Affordable Care Act / ObamaCare

[carlfense]

 

This is interesting to me in the sense that we cannot even agree on the most fundamental facts. Every credible estimate shows that the cost of doing nothing exceeds the cost of the ACA. Something is better than nothing by virtue of not being nothing is a terrible argument for something, and there are ample reasons to be skeptical of the ACA achiving its objectives, but cost of the legislation being greater than no action simply is not one of them.

 

I think of this as a similar conundrum as someone who is poor and working, but cannot afford to obtain reliable transportation. Say they have a 78' Cadillac that gets 10 MPG, drive an average of 1000 miles / month, and spending $2,000 / year in repairs. That puts their base cost of ownership at around $500 / month if fuel is $3.50 / gallon. Now let's also say they could get a new compact car that got 35 MPG, would cost $150 / month to finance, another $50 in additional registration fees and insurance, and would cost $1,000 / year to maintain. That puts the base cost of ownership at about $380 / month. On top of the owner cost, there is also cost to everyone with the Cadillac with higher air pollution and higher chance of vehicle failure that could cause an accident or otherwise stop traffic.

 

It's interesting that you bring up the conundrum of a getting a new car versus keeping your old one, being poor, and having very limited options as to what you can do because I'm pretty much in that boat right now myself. I understand the comparison you're making and it sounds good initially. I don't want to get bogged down on the analogy but this is I believe relevant to the discussion. I think there are some serious issues which you are not taking into account. For example, over the Mermorial Day weekend I went to four different dealerships with the express purpose to buy a car. The interest rates for these four different cars were 36.9%, 29.9%, 41.9%, and 26.9% respectively. Basically what's happening is that these car dealerships generally own the finance companies and they collude together so that the consumer is literally left with no choice to go through them if they are unable to secure a lower interest loan through their bank or credit union. Correlating this to the ACA, health care facilities will also collude together to keep their prices artificially high essentially trying to gouge the government financially at every turn. Essentially the healthcare providers are the car dealerships in this analogy. I guess what I'm trying to say is that you car analogy seems to assume all players and circumstances are static and won't change. In reality people and the market will shift in response to what the goverment is trying to do through this ACA legislation. And that's the larger point, we simply can not take these saving projections or cost controls at face value and assume they are accurate because nobody knows exactly how the ACA, if upheld, will change the health care system. Further, one thing we do know for certain is that when government tries to set prices for healthcare services, providers will then charge people who want to pay cash substantially more than they charge someone paying with Medicare to try and make up for lost revenue. We see this happen everyday in healthcare facilities across this country. Add in the fact that same services cost different amounts depending on where you live, which facility you go to, and even what the business agreement is.

 

http://www.nhhealthc...ceServices.aspx

 

 

Just a very basic example of the cost of doing nothing being higher when it may seem antithetical for someone in poor financial shape to buy a new car. There may be other options too of course, but that doesn't make it untrue that a new car may cost less. Some of us believe that health care is a matter of national priorities in a fiscal sense. Germany, Austria, Switzerland, Denmark, the Netherlands, Belgium, Norway, Sweden, Finland, Australia, New Zealand, Taiwan, Singapore...all countries that have managed to do universal healthcare with a mixed market approach while maintaining acceptable fiscal policies, some far better than America. Why can't we?

 

One reason, because doctors, upon graduation from college, have huge school loans to repay. To a lesser degree so do nurses and everyone else along the health care delivery line. Back to doctors though, combine loans with insane malpractice insurance costs and doctors typically will start their careers 150-200K in the hole. Did you know that in Germany students go to medical school for free? People in other countries, like the ones you listed, have pretty much grew up with socialism their whole lives and so to them it is no big deal to do with less money charged for services. But that's not the American way is it? Why should an American company charge 1.00 for something that costs them .10 to produce when they can charge 4.50? That's slight bit of sarcasm by the way.

 

What really bothers me immensely, and it's a reason why I don't trust this legislation or the people who produced it, is that they crafted this legislation in secret, behind closed doors, with absolutely no one outside the liberal left having any input. There wasn't any discussion or consensus about this. This legislation was essentially the elite liberal left forcing multiple and rather probable bad laws on us simply because they could.

 

I will agree with you that something needs to be done to make healthcare more affordable. I'm just not convinced this Obamacare is it.

+1. Thoughtful post.

 

Malpractice insurance costs are so high primarily because there is so much malpractice. Approximately 195,000 people are killed by preventable medical errors each year in the United States. The number of malpractice lawsuits filed on average per year? Somewhere between 15,000 and 19,000. If anything, there should be more malpractice suits. Doctors should pay for their errors just like the members of every other profession.

[carlfense]

The decision will be announced Thursday.

['SkersRule]

The decision will be announced Thursday.

 

I think it's safe to say that this ruling, whichever way it goes, will have the same kind of societal impact that Brown v. Board of Education, Roe v. Wade, et al had. I mean I'm certainly not a lawyer but it seems to me the precedent this case will set will have far reaching, way past healthcare, ramifications.

[carlfense]

The decision will be announced Thursday.

 

I think it's safe to say that this ruling, whichever way it goes, will have the same kind of societal impact that Brown v. Board of Education, Roe v. Wade, et al had. I mean I'm certainly not a lawyer but it seems to me the precedent this case will set will have far reaching, way past healthcare, ramifications.

I agree. Even more so if the individual mandate is struck down. If it's upheld (which sounds unlikely) it would be just another step in a long line of cases. It will mark a drastic departure from precedent of it's struck down. If that happens it will be one of the main cases studied in constitutional law cases.

[carlfense]

Early reading: mandate survives as a tax.

 

"The bottom line: the entire ACA is upheld, with the exception that the federal government's power to terminate states' Medicaid funds is narrowly read." (ScotusBlog)

[carlfense]

I guess we know why Scalia was so upset the other day.

 

Big day for the United States. Big win for Obama's presidency.

[krill]

Time to find out how many states have actually made plans to establish a health insurance exchange..

[carlfense]

Time to find out how many states have actually made plans to establish a health insurance exchange..

"oops."

[Ziggy]

Carl, does it bother you that they had to read between the lines in order to make the act constitutional? I mean the wording in the Act specifically stated that those who do not get insurance will not suffer a tax but instead a penalty. The president himself has on many occasions been very specific in saying it was not a tax, and many of the authors of the bill itself said the same, which begs the question why should the justices need to read into weather the penalty is really a penalty or is it really a tax acting as a penalty.

 

Look I think they act had lots of good parts, but I think we could have come up with better ways to decrease medical costs and increased overall medical coverage. But at the end of the day the whole thing is really just a talking point for politicians. Democrats will push this out as validation of the law, and Republicans will vilify it as a over step by congress on the American people.

 

Lastly were you surprised by Justice Roberts discussion to agree with the constitutionality of the act?

[carlfense]

Carl, does it bother you that they had to read between the lines in order to make the act constitutional? I mean the wording in the Act specifically stated that those who do not get insurance will not suffer a tax but instead a penalty. The president himself has on many occasions been very specific in saying it was not a tax, and many of the authors of the bill itself said the same, which begs the question why should the justices need to read into weather the penalty is really a penalty or is it really a tax acting as a penalty.

Read between the lines? I'm not sure what you mean. If I'm remembering correctly the solicitor general made several different arguments about how the law could be upheld. The majority agreed with one of them.

 

Look I think they act had lots of good parts, but I think we could have come up with better ways to decrease medical costs and increased overall medical coverage. But at the end of the day the whole thing is really just a talking point for politicians. Democrats will push this out as validation of the law, and Republicans will vilify it as a over step by congress on the American people.

I agree. Politics got in the way of a better law. That said, this is both constitutional and better than the status quo.

 

Lastly were you surprised by Justice Roberts discussion to agree with the constitutionality of the act?

I was.

[carlfense]

Extended reaction . . .

 

More than the electoral consequences, this is a win for the American people. Between 12.5 million and 24 million more people will be covered by insurance than if the mandate had been struck down. That's a very, very good thing.

 

 

 

 

Now back to the electoral consequences . . . I think this will be a double edged sword. The GOP base will be even more agitated prior to the election and they should have very high voter turn out.

 

On the other hand, Romney's going to have a tough time with this issue on the campaign trail. He can no longer say that his health care plan can be distinguished from the federal plan because a mandate at the federal level is unconstitutional. It's constitutional. Basically . . . it ties him even closer to Obamacare. Will Romney voters care about that? Sure. Will they still vote for Romney? I would guess that they will. Basically, the undecided voters will hear that Romney and Obama enacted the same health reforms and that they are both constitutional.

[huKSer]

I guess we know why Scalia was so upset the other day.

 

Big day for the United States. Big win for Obama's presidency.

And a big win for the GOP candidates in some states

 

What I heard on the news as far as the "penalty" - one reason that the act was considered constitutional was because there was no penalty (or consequence) if you chose to not buy insurance or pay the "penalty". Same with the state insurance exchange - they can't lose all of their medicare if they don't opt in, so its "Please, please please with sugar on top, follow the bill or nothing will happen to you"

[huKSer]

Extended reaction . . .

 

More than the electoral consequences, this is a win for the American people. Between 12.5 million and 24 million more people will be covered by insurance than if the mandate had been struck down. That's a very, very good thing.

 

 

 

 

Now back to the electoral consequences . . . I think this will be a double edged sword. The GOP base will be even more agitated prior to the election and they should have very high voter turn out.

 

On the other hand, Romney's going to have a tough time with this issue on the campaign trail. He can no longer say that his health care plan can be distinguished from the federal plan because a mandate at the federal level is unconstitutional. It's constitutional. Basically . . . it ties him even closer to Obamacare. Will Romney voters care about that? Sure. Will they still vote for Romney? I would guess that they will. Basically, the undecided voters will hear that Romney and Obama enacted the same health reforms and that they are both constitutional.

And the economic consequences - Hello, Greece

[Chaddyboxer]

Which part of the Constitution do you think denies them that power?

 

I wouldn't be surprised either way. I think there is about an 80% chance that they uphold it but I would be far from shocked if it was struck down.

 

Which part of the Constitution do think expressly gives them that power?

 

It should definitely be struck down and ruled as unconstitutional. The government has absolutely no right to require me to buy anything and they have even less power to fine me or send me to jail for refusing to buy whatever they are selling. That's the kind of bullsh** that happens in a dictatorship, not a republic.

Totally agree.

[Chaddyboxer]

If you think this is bad...the U.S. may be in for a rude awakening in the near future....this will only put our nation farther into debt. Yay..............