Author Topic: Supreme Court to opine on Obamacare tax credit  (Read 39248 times)

beltim

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #50 on: May 26, 2015, 01:23:27 PM »
This all begs the question for the US health system --

We live in a country with arguably one of the worst healthcare industries in the industrialized world,  we pay the highest percentage of GNP of any country in the world - So how in hell are we going to fix this and why are we not fixing it?

The US now ranks 37th in healthcare right behind Costa Rica and just ahead of Slovenia.     

The US health system sucks.  There is no debate about that and no ruling by any court will change that.   61% of bankruptcies are attributed to inability to pay for healthcare.   It is the only business that doesn't publish rates,  charges people differing rates and doesn't compete on prices.   It is the poster child for all that is screwed up with the systems in this country and our inability to acknowledge there is a problem and to fix it.

The fact that we are now mandated by law to fund it is just obscene. 

The rankings that show the US healthcare system "sucking" have as part of their rankings factors like access, efficiency, and equity.  The US health care system prior to the ACA was indeed terrible on these ratings (what with not having universal coverage and all).  But the ACA is the only attempt in recent memory to actually improve the health care system on those factors - and, by bringing more people into the system, is improving along those axes.

If you only look at the quality of health care delivered, the US competes pretty well with other developed countries - not as good as Switzerland, but better than Canada or France. 

http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror

Yes, the healthcare the US delivers is pretty good--if you can get it. It's just way more expensive than any other country. And it's not available uniformly (although the past 17 months have changed that some). A lot of the reason for the 37th ranking are things that are related to disparities in access and other things associated with poverty that are outside of the healthcare system. If you're a middle-class, educated, white mother, your baby is going to die as an infant at about the same rate as your average mom in Sweden. If you don't tick all those boxes, your baby's odds of dying can double or triple.

I pretty much agree, although I would argue that a significant portion of the expense is simply the higher standard living in the US (especially compared to countries outside the top 10 in per capita GDP).  See http://theincidentaleconomist.com/wordpress/sure-its-got-to-go-up-but-how-much/

The larger issue is that Bob W complains about the healthcare system, without realizing that the feature he calls "obscene" - requiring people to have health insurance – is the best and most important way to actually improve the health care system in our country.  If we give very good health care to those who use it (5th best according to my link, there are other rankings out there), then the best way to improve health outcomes is to actually bring more people into the system.

Cathy

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #51 on: May 26, 2015, 01:43:17 PM »
...I'm sure you're not naïve enough to believe that the named plaintiffs brought this case to seek the specific redress of denying themselves of the subsidies that the government argues they are entitled to...

At the heart of the case lies the basic idea that administrative agencies can only do what they are authorised to do by statute. It is the legislature that writes statutes. Administrative agencies cannot rewrite statutes or promulgate new statutes. The case thus has a laudable purpose: enforcement of the rule of law, as opposed to rule by arbitrary administrative fiat.

Regardless of the outcome, I have great respect for plaintiffs and lawyers who carry on this kind of litigation because the principles being tested are fundamental to our form of government. These litigators are engaging in a form of public service. To be clear, this is not an argument regarding standing. I am simply making the point that the named plaintiffs could have a meaningful interest in initiating the litigation -- namely to advocate for their vision of the rule of law.

Incidentally, in Canada, that kind of public interest consideration has long been accepted as relevant to standing. The first Supreme Court case on the topic is Nova Scotia Board of Censors v. McNeil, [1976] 2 SCR 265, which concerned the standing of the plaintiff McNeil to challenge the constitutionality of a law that prohibited theatres from showing certain films in Nova Scotia. McNeil had no connection to the film industry and was just a member of the ordinary public. The government argued that only the theatre-owners had standing to challenge the law, but all three levels of court found that as a member of the public, McNeil had a sufficient interest in bringing the challenge before the court. In modern cases, the courts call this "public interest standing" (although they didn't use that term in the McNeil case) and the test is more refined and has various conditions. I am not suggesting this is relevant to the US case being discussed in the thread. Obviously the US law on this topic is quite different.

brooklynguy

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #52 on: May 26, 2015, 01:57:31 PM »
I am simply making the point that the named plaintiffs could have a meaningful interest in initiating the litigation -- namely to advocate for their vision of the rule of law.

Yes, that could have been the motivation behind the case, but the fact is that it was not.  The legal challenge was concocted by a libertarian political organization which went on a plaintiff-seeking fishing expedition to find nominal plaintiffs who met the criteria (or so they believed) for legal standing to sue.  That said, I don't disagree with anything you said about the important public service legal actions like these serve.  But it's naïve, and wrong, to say that in this case, that policy objective can be divorced from the larger political context.  I hope the Supreme Court upholds the ACA tax credits on the merits, which I believe clearly support a decision in favor of the government.

forummm

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #53 on: May 26, 2015, 02:13:35 PM »
This all begs the question for the US health system --

We live in a country with arguably one of the worst healthcare industries in the industrialized world,  we pay the highest percentage of GNP of any country in the world - So how in hell are we going to fix this and why are we not fixing it?

The US now ranks 37th in healthcare right behind Costa Rica and just ahead of Slovenia.     

The US health system sucks.  There is no debate about that and no ruling by any court will change that.   61% of bankruptcies are attributed to inability to pay for healthcare.   It is the only business that doesn't publish rates,  charges people differing rates and doesn't compete on prices.   It is the poster child for all that is screwed up with the systems in this country and our inability to acknowledge there is a problem and to fix it.

The fact that we are now mandated by law to fund it is just obscene. 

The rankings that show the US healthcare system "sucking" have as part of their rankings factors like access, efficiency, and equity.  The US health care system prior to the ACA was indeed terrible on these ratings (what with not having universal coverage and all).  But the ACA is the only attempt in recent memory to actually improve the health care system on those factors - and, by bringing more people into the system, is improving along those axes.

If you only look at the quality of health care delivered, the US competes pretty well with other developed countries - not as good as Switzerland, but better than Canada or France. 

http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror

Yes, the healthcare the US delivers is pretty good--if you can get it. It's just way more expensive than any other country. And it's not available uniformly (although the past 17 months have changed that some). A lot of the reason for the 37th ranking are things that are related to disparities in access and other things associated with poverty that are outside of the healthcare system. If you're a middle-class, educated, white mother, your baby is going to die as an infant at about the same rate as your average mom in Sweden. If you don't tick all those boxes, your baby's odds of dying can double or triple.

I pretty much agree, although I would argue that a significant portion of the expense is simply the higher standard living in the US (especially compared to countries outside the top 10 in per capita GDP).  See http://theincidentaleconomist.com/wordpress/sure-its-got-to-go-up-but-how-much/

The larger issue is that Bob W complains about the healthcare system, without realizing that the feature he calls "obscene" - requiring people to have health insurance – is the best and most important way to actually improve the health care system in our country.  If we give very good health care to those who use it (5th best according to my link, there are other rankings out there), then the best way to improve health outcomes is to actually bring more people into the system.

Some of it could be cost of living. But I think it's more expensive on average to live in some of those EU countries than the US on average. And Japan is a good example. It's $50 total (to all payers) for an MRI there. Prices are just lower everywhere else.

Bob W

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #54 on: May 27, 2015, 10:13:15 AM »
Agreed that much of the health disparity is due to a very large percentage of the population not having access.   I disagree that the ACA changed that substantially.      In fact, many people who previously had decent coverage are now in the zone of super high deductibles and will opt to avoid health system contact.   For those locked out of the system in the past it is great to now have access!

If you contrast the US system with the Japanese system (I know, different cultures blah, blah) it is like night and day.   Their system is all private insurance,  everyone has it.   There are no bankruptcies due to health costs in Japan --- zero.   As mentioned previously,  the cost of everything is cheaper --- MRIs are like $50,  hospital stays are under $100 per night etc.

The coolest thing about their system is that no appointments are needed.  You simply show up at any doctor's offices (heart, brain,  GP) and the Doc sees you without much waiting.    They are in the customer service business.   

They also use the health system far more than we do but spend about 1/2 as much.

So the debate should really be -- "why the hell are we not adopting the Japanese health system here?"


beltim

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #55 on: May 27, 2015, 10:27:23 AM »
Agreed that much of the health disparity is due to a very large percentage of the population not having access.   I disagree that the ACA changed that substantially.      In fact, many people who previously had decent coverage are now in the zone of super high deductibles and will opt to avoid health system contact.   For those locked out of the system in the past it is great to now have access!

Well you're just factually wrong here.  Estimate vary, but something like 10 million more people have access to health care now than before the ACA.  The percentage of people with insurance is higher for every subgroup - women, men, white, black, Hispanic, Asian, every age group and every income group.

http://www.nytimes.com/interactive/2014/10/29/upshot/obamacare-who-was-helped-most.html?_r=0&abt=0002&abg=1

matchewed

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #56 on: May 27, 2015, 10:33:38 AM »
If you contrast the US system with the Japanese system (I know, different cultures blah, blah) it is like night and day.   Their system is all private insurance,  everyone has it.   There are no bankruptcies due to health costs in Japan --- zero.   As mentioned previously,  the cost of everything is cheaper --- MRIs are like $50,  hospital stays are under $100 per night etc.

The coolest thing about their system is that no appointments are needed.  You simply show up at any doctor's offices (heart, brain,  GP) and the Doc sees you without much waiting.    They are in the customer service business.   

They also use the health system far more than we do but spend about 1/2 as much.

So the debate should really be -- "why the hell are we not adopting the Japanese health system here?"

http://en.wikipedia.org/wiki/Health_care_system_in_Japan

http://en.wikipedia.org/wiki/Health_system#International_comparisons

Really? All private? You sure? How private is it when the government picks up 80% of healthcare costs? Isn't that more socialistic?

Bob you might want to brush up on facts before just launching into a false comparison. :)

I agree that the US could do things better but the ACA is a distinct move towards that goal.

brooklynguy

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #57 on: May 27, 2015, 10:38:31 AM »
Well you're just factually wrong here.  Estimate vary, but something like 10 million more people have access to health care now than before the ACA.  The percentage of people with insurance is higher for every subgroup - women, men, white, black, Hispanic, Asian, every age group and every income group.

And, to nip in the bud the argument that ACA opponents have made that access to health insurance coverage does not translate on a 1:1 basis into access to health care, it would strain reality to look at this data and conclude that, on a net basis, overall access to health care has not substantially increased.

forummm

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #58 on: May 27, 2015, 11:07:39 AM »
Agreed that much of the health disparity is due to a very large percentage of the population not having access.   I disagree that the ACA changed that substantially.      In fact, many people who previously had decent coverage are now in the zone of super high deductibles and will opt to avoid health system contact.   For those locked out of the system in the past it is great to now have access!

If you contrast the US system with the Japanese system (I know, different cultures blah, blah) it is like night and day.   Their system is all private insurance,  everyone has it.   There are no bankruptcies due to health costs in Japan --- zero.   As mentioned previously,  the cost of everything is cheaper --- MRIs are like $50,  hospital stays are under $100 per night etc.

The coolest thing about their system is that no appointments are needed.  You simply show up at any doctor's offices (heart, brain,  GP) and the Doc sees you without much waiting.    They are in the customer service business.   

They also use the health system far more than we do but spend about 1/2 as much.

So the debate should really be -- "why the hell are we not adopting the Japanese health system here?"



I don't think it's fair to say the ACA has made access worse for certain people. Medical cost inflation has been doing that for a long time and increased deductibles has been a growing movement in the industry--intentionally so as a method of cost control. It's easy for people to associate their plan changes with the ACA, but coinciding does not mean the relationship is causal. Also, their old plans likely weren't as good as they thought they were because they didn't have anything really expensive happen to them. Many of the old plans would suddenly show themselves to be very limited if you actually needed to use them for more than routine care.

We don't just have the Japanese system as a model to pick from. Literally every other major industrialized nation has a national healthcare system that works better and is much cheaper (like 50% to 70% cheaper) per capita.

Bob W

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #59 on: May 28, 2015, 08:53:05 AM »
Agreed that much of the health disparity is due to a very large percentage of the population not having access.   I disagree that the ACA changed that substantially.      In fact, many people who previously had decent coverage are now in the zone of super high deductibles and will opt to avoid health system contact.   For those locked out of the system in the past it is great to now have access!

If you contrast the US system with the Japanese system (I know, different cultures blah, blah) it is like night and day.   Their system is all private insurance,  everyone has it.   There are no bankruptcies due to health costs in Japan --- zero.   As mentioned previously,  the cost of everything is cheaper --- MRIs are like $50,  hospital stays are under $100 per night etc.

The coolest thing about their system is that no appointments are needed.  You simply show up at any doctor's offices (heart, brain,  GP) and the Doc sees you without much waiting.    They are in the customer service business.   

They also use the health system far more than we do but spend about 1/2 as much.

So the debate should really be -- "why the hell are we not adopting the Japanese health system here?"



I don't think it's fair to say the ACA has made access worse for certain people. Medical cost inflation has been doing that for a long time and increased deductibles has been a growing movement in the industry--intentionally so as a method of cost control. It's easy for people to associate their plan changes with the ACA, but coinciding does not mean the relationship is causal. Also, their old plans likely weren't as good as they thought they were because they didn't have anything really expensive happen to them. Many of the old plans would suddenly show themselves to be very limited if you actually needed to use them for more than routine care.

We don't just have the Japanese system as a model to pick from. Literally every other major industrialized nation has a national healthcare system that works better and is much cheaper (like 50% to 70% cheaper) per capita.

Agreed that there are many countries with better and much cheaper options.   (anyone who wants to argue about Japan is welcome too --- I'm not that current on it and the statements I made were taken from my memory of a PBS documentary a few years ago)

I think the whole 10 Million more people have enrolled in the system argument falls flat.   Being enrolled does not mean your health outcomes improved.   Proponents of the ACA in congress are now wringing their hands trying to figure out why so many people aren't going to hospitals or doctors.

 Or that prices would have risen anyway for that matter.  Prices have risen over the last 5 decades primarily due to the inflow of Government money at virtually every level.  I'm not talking just Medicaid and Medicare either.   A vast majority of the population is either directly or indirectly employed by Government and their so called insurance is funded by Government.  (think teachers,  public employees,  police,  military,  government contractors and healthcare providers themselves)

A much simpler system would be to simply allocate to each person a certain amount of health dollars over a lifetime.  Set the rules so that if the dollars are not spent that they can be passed down to heirs or charities.   You would then find the sweet spot where people take personal responsibility for both their health and their spending.   Health care providers and drug manufactures would not like this at all.   

The incentive for all health care providers is to charge more and to provide more service so the ACA plays into that paradigm nicely.  That is why it was written with the stamp of approval of the health industry lobbyists. 

The second major change should be that all health providers must publish their rates for each procedure.   It would also be nice if they published efficacy data such as "statin drugs lower your cholesterol but don't significantly extend life and have some nasty side effects"  or  "heart bypass surgery has never been FDA sanctioned and the outcomes are statistically better if one simply eats more vegetables and exercises"

As another point just to muddy the water more  --

A staggering huge amount of so called health care dollars are spent at end life.  The sad part is that the quality of life for those spending the dollars is worse than those who chose to die without intervention.   

"30% of all Medicare spending is attributed to 5% of beneficiaries that die each year and 1/3rd of that in the last month of life."     http://www.forbes.com/sites/michaelbell/2013/01/10/why-5-of-patients-create-50-of-health-care-costs/

You have a system that is burning money and resources that A.  decrease the quality of life and B.  attempts to extend life beyond a reasonable level.

It is in fact not a "healthcare" but a "sicknesscare"   business.     They don't make money when you are healthy.  They make money when you are sick.   

So imagine a situation where you or grandma have significant health problems --- What if you were given the choice of A. having lots of interventions and money spent on you with the result being that your quality of life sucks and you die at or about the same time or B.  foregoing the medical interventions,  dieing naturally and designating that the financial resources be added to your grandkids accounts.   

My personal experience with the ACA has been dreadful --- just awful  ---  Our rates at our office for our 10 staff have nearly doubled while our deductibles and premiums have skyrocketed.   My understanding is that this is not unusually.      It is folks like us who are now pretty much without insurance except catastrophic.   How else would you term paying 10K in premiums per person per year with 3K deductible?   

At lastly,  just to get this rant off my head ---  In or around 1999 our cost per employee was 90 dollars per month for 500 deduct.  Rates were rising at 20% per year.  We said this can't happen because cost will double every 4 years.    Well thankfully that didn't happen but instead rates doubled every 5 years while deductibles did as well. 

The problem is that as this process continues (and the trajectory is unmistakably clear) that within 5 years our rates will be close to the our salaries and deductibles will be in the 10-20K range.   So we will be paying 25K per year for insurance that no one can afford to use. 

Anyone who likes can argue in favor of the ACA and I agree with the access to care aspect of it but I'll be damned if I'll fall for any argument that our system is efficient or in anyway in the same league as the top 10 systems in the world. 


matchewed

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #60 on: May 28, 2015, 09:01:01 AM »
So the ACA sucks because old people cost healthcare systems more? Well shit, that's the same regardless of the system. Unless you've found a healthcare system that makes old people more healthy than young people.

And yes healthcare systems focus on when things are wrong. Yes doctors are encouraged to provide care and prevent death, this is not an ACA thing though, that has been present before and after and has little to nothing to do with the ACA.

No offense but it sounds to me that you're just throwing shit at the wall and seeing what sticks. I get it, you don't like the ACA. But there are much more socialist countries who also have a large chunk of their society employed either directly or indirectly by the government and they don't see that same increase. So blaming on the government is kind of silly when all those countries you laud about have government funded healthcare.

brooklynguy

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #61 on: May 28, 2015, 09:30:29 AM »
No offense but it sounds to me that you're just throwing shit at the wall and seeing what sticks.

Yep.  Bob, if I didn't know better, I would have thought most of your post was arguing in favor of the ACA.  The problems you identified with our nation's health care system exist independently of the ACA, and the ACA was the first step in a long time to take meaningful measures to try to address many of those issues (including curtailing the health care costs that have been spiraling out of control--not just indirectly by subsidizing insurance premiums for individuals, but directly by instituting measures designed to decrease the inherent costs in the system (for example, by disincentivizing unnecessary hospital readmissions)).

I agree that a better step would have been to go all the way and adopt the socialist health care model of some of the countries you identified, but the ACA was a compromise position given the political reality that going to the government funded universal healthcare end of the spectrum was never going to happen.

I think the whole 10 Million more people have enrolled in the system argument falls flat.   Being enrolled does not mean your health outcomes improved. 

This is exactly the argument I tried to address in post #59 above.  In my view, it is ludicrous to look at the exponential increase in health insurance coverage (those ~10 million people had zero insurance before) and argue that the population's access to the outcome-improving health care system, on a net basis, is lower after the implementation of the ACA than before.

beltim

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #62 on: May 28, 2015, 09:31:15 AM »

I think the whole 10 Million more people have enrolled in the system argument falls flat.   Being enrolled does not mean your health outcomes improved.   
No, it doesn't necessarily mean that health outcomes improved.  But it's a pretty ridiculous argument to say that more access to health care results in worse outcomes without any evidence - and you in fact have no evidence.
And in terms of comparing the US system to other countries, improving access is the easiest and best way to improve the strength of our system since those are the areas the US is comparatively worst.

forummm

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #63 on: May 28, 2015, 09:53:33 AM »
Agreed that much of the health disparity is due to a very large percentage of the population not having access.   I disagree that the ACA changed that substantially.      In fact, many people who previously had decent coverage are now in the zone of super high deductibles and will opt to avoid health system contact.   For those locked out of the system in the past it is great to now have access!

If you contrast the US system with the Japanese system (I know, different cultures blah, blah) it is like night and day.   Their system is all private insurance,  everyone has it.   There are no bankruptcies due to health costs in Japan --- zero.   As mentioned previously,  the cost of everything is cheaper --- MRIs are like $50,  hospital stays are under $100 per night etc.

The coolest thing about their system is that no appointments are needed.  You simply show up at any doctor's offices (heart, brain,  GP) and the Doc sees you without much waiting.    They are in the customer service business.   

They also use the health system far more than we do but spend about 1/2 as much.

So the debate should really be -- "why the hell are we not adopting the Japanese health system here?"



I don't think it's fair to say the ACA has made access worse for certain people. Medical cost inflation has been doing that for a long time and increased deductibles has been a growing movement in the industry--intentionally so as a method of cost control. It's easy for people to associate their plan changes with the ACA, but coinciding does not mean the relationship is causal. Also, their old plans likely weren't as good as they thought they were because they didn't have anything really expensive happen to them. Many of the old plans would suddenly show themselves to be very limited if you actually needed to use them for more than routine care.

We don't just have the Japanese system as a model to pick from. Literally every other major industrialized nation has a national healthcare system that works better and is much cheaper (like 50% to 70% cheaper) per capita.

Agreed that there are many countries with better and much cheaper options.   (anyone who wants to argue about Japan is welcome too --- I'm not that current on it and the statements I made were taken from my memory of a PBS documentary a few years ago)

I think the whole 10 Million more people have enrolled in the system argument falls flat.   Being enrolled does not mean your health outcomes improved.   Proponents of the ACA in congress are now wringing their hands trying to figure out why so many people aren't going to hospitals or doctors.

 Or that prices would have risen anyway for that matter.  Prices have risen over the last 5 decades primarily due to the inflow of Government money at virtually every level.  I'm not talking just Medicaid and Medicare either.   A vast majority of the population is either directly or indirectly employed by Government and their so called insurance is funded by Government.  (think teachers,  public employees,  police,  military,  government contractors and healthcare providers themselves)

A much simpler system would be to simply allocate to each person a certain amount of health dollars over a lifetime.  Set the rules so that if the dollars are not spent that they can be passed down to heirs or charities.   You would then find the sweet spot where people take personal responsibility for both their health and their spending.   Health care providers and drug manufactures would not like this at all.   

The incentive for all health care providers is to charge more and to provide more service so the ACA plays into that paradigm nicely.  That is why it was written with the stamp of approval of the health industry lobbyists. 

The second major change should be that all health providers must publish their rates for each procedure.   It would also be nice if they published efficacy data such as "statin drugs lower your cholesterol but don't significantly extend life and have some nasty side effects"  or  "heart bypass surgery has never been FDA sanctioned and the outcomes are statistically better if one simply eats more vegetables and exercises"

As another point just to muddy the water more  --

A staggering huge amount of so called health care dollars are spent at end life.  The sad part is that the quality of life for those spending the dollars is worse than those who chose to die without intervention.   

"30% of all Medicare spending is attributed to 5% of beneficiaries that die each year and 1/3rd of that in the last month of life."     http://www.forbes.com/sites/michaelbell/2013/01/10/why-5-of-patients-create-50-of-health-care-costs/

You have a system that is burning money and resources that A.  decrease the quality of life and B.  attempts to extend life beyond a reasonable level.

It is in fact not a "healthcare" but a "sicknesscare"   business.     They don't make money when you are healthy.  They make money when you are sick.   

So imagine a situation where you or grandma have significant health problems --- What if you were given the choice of A. having lots of interventions and money spent on you with the result being that your quality of life sucks and you die at or about the same time or B.  foregoing the medical interventions,  dieing naturally and designating that the financial resources be added to your grandkids accounts.   

My personal experience with the ACA has been dreadful --- just awful  ---  Our rates at our office for our 10 staff have nearly doubled while our deductibles and premiums have skyrocketed.   My understanding is that this is not unusually.      It is folks like us who are now pretty much without insurance except catastrophic.   How else would you term paying 10K in premiums per person per year with 3K deductible?   

At lastly,  just to get this rant off my head ---  In or around 1999 our cost per employee was 90 dollars per month for 500 deduct.  Rates were rising at 20% per year.  We said this can't happen because cost will double every 4 years.    Well thankfully that didn't happen but instead rates doubled every 5 years while deductibles did as well. 

The problem is that as this process continues (and the trajectory is unmistakably clear) that within 5 years our rates will be close to the our salaries and deductibles will be in the 10-20K range.   So we will be paying 25K per year for insurance that no one can afford to use. 

Anyone who likes can argue in favor of the ACA and I agree with the access to care aspect of it but I'll be damned if I'll fall for any argument that our system is efficient or in anyway in the same league as the top 10 systems in the world.

It is true that the government pays about half of all healthcare expenses. But I don't think it's correct to say that this flow of government money is the reason for the huge growth in healthcare costs. The government pays far less for services than private insurers and the uninsured pay for the same care. The private sector's cost growth on a per-service basis is faster than for that of government. And since the ACA, total per capita cost increases for Medicare have slowed dramatically. It could be due to other factors as well, but some of the ACA's programs, like the Pioneer Accountable Care Organization, have been shown to reduce costs and improve quality while achieving high patient satisfaction. The data supports the conclusion that healthcare costs have risen out of control because the private insurance market is not a well-functioning free market. There is tremendous market failure. Drug manufacturers can charge whatever they want. Providers can order any tests and prescribe any drugs they want and patients don't know if it's a good value. You go in to the hospital and the hospital's employees decide how much care you "need". This is one of the big reasons why literally every other major industrialized nation has a universal healthcare system--and theirs cost less. The US will continue to struggle with this until we pursue a different system.

I think your 'lifetime budget for health care dollars' approach is not workable. The point of health insurance is that we don't have any idea which people are going to have expensive health conditions, and at what point in their life. Some of us will live healthy lives and die in our sleep. Others will have multiple bouts of cancer. That's the reason for health insurance.

Your personal experience with the rising cost of care over the last 20 years is evidence that this is unrelated to the ACA. The ACA does not do enough in my opinion to arrest these absurd and unnecesary increases in the cost of care. But it's also not the casue of them. Your insurance premiums reflect the cost of delivering care. The ACA requires that 85% of your premiums go to medical care, and the insurer has to give any excess premium back to you if they don't meet that standard.

forummm

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #64 on: May 28, 2015, 09:58:55 AM »

I think the whole 10 Million more people have enrolled in the system argument falls flat.   Being enrolled does not mean your health outcomes improved.   
No, it doesn't necessarily mean that health outcomes improved.  But it's a pretty ridiculous argument to say that more access to health care results in worse outcomes without any evidence - and you in fact have no evidence.
And in terms of comparing the US system to other countries, improving access is the easiest and best way to improve the strength of our system since those are the areas the US is comparatively worst.

There are studies showing that fewer people are skipping needed care due to cost. These are all early studies, and many more will be available in the coming years. It takes time for them to wait for results to appear, collect the data, clean it, analyze it, report on it, etc.

Here's an example:
http://www.commonwealthfund.org/publications/issue-briefs/2015/jan/biennial-health-insurance-survey

Another showing that one component of the ACA increased doctor availability for Medicaid patients:
http://www.nejm.org/doi/full/10.1056/NEJMsa1413299
« Last Edit: May 28, 2015, 01:11:57 PM by forummm »

dramaman

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #65 on: May 28, 2015, 11:44:36 AM »
Regarding the need to get under control the relatively high amount of money spent treating end of life ailments, it should be noted that what little the ACA did do to even simply study the situation and make recommendations was labeled as Death Panels by the same foes who are now trying to get it overturned in the courts.

forummm

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #66 on: May 28, 2015, 12:54:42 PM »
Regarding the need to get under control the relatively high amount of money spent treating end of life ailments, it should be noted that what little the ACA did do to even simply study the situation and make recommendations was labeled as Death Panels by the same foes who are now trying to get it overturned in the courts.

Due to the political rhetoric about "death panels", the provision was removed from the bill. It would have paid for Medicare beneficiaries to, at their option, talk to a doctor about what care the beneficiary wanted to have at the end of life for a variety of circumstances. This conversation could lead to an advance medical directive or living will where the beneficiary gets the opportunity to make decisions about what is done to their body after they are no longer able to make decisions for themselves. Often patients are subjected to a lot of medical attention they don't want at the end of life, and that medical attention actually frequently reduces quality of life and can be harmful (in addition to incredibly expensive). But because it can extend the number of days they live (even if it makes those days more miserable), physicians often feel obligated to provide that extra medical attention unless the patient has explicitly asked not to have that kind of care prior to falling ill.

forummm

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #67 on: May 28, 2015, 01:14:32 PM »

I think the whole 10 Million more people have enrolled in the system argument falls flat.   Being enrolled does not mean your health outcomes improved.   
No, it doesn't necessarily mean that health outcomes improved.  But it's a pretty ridiculous argument to say that more access to health care results in worse outcomes without any evidence - and you in fact have no evidence.
And in terms of comparing the US system to other countries, improving access is the easiest and best way to improve the strength of our system since those are the areas the US is comparatively worst.

There are studies showing that fewer people are skipping needed care due to cost. These are all early studies, and many more will be available in the coming years. It takes time for them to wait for results to appear, collect the data, clean it, analyze it, report on it, etc.

Here's an example:
http://www.commonwealthfund.org/publications/issue-briefs/2015/jan/biennial-health-insurance-survey

Another showing that one component of the ACA increased doctor availability for Medicaid patients:
http://www.nejm.org/doi/full/10.1056/NEJMsa1413299

Another example just published this afternoon:
http://kff.org/health-reform/report/coverage-expansions-and-the-remaining-uninsured-a-look-at-california-during-year-one-of-aca-implementation/

Newly-insured Californians were more likely to have a usual source of health care (61%) than the uninsured (43%), and that the newly-insured also were more likely to have used any medical services (58% vs. 45%). In addition, newly-insured adults reported lower rates of difficulty paying medical bills, and were less likely to say they worry about their ability to afford medical care in the future.

As far as population-level metrics go, these are pretty large changes for just one year.

firedup

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #68 on: June 03, 2015, 06:39:41 PM »
Agreed that much of the health disparity is due to a very large percentage of the population not having access.   I disagree that the ACA changed that substantially.      In fact, many people who previously had decent coverage are now in the zone of super high deductibles and will opt to avoid health system contact.   For those locked out of the system in the past it is great to now have access!

If you contrast the US system with the Japanese system (I know, different cultures blah, blah) it is like night and day.   Their system is all private insurance,  everyone has it.   There are no bankruptcies due to health costs in Japan --- zero.   As mentioned previously,  the cost of everything is cheaper --- MRIs are like $50,  hospital stays are under $100 per night etc.

The coolest thing about their system is that no appointments are needed.  You simply show up at any doctor's offices (heart, brain,  GP) and the Doc sees you without much waiting.    They are in the customer service business.   

They also use the health system far more than we do but spend about 1/2 as much.

So the debate should really be -- "why the hell are we not adopting the Japanese health system here?"


AGREE!!!!!

 

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #69 on: June 04, 2015, 10:21:31 AM »
Agreed that much of the health disparity is due to a very large percentage of the population not having access.   I disagree that the ACA changed that substantially.      In fact, many people who previously had decent coverage are now in the zone of super high deductibles and will opt to avoid health system contact.   For those locked out of the system in the past it is great to now have access!

If you contrast the US system with the Japanese system (I know, different cultures blah, blah) it is like night and day.   Their system is all private insurance,  everyone has it.   There are no bankruptcies due to health costs in Japan --- zero.   As mentioned previously,  the cost of everything is cheaper --- MRIs are like $50,  hospital stays are under $100 per night etc.

The coolest thing about their system is that no appointments are needed.  You simply show up at any doctor's offices (heart, brain,  GP) and the Doc sees you without much waiting.    They are in the customer service business.   

They also use the health system far more than we do but spend about 1/2 as much.

So the debate should really be -- "why the hell are we not adopting the Japanese health system here?"

+1 to you!! :)

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #70 on: June 04, 2015, 12:37:29 PM »
Did the both of you miss the post showing that Japan doesn't have a private insurance system but a massive public one? So why don't you support ACA a move more towards the Japan system than the alternatives that have been proposed through legislation?

Insanity

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #71 on: June 04, 2015, 01:03:49 PM »
A one payer system has never been tried at the scale of the US. 

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #72 on: June 04, 2015, 01:35:23 PM »
A one payer system has never been tried at the scale of the US. 

What do you mean by that? There are plenty of single payer systems in very large industrialized nations. I consider something that works for a nation of 50 million people who have a per capita GDP similar to the US to be close enough to be on the same scale as the US. I don't think the level of difficulty increases much from 120 million to 310 million or from 80 million to 310 million.

brooklynguy

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #73 on: June 05, 2015, 12:24:24 PM »
FYI, there's an interesting article in yesterday's NY Times about how the ACA as implemented in left-leaning Vermont ironically transformed from a stepping stone to a complete single payer system for the state, as it was initially viewed, to a roadblock that helped to derail that ambitious plan.

http://www.nytimes.com/2015/06/05/us/in-vermont-frustrations-mount-over-affordable-care-act.html?ref=health

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #74 on: June 06, 2015, 11:23:38 PM »
A one payer system has never been tried at the scale of the US.

It also reduces health care choice. I fear a one-payer system would further entrench the pharma/insurance-dictating-health-choice/reduced-doctor-autonomy industrial complex.

But I have a feeling my opinions on the actual care that's provided is in the minority in the US. I really don't want to pay for care that I know I will never use or agree with.
« Last Edit: June 06, 2015, 11:28:39 PM by Daisy »

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #75 on: June 07, 2015, 06:11:39 AM »

A one payer system has never been tried at the scale of the US. 

What do you mean by that? There are plenty of single payer systems in very large industrialized nations. I consider something that works for a nation of 50 million people who have a per capita GDP similar to the US to be close enough to be on the same scale as the US. I don't think the level of difficulty increases much from 120 million to 310 million or from 80 million to 310 million.

There are a few factors at play.  One is the the number if people and the other is distribution costs of supplies to nation the physical size as the US.   Not to mention the extreme difference in population believe and lifestyle that lives across the US. 

I think the health care system needs to be simply regulated better.  Stop allowing corporations and group policies.  Every one pays if they want it and the government regulates it heavy. 

I happen to believe the corporate benefits angle has done more harm than good.  There is now a disillusionment of costs and affordability. 

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #76 on: June 07, 2015, 12:03:53 PM »

There are a few factors at play.  One is the the number if people and the other is distribution costs of supplies to nation the physical size as the US.   Not to mention the extreme difference in population believe and lifestyle that lives across the US. 

I think the health care system needs to be simply regulated better.  Stop allowing corporations and group policies.  Every one pays if they want it and the government regulates it heavy. 

I happen to believe the corporate benefits angle has done more harm than good.  There is now a disillusionment of costs and affordability.
You've nailed two genuine problems with the industry in the US--First of all, consumers have little visibility into or direct responsibility for the billed costs of their healthcare.  It all just goes to the insurance company, so the true cost gets masked.  And secondly, employer-sponsored health insurance is deductible, but if someone buys their own, it's not. 

Change insurance to a reimbursement system, and apply the deduction to all policies, and I think you'd see a dramatic shift.

Insanity

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #77 on: June 08, 2015, 09:14:54 AM »


There are a few factors at play.  One is the the number if people and the other is distribution costs of supplies to nation the physical size as the US.   Not to mention the extreme difference in population believe and lifestyle that lives across the US. 

I think the health care system needs to be simply regulated better.  Stop allowing corporations and group policies.  Every one pays if they want it and the government regulates it heavy. 

I happen to believe the corporate benefits angle has done more harm than good.  There is now a disillusionment of costs and affordability.
You've nailed two genuine problems with the industry in the US--First of all, consumers have little visibility into or direct responsibility for the billed costs of their healthcare.  It all just goes to the insurance company, so the true cost gets masked.  And secondly, employer-sponsored health insurance is deductible, but if someone buys their own, it's not. 

Change insurance to a reimbursement system, and apply the deduction to all policies, and I think you'd see a dramatic shift.

Yep.  Exactly. 

Those pockets and lack of visibility has also allowed some numbers games by hospitals and doctors office to claim losses.

brooklynguy

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #78 on: June 10, 2015, 07:48:55 AM »
FYI for anyone interested, there is an excellent, well-balanced analysis (in relatively plain English) in the Yale Law Journal outlining the potential options available to the Obama administration and to the affected states to mitigate the fallout of a potential decision against the government in the Supreme Court Case.  (It came to my attention through today's editorial in the New York Times lamenting the fact that the ACA is in peril, and separately there is also an editorial in yesterday's Wall Street Journal suggesting that Obama's recent speeches on the ACA reveal that the administration believes it is in danger of losing the case, which I don't necessarily agree with.)

Here is the ultimate conclusion of the Yale Law Journal paper:

Quote from: Yale Law Journal Essay
A ruling for the plaintiffs in King v. Burwell would be enormously disruptive for millions of people and for state insurance markets. There are no good options for either the Obama administration or the states. Together, they can apply some band-aids, but they cannot stop the bleeding. We nonetheless urge policymakers to prepare their contingency plans now, well in advance of a ruling. Without plans in place, they may find themselves with fewer options still, and even less time to implement them.

music lover

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #79 on: June 10, 2015, 08:28:43 AM »
A one payer system has never been tried at the scale of the US.

It also reduces health care choice. I fear a one-payer system would further entrench the pharma/insurance-dictating-health-choice/reduced-doctor-autonomy industrial complex.

But I have a feeling my opinions on the actual care that's provided is in the minority in the US. I really don't want to pay for care that I know I will never use or agree with.

If you have health insurance, you are already paying for care that you may not need or agree with.

I have my choice of doctors in Canada and have always received excellent care...it seems to be a myth in the US that other countries have little choice or worse care. I would never trade our medical system for yours, and can say with 100% certainty that no one I have ever known in Canada has ever been hit with a medical bill that causes financial difficulty.

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #80 on: June 10, 2015, 08:43:34 AM »
FYI for anyone interested, there is an excellent, well-balanced analysis (in relatively plain English) in the Yale Law Journal outlining the potential options available to the Obama administration and to the affected states to mitigate the fallout of a potential decision against the government in the Supreme Court Case.

This article contains some interesting analysis, but it's certainly not "well-balanced". All of the arguments in the article assume that either federal legislative or administrative actors or state legislatures or administrators, will be up against a very tight deadline after the decision of the Court is released, in order to prevent an alleged "meltdown of state insurance markets". Throughout the article, the writers discuss the necessity and difficulty of making use of the various options in such a short period of time (such as the difficulty of enacting laws and regulations on short notice). A central theme of the article is that the alleged short time to respond is what would make a response impossible.

However, the article revealed itself to be transparently political when the authors declined to consider the legality and merits of solution that Alito J alluded to during oral argument (at page 53 of the pdf), notably that the Court could potentially stay its mandate vacating the impugned regulation in order to allow federal and state actors a longer time to respond.

The rationale for a stay-after-judgment is hard to argue with. For a Canadian example, see Re Manitoba Language Rights, 1985 CanLII 33 (SCC), [1985] 1 SCR 721, in which the Supreme Court of Canada found that every statute in Manitoba was invalid. This would normally necessitate enjoining the enforcement of every law in Manitoba. However, the Court found that "declaring the Acts of the Legislature of Manitoba invalid and of no force or effect would, without more, undermine the principle of the rule of law" (at para 59). The Court found that an order with that kind of consequence would be unconstitutional because it would leave the province without laws, and on that basis, the Court stayed its judgment for a year in order to give the legislature time to enact valid laws.

Although the insurance situation is not quite as dire as leaving a jurisdiction to be lawless, if it's really as bad as Obama says, the stay option should have featured in the government's arguments. The fact that it didn't appear in the government's arguments was a political move because the government did not want to let on that an adverse ruling might not be catastrophic. However, the government's lawyer did admit at oral argument that such a stay would "reduce the disruption". It was therefore incumbent on any writer discussing the potential consequences of this case to at least consider the merits and legality of a stay, and also to question why the government did not argue for it.
« Last Edit: June 10, 2015, 08:58:32 AM by Cathy »

dramaman

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #81 on: June 10, 2015, 09:18:58 AM »
FYI for anyone interested, there is an excellent, well-balanced analysis (in relatively plain English) in the Yale Law Journal outlining the potential options available to the Obama administration and to the affected states to mitigate the fallout of a potential decision against the government in the Supreme Court Case.

This article contains some interesting analysis, but it's certainly not "well-balanced". All of the arguments in the article assume that either federal legislative or administrative actors or state legislatures or administrators, will be up against a very tight deadline after the decision of the Court is released, in order to prevent an alleged "meltdown of state insurance markets". Throughout the article, the writers discuss the necessity and difficulty of making use of the various options in such a short period of time (such as the difficulty of enacting laws and regulations on short notice). A central theme of the article is that the alleged short time to respond is what would make a response impossible.

However, the article revealed itself to be transparently political when the authors declined to consider the legality and merits of solution that Alito J alluded to during oral argument (at page 53 of the pdf), notably that the Court could potentially stay its mandate vacating the impugned regulation in order to allow federal and state actors a longer time to respond.

The rationale for a stay-after-judgment is hard to argue with. For a Canadian example, see Re Manitoba Language Rights, 1985 CanLII 33 (SCC), [1985] 1 SCR 721, in which the Supreme Court of Canada found that every statute in Manitoba was invalid. This would normally necessitate enjoining the enforcement of every law in Manitoba. However, the Court found that "declaring the Acts of the Legislature of Manitoba invalid and of no force or effect would, without more, undermine the principle of the rule of law" (at para 59). The Court found that an order with that kind of consequence would be unconstitutional because it would leave the province without laws, and on that basis, the Court stayed its judgment for a year in order to give the legislature time to enact valid laws.

Although the insurance situation is not quite as dire as leaving a jurisdiction to be lawless, if it's really as bad as Obama says, the stay option should have featured in the government's arguments. The fact that it didn't appear in the government's arguments was a political move because the government did not want to let on that an adverse ruling might not be catastrophic. However, the government's lawyer did admit at oral argument that such a stay would "reduce the disruption". It was therefore incumbent on any writer discussing the potential consequences of this case to at least consider the merits and legality of a stay, and also to question why the government did not argue for it.

I'm not up on all the possible fixes given an adverse ruling, but if any of them depend upon our current dysfunctional congress, then a stay might be meaningless given their inability to agree on anything that doesn't remove the ACA altogether. They'll just fritter away the time posturing until the stay is near end and the crisis is upon us. Does anyone really expect the same folks who drove us off the fiscal cliff and shut down the government for almost a month to act responsibly in this instance?

brooklynguy

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #82 on: June 10, 2015, 09:20:10 AM »
This article contains some interesting analysis, but it's certainly not "well-balanced". All of the arguments in the article assume that either federal legislative or administrative actors or state legislatures or administrators, will be up against a very tight deadline after the decision of the Court is released, in order to prevent an alleged "meltdown of state insurance markets". Throughout the article, the writers discuss the necessity and difficulty of making use of the various options in such a short period of time (such as the difficulty of enacting laws and regulations on short notice). A central theme of the article is that the alleged short time to respond is what would make a response impossible.

However, the article revealed itself to be transparently political when the authors declined to consider the legality and merits of solution that Alito J alluded to during oral argument (at page 53 of the pdf), notably that the Court could potentially stay its mandate vacating the impugned regulation in order to allow federal and state actors a longer time to respond.

That's a fair point.  The article really addresses the potential scenario of an adverse (from the gov't's perspective) Supreme Court decision with immediate effectiveness, and limited its analysis to that contingency.  I agree that the authors should have at the very least expressly stated as much in the article, and "well-balanced" was probably not the best way to describe it (and I'm sure my decision to characterize it that way reflects my own subconscious biases) -- but what I was really getting at is that the article does not automatically jump to the conclusion that dire consequences would result, but undertakes a reasoned analysis of various potential ways of mitigating the fallout that ACA-supporters contend would result, and ultimately concludes that there are no great fixes -- however, as you said, all of the analysis assume immediate action would be required, which would not necessarily be the case.

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #83 on: June 10, 2015, 09:52:20 AM »

There are a few factors at play.  One is the the number if people and the other is distribution costs of supplies to nation the physical size as the US.   Not to mention the extreme difference in population believe and lifestyle that lives across the US. 

I think the health care system needs to be simply regulated better.  Stop allowing corporations and group policies.  Every one pays if they want it and the government regulates it heavy. 

I happen to believe the corporate benefits angle has done more harm than good.  There is now a disillusionment of costs and affordability.
You've nailed two genuine problems with the industry in the US--First of all, consumers have little visibility into or direct responsibility for the billed costs of their healthcare.  It all just goes to the insurance company, so the true cost gets masked.  And secondly, employer-sponsored health insurance is deductible, but if someone buys their own, it's not. 

Change insurance to a reimbursement system, and apply the deduction to all policies, and I think you'd see a dramatic shift.

Even if you are interested, it's very difficult to shop prices (which vary dramatically).  If transparency were required from providers, I believe costs would drop.  I have an HSA (I pay for a significant part of my initial costs) and attempted to shop prices for a procedure.  Very difficult to get information to make an informed decision.

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #84 on: June 10, 2015, 05:05:55 PM »


There are a few factors at play.  One is the the number if people and the other is distribution costs of supplies to nation the physical size as the US.   Not to mention the extreme difference in population believe and lifestyle that lives across the US. 

I think the health care system needs to be simply regulated better.  Stop allowing corporations and group policies.  Every one pays if they want it and the government regulates it heavy. 

I happen to believe the corporate benefits angle has done more harm than good.  There is now a disillusionment of costs and affordability.
You've nailed two genuine problems with the industry in the US--First of all, consumers have little visibility into or direct responsibility for the billed costs of their healthcare.  It all just goes to the insurance company, so the true cost gets masked.  And secondly, employer-sponsored health insurance is deductible, but if someone buys their own, it's not. 

Change insurance to a reimbursement system, and apply the deduction to all policies, and I think you'd see a dramatic shift.

Even if you are interested, it's very difficult to shop prices (which vary dramatically).  If transparency were required from providers, I believe costs would drop.  I have an HSA (I pay for a significant part of my initial costs) and attempted to shop prices for a procedure.  Very difficult to get information to make an informed decision.

Yep.  I have a plan where I pay $900 a month for vision, dental, and medical.  Looking at a job that will require me to pay almost $1700.  Out of pocket maximums up to $6000.  Which makes no sense.  I have no way or ability to compare those plans and what would be or wouldn't be covered. 

Would it actually be more efficient to go with the lower cost and still be sufficient.  No way to know until you get on it.

Daisy

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #85 on: June 15, 2015, 11:12:42 AM »
A one payer system has never been tried at the scale of the US.

It also reduces health care choice. I fear a one-payer system would further entrench the pharma/insurance-dictating-health-choice/reduced-doctor-autonomy industrial complex.

But I have a feeling my opinions on the actual care that's provided is in the minority in the US. I really don't want to pay for care that I know I will never use or agree with.

If you have health insurance, you are already paying for care that you may not need or agree with.

I have my choice of doctors in Canada and have always received excellent care...it seems to be a myth in the US that other countries have little choice or worse care. I would never trade our medical system for yours, and can say with 100% certainty that no one I have ever known in Canada has ever been hit with a medical bill that causes financial difficulty.

Yes I am aware that with the current insurance model in the US I am paying for care I don't agree with. I see that getting worse with a one-payer system. It would be more difficult to convince a massive bureaucracy to include any kind of "alternative" care.

I'm talking more about the choice of more holistic type of care that the regular medical establishment does not acknowledge. You may argue that those types of care don't really work, yada yada yada. I don't mean to argue here whether they work or not, but rather that I want to have the choice as to what type of care I get.

In a big-insurance type model, that's not possible. For example, my current employer supplied health plan only covers acupuncture when it's prescribed by an MD and only in certain isolated cases, such as knee issues, etc. I've used acupuncture for other things and have to pay out of pocket.

For a long time, my plan did not cover chiropractic care. Now it does, but in a limited fashion.

I wonder if nutritional guidance is covered under "preventative" care. I doubt it. Why doesn't insurance cover gym memberships, exercise equipment, etc.? Sure, if you get injured it covers physical therapy but maybe if you had kept in shape all along you wouldn't have some debilitating issues that lead to physical therapy. Or how about having insurance cover healthy eating habits instead of stomach stapling or heart surgeries?

That's the kind of choice I am referring to. The current system tends to wait until you are sick to cover sick care, not the good type of preventative holistic care I choose.
« Last Edit: June 15, 2015, 11:17:41 AM by Daisy »

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #86 on: June 15, 2015, 01:54:02 PM »
A one payer system has never been tried at the scale of the US.

It also reduces health care choice. I fear a one-payer system would further entrench the pharma/insurance-dictating-health-choice/reduced-doctor-autonomy industrial complex.

But I have a feeling my opinions on the actual care that's provided is in the minority in the US. I really don't want to pay for care that I know I will never use or agree with.

If you have health insurance, you are already paying for care that you may not need or agree with.

I have my choice of doctors in Canada and have always received excellent care...it seems to be a myth in the US that other countries have little choice or worse care. I would never trade our medical system for yours, and can say with 100% certainty that no one I have ever known in Canada has ever been hit with a medical bill that causes financial difficulty.

Yes I am aware that with the current insurance model in the US I am paying for care I don't agree with. I see that getting worse with a one-payer system. It would be more difficult to convince a massive bureaucracy to include any kind of "alternative" care.

I'm talking more about the choice of more holistic type of care that the regular medical establishment does not acknowledge. You may argue that those types of care don't really work, yada yada yada. I don't mean to argue here whether they work or not, but rather that I want to have the choice as to what type of care I get.

In a big-insurance type model, that's not possible. For example, my current employer supplied health plan only covers acupuncture when it's prescribed by an MD and only in certain isolated cases, such as knee issues, etc. I've used acupuncture for other things and have to pay out of pocket.

For a long time, my plan did not cover chiropractic care. Now it does, but in a limited fashion.

I wonder if nutritional guidance is covered under "preventative" care. I doubt it. Why doesn't insurance cover gym memberships, exercise equipment, etc.? Sure, if you get injured it covers physical therapy but maybe if you had kept in shape all along you wouldn't have some debilitating issues that lead to physical therapy. Or how about having insurance cover healthy eating habits instead of stomach stapling or heart surgeries?

That's the kind of choice I am referring to. The current system tends to wait until you are sick to cover sick care, not the good type of preventative holistic care I choose.

You mention a lot of things that you are afraid a one-payer system wouldn't cover. But those are also things that are almost never covered, or are only covered very minimally in the current private insurance model. I'm not sure I follow the point you're trying to make. It sounds like a one-payer system would be at worst a similar level of coverage for those particular items.

The ACA requires most (i.e. nongrandfathered) health plans to cover intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention for beneficiaries who are overweight or obese and have additional CVD risk factors.

Employers and insurers are allowed to provide reimbursement for gym memberships. Many employers do that as part of a wellness program and even provide incentives to employees that meet fitness goals.

If there were a one-payer system, then that payer would have a huge incentive to do whatever it took to help keep people healthy. Since there are so many payers now, any individual payer that spends a lot to help keep people healthy risks having the benefits of that healthy person accrue to another payer once that person switches to a different insurer. Aetna doesn't want to pay so that United's patients don't get expensive heart attacks. If there were a single payer, prevention would be much more in line with the bottom line.

Daisy

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #87 on: June 15, 2015, 03:44:30 PM »
A one payer system has never been tried at the scale of the US.

It also reduces health care choice. I fear a one-payer system would further entrench the pharma/insurance-dictating-health-choice/reduced-doctor-autonomy industrial complex.

But I have a feeling my opinions on the actual care that's provided is in the minority in the US. I really don't want to pay for care that I know I will never use or agree with.

If you have health insurance, you are already paying for care that you may not need or agree with.

I have my choice of doctors in Canada and have always received excellent care...it seems to be a myth in the US that other countries have little choice or worse care. I would never trade our medical system for yours, and can say with 100% certainty that no one I have ever known in Canada has ever been hit with a medical bill that causes financial difficulty.

Yes I am aware that with the current insurance model in the US I am paying for care I don't agree with. I see that getting worse with a one-payer system. It would be more difficult to convince a massive bureaucracy to include any kind of "alternative" care.

I'm talking more about the choice of more holistic type of care that the regular medical establishment does not acknowledge. You may argue that those types of care don't really work, yada yada yada. I don't mean to argue here whether they work or not, but rather that I want to have the choice as to what type of care I get.

In a big-insurance type model, that's not possible. For example, my current employer supplied health plan only covers acupuncture when it's prescribed by an MD and only in certain isolated cases, such as knee issues, etc. I've used acupuncture for other things and have to pay out of pocket.

For a long time, my plan did not cover chiropractic care. Now it does, but in a limited fashion.

I wonder if nutritional guidance is covered under "preventative" care. I doubt it. Why doesn't insurance cover gym memberships, exercise equipment, etc.? Sure, if you get injured it covers physical therapy but maybe if you had kept in shape all along you wouldn't have some debilitating issues that lead to physical therapy. Or how about having insurance cover healthy eating habits instead of stomach stapling or heart surgeries?

That's the kind of choice I am referring to. The current system tends to wait until you are sick to cover sick care, not the good type of preventative holistic care I choose.

You mention a lot of things that you are afraid a one-payer system wouldn't cover. But those are also things that are almost never covered, or are only covered very minimally in the current private insurance model. I'm not sure I follow the point you're trying to make. It sounds like a one-payer system would be at worst a similar level of coverage for those particular items.

The ACA requires most (i.e. nongrandfathered) health plans to cover intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention for beneficiaries who are overweight or obese and have additional CVD risk factors.

Employers and insurers are allowed to provide reimbursement for gym memberships. Many employers do that as part of a wellness program and even provide incentives to employees that meet fitness goals.

If there were a one-payer system, then that payer would have a huge incentive to do whatever it took to help keep people healthy. Since there are so many payers now, any individual payer that spends a lot to help keep people healthy risks having the benefits of that healthy person accrue to another payer once that person switches to a different insurer. Aetna doesn't want to pay so that United's patients don't get expensive heart attacks. If there were a single payer, prevention would be much more in line with the bottom line.

I agree that the current system vs. one-payer won't change much as far as the types of things covered. It may be the same, but I fear worse, with one-payer. I fear it would be a one-size-fits-all approach. And with the strong lobbying efforts of pharmaceutical companies, I seriously doubt alternatives to pharmaceuticals or surgeries would be promoted by a huge bureaucracy in a one-payer system.

I could be wrong...but I look at the huge military industrial complex is a prime example of what would happen in a one-payer system. Lots of waste, misfocused efforts, etc. Maybe other governments around the world aren't as lobby-focused as ours so it may work in their system?

So you say they pay for behavioral counseling, but still no "coverage" for buying healthy fruits and vegetables. But they will cover cholesterol medications and things like that that in many cases (not all) can be resolved with lifestyle changes.

I guess I am cynical towards those in power and the decisions they make.

Paul der Krake

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #88 on: June 15, 2015, 04:13:51 PM »
I agree that the current system vs. one-payer won't change much as far as the types of things covered. It may be the same, but I fear worse, with one-payer. I fear it would be a one-size-fits-all approach. And with the strong lobbying efforts of pharmaceutical companies, I seriously doubt alternatives to pharmaceuticals or surgeries would be promoted by a huge bureaucracy in a one-payer system.

I could be wrong...but I look at the huge military industrial complex is a prime example of what would happen in a one-payer system. Lots of waste, misfocused efforts, etc. Maybe other governments around the world aren't as lobby-focused as ours so it may work in their system?

So you say they pay for behavioral counseling, but still no "coverage" for buying healthy fruits and vegetables. But they will cover cholesterol medications and things like that that in many cases (not all) can be resolved with lifestyle changes.

I guess I am cynical towards those in power and the decisions they make.
Countries with a single payer system typically have a much lower tolerance for bullshit than the United States. Things like "religious exemptions" or "freedom to choose what's best for my children" don't come up in the public debates like they do here. You are of course free to subject yourself to puddles bottles of stagnant water if you happen to believe that they are Jesus' own tears falling from heaven, and the state will even pay for the aftermath of your stupid decision, but they're not going store bottles of it at the neighborhood pharmacy and give you vouchers for it.

Once the medical board can provide convincing arguments that something should be covered, then it becomes covered.

music lover

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #89 on: June 15, 2015, 05:51:04 PM »
I agree that the current system vs. one-payer won't change much as far as the types of things covered. It may be the same, but I fear worse, with one-payer. I fear it would be a one-size-fits-all approach. And with the strong lobbying efforts of pharmaceutical companies, I seriously doubt alternatives to pharmaceuticals or surgeries would be promoted by a huge bureaucracy in a one-payer system.

I could be wrong...but I look at the huge military industrial complex is a prime example of what would happen in a one-payer system. Lots of waste, misfocused efforts, etc. Maybe other governments around the world aren't as lobby-focused as ours so it may work in their system?

So you say they pay for behavioral counseling, but still no "coverage" for buying healthy fruits and vegetables. But they will cover cholesterol medications and things like that that in many cases (not all) can be resolved with lifestyle changes.

I guess I am cynical towards those in power and the decisions they make.

I'm not sure you're approaching this with solid reasoning. Why would you expect a one payer system, or any system for that matter, to cover the cost of fruits and vegetables? To begin with, the logistics involved in that would be mind boggling and near impossible to implement, and of course, would come at a cost...paid by you.

All health care systems have their pluses and minuses, but I would never trade my one payer system for yours. No one I know would trade our health care system for yours.

No one up here has gone broke or lost their life savings due to a large hospital bill. No one has to stay at a crappy job because they are worried about losing their benefits.

A few years ago, my friend was hit by a semi truck while on his bicycle on the highway. He broke 27 bones and almost died, spent 2 weeks in IC, and another 4-5 in recovery, receiving excellent care the entire time. When he left the hospital he was not presented with a bill, and did not have to deal with an insurance company trying to avoid paying a claim, or only a portion of a claim. He left the hospital owing $0.
« Last Edit: June 15, 2015, 05:52:54 PM by music lover »

forummm

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #90 on: June 15, 2015, 06:15:10 PM »
A one payer system has never been tried at the scale of the US.

It also reduces health care choice. I fear a one-payer system would further entrench the pharma/insurance-dictating-health-choice/reduced-doctor-autonomy industrial complex.

But I have a feeling my opinions on the actual care that's provided is in the minority in the US. I really don't want to pay for care that I know I will never use or agree with.

If you have health insurance, you are already paying for care that you may not need or agree with.

I have my choice of doctors in Canada and have always received excellent care...it seems to be a myth in the US that other countries have little choice or worse care. I would never trade our medical system for yours, and can say with 100% certainty that no one I have ever known in Canada has ever been hit with a medical bill that causes financial difficulty.

Yes I am aware that with the current insurance model in the US I am paying for care I don't agree with. I see that getting worse with a one-payer system. It would be more difficult to convince a massive bureaucracy to include any kind of "alternative" care.

I'm talking more about the choice of more holistic type of care that the regular medical establishment does not acknowledge. You may argue that those types of care don't really work, yada yada yada. I don't mean to argue here whether they work or not, but rather that I want to have the choice as to what type of care I get.

In a big-insurance type model, that's not possible. For example, my current employer supplied health plan only covers acupuncture when it's prescribed by an MD and only in certain isolated cases, such as knee issues, etc. I've used acupuncture for other things and have to pay out of pocket.

For a long time, my plan did not cover chiropractic care. Now it does, but in a limited fashion.

I wonder if nutritional guidance is covered under "preventative" care. I doubt it. Why doesn't insurance cover gym memberships, exercise equipment, etc.? Sure, if you get injured it covers physical therapy but maybe if you had kept in shape all along you wouldn't have some debilitating issues that lead to physical therapy. Or how about having insurance cover healthy eating habits instead of stomach stapling or heart surgeries?

That's the kind of choice I am referring to. The current system tends to wait until you are sick to cover sick care, not the good type of preventative holistic care I choose.

You mention a lot of things that you are afraid a one-payer system wouldn't cover. But those are also things that are almost never covered, or are only covered very minimally in the current private insurance model. I'm not sure I follow the point you're trying to make. It sounds like a one-payer system would be at worst a similar level of coverage for those particular items.

The ACA requires most (i.e. nongrandfathered) health plans to cover intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention for beneficiaries who are overweight or obese and have additional CVD risk factors.

Employers and insurers are allowed to provide reimbursement for gym memberships. Many employers do that as part of a wellness program and even provide incentives to employees that meet fitness goals.

If there were a one-payer system, then that payer would have a huge incentive to do whatever it took to help keep people healthy. Since there are so many payers now, any individual payer that spends a lot to help keep people healthy risks having the benefits of that healthy person accrue to another payer once that person switches to a different insurer. Aetna doesn't want to pay so that United's patients don't get expensive heart attacks. If there were a single payer, prevention would be much more in line with the bottom line.

I agree that the current system vs. one-payer won't change much as far as the types of things covered. It may be the same, but I fear worse, with one-payer. I fear it would be a one-size-fits-all approach. And with the strong lobbying efforts of pharmaceutical companies, I seriously doubt alternatives to pharmaceuticals or surgeries would be promoted by a huge bureaucracy in a one-payer system.

I could be wrong...but I look at the huge military industrial complex is a prime example of what would happen in a one-payer system. Lots of waste, misfocused efforts, etc. Maybe other governments around the world aren't as lobby-focused as ours so it may work in their system?

So you say they pay for behavioral counseling, but still no "coverage" for buying healthy fruits and vegetables. But they will cover cholesterol medications and things like that that in many cases (not all) can be resolved with lifestyle changes.

I guess I am cynical towards those in power and the decisions they make.

There's lots of waste in the current system. People in the US pay about twice per capita in medical expenses what they do in other developed countries with a single-payer system. My opinion is that the waste would actually go down with a comprehensive reform. Heck, just negotiating drug prices down to what the other developed countries pay, and cutting the private insurer overhead down to what Medicare's is would save hundreds of billions of dollars per year. Sure PhRMA is a strong lobby, but when there's only one payer, you have a monopsony, and the US market is too important to be in.

No one is going to pay for your fruits and vegetables through a health insurance program. That's just not realistic.

dramaman

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #91 on: June 15, 2015, 10:37:15 PM »
As I said in my earlier post, I think it's a close case. I certainly wouldn't suggest that I can predict how the Court will rule, because I can't. But the case has absolutely nothing to do with "ACA opponents" or "ACA supporters" or the merits of any actual or intended law passed by Congress or the merits of any policies advocated by the President of the United States. Losing sight of these facts can reduce public confidence in the rule of law and lead people into believing that the law doesn't matter because everything comes down to arbitrary political decisions. I reject that narrative and thus I object to the politicisation of this administrative law case.

Object to it all you want, but to think this case is not politicized is wishful thinking. This Supreme Court, one of the most politically polarized in generations, is deciding a case that may seriously impact one of the most politically polarizing pieces of legislation in this generation. And it is not even without precedent. As far back as Marbury vs. Madison we can find examples of Supreme Courts taking political realities into account when deciding their cases. And lest we forget Bush v. Gore with five justices who happened to be Republicans deciding in favor of the Republican candidate against four justices who happened to be Democrats in favor of the Democratic candidate? The rule of law is a nice ideal, yet we humans often fall short of our ideals. I have no reason to think it won't happen this time.

Daisy

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #92 on: June 15, 2015, 10:39:51 PM »
A one payer system has never been tried at the scale of the US.

It also reduces health care choice. I fear a one-payer system would further entrench the pharma/insurance-dictating-health-choice/reduced-doctor-autonomy industrial complex.

But I have a feeling my opinions on the actual care that's provided is in the minority in the US. I really don't want to pay for care that I know I will never use or agree with.

If you have health insurance, you are already paying for care that you may not need or agree with.

I have my choice of doctors in Canada and have always received excellent care...it seems to be a myth in the US that other countries have little choice or worse care. I would never trade our medical system for yours, and can say with 100% certainty that no one I have ever known in Canada has ever been hit with a medical bill that causes financial difficulty.

Yes I am aware that with the current insurance model in the US I am paying for care I don't agree with. I see that getting worse with a one-payer system. It would be more difficult to convince a massive bureaucracy to include any kind of "alternative" care.

I'm talking more about the choice of more holistic type of care that the regular medical establishment does not acknowledge. You may argue that those types of care don't really work, yada yada yada. I don't mean to argue here whether they work or not, but rather that I want to have the choice as to what type of care I get.

In a big-insurance type model, that's not possible. For example, my current employer supplied health plan only covers acupuncture when it's prescribed by an MD and only in certain isolated cases, such as knee issues, etc. I've used acupuncture for other things and have to pay out of pocket.

For a long time, my plan did not cover chiropractic care. Now it does, but in a limited fashion.

I wonder if nutritional guidance is covered under "preventative" care. I doubt it. Why doesn't insurance cover gym memberships, exercise equipment, etc.? Sure, if you get injured it covers physical therapy but maybe if you had kept in shape all along you wouldn't have some debilitating issues that lead to physical therapy. Or how about having insurance cover healthy eating habits instead of stomach stapling or heart surgeries?

That's the kind of choice I am referring to. The current system tends to wait until you are sick to cover sick care, not the good type of preventative holistic care I choose.

You mention a lot of things that you are afraid a one-payer system wouldn't cover. But those are also things that are almost never covered, or are only covered very minimally in the current private insurance model. I'm not sure I follow the point you're trying to make. It sounds like a one-payer system would be at worst a similar level of coverage for those particular items.

The ACA requires most (i.e. nongrandfathered) health plans to cover intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention for beneficiaries who are overweight or obese and have additional CVD risk factors.

Employers and insurers are allowed to provide reimbursement for gym memberships. Many employers do that as part of a wellness program and even provide incentives to employees that meet fitness goals.

If there were a one-payer system, then that payer would have a huge incentive to do whatever it took to help keep people healthy. Since there are so many payers now, any individual payer that spends a lot to help keep people healthy risks having the benefits of that healthy person accrue to another payer once that person switches to a different insurer. Aetna doesn't want to pay so that United's patients don't get expensive heart attacks. If there were a single payer, prevention would be much more in line with the bottom line.

I agree that the current system vs. one-payer won't change much as far as the types of things covered. It may be the same, but I fear worse, with one-payer. I fear it would be a one-size-fits-all approach. And with the strong lobbying efforts of pharmaceutical companies, I seriously doubt alternatives to pharmaceuticals or surgeries would be promoted by a huge bureaucracy in a one-payer system.

I could be wrong...but I look at the huge military industrial complex is a prime example of what would happen in a one-payer system. Lots of waste, misfocused efforts, etc. Maybe other governments around the world aren't as lobby-focused as ours so it may work in their system?

So you say they pay for behavioral counseling, but still no "coverage" for buying healthy fruits and vegetables. But they will cover cholesterol medications and things like that that in many cases (not all) can be resolved with lifestyle changes.

I guess I am cynical towards those in power and the decisions they make.

There's lots of waste in the current system. People in the US pay about twice per capita in medical expenses what they do in other developed countries with a single-payer system. My opinion is that the waste would actually go down with a comprehensive reform. Heck, just negotiating drug prices down to what the other developed countries pay, and cutting the private insurer overhead down to what Medicare's is would save hundreds of billions of dollars per year. Sure PhRMA is a strong lobby, but when there's only one payer, you have a monopsony, and the US market is too important to be in.

No one is going to pay for your fruits and vegetables through a health insurance program. That's just not realistic.

I don't want insurance to pay for fruits and vegetables...but is it any more realistic to have insurance pay for stomach staplings? I have a friend that wanted stomach stapling surgery but insurance would only cover it if she was a certain weight. She purposefully gained the little extra weight she needed in order to have insurance pay for the surgery. Is that not insane? I wonder how many fruits and vegetables could have been purchased for the amount of that surgery, and for arguably better lifetime results.

I think all of those non-catastrophic cases are part of the reason health insurance is so expensive. Let me just say I am not happy with our current health care system in the US either. I'd be fine with a one-payer system for some minor routine care or for the catastrophic cases like the bicycle accident up above. But somehow in the US, not sure if it's the same in other countries, people abuse of the system and try to milk it and this raises the costs for everyone.

Oh well, I know I am in the minority in this opinion. Our health care system has been overrun by pharmaceuticals. What ever happened to "let food be your medicine and medicine your food"? Is that such an outrageous opinion to have?
« Last Edit: June 15, 2015, 10:50:08 PM by Daisy »

Cathy

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #93 on: June 16, 2015, 12:06:31 AM »
As I said in my earlier post, I think it's a close case. I certainly wouldn't suggest that I can predict how the Court will rule, because I can't. But the case has absolutely nothing to do with "ACA opponents" or "ACA supporters" or the merits of any actual or intended law passed by Congress or the merits of any policies advocated by the President of the United States. Losing sight of these facts can reduce public confidence in the rule of law and lead people into believing that the law doesn't matter because everything comes down to arbitrary political decisions. I reject that narrative and thus I object to the politicisation of this administrative law case.

Object to it all you want, but to think this case is not politicized is wishful thinking. This Supreme Court, one of the most politically polarized in generations, is deciding a case that may seriously impact one of the most politically polarizing pieces of legislation in this generation. And it is not even without precedent. As far back as Marbury vs. Madison we can find examples of Supreme Courts taking political realities into account when deciding their cases. And lest we forget Bush v. Gore with five justices who happened to be Republicans deciding in favor of the Republican candidate against four justices who happened to be Democrats in favor of the Democratic candidate? The rule of law is a nice ideal, yet we humans often fall short of our ideals. I have no reason to think it won't happen this time.

I deleted the post you quoted, but since you responded to it, I might as well post it again in full, with some additional comments:

These recent replies are a good illustration of why I posted my earlier thoughts in this thread.

I personally don't agree with the argument espoused by many opponents of US healthcare reform that libertarians must oppose government involvement in the healthcare industry. It can be argued instead that people can't be free unless they are healthy, and the so-called free market system of healthcare fails to deliver health to everybody, leaving some people in a situation where they lack access to meaningful freedom because they are plagued by health problems and an inability to afford the solutions to them or the advice and treatment to prevent them. In short, I personally could be persuaded to support a single-payer healthcare system. I don't consider myself an opponent of Obama's intended or actual healthcare reforms.

But that's all utterly irrelevant to this thread and the court case it discusses. In King v. Burwell, the Supreme Court is emphatically not considering the merits of the program commonly referred to as "Obamacare", nor is it considering the wisdom of the Treasury regulation codified at 26 CFR 1.36B-2 and its prescription of extending tax credits to residents of all states. Indeed, the sole issue before the Court is whether 26 CFR 1.36B-2 is authorised by law. The Court has an affirmative duty to "hold unlawful and set aside" any regulation that lacks a basis in law: 5 USC § 706. If the Court exercises that duty, it says nothing about what the Court thinks about the merits of the regulation or the policy it encompasses.

As I said in my earlier post, I think it's a close case. I certainly wouldn't suggest that I can predict how the Court will rule, because I can't. But the case has absolutely nothing to do with "ACA opponents" or "ACA supporters" or the merits of any actual or intended law passed by Congress or the merits of any policies advocated by the President of the United States. Losing sight of these facts can reduce public confidence in the rule of law and lead people into believing that the law doesn't matter because everything comes down to arbitrary political decisions. I reject that narrative and thus I object to the politicisation of this administrative law case.

***

I think it's a shame that popular news media leads people to conflate the merits of the regulation with its legal validity. It's entirely possible to think the regulation represents wise policy, while also believing it lacks a basis in law. The reverse is also possible. (I'm not saying I believe either of those things, since I'm not going to disclose my opinion on the lawsuit.)

The US Supreme Court as a matter of fact simply does not decide cases based on "liberal" and "conservative" votes from "liberal judges" and "conservative judges". That's what the popular news media says, but it has no basis in reality.

Let's consider the example of Scalia J, generally considered by the popular news media to be a "conservative judge" who supposedly bases his votes on conformance with the politics of the so-called American right. In a recent case (EEOC v. Abercrombie & Fitch Stores, Inc., slip op), Scalia J wrote for the majority in an opinion that established a very favourable standard for plaintiffs looking to prove discrimination in the workplace. Under a highly simplistic model of the Court where the judges vote based on political labels, that opinion would be unthinkable. However, that simplistic model just does not reflect the reality of how the law or the US Supreme Court works. An actual review of their opinions reveals they do not fall along any simplistic political lines.

The belief that the courts are fundamentally another political institution is at the same level of understanding as the belief that dividends are "free money". It's a first order understanding, and there is room for improvement. Once that first order understanding is mastered, then one can move on to the finer points where dividends actually have advantages compared to capital appreciation and the proceeds of stock sales; and one can move onto the jurisprudential differences between judges, which have little in common with popular political terms and even less in common with anything written about the Court in the popular news media. See also "The Low Information Diet", by MMM.
« Last Edit: June 16, 2015, 01:38:25 AM by Cathy »

seattlecyclone

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #94 on: June 16, 2015, 01:47:58 AM »
Well said, Cathy. Each of the Justices has their own viewpoints on legal issues, but labeling them as "liberal" or "conservative" is overly simplistic and in many cases inaccurate.

dramaman

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #95 on: June 16, 2015, 06:57:32 AM »
The US Supreme Court as a matter of fact simply does not ALWAYS decide cases based on "liberal" and "conservative" votes from "liberal judges" and "conservative judges". That's what the popular news media says, but it has no basis in reality.

Corrected that for you.

Let's consider the example of Scalia J, generally considered by the popular news media to be a "conservative judge" who supposedly bases his votes on conformance with the politics of the so-called American right. In a recent case (EEOC v. Abercrombie & Fitch Stores, Inc., slip op), Scalia J wrote for the majority in an opinion that established a very favourable standard for plaintiffs looking to prove discrimination in the workplace. Under a highly simplistic model of the Court where the judges vote based on political labels, that opinion would be unthinkable. However, that simplistic model just does not reflect the reality of how the law or the US Supreme Court works. An actual review of their opinions reveals they do not fall along any simplistic political lines.

Of course Supreme Court justices are more complex than the Manichean "liberal" vs. "conservative" strawman that you argue against. I don't disagree that the media, particularly the television media, can dumb it down to such a simplistic picture. I don't disagree that you can find examples of justices mixing and matching with whom they combine their votes with to decide cases based on particular areas they focus on, such as Scalia and free speech.

Yet it is naive to believe that just because the justices don't confirm to a simplistic narrative that the court consists of nine justices who are the legal equivalents of Mr. Spock, able to suppress their baser political biases and decide every case with pure legal objectivity; that all nine of them are immune to the political realities of what this case will be. And history shows this isn't so. Time and again, we see the Supreme Court influenced by the politics of the day, all the way back to Marbury v. Madison. Given that any decision for this particular case can be written to be extremely narrow, claiming to be argued on its administrative law 'merits' and applying only to the ACA (much like the decision that came out of Bush v. Gore) I have no reason to believe that most of the justices won't be voting in accordance with their political affiliations. In my opinion, the two exceptions may be Kennedy and/or Roberts. Roberts in particular is a very politically aware Chief Justice, taking into account the reputation of the Supreme Court and concerned for his legacy as its Chief Justice. I believe this is what led him to bend over backwards to come up with a legal justification to uphold most of the ACA in the preceding case, writing a legal opinion that I doubt he would have been able to swallow if the case hadn't been so politicized. He wanted to find it it constitutional and crafted the legalese to make it so.

The belief that the courts are fundamentally another apolitical institution is at the same level of understanding as the belief that dividends are "free money". It's a first order understanding, and there is room for improvement. Once that first order understanding is mastered, then one can move on to the finer points where dividends actually have advantages compared to capital appreciation and the proceeds of stock sales; and one can move onto the jurisprudential differences between judges, which have little in common with popular political terms and even less in common with anything written about the Court in the popular news media and yet are not immune to the political pressures that surround them. See also "The Low Information Diet", by MMM.

And fixed that one for you as well ;)
« Last Edit: June 16, 2015, 07:43:15 AM by dramaman »

brooklynguy

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #96 on: June 16, 2015, 07:17:47 AM »
But that's all utterly irrelevant to this thread and the court case it discusses.

While I agree that many people (including myself) are guilty of allowing their political views to color their views about this case (and hopefully (and presumably) the Supreme Court justices will do a better job of remaining impartial), for the most part that's not what's going on here in this thread.  Policy (and not merely legal) considerations do have relevance towards the outcome of the case, and the political climate has relevance towards the policy considerations (for example, the justices entertained discussion about the practical consequences of an "adverse" decision during oral argument, including the question of whether and how Congress would react).  In addition, as I said in my initial objection to the banishment of this thread to the Off Topic subforum, the stated purpose of this thread is not limited to the narrow topic of the disposition of the legal case before the Supreme Court but includes the broader topic of the implications thereof on our collective retirement planning (which necessarily sweeps into its scope the current political situation).  Moreover, this thread, together with the subsequently created parallel thread in the Post-FIRE subforum, have almost become the forum's central clearing house for any and all discussion relating to the ACA and the associated political and policy considerations.  So, I think you're reading too much into the expansion of the scope of the discussion here, which does not necessarily represent the politicization of the Supreme Court case.

forummm

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #97 on: June 16, 2015, 07:39:01 AM »
Cathy, you might consider that certain justices are not quite so honor bound or free from bias as you might wish them to be. I agree that the "liberal" and "conservative" labels are overly simplistic. But there is a clear pattern of behavior for certain justices to issue rulings in certain directions, even if it contradicts what they've said before.

Scalia is the easiest example because he's such a personality. He normally tends to vote to reduce worker ability to sue for discrimination. But Scalia wants Christians to have the ability to sue for discrimination, so the Abercrombie case you cite is about a religious freedom, and that's his goal there. He normally tends to vote in favor of states rights for things he wants states to be able to do (like not participate in the Medicaid expansion). But when it comes to states doing what they want with things he doesn't like (say having different medical marijuana policy), he's suddenly on the side of the federal government.

Cathy

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #98 on: June 16, 2015, 11:17:11 AM »
...the justices entertained discussion about the practical consequences of an "adverse" decision during oral argument, including the question of whether and how Congress would react...

The Court does have a long history of questioning the parties about the practical consequences of potential decisions, even though this is often irrelevant to the case. Many scholars object to this practice of the Court, but it's generally considered unwise to object to it at oral argument. I am reminded of Lawrence Lessig's retrospective on Eldred v. Ashcrof, where he represented the plaintiffs in their challenge to the constitutionality of a copyright term extension. At oral argument, several judges asked him what harm the statute was visiting upon producers of creative content, and he responded by informing the Court that those questions were irrelevant and that he would not answer them. He now believes that that response, although legally accurate, caused him to lose the case. He wrote an analysis on this in one of the later chapters of his book "Free Culture".

brooklynguy

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Re: Supreme Court to opine on Obamacare tax credit
« Reply #99 on: June 16, 2015, 11:29:37 AM »
He now believes that that response, although legally accurate, caused him to lose the case.

If true, doesn't this contradict the objections you've raised in this thread?  And whether or not true, doesn't the very fact that no lesser a legal scholar/Supreme Court practitioner than him holds that belief itself throw those objections into doubt?