Thread: Would SCOTUS overturning part or all of ACA/'Obamacare' really be a WIN for Dems???

Originally Posted by Downbound Train

But remember, life isn't fair and everyone dies. We don't have to bankrupt the nation to make everything "fair".

What is bankrupting the US is clinging to a "free market" health care and insurance system that costs 3 times as much as single-payer systems while delivering worse care. Every other industrialized nation gets better care cheaper, with almost universal coverage, but somehow the "home of the free" cannot figure it out, because every system that works requires heresy in the Holy Church Of The Free Market.

Originally Posted by tommyvee

What is bankrupting the US is clinging to a "free market" health care and insurance system that costs 3 times as much as single-payer systems while delivering worse care. Every other industrialized nation gets better care cheaper, with almost universal coverage, but somehow the "home of the free" cannot figure it out, because every system that works requires heresy in the Holy Church Of The Free Market.

Nice chart.

You're a moron.

Those countries live off what's left of our free market healthcare system just like they use our military for defense.

When either of them goes away, the shit hits the fan.

Originally Posted by tommyvee

The market already has an "answer".
http://www.usatoday.com/news/nation/...red17_ST_N.htm

http://news.harvard.edu/gazette/stor...alth-coverage/

Show me the part of the constitution that guarantees everlasting life paid for by someone else.

Evolution is real isn't it?

Why do you want to play God in a world that has no God?

The system you believe in requires the more fit to survive and the less fit to perish sooner.

Did you know EVERYONE with health insurance dies???? It's true!!!!

Originally Posted by Downbound Train

Show me the part of the constitution that guarantees everlasting life paid for by someone else.

Evolution is real isn't it?

Why do you want to play God in a world that has no God?

The system you believe in requires the more fit to survive and the less fit to perish sooner.

Did you know EVERYONE with health insurance dies???? It's true!!!!

Sounds fine and dandy til it's your relative/friend who finds out they have a nasty disease while they aren't covered... and as costs keep going up you WILL have a Brother/Sister or Son/Daughter (Sorry, would they properly be called "spawn" or "minions" instead?) finding themselves out of a job and out of health care coverage. Count on it.

Originally Posted by tommyvee

What is bankrupting the US is clinging to a "free market" health care and insurance system that costs 3 times as much as single-payer systems while delivering worse care. Every other industrialized nation gets better care cheaper, with almost universal coverage, but somehow the "home of the free" cannot figure it out, because every system that works requires heresy in the Holy Church Of The Free Market.

Right! By every metric we're the worst! That's why nobody comes here to get care

Anyway, if you want to move to the European model, wouldn't it be unfair to keep our personal taxes which, according to the oecd, are the MOST progressive in the developed world?

USA is the best AFTER you are sick IF you have access to good care (via money or insurance etc).

We suck at access and preventative care. There is no market force for preventative care when the business model is for insurance/employers to swap out customers/employees sooner than they'd see a positive ROI for preventative care because you swap em out and deny preexisting conditions (or charge them infinity dollars). It makes sense. It is insurance, not health management or promotion, but we try to use it as the latter and get fucked in every way.

If you want my opinion, socialize preventative care and socialize some emergency and chronic care contingent on compliance with preventative care. The rest would be insurance in a truer sense of the word. THAT is responsibility and health promotion where the country will see a return on its money through increased productivity and decreased costs.

The ACA will fix healthcare about as well as the current student loan system has fixed education.

Originally Posted by ilikecandy

Right! By every metric we're the worst! That's why nobody comes here to get care

Anyway, if you want to move to the European model, wouldn't it be unfair to keep our personal taxes which, according to the oecd, are the MOST progressive in the developed world?

People do come here to get medical care but only people with LOT's of money like my od boss. Your typical foreign national isn't going to be able to afford our health care system.

Not sure what anybodys point is when they compare health care systems in different countries with different political systems. It's apples and oranges. We tyically get better care here so we probably pay more (note I said typically - not true if you're in the middle -- getting less true everyday). Yah some other countries do better about taking care of everybody but they also likely take care of everybody in a lower than US standard typically. That being said it's basically a choice between socialism where you pay for everybody or capitalism where the better off you are the better health care you get. That being said the most poor actually could get better health care than your typical middle class person who is too broke to pay for good/mediocre insurance and gets behind on bills (I'm starting to learn this - it's almost better to be broke if you are not married but are sick). It's hard to say what's better. You want the best care you better be able to afford it. Otherwise if you want pretty good care everybody could have it. Seems like the Europeans are doing it better as far as equal care regardless of income but you might have to wait quite a while and don't expect to be given that crazy expensive treatment. It's not so back and white if you picture yourself really sick. DBT would say you don't deserve the treatment if you can't afford it. The HUGE question is whether he is right. He's right that nobody owes you anything in the world but where do you draw the line? It's not really the governments job to keep me alive if I can't afford it, yet it's so CRASS not to. The basic question and answer to the whole devate hinge on if you care about everybody getting treated and, if so, are you willing to recieve a little lower standard of health care for the common good. What do you think? Every man for himself or common good?

/end AKRover post.... (sorry AKR, I think you have a good heart but are a little to idealistic. You remind me of a younger version of myself. I actually used to think I could change the world).

hey if you don't like me drunk, I'm more longwinded baked

Originally Posted by Summit

USA is the best AFTER you are sick IF you have access to good care (via money or insurance etc).

There is no market force for preventative care when the business model is for insurance/employers to swap out customers/employees sooner than they'd see a positive ROI for preventative care because you swap em out and deny preexisting conditions (or charge them infinity dollars). .

Trust me this is true and has happened to me. Even if you can get back to work after you are pretty sick, uour employer will likely lay you off so you aren't a drag on their insurance premiums. Then U R sorta FUCTED. If you think you're economically stable just make sure you don't get sick. My boss told me how bad they needed to hire somebody and kept telling me they were going to need to replace me. I said, "Hey man, you gotta do what you have to but I can't work (like every month)." Then once I came back they laid me off after two months. Some of you are gonna see an ugly reality. Really doesn't bother me much because I feel like I've lived a full life. Hopefully you do too.

Edt: And realistically there is no way the US is going to get back on track unless everybody takes a little dive in lifestyle regardless of the healthcare system.

Originally Posted by ilikecandy

Right! By every metric we're the worst! That's why nobody comes here to get care

Relative to the number of americans seeking medical care abroad, you are right, less than 100,000 worldwide come here for medical care.

If we actually had a free market health care system in place, it would work. What we have now and have had historically is not a free market system.

We need to make it illegal for employers to offer health care, open competition between health care companies (across state lines) and let them compete for our business. This would drive down costs. The government (state or federal) should only be involved in regulation of the industry.

Originally Posted by cbgarrett

We need to make it illegal for employers to offer health care, open competition between health care companies (across state lines) and let them compete for our business. This would drive down costs. The government (state or federal) should only be involved in regulation of the industry.

Tell me how making it illegal for companies to offer Health Insurance would foster competition and the holy grail, free market forces?

Much simpler would be to tax the value of employer offered health care programs as income.

Beyond that, sure let you shop state to state for an insurance policy.

Keep in mind that the current costs in one state may be cheaper than another state only because state # 1 requires less coverage than state # 2, not for any other market force reasoning.

Insurance, any insurance is all about spreading and sharing risk. Nothing more complex than that.

Originally Posted by cbgarrett

If we actually had a free market health care system in place, it would work. What we have now and have had historically is not a free market system.

We need to make it illegal for employers to offer health care, open competition between health care companies (across state lines) and let them compete for our business. This would drive down costs. The government (state or federal) should only be involved in regulation of the industry.

Actually the reasons for market failure in health care have been defined and understood by economists for more than 50 years. US people are brainwashed to have a religious faith in the "Holy Free Market", even though both world-wide experience, economic theory, and statistical data show that a pure free market health care system is inherently less efficient and inherently dysfunctional.

If you look at the graphs I posted up-thread, every single real system in the world has some mix of private and public funding, and some mix of government and private implementation. Finding the optimum mix to deliver the best health care cheapest is the real question (and some market/regulatory hybrids like Switzerland perform very well). But the pure "free market" health care system exists only in the pink-unicorn and rainbow dreams of libertarian idiots, because every attempt to create such a system in the real world crashes into reality and fails. But of course the non-existence of such a system does not keep DBT from bloviating about it.

http://bevansrun.blogspot.com/2012/0...re-part-1.html

The theory of market failure in healthcare was first described by Professor Kenneth Arrow in 1963 in his seminal paper, "Uncertainty and the welfare economics of medical care".

The following non exhaustive list gives the main reasons for market failure in healthcare as outlined by Arrow, Brown and others:

1. “Information asymmetry”

Markets are most efficient when buyers and sellers have equal information. However, in the case of the health care market, information is not equally shared between buyers and sellers. Instead the seller, the doctor, has far more information than the buyer, the patient. Patients are not sovereign in this situation ie patients are not well enough informed to make choices and the doctor (the seller) is actually their main “agent” or advocate. This means we are expecting our doctor to divide him/herself in half - on the one hand to act in our interests as the buyer of health care for us, but on the other to act in her own interests as the seller of health care. In a free market situation where the doctor is primarily motivated by the profit motive, the possibility exists for doctors to exploit patients by advising more treatment to be purchased than is necessary – this is known as supplier induced demand. Hence doctors' behavior has been controlled by a professional code of practice and a system of licensure. As Kenneth Arrow put it "The control that is exercised ordinarily by informed buyers is replaced by internalised values". These “internalized” professional values disrupt the efficient functioning of the market.

In the same mould there is asymmetry of information between “purchasers” (Primary Care - General Practitioners/PCT commissioners/Clinical commissioning Groups (CCGs)) and “providers” (Secondary care – hospitals) of healthcare in the purchaser provider split model of a market system. If GPs are buying specialist care from hospitals, it is the hospital specialists who have the information advantage because they are the experts in their chosen fields. This results in provider domination in the market and once again the problem of supplier induced demand. Hence, the growth of secondary care and super-specialism in medicine. Furthermore, it’s not just overtreatment that is problem. Undertreatment of non profitable conditions is also a problem.

2. Healthcare is difficult and expensive to commodify

In a healthcare market, the illnesses and diseases of patients, and their treatments and investigations are the commodities that are traded. Thus illness and diseases and their investigations and treatments have a market value. Complex layers of bureaucracy are required in the commodification process such as HRG coding and pricing of procedures, “double accounting”, legal contracts, auditing, IT costs etc.

3. Excess capacity is needed for market choice to work
If patients want to choose between hospitals in order to stimulate the competition that drives the market, there must be excess capacity in the system to accept extra patients, otherwise there will be waiting lists and a poorer service. This means some services will be idle in the system, creating inefficiency.

4. “Exit” from the market is very difficult
Hospital closures are deeply unpopular with local communities and therefore a political hot potato. The Kidderminster Hospital and Wyre Forest episode of the election of the local health campaigner, Dr Richard Taylor, to Parliament is a classic case in point.
Even closure of some individual services can have a huge knock on effects, because many specialties are interrelated and rely on each other to provide comprehensive services to patients. You cannot run a trauma service without a vascular surgeon, for example – Someone needs to stop the bleeding! In addition, since income is related to hospital activity, closure of services and loss of income creates a vicious circle of financial pressures leading to further closures.

5. Market “entry” is prohibitively expensive
Hospitals are very expensive complex buildings and contain expensive equipment and staff. To date, most private sector provider involvement in the NHS has been with smaller units such as Independent Sector Treatment Centres and “Darzi centres”. This links in with this issue of the costs of excess capacity

6. Problems with private insurance systems
Private insurance gives the cheapest and best coverage to the well, and the most expensive and least coverage to the sick. This is a classic case of the Inverse Care Law - the poorest and most vulnerable need healthcare the most, but will get least access.

7. Price signals don't work
Payment occurs after care in most cases. Illness is unpredictable and healthcare costs can be prohibitive e.g a stay on an Intensive Care Unit due to an accident could cost hundreds and thousands of pounds, which the vast majority of the population could not afford. Hence there is a need for risk pooling and insurance systems. As stated above, private insurance disadvantages the most vulnerable, so national insurance systems are naturally the best choice.

8. Medical professionalism is anti-market
Market theory in the form of Public Choice Theory rejects the public service ethos and professional ethics. Medical professionalism is fundamentally anti-market in nature because Doctors (GPs) control access to the healthcare market and want to refer unwell patients to good local services. The doctor patient relationship and the social contract is fundamentally based on trust. Market systems rely on self interest and distrust. The market is a blind power without any social or ethical orientation.
I’ve previously discussed the problems of medical professionalism and the market here and will return to it.


9. Patients want local services

Just as doctors like referring to local service, patients also like to use local services. The influential work by Professor Julian Le Grand on the British Social Attitudes survey, which showed the public did want choice of hospitals is fundamentally flawed, because it was a survey of the public, not patients. When you feel ill you don’t want to travel far and you also need to be close to your support network of loved ones and friends. It is therefore not surprising that Barr et al’s detailed analysis of patient choice had very different conclusions.

10. Markets provide for wants rather than needs
Markets are driven by the wants of consumers rather than needs. This focus on citizen-consumerism, disguised as patient choice, serves to drive up healthcare expenditure, not reduce it.

11. Need for specialty clusters, high volume workload and regional and national planning
Rare conditions or conditions that require highly complex treatments require specialty clusters and high volume workloads to ensure enough expertise for safe and effective care. This often requires the development of clinical networks and specialist centers, through local, regional and national planning based on local, regional and national population needs. This is again anti-market in nature.

12. First duty of investor owned firms is to their shareholders, not patients
This results in the problem of “cream skimming”, where private sector companies will only treat the most profitable conditions, leaving the unprofitable cases to state providers. In a competitive external market system, the state providers (which provide comprehensive services to local populations) are therefore most at risk of failure.

This list is not exhaustive, but goes a long way to explain why market failure is inherent in the delivery of healthcare, which is close to a natural monopoly.

So if someone could come up with a few potential flaws of purely socialized health care, you would demand we abandon any system that includes socialist elements, right?

Originally Posted by ilikecandy

So if someone could come up with a few potential flaws of purely socialized health care, you would demand we abandon any system that includes socialist elements, right?

Reading comprehension is clearly not your strong point. Every real system is a mix of private and public, so a "pure" socialist system is just as unlikely and dysfunctional as a pure market system. Even single-payer systems have many market components, in a French hospital all the drugs and technology are still produced by for-profit companies, and nobody sane would argue that a purely socialist medical system that had government factories to make drugs and equipment would be optimum.

I explicitly posted that finding the optimum mix of private and public is the real question, so of course I do not support any pure socialist system any more than I support a pure capitalist system. Removing all market elements from the medical system is a ludicrous and impossible strawman. And every real system has shortcomings, and needs continuous review and improvement, so the mix should change over time.
Quoting myself

If you look at the graphs I posted up-thread, every single real system in the world has some mix of private and public funding, and some mix of government and private implementation. Finding the optimum mix to deliver the best health care cheapest is the real question (and some market/regulatory hybrids like Switzerland perform very well).

Originally Posted by tommyvee

Reading comprehension is clearly not your strong point. Every real system is a mix of private and public, so a "pure" socialist system is just as unlikely and dysfunctional as a pure market system. Even single-payer systems have many market components, in a French hospital all the drugs and technology are still produced by for-profit companies, and nobody sane would argue that a purely socialist medical system that had government factories to make drugs and equipment would be optimum.

I explicitly posted that finding the optimum mix of private and public is the real question, so of course I do not support any pure socialist system any more than I support a pure capitalist system. Removing all market elements from the medical system is a ludicrous and impossible strawman. And every real system has shortcomings, and needs continuous review and improvement, so the mix should change over time.
Quoting myself

Old long johnson.

I love how all you dopes are missing the argument that is actually before the court: that congress does not have the power to force anyone to buy anything. That power has not been conferred on them. Trot out every sad story of uninsured cancer patients you want (and that is truly a sad thing that needs addressing) but that's not what's being argued.

Keep missing the forest for the trees fellas.

Originally Posted by BmillsSkier

I love how all you dopes are missing the argument that is actually before the court: that congress does not have the power to force anyone to buy anything. That power has not been conferred on them. Trot out every sad story of uninsured cancer patients you want (and that is truly a sad thing that needs addressing) but that's not what's being argued.

If I understand it correctly, I don't think anyone is being forced to buy insurance, but if you don't, and you have the means, you get penalized thru the tax code. Since the country, for the most part, has failed to address the "sad thing", the Feds have stepped up in an attempt to shore this up via the commerce clause. It's going to come down to how broadly or narrowly they interpret the clause. I think it was Breyer that suggested it would have been simpler to have addressed this through the tax and spend clause (single payer).

Originally Posted by BmillsSkier

I love how all you dopes are missing the argument that is actually before the court: that congress does not have the power to force anyone to buy anything. That power has not been conferred on them. Trot out every sad story of uninsured cancer patients you want (and that is truly a sad thing that needs addressing) but that's not what's being argued.

Keep missing the forest for the trees fellas.

Looks like you've missed the point of the thread entirely. Indeed, the individual mandate may be unconstitutional...if it is, then the GOP will be blamed for thwarting the last attempt at salvaging the private healthcare system in the US. It's ironic...that's the point...that a health reform plan developed by conservatives and implemented by democrats may be deamed unconstitutional by an activist conservative SCOTUS, likely along party lines.

Missing the forest for the trees is a pretty true statement of yourself, and other conservatives around here. What happens to Medicare if ACA is thrown out? What about folks with pre-existing conditions that cannot get health insurance otherwise?

If ACA gets struck down by the SCOTUS then so be it...it's not a good thing for anyone...then again I think a single payer system is probably more effective at solivng our healthcare issues than ACA could be...and really, maybe ACA was just a way to stave off the inevitability of a single payer system? Eitehr way the ultimate outcome will be the same, which is counter to what conservatives wanted all along.

Originally Posted by Downbound Train

Looks like the law is toast.

Even the Dems know it.

The spin is SHAMELESS!!! BIG WIN for Dems!!

Bwwaaaaahhhhhh

I can see the Obama ad now.

Hey folks, the only thing I accomplished was declared unconstitutional.

That's not FAIR!!!!

I want another chaaaaannnnnnnccccce. Whaaaaah

http://www.latimes.com/news/politics...,2058481.story
The Supreme Court's conservative justices said Wednesday they are prepared to strike down President Obama’s healthcare law entirely.

Picking up where they left off Tuesday, the conservatives said they thought a decision striking down the law's controversial individual mandate to purchase health insurance means the whole statute should fall with it.

The court’s conservatives sounded as though they had determined for themselves that the 2,700-page measure must be declared unconstitutional.

"One way or another, Congress will have to revisit it in toto," said Justice Antonin Scalia.

Agreeing, Justice Anthony Kennedy said it would be an "extreme proposition" to allow the various insurance regulations to stand after the mandate was struck down.

Meanwhile, the court's liberal justices argued for restraint. Justice Ruth Bader Ginsburg said the court should do a "salvage job," not undertake a “wrecking operation." But she looked to be out-voted.

Chief Justice John G. Roberts Jr. and Justice Samuel A. Alito Jr. said they shared the view of Scalia and Kennedy that the law should stand or fall in total. Along with Justice Clarence Thomas, they would have a majority to strike down the entire statute as unconstitutional.

Great call, as usual.

Ten bucks says Mogul doesn't sleep for at least five days and jacks off at least 130 times during that period.

Originally Posted by Jer

Ten bucks says Mogul doesn't sleep for at least five days and jacks off at least 130 times during that period.

Nahh, I like sleeping. I'll just settle for 130 wet dreams.

Originally Posted by Moeghoul

Nahh, I like sleeping. I'll just settle for 130 wet dreams about Obama.

Well, at least you're honest.