Supreme Court Health Care Decision Thread

[JeanFromBNA]

This recently over-marketed Libertarian narrative that the 'collective expenses' of a society are just a means of redistributing the wealth is a dangerous narrative.

What's worse is all the unnoticed real re-distribution that is going upward to corporations like the oil companies, the military industrial complex and like the farm subsidies that go with certain parcels of land and are not based on any real need to keep commodity prices stable.

Very few ideas are really "dangerous." Actions can be dangerous, but describing an idea as dangerous is at best a way to cut off discussion. I don't buy it.

To answer you and RandFan both, the pie is only so big. We can disagree about how big it should be, but at some point, we can't make it any bigger. We can vote ourselves all of the benefits that we ever wanted, but they will have to be paid for.

My personal opinion is that health care reform legislation is long overdue, and a wealthy country like the US is able to provide for the basic healthcare needs of its citizens and should do so as a matter of promoting the general welfare. This 2400 page "mismosh of legislation," as somebody called it above, will do little than create more confusion and more bureacracy and more laws to sort out the confusion.

I'm not sure how oil companies and the "military industrial complex" relate to the health care decision. I oppose most corporate, farm/market or personal subsidies.

 

[Kestrel]

Fire prevention is a big part of the fire service. Making out public buildings like supermarkets, stores, etc. safe from fire is a huge part of the fire service. They also have measures that they enforce that require certain life safety devices are in place in case of a fire. The fire department is vastly a polar opposite of the police, just by their nature. Fire departments are very proactive, where a police department is reactive. They can only do so much to prevent crime. Whereas the fire department can revoke a person's certificate of occupancy for a business that is unfit WRT: life safety, thereby preventing them from endangering people.

I always call the fire marshall when I notice a business doing something really stupid like blocking a fire exit. The good news is that I haven't had to do it for years.

 

[Skeptic Ginger]

...
But, it's really not. People don't get a rebate if they already have health insurance. People do now. But now it makes those that don't, who can't claim that rebate on their taxes, pay more in taxes. Above and beyond not getting the deduction.

I'm trying to figure out what you are saying here and I can't.

 

[Skeptic Ginger]

I directly benefit from their presence, and can utilize them at any cost. It's also a law that the government provide those services. However, everyone does not pay those taxes. Here in my county, and city, I pay those taxes because I own my home. People whom rent, or live in apartments, do not pay. Granted, the property owners do.... But I digress.

You directly benefit just as much from that ED being in your town.

And those I can use at any time, without additional fees, for the most part. (toll roads of course. Plus, the trucking companies that supply my food, water, and commercial goods use them, and as such, greatly benefit me)

It's interesting to me how you are conceptualizing these things in your head.

You have roads you don't use, but you could use them, police and fire you don't use but you could use them, and hospitals you don't use but you could use them, yet all these things seem different to you.

No, you pay medical costs because medical facilities pass their losses on to the insurance companies, and the insurance companies pass that fee on to you. It is NOT a tax levied by the government. The government doesn't run the hospitals (for the most part) private companies and NPO's do.

Same strange parsing here. I pay for people who don't pay. It's not the government causing me to pay that cost, it is the uninsured person who used care he/she didn't pay for.

There are two ways to deal with this. Either the burden for this unpaid care is unevenly put on the people who do pay, or it is more fairly distributed through public funding.

The government requires insurance when someone costs other people money by driving and crashing. The government requires everyone to pay for police, fire and military services.

You seem to be saying it's OK that those uninsured people cost me money but it is not OK the government protects me by making them pay.

(Just whatever you do, don't take anything I say personally. I fully support AHCA because it DOES make it fair for everyone, and makes our country, as a whole, better. I'm simply basing this from "their" side.)

Not taking anything personally, I take it as strange but true: human brains experience reality differently.

 

[Skeptic Ginger]

...
And that makes no difference. The hospital provided a service, and as such, should be paid for their service. They are also very much funded by private insurance also.

I think you are mistaken about just what percentage of the money to run hospitals are government funds but it's not necessary to take this any further.

...Firefighter paramedic. (Irony, I know.... )

 

[Skeptic Ginger]

Really? Citation please? That wasn't something I saw....

Just Google "13 million rebates".

Nearly 13 Million Expected To Get Insurance Rebate

Health insurers are set to give out a total of $1 billion in rebates to nearly 13 million Americans this summer, an average of $151 per family.

The rebates come from a provision in the 2010 health care reform law, known as the 80/20 rule, which punishes insurers who spend too much of premiums collected for boosting company profits instead of paying for medical care. Under the law, insurance companies are required to spend a minimum of 80 percent of consumer's premiums on medical care.

I fear nothing, and if you'd have read my more recent posts, you'd realize that I am 100% FOR AHCA. Why there's such a stink about it is because of idiots who've not done their own research, and adhere to party lines like rabid dogs. ....

By repeating the right wing narrative, we are contributing to those idiots' beliefs. Fighting talking points with talking points is a problem Progressives just haven't gotten a handle on.

 

[Skeptic Ginger]

SG, you're smarter than that. Someone postured that it was a reward for buying health insurance. Which, the opposite of a reward is a penalty.

Hence, it could not be considered a reward, it's a rebate for some, and a tax for some.

That's not what I was referring to. Here's your full quote:

It does. If I am penalized for say, not paying my income taxes, I can request a hearing to dispute the penalty.

If I receive a ticket, a penalty for not obeying the state speed limit, I can elect to have a court hearing to dispute the penalty.

Calling this a penalty, and not allowing any recourse and due process, violates mine, and your, constitutional right.

Perhaps I didn't read that right but the bolding is what my comment referred to.

 

[Skeptic Ginger]

Didn't know that this originally was a GOP idea in the 80's. ...

"The Heritage Foundation" is where the mandate was first described.

 

[ZirconBlue]

I disagree with this...

My premiums are about $1,200 per year, not including any co-pays I might have...which is exceptional low considering what I see others pay. Some pay as much as $5,000 a year.

If I didn't have an HCP, I'd be fined $600.

I hardly see paying 2-9 times more than the fine a "reward". Some people are just plain going to not buy a HCP because, heck, it's still cheaper not to.

Except that you not only don't have to pay the $600, but you also have health insurance. The person paying $600 still doesn't have health insurance. You paid a large amount for insurance. They paid a small amount for nothing. Therefore, your 2-9 times more got you infinitely more than their $600.

So now, because the insurance companies are really scared, they've basically worked their way into the good graces of the Republicans, ($$$) and they now oppose it.

I think the insurance companies are for it. The individual mandate gives them a whole bunch of new (mostly young, healthy) customers they didn't have before.

 

[Skeptic Ginger]

Very few ideas are really "dangerous." Actions can be dangerous, but describing an idea as dangerous is at best a way to cut off discussion. I don't buy it.

Using propaganda to manipulate how people perceive an issue can indeed be dangerous. I'm referring to distorting reality as is often what propaganda refers to.

This is what I said:
This recently over-marketed Libertarian narrative that the 'collective expenses' of a society are just a means of redistributing the wealth is a dangerous narrative.

The result is people like those in the TEA Party believing the poor don't need help and are really free loaders. I don't want to take the thread too far off topic debating whether every person on welfare is a lazy freeloader. But when you convince enough people that the society has no valid needs that the public should be obligated to fund collectively you end up with really bad results.

So it is a dangerous idea because it is a lie.

To answer you and RandFan both, the pie is only so big. We can disagree about how big it should be, but at some point, we can't make it any bigger. We can vote ourselves all of the benefits that we ever wanted, but they will have to be paid for. ....

... I'm not sure how oil companies and the "military industrial complex" relate to the health care decision. I oppose most corporate, farm/market or personal subsidies.

You talk about the pie being only so big and you don't see how corporate welfare relates?

Is there as much public outcry over that corporate welfare as there is over this health care expenditure of pie pieces?

 

[JoeTheJuggler]

My problem with this is simple. It's a tax on nothing. I received no product or service, and I would be taxed on...nothing.

It's a tax penalty (and there is case law that says tax penalties are indeed taxes, as long as they're intended to raise revenue aside from also enforcing compliance to regulations).

If you pay your income tax late, you will likely be charged a penalty. Isn't that also "a tax on nothing"? Is that outside the taxing authority of Congress? [ETA: In fact, the same point can be made wrt any income tax, the payroll tax, property tax, etc. The only kind of tax that is a tax on a product or service are the various types of sales taxes. As far as I know, Congress doesn't use sales taxes at all.]

The tax on "nothing" ignores the fact that the uninsured cost the healthcare system over $40 billion in 2004. The regulation is intended to prevent gaming the system (especially since we now ban insurers from using pre-existing conditions to deny insurance, claims, or to charge higher premiums).

 

[JoeTheJuggler]

I don't know about that, but I do know that the tax is much cheaper than buying health insurance. So if you are healthy and young, it's pretty easy to game the system. Don't buy health insurance and just pay the tax. If you do get sick, go out and buy health insurance, because after all, they can't discriminate against you for your now pre-existing condition.

And if this happens enough to matter, Congress can increase the tax penalty.

I'm guessing it won't because having minimum essential coverage also gets you that no-out-of-pocket preventive care stuff. In the long run, it will probably cost you more to pay the penalty.

 

[JoeTheJuggler]

But then, using the same rationale, there's lots of taxes for things you don't do.

There's a tax credit for having children. Does that mean I'm taxed if I don't have them?

Here, there's a tax credit for first-time home buyers. I guess I'm taxed because I still rent.

Since there are all sorts of deductions for doing things, does not doing them mean you're taxed for not doing them?

Exactly. And again*, these distinctions between paying a tax and not receiving a tax credit matter to the federal budget.

*ETA: Sorry--the "again" was because I thought I was back on this thread.

 

[JoeTheJuggler]

Hence, it could not be considered a reward, it's a rebate for some, and a tax for some.

But it's not.

In those terms, it's a tax for some and not a tax for some.

The CBO estimate of revenues from this tax penalty is $0.4 trillion (over the 10 years, I assume). If it were a tax credit (paid to those who comply but denied those who don't) the effect on the budget would be the opposite.

[ETA: If it were both, as you describe it, the net effect would also be loss of revenues to the federal government, since far more people will comply than not.]

 

[Sabretooth]

I think the reason that so many Republicans are so up in arms about this is due to the mandate alone. I really don't see a problem with the AHCA other than this provision.

I mean, when you get to the brass tacks, the government is ultimately forcing you to get health insurance. IMO, it's a borderline invasion of government into private lives. Americans should have the right to choose without fear of penalty. I'm not happy about it either, but I understand (for the most part) why they are doing it.

I haven't been through the whole thing yet, but on the surface, I'm finding that the AHCA is a good plan in it's intention. It makes sense to get citizens of the USA proper insurance...but is it really going to reduce cost? I mean, people have mentioned MA having a similar system that is working...but MA also has the highest premiums in the country. I'm not convinced that this plan isn't going to drive up costs and take more money out of my already thin pockets.

Still - I'm willing to take a wait-and-see approach for now.

I don't want to see us have a system like Canada (sorry, neighbors). I mean, how good can it be if Canadians are coming over the border to pay cash for services here instead of getting them free back home? I can't imagine that is a sign of a working system.

Anyway, I'm ranting...sorry.

 

[Brown]

I have seen so many comments on the health care ruling, many of them pig-ignorant, many of them thoughtful. The pig-ignorant ones are usually pretty easy to spot: they are characterized by clever phrases that praise or condemn the ruling, but are devoid of any reasonable analysis of the issues. In many cases, jumping straight to the conclusion is a sign of not having read the actual document that one is effusively praising or condemning.

Many on this very forum have taken the "thoughtful" path. My hat is off to you.

I have identified about a dozen angles for commentary, and found that others have already written on those topics. So here is one that I'm not sure has been written about yet:

The Commerce Clause issue is indeed a sticky one, and it was decided upon what seems to be a rather unusual ground. Quoting Chief Justice Roberts: "Given its expansive scope, it is no surprise that Congress has employed the commerce power in a wide variety of ways to address the pressing needs of the time. But Congress has never attempted to rely on that power to compel individuals not engaged in commerce to purchase an unwanted product." Congress can regulate commerce, said the Chief, but Congress cannot force people to engage in commerce. Congress can monitor activity, said the Chief, but Congress cannot force people to become active.

The dissenting justices echoed this theme: "But that failure—that abstention from commerce—is not 'Commerce.' To be sure, purchasing insurance is 'Commerce'; but one does not regulate commerce that does not exist by compelling its existence."

The distinction between activity and passivity (as it is sometimes known) is well-known to other fields of law, notably tort law. There are circumstances in which actively doing something to hurt another person leads to liability, while sitting back and letting another person be hurt by your inaction (while morally disgusting) leads to no liability. There are reasons for such rules. If you act, you have a legal obligation or duty to act reasonably; but if you are "not involved" and if you have no legal duty to do anything, the law cannot go against you if you choose not to become "involved." You can sit back and watch the tragedy unfold. Light up a cigar and watch a child drown, if you like, even though you could easily save that child's life at virtually no risk to yourself.

The difficulty is that sometimes it is awfully damn difficult to tell "active" from "passive," and the law books are full of actual cases (as well as hypotheticals) in which the active-passive distinction does not make sense. In some legal cases, appellate courts have done away with the distinction, or have directed that liability based upon action and liability based upon inaction are to be treated on more or less equal footing.

Yet this is the distinction that five justices of the Court found to be so important.

 

[RandFan]

I don't want to see us have a system like Canada (sorry, neighbors). I mean, how good can it be if Canadians are coming over the border to pay cash for services here instead of getting them free back home? I can't imagine that is a sign of a working system.

Where do the Americans go when they can't get health care? (see links below, it just might surprise you) I don't understand your argument. Here we are, the industrialized nation with ¹the highest per GDP health costs, fastest rising costs, little to no preventative medicine for a large section of the population. It's become so bad that many poor Americans are getting health care from ²Military personnel and ³volunteer doctors working in stadiums and country fairs. You don't think that is a sign of a broken system? Did you know that many Americans ⁴go to other countries for health care? Did you know that ⁵many Americans go to Canada? Did you know that ⁶Canadians are overwhelmingly happy with their system?

1. U.S. scores dead last again in healthcare study
2. A health care 'Judas' recounts his conversion
3. Using the military to provide health services
4. Medical tourism.
5. Americans go to Canada for health care to save money.
6. Canadians are (gasp!) happy with their health care system, and don’t want ours

What does all of that say about the comparison of the two systems? I'd take their system in a heart beat.

 

[Bob001]

..... Congress can regulate commerce, said the Chief, but Congress cannot force people to engage in commerce. Congress can monitor activity, said the Chief, but Congress cannot force people to become active......

One argument, which the majority of the court rejected, is that everyone is a participant in the market for health care (care, not insurance). If you don't have health insurance the rest of us share the cost of the uncompensated care that you can and sooner or later will receive in emergency rooms. We will also share the consequences of your failure to receive timely treatment: If you have an contagious disease that is untreated because you can't afford a doctor, for example, everyone who comes into contact with you is at risk. If you call in sick a lot because of an untreated illness, or you can't hold a job because of one, the society loses your productivity. The society is better off if everyone has access to health care, and we seem to have decided that insurance, like the French and German systems, is a better mechanism to deliver that goal than a government-run health service like the UK's and Canada's.

That argument seems to make sense to me: We all share the cost of something that benefits us all. What's wrong with it?

 

[Bob001]

I have posted this in other threads, but it bears repeating. T.R. Reid is a journalist who has written extensively, including two books, about how health care is delivered around the world. For this PBS "Frontline" special he went to several different countries and asked how they would treat his own old shoulder injury and how much it would cost, by way of illustrating how those systems work. The show is accessible online, along with some of his other reports:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

This is what he says about the U.S. system:
".... These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we're Britain or Cuba. For Americans over the age of 65 on Medicare, we're Canada. For working Americans who get insurance on the job, we're Germany. For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India..."
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html

How the systems work in five capitalist democracies:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

 

[RandFan]

I have posted this in other threads, but it bears repeating. T.R. Reid is a journalist who has written extensively, including two books, about how health care is delivered around the world. For this PBS "Frontline" special he went to several different countries and asked how they would treat his own old shoulder injury and how much it would cost, by way of illustrating how those systems work. The show is accessible online, along with some of his other reports:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

This is what he says about the U.S. system:
".... These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we're Britain or Cuba. For Americans over the age of 65 on Medicare, we're Canada. For working Americans who get insurance on the job, we're Germany. For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India..."
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html

How the systems work in five capitalist democracies:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

Thank you. I watched it when you posted it before and it's very good.