up the House would also be greater than 50%.

Edited March 29, 2012 by sukeban

[pseudobio]

I am of two minds regarding this issue, actually.

 

The first views it as a threat, the second as an opportunity. The first is easy enough. Though I dislike the bill as it is written, it is at least a small step toward reform--really, the only progress made in the realm of healthcare since LBJ and the Great Society. In that sense, I would be dismayed to see it struck down (as, as per Aurielius--if the Mandate is struck, the Act no longer has a revenue stream--rendering it essentially void). Sadly, it might be another forty years before the issue was ever revisited.

 

However, part of me almost wants the Act to be stuck down--as a (likely naive) challenge to our nation to pass something better. Marharth is totally correct in saying that the Act was a lobbyist-concocted windfall for the insurance companies, whose coffers would be lavishly padded by the millions of Americans uniquely compelled to purchase their products. Plus, with the insurance companies still the primary brokers of insurance--and continuing to pay doctors on a fee-for-service basis--I would have severe reservations that the Act would actually succeed in stabilizing the cost of healthcare in the country.

 

As a younger person this is very important to me. I lament the increasingly large percent of GDP and federal budget spent on healthcare--and Medicare in particular--while premiums, drug, and procedure costs continue to rise unabated. All this because of the rapacious demands for healthcare by a large and aging segment of the population (Boomers, and their parents before them) and the pricing of said healthcare on a per-service basis rather than taking into account positive health outcomes or procedure efficacy. What this amounts to is a massive transfer of wealth from the young and middle-aged to the elderly, from two demographics that are under-using healthcare (preventative care) to another that is over-using it (ludicrously expensive end-of-life and palliative care).

 

I don't want to sound mercenary, but perhaps it can't be helped. I suppose that I view this as absolutely not a rational allocation of scarce public dollars. Which is why cost control--and yes, rationing--is needed to bend the cost curve downward. Taiwan is widely considered to have one of the dollar-for-dollar best healthcare systems in the world. Taiwan also does not provide chemotherapy to citizens over 90. Why? Because it is not a rational use of public resources. Not when there are children to be educated and hungry mouths to feed.

 

Hrmm. This is getting long and I haven't really even addressed what it was that I started out to say. Another post, I suppose.

 

So your point is that the elderly and disabled are dead weight and that they have much less value than YOU? So lets cut away the dead weight and throw them to the wolves so that YOU can have more?

 

No--I do not think that is exactly what she is saying. Don't start engaging in personal attacks. You are new so I will let you know to keep to the argument as the facts. Perhaps ask how this would help. How can one do this without sounding like you just said. Or show how not valuing our elders hurts society. Get my meaning? Thank you have a nice day.~Lisnpuppy

[pseudobio]

Sorry Lisnpuppy and Sukeban, personal attack warning understood. For me, this is a bit more personal and emotional than for Sukeban, our thread OP, perhaps. I am a member of one of the groups (disabled) that others specifically have said (in other forums threads on health care) need their health care rationed in favor of another group, and am fast reaching the age of the other group (elderly) usually mentioned needing rationing as well. On several of those other forums, the rationing proponents were very clear about worthiness of one group over another, and that is rather disturbing to me.

 

Ok, how will rationing help without hurting specific groups like the elderly and disabled? And if we are rationing, why should only specific groups have their health care rationed? Why not ration everyone's care equally? I also see equal healthcare as one of the civil rights issues those of us with disabilities need to fight for, as well as equal acess and equal employment. Without equal healthcare, getting the assistive devises some of us in the disabled community need might be more difficult. How can we ration care while still providing quality care for everyone? Too me, no one group needs to suffer less care while other groups get better care, because that creates new majority vs. minority rights issues. Historically speaking, minorities have almost always lost, until the last 100 years or so.

 

Apology accepted and kudos to you for being able to own up to a mistake.~Lisnpuppy

 

[HeyYou]

I too fall into the category of Disabled. (I have MS.) I am also 51 years old, so, rapidly approaching 'elderly' status as well..... None of the health care reform applies to me though, as I am also a veteran, and my health care is taken care of by the veterans administration. So what's my dog in this hunt? Congress assuming powers that are what I consider WELL beyond anything they are constitutionally entitled to. If the supreme court upholds the individual mandate on health insurance, that basically gives them the power to mandate folks purchasing other products as well, simply because it would help the economy. Kinda. After all, the housing market is in deep dark trouble, now, if everyone were legally required to buy a house, the market would recover..... or the automotive industry.. if everyone were required to buy a car, that would be a big shot in the arm for them.

 

There are many other examples that could fall into the same category. I, for one, Do NOT want the government dictating how I spend my money.