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Health Care - Back To The Drawing Board?

Posted 9 months ago|29 comments|483 views
Medicare For All!
Written by
Altruist
Eugene, OR
The 11th Circuit Board of Appeals ruled that the Individual Mandate, a crucial part of the Affordable Care Act, was unconstitutional. http://swampland.time.com/2011/08/12/11t...

This is the part of the health Care law that most of the people objected to. The rationale behind requiring everyone to buy health care, is that if the insurance companies just had to insure those who were old and sick, the premiums would be very costly. By forcing everyone, even the young and healthy to get into the insurance pool, the cost would be spread out, bringing everyone's costs down.

Of course a prior ruling from the 6th court ruled that the law was constitutional, so now the issue will go to the Supreme Court. Given the makeup of the Supreme court, I don't hold out much hope for upholding that portion of the law. That is unfortunate because it means that everyone's health care costs will go up a lot, just when the economy is getting worse, and with the austerity measures, we have less money to spend.

There is one ray of hope however. Individual States have the ability to determine the best way to fund their citizen's health care. One State, Vermont has passed and the governor has signed into law, a Single Payer health Care law that promises to be much cheaper than any of the private insurance plans the other states are working on. http://www.huffingtonpost.com/2011/05/26...

Single payer health care is cheaper than private insurers for two main reasons. The first is profit. The private insurance companies are motivated by profit, and currently the insurance companies have 30% profit rates. Of course states are free to select the cheapest health care providers, and non profit providers could provide quality health care for a third less than for profit ones.

The other reason that a single payer health care provider would be cheaper is the administrative costs. The private insurers have administrative costs of 30%, mainly because they spend a lot of time trying to figure out how to avoid paying for health care. They can only make a profit by denying service. Half of the people in the country have pre-existing conditions that would allow insurance companies to deny payment of services, unless they were forced to accept them. The Affordable Care Act will force them to accept everyone in 2014. http://www.healthcare.gov/center/reports...

A single payer system like Vermont's would help everyone that was in need. There would be no complicated forms and no denial of service for trivial reasons. For these reasons Vermont will provide health care for much less than what other States can afford. Vermont doesn't need a 30% profit margin and they will have very small administrative fees. When other states see that a single payer system is much cheaper, they will also adopt similar systems.

That is what happened in Canada. One province started with single payer and the other provinces saw that it was cheaper and more efficient, so soon the entire nation had single payer.

That is what the rest of the developed world knows, and that is why they can provide health care for half the cost of ours. That is what liberals tried to get Obama to pass, but Congress insisted on a complicated system that relied on expensive middlemen, the private insurance companies. They designed a complicated mess and a huge new bureaucracy to appease the Republicans, and the only way such a private insurance program would be economically feasible was to use an idea the Republicans came up with, that is used in Massachusetts. This complicated law relied on the individual mandate to bring costs down as they have in Massachusetts.

Of course we don't really need a huge new bureaucracy. We already have an existing non profit health care structure that everyone loves, that is very efficient and which only has 3% administrative costs. We should just expand Medicare for everyone. This would also solve the solvency problems of Medicare because it would no longer just be caring for the old and infirm, the costs would be shared by the healthy, and there is no doubt about Medicare being constitutional. http://www.commondreams.org/view/2011/08...
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COMMENTS
9 months ago: Are you talking 3% cost for Medicare in Federal dollars? Careful.
9 months ago: Al? "By forcing everyone". What is next on your list "by force"? Cars made by Goverment Motors? Bean sprouts? Solar energy? You might want to read the commerce clause of your Constitution. It prohibits the government to mandate the purchase of anything. No if, and or but.
Perfect Horizon
Perfect Horizon
Chicago, IL
9 months ago: So inaccurate it's not even funny:

Article 1, Section 8 (The Commerce Clause):

"To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes"

Existing case law is clear on this that Congress has the power to regulate healthcare and healthcare insurance industries.

Moving on, also from Article 1, Section 8 (The Necessary and Proper Clause):

"make all laws which shall be necessary and proper for carrying into Execution the foregoing powers"

Again giving constitutional backing to the existing case law that permits Congress to regulate healthcare.

The Unconstitutional part lies in the taxation penalty for not carrying insurance. However, the Constitution and existing precedent are clear on this one, Congress can force you to buy health insurance.
9 months ago: Which one of the three listed in the Commerce Clause do individual U.S. citizens fall into? Foreigh Nations? No. States? No. Indian Tribes? No.

Please do not dilute the meaning with the Necessary and Proper Clause.

Prove that the Affordable Care Act only regulates for Foreign Nations, States and or Indian Tribes. And does not regulate anyone else that is not enumerated.

Yep, You forgot that word. Enumerated.
Out Of The Box
Out Of The Box
 Moderator
9 months ago: PH

Congress can regulate health care, true enough. That does not give them the power to penalize you for not buying a service, ie insurance. Can you name one purchasable product or service that has been required by the federal government ?
I can't think of a single one. The ability to regulate commerce does not include the power to force someone to participate in commerce unwillingly.

Now, since the individual mandate is the cornerstone of the Affordable Care Act, insurance premiums are going to skyrocket, leaving more people without insurance, and more people out of a job because employers will not be able to afford the new government requirements.
Perfect Horizon
Perfect Horizon
Chicago, IL
9 months ago: I said the penalty was unconstitutional.

As for that product you are looking for:

I am forced to pay for retirement insurance every 2 weeks (Social Security).
Perfect Horizon
Perfect Horizon
Chicago, IL
9 months ago: You need to do some research, turn off fox news and glenn beck and do some real research. Case law permits the regulation of healthcare and health insurance.

The Necessary and Proper clause is part of the same article of the Constitution...it is relevant to this issue.

This is a perfect case-in-point of conservatives picking and choosing which parts of the Constitution they like and which parts to ignore.
Out Of The Box
Out Of The Box
 Moderator
9 months ago: "...As for that product you are looking for:

I am forced to pay for retirement insurance every 2 weeks (Social Security). ..."

That is what is known as a T-A-X, paid directly to the Federal Government. Are you proposing that the Federal Government redefine the *personal* insurance mandate to become a premium in the form of a tax paid directly to the Federal Government? That is the only way it would be Constitutional. Forcing you to conduct business or enter into a contract with a privately owned company is UNConstitutional.
Out Of The Box
Out Of The Box
 Moderator
9 months ago: "...This is a perfect case-in-point of conservatives picking and choosing which parts of the Constitution they like and which parts to ignore...."

I guess next you'll be telling the 11th Court of Appeals to turn off Fox News and do some real research. Judge Frank Hull, who was nominated by former President Bill Clinton, ruled the individual mandate as unconstitutional.

Regulating healthcare and health insurance is one thing, and does fall under the jurisdiction of Commerce. I'm not even arguing that point. Forcing me to buy a product that I don't want, from an individual, does not fall under that jurisdiction.

Show me some case law that says it does.
Perfect Horizon
Perfect Horizon
Chicago, IL
9 months ago: They ruling was because of the penalty associated with the mandate. The first court that heard it ruled the other way because the congress used the necessary and proper clause in conjunction with the mandate to claim that it is needed for everyone to have insurance.

Also, Yes, I think a tax based premium and government provided insurance would be great.
Out Of The Box
Out Of The Box
 Moderator
9 months ago: 11th Circuit Court of Appeals

Dubina and Hull declared that "Congress exceeded its enumerated commerce power" when it "mandate[d] that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die." They added:

"Few powers, if any, could be more attractive to Congress than compelling the purchase of certain products. Yet even if we focus on the modern era, when congressional power under the Commerce Clause has been at its height, Congress still has not asserted this authority. Even in the face of a Great Depression, a World War, a Cold War, recessions, oil shocks, inflation, and unemployment, Congress never sought to require the purchase of wheat or war bonds, force a higher savings rate or greater consumption of American goods, or require every American to purchase a more fuel efficient vehicle."

Moreover, they wrote,

"The individual mandate is breathtaking in its expansive scope. It regulates those who have not entered the health care market at all. It regulates those who have entered the health care market, but have not entered the insurance market (and have no intention of doing so). It is overinclusive in when it regulates: it conflates those who presently consume health care with those who will not consume health care for many years into the future. The government's position amounts to an argument that the mere fact of an individual's existence substantially affects interstate commerce, and therefore Congress may regulate them at every point of their life. This theory affords no limiting principles in which to confine Congress's enumerated power. [Emphasis in original.]"

Looks to me like they had a problem with mandating contracts between private entities, not the penalty associated with it. Read the whole 207 page opinion, and come back with the part that says it was only unconstitutional because of the penalty associated with it.
Perfect Horizon
Perfect Horizon
Chicago, IL
9 months ago: Are you not mandated to carry Car Insurance? Why is that any different? I agree that the mandate should come from the states, but its not really any different. Why is it ok for your state to mandate you carry insurance but no the federal government?

The first court which heard the case ruled the opposite way, saying it was Constitutional...so clearly it is a conflicting opinion. What happens if the Supreme Court of the United States says it is Constitutional? Will you accept it then????
9 months ago: Short answer on the car insurance mandate. No. Prove me wrong if you can.
Out Of The Box
Out Of The Box
 Moderator
9 months ago: You only have to have car insurance if you drive a car. And that is only if you live in a state that requires auto insurance. New Hampshire and Wisconsin are the two that don't. My grandmother lived for quite a while after she stopped driving, and quit paying her auto insurance, even though her cherry 1963½ Ford Galaxy 500 sat in her driveway until her passing.

"...Why is it ok for your state to mandate you carry insurance but no the federal government?..."

Because the Federal government is not allowed to do that. That is not one of the powers enumerated to the government by the Constitution.

This is clearly a case of someone wanting something so badly that they are willing to add power to an already overbearing Federal Government. You want centralized healthcare, so your willing to give a bit on the constitutionality of requiring everyone pay premiums to private businesses.

How would you feel if this were called the Affordable Housing Act, and require that everyone, even those that don't want to own a home, pay onto the system? Or the Affordable Education Act, which would require that everyone start paying for Masters degree education or it's equivalent? Not only would that put a strain on those who do not intend to go to college, but it would flood the colleges with those that, well frankly, have no business even trying to go to college.

That's what this affordable government run healthcare is going to do. It's going to flood the medical services providers with those that would normally tough it out and get better naturally.
9 months ago: Your forced to pay Social Security? What a novel liberal idea. How does SS equate to mandated auto insurance?
Out Of The Box
Out Of The Box
 Moderator
9 months ago: You would think that the Affordable Health Care Act was written by and for the insurance companies themselves. Apparently, Obama went to them and asked, "How can make sure insurance premiums go up in price as much as possible over the least amount of time?"

"Well", they said, "Get rid of the pre-existing condition rules, get rid of the lifetime caps on coverage, and let the kids stay on their parent's policies. You could make it a law, so we could say we don't have any choice."

"Ok then, but how would we pass it off without it looking so deliberate?"

"Tell 'em it'll all be covered by the healthy people who don't need insurance. Then later on we can tell 'em 'oops, we didn't realize we aren't authorized to make you do that.'"
Out Of The Box
Out Of The Box
 Moderator
9 months ago: Basically, we can thank Obama for skyrocketing health care insurance costs.
Altruist
Altruist
Eugene, OR
9 months ago: The Free Market system and greed is what is driving insurance prices and profits up. They have a monopoly and can charge whatever the market will stand.

You are right about Congress letting the Insurance companies draw up the ACA rules and regulations. There was an enormous amount of money and lobbying and the entire act is designed to give the insurance companies more of a monopoly with government mandated customers. Instead of a new complex program that benefited the corrupt insurance companies we should have just gone to what we know works - Medicare.

What I and most of the liberals have always advocated is doing away with the greedy middlemen altogether. All we need is the medical establishment. If the entire nation was covered by Medicare the administrative costs of Medicare (now 3%) might even go down because we wouldn't need to contact thousands of different insurance companies all with different rules, forms, regulations and requirements. The doctors and nurses wouldn't need to spend so much time on paperwork and could spend more time caring for their patients. http://www.pnhp.org/facts/single-payer-f...

Still there is much we can do to bring down the cost of medical care.

1. Establish a nationwide computerized database that all doctors and caregivers can access that will help the doctors diagnose maladies, that would prescribe the best treatments, and that would keep track of the cheapest, most effective drugs and their side effects and most importantly their interactions with other drugs and foods.

There are so many illnesses out there and so many drugs that no doctor can know enough to be able to diagnose all diseases, and have just a faint idea of what cures and treatments are out there. They are left to guess in many cases and often guess wrong. As for drugs the doctors are dependent on drug company salesmen to tell them what drugs are available and they often don't tell the doctors about side effects or drug interactions that might prove deadly.

If we had such a computerized database and if doctors used this database to diagnose an illness and the proscribed recognized treatment protocol they should be shielded from being sued which would also bring down costs.

2. We need to minimize costly visits to hospitals. It is not only expensive it is dangerous. The hospitals become a breeding ground for all of the communities communicative diseases. If people limit their visits to the hospital they would limit their exposure and also limit communication of pathogens. If a new plague hit we are completely unprepared to respond to a situation where people should stay home.

Most of the visits to hospitals are for information about benign or non serious issues. Access to the nationwide computer database and inexpensive programs like ASK A Nurse, would eliminate most visits to the hospitals. These should serve as a triage system that would flag serious illnesses and reassure patients of minor problems that can be treated at home.

We need to reestablish home visits. This can be done by nurses and by paramedics that have been trained and gained experience in the military. Currently military paramedics have to start at the bottom and re acquire all of the training they already have. These nurses/paramedics can do routine things like checking vitals and testing blood, and giving shots and once again triage to separate those who really do need care from those who can be treated at home.

3. We need to get more doctors and nurses, Physical therapists, and other health care workers into the system. We need to make it easier and cheaper to get into medical schools and help students graduate without half a million dollar debts. This would bring medical costs down and create millions of new jobs.

This court case doesn't make a univer
Out Of The Box
Out Of The Box
 Moderator
9 months ago: "...most of the liberals have always advocated is doing away with the greedy middlemen altogether."

But yet when this monstrosity was passed, what the liberals said was "it's better than nothing." Actually it isn't better than nothing, it is far worse than nothing. You were sold out by your own party, told that it had to be passed untested. It will wind up driving up insurance costs and the cost of medical services across the board.
Altruist
Altruist
Eugene, OR
9 months ago: This court case doesn't make a universal Health Care System more difficult. It just makes a system dependent on private insurance companies much more expensive. It makes a universal Single Payer system like Medicare much more attractive.
Altruist
Altruist
Eugene, OR
9 months ago: No I still think that it is better than nothing. It has already provided many protections for children. Children can no longer be denied service because of pre-existing conditions and they can get on their parent's plan which saves a bunch of money. The rest of us will have to wait till 2014 to be protected from denial of service, requirements that no more than 20% go to administration, and for most of the good parts of the act to kick in.

But besides the benefits and protections of the act it is a pretty open scaffolding that we can use to build up the best and most efficient way to provide health care in the most affordable way. It has a bunch of Pilate programs and each individual state is allowed to determine the best and cheapest way to provide health care, so there are another 50 experiments. Vermont looks the most promising but Oregon and California has some good ideas too.

It is obvious that if anyone is serious about containing the debt that we have to do something about health care. Health costs are the biggest budget item and it is growing faster than anything else. http://www.commondreams.org/view/2011/08...

Switching to a Single Payer system like Medicare would save $400 billion per year, whereas the Affordable Care Act would only save $143 billion over the next 10 years. http://docs.house.gov/energycommerce/COS...
9 months ago: "...a Single Payer health Care law that promises to be much cheaper than any of the private insurance plans ..."

Yea, and cow flatulence is killing all the polar bears.

For crying out loud Al.
Colorado
Colorado
Westcliffe, CO
9 months ago: Good post.

Starting over would be a great start. The thing I would like to see is that the consumer has a voice in the cost and quility of the service provided rather than it disappering into paperwork land. This wont work in emergancy situations but for the vase majority of people their health issues are not an immediate threat. I voice makes the system accountable to the most important people, the citizen.

Keep up the good work.
Colorado
Colorado
Westcliffe, CO
Content Removed by Colorado
Altruist
Altruist
Eugene, OR
9 months ago: Good idea Colorado. Having consumers having a voice in the cost and quality of care is important.

If for example insurance gave a set amount for an injury patients could search around for the most cost effective treatments. Some hospitals charge twice as much for a procedure as another hospital in the same town for the same procedure. Changing the pay of doctors to a set amount would bring costs down,. Now hospitals inflate their costs and no one knows about it because it is so hard to determine prices. http://www.msnbc.msn.com/id/37977992/ns/...#.TkrQemGo1uw

Medicare pays fixed amounts for procedures and would simplify everything.
Out Of The Box
Out Of The Box
 Moderator
9 months ago: If insurance gave a set amount for each type of injury, then the care issued would be the minimum covered by that particular insurance claim. Same as would happen under a single payer system. Doctors already hate Medicaid, because getting them to pay is such a pain. Now, mostly only fledgling doctors or pediatricians will even accept Medicaid patients.

And setting a doctor's pay? I'm confused as to how that would bring costs down. And it would a bit over-reaching of the government to try to set the salaries of non-government positions. I certainly wouldn't want the government to try to tell me how much I can make in my chosen field. If they do, I'll be sure to petition that the movie stars, athletes, and musicians can only make a certain amount, to bring entertainment costs down. It'll be a pretty big hit to our income tax revenue, but hey, everything would be cheaper if the government steps in and limits our incomes.
9 months ago: Box. It ain't "anti-trust" when the governement fixes the prices.
Altruist
Altruist
Eugene, OR
9 months ago: The 50 million people without health care and those of us who only have catastrophic insurance need to shop around before we get sick to find out which hospitals charge the least for services. Here is a good survival guide. http://moneyfor20s.about.com/od/healthin...

Hospitals should consider the quality of the care and the safety of the patients to be their highest priorities. At the Mayo Clinic, Cleveland Clinic, Kaiser Permanente and other integrated systems, doctors are salaried to improve quality. This allows them to spend more time with patients instead of being paid on volume. If hospitals have integrated systems (like the nationwide system I advocated) costs go down because there are less mistakes, people get well quicker and there are fewer returns. http://prescriptions.blogs.nytimes.com/2...
9 months ago: Seems like those 50 Million without healthcare are making a chioce out of the 330 million Americans. No? Who make up that 50 Million? Please present the government doles they are already ENTITLED to.

Yep, While your at it list the amount of income tax they pay. It can't be that hard.

ZERO.
9 months ago: OK. It's time for a hardcore statement. Like it or not.

"No pay in" equals "No pay out".

Sorry your promised checks have been canceled. Best get a greeters job at WalMart.

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