5-4 Insurance Mandate Upheld

thunderbolt23 · July 3, 2012, 2:18pm

[quote]Mufasa wrote:

While I totally agree with this, Bolt…would you not ALSO agree that there would have to be VERY fundamental changes in the way “business is done” in Washington?

That’s been my argument all along. As things stand now; in order to get ANY bill passed, there often has to be “compromise” (i.e. “somebody gets something”). When that occurs, all too often, a Bill begins going down that slippery slope of losing much of it’s original intent.

So while I’m the first to feel that leadership counts; ANY leader eventually comes head-to-head with the realities of Washington. Granted; some deal with it better than others; but eventually ALL leaders hit the “realities” of Washington.

To be honest, I’m really hoping that that the GOP gains FULL control of the House and Senate and also Wins the White House. Then I’ll judge for myself if who is in “control” really matters one iota.[/quote]

I’d actually say the opposite - the forces of compromise are one the essential forces that stops grandiose, overreaching bills in favor of smarter, smaller bills. If we had in place a system of less compromise, we’d simply trade one big bill after another, as new majorities would overturn the last big bill with a big bill of their own, turning the process into even worse ideological “scorched earth” lawmaking. And this is bad for the country - and it’s unstable policy, so it’s bad for politics and the economy.

Compromise is one the features of the system. Sweeping laws are supposed to be hard to pass - the was the Founders’ design. If anything, I would prefer a system that puts more pressure on politicians to break up big bills into small ones on account that the big bills just can’t be passed.

One feature at the state level is the idea of a “caption clause” - meaning, the law can’t entail policy outside of what is stated in its caption clause. Would this fly at the federal level? Probably not, given the vested interests against it, but it would certainly go a long way to my wish of frustrating overreaching legislation.

Tiribulus · July 3, 2012, 3:13pm

[quote]thunderbolt23 wrote:<<< If anything, I would prefer a system that puts more pressure on politicians to break up big bills into small ones on account that the big bills just can’t be passed.

One feature at the state level is the idea of a “caption clause” - meaning, the law can’t entail policy outside of what is stated in its caption clause. Would this fly at the federal level? Probably not, given the vested interests against it, but it would certainly go a long way to my wish of frustrating overreaching legislation.[/quote]I would also prefer smaller bills for the sake of much more tightly targeted policy per bill which is what it looks you’re getting at here with the “caption clause” deal. It would cut waaay down on abuse and pork I think. This crap of tucking the payoff for a campaign supporter into an entirely unrelated bill it completely outta hand. That will not likely happen either though and if it did, they’d get around it.

Mufasa · July 3, 2012, 3:44pm

[quote]thunderbolt23 wrote:

[quote]Mufasa wrote:

While I totally agree with this, Bolt…would you not ALSO agree that there would have to be VERY fundamental changes in the way “business is done” in Washington?

That’s been my argument all along. As things stand now; in order to get ANY bill passed, there often has to be “compromise” (i.e. “somebody gets something”). When that occurs, all too often, a Bill begins going down that slippery slope of losing much of it’s original intent.

So while I’m the first to feel that leadership counts; ANY leader eventually comes head-to-head with the realities of Washington. Granted; some deal with it better than others; but eventually ALL leaders hit the “realities” of Washington.

To be honest, I’m really hoping that that the GOP gains FULL control of the House and Senate and also Wins the White House. Then I’ll judge for myself if who is in “control” really matters one iota.[/quote]

I’d actually say the opposite - the forces of compromise are one the essential forces that stops grandiose, overreaching bills in favor of smarter, smaller bills. If we had in place a system of less compromise, we’d simply trade one big bill after another, as new majorities would overturn the last big bill with a big bill of their own, turning the process into even worse ideological “scorched earth” lawmaking. And this is bad for the country - and it’s unstable policy, so it’s bad for politics and the economy.

Compromise is one the features of the system. Sweeping laws are supposed to be hard to pass - the was the Founders’ design. If anything, I would prefer a system that puts more pressure on politicians to break up big bills into small ones on account that the big bills just can’t be passed.

One feature at the state level is the idea of a “caption clause” - meaning, the law can’t entail policy outside of what is stated in its caption clause. Would this fly at the federal level? Probably not, given the vested interests against it, but it would certainly go a long way to my wish of frustrating overreaching legislation.[/quote]

Again, I agree IF compromise allows the “job to get done”.

Too often it doesn’t.

Mufasa

Severiano · July 3, 2012, 5:07pm

[quote]countingbeans wrote:

[quote]Severiano wrote:
Should I have the option to opt out, even though I know damn well if I am severely injured and cant work, I’m basically homeless because I don’t have a heck of a lot saved?[/quote]

Yes. Yes you should. If you can’t be responsible enough to see the error of your ways, in the above example, then you deserve, with all the freedom America is supposed to provide, to be homeless.

And no, I don’t feel bad for you.

Funny part is, in college, I lived off campus in an appartment and worked retail. I lived off of 12k a year. I still had savings, 4 figures worth, in excess of 10% of my income…

Why should the government be the one to force people to be responsible?

Why not? Because taking care of yourself and making the right/wrong choices shoudln’t be up to the individual? [/quote]

You got this wrong, because if I end up being a dumby and opting to drop my health insurance and lose my ass, it still ends up having to get paid by the taxpayer.

This would make me if I were that stupid a two time loser, and you a loser. Me because I end up broken and homeless, rather than just broken. You because you still have to pay for my ignorant ass if I choose to be ignorant and irresponsible.

I’d rather people have the option of opting out if they are willing to put around 2 mil in a bond that could be used for medical purposes. I do like the idea of people having the option.

I’m not sure of the soundness of the bill itself or how things will turn out because both sides like to put their own, unique deceptive spin on things. What I do like is the idea that people without health insurance because they cannot afford it would get it, also that civilians would have certain protections which would prevent insurance companies from dropping people because of their ailments. My statement about people in Texas stands, there are too many people around who live paycheck to paycheck that outright can’t afford health insurance. When I say paycheck to paycheck, I’m saying they are working class people who don’t have skill sets in demand, and they tend to not be educated and we end up paying for this sort of person one way or another. It only seems humane that in the United States people can go to a hospital if they are injured and not have to worry about losing their home, or not being able to pay rent because of it.

If there is shady shit in the bill, which I’m sure there is I’d like to hear the specifics from both sides. Getting the truth about this sort of stuff is usually an independent venture that takes a bit of time (for me at least).

But, what I found here were people moaning and crying (like little girls, look at the first several pages) about how it’s a tax and wrong in all the exact same ways Romneycare was wrong. That is honestly what I read the first few pages before my initial post.

I’m certainly concerned with state vs. federal law and how that impacts our rights, and that is definitely a point that would change my position on this particular topic due to precedent, even if the end result is something I agree with, precedent trumps… After some of your posts (not you Zeb, wont give you the satisfaction :P) I realize there is a bit more to this than meets the eye, and if I try to intelligently defend the bill (which I probably wouldn’t), I need to get very familiar with it’s consequences. Hopefully that clears things up!

Cheers folks, great discussion.

countingbeans · July 3, 2012, 5:19pm

[quote]Severiano wrote:

You got this wrong, because if I end up being a dumby and opting to drop my health insurance and lose my ass, it still ends up having to get paid by the taxpayer.

This would make me if I were that stupid a two time loser, and you a loser. Me because I end up broken and homeless, rather than just broken. You because you still have to pay for my ignorant ass if I choose to be ignorant and irresponsible. [/quote]

In the real world, yeah, you are right. I would pay for your broke ass. I was speaking purely in a hypothtical situation.

Fact is, before and after Obamacare I would pay for hypothetical you as a tax paying insurance consumer.

I guess being able to choose where I spend my money and at least pretend I’m free is the better situation in my mind.

Agreed, a whole lot of people seem to like giving up the option.

This could have been fixed in much better ways than the current solution. Thunder mentioned focus on lowering costs, and then the insurance will come to the people.

But right now it is, send the people to the insurance, the costs will come to them.

I understand people are broke. But isn’t giving them free shit trying to fix the effect rather than the cause?

Medicare tax on investment income comes to mind off the bat.

Being mandated what private services I am to purchase simply because my heart beats.

[quote]

But, what I found here were people moaning and crying (like little girls, look at the first several pages) about how it’s a tax and wrong in all the exact same ways Romneycare was wrong. That is honestly what I read the first few pages before my initial post. [/quote]

I wish, more than anything that Romney would just come out and admit he fucked up. His bill wasn’t as big as a clusterfuck as ACA, but it still sucks. Our costs are highest in the nation. Highest. Romeny fucked up. He should (can’t because of politics) man the fuck up and admit it was a fuck up, failed experiment, and he attacked it from the wrong angle. Then come up with an alternative that works.

And yes, I did bitch and moan like a little girl, and have no shame. I was pissed.

ZEB · July 3, 2012, 5:48pm

[quote]Severiano wrote:
After some of your posts (not you Zeb, wont give you the satisfaction :P) I realize there is a bit more to this than meets the eye…
[/quote]

Oh no what will I ever do?

LOL

Schlenkatank · July 3, 2012, 9:49pm

[quote]666Rich wrote:
Yes,

it is a stupid comparison. Take public transportation like millions of people in new york city. Walk. Ride a fucking bike. You wont have to purchase auto insurance.
[/quote]
I’m not ignoring the rest of your post, but I have to take issue with this here. The comparison to car insurance seems very similar to me; the argument that you and others make that you don’t have to own a car in one scenario is silly because you’re not thinking about this clearly. Let me see if I can help.

To clarify:

Everyone who owns a body and is uninsured is a liability to everyone else because everyone in their life will get sick. This is common sense.

Not everyone owns a car, but amoung those who do they are required by law to purchase car insurance to protect them from liability. As was diuscused, all 50 states require you to prove you can cover dammages to drivers and the state should a lawsuit result.

The difference between owning a car and owning a body? Everyone owns a body and the dammages to it can be considerably more expensive. Why should the rules be any different?

Schlenkatank · July 3, 2012, 9:55pm

I have to say to thunderbolt and the Dr. that I like some of your ideas. I can guarantee that some of the issues in affordability of care stem from the lack of competitive pressure from insurance companies and drug companies.

One problem I have with the idea that the issue is as simple as disentangling insurance from employment is that while I think it’s possible that this could reduce the cost of care, I don’t think it would be enough to make the remaining problem a cinch. Not that I’m opposed to the idea, I’m just not sure that the effect would be as grand as you suggest–obviously governemnt spending on healthcare is insane as i’m sure you know.

What do you think about the provision in the ACA that allows for more approval of generic drugs to increase competitive pressure with drug companies? Also, what about one of the provisions that states physicians will be paid based on the quality of their care effective 2016 (I think)?

orion · July 3, 2012, 9:50pm

[quote]Schlenkatank wrote:

What do you think about the provision in the ACA that allows for more approval of generic drugs to increase competitive pressure with drug companies? Also, what about one of the provisions that states physicians will be paid based on the quality of their care effective 2016 (I think)? [/quote]

What do you think about the fact that cheaper drugs NEED TO BE ALLOWED!?!

Aragorn · July 3, 2012, 9:50pm

[quote]Severiano wrote:

It only seems humane that in the United States people can go to a hospital if they are injured and not have to worry about losing their home, or not being able to pay rent because of it.[/quote]

You and I probably don’t agree on much politically speaking, but it seems you are a pretty intelligent person who likes to think, and I like that. This statement is problematic for a couple reasons: First, it constitutes a marginal appeal to emotion in argumentation, which is obviously a logical fallacy. More importantly however–and what I believe you may have been intending to get at, is the cost issue of healtcare bankrupting people for operations. THIS is important because as Thunderbolt, Skeptix, Powerpuff’s relative (hospital admin), and myself have all already noted the ACA does NOTHING TO FIX. It doesn’t even address the foundational issue you speak of!! In fact, almost all the fundamental issues that are causing healthcare to skyrocket will be made WORSE by the bill over time. It was made on pure political ideology, to buy votes and push an agenda, not because it was the most reasonable way to approach the problem. Historical evidence from Mass and the UK indicate that costs will go up, not down (referencing UK, look at inflation adjusted figures for various costs from decades ago to today).

The further difference is that the tax and govt structures that exist in Europe which allow these national healthcare systems to avoid bankruptcy for so long do not exist in the US. Call it a difference of culture. So not only is it bad economic policy, the gov’t infrastructure that allows it to sort of function overseas is not present here. That makes the problem worse, not better. We just put a tiger in a room of bystanders without giving it anything to eat first.

[quote]If there is shady shit in the bill, which I’m sure there is I’d like to hear the specifics from both sides. Getting the truth about this sort of stuff is usually an independent venture that takes a bit of time (for me at least).

But, what I found here were people moaning and crying (like little girls, look at the first several pages) about how it’s a tax and wrong in all the exact same ways Romneycare was wrong. That is honestly what I read the first few pages before my initial post. [/quote]

Well, I disagree with you on several levels. First and foremost, this was not, is not, and never was, a “tax” no matter what Justice Roberts’ tortured logic dictates in his opinion paper. It is and has always been a penalty, and that is a HUGE issue for me.

A second and gigantic issue is the re-definition of “tax” according to the recent ruling which essentially endangers and destroys a large chunk, a huge piece, of the separation between freedom and Federal power. This is related to the Constitutional issues–and anybody choosing to conveniently ignore or dismiss (my eye here is on several noted left leaning posters) shows their ignorance of the monumental issues at hand, regardless of the visage which these issues took in the court (that appearance would be insurance and healthcare, as opposed to say, firearms or religious issues or whatever).

Thirdly, this is wrong economically in all the same ways Romneycare was wrong (and look at the increased costs there–that is the exact opposite of what needs to happen), however it is wrong in many more principled ways that Romneycare–howevermuch it was terrible policy and economically burdensome–is controversy free by virtue of there being a significant and often not understood difference between what a State may do legislatively and what the Federal legislature may do Constitutionally.

[quote]I’m certainly concerned with state vs. federal law and how that impacts our rights, and that is definitely a point that would change my position on this particular topic due to precedent, even if the end result is something I agree with, precedent trumps… After some of your posts (not you Zeb, wont give you the satisfaction :P) I realize there is a bit more to this than meets the eye, and if I try to intelligently defend the bill (which I probably wouldn’t), I need to get very familiar with it’s consequences. Hopefully that clears things up!

Cheers folks, great discussion.

[/quote]

If you haven’t read it already, I would start by reading the Judge Napolitano piece pushharder posted up a few pages back and then the dissenting opinions. They give a very clear reasoning to the difficulties at hand. If you are able to do it without resorting to partisan knee-jerk reaction–which I believe you are–you will likely come up with a very long list of issues that concern you, much as they do us who are opposed to the bill.

Fundamentally, what has most of us so up in arms is the fact that this is not an Insurance issue, as countingbeans has so clearly hammered in his posts. Further, think of this: the door is open for this new “tax” paradigm to be pushed by the Right on things that the left-leaning people will find extremely dis-tasteful—but they won’t be able to cross it since this was their “baby”. This is a weapon NEITHER side should have access to.

Schlenkatank · July 3, 2012, 10:03pm

[quote]orion wrote:

[quote]Schlenkatank wrote:

What do you think about the provision in the ACA that allows for more approval of generic drugs to increase competitive pressure with drug companies? Also, what about one of the provisions that states physicians will be paid based on the quality of their care effective 2016 (I think)? [/quote]

What do you think about the fact that cheaper drugs NEED TO BE ALLOWED!?![/quote]

Well I’m not sure that’s what’s going on here, but thanks for that perspective. I think what that provision is intended to do is essentially eliminate obstacles in the FDA that make it difficult for generics to enter the market. This will increase competition with the BIG drug companies that frequently run the table on newer drugs and charge insane amounts of $.

Edit: I understand, sorry. they don’t, it just turns out that deregulation in this instance will help the cost of care. It’s not that the cost of care is so ridiculous we have no other option but to deruegulate, it’s just part of the problem. Ok?

Aragorn · July 3, 2012, 9:58pm

[quote]Schlenkatank wrote:
I have to say to thunderbolt and the Dr. that I like some of your ideas. I can guarantee that some of the issues in affordability of care stem from the lack of competitive pressure from insurance companies and drug companies.

One problem I have with the idea that the issue is as simple as disentangling insurance from employment is that while I think it’s possible that this could reduce the cost of care, I don’t think it would be enough to make the remaining problem a cinch. Not that I’m opposed to the idea, I’m just not sure that the effect would be as grand as you suggest–obviously governemnt spending on healthcare is insane as i’m sure you know.
[/quote]

Well, I think that is only one of many things that can make a difference cumulatively. But from a purely rational standpoint it makes infinitely more sense to take easy, self-evident, non-controversial steps to fix a problem incrementally, and assess the overall affect before starting grandiose ideological schemes doesn’t it?

Perhaps it would not be as grand as we think in effect. However, having taken initial steps to fix the underlying foundational problems, we would be in a much better, MORE INFORMED place to tackle the remaining issues or lack of coverage. To any rational person, a decision cannot be made without data, and the more data you have the more chance the your solution works. To skip any and all real, easy, cheap steps toward solving in favor of a gigantic, slovenly written, overreaching, and astronomically expensive path is the worst sort of policy decision imaginable.

This was the worst conceivable process to fixing a problem that is not insoluble. As many have said, historical data indicate that costs will get worse instead of better, and some are already looking at that reality (the Dr for one, and several others I can’t remember here).

storey420 · July 3, 2012, 9:59pm

Well said Aragorn

DrSkeptix · July 3, 2012, 10:48pm

[quote]Aragorn wrote:

[quote]Schlenkatank wrote:
I have to say to thunderbolt and the Dr. that I like some of your ideas. I can guarantee that some of the issues in affordability of care stem from the lack of competitive pressure from insurance companies and drug companies.

…
[/quote]

Well, I think that is only one of many things that can make a difference cumulatively. But from a purely rational standpoint it makes infinitely more sense to take easy, self-evident, non-controversial steps to fix a problem incrementally, and assess the overall affect before starting grandiose ideological schemes doesn’t it?

Perhaps it would not be as grand as we think in effect. However, having taken initial steps to fix the underlying foundational problems, we would be in a much better, MORE INFORMED place to tackle the remaining issues or lack of coverage. To any rational person, a decision cannot be made without data, and the more data you have the more chance the your solution works. To skip any and all real, easy, cheap steps toward solving in favor of a gigantic, slovenly written, overreaching, and astronomically expensive path is the worst sort of policy decision imaginable.

This was the worst conceivable process to fixing a problem that is not insoluble. As many have said, historical data indicate that costs will get worse instead of better, and some are already looking at that reality (the Dr for one, and several others I can’t remember here).[/quote]

The mistake is to presume that market forces are at work in the pharmacy business. With regard to affordability of drugs and competition, unfortunately, no…generic medicines are not automatically cheaper and more available.

In the last 3 years cheap generic chemotherapy agents–made by a number of “competing” generic drug makers–have simultaneoulsly disappeared from the market. Some of these once cheaper drugs are used in curative regimens: 5FU (which costs pennies), leucovorin, doxorubicin, cisplatin, methotrexate–have serially or simultaneously been discontinued by the generic houses. No one has investigated this as a conspiracy, but the results are clear: the supply has been artificially restricted, and instead, I have had to choose alternatives which costs 10 or more times the parent compound.

When generics are available, every 3 months the prices rise, and for no apparent reason since the generic houses are not engaging in new trials or development. (Generic oxaliplatin, made by more than one company, almost tripled in price once the trade-name drug withdrew from the American market. Now where were those competitive market forces, please?)

kamui · July 4, 2012, 1:12am

Given the nature of its products, and current laws on intellectual property, the pharmacy business will always be oligopolistic at best, and monopolistic at worst.

One thing to consider :
During more than a century, from 1844 to 1959, drugs were not patentable in France.
One could still patent the industrial processes, but not the chemical formulas themselves.
Apparently, it didn’t killed the market.

DrSkeptix · July 4, 2012, 2:24am

[quote]kamui wrote:
Given the nature of its products, and current laws on intellectual property, the pharmacy business will always be oligopolistic at best, and monopolistic at worst.

One thing to consider :
During more than a century, from 1844 to 1959, drugs were not patentable in France.
One could still patent the industrial processes, but not the chemical formulas themselves.
Apparently, it didn’t killed the market.
[/quote]

Oh?

So, how many drugs were developed in France between 1909 to 1959 compared to 1959 to 2009?
Just askin’

(I can tell you how many French chemotherapy drugs were developed before 1959.)

Severiano · July 4, 2012, 3:46am