Health Care Reform

[Voronwë the Faithful]

So Roberts completely buys the activity/inactivity distinction that conservative bloggers have invented over the past couple of years to limit the commerce power of Congress. But then he cuts their legs out from under them by buying the government's alternative argument that the penalty is a a valid application of Congress' taxing power. But, he also holds that the court can reach this decision, because the penalty is not a tax for the purposes of the Anti-Injunction Act (which provides that a tax can't be challenged until it goes into effect. It boggles the mind!

[Primula Baggins]

Apparently the four "no" votes all wanted to overturn every provision of the entire law. Somewhere in the flurry I read someone wondering whether it was the radical nature of that option that forced Roberts to vote to uphold.

[Voronwë the Faithful]

I don't claim to understand any of this but, as someone who was uncomfortable/skeptical regarding the constitutionality of the mandate, I had asked myself if there was any meaningful philosophical difference between this "mandate" and taxation. So the judges are essentially saying, no, there's not?

Yov, that is essentally correct, with the added caveat that it is the penalty that goes along with the mandate that is equivalent to a tax.

[Voronwë the Faithful]

Apparently the four "no" votes all wanted to overturn every provision of the entire law. Somewhere in the flurry I read someone wondering whether it was the radical nature of that option that forced Roberts to vote to uphold.

That's interesting, Prim. I haven't gotten to the dissent yet (or even to the concurring opinion that would have also upheld it on the commerce clause). My gut tells me that may well be right.

Of course, this is meaningless if Obama loses the election and the GOP holds the house and gains a majority in the Senate. Does anyone doubt that if the GOP gets a majority in the Senate they will hesitate to change the fillibuster rules to prevent the Democrats from using it to block repeal?

[vison]

I think I am going to say, "Congratulations" to the US.

It's a very bad system, but it's better than no system at all.

[Dave_LF]

I am a bit surprised by how relieved I am over this. I think this decision, had it gone the other way as I expected, would have done more to destroy my faith in the US system of government than anything George W. Bush or the Tea Republicans have done. I woke up this morning depressed, and was pleasantly surprised instead. My brain says I can't relax yet because it did come down to 5-4 and because the forces that have been trying to prevent healthcare reform since Roosevelt will now be pouring all their energy and funds into defeating Obama, but I'll savor things for a moment anyway.

[River]

The individual mandate is unpopular, but the other provisions of the law aren't, so if it gets repealed, the people doing it had better have viable replacements for the parts people like (kids on policies until they're 26, coverage for pre-existing conditions, etc.). Or maybe they don't. Maybe, with all the money behind them, they really won't have to care what us plebians think.

[Inanna]

Woot!

What I would like now is for the Obama Reelection campaign to go ALL OUT touting the BENEFITS of this law to everyone. Public opinion can be changed, DO IT!

ETA: http://www.barackobama.com/health-care/

[Inanna]

Okay, I have the opinion now. Only 193 pages.

Never in my wildest dreams would I have believed that the law would be upheld without Kennedy's vote. Wow!

I agree. It might make for an interesting change in the SCOTUS' dynamics. This ruling comes soon after TIME's magazine cover story on Kennedy and how the law of the land hangs on him (with the 4-4 votes decided for most controversial judgments). Apparently not.

[Folca]

Eh, I expected this to happen. Glad I don't have children to inherit the mess all of these individuals have created.

I don't feel that a more intrusive role in our lives is the government's role, regardless of the circumstances. Life is hard, live it or check out. Take responsibility for yourself and accept the fact that fairness and equality are ideals, not reality. None of us are entitled to anything except life, liberty and the OPPORTUNITY to pursue happiness. The rest is a bonus.

The real reform needs to be against the medical industry itself. "Do no harm" my kiester. Any industry that saves the lives of others only to deliver them into abject poverty while declaring their efforts helping and being paid like mercenaries does not deserve to be catered to. I consider this legislation intrusive and catering to the medical industry. And people complain about war profiteering!? I don't consider the medical industry any less culpable in taking advantage of human misery and inflicting an ungodly cost. I find it interesting that people are so hung up on the casualty counts of wars but ignore the death toll inflicted by malpractice every year.

I am no expert in this law, but considering that construing this legislation as a form of tax even though it wasn't presented as one when the legislation was introduced is just proof to me that SCOTUS and politicians seek to inflict their personal agendas on the masses. The decision appears to be highly interpretive.

[Primula Baggins]

I'm glad my three children will be allowed to continue inheriting the benefits of this law. Given that entry-level jobs at present (if they can be obtained at all) pay no benefits, through us our children can continue to have health care until (yes) the full provisions of the ACA kick in in 2014 and affordable plans are available to them.

I'm also keen on the idea that if my cancer comes back, I don't have to die, even though I'm self-employed and am not (I guess?) entitled to the same chance at life as someone working for a corporation. But then I guess fairness and equality are "ideals" (which means [I guess?] that no one should ever hope to receive them).

It's tough and manly and admirable to face life without help. That I concede (I guess). It's a little different to face death without help. It might be educational for health-care libertarians to try that sometime. Or watch someone they love try it.

[Voronwë the Faithful]

Eh, I expected this to happen. Glad I don't have children to inherit the mess all of these individuals have created.

This law is far from perfect, but it actually moves in the direction of cleaning up the mess that we have created for our children, slowing the runaway train that is health care costs in America. There will need to be major changes in the future, and (yes) major additional reforms of Medicare and Medicaid to control costs, but it is step in the right direction, while ensuring that fewer of our citizens fail to get the care that they need.

Take responsibility for yourself ...

Here is the irony of the conservative assault on the individual mandate. The idea was created by conservatives as a way to ensure that people, wait for it, take responsibility for themselves. The reason why something like it was necessary is that too many people refused to do the responsible thing, and just relied on society taking care of them if they had a medical emergency. The idea that "Obamacare" is "socialism" or the government taking over health care is so far from the truth that it is laughable. It is the free market alternative to single-payer (e.g., government) coverage. It is, in essense, the last ditch effort to save the health insurance industry. If it doesn't work, the ONLY alternative will be true socialized medicine. Republicans and conservatives should be doing everything they can to make it work, not to defeat it.

[Griffon64]

It's tough and manly and admirable to face life without help. That I concede (I guess). It's a little different to face death without help.

That is one of the most thought-provoking things I've ever read on this board or any other. Wow.

I'm wondering if this law will be of any help in a possible scenario I'm facing. Sadly, my homeland isn't getting more stable as time progresses - it is getting less stable. So I have to face the possibility that I may need to bring my parents over here to live. While they are financially secure enough that they'd be able to live a middle-class life here if health care costs were the same here as where they're from, up to this point there was no way, no no way, that we'd be able to actually do it, because of the cost of health care. Since they don't qualify for Medicare all their health insurance would have to be private, and the cost of insuring people in their late 60's and beyond privately is prohibitively expensive. So I wonder whether these exchanges and things the health care reform brings would make it any more feasible now, or if elderly immigrant parents will still fall through the cracks. I'll have to research it all now that the law is standing.

I agree fervently that the cost of health care needs to be tackled smartly.

Growing up, America was one of the good guys to the rest of the world. Living in America, I've grown steadily more appalled that a sliver of the "good guys" have an "I got mine, you can go die" attitude towards their own fellow citizens. Ouch.

[vison]

"I'm all right, Jack". That's the title of an old and apropos movie.

Since I am in exactly the position that Primula brings up: facing death in a socialized medical system, my opinions are pretty strong.

It's probably too late now for the US to go with some version of the Canadian system. The choices were made long ago and now you are all faced with the consequences of ideology that simply NEVER made sense to me. Why was health insurance ever tied to employment? Sorry to bang on that drum, I know it's futile to think of "what might have been".

Folca is partly right, but he's right in the wrong way. The CHOICE to go with "socialized" medicine was a CHOICE Canadians and others made. It seemed - and was, and is - more cost effective and efficient. It does what insurance is supposed to do: spread the risk as widely as possible. This was what was good for Canada, this was not what was good for the medical industry or the insurance industry.

Our system isn't perfect, but hey, look at me. Within days of a diagnosis, brain surgery in one of Canada's best hospitals by one of Canada's best surgeons. Almost instantly further treatment in the form of radiation. Next, referral to another brilliant surgeon. At the same time, my medical premium is $128 a month for my family of three. True that if I lived in Pouce Coupee things might be different, but people who live in remote American places are in the same boat, insurance or no insurance. Our system is groaning under the burden, but we are not going to abandon it, we are going to tweak it and tweak it and do some serious triage. At the same time, there IS private insurance and there are procedures that people pay for if the waiting lists (and there are admittedly waiting lists) are too long.

Look at what Terermia has endured in the form of bureaucratic crap. I don't know how she could have been "more responsible for herself" and not expect "others" to take care of her!!! She did what she was supposed to do and the stupid system keeps failing her in the most appalling way.

In a civilized society people must care for each other. The poor and uninsured in the US get treated now at an enormous and wasteful cost. Yes, Folca is right: this is a bloated and self-entitled medical behemoth and in most ways the system caters to it and, worse, to insurance companies that cannot fulfill the most basic duties of INSURANCE. But the answer is not to let them have yet more power, the answer is to start pushing back with some common sense.

How I wish I thought that ideology would be pushed aside for the good of the nation. That there be some sort of campaign for maybe 'regional' insurance schemes and that people who move from one job to another or to one state or another could take, not only their pensions, but their health insurance with them.

I don't know if Folca or anyone in his family has ever been in my or Primula's or Teremia's position. I hope not. Or, if they have, I hope they have deep, deep, deep pockets.

Griffon, move to Canada.

[yovargas]

I don't feel that a more intrusive role in our lives is the government's role, regardless of the circumstances. Life is hard, live it or check out. Take responsibility for yourself and accept the fact that fairness and equality are ideals, not reality. None of us are entitled to anything except life, liberty and the OPPORTUNITY to pursue happiness. The rest is a bonus.

As a pretty libertarian-leaning guy, this tends to be my general line of thinking as well. But there are undeniably some things that have to done by society and not individuals, and while I would philosophically strongly prefer a private solution to the major problem of healthcare, nobody had offered a reasonable one that I can see. Republicans have been too focused on attacking "Obamacare" to offer any real solutions. So I've just concluded I'll back the people who are at least trying to find a solution, even if it grates on my general philosophical outlook on things.

[Griffon64]

Republicans have been too focused on attacking "Obamacare" to offer any real solutions. So I've just concluded I'll back the people who are at least trying to find a solution, even if it grates on my general philosophical outlook on things.

Ah, so it's not just me. I could have written this.

[yovargas]

Griffons are wise.

[Frelga]

I am a died-in-the-wool non-partisan. I'm nearly anti-partisan. But IAWY.

Christian Science Monitor, which I highly respect, has a quiz on the various aspects of Health Reform. One of the things they say is that an average family currently spends about $1,000 per year more on health care to absorb the costs of care for the uninsured.

They also gave one of the options for the official name of the bill as GOP Repeal Bait Act of 2010.

[Griffon64]

My original post also contained a bit about going back and forth on how to register to vote ( party-wise ) and deciding on independent in the end - I then deleted it in favor of brevity. But I've got a "nearly anti-partisan" card in my wallet for sure.

My only thought for registering with a party was to put weight behind the saner candidates for the party instead of letting the frantic fringes throw up candidates, but in the end I decided I'd rather be independent. I have too much of a beef with parts of what both parties stand for to, at this point, want membership in either.

[Folca]

Certainly not defending Republicans, as they haven't done anything to fix the problem either. I just don't believe that we should be forcing people to make good decisions for themselves. If someone isn't smart enough to figure out they need to find a way to take care of themselves, I don't understand why I should be taxed in any way to help them. If people are truly good and desire to help one another, why isn't the welfare system run on donations? In principle, I don't see much difference. I don't believe in rewarding irresponsibility. An ex girlfriend chose to move to LA and become an actor, and lamented her lack of health insurance. She could have chosen a career or job that provided insurance, but instead elected not to. She knew the associated risk but still felt it unfair. I think it was very fair, as it was a known price of the decision. I specifically chose an occupation that is in the top ten most dangerous jobs, with low pay but decent benefits because I wanted it. I love what I do. But I would not have chosen the job if it did not provide health insurance, because I knew I wouldn't be able to afford to pay for any medical care when unfortunate circumstances arose.

I watched my life's mentor waste away and die of a terminal illness over the course of three and a half years. He was my grandfather. Aside from my parents, no other person has had more influence on how I was shaped as a person. One of his medicatons cost over $3500 a month. What saved him from an earlier death and abject poverty was being retired military. And I purchased their residence to create the nest egg that got him and my grandmother through to their deaths. All of my grandparents were afflicted with terminal diseases that cost them dearly in many ways. I am no stranger to the cruelty of life, death or the societal systems we employ to delay or secure those things. Cancer, heart failure, Alzhiemers, diabetes are all prevelant in my extended family.

My family does not have deep pockets, which is why I despise the medical industry as mercenaries who sheath themselves in the guise of miracle workers, lance my own infections with a knife and selected a job where I was going to be provided medical insurance. If medical professionals truly wanted to help people, they would drive Camrys and Taurus sedans, and live in modest homes...and save lives.

Unless this legislation actually fixes the impoverishment of those saved by the medical industry, it only delays the financial destruction of anyone unfortunate enough to be compelled to be treated.

You can do everything right, and still end up short. I have done my best to pursue my own form of life, liberty and happiness, but circumstances outside of my control may still lead the the destruction of all that I have and all that I am. How I feel about that reality is immaterial. How I accept and adapt to my current reality will determine how I end this existence. I recognize every day as a blessing, and am grateful for opportunity to act on my own accord. The world is an amazing a beautiful place. Society...not so much.

I just don't believe in encouraging people to shirk taking care of themselves with utmost effort, and I think this legislation does that. And then I also think the decision is tainted. The timing is pretty good to keep Obama in office. Since its inception, the whole thing has smacked of a bid to purchase votes, because that is what politicians do. Obama, like any other politician, couldn't care less about individuals aside from votes, otherwise why is he such an egalitarian a millionaire?