obamacare

[B-Large]

And this has happened because healthcare is practically the only industry where the consumer has no idea of what the real cost of service is. The costs are hidden in the insurance that most people don't pay on their own.

 

Yet the administration is trying to paint the picture that the system can be fixed by eliminating insurance companies, while not addressing the expectation of service and the actual cost.

 

And then their feathers are ruffled when somebody calls them clueless.

 

good thoughts- I have long been an advocate of very high decuctible health plans where Amercians would be incented to get cost estimates, so they would "feel" the pain (no pun intended) of paying their bills... perhaps that would incent people to not be fat and lazy and stupid and start taking care of themselves.

 

The contention with insurance carriers is pass-through money... why does it cost Cigna 30% of premium dollars to provide third party adminstration, when it costs Medicare 4%? They do the same thing, why the discepancy? The public option was proposed to have non-profit TPA's that had alower pass through cost, under 10% if not more. The Public Option could have been adminstered from the City of State Level, not the Federal Level and met the needs of citizens locally... but that was consider socilist or someting like that... heck, it would have been a nice solution, Liberals could habe their non-proficts cooperative and conservatives could habe still bought private insurance coverage from private compnaines, each side with high deductibel plans...

Edited March 27, 2012 by B-Large

[B-Large]

That is the centerpiece of the bill. The mandate theoretically is how Obamacare will be funded. But if you make exceptions for millions of people and have such a weak penalty that it still makes sense to not carry insurance, you basically get the sick/sickest people paying for insurance and dropping it when they don't need it. It's like being able to buy car insurance after you've had an accident and then dropping it after the car has been fixed. To me, it was a transparent attempt for the Dems to get private insurance companies to go out of business, forcing the government to have to step in.

 

I don't know if I buy that selling across state lines won't have a positive effect. I have limited choices for health care in my area. More choices means more competition.

 

Victims should get compensation for malpractice. But there should be caps and there should be a review panel that allows certain cases to proceed or not.

 

I agree that expectations need to be changed. Health care is like a buffet. You pay one price and expect to get your money's worth. So you use/eat more than you should. HDHP's/HSA's are the way to go. It puts you in control of your medical care and expenditures. I had a patient, who had a HDHP/HSA say "I don't like it because I don't like keeping track of that stuff." Yes, because caring about your health and health care dollars shouldn't be a concern to you.

 

Yep that is the biggest issue. People will wait until they get sick, sign up, and drop it when they are well again... but you have to consider there are alot of honest, good Americans out there who would like to do it right, pay for coverage even if they are rated higher, and not in it to work the system. How do you serve the worthy and stop on the cheaters??

 

Insurance compaines operate where they think they can make money, and perfer States that have lax regulation to protect citzens and premium payors from fraud and abuse (not that all insurers are out ot screw people over, thats is another intrue blanket assumption). One of the the things you have to consider is that if we let insurance compaines operate from the National Level, they would be answering to Federal Regulatory scrutiny... you know how Washington works, there is little chance a Federal oversight of Insurance compaines would reduce overall costs... I just don't see how insurers would help reduce prices, in fact they would gain better favor for contracts by paying higher reimbuirsements to providers and facilities...

 

Your not kidding about the buffet. the most entitled, the most irresponsible are often people on Medicaid. many of them freak out when you try to collect their $2 copay, and when they can't pay they scream because we tell them they will have reschedule. Much like understanding the home loans you are signing up for, people need to understand and god forbid keep track of their medical expeditures... geesh

[GG]

good thoughts- I have long been an advocate of very high decuctible health plans where Amercians would be incented to get cost estimates, so they would "feel" the pain (no pun intended) of paying their bills... perhaps that would incent people to not be fat and lazy and stupid and start taking care of themselves.

 

The contention with insurance carriers is pass-through money... why does it cost Cigna 30% of premium dollars to provide third party adminstration, when it costs Medicare 4%? They do the same thing, why the discepancy? The public option was proposed to have non-profit TPA's that had alower pass through cost, under 10% if not more. The Public Option could have been adminstered from the City of State Level, not the Federal Level and met the needs of citizens locally... but that was consider socilist or someting like that... heck, it would have been a nice solution, Liberals could habe their non-proficts cooperative and conservatives could habe still bought private insurance coverage from private compnaines, each side with high deductibel plans...

 

The cost differential between the two is the biggest crock of craptastic analogies ever, because it doesn't compare similar items. Medicare's 4% G&A cost is an accounting allocation that bears no semblance to what the true costs of setting up a proper administration system. By virtue of being a 35% buyer of the market and effectively setting reimbursement rates with the threat of full government armada behind it, providers are not going to challenge Medicare head on. What they do on the other hand is figure out ways to game Medicare. That's why fraud is far bigger under a government program than with an insurance company that has real management and investors to answer to. If you do a true analysis of the operating costs of Medicare vs private insurance, that 4% to 30% comparison will quickly fly out the window.

[Doc]

Yep that is the biggest issue. People will wait until they get sick, sign up, and drop it when they are well again... but you have to consider there are alot of honest, good Americans out there who would like to do it right, pay for coverage even if they are rated higher, and not in it to work the system. How do you serve the worthy and stop on the cheaters??

 

Insurance compaines operate where they think they can make money, and perfer States that have lax regulation to protect citzens and premium payors from fraud and abuse (not that all insurers are out ot screw people over, thats is another intrue blanket assumption). One of the the things you have to consider is that if we let insurance compaines operate from the National Level, they would be answering to Federal Regulatory scrutiny... you know how Washington works, there is little chance a Federal oversight of Insurance compaines would reduce overall costs... I just don't see how insurers would help reduce prices, in fact they would gain better favor for contracts by paying higher reimbuirsements to providers and facilities...

 

Your not kidding about the buffet. the most entitled, the most irresponsible are often people on Medicaid. many of them freak out when you try to collect their $2 copay, and when they can't pay they scream because we tell them they will have reschedule. Much like understanding the home loans you are signing up for, people need to understand and god forbid keep track of their medical expeditures... geesh

Honesty goes out the window when people realize they can game a system, rationalizing that "they set the rules." And I just learned that if you don't buy coverage and get penalized and don't pay the penalty, nothing happens to you. What kind of deterrent is that?

 

And don't get me started on Medicaid. Requiring a $5 co-pay or kicking them off is a good way for them to stop wasting services.

[IDBillzFan]

But America has always been about compromise, thats what make Democracies special. as far as Leadership, don't leaders set goals and get them accomplished? If the contetnion is sticking to single payor that has zero chance passing no matter what, unwavering, and continuing the bang ones head against the wall leadership, well then we should keep doing the same thing. I woudld argue that Obama was bold in his leadership of getting the ACA passed, now if your point of view is not from his idealogy, then I understand the questioning of leadership, its all relative to your politics, right?

 

So he and the democratic congress bent, bent, bent and bent... and that is why you got a bills that was way more compicated than it had to be.

 

From the beginning I have held the belief that we should not in absolute hold healthcare to the principles of market economics unless we are making sure 100% of Americans are partipcating, because at some point no matter how much we expercise, everybody uses it, no expections... by we continue to try to apply marketing priciples to a system where some people can play, and not pay.

 

Look, I tend believe Americans need to be left alone, purchase what they want, and if they want to smoke and eat and get real big and fat and get cancer, that is their protected right to do so... but don't expect the rest of us to bail you out, when you are crying about not having the mean to pay for your healthcare... cry to someone else.

Compromise is fine, but it's not a panacea. There was a moment when the intended goals of the law were dropped for the sake of getting it passed though compromises, and THAT was the moment a true leader says "This is no longer about getting comprehensive health care reform and more about passing anything so no one will accuse us of having spent the last year pissing in the wind."

 

That moment is typically easy for a true leader to see coming because it's the same moment the leader STOPS talking about how great the law is going to be and STARTS explaining why it's NOT going to be perfect, and WILL need lots of work. By the time you hear your staff saying things like "We need to pass it to find out what's in it," a true leader cuts bait.

 

Obama ain't no leader. As I've said and will continue to say, I'd be surprised to find out he's even able to organize a linen closet let alone a community. We've been duped, and you have to be massively blind to think otherwise. If this law is thrown out, I will spend the rest of his time in office mocking any idiot who defends this dolt.

[Doc]

Reportedly during the hearing, Barry's solicitor general was so ill-prepared, or nervous, that he had to have Justice Ruth Bader Ginsburg make his arguments for him.

[Chef Jim]

Reportedly during the hearing, Barry's solicitor general was so ill-prepared, or nervous, that he had to have Justice Ruth Bader Ginsburg make his arguments for him.

 

[dayman]

While today was a brutal and brutal from the very first question, it's absolutely INSANE to put any real stock in where the judge's are going based on their questioning. They use it to play devil's advocate to their own opinion, to communicate with each other, and yes often to just answer a question they too are wondering...but the bottom line is if you listen to SC oral arguments over time you know that it's dangerous to assume anything b/c of them.

 

Also I love how some people in this thread say things like "obviously unconstitutional" and "oh just gave libs the next great idea." Ya...the mandate was a Republican idea first and foremost. And a huge portion of lawmakers passed the bill, and thus thought it would be constitutional.

 

Also, I'd like to point out that if I were a justice and I was dead set to uphold the mandate...the questions I would ask would all center around "what limit" does the commerce clause have if any b/c in writing my opinion I'd be hard pressed not to include SOME dicta in there speaking to that point. So that's one example of how questioning isn't what it may seem. A justice asking a question is not a justice implying they disagree with what they are questioning.

Edited March 27, 2012 by dayman

[Doc]

While today was a brutal and brutal from the very first question, it's absolutely INSANE to put any real stock in where the judge's are going based on their questioning. They use it to play devil's advocate to their own opinion, to communicate with each other, and yes often to just answer a question they too are wondering...but the bottom line is if you listen to SC oral arguments over time you know that it's dangerous to assume anything b/c of them.

 

Also I love how some people in this thread say things like "obviously unconstitutional" and "oh just gave libs the next great idea." Ya...the mandate was a Republican idea first and foremost. And a huge portion of lawmakers passed the bill, and thus thought it would be constitutional.

Not exactly. When the swing judge asks "where will it stop" and the solicitor general fumbles his answer to it, you pretty much know it's over. Heck even CNN is saying "Obamacare in serious trouble" today.

 

And as for the mandate being a Republican idea, so what? Had it passed, the Dems could have rightfully challenged it's constitutionality.

[dayman]

Not exactly. When the swing judge asks "where will it stop" and the solicitor general fumbles his answer to it, you pretty much know it's over. Heck even CNN is saying "Obamacare in serious trouble" today.

 

And as for the mandate being a Republican idea, so what? Had it passed, the Dems could have rightfully challenged it's constitutionality.

 

Well in this instance I'm not convinced there is an identifiable "swing judge" but either way I can't argue that it's not perfectly reasonable to argue today didn't go well.

 

As for the mandate being a Republican idea, that has nothing to do with the legal question it just to me is funny given the way political people are acting now.

[birdog1960]

While today was a brutal and brutal from the very first question, it's absolutely INSANE to put any real stock in where the judge's are going based on their questioning. They use it to play devil's advocate to their own opinion, to communicate with each other, and yes often to just answer a question they too are wondering...but the bottom line is if you listen to SC oral arguments over time you know that it's dangerous to assume anything b/c of them.

 

Also I love how some people in this thread say things like "obviously unconstitutional" and "oh just gave libs the next great idea." Ya...the mandate was a Republican idea first and foremost. And a huge portion of lawmakers passed the bill, and thus thought it would be constitutional.

 

Also, I'd like to point out that if I were a justice and I was dead set to uphold the mandate...the questions I would ask would all center around "what limit" does the commerce clause have if any b/c in writing my opinion I'd be hard pressed not to include SOME dicta in there speaking to that point. So that's one example of how questioning isn't what it may seem. A justice asking a question is not a justice implying they disagree with what they are questioning.

well said. i listened to kennedy and roberts question florida's lawyer and didn't come away thinking anything was a done deal. listening to questions addressed to both side it appears the potential swing votes are well aware of what's at stake: nearly 20% of gdp and tons of political ramifications. i'd hold the dancing in the streets til late june.

 

i found it interesting that some of the greatest legal minds in the nation used similar arguments to those labelled ridiculous here....like the analogy with car insurance. of course, any comparison to broccoli is just idiotic.

[dayman]

 

i found it interesting that some of the greatest legal minds in the nation used similar arguments to those labelled ridiculous here....like the analogy with car insurance. of course, any comparison to broccoli is just idiotic.

 

Ya what was great was day 1 where you have Roberts clearly showing he feels a toothless legal obligation is no obligation at all. Then Kagan clearly feels the opposite. To me anyway, based on the questioning.

 

Any 5 year old has weighed this idea in their head about the countless rules their mom gives them. Is it a rule if there is no punishment? Yet there are two distinguished judges with what at least seems clear (through questioning...but again I'm the one saying it isn't smart to read into that) that disagree about that.

[Doc]

Well in this instance I'm not convinced there is an identifiable "swing judge" but either way I can't argue that it's not perfectly reasonable to argue today didn't go well.

 

As for the mandate being a Republican idea, that has nothing to do with the legal question it just to me is funny given the way political people are acting now.

There are 4 Dem- and 4 Repub-appointed judges who in the past have voted along those lines. Kennedy was Repub-appointed, but has been a wildcard with his decisions.

 

Had the Repubs gotten their personal mandate (ostensibly with REAL deterrents to not having insurance) health care law passed, I would also have had a problem with it. This goes beyond just health care.

well said. i listened to kennedy and roberts question florida's lawyer and didn't come away thinking anything was a done deal. listening to questions addressed to both side it appears the potential swing votes are well aware of what's at stake: nearly 20% of gdp and tons of political ramifications. i'd hold the dancing in the streets til late june.

 

i found it interesting that some of the greatest legal minds in the nation used similar arguments to those labelled ridiculous here....like the analogy with car insurance. of course, any comparison to broccoli is just idiotic.

Can't be "some of the greatest legal minds" if they mentioned car insurance, since it's a state-mandated thing. The burial insurance example was great, though.

[dayman]

There are 4 Dem- and 4 Repub-appointed judges who in the past have voted along those lines. Kennedy was Repub-appointed, but has been a wildcard with his decisions.

 

Yea but that isn't the way it always works being a conservative judge is not the same as being a conservative political person and to use one example many though Scalia would support the mandate based on his strong view of the commerce clause. At this point it doesn't seem like Scalia is leaning that way...but who knows!

 

Anyway all I'm saying is this one isn't "all on Kennedy" as is the common view (even though it's an over simplification in most situations and not just this one).

Edited March 27, 2012 by dayman

[Alaska Darin]

Republican idea first and foremost. And a huge portion of lawmakers passed the bill, and thus thought it would be constitutional.

I would venture to guess that the percentage of politicians in this country who have anything beyond a basic understanding of the Constitution is in the single digits.

[dayman]

I would venture to guess that the percentage of politicians in this country who have anything beyond a basic understanding of the Constitution is in the single digits.

 

Like it or not there's a legal presumption they know what they're talking about.

[Rob's House]

well said. i listened to kennedy and roberts question florida's lawyer and didn't come away thinking anything was a done deal. listening to questions addressed to both side it appears the potential swing votes are well aware of what's at stake: nearly 20% of gdp and tons of political ramifications. i'd hold the dancing in the streets til late june.

 

i found it interesting that some of the greatest legal minds in the nation used similar arguments to those labelled ridiculous here....like the analogy with car insurance. of course, any comparison to broccoli is just idiotic.

The fact that these "greatest minds" are resorting to such patently absurd analogies as car insurance is how you know they've got nothing. The whole point of the reference to broccoli is to illustrate how idiotic the oppositions argument is.

[birdog1960]

The fact that these "greatest minds" are resorting to such patently absurd analogies as car insurance is how you know they've got nothing. The whole point of the reference to broccoli is to illustrate how idiotic the oppositions argument is.

says the future law student. sure, kagan's got nothin on you.

[DC Tom]

says the future law student. sure, kagan's got nothin on you.

 

Arguments to authority translate to "I've got nothing, so I'm going to name-drop."

[birdog1960]

Arguments to authority translate to "I've got nothing, so I'm going to name-drop."

maybe scalia read the forbes script? now who's reading the teleprompter talking points?