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Post by gailkate on Jun 28, 2012 9:08:23 GMT -5
I'm watching www.SCOTUSBlog.com and channel surfing. I'm anxious, almost as if awaiting a decision about going to war. It really is a bit like declaring war no matter what happens. Now someone is saying the individual mandate is unconstitutional. I need a xanax.
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Post by gailkate on Jun 28, 2012 9:23:32 GMT -5
Nope - it IS constitutional under the power to tax. I'm not going to keep commenting because the interpretations are still so scattered. But now it looks as if the whole law has been upheld. But I don't see how it would be implemented. Couldn't the Rep. Congress be able to write new legislation barring a tax levied if you don't get insurance?
Chief Justice Roberts seems to have found a way to make healthcare a right under the Constitution.
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Post by doctork on Jun 28, 2012 22:03:32 GMT -5
It was a cliffhanger all around.
I don't think Roberts went so far as to say health care is a right, but rather that ACA was not unconstitutional in its taxing provisions that 'encourage" people to purchase health insurance. Interesting and surprising, since almost all the debate was w/r/t the mandate and the commerce clause.
As for further Congressional actions, well that is the point - it requires Congress, so when Gov Romney states he will "repeal Obamacare [his] first day in office" that is laughable. The President does not repeal Congressional legislation, though he must sign legislation passed by Congress for it to take effect.
Any tax or other money-related legislation must originate in the House, but it still has to be approved in the Senate as well, so a Republican House cannot unilaterally bar the health insurance tax/penalty. There is certainly precedent in that alcohol and tobacco taxes are calculated (partially) to cover the additional health costs associated with their usage. Seems reasonable to me to figure the tax/penalty should cover the expected costs such uninsured individuals would otherwise pile on to the rest of us who are insured.
What really happens during the rest of implementation will depend on who controls the House, the Senate and the White House after November. Though a majority of Americans claim to oppose ACA in recent polls, when queried about ACA provisions individually they are in favor of: eliminating discrimination based on pre-existing conditions (and this is already in effect for children up to age 18); covering all Americans; allowing kids age 18 - 26 to be covered under their parents' plans; banning lifetime caps (if you have cancer, a premature baby or a bad car accident, it is very easy to go over $1,000,000); prohibiting an insurer from dropping you if you get sick.
Since these all of the above features are very popular, I do not know if Republicans would really want to repeal them.
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Post by gailkate on Jun 29, 2012 0:03:02 GMT -5
At one point I heard Boehner was scheduling a vote to repeal the ACA, but so much was changing so fast I don't know that he stuck with that promise. And yes, if the House passed a bill to repeal, the Senate would reject it. Moreover, it's hard to see most Republicans voting to repeal the whole thing, as so much of it is popular. Of course, Roberts didn't make it a right in the strict sense. What he did was try to find a way not to reject the law; most commentators I've heard see him as unwilling to be remembered as the Chief Justice who killed healthcare. Since most Americans already have healthcare, this can only help in the long run - protecting those who can't afford it and requiring those who can but won't buy coverage to pay a fine. I can't help feeling some relief that ultimately there will be fewer people relying on emergency care rather than paying their share like everyone else. If insurance exchanges work the way they're supposed to, many more people will be able to find affordable care. It will take time to see how the kinks get worked out, but in 20 years, we're going to be a lot better off. (Well, not me. ) Healthcare will no longer be pushing toward 20% of GDP. Of course, insurance costs could have been controlled more effectively if the bill had capped rate increases when it was first passed. Waiting 2 years gave them tons of time to jack up rates.
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Post by doctork on Jun 29, 2012 0:38:03 GMT -5
I suspect Roberts wanted to be remembered as the historic Chief Justice responsible for America achieving universal healthcare, after a century of other failed efforts. I don't begrudge him that. Moreover, I think the majority opinion is correct - it is clear that Congress can tax, but the underpinnings of the commerce clause argument were a little shaky IMHO.
Under ACA, insurers have to spend at least 80% of their premium dollars on health care, so rate increases would have to correlate with improved benefits and increased pay out for care.
As it is now, most states' Insurance Commissioners require that insurers prove that a rate increase is needed to cover increased medical costs so for the most part, premiums are not raised to increase profit, but rather to cover higher costs. Increased medical costs are the main driver of increasing insurance costs. It won't be easy to arbitrarily jack up rates.
I think Boehner has scheduled a House vote on repeal for July 17. Pretty much meaningless as many Republicans might become hesitant to vote against covering sick kids, allowing parents to pay for their uninsured 18 - 26 year old kids' coverage and protecting sick people from being dropped when they hit $1,000,000 in the midst of their life-saving chemotherapy.
We no longer see the snarky remarks "Oh so these 25 year olds are children?" implying they are little toddlers who can't manage without mommy and daddy. No - they the population segment with the highest rate of uninsured because they are young people still in school or starting out in jobs that don't offer health insurance. They are mostly healthy and cheap to insure, which is why most large insurers began offering that benefit before it was required by law. Over three million young adults are covered this way; do Republicans really want to take that away?
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Post by doctork on Jun 29, 2012 0:51:55 GMT -5
I can't resist quoting this commentary on Boehner's decision to schedule a repeal vote (this is off-color, so if it offends you, do not read further):
"Boner needs the Baggers to wave their weenies!"
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Post by gailkate on Jun 29, 2012 9:23:14 GMT -5
Love the boner joke. As it is now, most states' Insurance Commissioners require that insurers prove that a rate increase is needed to cover increased medical costs so for the most part, premiums are not raised to increase profit, but rather to cover higher costs. Increased medical costs are the main driver of increasing insurance costs. It won't be easy to arbitrarily jack up rates. Presumably, but the people I know who hate the ACA are blaming Obama. Even my dentist, whom I adore, while I was trapped in his chair with my mouth full of clamps and drills! In the 5 years since Jerry retired, our rates went up 20% per year. If that is a true reflection of costs, then we simply have to clamp down on costs. Personally, I think insurance companies are unnecessary middle-men. Certainly profits paid out in the form of top salaries have been rising dramatically. I think we have to put limits on what supposedly non-profit businesses and organizations can use for salaries and administration.
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Post by doctork on Jul 2, 2012 4:32:36 GMT -5
Medical costs overall increase about 2.5% points higher than CPI, but the increases are much higher if you have an individual vs a group plan. Trends in healthcare costs have generally been bad for more than 20 years. Since Obama said and did something about healthcare reform, he'll get blamed. Bad stuff would be happening regardless.
Dentists basically run a cash business as very few people have dental insurance. If you don't mind messing with mouths all day, it's a very good job. Maybe your dentist was upset about his staffs' rate increases?
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Post by doctork on Jul 2, 2012 20:59:12 GMT -5
Love the boner joke. As it is now, most states' Insurance Commissioners require that insurers prove that a rate increase is needed to cover increased medical costs so for the most part, premiums are not raised to increase profit, but rather to cover higher costs. Increased medical costs are the main driver of increasing insurance costs. It won't be easy to arbitrarily jack up rates. Presumably, but the people I know who hate the ACA are blaming Obama. Even my dentist, whom I adore, while I was trapped in his chair with my mouth full of clamps and drills! In the 5 years since Jerry retired, our rates went up 20% per year. If that is a true reflection of costs, then we simply have to clamp down on costs. Personally, I think insurance companies are unnecessary middle-men. Certainly profits paid out in the form of top salaries have been rising dramatically. I think we have to put limits on what supposedly non-profit businesses and organizations can use for salaries and administration. There are plenty of people who will hate Obama no matter what he does; after all, he is a Democrat, he is black, and he has a funny name, possibly Mooooslim. For proof it's the man not the idea, recall that the individual mandate was a creation of the (radical left) Heritage Foundation and American Enterprise Institute, and a similar law was implemented by that rascally Mitt Romney, Democrat guv of MA. Oh wait.... I think there are limits on admin expenses, including salaries, for non-profits, though I bet Joe knows a lot more about that, since it is the IRS that determines who is a tax-exempt non-profit. For publicly traded firms the Boards of Directors are supposed to monitor salaries and other expenses to ensure they are in line with industry norms. In addition there are those public reporting websites that inform you whether a charitable organization uses your donations wisely, and SEC demands financial reports from listed for-profits, which you can read before buying the stock. The insurance company's "middle man" function is an important one - someone has to enroll members, collect premium, evaluate and pay claims, answer questions about coverage, and also keep an eye out for fraud, all doing so confidentially. Then there is the actual underwriting/insurance function - unless there are many (fairly healthy) covered lives for whom premium is paid, the company will go bankrupt the first time a $500,000 claim for a premature baby or liver transplant comes due. I don't see how health insurance could be done without the middle man function. Maybe it's my bias from having spent years as an insurance exec, but I don't understand how that would work.
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Post by gailkate on Jul 2, 2012 23:59:25 GMT -5
Who/what is the middle man for Medicare? I think I've read that the Feds outsource a lot of the administrative functions to private companies, but that seems like sub-contracting. I don't know how it works in Canada or UK countires.
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Post by Jane on Jul 3, 2012 7:51:40 GMT -5
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Post by doctork on Jul 3, 2012 9:53:07 GMT -5
Who/what is the middle man for Medicare? I think I've read that the Feds outsource a lot of the administrative functions to private companies, but that seems like sub-contracting. I don't know how it works in Canada or UK countires. Medicare's "middle men" are insurance companies, usually "Blues" or at least companies that were historically Blue Cross/Blue Shield, as they predominated when Medicare was created. The federal government was not prepared to be an insurance company so the Blues helped out and were essentially given a right of first refusal in contracting for administrative services. Other insurers have some of the contracts too now. The rates are very low because of the guaranteed high volume and the standardization of benefits, which keeps the Medicare overhead quite low; CMS claims it is 3%, as opposed to the maximum 20% ACA is now demanding of insurers. The UK has "socialized medicine" in that the government owns most hospitals and pays most physicians on a salaried basis. That said, about 10 - 15% of the population has private insurance outside the NHS (National Health System) presumably because they want some "extras." However, most Brits are very happy with their NHS. Canada's system is a single payer system organized by each province but health care is delivered privately; most hospitals and almost all doctors are private practice. You can choose the doctor you like and go to that private office, show your Health BC (or whatever province), receive your services, and the bill is sent to Health BC. You might choose to pay extra fees for such services as the ability to speak with your doctor at night or to be seen in his/her office on the weekends instead of the Accident & Emergency ward ("ER"). If you are American and choose to see a Canadian doctor, you will have to sign a liability waiver acknowledging that you can't sue at the drop of a hat as is done in the US; then you will receive excellent care at half the price, and can purchase your meds at Canadian pharmacies for one-third to one-half the US price. AFAIK private insurers are almost non-existent in Canada. There was a Canadian Supreme Court case about 6 years ago in Ontario where I think one private insurer was allowed, but I do not think that went very far after the "victory" in court. I speak mainly of my experience with British Columbia and its neighboring province Alberta, both of which I understand are relatively wealthy compared to other provinces. When I meet or work with Canadian doctors who practice in the US, they are usually from Ontario, where I think there is less satisfaction with the health care system.
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Post by gailkate on Jul 3, 2012 15:18:25 GMT -5
I passed, too, Jane! Too bad so many people listen to the rabid liars. I don't understand why Romney isn't afraid God will strike him dead for all the crap he spouts. In MN we're under investigation for having overpaid our middle men. One is UCare, originally (and still?) connected to the U of MN and now my supplemental provider. Whatever they're doing that is getting all this attention, they're giving me superb coverage at a fraction of what I paid before hitting my golden years. We're not going to agree, I think. For someone who is on high alert for all the sins of the corporatocracy, you seem very easy on insurers. But I'm probably very hard on them. In truth, I guess I suspect everyone and have been only sort of loyal even to my own employers - education, private corporation, government, small non-profit. I don't know what size company you worked for or what you mean by "exec," but as a manager in MN govt, I saw all kinds of shenanigans. Just 8 months in pharmaceutical sales made me physically ill. That was my first xanax. Overall, I think we're extremely prone to greed and self-serving rationalizations. Every organization looks out for itself, not for the greater good. As Milton Friedman said, the business of business is to make money. That's why I believe in government. We need help policing ourselves. Unfortunately, a whole lot of government isn't very good at that either. Anyone want to live on a commune and doctor ourselves with tansies and poultices?
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Post by doctork on Jul 4, 2012 0:42:42 GMT -5
I worked mostly for large insurers, one non-profit, two for-profit; the ones I worked for followed all laws and regulations. By "executive" I mean a senior level leader of the corporate management team. Health insurance companies have CEO's, CFO's, COO's and CMO's (Chief Medical Officers) that work as a team to develop and implement strategies and business plans to ensure corporate success. I was a CMO.
Milton Friedman is of course correct, the business of business is making money. That is the point of a capitalistic economy - it is based on greed, and for-profit companies exist to make money for shareholders, not to do greater good for society, except to the extent that "a rising tide raises all boats." People, including us with our mutual funds, 401k, and pension plans, invest in such companies in hopes of achieving profits, saving to buy a home, saving for kids' college, living a healthy retirement, etc.
Many large firms have affiliated foundations dedicated to societal good, and of course there are many non-profits whose goal is serving the greater good. I think the capitalistic system is great, I just don't think that the for-profit capitalist model is the best way to deliver health care. IMHO, the main goal of health insurance and healthcare companies should be delivering good care, not profits for shareholders. However, as long as we have ceded health insurance to the for-profit market, I don't think it is "soft" to acknowledge their right/obligation to make as much money as possible within the bounds of the law.
My concern with the corporatocracy is the unethical process by which a revolving door exists between corporate America and federal government officials who leave office having rigged the game, then use their contacts and influence to gain clients and win "no bid" contracts to profit at taxpayer expense. This corporatocracy extends to western nations' dominance over developing nations, ensuring through financial manipulation that those countries "side with us." Making money is not evil and for-profit corporations are not inherently bad, but all should be compelled by relevant regulators to obey the law, and none should engage in unethical predatory practices.
Government officials lately have not fulfilled their responsibility; too often their major concern is the use of public office as a stepping stone to later private riches. Check the officers and Boards of Directors of any defense contractor and you will find many former government officials both (R) and (D), highly paid rainmakers who use their contacts and influence gained through public office to unfairly nab lucrative government contracts. Dick Cheney and Halliburton are a good example but there are hundreds of others.
Though I've considered intentional communities, I don't want to live on a commune and use only alternative medicine. Our whole family would be dead without modern medicine and its miracles developed by entrepreneurs in a capitalist system!
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