Affordable Health Care Law under review by SCOTUS

[Lucky]

This entire debate is so ridiculous. If you show up at an ER, they have to treat you. So how does the argument that people can 'opt out' of health insurance make any sense? We are all in the system because we will receive care if we need it. Everyone needs coverage in some form or another because we will all receive care if we need it. Done, argument over. How did the solicitor general fail to make this argument?

They don't actually have to treat you unless it is an emergency. Plus, even if it is an emergency, you get no followup care. And they bill you for what they do. And they sue you if you don't pay. My court gets over 130 cases every month on behalf of the local hospital, suing patients.

Doctors have told us for years that preventive medical care is the smart way. Yet we have a system which causes people to wait until their condition is bad enough to constitute an emergency before they can see a doctor, and then get charged ten times what an earlier office visit would have cost. (The basis for that is that office visits here locally are less than $100, and even the most basic emergency room visit pushes $1000. My insurance carrier just changed the provisions on ER coverage, to include a $250 deductible that is not subject to any stop-loss provisions. As someone who winds up there four or five times a year, that's hard to swallow.)

[Erik]

or just expand Medicare which everyone, including teapartiers (even though they apparently have no f'n clue who runs it) likes.

I've never understood why this wasn't attempted in the first place.

[Lucky]

I've never understood why this wasn't attempted in the first place.

It makes too much sense. I know that people talk about Medicare fraud all the time, but I think their care/administration ratio is pretty good. They could all take a lesson from the VA, though. They provide great care, and don't spend crazy amounts on admin costs.

Doesn't the Affordable Care Act cap insurance company administrative expenses at 20%, or is that some other law which does that?

[B-Fly]

Let's be precise here, because I'm not entirely sure what y'all are promoting. Medicare is for the elderly and people of all income brackets can participate, although there is a sliding scale income-based premium for some aspects of the coverage. Medicaid is for the poor. Which one would you expand and how, to cover whom? Most of the uninsured are not elderly, they're young.

[onejayhawk]

One again, OJH does not understand what is going on. There were four topics to be discussed during this week's session. These were decided in advance. Discussing severability of the individual mandate was part of the schedule, as that issue already came up in a Circuit Court decision.
1) Anti - Injunction Act Issues (Monday)
2) Minimum Coverage Provision (Tuesday)
3) Severability Issues (Wednesday)
4) Medicaid Issues (Wednesday)

Thanks. I was not up on the schedule.

J

[chancellor]

Let's be precise here, because I'm not entirely sure what y'all are promoting. Medicare is for the elderly and people of all income brackets can participate, although there is a sliding scale income-based premium for some aspects of the coverage. Medicaid is for the poor. Which one would you expand and how, to cover whom? Most of the uninsured are not elderly, they're young.

Expand Medicare, eliminate Medicaid. Just about every doc I know says the Medicare regs are much clearer and easier to deal with than Medicaid, and while it's possible to commit fraud as a doc on Medicare, you're much more likely to get caught than Medicaid. I'm not up on the paperwork differences, but I'm surprised at how uniform the response is.

[chancellor]

And what, then, to do about poor folk who cannot afford insurance and can easily get buried under mountains of deductibles? Or those who hit lifetime caps? Or those who have preexisting conditions?

Honestly, there still is no sane answer that does not involve single payer. Administrative costs in this country are a total joke in the private insurance industry.

Your point about admin costs may well be valid, but that doesn't make single payer any more valid. Last I saw, we're still running a $1.3ish trillion deficit per year, and single payer will do nothing but add astronomically to that total, unless you're going to work under the illusion that our government will break a near 50-year trend and actually bring in a health care program at anywhere near the costs estimated.

[onejayhawk]

I think you're scared of ghosts. We're already spending almost 20% of GDP on health care. You think it'll get worse than that? I think that evidence doesn't support that position. I think it would be tough to get any worse at this point. We have a mediocre (which is an extremely generous term, actually) system that costs more than just about anyone else AND millions upon millions aren't even participants.

I think the real illusion is that we're not adding to our financial woes by using the broken system we use right now. The hole keeps getting deeper and deeper and free-market delusionists dig their heels in ever further to defend the failure.

Edit: Put in wrong % the first time.

We had this debate before. I agree with chancellor.

Just a quick point on your 20%. What makes you think that use of tax money would reduce that rather than dig the hole deeper and deeper and single payer delusionists dig their heels in ever further to defend the failure?

J

[chancellor]

Wait, we can't afford what now? We can't afford not to change the system at this point.

Hey, as long as those of your political persuasion are willing to make the tough cuts - and they'll be brutal - to actually afford national health care, go for it. Take about a trillion out of spending plus the additional cuts to bring on national health care, and it'll have incredible broad-based support.

[GwynnInTheHall]

Hey, as long as those of your political persuasion are willing to make the tough cuts - and they'll be brutal - to actually afford national health care, go for it. Take about a trillion out of spending plus the additional cuts to bring on national health care, and it'll have incredible broad-based support.

I don't think there's any reluctance to cuts, but they have to be across the board starting with the DOD and moving on from there. Making Healthcare and Pharma non profit would be the next step to lowering costs.

[chancellor]

Again, not true. Every single evaluation of single payer costs has spoken to the fact that the savings associated with lower administrative costs would more than offset the costs of universal health care.

http://www.pnhp.org/facts/single_payer_system_cost.php?page=all

Link after link after link after link saying the same thing: single payer health care would save money.

And real-life experience after real-life experience in our country says the same thing: any health-care benefit started by government grossly exceeds budgeted costs, and typically exceeds even the highest end estimates of costs, with the most recent example being the Medicare drug expansion during the Bush admin.

[Controller Jacobs]

Among other things, we're currently stuck in a bad cycle with emergency rooms.

Currently, any hospital that has an ER and takes Medicare has to provide emergency care and stabilizing treatment, regardless of ability to pay. That includes full care for a pregnancy.

This is bad news, as it means a lot of people without coverage showing up for minor stuff, even taking a free ambulance ride there.

But it gets much worse when you add liability. Unlike family physicians, hospitals have:
- far less history on the client (or none at all),
- have a lot of clients,
- have a lot of money,
- have the means to test for unusual conditions.
Having the means to test for all these unusual conditions, and little history on a large clientele, makes hospitals liable to do so. This costs the hospitals a lot of money, which they have make up somewhere.

So one hope I have for health care reform would be to get people without coverage into regular, preventative care, and out of hospital ERs. If a program were to succeed in that, it would have a short-term cost and long-term savings.

Unfortunately, short-term loss for long-term gain is a tough sell.

[onejayhawk]

I don't think there's any reluctance to cuts, but they have to be across the board starting with the DOD and moving on from there. Making Healthcare and Pharma non profit would be the next step to lowering costs.

I am on board with across the board cuts. So far we have not seen any cuts in anything, just reduced increases.

J

[Moonlight J]

What does real life experience tell us about private industry running our nation's health care?

It grossly overcharges us to fatten their own wallets

[cardboardbox]

anything started by government grossly exceeds budgeted costs

fixed.