SCOTUS Ruling: a set back for Obama Care

[LukeinNE]

The Economist didn't say that study was calibrated to make America look bad. It focused on things that real-world people would find important.

 

 

Its emphasis on access and per-capita spending mean that America, struggling to extend its insurance coverage, while committing a large amount to overall health-care spending, regularly comes bottom of the Commonwealth Fund table.

 

 

I don't think it was an unfair paraphrase on my part. It emphasized the things America is bad at and de-emphasized the things America is good at. And I'd imagine real world people would care about quality as well as access and cost.

[knapplc]

 

The Economist didn't say that study was calibrated to make America look bad. It focused on things that real-world people would find important.

 

 

Its emphasis on access and per-capita spending mean that America, struggling to extend its insurance coverage, while committing a large amount to overall health-care spending, regularly comes bottom of the Commonwealth Fund table.

 

 

I don't think it was an unfair paraphrase on my part. It emphasized the things America is bad at and de-emphasized the things America is good at. And I'd imagine real world people would care about quality as well as access and cost.

 

 

If by not an unfair paraphrase you mean saying something that wasn't remotely what that four-paragraph blurb was getting at, then yes, it wasn't unfair. If you mean that paraphrase accurately summed up what they were trying to convey... not so much.

 

To be sure quality is an issue, but it is no more important than cost or access. I'm a real-world people, and I care very much about quality. But that doesn't mean that I didn't just get done paying for a procedure that my wife had 18 months ago. That's an onerous cost for a procedure that would have cost about 1/3 as much in another country.

[knapplc]

In other news, Obama is now trying to make some other news, showing once again how dysfunctional our political system is.

 

Today he gets handed a defeat on healthcare, his presidency's signature legislation. So what's he doing in his afternoon presser? Bashing the Republicans on immigration reform. Pandering to the base. Hey look over here, something shiny!

 

It's ponderous man. Ponderous.

[LukeinNE]

 

 

If by not an unfair paraphrase you mean saying something that wasn't remotely what that four-paragraph blurb was getting at, then yes, it wasn't unfair. If you mean that paraphrase accurately summed up what they were trying to convey... not so much.

 

To be sure quality is an issue, but it is no more important than cost or access. I'm a real-world people, and I care very much about quality. But that doesn't mean that I didn't just get done paying for a procedure that my wife had 18 months ago. That's an onerous cost for a procedure that would have cost about 1/3 as much in another country.

 

 

I read the article as saying: the Commonwealth study focused on access and cost issues, and as those happen to be the weak points in the US health care system, the American system did particularly poorly in that study. When looking at treatment outcomes in the cancer and cardiovascular areas (top two killers in America), for example, America comes out either on top or very close to it, and the study buried those facts.

 

In any case, as I said before, it is not enough to moan about how much better Europe's health care system is and argue for copying them. We've already got a couple NHS-style health care systems here, and they're generally considered to be miserable failures. I've outlined what I think would be a workable solution to the health care system in this country. Do you have an issue with it, and if so, why?

[carlfense]

In other news, Obama is now trying to make some other news, showing once again how dysfunctional our political system is.

 

Today he gets handed a defeat on healthcare, his presidency's signature legislation. So what's he doing in his afternoon presser? Bashing the Republicans on immigration reform. Pandering to the base. Hey look over here, something shiny!

 

It's ponderous man. Ponderous.

Yeah, but this ruling is just another attempt to distract us from Benghazi.

[tschu]

 

In other news, Obama is now trying to make some other news, showing once again how dysfunctional our political system is.

 

Today he gets handed a defeat on healthcare, his presidency's signature legislation. So what's he doing in his afternoon presser? Bashing the Republicans on immigration reform. Pandering to the base. Hey look over here, something shiny!

 

It's ponderous man. Ponderous.

Yeah, but this ruling is just another attempt to distract us from Benghazi.

 

 

http://thecolbertreport.cc.com/videos/suqg0f/stephen-colbert-s-bats--t-serious---the-vast-government-soccer-conspiracy

[TGHusker]

I also want to point out how something as simple as the title of this thread is evidence of this sort of thing --- to TGH, this isn't a setback for women, or for people who are trying to get coverage, or for basically anyone who doesn't want their lives controlled by corporations, or any of that. This is a setback for Obamacare and should be celebrated, and is probably a sign that Obamacare will fail and yadayada. It's just not logical thought.

That wasn't the point of the OP and you have mis-read my motive as to why I posted this. I did not set off fireworks in celebration. I provided the link and asked 2 generic questions. I'm addressing the law by itself. Simply: will the law stand or be strongly revised eventually due to this ruling. And yes, as a law, which is the topic, it is a set back for ObamaCare and those who wish to have the contraceptive language in the law will have to find another way. As noted above in one of my posts, I believe that any 're-write' itself will retain much of the ACA languarge. Being on the forum over the past year and listening to Carl and others speak on this issue, I'm not as opposed to the full law as I was at 1st. There are some very needed and good things about it. And yes, I want coverage to be available to all. However, I do agree with this ruling. Family held corporations like Hobby Lobby should not have to sacrifice their 1st amendment religious views on what their health care dollars are spent on. My guess is that Obama/Congress will find another way to fund those issues under these new realities. As noted above, I believe any future rewrite will remain some type of govt/private partnership to make the law less costly and easier to manage. (more administrative than content).

[TGHusker]

 

 

 

What do you think single-payer would look like in a practical sense?

 

 

Look at essentially any other first-world country that exists in the world today, and there's your answer.

 

The US is completely idiotic when it comes to healthcare, and most of our country seems to either not care or actively wants to keep it that way. Maybe that's because our educational system sucks as well?

 

The education system does suck as well, horribly in fact. I think it is a huge reason why our citizen population is getting dumber on relevant issues each passing year.

 

But,

 

Is it ONLY because the education system is terrible or is it also directly linked to the kind of society we live in that puts emphasis and pressure on wants and desires rather than needs? I bet 70-80% of the college aged kids in this country have no clue about most of the stuff talked about on this P&R forum, (politically).

 

 

I was more talking about how, objectively, we're behind 51 other countries in our quality of math and science education. And this is why we're slipping and will probably continue to slip in the global economy.

 

Politically, we're dumb because people see it as a game or a sport where people choose sides and want to win, rather than a set of issues that need to be resolved. And yes, I'm mainly pointing at the Republican party, but it goes both ways too. The amount of disinformation out there is incredible. It's not a game, and until people wake up and realize this, we're going to get the congressional gridlock just perpetuating itself until one party gets lucky and holds the WH, Senate, and House all at the same time again. Might not be until the Dems likely do it in 2020 or 2022.

 

There's also a ton of overlap between politics, religion, education, etc etc that all explain why we're getting dumber.

 

Tschu - I do agree with you on this point I highlighted - especially the part - "a set of issues that need to be resolved". You are correct in saying we get into our political camps and pull for our side. I've been guilty of this. Sometimes, however, it isn't a matter of bad guy vs good guy. With some issues, we have different paths to the same end that are sincerely held. I tend to go towards a market driven solution others more of a govt run solution but both want all people covered. The solution is in the middle some place. We should concentrate on the issue and not the sport of finding out who's path is chosen.

[tschu]

I tend to go towards a market driven solution others more of a govt run solution but both want all people covered. The solution is in the middle some place. We should concentrate on the issue and not the sport of finding out who's path is chosen.

 

 

And we have all the data in the world to suggest that a market-based solution leaves the people who most need healthcare hanging out to dry. That's because healthcare doesn't operate under your regular economic principles - our own health has a value to us that is nearly infinite - yet surely we all agree that the cost of healthcare should remain as low as possible. A market is always going to drive prices sky-high and an insurance-based system will exclude those who need care based on that simple fact. Their objective is to keep their costs low however possible. Yet our lives are like the life of the king in chess - you cannot place a dollar amount on them, they have infinite worth. The only way to reconcile those differences in motive between the consumer and the insurance company is to either deny coverage outright or charge an absurd premium. And that doesn't even cover the issue of those who are too poor to even pay a regular premium in the first place.

 

Surely you'd agree that everyone in America deserves equal healthcare, right? I'd hope so... Then again, with the number of states that aren't enacting the Medicaid expansion and the Republican voters out there who A-OK with that, I'm not so sure...

 

I'm not playing a game here. This country needs single-payer.

[LukeinNE]

And we have all the data in the world to suggest that a market-based solution leaves the people who most need healthcare hanging out to dry.

 

 

Frankly it's never been tried. A purely market-based approach as you noted, is doubtful to work because healthcare doesn't behave like a normal market, but abolishing every element of markets from health care.....well look at the VA. Not to mention the US is responsible for the bulk of medical innovation because its system financially rewards the companies that invest billions into medical research.

 

Surely you'd agree that everyone in America deserves equal healthcare, right?

 

 

"Equal" health care is a complete myth. Even in the most socialist health care system in the world, you're going to see important (or just well connected) people prioritized over ordinary people. You're going to see wealthy people get on planes and check themselves into the best hospitals in the world. This is going to happen no matter what system we have in place, and there's no sense in pretending otherwise.

 

Then again, with the number of states that aren't enacting the Medicaid expansion

 

 

Medicaid is a documented waste of money that has no positive health impact. It is another part of our health care system that is broken and needs fixing, it is not an answer to any of our problems.

 

This country needs single-payer.

 

 

You're putting your ideological cart way before the horse here.

 

First, we already have two single payer systems in the US: the VA, and the Indian Health Service, and both are failures. If you want all of American health care to look like the VA, you need to defend the VA's miserable performance, not say "well it works in Europe, I'm sure it'll work well here."

 

Second, the idea that "every other first world country" has single payer is a myth. The majority of them have done what the US needs to do: identified the strengths and weaknesses of their systems, devised a form of social insurance, to help with coverage and given their citizens the option of buying their own supplemental plans. Many countries leave their hospitals in largely private hands. Japan has devised a creative cost control policy: capless co-pays. My point is that every country designed their health care system to reflect their unique situations. Health care reform needs to happen, but it needs to be an American solution, not a British one.

[huKSer]

I do think any re-write will retain large portions of the bill. By the time the repubs do anything on it (crickets) the law will be so entrenched it will be difficult to go back to a purely market driven plan.

 

Yeah, prohibition was so entrenched that most of the country STILL doesn't drink.

[carlfense]

. . . the VA, and the Indian Health Service, and both are failures.

Care to elaborate? I'm more familiar with the VA than the IHS so for the sake of argument . . . why do you so conclusively state that the VA is a failure? What metric are using to make that determination? Outcomes? Patient satisfaction?

[TGHusker]

This article, below, gives a summary of the ruling. The ruling at its heart is about 1st amendment rights and not health care access. As LukeinNE notes above, equal health care is a myth. However, I believe we can come up with a system that provides for equal access. In this ruling we have to remember that Hobby Lobby agreed to 16 of the 20 listed contraceptives. They objected to the abortion inducing contraceptives (ie morning after) - having religious beliefs that life begins at conception. The ruling reinforces the Religious Freedom Restoration Act (RFRA) signed into law under President Clinton. The ruling does not ban access to certain drugs only that a limited # of privately held corps do not have to pay for those drugs via their benefit plan. The ruling does not restrict anyone's reproductive rights - it does restrict who has to pay for the drugs as a consequence of practicing those rights. This ruling would not have been necessary if HHS had not strong armed its agenda into the healthcare law in violation of the religious rights of others - a foundational right as so deemed by our founders in the Bill of Rights - the gov't cannot prohibit the free exercise "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof"

Also, health care is a part of a compensation plan along with salary, vacation etc. - exchange labor for compensation. I've seen arguments on the web that the laborers earned this coverage as well. I would counter that if the compensation (including all terms of health benefits plan) aren't too a person's liking, there is no one forcing individuals to work for a company like Hobby Lobby. People leave companies every day to get a different wage, vacation or health care plan. Equal access is still obtained by one's ability to chose which company to work for if they deem that access to the 4 uncovered drugs are the most important criteria they are looking for in a company. Regardless, these 4 drugs are still available to be purchased with ones own funds if one's lifestyle deems that these 4 particular drugs are needed.

 

 

http://www.nationalreview.com/bench-memos/381545/hobby-lobby-ruling-ed-whelan

 

Hobby Lobby Ruling

By Ed Whelan

June 30, 2014 11:41 AM

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Here’s a quick summary of (and a few comments on) Justice Alito’s majority opinion in Hobby Lobby:

1. For-profit corporations are persons protected under RFRA. (Pp. 16-20.)

2. Closely held for-profit corporations are capable of engaging in an exercise of religion protected by RFRA. (It “seems unlikely” that publicly traded corporations would “often” assert RFRA claims, but no need to decide whether they can.) (Pp. 20-31.)

3. The HHS mandate substantially burdens the exercise of religion by the Hahns, the Greens, and their companies. (Pp. 31-38.)

a. Severe economic consequences.

b. We need not reach novel claim that companies would be better off forcing their employees into the exchanges. But if we did reach the claim, we wouldn’t find it persuasive. (Pp. 32-38.)

4. We need not decide whether the HHS mandate is in furtherance of a compelling governmental interest. Even if we assume it is, the mandate flunks the least-restrictive-means test. (Pp. 38-40.)

5. The mandate flunks the least-restrictive-means test. (Pp. 39-45.)

The least-restrictive-means test is “exceptionally demanding.” (P. 39.)

The most straightforward way for the government to achieve its desired goal would be to pay the cost of the objected-to contraceptives itself. We see nothing in RFRA that supports the argument that the government can’t be required to create entirely new programs in order to comply with RFRA. (Pp. 41-43.)

We need not rely on the option of a new government-funded program because HHS has already demonstrated that it has at its disposal an approach that is less restrictive of religious liberty—the accommodation for religious nonprofits. “We do not decide today whether [the accommodation] complies with RFRA for purposes of all religious claims. At a minimum, however, it does not impinge on the plaintiffs’ religious belief that providing insurance coverage for the contraceptives at issue here violates their religion, and it serves HHS’s stated interests equally well.” (Emphasis added.)

Commentary: There will be much parsing of this passage. I think that some mandate opponents, worried that a defeat is lying in this victory, will misread this passage. What I think that Alito is saying is that the objection to the accommodation is not to “providing insurance coverage” per se but rather to providing a self-certification that has the consequences of making the certifier morally complicit in the provision of objected-to drugs and devices.* This issue is being, and will continue to be litigated, in the pending suits against the accommodation.

Indeed, it bears highlighting that the majority, in a footnote (footnote 9 on page 10) has offered an expansive reading of the relief that it afforded the Little Sisters of the Poor in the Little Sisters’ challenge to the accommodation: That order means that all “eligible organizations” must “be permitted to opt out of the contraceptive mandate by providing written notification of their objections to the Secretary of HHS, rather than to their insurance issuers or third-party administrators.” Together with the Court’s sound understanding of substantial burden, that proposition ought to provide gives high hopes for a victory to the challengers to the accommodation.

(In his brief concurrence, Justice Kennedy cites the passage above from the majority opinion in stating that the accommodation “does not impinge on the plaintiffs’ religious beliefs.” In context (given that Kennedy joins Alito’s opinion and does nothing more than cite the passage above), I think that it’s clear that he is saying nothing more than Alito is saying: only that the religious beliefs that plaintiffs have set forth in this case against providing insurance coverage wouldn’t be impinged by the accommodation.)

6. This ruling will not lead to the parade of horribles that the dissent trots out. (Pp. 45-49.)

* Justice Ginsburg, in her wildly overwrought dissent, offers a compatible reading on this narrow point, as she asserts that the government has shown that there is no less restrictive means that would “satisfy the challengers’ religious objections to providing insurance coverage for certain contraceptives.” (Dissent at 27-28.)

[TGHusker]

From my post above: For-profit corporations are persons protected under RFRA. (Pp. 16-20

Regarding the "person hood" of a corporation under RFRA, please see this explanation from the Harvard Law Review:

http://harvardlawreview.org/2014/05/hobby-lobby-corporate-law-and-the-theory-of-the-firm/

 

I. RFRA Personhood, For-Profit Corporations, and the Scholars’ Claims

As noted in the introduction, RFRA prevents unjustified interference with religious exercise by “persons.” The most natural reading of the term “person” in RFRA includes for-profit corporations. Congress passed RFRA in response to Employment Division v. Smith,¹² which abandoned application of strict scrutiny to neutral laws burdening religious exercise.¹³ Because RFRA implements a previous constitutional rule, one could seek the meaning of “person” in constitutional precedent. As Justice Brennan explained, “by 1871, it was well understood that corporations should be treated as natural persons for virtually all purposes of constitutional and statutory analysis.”¹⁴ Thus, the Supreme Court has repeatedly held that for-profit corporations are constitutional “persons.”¹⁵ Furthermore, the so-called “Dictionary Act,” which defines terms appearing in the U.S. Code, provides that, “unless the context indicates otherwise,” the term “person” includes corporations, partnerships, and other entities, “as well as individuals,” without regard to whether such firms or individuals are engaged in profit-seeking activities.¹⁶

The Dictionary Act’s language allowing a different meaning when “the context indicates otherwise” does not authorize judges to fashion optimal definitions of “person” on a statute-by-statute basis. The Act’s presumption is stronger than that. Instead, the Supreme Court has characterized the “context” caveat as a sort of escape hatch that courts may employ if, and only if, the Act’s definition of person “seems not to fit” with the statute in question.¹⁷ In such cases, the Court has said, the context caveat and resulting departure from the Dictionary Act’s definition of person can save the courts from “forcing a square peg into a round hole.”¹⁸

[carlfense]

For profit corporations (whether in the class that the majority invented or not) don't have religious beliefs. No need to make it more complicated than that.

 

Additionally, these pills are not abortion inducing now and they were not abortion inducing when Hobby Lobby paid for them for years before being told that they were required to pay for the pills.