SCOTUS Ruling: a set back for Obama Care

[LukeinNE]

 

. . . 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?

 

 

The Indian Health Service is largely a black hole on the internet, however I did turn up a pair of investigations targeted at the IHS locations that serve Montana, the Dakotas, Nebraska, and Iowa. And health outcomes are consistently bad.

 

On the VA, wait times, lack of accountability, and a series of lethal bureaucratic and medical malpractice incidents going back nearly to the program's birth are major issues. Overall health outcomes are generally pretty good, but placing that sort of power in the hands of a relatively small number of government bureaucrats with little to no legal recourse for the patients is bad news.

 

Not specifically related to the VA, but I think nationalizing all of our nation's health care assets to essentially adopt "VA-care" would be unnecessarily disruptive. I would prefer more of a "Medicare for all" approach, with providers remaining private and supplemental private insurance available for purchase to anyone who wants it. Medicaid would be immediately abolished and folded into the program. The VA and IHS could either be retained or phased out as practical needs dictated.

[LukeinNE]

More on topic, I think Republicans should take Bobby Jindal's advice on the contraceptives issue:

 

Tl;dr or hidden behind paywall: Make the pill OTC. It's in line with small government principles, much of Europe already does it, and it defuses a pretty stupid issue.

[carlfense]

On the VA, wait times, lack of accountability, and a series of lethal bureaucratic and medical malpractice incidents going back nearly to the program's birth are major issues. Overall health outcomes are generally pretty good, but placing that sort of power in the hands of a relatively small number of government bureaucrats with little to no legal recourse for the patients is bad news.

The bold would be the most relevant indicator as to whether or not the VA is a failure, correct?

 

And, FWIW, those outcomes are not just pretty good . . . they are equal to or slightly better than private health care. That takes us to the next point . . .

 

Not specifically related to the VA, but I think nationalizing all of our nation's health care assets to essentially adopt "VA-care" would be unnecessarily disruptive. I would prefer more of a "Medicare for all" approach, with providers remaining private and supplemental private insurance available for purchase to anyone who wants it. Medicaid would be immediately abolished and folded into the program. The VA and IHS could either be retained or phased out as practical needs dictated.

. . . I agree. Medicare for all is probably the least disruptive path. Quite frankly, it might have been less disruptive than the conservative ideas found in the Affordable Care Act. Naturally, it would have been demonized as "socialism", "communism", and a "government takeover of healthcare".

 

The main concern with Medicare for all is the similar to your primary complaint about the VA. A relatively small number of bureaucrats would almost literally control medicine through fee schedules.

[LukeinNE]

 

On the VA, wait times, lack of accountability, and a series of lethal bureaucratic and medical malpractice incidents going back nearly to the program's birth are major issues. Overall health outcomes are generally pretty good, but placing that sort of power in the hands of a relatively small number of government bureaucrats with little to no legal recourse for the patients is bad news.

The bold would be the most relevant indicator as to whether or not the VA is a failure, correct?

 

And, FWIW, those outcomes are not just pretty good . . . they are equal to or slightly better than private health care. That takes us to the next point . . .

 

Not specifically related to the VA, but I think nationalizing all of our nation's health care assets to essentially adopt "VA-care" would be unnecessarily disruptive. I would prefer more of a "Medicare for all" approach, with providers remaining private and supplemental private insurance available for purchase to anyone who wants it. Medicaid would be immediately abolished and folded into the program. The VA and IHS could either be retained or phased out as practical needs dictated.

. . . I agree. Medicare for all is probably the least disruptive path. Quite frankly, it might have been less disruptive than the conservative ideas found in the Affordable Care Act. Naturally, it would have been demonized as "socialism", "communism", and a "government takeover of healthcare".

 

The main concern with Medicare for all is the similar to your primary complaint about the VA. A relatively small number of bureaucrats would almost literally control medicine through fee schedules.

 

 

My main concern with the VA is actually the public run nature of the hospitals themselves. As long as the providers remain in private hands, they are far easier to punish for malpractice. There are all sorts of legal standing issues when it comes to suing one's own government. Making room for additional private coverage if someone wants to purchase it also mitigates the risk of "death panels" or whatever.

 

In the end, I don't care what people call it. Increasing the government role in health care cuts against a lot of my general ideology, but it's the only realistic way to cover everyone effectively, and as I said before, I think the private elements that would remain, namely insurance choice beyond the base public plan, and private delivery of care, all comes together for a workable, yet uniquely American solution.

[TGHusker]

More on topic, I think Republicans should take Bobby Jindal's advice on the contraceptives issue:

 

Tl;dr or hidden behind paywall: Make the pill OTC. It's in line with small government principles, much of Europe already does it, and it defuses a pretty stupid issue.

I agree with this. However, this removes the democratic attack line of the 'republican war on women' - thus because of politics and political fund raising - this simple solution will be ignored. Another simple solution could have end all of this liberal grandstanding war on women line - Obama could have done 5 minutes after the ruling - extend his non-profit executive order to these tightly held for profit organizations: require insurance companies to pay for the 4 contraceptives in question without charging the for profit companies back. A bit of a history lesson:

1. The abortion inducing drugs were not in the original ACA law that passed Congress. Bob Casey, the good pro-life Catholic dem had to be convinced of this before he cast one of the deciding votes

2. Obama via executive order via HHS Sec, says these types of drugs must be included in the coverage. Note: this was not via law enacted as an amendment to the ACA. His exec order is in violation of existing law - RFRA when forced on religious organizations as the supreme court verified yesterday.

3. Because of the uproar - another executive order is given - religious non-profits are exempted from having to provide those drugs

4. Hobby Lobby, recognizing that they are a "person' under the RFRA files suit. Remember that the RFRA was based almost unanimously (lacked 3 Senate votes I believe) by a democrat controlled house and senate and signed by a dem Pres - Clinton. (Whose wife attacted the RFRA yesterday - either forgetting or hoping the press won't report that her husband signed it into law).

5. Because Obama by-passed Congress with his HHS mandate, it did not have the weight of Congressional law. The RFRA trumps his exec order.

6. Now Obama wants a Repub control House to address the issue - not to fix it but to make it a fund raising, repubs hate women campaign. He knows the repubs won't do so, because they respect the 1st amendment rights of others. Thus, Obama gets his campaign theme and the repubs are placed between a rock and a hard place.

7. We got into this place due to an executive directive and we can get out by an executive directive that would remove the grandstanding - extend to the "For profits" the same exempts given to non- profits.

 

http://time.com/2941491/hobby-lobby-white-house-politics-congress/

But Earnest quickly added that President Obama, who has been touring the country promoting his ability to work around Congress, plans no immediate executive actions to remedy the situation created by the Hobby Lobby ruling. “The Supreme Court was ruling on the application of a specific law that was passed by Congress,” Earnest said. “So what we’d like is for Congress to take action to pass another law that would address this problem.”

This is a notable departure in strategy for the White House that is likely to increase the visibility of the issue in an election year, while delaying the arrival of a solution for those women who will now be denied certain contraceptive coverage. All signs Monday pointed to the fact that Democrats would rather stage a political fight over the issue than quickly resolve it for the affected women. Both the Democratic Party and the White House Twitter accounts spend much of the day rallying people to outrage on social media over the decision. “It’s time that five men on the Supreme Court stop deciding what happens to women,” tweeted Senate Majority Leader Harry Reid.

Legal observers say it would not be difficult for the Obama Administration to resolve the situation unilaterally. The Department of Health and Human Services has already taken unilateral executive action to ensure that women employed by religious nonprofits get contraception coverage in cases where the employer declines to pay. “There was nothing in the statute that specifically allowed them to create the exemption for non-profit organizations so I don’t see why they couldn’t extend that to for-profit corporations,” said Timothy Jost, a law professor at Washington and Lee University and an expert on the Affordable Care Act’s regulations. “I don’t know why they couldn’t do it themselves.”

In fact, in a concurring opinion at the Supreme Court, Justice Anthony Kennedy recognized Obama’s unilateral powers as a rationale for allowing the for-profit companies to opt out of the contraception mandate in the Affordable Care Act. “In other instances the Government has allowed the same contraception coverage in issue here to be provided to employees of nonprofit religious organizations,” Kennedy wrote. “The accommodations works by requiring insurance companies to cover, without cost sharing, contraception coverage for female employees who wish it.”

[carlfense]

1. The abortion inducing drugs . . .

They aren't abortion inducing drugs.

[TGHusker]

The bold and underline detail why Hobby Lobby claims the drugs to be abortion related drugs

 

http://www.usatoday.com/story/news/nation/2014/06/30/morning-after-iuds/11768653/

he Supreme Court decision in the Hobby Lobby case doesn't currently affect the birth control methods that are most commonly used. But Planned Parenthood Federation of America spokeswoman Justine Sessions says the decision "opens the door for other corporations to be able to opt out of providing any form of birth control."

It doesn't affect:

• Most birth control pills

• Condoms

• Sponges

• Sterilization

It does affect:

• Plan B "morning-after pill"

• Ella "morning-after pill"

• Hormonal and copper intrauterine devices (IUDs)

The companies in the case and their supporters object to IUDs and morning-after pills, saying they cause abortions by blocking a fertilized egg from implanting in the uterus. Groups that lobby for reproductive rights contend the drugs and devices prevent fertilization from occurring, which can lead to unwanted pregnancies and surgical abortions.

[carlfense]

An abortion is a termination of pregnancy, correct?

 

That definition requires that a woman be pregnant before she could have an abortion.

[TGHusker]

Ok, we are down to splitting hair definitions here. From the medical dictionary:

 

Pregnancy

Definition

The period from conception to birth. After the egg is fertilized by a sperm and then implanted in the lining of the uterus, it develops into the placenta and embryo, and later into a fetus. Pregnancy usually lasts 40 weeks, beginning from the first day of the woman's last menstrual period, and is divided into three trimesters, each lasting three months.

con·cep·tion (kn-spshn)n.

1.

a. Formation of a viable zygote by the union of the male sperm and female ovum; fertilization.

b. The entity formed by the union of the male sperm and female ovum; an embryo or zygote.

Zygote:

Definition: After a female egg is fertilized, the resulting one-celled organism becomes known as a zygote. Once this has occured, the zygote begins a two-week period of rapid cell division and will eventually become an embryo. The zygote divides through a process known as mitosis, in which each cell doubles by dividing into two cells. This two-week stage is known as the germinal period of development and covers the time of conception to the implantation of the embryo in the uterus

Abortion:

əˈbôrSHən/

noun

noun: abortion; plural noun: abortions

1.

the deliberate termination of a human pregnancy, most often performed during the first 28 weeks of pregnancy.

Versus a natural miscarriage

Miscarriage Definition

Miscarriage means loss of an embryo or fetus before the 20th week of pregnancy. Most miscarriages occur during the first 14 weeks of pregnancy. The medical term for miscarriage is spontaneous abortion.

http://medical-dictionary.thefreedictionary.com/Pregnancy

Therefore, if pregnancy starts at conception and the drugs prevent the fertilized egg (now a zygote) to develop by preventing it from attaching to the uterus, the pills cause the abortion( deliberate termination) of the pregnancy.

[carlfense]

Therefore, if pregnancy starts at conception and the drugs prevent the fertilized egg (now a zygote) to develop by preventing it from attaching to the uterus, the pills cause the abortion( deliberate termination) of the pregnancy.

It's medically incorrect to say that pregnancy starts before a fertilized egg is implanted.

 

Not to mention that it's certainly not a matter of religious belief.

[TGHusker]

Perhaps this can narrow the gab in our interpretations:

 

 

 

In a footnote, Justice Alito explained his "already fertilized egg" passage. He writes: "The owners of the companies involved in these cases and others who believe that life begins at conception regard these four methods as causing abortions, but federal regulations, which define pregnancy as beginning at implantation ... do not so classify them."

 

http://www.cnsnews.com/commentary/terence-p-jeffrey/hobbled-hobby-lobby-decision

[carlfense]

I wouldn't worry so much about the definition found in federal regulations (but I can certainly understand why Alito would choose to focus on them).

 

He could have chosen to focus instead on the definition given by the American Congress of Obstetricians and Gynecologists or the American Medical Association. But of course those wouldn't have been as easy to dismiss as those hated federal regulations, right?

[TGHusker]

I don't know his motive. Probably the federal regulation's definition was used because of the nature of the issue they were discussing - Regardless of definition or source of definition, the court by it's ruling sided with Hobby Lobby's definition and ruled accordingly. With a 5/4 decision - it probably reflects the polarization of opinion outside of the court - as also reflective in our discussion today.

[Junior]

 

I wouldn't worry so much about the definition found in federal regulations (but I can certainly understand why Alito would choose to focus on them).

 

He could have chosen to focus instead on the definition given by the American Congress of Obstetricians and Gynecologists or the American Medical Association. But of course those wouldn't have been as easy to dismiss as those hated federal regulations, right?

 

 

But why listen to scientists and medical professionals when there are right wing politicians to tell us about the scientific issues of the day?

[LukeinNE]

 

 

I wouldn't worry so much about the definition found in federal regulations (but I can certainly understand why Alito would choose to focus on them).

 

He could have chosen to focus instead on the definition given by the American Congress of Obstetricians and Gynecologists or the American Medical Association. But of course those wouldn't have been as easy to dismiss as those hated federal regulations, right?

 

 

But why listen to scientists and medical professionals when there are right wing politicians to tell us about the scientific issues of the day?

 

 

In fairness, pro-choice activists don't much care about what medicine and scientists have to say about fetal pain and viability. Politics > fact. And that goes for both sides.