Supreme Court Upholds ObamaCare

[DocDarm]

As a doctor, all I can say is,

YES!!!

[El Guapo]

This thread is so lonely.

[Isgrimnur]

Should we tell him the party started over here?

[El Guapo]

Should we tell him the party started over here?

Shhhhh!!! We didn't invite him!

[Arcanis]

Well this has me curious now. Why as a doctor does this ruling make you happy? Almost universally the opinions on it I've heard from doctors were negative or just didn't care about it.

[zinckiwi]

Well this has me curious now. Why as a doctor does this ruling make you happy? Almost universally the opinions on it I've heard from doctors were negative or just didn't care about it.

At a guess, he's empathetic and happy that millions of people will now get healthcare without going bankrupt.

At a guess.

[noxiousdog]

Well this has me curious now. Why as a doctor does this ruling make you happy? Almost universally the opinions on it I've heard from doctors were negative or just didn't care about it.

At a guess, he's empathetic and happy that millions of people will now get healthcare without going bankrupt.

At a guess.

This will actually harm most uninsuredpeople financially. They now will be forced to pay insurance premiums that only 80% will be used for actual expenses and that assumes they would even use their quota.

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[SpaceLord]

Well this has me curious now. Why as a doctor does this ruling make you happy? Almost universally the opinions on it I've heard from doctors were negative or just didn't care about it.

At a guess, he's empathetic and happy that millions of people will now get healthcare without going bankrupt.

At a guess.

This will actually harm most uninsuredpeople financially. They now will be forced to pay insurance premiums that only 80% will be used for actual expenses and that assumes they would even use their quota.

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Or, they'll pay 2.5% of their income, or 2085 bucks a year.

[DocDarm]

Most docs I know (that aren't on news programs) believe EVERYONE should be insured. Even 22 year old healthy fast food workers. But few CHOOSE to be insured in that age bracket. Health care SHOULD be mandated, because every single one of us will use health care someday.

I see people that I could help, but can't because they can't afford the medications that are needed to properly treat their condition (IE diabetes). I have seen financially secure people lose everything, I mean EVERYthing, from a catastrophic illness that wiped out their savings.

Some of us will kibble about the details, but there is general agreement amongst my peers that we ALL need insurance of some sort.

I, for one, believe all insurers should be non-profits, but that's another story.

[noxiousdog]

I, for one, believe all insurers should be non-profits, but that's another story.

There are plenty that are non-profit (blue cross, state farm for example) in many industries and yet the for profits manage to compete with them quite well.



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[El Guapo]

In Massachusetts there's been a decent amount of controversy over Blue Cross being non-profit in form but not so much in substance.

[DocDarm]

I, for one, believe all insurers should be non-profits, but that's another story.

There are plenty that are non-profit (blue cross, state farm for example) in many industries and yet the for profits manage to compete with them quite well.

My reasoning here goes beyond my ability to converse on this forum, but I deal with issues with commercial insurers that no one would believe. THEY are the ones rationing health care, without oversight.

I think it's a conflict of interest to try to make profit off of health insurance. I was fuming when the United CEO got a 150 million dollar bonus, but his company wouldn't pay for diabetic test strips on some of our patients.

If we're all paying into a pot for heath care, why should administrative vultures (commercial plans) skim off the top?

PS. Blue Cross is FOR profit.

[El Guapo]

Blue Cross is non-profit in Massachusetts, at least formally.

[noxiousdog]

In Massachusetts there's been a decent amount of controversy over Blue Cross being non-profit in form but not so much in substance.

Just like a lot of hospitals and universities. But theoretically, there are no owners pulling out capital.

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[noxiousdog]

BCBS is apparently a federation. Individual members can either be nonprofit or not. Wellpoint is for profit, health care services corp is non.

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[LordMortis]

In Massachusetts there's been a decent amount of controversy over Blue Cross being non-profit in form but not so much in substance.

Just like a lot of hospitals and universities. But theoretically, there are no owners pulling out capital.

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This. In Michigan, BCBSM is technically a nonprofit as are many of the hospital systems. That doesn't mean they don't hemorrhage money for operating costs. I think one of the more interesting things about Obama care is the mandate on the ratio of "administrative and executive" to benefits payments when it comes to charging premiums. We'll see how it all pans out.

http://www.healthcare.gov/blog/2010/10/mlr.html

[noxiousdog]

This. In Michigan, BCBSM is technically a nonprofit as are many of the hospital systems. That doesn't mean they don't hemorrhage money for operating costs. I think one of the more interesting things about Obama care is the mandate on the ratio of "administrative and executive" to benefits payments when it comes to charging premiums. We'll see how it all pans out.

http://www.healthcare.gov/blog/2010/10/mlr.html

Obama's limit will likely cause no changes. 20% overhead is fairly common across medical insurance.

[LordMortis]

Obama's limit will likely cause no changes. 20% overhead is fairly common across medical insurance.

Or at least small changes for about 3 million people in 2012.

http://www.insurancejournal.com/news/na ... 245209.htm

I don't know what the repercussions of those changes will be, though.

It's not what I'm looking for but in this case I think it might be that mediocrity is not the enemy of excellence or whatever they say... We'll see.

[Buatha]

While I agree that our medical system still has issues, I do believe in the mandatory mandate for health insurance since you will need health insurance at some point in your life. I don't think it's fair that most of us are paying into the pool while some people will go a decade or more without paying, then decide to start paying when they get sick/injured. The benefit of those funds built up by the participants when needed is given to someone who hasn't participated all along, thus reducing the amount of funds available for the dutifully paying participants.

[Arcanis]

Well thanks for the answer Doc. As I said most I've gotten to speak on the subject either didn't care as long as they were still able to help people or were against it for various reasons. I was just wanting to see a reasoned approach to why a Dr. would be for it.

[DocDarm]

While I agree that our medical system still has issues, I do believe in the mandatory mandate for health insurance since you will need health insurance at some point in your life. I don't think it's fair that most of us are paying into the pool while some people will go a decade or more without paying, then decide to start paying when they get sick/injured. The benefit of those funds built up by the participants when needed is given to someone who hasn't participated all along, thus reducing the amount of funds available for the dutifully paying participants.

Me too. I think is should almost be like paying a tax to support police/fire depts. Heath care is a right in this country, and we must all take part in making it available for all. Either socialize medicine outright, or mandate that all most have some sort of insurance. It's all the same to me. But then again, I'm not a politician with a spin to maintain.

[noxiousdog]

Obama's limit will likely cause no changes. 20% overhead is fairly common across medical insurance.

Or at least small changes for about 3 million people in 2012.

http://www.insurancejournal.com/news/na ... 245209.htm

I don't know what the repercussions of those changes will be, though.

It's not what I'm looking for but in this case I think it might be that mediocrity is not the enemy of excellence or whatever they say... We'll see.

" with employer coverage averaging about $5,400 a year for an individual, $15,100 for a family, $127 isn’t a whole lot of money. It amounts to 2 percent of an individual plan, and a little less than 1 percent of the family premium."

[msteelers]

While I agree that our medical system still has issues, I do believe in the mandatory mandate for health insurance since you will need health insurance at some point in your life. I don't think it's fair that most of us are paying into the pool while some people will go a decade or more without paying, then decide to start paying when they get sick/injured

While I like Obamacare and the mandate, you are wrong. Its well within someone's right to not go to the doctor, or if they do to pay out of pocket.

Having said that though, forcing everyone to pay into the pot even if they never use it is the only reasonable solution to health care that I have seen.

[DocDarm]

While I like Obamacare and the mandate, you are wrong. Its well within someone's right to not go to the doctor, or if they do to pay out of pocket.

Yup. And what about someone hit by a car? Or in a house fire? They're going to the emergency room, brought by the paramedics.

[LawBeefaroni]

Me too. I think is should almost be like paying a tax to support police/fire depts. Heath care is a right in this country, and we must all take part in making it available for all.

What "level"* of healthcare is included in that right? County hospital? Academic medical center? Mayo Clinic?

Unless either costs or expectations are contained, I don't see any equitable way to tax our way to universal coverage.

And once it becomes a tax issue it almost becomes a matter for a budget office. Triage aside, does the guy who has never used coverage for anything but the annual preventive get his knee-scope before or after the non-compliant gangrenous diabetic on his second amputation? Do we even want to have to make that decision? Do we start taxing pregnancy or smoking? Playing basketball?

I'm intimately acquainted with the shortcomings of our current system. I welcome reform, both from philosophical and job-related standpoints. I still feel that this perfect-world, everyone gets equal coverage proposal we're being sold is not a workable solution.




*this is in quotes because I'm deliniating cost level, not necessarily quality of care level at these types of facilities.

[Buatha]

While I like Obamacare and the mandate, you are wrong. Its well within someone's right to not go to the doctor, or if they do to pay out of pocket.

Yes, it is their right, but will we let them die for it? If someone finds the sick/injured person and sends them to the hospital, be it in a car accident or lying unconscious, I'm pretty sure that today the hospital will not stop trying to save them even if uninsured. I don't know what happens in those situations. Do we, the paying insurance members, eat that cost? Does the hospital send the bill to the government?

EDIT: DocDarm beat me to the question.

[El Guapo]

Well, where things are going is some amount of cost shifting, wherein you pay something like a $50 copay to go to your nearby community hospital, but $250 to go to the downtown AMC. Not shifting the whole cost of more expensive facilities onto the patient (since almost nobody could afford that), but enough to make patients aware which facilities are more expensive, and so to deter use of AMCs for much beyond the actually complicated procedures.

[DocDarm]

Yes, but it's definitely a step in the right direction. A tiered approach, perhaps? Low level "federal" insurance to cover car crashes and disasters, and tier 3 insurance to cover botox and face lifts.

[LawBeefaroni]

While I like Obamacare and the mandate, you are wrong. Its well within someone's right to not go to the doctor, or if they do to pay out of pocket.

Yes, it is their right, but will we let them die for it? If someone finds the sick/injured person and sends them to the hospital, be it in a car accident or lying unconscious, I'm pretty sure that today the hospital will not stop trying to save them even if uninsured. I don't know what happens in those situations. Do we, the paying insurance members, eat that cost? Does the hospital send the bill to the government?

ERs are required by law to treat them. If the patient can't pay, the facility writes-off the cost. This is usually paid for by other patients (and their insurance) and, if the facility is a non-profit, by tax exemption.

[El Guapo]

Also, there's not only tiering of copayments (which is what I'm referring to in my above post), but also limited networks, where you pay less premium up front but don't get access to all of the expensive AMCs and certain other facilities.

At least, that's the current trend in Mass.

[GreenGoo]

edit: to include the post I was responding to.

Me too. I think is should almost be like paying a tax to support police/fire depts. Heath care is a right in this country, and we must all take part in making it available for all.

What "level"* of healthcare is included in that right? County hospital? Academic medical center? Mayo Clinic?

Unless either costs or expectations are contained, I don't see any equitable way to tax our way to universal coverage.

And once it becomes a tax issue it almost becomes a matter for a budget office. Triage aside, does the guy who has never used coverage for anything but the annual preventive get his knee-scope before or after the non-compliant gangrenous diabetic on his second amputation? Do we even want to have to make that decision? Do we start taxing pregnancy or smoking? Playing basketball?

I'm intimately acquainted with the shortcomings of our current system. I welcome reform, both from philosophical and job-related standpoints. I still feel that this perfect-world, everyone gets equal coverage proposal we're being sold is not a workable solution.




*this is in quotes because I'm deliniating cost level, not necessarily quality of care level at these types of facilities.

Those questions have been answered in other systems. They aren't necessarily show stoppers nor do you need to reinvent the wheel. Review other systems, take what you like (if anything), come up with your own for the rest. This hand ringing over "what if's" seems unique to the US.

Knowing that there is no "perfect" solution, you just need to make improvements (presumably). Being completely paralyzed by the prospect of making changes isn't going to help anyone, not even the status quo (since it's unsustainable).

[LawBeefaroni]

Well, where things are going is some amount of cost shifting, wherein you pay something like a $50 copay to go to your nearby community hospital, but $250 to go to the downtown AMC. Not shifting the whole cost of more expensive facilities onto the patient (since almost nobody could afford that), but enough to make patients aware which facilities are more expensive, and so to deter use of AMCs for much beyond the actually complicated procedures.

So the person that can pay $250 will always get top level care, and a much higher contribution from insurance (and thus draws more from the system) while the person who can't (or won't) pay the higher copay gets lower level* care and takes less from the system. And you may be forcing people to go outside their local community to find care with lower out-of-pocket expense.




* again, cost doesn't always reflect level of care.

[LawBeefaroni]

Those questions have been answered in other systems. They aren't necessarily show stoppers nor do you need to reinvent the wheel. Review other systems, take what you like (if anything), come up with your own for the rest. This hand ringing over "what if's" seems unique to the US.

Knowing that there is no "perfect" solution, you just need to make improvements (presumably). Being completely paralyzed by the prospect of making changes isn't going to help anyone, not even the status quo (since it's unsustainable).

I agree completely. We should take what works from other systems and implement it.

However, the problem isn't being "completely paralyzed by the prospect of making changes". The problem is the desire to make changes just for the sake of makign changes. Rather than focus on the underlying problem at the foundation, the high cost of healthcare in the US, we want to gloss over it and make structural changes. We want to slap a bureaucracy on the problem to make it go away. I'm arguing that it won't help the real problem of cost.

Yes, the current system is broken. But the proposal doesn't actually fix it. It spends a lot of time and money on implementing another equally broken system. Broken because of, dare I say it again, cost.

The hand-wringing over "what-ifs" is unique to the US because no other country has had to overhaul a healthcare system that spends $2.25 trillion annually on healthcare. Mistakes can be costly.

[GreenGoo]

Fair enough. It's not like we aren't suffering from rising health care costs as well, so I sympathize. It's a shame we don't have a Canadian Lawbeef here, since I'm no expert on our system and could use some input from people more knowledgable than I am.

Oh, and by paralyzed, I meant the conflict politically that prevents meaningful reform. At least I meant that partially.

[stessier]

While I like Obamacare and the mandate, you are wrong. Its well within someone's right to not go to the doctor, or if they do to pay out of pocket.

Yes, it is their right, but will we let them die for it? If someone finds the sick/injured person and sends them to the hospital, be it in a car accident or lying unconscious, I'm pretty sure that today the hospital will not stop trying to save them even if uninsured. I don't know what happens in those situations. Do we, the paying insurance members, eat that cost? Does the hospital send the bill to the government?

EDIT: DocDarm beat me to the question.

It's a decision we made as a country to treat those people regardless of cost or ability to pay. It is a different question to ask if the government can force people to pay for something they may only potentially use in the future. Indeed, Roberts says it can't.

[Enough]

Oh my goodness, look at all the upset puppies threatening to move to Canada over the decision.

#SCOTUS holds up free healthcare for everyone?! Screw this commie country, I'm moving to #Canada #whoswithme

That is right up there with all the old people on medicare protesting this morning against taking from medicare to support socialized medicine.

[GreenGoo]

Oh my goodness, look at all the upset puppies threatening to move to Canada over the decision.

#SCOTUS holds up free healthcare for everyone?! Screw this commie country, I'm moving to #Canada #whoswithme

That is right up there with all the old people on medicare protesting this morning against taking from medicare to support socialized medicine.

I particularly like that he thinks this has something to do with free healthcare.

[Jag]

Oh my goodness, look at all the upset puppies threatening to move to Canada over the decision.

#SCOTUS holds up free healthcare for everyone?! Screw this commie country, I'm moving to #Canada #whoswithme

That is right up there with all the old people on medicare protesting this morning against taking from medicare to support socialized medicine.

I particularly like that he thinks this has something to do with free healthcare.

GG you have some room on your couch? I'd move in with Icebear, but I think he snores.

[tru1cy]

While I like Obamacare and the mandate, you are wrong. Its well within someone's right to not go to the doctor, or if they do to pay out of pocket.

Yes, it is their right, but will we let them die for it? If someone finds the sick/injured person and sends them to the hospital, be it in a car accident or lying unconscious, I'm pretty sure that today the hospital will not stop trying to save them even if uninsured. I don't know what happens in those situations. Do we, the paying insurance members, eat that cost? Does the hospital send the bill to the government?

EDIT: DocDarm beat me to the question.

EMTALA already cover those needing emergent/urgent care. It's the follow up care needed afterwards that is the kicker.

I agree Healthcare Act is a good thing.


Lawbeefroni beat me to the EMTALA Act

[Exodor]

Saw this linked elsewhere and found it interesting - Congress mandated Health Coverage for sailors in 1798

The law did a number of fascinating things.

First, it created the Marine Hospital Service, a series of hospitals built and operated by the federal government to treat injured and ailing privately employed sailors. This government provided healthcare service was to be paid for by a mandatory tax on the maritime sailors (a little more than 1% of a sailor’s wages), the same to be withheld from a sailor’s pay and turned over to the government by the ship’s owner. The payment of this tax for health care was not optional. If a sailor wanted to work, he had to pay up.

This is pretty much how it works today in the European nations that conduct socialized medical programs for its citizens – although 1% of wages doesn’t quite cut it any longer.

The law was not only the first time the United States created a socialized medical program (The Marine Hospital Service) but was also the first to mandate that privately employed citizens be legally required to make payments to pay for health care services. Upon passage of the law, ships were no longer permitted to sail in and out of our ports if the health care tax had not been collected by the ship owners and paid over to the government – thus the creation of the first payroll tax in our nation’s history.