Impeach John Roberts?

[Duck_dodgers007]

Please excuse me for abbreviating your post. I'm trying to keep the post on topic with respect to your original point.

 

You and Doc are both t

You sir, are a genius!

[Doc]

Please excuse me for abbreviating your post. I'm trying to keep the post on topic with respect to your original point.

 

You and Doc are both making this point: that health care resource utilization won't flatten or go down; in fact, they'll go up when more folks have health insurance.

 

I see this entirely differently and I think that there is where the ripe point for debate is (trying not to be too doctrinal btw).

 

 

 

With all due respect, I think that you've way over-simplified the matter to an almost contrived debate point. I think the issue was less that people couldn't get care, as much as it was:

 

1. People were going to the ER or Urgent Care to get basic health care services

2. Insurers were charging exorbitant rates for insurance-seekers with pre-existing conditions

3. Too many relied on good will entities and caregivers for health care services - these efforts are subsidized by taxpayer donations and pro bono medical support initiatives

4. Many folks who didn't have insurance weren't responsive to small and relatively benign issues that may have been discovered early - however at the point when the issue became impossible to ignore, the individual opted to go to the ER. Then a once easily manageable matter becomes one that becomes significant costly, both from a health and a cost perspective.

5. Many folks relied on taxpayer subsidized programs (planned parenthood, local health clinic) for basic health services.

 

Ergo, a very costly and inefficient process. With that in mind, I think that it is an issue of inefficiency in the process of health management as much as it is anything. I think that it is also an issue of CEOs profiting hansomely off of people's feebleness.

 

Doc, in your effort to dismiss the 'resource flattening' idea, you ignore these points - especially point 4. Everyone having insurance doesn't make more people sick. As discussed above, everyone having health insurance theoretically should mean that the conduit through which people seek health care services is more direct and efficient. Right now, it's not. Right now, people become more sick (and consequently, more costly, and more demanding of resources), because they don't have health insurance preliminarily. As logically incongruent as you may think that it is, I believe that people become more resource and financially costly to everyone else by not having insurance versus when they are insured.

 

For the reasons mentioned above, I don't believe that there will be any added strain on resources. If anything, I think that there will be an alleviation of that strain. There may be a rise in day-to-day services, physicals, diagnostics, etc. but the cost of catastrophic-level care should decrease because there will be a greater percentage of folks who had no belief that they could visit a physician early before, whose issues will be caught before it reaches a more costly (and resource demanding) level of care.

 

That will result in substantially decreased individual service cost and resource utilization over time.

 

With respect to day-to-day over-burdening of resources, medical schools have increased enrollment for 14 years in a row (2009 and 2011 articles):

 

http://www.modernhealthcare.com/article/20111024/NEWS/310249959#

 

http://www.usatoday.com/news/health/2009-10-20-medical-school_N.htm

 

To be fair, apparently they are still short of their goal but the numbers are still encouraging:

 

http://blogs.wsj.com/health/2010/05/10/med-school-enrollment-in-2015-will-miss-goal/

 

The reason that enrollment was up - to prepare for the impending baby boomer retirement - is not as a big a deal as once thought. That baby boomer retirement expectation is considerably more phased, progressive and intermittent because of the economic downturn:

 

http://www.abcactionnews.com/dpp/money/late-boomer-bloomers-older-workers-carve-out-new-careers-to-stall-retirement

Adding 30 million more people means you need to provide 10% more providers to take care of those new patients. When there is already a shortage. And likely a bigger shortage coming as older doctors accelerate their retirement plans and enrollments start to dwindle in med school since it looks like Obamacare may stand (this is still subject to the election). And while PA's and APRN's are a nice adjunct, they're not doctors.

 

As for your scenario of uninsured people leaving small problems alone until they become big and require a trip to the ER, that's a tiny fraction of ER visits. And the majority of those are more a case of denial than lack of insurance, since not having insurance doesn't mean you can't visit a doctor. The majority of ER cases are:

 

1. True emergencies

2. Social/psych cases

3. People who don't want to wait the weeks to months to be seen by a doctor

4. Illegal aliens

 

Those won't change a bit, and with EMTALA still around, they can't be turned away. Can they?

 

So, where will the cost-savings come from, considering there is only so much you can wring from providers (who account for just 10% of all medical expenditures, and the best you can achieve is a 1% reduction before you turn people away from the field)? Look no further than the Independent Payment Advisory Board (IPAB). That's where the justification for rationing and death panels will come. The first target will be the elderly (in Britain, it's estimated that 134,000 elderly are euthanized annually because it's too expensive to keep them around). Then after that, it will be those with expensive medical problems that will be denied access to care (the good news tgreg is you won't be denied insurance coverage. The bad news is, you won't receive your usual level of treatment). And cancer screening will be reduced. Look at the cancer survival rates in countries with socialized medicine.

Edited July 3, 2012 by Doc

[Juror#8]

Adding 30 million more people means you need to provide 10% more providers to take care of those new patients. When there is already a shortage. And likely a bigger shortage coming as older doctors accelerate their retirement plans and enrollments start to dwindle in med school since it looks like Obamacare may stand (this is still subject to the election). And while PA's and APRN's are a nice adjunct, they're not doctors.

 

I posted some recent material with respect to medical school enrollment and matriculation being at an all time high and continuing to trend upwards (as it has for almost 15 years in a row).

 

Won't that address the resource shortage that you mention? And promote the entry of MDs and DOs into the healthcare industry marketplace?

 

As for your scenario of uninsured people leaving small problems alone until they become big and require a trip to the ER, that's a tiny fraction of ER visits. And the majority of those are more a case of denial than lack of insurance, since not having insurance doesn't mean you can't visit a doctor. The majority of ER cases are:

 

1. True emergencies

2. Social/psych cases

3. People who don't want to wait the weeks to months to be seen by a doctor

4. Illegal aliens

 

Those won't change a bit, and with EMTALA still around, they can't be turned away. Can they?

 

In your experience, do you find that there are those who sit on an issue until it is so nagging that it demands treatment? In fact, don't many health care providers implore folks to get checked out regularly for relatively manageable issues (detected early) - especially amongst certain ethnic and age groups?

 

Would you agree that those without insurance are going to be less likely to get checked out if there is nothing overtly wrong? Would you agree that the abjectly impoverished, without insurance, are going to be even furthermore less likely to get checked out under similar circumstances?

 

And if your answer to the above questions are "yes," won't the resulting instance of treating overt medical problems be more costly and expensive than addressing a more bourgeoning issue.

 

Assuming that you agree with my points along this Socratic tunnel, what is the cost difference in one person's example? $500, $1000, $2000, $5000, $10,000? Now multiply that by hundreds of thousands of people, maybe even millions of people.

 

Admittedly, my argument here relies on a few points:

 

1. That people without insurance put off regular treatment and checkups until things become noticeable.

2. That VERY poor people without insurance put off seeing a physician until things rise to the level of being a significant medical issue.

3. These tendencies will change once they have insurance.

 

But I think that these are truisms and play themselves out in every corner of this country.

 

Basically, my view is that MOST people without insurance see a hospital/doctor as a matter of last resort - when the ______ just won't go away.

 

People with insurance are more likely to be proactive and follow a regimen for better overall health.

 

I think the statistics bear this out as does basic common sense. Go to any stop on the metro Red Line after Tenleytown and before Catholic U. Find the people whose permanent home is the less traveled side of the escalator or on the back side of the SmartTrip machines. Then look at the people using the SmartTrip machines.

 

Whose dental bill will cost less? Who will cost less to restore to status quo ante?

 

Why?

 

They'll both go to the hospital. The Smarttrip machine user will go every 8-12 months. That keeps care costs down. The individual who calls the Smarttrip machine home will go when he loses the use of his leg because of some diabetes-related complication. If he would have had insurance, he may have been on some managed care program.

 

Since he didn't, the taxpayer just paid for the ambulance ride and ER visit.

 

Again, multiply this by thousands....cause that is the cost that was just spread to the taxpayer and will continue to be unless we do something.

 

Basically what I'm saying is the taxpayer is taking a hit on this either way. Some people are just too opaque to realize it so they're blindly following the "No No No" crowd as if they're not subsidizing a broken and inefficient system RIGHT NOW.

 

The irony is astounding.

 

As an aside -

 

Is the common denominator in this debate:

 

Proponents of ACA - those who want to know how their taxpayer dollars are being spent with respect to healthcare costs.

 

Those who don't want health reform (notice I didn't say 'opponents of the ACA') - those who don't want to know how much of their taxpayer dollars are being spent with respect to re-distributed health care costs cause they're used to it anyway.

 

The above is tongue and cheek cause I know that it is not this simple. But....

 

So, where will the cost-savings come from, considering there is only so much you can wring from providers (who account for just 10% of all medical expenditures, and the best you can achieve is a 1% reduction before you turn people away from the field)? Look no further than the Independent Payment Advisory Board (IPAB). That's where the justification for rationing and death panels will come. The first target will be the elderly (in Britain, it's estimated that 134,000 elderly are euthanized annually because it's too expensive to keep them around). Then after that, it will be those with expensive medical problems that will be denied access to care (the good news tgreg is you won't be denied insurance coverage. The bad news is, you won't receive your usual level of treatment). And cancer screening will be reduced. Look at the cancer survival rates in countries with socialized medicine.

 

I believe that I demonstrated, at least in one instance, how cost savings will find it's way into the system.

 

With regard to the IPAB, do you have any support for the idea that people will be "euthanized" to promote savings objectives? No offense, but that seems very, very conspiratorial.

Edited July 5, 2012 by Juror#8

[Doc]

I posted some recent material with respect to medical school enrollment and matriculation being at an all time high and continuing to trend upwards (as it has for almost 15 years in a row).

 

Won't that address the resource shortage that you mention? And promote the entry of MDs and DOs into the healthcare industry marketplace?

 

 

 

In your experience, do you find that there are those who sit on an issue until it is so nagging that it demands treatment? In fact, don't many health care providers implore folks to get checked out regularly for relatively manageable issues (detected early) - especially amongst certain ethnic and age groups?

 

Would you agree that those without insurance are going to be less likely to get checked out if there is nothing overtly wrong? Would you agree that the abjectly impoverished, without insurance, are going to be even furthermore less likely to get checked out under similar circumstances?

 

And if your answer to the above questions are "yes," won't the resulting instance of treating overt medical problems be more costly and expensive than addressing a more bourgeoning issue.

 

Assuming that you agree with my points along this Socratic tunnel, what is the cost difference in one person's example? $500, $1000, $2000, $5000, $10,000? No multiply that by hundreds of thousands of people, maybe even millions of people.

 

Admittedly, my argument here relies on a few points:

 

1. That people without insurance put off regular treatment and checkups until things become noticeable.

2. That VERY poor people without insurance put off seeing a physician until things rise to the level of being a significant medical issue.

3. These tendencies will change once they have insurance.

 

Basically, my view is that MOST people without insurance see a hospital as a last resort - when the ______ just won't go away.

 

People with insurance are more likely to be proactive and follow a regimen for better overall health.

 

I think the statistics bear this out as does basic common sense. Go to any stop on the metro Red Line after Tenleytown and before Catholic U. Find the people whose permanent home is the less traveled side of the escalator or on the back side of the SmartTrip machines. Then look at the people using the SmartTrip machines.

 

Whose dental bill will cost less? Who will cost less to restore to status quo ante?

 

Why?

 

They'll both go to the hospital. The Smarttrip machine user will go every 8-12 months. That keeps care costs down. The individual who calls the Smarttrip machine home will go when he loses the use of his leg because of some diabetes-related complication. If he would have had insurance, he may have been on some managed care program. Since he didn't, the taxpayer just paid for the ambulance ride and ER visit.

 

Again, multiply this by thousands....cause that is the cost that was just spread to the taxpayer and will continue to be unless we do something.

 

Basically what I'm saying is the taxpayer is taking a hit on this either way. Some people are just too opaque to realize it so they're blindly following the "No No No" crowd as if they're not subsidizing a broken and iefficient system RIGHT NOW.

 

As an aside -

 

Is the common denominator in this debate:

 

Proponents of ACA - those who want to know how their taxpayer dollars are being spent with respect to healthcare costs.

 

Those who don't want health reform (notice I didn't say 'opponents of the ACA') - those who don't want to know how much of their taxpayer dollars are being spent with respect to re-distributed health care costs cause they're used to it anyway.

 

The above is tongue and cheek cause I know that it is not this simple. But....

 

 

 

I believe that I demonstrated, at least in one instance, how cost savings will find it's way into the system.

 

With regard to the IPAB, do you have any support for the idea that people will be "euthanized" to promote savings objectives? No offense, but that seems very, very conspiratorial.

Very poor people have Medicaid. If they're putting things off it's not because they don't have insurance. And you'll need to provide actual numbers of people who can't afford insurance who put things off because of lack of insurance, and not denial. You'll probably find the numbers to be inconsequential to making a dent in lowering costs. And again, without any true savings, the money has to come from somewhere.

[DC Tom]

Very poor people have Medicaid. If they're putting things off it's not because they don't have insurance.

 

People I've known on Medicaid haven't put off care so much as they've been told by Medicaid to put off care. ("Oh, we know half you family has died of abdominal cancers. And we know you're having severe, crippling stomach pains and weight loss. Here's some percocet for the pain, come back in a year if you're not feeling better." "What, you broke your wrist? Here's an ace bandage, follow up in six months.")

[Juror#8]

Very poor people have Medicaid. If they're putting things off it's not because they don't have insurance. And you'll need to provide actual numbers of people who can't afford insurance who put things off because of lack of insurance, and not denial. You'll probably find the numbers to be inconsequential to making a dent in lowering costs. And again, without any true savings, the money has to come from somewhere.

 

I realize that medicaid is out there - for those who qualify. But I still understand your point.

 

What constitutes "poverty" such that people would qualify for Medicaid is somewhat unrealistic though considering the realities of the current economy (gas, food, and travel costs).

Edited July 5, 2012 by Juror#8

[DC Tom]

I realize that medicaid is out there - for those who qualify. But I still understand your point.

 

What constitutes "poverty" such that people would qualify for Medicaid is somewhat unrealistic though considering the realities of the current economy (gas, food, and travel costs).

 

Most economic qualifications are unrealistic considering the realities of the economy.

[Jauronimo]

You !@#$ing idiot. While you're not wrong, what you just wrote runs completely counter to EVERY bull **** ECONOMIC POST YOU'VE MADE UP TO THIS POINT!!!!!

What would you expect from a hardcore lefty, Obama fan boy, champion of unions and free markets alike who has the utmost admiration for Ayn Rand, while being a self described anarcho-communist?

[MARCELL DAREUS POWER]

What would you expect from a hardcore lefty, Obama fan boy, champion of unions and free markets alike who has the utmost admiration for Ayn Rand, while being a self described anarcho-communist?

 

im not left on every issue, im not a fan of obama, yes i support unions and worker owned, yes they should compete in a market, and i admire ayn rand for his individualism. i just dont take it to the extreme like her...

 

in other words, im not some ideological hack like yourself. i evaluate an argument on its logic, evidence, and does it make sense...

 

for example, im pro life after the 1st trimester unless the mothers life is in danger. then it should be her choice.

 

i differ at school and with friends when i say i believe in profits and markets....

Edited July 5, 2012 by MARCELL DAREUS POWER

[Rob's House]

I realize that medicaid is out there - for those who qualify. But I still understand your point.

 

What constitutes "poverty" such that people would qualify for Medicaid is somewhat unrealistic though considering the realities of the current economy (gas, food, and travel costs).

I can't find your post in defense of Wickard so I'll reply here. Wickard is bad law, period. It wasn't an honest disagreement about proper interpretation of the commerce clause. They knew they were rewriting the constitution when they gave the ruling, but it was the outcome they wanted so they went with it. You can argue (as you did) that you like the outcome because you want the Feds to be empowered to do many of the things they've done using that power, but that is an entirely different argument from whether the decision was consistent with the constitution.

[Doc]

People I've known on Medicaid haven't put off care so much as they've been told by Medicaid to put off care. ("Oh, we know half you family has died of abdominal cancers. And we know you're having severe, crippling stomach pains and weight loss. Here's some percocet for the pain, come back in a year if you're not feeling better." "What, you broke your wrist? Here's an ace bandage, follow up in six months.")

Well, that's another form of denial.

[Jauronimo]

im not left on every issue, im not a fan of obama, yes i support unions and worker owned, yes they should compete in a market, and i admire ayn rand for his individualism. i just dont take it to the extreme like her...

 

in other words, im not some ideological hack like yourself. i evaluate an argument on its logic, evidence, and does it make sense...

 

for example, im pro life after the 1st trimester unless the mothers life is in danger. then it should be her choice.

 

i differ at school and with friends when i say i believe in profits and markets....

You're all over the map with ideas that can't possibly be reconciled and it shows. But that won't stop you from referring to everyone else as totally ignorant of their own ideology, whatever the f#$% that means, or calling me an ideological hack which again, I can only guess as to what that sentence means.

 

I bet you differ at school and with friends and here in PPP. Consistency isn't one of your strengths.

[3rdnlng]

You're all over the map with ideas that can't possibly be reconciled and it shows. But that won't stop you from referring to everyone else as totally ignorant of their own ideology, whatever the f#$% that means, or calling me an ideological hack which again, I can only guess as to what that sentence means.

 

I bet you differ at school and with friends and here in PPP. Consistency isn't one of your strengths.

 

Yes, he's all over the map:

 

MARCELL DAREUS POWER, on 05 July 2012 - 12:24 PM, said:

 

im not left on every issue, im not a fan of obama, yes i support unions and worker owned, yes they should compete in a market, and i admire ayn rand for his individualism. i just dont take it to the extreme like her...

 

in other words, im not some ideological hack like yourself. i evaluate an argument on its logic, evidence, and does it make sense...

 

for example, im pro life after the 1st trimester unless the mothers life is in danger. then it should be her choice.

 

i differ at school and with friends when i say i believe in profits and markets....

[Rob's House]

I'm surprised you guys still respond to MDP. I don't even read his posts anymore. He's either trolling or functionally retarded. Either way, nothing worth seeing.

[Juror#8]

I can't find your post in defense of Wickard so I'll reply here. Wickard is bad law, period. It wasn't an honest disagreement about proper interpretation of the commerce clause. They knew they were rewriting the constitution when they gave the ruling, but it was the outcome they wanted so they went with it. You can argue (as you did) that you like the outcome because you want the Feds to be empowered to do many of the things they've done using that power, but that is an entirely different argument from whether the decision was consistent with the constitution.

 

Wickard is good law. If that is news to you, the 70 years of commerce clause jurisprudence should get you caught up.

 

Wickard has been distinguished, but it is still held out as good law. The 50 or so justices who have occupied the highest legal perch in the land - both conservatives and democrats - agree that Wickard is principally solid (at least in concert).

 

Wickard advanced the whole aggregate effect concept. That is not legal fiction nor is it creative legal word-smithing. The cumulative effect of individuals over-producing a crop would upset the price stabilization that Congress is Constitutionally obliged to regulate.

 

So, where does it stop - one person private consumption, two, 50, 500, 5000. If one private farmer and consumer is ok then 5000 would have to be. Congress was stabilizing the price of wheat. Filburn was growing more to enjoy for himself. If 5000 people did the same thing, demand would wane and upset the post-depression price stabilization effort. There is a decided and unchallengeable effect on commerce in that instance.

 

70+ years later and no SC has disagreed. I think that there is a good reason for that.

Edited July 5, 2012 by Juror#8

[Duck_dodgers007]

Is it too late to nominate a real Conservative? Ron Paul, I'm looking at you!!

 

Asked if that now makes the insurance mandate he approved as governor of Massachusetts a tax increase, Romney insisted it did not because last week's Supreme Court ruling did not restrict states from implementing mandates.

 

'The chief justice in his opinion made it very clear that at the state level, states have the power to put in place mandates. They don't need to require them to be called taxes in order for them to be constitutional," Romney argued. "And as a result, Massachusetts' mandate was a mandate, was a penalty, was described that way by the legislature and by me, and so it stays as it was."

 

Under the Roberts' ruling, the federal government doesn't have the same "powers" as states, Romney told CBS. He argued that because the Supreme Court is the final law of the land, the mandate under Obama's health care is a "tax"—no matter what anyone else says.

 

http://news.yahoo.com/blogs/ticket/romney-suggests-politics-motivated-roberts-health-care-ruling-141456751.html

 

And Romney's a "Conservative" because he says he is--this week! Unbelievable! A tax is a tax, period

[Doc]

Is it too late to nominate a real Conservative? Ron Paul, I'm looking at you!!

 

 

 

http://news.yahoo.com/blogs/ticket/romney-suggests-politics-motivated-roberts-health-care-ruling-141456751.html

 

And Romney's a "Conservative" because he says he is--this week! Unbelievable! A tax is a tax, period

Who said that the penalty under Romneycare was a tax? Certainly not SCOTUS.

[ExiledInIllinois]

There is a lot of good things to the ACA... Like keeping your kids on till they are 26. Not getting dumped for having pre-existing conditions. That pesky tax thing... I don't like paying it, it invades my liberty to freeload and spend otner people's money! What the hell were the liberals thinking, this is so outta form.

 

Only in America! The polls say it all.

[3rdnlng]

There is a lot of good things to the ACA... Like keeping your kids on till they are 26. Not getting dumped for having pre-existing conditions. That pesky tax thing... I don't like paying it, it invades my liberty to freeload and spend otner people's money! What the hell were the liberals thinking, this is so outta form.

 

Only in America! The polls say it all.

 

Dumped for pre-existing conditions? Where is that happening?

[Rob's House]

Wickard is good law. If that is news to you, the 70 years of commerce clause jurisprudence should get you caught up.

 

Wickard has been distinguished, but it is still held out as good law. The 50 or so justices who have occupied the highest legal perch in the land - both conservatives and democrats - agree that Wickard is principally solid (at least in concert).

 

Wickard advanced the whole aggregate effect concept. That is not legal fiction nor is it creative legal word-smithing. The cumulative effect of individuals over-producing a crop would upset the price stabilization that Congress is Constitutionally obliged to regulate.

 

So, where does it stop - one person private consumption, two, 50, 500, 5000. If one private farmer and consumer is ok then 5000 would have to be. Congress was stabilizing the price of wheat. Filburn was growing more to enjoy for himself. If 5000 people did the same thing, demand would wane and upset the post-depression price stabilization effort. There is a decided and unchallengeable effect on commerce in that instance.

 

70+ years later and no SC has disagreed. I think that there is a good reason for that.

I didn't mean it's bad law as in it has been overturned, I meant that the ruling was wrong to begin with. The reason no SC has overturned it doesn't mean much. It can largely be chalked up to stare decisis, but more accurately because the court prefers to distinguish whenever possible. Hell, Plessy's still good law according to this definition.

 

And the question of increments is irrelevant. The question has to do with whether the commerce is in its nature interstate commerce regardless of volume.

 

The ruling itself is absurd. If anything that "significantly" affects interstate commerce in the aggregate is within the scope of Congress' regulatory power it renders a good portion of article 1 sec 8 superfluous.

 

Again, you can argue that you prefer the direction they took because you prefer centralized control or other reasons, but you can't honestly argue that the ruling was consistent with the text.